Chapter 21 - Pelvic Inflammatory Disease & infertility Flashcards
the buildup of fluid within the air sacs of alveoli within the lungs
acute respiratory distress syndrome
a hormone such a tester one that is responsible for a male characteristic
androgen
syndrome characterized by endometrial adhesions that typically occur as result of scar formation after some types of uterine surgery
ashermann syndrome
inflammation of the cervix
cervicitis
sexually transmitted disease that can lead to an infection of the genital tract in both sexes
chlaymidia
inflammation of the GB
cholecystitis
function ectopic endometrial tissue located outside of the uterus
endometritis
permanent form of birth control that uses small coils placed into the proximal isthmus segment of the FT
essure device
a perihepatic infection that results in liver capsule inflammation from the pelvic infections such as gonorrhea and chlamydia
Fitz-Hugh-Curtis-Syndrome
technique used for in vitro fertilization in which follicles are drained for oocyte retrieval
follicular aspiration
infertility treament in which oocytes and sperm are placed in the FT by means of laparoscopy
gamete intrafallopian tube transfer
a sexually transmitted disease that can lead to PID
gonnorrhea
peritoneal space located between liver and right kidney ; also referred to as Morrison pouch
hepatorenal space
coexisting ectopic & intrauterine pregnancies
heterotopic pregnancy
abnormal accumulation of fluid within the Fallopian tube
hydrosalpinx
excessive serum androgen levels ; produces male characteristics in females
hyperandrogegism
an increase in blood flood
hyperemic
fertility treatment that requires that a mature ovum be extracted from the ovary with fertilization taking place outside of the body
in vitro fertilization
an elevated white blood cells count
leukocytosis
when the endometrium does not develop appropriately in the luteal phase of the endometrial cycle as a result of reduced progesterone production
luteal phases deficiency
a small plastic T-shaped intrauterine device
Mirena
overweight to the point of causing significant health problems and increased mortality
obesity
infrequent or light menstrual periods
oligomenorrhea
scant or decreased urine output
oliguria
the removal of oocytes from ovarian follicles by aspiration
oocyte retrieval
a syndrome resulting from hyper stimulation of the ovaries by fertility drugs ; results in development of multiple enlarge follicular ovarian cysts
ovarian hyperstimulation syndrome
the stimulation of the ovaries by hormonal therapy in order to treat infertility
ovulation induction
intrauterine contraceptive device that utilizes copper in its composition to inhibit sperm transport or to prevent fertilization or transplantation
paraguard
infertility medicine used to stimulate the follicular development of the ovaries
pergonal
time directly after giving birth and extending to about 6 weeks
postpartum
synthetic progesterone secreted by some intrauterine devices to regulate menstrual flow
progestin
an inflammatory reaction that leads to the formation of pus
purulent
presence of pus within uterus
pyometra
presence of pus within the FT
pyosalpinx
artifact seen posterior to air or gas bubbles
ring down artifact
inflammation of FT
salpingitis
method of reducing with number of pregnancies in a multiple gestation whereby certain embryos or fetuses are terminated
selective reduction
an illness resulting from another disease, trauma, or injury
sequela
sonographic finding that is described as the presence of 10 fr more small cysts measuring 2 to 18 mm along the periphery of the ovary
“String of pearls” sign
functional ovarian cysts that are found in the presenceof elevated levels of HCG ; also referred to as theca luteal cyst
theca lutein cysts
the formation of clot within a blood vessel with the potential to travel to a distant site and cause occlusion
thromboembolism
a permanent form of female sterilization in which the FT are severed
tubal ligation
a pelvic abscess involving FT and OV that is often cause by pelvic inflammatory disease
tube-ovarian abscess
when adhesions develop within pelvis that leads to fusion of ovaries and dilated tubes as a result PID
tube-ovarian complex
the uterus, ovaries and FT
upper genital tract
a benign, smooth muscle tumor of the uterus ; may also be referred to as a fibroid or uterine myopia
uterine leiomyoma
inflammation of the vagina
vaginitis
infertility treatment where the zygote is placed into the FT
zygote intrafallopain transfer
An infection in the upper genital tract
PID
What is the origin of PID
ascension of an infection from the lower genital tract
Risk factor for PID
IUD
