Your SlideShare is downloading. ×
0
Salpingitis and related diseases
Salpingitis and related diseases
Salpingitis and related diseases
Salpingitis and related diseases
Salpingitis and related diseases
Salpingitis and related diseases
Salpingitis and related diseases
Salpingitis and related diseases
Salpingitis and related diseases
Salpingitis and related diseases
Salpingitis and related diseases
Salpingitis and related diseases
Salpingitis and related diseases
Salpingitis and related diseases
Salpingitis and related diseases
Salpingitis and related diseases
Salpingitis and related diseases
Salpingitis and related diseases
Salpingitis and related diseases
Salpingitis and related diseases
Upcoming SlideShare
Loading in...5
×

Thanks for flagging this SlideShare!

Oops! An error has occurred.

×
Saving this for later? Get the SlideShare app to save on your phone or tablet. Read anywhere, anytime – even offline.
Text the download link to your phone
Standard text messaging rates apply

Salpingitis and related diseases

2,119

Published on

0 Comments
2 Likes
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total Views
2,119
On Slideshare
0
From Embeds
0
Number of Embeds
3
Actions
Shares
0
Downloads
142
Comments
0
Likes
2
Embeds 0
No embeds

Report content
Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
No notes for slide

Transcript

  • 1. Salpingitis and Related Diseases <ul><li>Etiology </li></ul><ul><li>Risk Factors </li></ul><ul><li>Diagnosis and DDx </li></ul><ul><li>Management </li></ul><ul><li>Treatment </li></ul><ul><li>Complications </li></ul><ul><li>References </li></ul>www.freelivedoctor.com
  • 2. Etiology <ul><li>Salpingitis is really part of the larger family of pelvic inflammatory disease (PID). </li></ul><ul><li>PID is a polymicrobial infection of the upper female genital tract (uterus, fallopian tubes, ovaries) caused by an ascending infection of the vagina or cervix. </li></ul><ul><li>N. gonorrhea and C. trachomatis cause the majority but endogenous bacteria can also be present. </li></ul>www.freelivedoctor.com
  • 3. Etiology <ul><li>N. gonorrhea </li></ul><ul><ul><li>Causes roughly 50% of salpingitis. </li></ul></ul><ul><ul><li>15% of GC cervicitis progresses to PID. </li></ul></ul><ul><li>C. trachomatis </li></ul><ul><ul><li>More common than GC by up to 10:1, but only accounts for 20-35% of PID. </li></ul></ul><ul><ul><li>Classically produces a more mild form of PID with insidious onset. </li></ul></ul><ul><li>Other bugs </li></ul><ul><ul><li>Strep., Staph., E. coli, Bacteroides, Actinomyces, Peptococcus, Clostridium, Gardnerella, Haemophilus, CMV, etc. </li></ul></ul>www.freelivedoctor.com
  • 4. Risk Factors <ul><li>Young age (&lt;25) </li></ul><ul><li>Prior history of STD </li></ul><ul><li>IUD or other non-barrier contraception </li></ul><ul><li>Multiple partners </li></ul><ul><li>Promiscuous partners </li></ul><ul><li>Iatrogenic factors </li></ul>www.freelivedoctor.com
  • 5. Clinical Criteria for Diagnosis of PID <ul><li>All 3 of the following: </li></ul><ul><ul><li>Abdominal tenderness with or without rebound. </li></ul></ul><ul><ul><li>Adnexal tenderness </li></ul></ul><ul><ul><li>Cervical motion tenderness </li></ul></ul><ul><li>Plus 1 of the following: </li></ul><ul><ul><li>Temp. of &gt;101 °F </li></ul></ul><ul><ul><li>WBC &gt;10,000 or elevated CRP or ESR </li></ul></ul><ul><ul><li>Gram stain with gram neg. intracellular diplococci </li></ul></ul><ul><ul><li>Inflammatory mass </li></ul></ul><ul><ul><li>Purulent material from peritoneal cavity </li></ul></ul>www.freelivedoctor.com
