Adnexa

Question 0

More than likely what is PID caused by?

Answer 0

Sexually transmitted diseases - gonorrhea and chlamydia

Question 1

______ and ______ are diffuse disease processes of the female pelvic cavity.

Answer 1

PID and endometriosis

Question 2

Uncommonly what can PID be caused by?

Answer 2

Ruptured appendix and peritonitis

Question 3

What is a common complication of child birth or post-abortion?

Answer 3

IUD

Question 4

PID and endometriosis have very same or different clinical presentations and pathologies.

Answer 4

Different

Question 5

Early in the disease, the clinical presentation of both PID and endometriosis are…

Answer 5

Nonspecific

May mimic functional bowel disease

Question 6

PID is an inclusive term for all pelvic infections…name 7.

Answer 6

Endometritis
Salpingitis
Hydrosalpinx
Pyosalpinx
Periovarian inflammation
Tubo-ovarian complex
Tubo-ovarian abscess

Question 7

Infections usually occur ______ and may be found in what parts of the pelvis?

Answer 7

Endometrium - endometritis
Uterine wall - myometritis
Uterine serosa & broad ligament - parametritis
Ovary - oophoritis
MOST COMMON –> oviducts or fallopian tubes - salpingitis

Question 8

______ PID has limited sonographic value because inflammatory changes have not yet began to manifest

Answer 8

Acute

Question 9

In chronic PID, what can ultrasound indentify?

Answer 9

Dilated fallopian tubes, abscess, complex intraperitoneal fluid

Question 10

PID occurrence statistics…

Answer 10

Becoming more common
11% of young women during reproductive age
Peak incidence at 20-24 years old
Affects 750,000 american women each year

Question 11

6 risks factors on PID…

Answer 11

Early sexual contact
Multiple sexual partners
History of STD's
Previous history of PID
IUD
Douching

Question 12

PID can either be ______ or ______ and the infection spread to the ______.

Answer 12

Acute or chronic

Pelvis

Question 13

What might been seen on an image of someone with PID?

Answer 13

Large, palpable, complex mass
Ovary may be seen separate from mass
Free fluid in the cul de sac
Increased vascularity and diastolic flow - Doppler

Question 14

What is PID associated with?

Answer 14

Infertility

Endometritis

Question 15

If PID travels upward through the right flank, what will it cause?

Answer 15

Perihepatic inflammation

Question 16

PID pain may mimic…

Answer 16

Liver, GB, or right renal pain

Question 17

How can perihepatic inflammation be detected sonographically?

Answer 17

By scanning along the liver margin and identifying hypoechoic rim between liver and adjacent rib

Question 18

Perihepatic inflammation is also called…

Answer 18

Fitz-Hugh-Curtis syndrome

Question 19

Sexually transmitted PID spreads via ______ through ______ into ______ and out of the ______ to the ______.

*give location and the specific “-itis”

Answer 19

Via mucosa of pelvic organs
Through cervix
Into uterine endometrium (endometritis)
Out of the fallopian tubes (acute salpingitis)
To the area of ovaries & peritoneum (oophoritis/peritonitis)

Question 20

As tube becomes obstructed it fills with what?

Answer 20

Pus (pyosalpinx)

Question 21

What happens to the margin of ovaries and other pelvic structures when extensive PID settles in?

Answer 21

Becomes difficult to distinguish from each other

Question 22

Clinical symptoms of PID…

Answer 22

Intense pelvic pain and tenderness
Constant vaginal discharge
Fever
RUQ pain
Dyspareunia
Irregular menstrual bleeding
Hx of infertility
Elevated WBC - chlamydia
Fitz-Hugh-Curtis syndrome - gonorrhea

Question 23

PID that is asymptomatic or only has minor symptoms can still do what?

Answer 23

Cause serious damage to the reproductive organs

Question 24

PID differentials are?

Answer 24

Hematoma Dermoid cyst Ovarian neoplasm Endometriosis

Question 25

What is the 1st and 2nd findings of acute PID?