Post abortion
Post Childbirth
Douching
Mulitple Sexual Partners
Early Sexual Contact
After PID it manifests
TB
Association of Appdx
Ruptured colonic diverticulum
Pelvic surgery
Common causes of PID are
Chlamydia & Gonorrhea
PID is usually ___
Bilateral
Clinical findings of Acute PID
fever
chills
pelvic pain/tenderness
purulent vaginal discharge
vaginal bleeding/itchiness
dyspareunia
leukocytosis
Sonographic findings of acute PID
Thickened Irregular Endometrium
Ill defined uterine borders
Pyosalpinx
Hydrosalpinx
Cul de sac Fluid
Multicystic and solid complex andexal masses
Clinical findings of chronic PID
Continual Pelvic / Abd Pain
Infertility
Palpable Adnexal Mass
Irregular Menses
Purulent Vaginal Discharge
Sonographic findings of Chronic PID
Hydrosalpinx
Scars in Fallopian Tubes (Echogenic bands in tube)
Adhesions may obliterate distinct borders
Multicystic and solid complex adnexal masses
The most common initial clinical presentation in early stages of PID
Vaginitis
Vaginitis can lead too
excesssive vaginal discharge & purulent foul smelling discharge
The progression vaginitis into the cervix
Cervicitis
Inflammation of the endometrium
endometritis
Endometritis can occur after
Postpartum
D&C
IUD
Clinical findings of Endometritis
HX of Abortion, Postpartum, D&C, PID, Surgery, and IUD
Pelvic Tenderness
Fever
Leukocytosis
Snographic findings of endometritis
Thickened echogenic or irregular endometrium
Endometrial Fluid
Ring down artifact (Gas or air within the endometrium)
Patients suffering from saplinigitis may present with
symptoms like cholecytisis
Chlamydia or Gonorrhea can lead to what
perihepatic infections (development of adhesions located between the liver & diaphragm)
Fitz Hugh Curtis syndrome
chlyamidia and gonorhhea can lead to this , liver capsules become inflamed, mimicking GB disease , elevated liver function tests
PID is linked to
Ectopic pregnancy
Clinical findings of Salpingitis
PID Findings
Pelvic Tenderness
Fever
Leukocytosis
Sonographic findings of Salpingitis
distended Fallopian tube filled with echogenic material (pus) or anechoic fluid
-hyperemic flow within or around the affected FT
-nodular thickness wall of FT
As PID progresses what happens
Reaches beyond the FT and involves the ovaries and peritoneum
The progression of Tube Ovarian complex
Tubo Ovarian Abcess
Both Tubo Ovarian Complex and Abcess Sonographic Findings
Thickened, Irregular Endometrium
Pyosalpinx / Hydrosalpinx
Culd de sac fluid
Multicystic and solid complex adnexal masses
What are the Sonographic Findings for both Tubo Ovarian Abcess and Complex
Thickened, Irregular Endometrium
Pyosalpinx / Hydrosalpinx
Cul de sac fluid
Multicystic and solid complex adnexal masses
With Tubo Ovarian Complex what is a sonographic findings that is different than with an abcess?
Ovaries and tubes recognized as distinct structures but the ovaries will not be seperated by pushing them with a vaginal probe
PID is a common cause of
Infertility
What are some causes of Female Infertility ?
Septate Uterus
Endometriosis
PCOS
Asherman Syndrome
Uterine Leiomyoma
Tubal Causes
Uterine malformations often lead to what?
Repeated abortions
How does implantation of ectopic endometrial tissue result?
From passing through the fallopian tubes during menstruation or may result from scarring from surgery after a c - section
Ectopic endometrial tissue undergoes physiologic changes?
As a result of stimulation of the hormones of the menstrual cycle
Hemorrhage of endometriosis tissue occurs resulting in what?
Focal areas of bloody tumors - endometriomas
Chocolate cysts
Endometriosis is most commonly located where?
Ovaries
Where can ednometriosis be located?
Within C- section scars, liver, lungs and extremities
Endometrial age range
25 TO 35
infertility results from development of pelvic adhesions that may alter normal anatomy - prevents ovum from being picked up
Infertility & Endometriosis
The Clinical Findings of Endometriosis
Asymptomatic
Pelvic Pain
Infertility
Dysmenorrhea
Dyspareunia
Menorrhagia
Painful bowel movement
Sonographic findings of endometriosis
Cystic mass with low level internal echos - hemorrhagic cyst
Anechoic or complex mostly cystic mass with posterior enhancement and may contain a fluid - fluid level
Polycystic ovary syndrome is also known as what
Stein Levethal Syndrome
Patients with Polycystic Ovarian Syndrome may suffer from chronic anovulation as a result from?
Hormonal imbalances
PCOS is cited as the most common cause of
Androgen excess
Diagnosis of PCOS includes what ?
Oligo or Annovulation
Blood work shows Hyperandrogenism
Sonographic Findings of PCOS
For a diagnosis the ovaries should contain what ?
