Chapter 21 - Pelvic Inflammatory Disease & infertility Flashcards by Gabriella Santangelo

the buildup of fluid within the air sacs of alveoli within the lungs

acute respiratory distress syndrome

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a hormone such a tester one that is responsible for a male characteristic

androgen

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syndrome characterized by endometrial adhesions that typically occur as result of scar formation after some types of uterine surgery

ashermann syndrome

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inflammation of the cervix

cervicitis

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sexually transmitted disease that can lead to an infection of the genital tract in both sexes

chlaymidia

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inflammation of the GB

cholecystitis

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function ectopic endometrial tissue located outside of the uterus

endometritis

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permanent form of birth control that uses small coils placed into the proximal isthmus segment of the FT

essure device

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a perihepatic infection that results in liver capsule inflammation from the pelvic infections such as gonorrhea and chlamydia

Fitz-Hugh-Curtis-Syndrome

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technique used for in vitro fertilization in which follicles are drained for oocyte retrieval

follicular aspiration

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infertility treament in which oocytes and sperm are placed in the FT by means of laparoscopy

gamete intrafallopian tube transfer

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a sexually transmitted disease that can lead to PID

gonnorrhea

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peritoneal space located between liver and right kidney ; also referred to as Morrison pouch

hepatorenal space

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coexisting ectopic & intrauterine pregnancies

heterotopic pregnancy

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abnormal accumulation of fluid within the Fallopian tube

hydrosalpinx

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excessive serum androgen levels ; produces male characteristics in females

hyperandrogegism

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an increase in blood flood

hyperemic

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fertility treatment that requires that a mature ovum be extracted from the ovary with fertilization taking place outside of the body

in vitro fertilization

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an elevated white blood cells count

leukocytosis

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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

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a small plastic T-shaped intrauterine device

Mirena

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overweight to the point of causing significant health problems and increased mortality

obesity

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infrequent or light menstrual periods

oligomenorrhea

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scant or decreased urine output

oliguria

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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

Which of the following is not a potential cause of PID Is A. intrauterine contraception B. postabortion C. chlymadia D. pyelonephritis

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

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

the most common initial clinical presentation of PID is: a. endometritis b. tubo-ovarian abscess c. vaginitis d. pyosalpinx

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

What is another name for an endometrioma A. dermoid B. teratoma C. chocolate cyst D. string of pearl

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

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 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

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

Assisted reproductive therapy can result in all of the following of except : A. hetertopic pregnancy B. multiple gestations C. OHS D. asherman syndrome

Polycystic ovarian syndrome may also be referred to as: A. Fitz-Hugh Curtis syndrome B. plateau syndrome C.stein leventhal syndrome D. asherman syndrome

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

What term is used to describe painful intercourse? A. dyspareunia B. Dysuria C. dysmenorrhea D. dynsconception

the presence of functional, ectopic endometrial tissue outside the uterus is termed: A. adenomyosis B. asherman syndrome C. Fitz-Hugh Curtis syndrome D. endometriosis

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 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

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 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

amenorrhea, hirsutism, and obesity describe the clinical features of: a. Fitz-Hugh-Curtis syndrome b. Stein-Leventhal syndrome c. Asherman syndrome d. Endometriosis

the sonographic evidence of a hyperemic fallopian tube is consistent with: a. pyosalpinx b. hydrosalpinx c. endometritis d. salpingitis

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

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