Ch. 7 Adnexal Pathology

Question 1

What is the generic term referring to inflammation of the pelvic and adnexal structures?

Answer 1

Pelvic inflammatory disease (PID)

Question 2

How does PID typically spread?

Answer 2

In ascending order. Starting at the cervix and working it’s way up towards the adnexa.

Question 3

What is the most common cause of PID?

Answer 3

Sexually transmitted and polymicrobial organisms. May also be introduced via D&C, ruptured appendix, abortion or postpartum.

Question 4

List risks associated with PID

Answer 4

Infertility, tubal scarring, ectopic pregnancy

Question 5

Which stage of PID may result in pyosalpinx?

Answer 5

Stage II

Question 6

Which stage of PID may result in a tubo-ovarian abscess, peritonitis, or acute perihepatitis?

Answer 6

Stage III

Question 7

What is Fitz-Hugh-Curtis syndrome?

Answer 7

Inflammation around the liver

Question 8

Stage of PID in which adhesions may cause pelvic organs to merge centrally, leading to the “Indefinite uterus sign”

Answer 8

Chronic PID

Question 9

List clinical signs associated with PID

Answer 9

Fever, leukocytosis, lower abdominal pain, purulent vaginal discharge, cervical motion tenderness, dyspareunia

Question 10

Sono findings of stage I PID

Answer 10

Thickening and irregularity of endometrium, fluid, debris, or gas within the endo cavity. Diffuse hypoechogenicity of the uterus. Complex fluid in the posterior cul de sac.

Question 11

Sono findings of stage II PID

Answer 11

Pyosalpinx, shaggy tubal walls, usually unilateral but can be bilateral

Question 12

Sono finds of stage III PID

Answer 12

TOA, complex adnexal mas(es) with hyperemic flow on color doppler, indistinct walls around the mass, Tubo-ovarian complex- visible tube and ovary, inflamed, NO ABSCESS.

Question 13

Sono finds of chronic PID

Answer 13

hydrosalpinx, uterus and ovaries situated central in pelvis and difficulty in visualizing borders. “INDEFINITE UTERUS” or “LOBSTER CLAW’ sign

Question 14

The presence of functional endometrial tissue outside of the endometrium and myometrium

Answer 14

Endometriosis

Question 15

List the most common places that endometrisos implants may occur

Answer 15

ovaries (80% of cases), oviducts, broad ligament, posterior cul-de-sac, pelvic peritoneum

Question 16

Endometreosis is more common in which group of women

Answer 16

White, of reproductive age, higher socioeconomic status who postpone having children until later in life.

Question 17

What are the two types of endometriosis

Answer 17

Diffuse (scattered minute implants) and localized (endometrioma) which is a discrete mass sometimes called a chocolate cyst

Question 18

Which stage of endometrosis is defined as the involvement of the ovaries and the presence of adhesions. Infertility typically occurs at this stage

Answer 18

Stage III, Moderate

Question 19

Clinical signs of chronic progression of endometriosis

Answer 19

Infertility, chronic pain, the 4 D’s of edometriosis = DYSmenorrhea, DYSpareunia, DYSuria, DYSchezia- painful defecation

Question 20

Sono finds of endometrosis

Answer 20

well defined, homogeneous, low-level echoes, post acoustic enhancement, solid, cystic or complex, diffuse form is rarely seen on US, NO FLOW W/Doppler

Question 21

When would bowel wall thickening be seen

Answer 21

In the presence of diverticulitis, gastroenteritis, bowel related abscess.

Question 22

At what diameter is appendicitis called

Answer 22

> 6mm

Question 23

Bladder wall thickening either focal or diffuse, with pt hx of UTI

Answer 23

interstitial cystitis

Question 24

Urine filled outpouching of bladder wall which may be mistaken for ov or adx cyst

Answer 24

Bladder diverticulum

Question 25

What is a neurogenic bladder

Answer 25

urinary bladder malfunction due to neurologic deficit, may result in bladder stasis, pt may self-cath for emptying