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OB/Gyn > pathology of the adnexa > Flashcards

pathology of the adnexa Flashcards

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0
Q

What causes PID?

A

std

gonorrhea and chlamydia

IUD

complications of childbirth

post abortion

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1
Q

What is PID?

A

diffuse disease processes of the female pelvic cavity

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2
Q

PID is an inclusive term for all pelvic infections like:

A

endometritis

salpingitis

hydrosalpinx

pyosalpinx

periovarian inflammation

tubo-ovarian complex

tubo-ovarian abscess

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3
Q

Is PID unilateral or bilateral?

A

bilateral

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4
Q

what locations might you find PID?

A

endometrium (endometritis)

uterine wall (myometritis)

uterine serosa and broad ligaments (parametritis)

Ovary (oophoritis)

MOST COMMON LOCATION: oviducts or Fallopian tubes (salpingitis)

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5
Q

During acute PID can you sonographically see PID?

A

no…it hasn’t really begun to manifest the inflammatory changes yet

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6
Q

In chronic PID what can ultrasound identify?

A

dilated Fallopian tubes (hydrosalpinx or pyosalpinx)

abscess

complex intraperitoneal fluid

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7
Q

When does PID peak?

A

20-24 years of age

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8
Q

What are the risk factors for PID?

A

early sexual contact

multiple sexual partners

hx of std

previous hx of PID

intrauterine contraceptive device IUD

douching (may push bacteria into the upper genital tract)

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9
Q

How does PID appear sonographically?

A

large, palpable, bilateral complex mass

ovary may be seen separate from mass

free fluid in cul-de-sac

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10
Q

How does PID appear with Doppler?

A

increased vascularity and diastolic flow

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11
Q

What is PID associated with?

A

infertility and endometritis

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12
Q

Where does PID infrequently spread to?

A

may travel upward through right flank, causing perihepatic inflammation

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13
Q

what is perihepatic inflammation called?

A

Fitz-Hugh-Curtis syndrome

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14
Q

How is PID spread?

A

sexually transmitted PID spread via mucosa of pelvic organs through cervix into uterine endometrium (endometritis) and out Fallopian tubes (acute salpingitis) to area of ovaries and peritoneum (oophoritis/peritonitis)

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15
Q

What are the clinical symptoms of PID?

A

intense pelvic pain and tenderness

constant vaginal discharge

fever

pain in RUQ

dyspareunia

irregular menstrual bleeding

hx of infertility

elevated WBC - chlamydia

fitz-hugh-curtis syndrome - gonorrhea

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16
Q

Can PID be asymptomatic?

A

yes but can seriously damage reproductive organs (because of scarring)

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17
Q

What are the differentials for PID?

A

hematoma

dermoid cyst

ovarian neoplasm

endometriosis

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18
Q

What are the three things you might find with acute PID?

A

1st finding: endometritis - small amount of fluid in endometrial cavity

2nd finding: small amount of free fluid in posterior cul-de-sac

increasing amount of fluid spreading superiorly

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19
Q

What is an indefinite uterus?

A

fibrosis of adhesions “merging” all pelvic structures

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20
Q

What is the thickening or fluid in endometrium called?

A

endometritis

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21
Q

What are the clinical and sonographic findings of salpingitis?

A

Clinical:

asymptomatic to pelvic fullness or discomfort

low-grade fever

Sonographically:

dilated tube

tortuous

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22
Q

What is a peritoneal inclusion cyst?

A

complex cystic adnexal masses consisting of a normal ovary entrapped in multiple fluid-filled adhesions

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23
Q

what is peritonitis?

