Pelvic Inflammatory Disease Overview

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Questions and Answers

Which of the following is a common risk factor for developing Pelvic Inflammatory Disease?

Use of barrier contraceptives

Single sexual partner

Early sexual contact (correct)

Regular gynecological check-ups

Which complication may occur if a pelvic infection travels upward through the right flank?

Ovarian torsion

Ectopic pregnancy

Uterine rupture

Fitz-Hugh-Curtis syndrome (correct)

What is the peak age for the incidence of Pelvic Inflammatory Disease (PID)?

25 to 30 years

30 to 35 years

20 to 24 years (correct)

15 to 19 years

What might result if the fallopian tubes become obstructed due to Pelvic Inflammatory Disease?

Pyosalpinx Signup and view all the answers

Douching is considered a risk factor for PID because it can potentially:

Push bacteria into the upper genital tract Signup and view all the answers

Which of the following factors is NOT associated with an increased risk of PID?

Use of hormonal contraceptives Signup and view all the answers

The occurrence of PID affects what percentage of women during their reproductive age?

11% Signup and view all the answers

What imaging technique is used to observe increased vascularity and diastolic flow in PID?

Doppler ultrasound Signup and view all the answers

What are the most common causes of pelvic inflammatory disease (PID)?

Sexually transmitted diseases, particularly gonorrhea and chlamydia Signup and view all the answers

Which of the following conditions is NOT included under pelvic inflammatory disease?

Uterine fibroids Signup and view all the answers

Which location is the most common site of infection in pelvic inflammatory disease?

Oviducts Signup and view all the answers

What does chronic PID typically allow ultrasound to detect?

Dilated fallopian tubes or abscesses Signup and view all the answers

How does pelvic inflammatory disease typically present in its early stage?

With symptoms mimicking functional bowel disease Signup and view all the answers

What role does ultrasound play in the evaluation of pelvic inflammatory disease?

It can identify conditions like hydrosalpinx and abscess in chronic cases Signup and view all the answers

What is the primary characteristic of hydrosalpinx?

It is an obstructed tube filled with serous secretions. Signup and view all the answers

Which uncommon cause of PID can result from a ruptured appendix?

Peritonitis Signup and view all the answers

In what patient situation may endometritis develop postpartum?

Post cesarean section or difficult labor Signup and view all the answers

What sonographic finding is typical for pyosalpinx?

Complex mass with thick, echogenic pus. Signup and view all the answers

Which of the following conditions can lead to hydrosalpinx?

Pelvic inflammatory disease (PID). Signup and view all the answers

What symptoms may indicate the presence of hydrosalpinx?

Low-grade fever and pelvic fullness. Signup and view all the answers

How does the appearance of hydrosalpinx typically present sonographically?

Thinned walls with pointed beak at swollen tube end. Signup and view all the answers

What distinguishes tubo-ovarian abscess (TOA) from other conditions?

It is often associated with inflamed periovarian adhesions. Signup and view all the answers

What clinical signs are common in both hydrosalpinx and pyosalpinx?

Clinical findings can range from asymptomatic to discomfort. Signup and view all the answers

What is the recommended treatment for tubo-ovarian abscess (TOA)?

Antibiotic treatment without need for surgical intervention. Signup and view all the answers

What is a common cause of inflammation in peritonitis?

Infectious organisms entering via various routes Signup and view all the answers

Which sign is typically observed in sonographic findings for peritonitis?

Gas-forming bubbles Signup and view all the answers

Which of the following conditions is associated with endometritis?

Pelvic inflammatory disease Signup and view all the answers

What feature typically raises suspicion for endometritis based on sonographic findings?

Endometrial measurement greater than 20 mm Signup and view all the answers

What diagnostic method can aid in the drainage of a tubo-ovarian abscess?

Sonographic guidance Signup and view all the answers

Which structure is NOT typically evaluated in sonographic findings of peritonitis?

Bladder wall thickness Signup and view all the answers

What is a common consequence of untreated tubo-ovarian abscess?

Sepsis or systemic infection Signup and view all the answers

Which situation is a known risk factor for developing peritonitis?

Rupture or perforation of associated structures Signup and view all the answers

What is a common clinical finding associated with endometriosis?

Severe dysmenorrhea Signup and view all the answers

Which of the following is a potential cause of endometriosis?