Answer 25

1st - endometritis - small amount of fluid in the endometrial cavity 2nd - small amount of free fluid in posterior cul de sac **increasing amount of fluid spreads SUPERIORLY

Question 26

With chronic PID, the fibrosis of adhesions do what?

Answer 26

Merge all the pelvic content together

Question 27

Chronic PID within the uterus is called what?

Answer 27

Indefinite uterus

Question 28

PID sonographic findings of endometritis...

Answer 28

Thickening or fluid in endometrium Greater than 20 mm is abnormal Increased risk with PROM, POC, clots, or prolonged labor

Question 29

PID sonographic findings of periovarian inflammation...

Answer 29

Enlarged ovaries with multiple cysts Indistinct margins

Question 30

PID sonographic findings of salpingitis...

Answer 30

Nodular thickening Irregularity of tube with diverticula - dilated & tortuous

Question 31

PID sonographic findings of pyosalpinx...

Answer 31

Fluid filled irregular fallopian tubes with or without echoes May appear as a complex mass

Question 32

PID sonographic findings of Tubo-ovarian abscess...

Answer 32

Complex mass with septations Irregular margins Internal echoes Usually in cul de sac Outside of uterus

Question 33

PID sonographic findings of hydrosalpinx...

Answer 33

Walls become thin secondary to dilation Multicystic or fusiform mass Follow dilated tubes from fundus to uterus Look for pointed "beak" at swollen end of tube near isthmus Bilateral Ampullary portion more dilated than interstitial part of tube

Question 34

Description and clinical symptoms of salpingitis...

Answer 34

Inflammation of fallopian tubes - acute, subacute, chronic Asymptomatic to pelvic fullness or discomfort Low grade fever

Question 35

Description and clinical symptoms of hydrosalpinx...

Answer 35

Obstructed tube filled with serous secretions Occurs secondary to PID, endometriosis, post-operative adhesions Asymptomatic to pelvic fullness or discomfort Low grade fever

Question 36

Description and clinical symptoms of pyosalpinx...

Answer 36

Retained pus in oviduct with inflammation Asymptomatic to pelvic fullness or discomfort Low grade fever

Question 37

For TOA, what may further adhere to the ovary and/or other peritoneal surfaces? What does this cause?

Answer 37

Adhesive, edematous, inflamed serosa Distorts anatomy

Question 38

If TOA infection worsens, what may form?

Answer 38

Periovarian adhesions

Question 39

What is a tubo-ovarian complex?

Answer 39

When the ovary cannot be separated from inflamed dilated tube

Question 40

TOA usually responds well to...

Answer 40

Antibiotic treatment without need for surgical drainage

Question 41

How is ultrasound used to evaluate TOA?

Answer 41

Serial US images during treatment allow for observation of resolution

Question 42

For TOA, sonographic guidance can be used to assist in...

Answer 42

Percutaneous or transvaginal drainage for culture and sensitivity Complete drainage and thus hasten recovery

Question 43

What is peritonitis?

Answer 43

Inflammation of the peritoneum - the serous membrane lining the ABD cavity and then covering the viscera

Question 44

If infectious process spreads to involve bladder, ureter, bowel, and adnexal area, it becomes _________.

Answer 44

Pelvic peritonitis

Question 45

Peritonitis sonographically...

Answer 45

Gas forming bubbles Loculated areas of fluid within pelvis, paracolic gutters, mesenteric reflections Evaluation of space between rt kidney and liver & lt kidney and spleen

Question 46

_________ is an inflection of the endometrium and can be divided into _________ and _________ cases.

Answer 46

Endometritis Obstetric and Nonobstetric

Question 47

_________ infection is associated with PID or gyne instruments; endometritis can be acute or chronic.

Answer 47

Nonobstetric

Question 48

_________ cases occur in immediate postpartum period; endometritis is most common cause of fever in postpartum patients.

Answer 48

Obstetric

Question 49

_________ is defined as presence of functioning endometrial tissue in abnormal locations.

Answer 49

Endometriosis

Question 50

_________ tissue can be found almost anywhere in the body.

Answer 50

Ectopic

Question 51

4 clinical findings of endometriosis...

