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0

What is PID?

diffuse disease processes of the female pelvic cavity

1

What causes PID?

std

gonorrhea and chlamydia

IUD

complications of childbirth

post abortion

2

PID is an inclusive term for all pelvic infections like:

endometritis

salpingitis

hydrosalpinx

pyosalpinx

periovarian inflammation

tubo-ovarian complex

tubo-ovarian abscess

3

Is PID unilateral or bilateral?

bilateral

4

what locations might you find PID?

endometrium (endometritis)

uterine wall (myometritis)

uterine serosa and broad ligaments (parametritis)

Ovary (oophoritis)

MOST COMMON LOCATION: oviducts or Fallopian tubes (salpingitis)

5

During acute PID can you sonographically see PID?

no...it hasn't really begun to manifest the inflammatory changes yet

6

In chronic PID what can ultrasound identify?

dilated Fallopian tubes (hydrosalpinx or pyosalpinx)

abscess

complex intraperitoneal fluid

7

When does PID peak?

20-24 years of age

8

What are the risk factors for PID?

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)

9

How does PID appear sonographically?

large, palpable, bilateral complex mass

ovary may be seen separate from mass

free fluid in cul-de-sac


10

How does PID appear with Doppler?

increased vascularity and diastolic flow

11

What is PID associated with?

infertility and endometritis

12

Where does PID infrequently spread to?

may travel upward through right flank, causing perihepatic inflammation

13

what is perihepatic inflammation called?

Fitz-Hugh-Curtis syndrome

14

How is PID spread?

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)

15

What are the clinical symptoms of PID?

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

16

Can PID be asymptomatic?

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

17

What are the differentials for PID?

hematoma

dermoid cyst

ovarian neoplasm

endometriosis

18

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

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

19

What is an indefinite uterus?

fibrosis of adhesions "merging" all pelvic structures

20

What is the thickening or fluid in endometrium called?

endometritis

21

What are the clinical and sonographic findings of salpingitis?

Clinical:

asymptomatic to pelvic fullness or discomfort

low-grade fever

Sonographically:

dilated tube

tortuous

22

What is a peritoneal inclusion cyst?

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

23

what is peritonitis?

inflammation of the peritoneum

serous membrane lining the abdominal cavity and covering the viscera

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