A

inflammation of the peritoneum

serous membrane lining the abdominal cavity and covering the viscera

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24
internal endometriosis is called?
andenomyosis (internal, direct)
25
what is the most common form of endometriosis?
external, indirect outside of uterus and may be found in: Pouch of Douglas surface of ovary Fallopian tube uterus broad ligaments rectovaginal septum
26
How many American women are affected by PID each year?
750,000
27
How can you Sonographically detect perihepatic inflammation?
by scanning along liver margin and identifying hypoechoic rim between liver and adjacent ribs
28
What do you most likely have if you have enlarged ovaries with multiple cysts, indistinct margins?
periovarian inflammation
29
What has nodular thickening, irregularity of tube with diverticula?
salpingitis
30
What are the two kinds of fluid-filled irregular Fallopian tube with or without echoes?
pyosalpinx hydrosalpinx
31
What complex mass with septations, irregular margins, internal echoes and usually found in the cul-de-sac?
tubo-ovarian abscess
32
When does hydrosalpinx tend to occur?
secondary to PID, endometriosis, or postoperative adhesions
33
What are the clinical symptoms of hydrosalpinx?
asympotmatic to pelvic fullness or discomfort low grade fever
34
what are sonographic findings of hydrosalpinx?
walls become thin secondary to dilation appearance of mulicystic or fusiform mass follow dilated tubes from fundus of uterus look for pointed "beak" at swollen end of tube near isthmus bilateral ampullary portion more dilated than interstitial part of tube
35
what are the clinical symptoms of pyosalpinx?
asymptomatic pelvic fullness or discomfort low grade fever
36
What are the sonographic findings of pyosalpinx?
may appear as a complex mass pus within dilated tube - very thick and echogenic poor sound transmission
37
When you have tubo-ovarian abscess what happens to the ovary?
cannot be separated from inflamed dilated tube
38
Why does tubo-ovarian abscess distort anatomy?
adhesive, edematous, inflamed serosa may further adhere to ovary and/or other peritoneal surfaces as infection worsens, periovarian adhesions may form
39
What usually responds well to antibiotic treatment without need for surgical drainage?
Tubo - ovarian abscess TOA
40
When does peritonitis become pelvic peritonitis?
if infectious process spreads to involve bladder, ureter, bowel, and adnexal area
41
How exactly is peritonitis aquired?
inflammation caused by infectious organisms that gain access by way of rupture or perforation of viscera or associated structures. via the female genital track piercing abd wall via bloodstream or lymphatic vessels via surgical incisions by failure to practice antiseptic techniques during surgery
42
What does peritonitis look like sonographically?
gas forming bubbles loculated areas of fluid within pelvis, paracolic gutters, mesenteric reflections evaluation of space between right kidney and liver and left kidney and spleen
43
Endometritis can be divided into what two cases?
obstetric and nonobstetric
44
What is nonobstetric endometritis?
infection associated with PID or gynecologic instrumentation acute or chronic
45
What is obstetric endometritis?
occurs in immediate postpartum period most common cause of fever in postpartum patient
46
How does endometritis look sonographically?
endometrium may appear thick, contain fluid, air or clot or appear normal (normal up to 20mm)
47
When the endometrium measures greater than 20mm, what should you be suspicious of?
endometritis hemorrhage retained products of conception
48
If you have premature rupture of membranes (PROM), retained clot, or POC's or prolonged labor , what happens to your risk of endometritis?
it increases
49
What is the definition of endometriosis?
the presence of functioning endometrial tissue in abnormal locations ectopic tissue can be found almost anywhere in the body
50
What are the clinical symptoms of endometriosis?
severe dysmenorrhea chronic pelvic pain from peritoneal adhesions bleeding dyspareunia
51
What may cause endometriosis?
retrograde travel of endometrial cells through Fallopian tubes metaplastic transformation of peritoneal epithelium into endometrial tissue traumatic spread from uterine surgery or amniocentesis
52
What are the two forms of Endometriosis?
internal and external
53
What is the extent of endometriosis?
varies from small foci to widespread sheets of tissue to focal discrete masses
54
What kind of tissue cyclically bleeds and proliferates as stimulated by changes in hormonal influence?
endometrial tissue in endometriosis
55
With adenmyosis, where do the endometrial cells begin to grow
into the uterine body, invading junctional zone and myometrium
56
What are the clinical symptoms for adenomyosis?
heavy menstrual bleeding painful menses uterine enlargement
57
With whom is adenomyosis most common?
in women who have had uterine surgery
58
What are the sonographic findings of endometriosis?
bulbous uterus - with/without myometrial "cysts" border becomes indistinct between endometrium and myometrium "blurred border" appearance more common in posterior aspect of uterus
59
Which modality is more specific in the findings of endometriosis, ultrasound or MRI?
MRI
60
What are the localized endometriomas called?
endometrioma or chocolate cyst
61
When do endometriomas become a surgical emergency?
when they become moderately enlarged and rupture by causing ovary to twist on vessels that supply it causing torsion
62
How do endometriomas appear sonographicallY?
appear as bilateral or unilateral ovarian masses patterns ranging from anechoic (rare) to solid - depending on amount of blood and its state of organization
63
If you have endometriosis what can happen to the ovaries?
typically adhere to posterior surface of uterus or are stuck in cul-de-sac and my be difficult to define
64
What are obscured organ borders and multiple irregular cystic masses also suggestive of?
disseminating cancer or pelvic infection
65
What is stage 1 acute PID?
endometritis: infection of endometrium vaginal discharge irregular vaginal bleeding
66
what is stage 2 of PID?
Salpingitis: infection of Fallopian tubes low grade fever pelvic pain rebound pain pain with cervical manipulation dyspareunia
67
what is stage 3 PID?
TOA: Purulent material spill form Fallopian tube to ovary causing the tube and ovary to become adherent severe pelvic pain high fever and shaking/chills nausea/vomiting leukocytosis
68
What is stage 4 PID?
peritonitis: Infectious spread to peritoneum RUQ pain: inflammation of the pericolic gutter causing perihepatic infammation (Fitz-Hugh-Curtis syndrome)
69
What is the sonographic sign for PID?
"Beads on a String" seen with chronic PID Hyperechoic mural nodules on the inner walls of the Fallopian tubes

OB/Gyn (14 decks)

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