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Pathology of the Adnexa
Terms in this set (94)
___________ is most commonly caused by sexually transmitted disease, including gonorrhea and chlamydia.
____________ & ___________ are diffused disease processes of the female pelvic cavity.
Pelvic Inflammatory Disease (PID) & Endometriosis
The uncommon cause of PID can be caused by _____________ & __________.
ruptured appendix and peritonitis
PID is an inclusive term that refers to _______________
all pelvic infections.
Name all of the pelvic infections associated w/PID
Pelvic infection usually occurs (Unilaterally or Bilaterally)
What are some of the places a pelvic infection can be found?
Uterine wall (myometrium)
Oviducts (fallopian tubes)
Inflammation of the endometrium is known as
Inflammation of the myometrium is known as
Inflammation of the serosa and broad ligaments is known as
Inflammation of the ovary is known as
Inflammation of the oviducts is known as
The most common location for infection is the
_________ is the presence of endometrial glands or stroma in abnormal locations.
PID is becoming more ________. It occurs in ________% of young women during __________ age, with peak incidence at _____ years.
common; 11%; reproductive; 20-24
The increase risk for PID in younger population may be due to __________________ of the cervix and consequent higher risk of _________________ infections.
immaturity; sexually transmitted
What are the risk factors for PID?
Early sexual contact
Multiple Sexual Partners
History of STD
Previous History of PID
Other possible routes for infection are:
-Direct extension from appendiceal, diverticular, or postsurgical abscess collection that have ruptured into the pelvis
-String from the IUCD
-Puerperal and postabortion complication
Two forms of endometriosis:
adenomyosis of the uterus (diffused)
Adnexal masses are called
PID is usually found bilateral within the pelvic cavity, except when it is caused by _______________ of an adjacent inflammatory process, in which case it is most commonly __________.
direct extension; unilateral
Patients with PID resulting gonrrhea, a pelvic infection may travel upward through the right flank, causing a __________ inflammation.
A perihepatic inflammation may cause pain resembling a ________, _________, & _________ pain
liver, gallbladder, and right renal
Perihepatic inflammation can be found on ultrasound along the ________ margin, identifying a ____________ rim between the liver and adjacent ribs.
Perihepatic inflammation is called the _____________ syndrome.
Sexually transmitted PID is spread via the ______ of the pelvic organs through the cervix into the _______________ and out of the _______________ to the area of the ovaries and peritoneum.
mucosa; uterine endometrium; fallopian tubes
As the tube becomes obstructed due to PID, it fills with pus. This is referred to as _____
Patient with pelvic infection experience intense pelvic __________ and __________ , with constant ____________.
Pain and tenderness; vaginal discharge
Other symptoms patients may have due to PID are:
Pain in the Rt upper abdomen
Irregular Menstrual bleeding
A history of ________ may also be present with patients with Previous PID.
Lab tests may show an elevated ____________ in PID, particularly when caused by a ______________ infection
WBC count; chlamydial
In some cases the patient with PID maybe ___________ or the disease may produce only minor symptoms. However, this can cause _______ damage to the reproductive organs.
Sonographic findings of endometritis are
thickening and fluid in the endometrium
Sonographic findings of periovarian inflammation are
enlarged ovaries w/multiple cysts, indistinct margin
Sonographic findings of salpingitis are
nodular thickening, irregularity of tube with diverticula
Sonographic findings of pyosalpinx and hydrosalpinx are
fluid-filled irregular fallopian tube with or without echoes
Sonographic findings of tubo-ovarian abscess are
complex mass with septations, irregular margins,and internal echos; usually in the cul-de-sac
____________ is inflammation of a fallopian tube
__________________ fallopian tube is not usually visualized unless it is surrounded by fluid.
Do not confuse the dilated tube with a dilated ____________ or prominent ________________. You can use _____________ or ________________ ________________ Imaging to show blood flow in an adnexal blood vessel and no flow in a hydrosalpinx.
ureter; vessel; color; pulsed Doppler
Salpingitis may be ________, __________, or ________
acute, subacute, or chronic
Clinical signs of salpingitis may range from
asymptomatic to pelvicfullness or discomfort, or a low-grade fever
An obstructed tube filled with serous secretions is a _______ resulting from a PID, endometriosis, or postoperative adhesions
A sonographic findings of a patient with salpingitis would present
dilated and tortuous tube
A sonogram of a dilated tube related to hydrosalpinx may show a __________ at the swollen end of the tube near the _________ where the tube enters the uterus.
pointed beak; isthmus
Sonographic findings of Hydrosalpinx:
Thin wall secondary to dilation
Appearance of multicystic or fusiform mass
_________ occurs secondary to PID, endometriosis, or postoperative adhesions
If the dilated tube become infected, it is called
A pyosalpinx may appear as ___________ mass
The likelihood of recurrent infection and ectopic pregnancy _________ with PID.
