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Questions and Answers
What might be indicated by a patient with a history of chronic PID that is unresponsive to broad-spectrum antibiotics?
Endometrial biopsy is recommended for virgin females.
False
What type of mass was found during the pelvic examination?
Adenexal mass
In the premenstrual phase, the endometrial biopsy sample was taken from the _______.
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Match the examination findings with their corresponding descriptions:
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What is a characteristic finding in the fallopian tubes during laparoscopy?
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Hysteroscopic adhesiolysis is an appropriate treatment for tuberculosis.
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What is the initial management for tuberculosis leading to infertility during laparoscopy?
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In cases of infertility with a distorted pelvic anatomy, the recommended treatment is _____.
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Match the conditions to their appropriate treatments:
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What is the most common route for the spread of genital tuberculosis?
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The Fallopian tube is the least common site for genital tuberculosis.
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What is the most common presentation of genital tuberculosis affecting the Fallopian tube?
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The characteristic appearance of the tubes on HSG can present as a ______.
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Match the following HSG appearances with their descriptions:
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What is the best time for an endometrial biopsy to investigate genital TB of the uterus?
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Genital TB can affect the myometrium of the uterus.
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What common complication is associated with genital TB leading to infertility?
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Genital TB is most commonly found in females aged _____ to _____ years.
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Match the following clinical features with their corresponding descriptions:
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Study Notes
Laparoscopy Findings
- Fallopian tubes may appear red, swollen, and dilated.
- Ovaries and peritoneum may also be involved.
- Presence of tubercles suggests tuberculosis.
- Laparoscopy is indicated when there is high suspicion of tuberculosis despite a negative endometrial biopsy.
Management
- Tuberculosis: Treated with Anti-Tuberculosis Treatment (ATT) for 6 months, which can improve fertility.
- Asherman Syndrome: Treated with hysteroscopic adhesiolysis, followed by insertion of a pediatric Foley's catheter, and hormonal therapy with estrogen and progesterone for 3 months.
- Infertility: May require In Vitro Fertilization (IVF) due to distorted pelvic anatomy or tubal blockage.
General Examination
- Fever and weight loss may be present.
- Abdomen may be doughy and distended.
Pelvic Examination
- Ulcers may be observed on the cervix, vagina, or vulva.
- Pelvis is generally normal in men and women.
Pelvic and Speculum Examination
- Adenexal mass may be detected.
- Genital TB is rare in young or pubertal females.
- A 5/2 mass (meaning unclear) may be present.
History
- Past history of tuberculosis.
- Family history of tuberculosis may be significant.
- Chronic pelvic inflammatory disease (PID) unresponsive to broad-spectrum antibiotics raises suspicion.
Endometrial Biopsy
- Sample should be taken from the cornua (6/L) and in the premenstrual phase for optimal results.
- Samples should be sent for culture, NAAT, and PCR for confirmation of tuberculosis.
- Histological diagnosis is in formation.
Ultrasound (USG)
- Endometrial biopsy should not be performed in virgin females.
- Menstrual blood collected on day 14 of the cycle can be analyzed.
Possible Findings
- Pelvic mass.
- Pyosalpinx (pus-filled fallopian tube).
- Tubal dilatation.
Genital Tuberculosis
- Most common route of spread is hematogenous.
- Sexual transmission is rare.
- Most common site is the fallopian tube, particularly the ampulla, followed by the uterus and ovary.
- Involvement of the vagina and vulva is less common (5%).
Genital TB of Fallopian Tube
- Bilateral involvement is typical.
- Ampulla is the most common site, followed by the isthmus.
- Infertility is the most common presentation.
Investigations for Genital TB of Fallopian Tube
- Hysterosalpingography (HSG) is used to assess tubal patency.
- HSG can lead to dissemination of tuberculosis, so it should be performed after ATT.
Characteristic Findings on HSG
- Beaded appearance.
- Lead pipe appearance.
- Tobacco pouch appearance.
- Golf stick appearance.
- Bilateral cornual block.
- Cotton wool appearance.
- Hydrosalpinx.
Genital TB of Uterus
- Spread occurs directly from the fallopian tube.
- Superficial layers of endometrium are affected.
- Myometrium is typically spared.
Significance of Genital TB of Uterus
- First-day menstrual blood can be used for investigation.
- Pre-menstrual phase is ideal for endometrial biopsy as tubercles are located in the superficial layers.
Presentation of Genital TB of Uterus
- Initially, endometrium is normal, and there are no menstrual symptoms.
- In acute cases, endometritis causes menorrhagia.
- Chronic infections lead to adhesions (Asherman syndrome), resulting in secondary amenorrhea or oligomenorrhea.
Genital TB of Ovaries
- Infection is limited to the surface of the ovary due to the tunica albuginea, which prevents spread to the stroma.
- Tubercles are visible on the surface of the ovary during laparoscopy.
Tubercular Peritonitis
- Genital TB can be associated with peritonitis, which can cause ascites.
Clinical Features of Genital TB
- Common age group: 20-30 years.
- Can affect young girls.
- Common cause of PID in virgin females.
Prodromal Symptoms
- Low-grade fever.
- Malaise.
- Decreased appetite and weight loss.
Presentation of Genital TB
- Infertility due to tubal blockage is common.
- Menstrual irregularities:
- Menorrhagia initially due to endometritis.
- Secondary amenorrhea or hypomenorrhea due to Asherman syndrome.
- Chronic pelvic pain.
- Blood-stained discharge is rare.
- Risk of ectopic pregnancy in the future.
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Description
This quiz covers the key findings from laparoscopy, including the appearance of fallopian tubes and potential indicators of tuberculosis. It also discusses management strategies for conditions such as tuberculosis, Asherman syndrome, and infertility. Test your knowledge on the indications and treatments involved in laparoscopic evaluations.