12 or more follicles that measure between 2 and 9 in diameter
PCOS ovarian volume should not exceed
10 ml
Hydrosalpinx occurs because
Obstruction of fimbriated end of the fallopian tube by adhesions
The clinical findings of Sherman syndrome
HX of D&C, Trauma, Uterine Surgery
-recurrent pregnancy loss
-amenorrhea/hypomenorrhea
What kind of fibroids can impede fertilization
Intracavity or submucosal
What causes female infertility
-Uterine malormations
-Endometriosis
-PCOS
-Tubal
-Luteal Phase Deficiency
-Asherman Syndrome
-Uterine Leiomyoma
Ovulation
Induction
Clomid
Personal
Clomid is also known as
Clomiphene Citrate
Women who are undergoing ovulation induction by means of hormone administration are at an increased risk for developing what?
Ovarian Hyperstimulation
With OHS ovaries will often measure
5 to 12 cm
with OHS what kind of cysts
Theca Lutein Cysts
with OHS ovaries become so large
Ovarian torsion is possible
OHS can initiate
Renal Failure, Thromboembolism, Acute Respiratory Distress Syndrome
The clinical findings of OHS
Abdominal Distension
Oliguria
Ovarian Enlargement
Nausea
Vomiting
Fertility treatment
What is the radiographic procedure used to evaluate the patency of the FT
A. sonohysterography
B. hysterosalpingography
C.Hysteroscopy
D. Hysterscopic fallopa
Hysterosalpingography
The sonographic finding of a tubular, simple-appearing, anechoicstructure within the adnexa is most consistent with
A. Dyspareunia
B. Hematometra
C. Hydrosaplinx
D. Endometritis
Hydrosalpinx
All of the following are considered risk factors for PID except
A. IUD
B Multiple sexual partners
C. Post childbirth
D. Uterine leiomyoma
Uterine leioymoma
Which of the following would be the least likely clinical finding for a pt with endometriosis
A. pelvic pain
B. Dysmenorrhea
C. painful bowel movements
D. hyperandrogenism
D
Which of the following is not a potential cause of PID Is
A. intrauterine contraception
B. postabortion
C. chlymadia
D. pyelonephritis
D
a patient presents to the sonography department with a fever, chills, and vaginal discharge. sonographically, what findings would you most likely not encounter?
c. cul-de-sac fluid
b. uterine adhesions
c. dilated uterine tubes
d. ill-defined uterine border
B
a 26-year old patient presents to the sonography department with a history of infertility and oligomenorrhea. sonographically, you discover that the ovaries are enlarged and contain multiple, small follicles along their periphery, with prominent echogenic stromal elements. what is the most likely diagnosis?
a. ovarian torsion
b. OHS
c. PID
d. PCOS
D
the most common initial clinical presentation of PID is:
a. endometritis
b. tubo-ovarian abscess
c. vaginitis
d. pyosalpinx
C
sonographic findings of the endometrium in a patient with a history of PID, fever, and elevated white blood cell count would include all of the following except:
a. ring-down artifact posterior to the endometrium
b. thin, hyperechoic endometrium
c. endometrial fluid
d. thickened, irregular endometrium
B
What is another name for an endometrioma
A. dermoid
B. teratoma
C. chocolate cyst
D. string of pearl
C
Fitz-Hugh-Curtis syndrome could be described as:
a. clinical findings of gallbladder disease as a result of PID
b. the presence of uterine fibroids and adenomyosis in the gravid uterus
c. coexisting intrauterine and exrauterine pregnancies
d. the presence of pyosalpinx, hydrosalpinx, and endometritis
A
all of the following statements concerning PID are true except:
a. PID is typically a unilateral condition
b. PID can be caused by douching
c. PID can lead to a tubo-ovarian abscess
d. dyspareunia is a clinical finding in acute PID
A
a patient presents to the sonography department with complaints of infertility and painful menstrual cycles. sonographically, you discover a cystic mass on the ovary consisting low-level echoes. based on the clinical and sonographic findings, what is the most likely diagnosis?
a. cystic teratoma
b. endometrioma
c. PID
d. OHS
B
The development of adhesions between the liver and the diaphragm as a result of PID is termed
A. fitz hugh curtis syndrome
B. Dandy Walker syndrome
C. Stein leventhal syndrome
D. aSherman syndrome
A
Assisted reproductive therapy can result in all of the following of except :
A. hetertopic pregnancy
B. multiple gestations
C. OHS
D. asherman syndrome
D
Polycystic ovarian syndrome may also be referred to as:
A. Fitz-Hugh Curtis syndrome
B. plateau syndrome
C.stein leventhal syndrome
D. asherman syndrome
C
PID can lead to all of the following except:
a. infertility
b. polycystic ovarian disease
c. ectopic pregnancy
d. scar formation in the fallopian tubes
B
What term is used to describe painful intercourse?