Answer 51

Severe dysmenorrhea Chronic pelvic pain from peritoneal adhesions Bleeding Dyspareunia

Question 52

What 3 causes may arise from peritoneal seeding?

Answer 52

Retrograde travel of endometrial cells through fallopian tubes Metaplastic transformation of peritoneal epithelium into endometrial tissue Traumatic spread from uterine surgery or amniocentesis

Question 53

Endometriosis has 2 forms: _________ and _________

Answer 53

Internal and external

Question 54

_________ endometriosis occurs within uterus (adenomyosis)

Answer 54

Internal/direct

Question 55

_________ endometriosis outside uterus and may be found in pouch of Douglas; surface of ovary, fallopian tube, uterus broad ligaments, or rectovaginal septum.

Answer 55

External/indirect

Question 56

What is the most common type of endometriosis?

Answer 56

External - indirect

Question 57

_________ is the internal/direct form of endometriosis.

Answer 57

Adenomyosis

Question 58

Endometriosis varies from a small _________ to _________ sheets of tissue to _________ masses.

Answer 58

Foci Widespread Focal discrete

Question 59

Endometrial tissue in endometriosis cyclically _________ and _________ as stimulated by changes in hormonal influences.

Answer 59

Bleeds and proliferates

Question 60

Clinical symptoms of adenomyosis...

Answer 60

Heavy bleeding Painful menses Uterine enlargement

Question 61

_________ is most common in women who have had uterine surgery.

Answer 61

Adenomyosis

Question 62

Sonographic findings of adenomyosis...

Answer 62

Bulbous uterus w/ or w/o myometrial cysts Borders become indistinct between endometrium and myometrium "Blurred border" appearance more common in POSTERIOR aspect of uterus MRI more specific than US

Question 63

_________ is a localized form consists of a discrete mass.

Answer 63

Endometrioma

Question 64

2 other names for an endometrioma...

Answer 64

Chocolate cyst Sampson cysts

Question 65

Clinical symptoms of endometriomas...

Answer 65

Asymptomatic

Question 66

Endometriomas could become a surgical emergency if they _________ or _________.

Answer 66

Rupture or torse

Question 67

_________ endometriosis, the most common form, is rarely deteted sonographically unless it's a focal mass, _________, is present.

Answer 67

Diffuse Endometrioma

Question 68

_________ may appear as bilateral or unilateral ovarian masses with patterns ranging from anechoic to solid, depending on amount of blood and its state of organization.

Answer 68

Endometriomas

Question 69

With _________, ovaries typically adhere to posterior surface of uterus or are stuck in cul de sac and may be difficult to define.

Answer 69

Endometriosis

Question 70

Acute PID has how many stages?

Answer 70

4

Question 71

What is acute PID stage 1?

Answer 71

Endometritis - infection of the endometrium Irregular vaginal bleeding & discharge

Question 72

What is acute PID stage 2?

Answer 72

Salpingitis - infection of the fallopian tubes Low grade fever, pelvic pain, + Mcburney's, dypareunia

Question 73

What is acute PID stage 3?

Answer 73

TOA - purulent material spills from fallopian tube to ovary causing the tube and ovary to become adherent Sever pain, high fever/chills, nausea, vomiting, increased WBC

Question 74

What is acute PID stage 4?

Answer 74

Peritonitis - infectious spread to the peritoneum Same as TOA, plus RUQ pain (perihepatic & Fitz-Hugh-Curtis syndrome

Question 75

2 types of PID?

Answer 75

Acute or chronic

Question 76

Describe chronic PID...

Answer 76

Extensive fibrosis and adhesions may form (pelvic definition is lost) Hydrosalpinx or pyosalpinx

Question 77

Chronic PID sonographically..

Answer 77

"BEADS ON A STRING" sign Hyperechoic nodules on the inner wall sod the fallopian tubes