Pelvic Infections and Inflammatory Disease

What are the pelvic infections?

-endometritis

-myometritis

-parametritis

-oophoritis

-salpingitis

What is Endometritis?

inflammation of the endometrium

What is Myometritis?

inflammation of the myometrium

What is Parametritis?

inflammation of the broad ligaments

What is Oophroritis?

inflammation of the ovaries

What is Salpingitis?

inflammation of the fallopian tubes

What are the 2 categories of Ectopic Endometrium?

-endometriosis

-adenomyosis (endometrium invades the myometrium)

PID is more common in who?

20-24 year olds

-11% in reproductive age group

-immaturities to the cervix increases the risk of STDs

What are the risk factors of PID?

-early sexual contact

-multiple partners

-Hx. of STI or PID

-IUCD

What causes PIDs?

-STI (most common)

-other pelvic infections (appendicitis/diverticulitis)

-postsurgical or procedure complications

-puerperal or postabortion complications

PID is a _________ process

bilateral

What are the symptoms of PID?

-pelvic pain/tenderness

-vaginal discharge

-fever

-irregular bleeding

What are the differential Dx. of PID?

-hematoma

-dermoid cysts

-ovarian neoplasms

-endometriomsis

What is the PID pathway?

it starts at the vagina to the cervix to the uterus and finally to the fallopian tubes

Are fallopian tubes usually seen on ultrasound?

No, they’re not easily seen on ultrasound without pathology

What pathology is seen with the fallopian tubes?

-salpingitis

-hydrosalpinx

-pyosalpinx

What is hydrosalpinx?

fluid within the fallopian tubes

What is pyosalpinx?

pus within the fallopian tubes

The 3 stages of salpingitis are……

-acute

-subacute

-chronic

What are the symptoms of Salpingitis?

usually asymptomatic

-discomfort

-low grade fever

What is this image showing?

the left fallopian tube

How can we confirm if we see the fallopian tubes on ultrasound?

follow the fallopian tubes to the ovaries and the uterus

What can you also find on ultrasound in PID?

-fluid in the cul de sac

-mild uterine enlargement

-endometrial fluid

-tubal fluid

What is this?

dilated hydrosalpinx

What is this image?

and incomplete septum hydrosalpinx

-appears when dilated tube folds upon itself

What is this image?

scarred hydrosalpinx

(no distinguishable ovary)

How can a scarred hydrosalpinx form?

by DES exposure

What is this image showing?

blood flow in scarred wall

What are the differential dx. of hydrosalpinx?

1. dilated veins/varicoceles

2. fluid filled loops of bowel

3. dilated/tortuous ureters

4. septated cyst/ovarian cyst

5. ectopic

6. endometriosis

What is Tubo-ovarian abscess?

a focal infection, it progresses so much to cause an abscess

-located in the area of the fallopian tube and ovary

Tubo-Ovarian Abscess can be……..

unilateral or bilateral

-adhesions may develop

What related diagnostic test for tubo ovarian abscess is?

-urine

-cultures of vaginal secretions

-laparoscopy

-CT/MRI

-culdocentesis

What is this?

an ovarian abscess

What is a pelvic abscess appearance?

-heterogenous

-hyperemic

-well defined borders

What is the appearance of peritonitis?

inflammation of the peritoneal

What is Fitz-Hugh-Curtis Syndrome/Perihepatitis?

rare complication of PID

-fluid that is produced from inflammations

-liver adhesions from exudates