acute salpingo-oophoritis and chronic PID

Question 1

Acute salpingo
oophoritis: On examination:

Answer 1

mucopurulent cervical discharge
*cervical-motion tenderness
*bilateral adnexal tenderness are
present.
*Fever, tachycardia
*Lower abdomen tenderness

Question 2

Investigative findings of Acute salpingo
oophoritis

Answer 2

elevated WBC and ESR
*Pelvic sonography is usually
unremarkable
*Laparoscopy will show erythematous,
edematous, purulent oviducts.
*Cervical positive for chlamydia or
gonorrhea.

Question 3

Outpatient treatment of Acute salpingo-oophoritis

Answer 3

• in mild to moderate cases
  *1. ceftriaxone 1 gm IM plus doxycycline po bid for 14 days
  2. with/without metronidazole po bid for 14 days

Question 4

Inpatient treatment of Acute salpingo-oophoritis:

Answer 4

• in severe cases
• Criteria:-
• failed outpatient therapy
  -; unable to tolerate oral
  medications;
  -; severe illness, high fever, nausea/vomiting; tubo
  ovarian abscess
  -pregnancy
  -surgical emergency (appendicitis e.g)

**
1) cefotetan IV Q 12 h plus doxycycline po or IV q 12 h or
2) clindamycin plus gentamicin IV q 8 h

Question 5

Chronic PID pathogenesis

Answer 5

*recurrent salpingo -oophoritis
*If the salpingo-oophoritis is not appropriately treated, the body’s immune defenses will often
overcome the infection but at the expense of persistent adhesions and scarring.

Question 6

Chronic PID Symptoms

Answer 6

she may have :
*Chronic bilateral lower
abdominal-pelvic pain
*abnormal vaginal
bleeding
* history of infertility (most common complication)
*Dyspareunia
* ectopic pregnancy

**she may have no symptoms except infertility

Question 7

Investigative findings of Chronic PID

Answer 7

*negative cervical cultures with normal WBC and ESR.
*Sonography may show bilateral cystic pelvic masses consistent
with hydrosalpinges.
*

Question 8

Chronic PID Diagnosis:

Answer 8

Diagnosis is based on laparoscopic visualization of pelvic adhesions.

Question 9

Chronic PID Management

Answer 9

1utpatient mild analgesics for pain.
2. Lysis of tubal adhesions may be helpful for infertility
3. Severe unremitting pelvic pain may require a pelvic clean-out
(TAH, BSO).
4. If the ovaries are removed, estrogen replacement therapy is
indicated.