A. dyspareunia
B. Dysuria
C. dysmenorrhea
D. dynsconception
A
the presence of functional, ectopic endometrial tissue outside the uterus is termed:
A. adenomyosis
B. asherman syndrome
C. Fitz-Hugh Curtis syndrome
D. endometriosis
D
all of the following are sonographic findings of a tubo-ovarian abscess except:
a. the presence of 10 or more small cysts along the periphery of the ovaries
b. dul-de-sac fluid
c. thickened, irregular endometrium
d. fusion of the pelvic organs as a conglomerated mass
A
a patient presents to the sonography department with a history of Chlamydia and suspected PID. which of the following would be indicative of the typical sonographic findings of PID?
a. enlarged cervix, thin endometrium, and theca lutein cysts
b. atrophic uterus, free fluid, and small ovaries
c. bilateral, cystic enlargement of the ovaries with no detectable flow
d. thickened irregular endometrium, cul-de-sac fluid, and complex adenexal masses
D
causes of female infertility include all of the following except:
a. previous intrauterine device use
b. polycystic ovary syndrome
c. Asherman syndrome
d. endometriosis
A. previous intrauterine device use
Infertility is defined as
A. the inability to conceive a child after 2 years of unprotected intercourse
B. the inability to conceive a child after 5 years of unprotected intercourse
C. The inability conceive a child after 1 year of unprotected intercourse
A
a 25-year old patient present to the sonography department complaining of pelvic pain, dyspareunia, and oligomenorrhea. an ovarian mass, thought to be a chocolate cyst, is noted during the examination. which of the following is consistent with the sonographic appearance of a chocolate cyst?
a. simple-appearing anechoic mass
b. echogenic mass with posterior shadowing
c. cystic mass with low-level level echoes
d. anechoic mass with posterior shadowing
C.
amenorrhea, hirsutism, and obesity describe the clinical features of:
a. Fitz-Hugh-Curtis syndrome
b. Stein-Leventhal syndrome
c. Asherman syndrome
d. Endometriosis
B
the sonographic evidence of a hyperemic fallopian tube is consistent with:
a. pyosalpinx
b. hydrosalpinx
c. endometritis
d. salpingitis
D
the sonographic “string of pearls” sign is indicative of
polycystic ovary syndrome
complex-appearing fluid within the fallopian tubes seen with PID is most likely:
a. pyosalpinx
b. pyometra
c. hydrosalpinx
d. hematometra
a
sonographic findings of OHS include all of the following except:
a. cystic enlargement of the ovaries
b. ascites
c. pleural effusions
d. oliguria
oliguria
he development of adhesions within the uterine cavity is termed
a. fitz-hugh-curtis syndrome
b. dandy-waler syndrome
c. stein-leventhal syndrome
d. asherman syndrome
Asherman syndrome
OHS can cause multiple large follicles to develop on the ovaries termed
OHS can cause multiple large follicles to develop on the ovaries termed:
a. theca lutein cysts
b. chocolate cysts
c. corpus luteum cyst
d. dermoid cysts
Theca lutein cysts
what is another name for adhesions within the endometrial cavity
what is another name for adhesions within the endometrial cavity?
a. endometritis
b. synechiae
c. septation
d. mural nodules
Synechiae
a female patient presents to the sonography department with a clinical history of Clomid treatment. She is complaining of nausea, vomiting, and abdominal distention. What circumstance is most likely causing her clinical symptoms
a. stein-leventhal syndrome
b. pcos
c. fitz-hugh-curtis syndrome
d. OHS
OHS
a 35 year old patient presents the the sonography department with a history of tubal ligation and positive pregnancy test. What condition should be highly suspected?
a. asherman syndrome
b. pcos
c. endometriosis
d. ectopic pregnancy
ectopic pregnancy
patients with OHS are at increased risk for:
a. ovarian torsion
b. Chlamydia
c. gonorrhea
d. vaginitis
ovarian torsion
which of the following would be described as functional cysts that are found in the presence levels of hcg
a. theca lutein cysts
b. chocolate cysts
c. corpus luteum cysts
d. endometrial cysts
theca lutein cysts
The presence of pus within the uterus defines:
A. Pyosalpinx
B. Pyometra
C. Pyocolpos
D. Pyomyoma
Pyometra
The occurrence of having both an intrauterine and extrauterine pregnancy at the same time describes
a. PID
b. ectopic pregnancy
c. heterotopic pregnancy
d. molar pregnancy
heterotopic pregnancy
excessive hair growth in women in areas where hair growth is normally negligible would be see with:
a. ectopic pregnancy
b. fitz-hugh-curtis syndrome
c. asherman syndrome
d. stein-leventhal syndrome
Stein leventhal syndrome
what form of permanent birth control would be seen sonographically as echogenic, linear structures within the lumen of both isthmic portions of the fallopian tubes?
a. Essure devices
b. ParaGards
c. Lippes loops
d. Mirenas
A