When the ovary cannot be separated from the inflamed dilated tube this is called
To determine if an adnexal mass is separate from the ovary, _____________ with the transvaginal transducer can be used to identify seperate or contiguous movement.
Fluid in the cul-de-sac is very __________________ when a patient has PID.
_____________ fuse the inflamed ovary and tube, and the ovary cannot be separated from the tube which causes further loculation of pus known as a __________
Periovarian adhesions; tubo-ovarian abscess (TOA)
TOA may be _____________ abscess or _____________ and appears as a _____________ mass in the ____________ cul-de-sac.
unilateral; bilateral; complex; posterior
A tubo-ovarian complex or abscess usually respond well with ______________ treatment without the need for ___________
antibiotic; surgical drainage
What can be used to assist in percutaneous or transvaginal drainage for culture and sensitivity or complete drainage and thus hasten recovery?
___________is the inflammation of the peritoneum.
If the infectious process of peritonitis spreads to involve the bladder, ureter, bowel, and adnexal area, it becomes _____________
Endometritis, infection of the endometrium, can be divided into _____________ and ____________ cases.
Obstetric and nonobstetric
Nonobstetric infection is associated with _________ or ______. Endometritis can be _______ or ______.
PID or gynecologic instrumentation; acute or chronic
Obstetric infection occur in the immediate ___________ period.
_________________ is the most common cause of fever in postpartum patient.
Endometritis is an ____________ ____________ _________ ______________________.
infection of the endometrium
Postpartum fever is considered a temperature ___________ on any 2 of the first 10 days postpartum.
The endometrium is considered normal in size up to ____
If the endometrium measures more than 20mm it should raise suspicion for _____, __________, or ____________
endometritis, hemorrhage, or retained products of conception (POCs)
The risk of endometritis _______ with premature rupture of membranes, retained clot or products of conception (POCs), and prolonged labor.
________________ _________________ is one of the most common gynecologic disease.
Endometriosis is defined as the presence of __________________ in abnormal locations.
functioning endometrial tissue
Endometriosis can be found ___________ in the body.
Clinical findings of endometriosis are:
not distinctive, sacral backache during menses, infertility, severe dysmenorrhea, chronic pelvic pain from peritoneal adhesions and bleeding, or dyspareunia (painful intercourse)
Endometriosis has two forms:
internal and external
_____________ endometriosis occurs within the uterus
Internal endometriosis is referred to as
_________ endometriosis occurs outside the uterus and may be found in pouch of Douglas, surface of the ovary, fallopian tube, broad ligaments, or rectovaginal septum
The most common form of endometriosis is the
external (indirect) form
The disease process for the external form of endometrosis varies in extent from _______________ to _______________ to _________________.
small foci; sheets of tissue; focal discrete masses
It is estimated that 5.5 million women in _______________ are currently affected by external endometriosis
The second less common form of endometriosis is
internal (direct) form
When the endometrial cells begin to grow into the uterine body, invading the junctional zona and myometrium this is known as
Adenomyosis (internal form)
Clinical symptoms of adenomyosis are:
heavy menstrual bleeding, painful menses, and uterine enlargement
Adenomyosis is most common in women who have had ____
uterine surgery (cesarean or myomectomy)
Endomeotriosis can be either:
diffused or localized
The __________ is the most common form of endometriosis and is rarely diagnosed by sonography because the implants are so small
The localized form of endometrosis consists of a discrete mass called
endometrioma (chocolate cyst)
Endometriosis may occur in any ___________ female
Clinical symptoms of endometriosis include:
painful period (dysmenorrhea) or painful intercourse (dyspareunia), or irregular bleeding and infertility
Women with endometrioma are
_________________ has decreased patient costs by obviating the need for surgery and a lengthy hospital stay.
__________ or ____________ is used for aspiration of benign-appearing cysts.
TA or TVS
___________ ______________ is helpful in TOAs, other pelvic abscesses, and drainage of postoperative fluid collections
_________ drainage is used for deep pelvic abscesse
______________ sonography is used in obtaining biopsies for benign and malignant solid pelvic masses and to drain recurrent malignant collections
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