Acute Salpingitis

Question 0

Tubo-ovarian abscess? Treatment?

Answer 0

Collection of purulent material around distal tube and ovary;

unlike typical abscess, can be treated with antibiotic therapy

Question 1

Salpingitis – a.k.a.? Suggestive physical exam sign?

Answer 1

Pelvic inflammatory disease; Cervical motion tenderness

Question 2

Common presentation of salpingitis?

Answer 2

Young, nulliparous female complaining of lower abdominal/pelvic pain and vaginal discharge with fever, and nausea/vomiting

Question 3

Signs and symptoms of acute salpingitis?

Answer 3

1. Abdominal, Cervical motion, adnexal tenderness
2. Vaginal discharge
3. Fever
4. Pelvic mass on physical exam/ultrasound

Question 4

Fitz-Hugh and Curtis syndrome?

Answer 4

Right upper quadrant pain seen in salpingitis when PERIHEPATIC ADHESIONS are present

Question 5

When salpingitis diagnosis is in doubt – best confirmatory method? Look for?

Answer 5

Laparoscopy; purulent discharge from fimbria

Question 6

Manage salpingitis as outpatient if? Tx?

Answer 6

1. Low-grade fever
2. Absence of paratonia signs
3. Tolerance of oral medication

Single IM ceftriaxone and oral doxycycline for 10-14 days

Question 7

Criteria for inpatient therapy?

Answer 7

1. Fails outpatient therapy (after reassessing for you hours after initiating)
2. Pregnant
3. Extremes of age (no teenagers)
4. Cannot tolerate oral medication ( nausea)

IV cefotetan or oral/IV doxycycline

Question 8

Patient on inpatient therapy for salpingitis does not improve within 48 to 72 hours – next step?

Answer 8

Laparoscopy to assess disease

Question 9

Tubo-ovarian abscess – organism? Abx? Complication?

Alternative treatment?

Answer 9

Anaerobics; clindamycin or metronidazole

Rupture

Radiological percutaneous drainage

Question 10

Long-term complications of salpingitis?

Answer 10

1. Chronic pelvic pain
2. Involuntary infertility
3. Ectopic pregnancy

Question 11

Infertility from PID directly related to?

Answer 11

Number of episodes of salpingitis

Question 12

Contraception that increases risk for PID? (Why?) another risk factor?

Decreases risk?

Answer 12

IUD (endocervical barrier is broken upon placement of IUD); OCP

Nulliparity

Question 13

Acute salpingitis – organism?

Answer 13

Multiple organisms

Question 14

Gold standard for diagnosing salpingitis?

Answer 14

Laparoscopy

Question 15

Sulfur granules in tubes – organism? Woman likely has a? Treatment?

Answer 15

Actinomyces; IUD; penicillin

Question 16

When to suspect septic shock with PID?

Answer 16

No septic shock with PID unless rupture of tubo-ovarian abscess