Chapter 39: Pathology of the Adnexa Flashcards
What are two diffuse disease processes of the female pelvic cavity?
- PID
- endometriosis
What are PID and endometriosis most commonly associated with?
gonorrhea and chlamydia
PID is an inclusive term for all pelvic infections including (7):
- endometritis
- salpingitis
- hydrosalpinx
- pyosalpinx
- periovarian inflammation
- tubo-ovarian complex
- tubo-ovarian abscess
Where can PID be be found?
BILATERALLY
- in the endometrium (endometritis)
- in the uterine wall (myometritis)
- the uterine serosa and broad ligaments (parametritis)
- the ovary (oophritis)
- the oviducts (salpingitis)
Where is PID found most commonly?
the oviducts AKA salpingitis
What are 6 risk factors of PID?
- early sexual contact
- multiple sexual partners
- HX of sexually transmitted disease
- previous hx of PID
- IUCD’s
- Douching
T/F: PID is becoming more common?
True
Routes of infection include:
- douching
- direct extensions from post-surgical abscess collection that have ruptured into the pelvis
- the string from IUCD
- puerperal and post abortion complications
- other invasive instrumentation procedures
Infrequently with patients with PID resulting from gonorrhea, where may the PID ascend?
may ascend the right flank causing a perihepatic inflammation..causing pain that might mimic liver, GB, or rt. renal pain
Perihepatic inflammation is AKA
Fitz-Hugh-Curtis syndrome
Sexually transmitted PID is spread via the _____
mucosa of the pelvic organs through the cervix into the endometrium and out the fallopian tubes
If a pregnancy test is positive in a woman with previously treated PID, what is indicated?
careful eval. of the adnexa even with a normal IUP
Clinical symptoms of PID (8):
- intense pelvic pain
- tenderness
- fever
- pain in rt upper abdomen
- painful intercourse
- irregular menstrual bleeding
- hx of infertility
- elevated WBC’s
Son findings of endometritis?
thickening or fluid in the endometrium
Son findings of periovarian inflammation?
enlarged ovaries with multiple cysts, indistinct margins
Son findings of salpingitis?
nodular thickening, irregularity of tube with diverticula
Son findings of pyosalpinx or hydrosalpinx?
fluid-filled irregular fallopian tube with or without echoes
Son findings of Tubo-ovarian abscess?
complex mass with septations, irregular margins, and internal echoes..usually in the cul-de-sac
What is salpingitis?
inflamation of fallopian tube; acute, subacute, or chronic
What are clinical findings of salpingitis?
asymptomatic to pelvic fullness or discomfort, low grade fever
What are sonographic findings of salpingitis?
dilated, tortuous tube
Describe hydrosalpinx?
obstructed tube filled with serous secretions; occurs secondary to PID, endometriosis or postop adhesions
What are clinical findings of hydrosalpinx?
asymptomatic to pelvic fullness or discomfort,low grade fever
What are sonographic findings of salpingitis?
walls become thin secondary to dilation; appearance of multicystic or fusiform mass..follow dilated tubes from the fundus of uterus and look for pointed beak at swollen end of the tube near isthmus..bilateral..ampullary portion more dilated that interstitial part of tube