Retrograde travel of endometrial cells Signup and view all the answers

Which type of endometriosis involves the invasion of the myometrium?

Adenomyosis Signup and view all the answers

Which location is NOT typically associated with external endometriosis?

Endometrial cavity Signup and view all the answers

What is a characteristic sonographic finding in cases of adenomyosis?

Bulbous appearance of the uterus Signup and view all the answers

What condition is marked by the presence of functioning endometrial tissue in abnormal locations?

Endometriosis Signup and view all the answers

Which symptom is commonly associated with adenomyosis?

Heavy menstrual bleeding Signup and view all the answers

Which of the following factors increases the risk for endometritis?

Prolonged labor Signup and view all the answers

Study Notes

Pelvic Inflammatory Disease (PID)

PID is an inclusive term for all pelvic infections, including: endometritis, salpingitis, hydrosalpinx, pyosalpinx, periovarian inflammation, tubo-ovarian complex, and tubo-ovarian abscess.
PID is most commonly caused by sexually transmitted diseases like gonorrhea and chlamydia.
PID affects approximately 750,000 American women annually, with a peak incidence between 20 to 24 years old.
PID risk factors include: early sexual contact, multiple sexual partners, history of previous PID, and the use of an IUCD.
Ultrasound plays a limited role in diagnosing acute PID; however, it is useful in identifying chronic PID, dilated fallopian tubes, abscesses, and complex intraperitoneal fluid.
Fitz-Hugh-Curtis syndrome is a rare complication of PID where infection spreads to the right flank, causing perihepatic inflammation. Sonography can detect this by identifying a hypoechoic rim between the liver and adjacent ribs.

Hydrosalpinx

Hydrosalpinx is a dilated fallopian tube filled with serous secretions.
It is a common sequelae of PID, endometriosis, or postoperative adhesions.
Sonographically, hydrosalpinx appears as a multicystic or fusiform mass, often with a pointed "beak" at the swollen end of the tube near the isthmus.

Pyosalpinx

Pyosalpinx is a dilated fallopian tube filled with pus, often associated with inflammation.
Sonography reveals a complex mass with very thick and echogenic pus within the dilated tube.

Tubo-Ovarian Abscess (TOA)

TOA usually forms when a tubo-ovarian complex, an inflamed and dilated fallopian tube adhered to the ovary, becomes infected.
TOA often responds well to antibiotic treatment, but sonographic guidance may be necessary for percutaneous or transvaginal drainage.

Peritonitis

Peritonitis is an inflammation of the peritoneum, the serous membrane lining the abdominal cavity.
Pelvic peritonitis occurs when the infection spreads to involve the bladder, ureter, bowel, and adnexal area.
Sonography can reveal gas-forming bubbles and loculated areas of fluid within the pelvis, paracolic gutters, and mesenteric reflections.

Endometritis

Endometritis is an infection of the endometrium (uterine lining).
Nonobstetric cases are often associated with PID or gynecological instrumentation.
Obstetric cases typically occur in the immediate postpartum period, being the most common cause of fever in postpartum patients.
Sonography may reveal a thickened endometrium, containing fluid, air, or clot, or a seemingly normal endometrium. Measuring an endometrium greater than 20 mm should raise suspicion of endometritis, hemorrhage, or retained products of conception.

Endometriosis

Endometriosis is characterized by the presence of functioning endometrial tissue in abnormal locations throughout the body.
Clinical findings include severe dysmenorrhea, chronic pelvic pain, bleeding, and dyspareunia.
Endometriosis may arise from retrograde travel of endometrial cells through the fallopian tubes.

Types of Endometriosis

Internal Endometriosis (Adenomyosis): Endometrial cells invade the myometrium (uterine muscular wall).
External Endometriosis: Endometrial tissue is found outside the uterus, in locations like the Pouch of Douglas, ovary, fallopian tubes, uterine broad ligaments, and rectovaginal septum.

Adenomyosis

It is the most common type of internal endometriosis.
May show sonographically as a bulbous uterus with myometrial "cysts" or an indistinct border between the endometrium and myometrium.
Often associated with heavy menstrual bleeding, painful menses, and uterine enlargement.

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Description

This quiz covers the key aspects of Pelvic Inflammatory Disease (PID), including its causes, risk factors, and implications for women's health. You will learn about common complications, diagnostic methods, and the significance of ultrasound in managing PID. Test your knowledge on this important topic affecting many women.