  • 6. Differential Diagnosis <ul><li>Acute appendicitis </li></ul><ul><li>Ectopic pregnancy </li></ul><ul><li>Ruptured ovarian cyst </li></ul><ul><li>Tubo-ovarian abscess </li></ul><ul><li>Endometriosis </li></ul><ul><li>Adnexal torsion </li></ul><ul><li>Acute UTI </li></ul><ul><li>Diverticulitis </li></ul><ul><li>Crohns/Ulcerative Colitis </li></ul>www.freelivedoctor.com
  • 7. Management <ul><li>Lab studies </li></ul><ul><ul><li>CBC to look for leukocytosis </li></ul></ul><ul><ul><li>β -HCH to r/o ectopic pregnancy </li></ul></ul><ul><ul><li>Gonorrhea and Chlamydia cultures </li></ul></ul><ul><ul><li>ESR/CRP </li></ul></ul><ul><ul><li>UA to r/o cystitis or pyelonephritis </li></ul></ul><ul><ul><li>Fecal occult blood test </li></ul></ul><ul><ul><li>Wet mount </li></ul></ul><ul><ul><li>R/o other concurrent STDs with RPR/VDRL and HIV test </li></ul></ul>www.freelivedoctor.com
  • 8. Management <ul><li>Imaging Studies </li></ul><ul><ul><li>Pelvic ultrasound to r/o tubo-ovarian abscess, ectopic pregnancy and ovarian torsion. </li></ul></ul><ul><li>Procedures </li></ul><ul><ul><li>Laparoscopy if still unsure of diagnosis </li></ul></ul><ul><ul><li>Culdocentesis is now rarely required </li></ul></ul>www.freelivedoctor.com
  • 9. Treatment <ul><li>Outpatient therapy </li></ul><ul><ul><li>Regimen A </li></ul></ul><ul><ul><ul><li>Ofloxacin/Levofloxacin + Metronidazole PO x 14 days </li></ul></ul></ul><ul><ul><li>Regimen B </li></ul></ul><ul><ul><ul><li>Ceftriaxone or Cefoxitin (+probenecid PO) IM x 1 dose + Doxycycline +/- Metronidazole PO x 14 days </li></ul></ul></ul><ul><ul><li>Remember to also provide treatment to the patient’s partner if the infection is due to an STD. </li></ul></ul>www.freelivedoctor.com
  • 10. Treatment <ul><li>Inpatient therapy </li></ul><ul><ul><li>Regimen A </li></ul></ul><ul><ul><ul><li>Cefotetan or Cefoxitin IV until clinical improvement + Doxycyline x 14 days </li></ul></ul></ul><ul><ul><li>Regimen B </li></ul></ul><ul><ul><ul><li>Clindamycin + Gentamycin IV until clinical improvement + Doxycycline or Clindamycin PO x 14 days </li></ul></ul></ul><ul><li>Medical therapy alone results in an 85% cure rate with the rest requiring surgical intervention. </li></ul>www.freelivedoctor.com
  • 11. Indications for Hospitalization <ul><li>Pregnancy </li></ul><ul><li>Immunodeficient </li></ul><ul><li>Nausea/Vomiting and high fever </li></ul><ul><li>Unpredictable compliance </li></ul><ul><li>Poor response to outpatient therapy </li></ul><ul><li>Tubo-ovarian abscess </li></ul>www.freelivedoctor.com
  • 12. Complications <ul><li>Infertility 2 ° tubal scarring </li></ul><ul><ul><li>10% risk after a single episode of PID </li></ul></ul><ul><ul><li>30% risk after 2 episodes </li></ul></ul><ul><ul><li>50% risk after 3 or more episodes </li></ul></ul>www.freelivedoctor.com
  • 13. Complications <ul><li>Chronic pelvic pain </li></ul><ul><ul><li>Found in up to 18% of women after resolution of PID. </li></ul></ul><ul><li>Adhesions </li></ul><ul><li>Dyspareunia </li></ul>www.freelivedoctor.com
  • 14. Complications <ul><li>Ectopic Pregnancy </li></ul><ul><ul><li>Also 2 ° to tubal scarring </li></ul></ul><ul><ul><li>7-10 fold increased risk after a single episode </li></ul></ul>www.freelivedoctor.com
  • 15. Complications <ul><li>Ectopic Pregnancy </li></ul>www.freelivedoctor.com
  • 16. Complications <ul><li>Tubo-ovarian abscess </li></ul><ul><ul><li>Serious sequelae of PID causing 350,000 hospitalizations and 150,000 surgeries/yr. </li></ul></ul><ul><ul><li>Occurs in 15-30% of women requiring hospitalization for PID treament. </li></ul></ul><ul><ul><li>Ruptured TOA has a mortality rate as high as 9%. </li></ul></ul>www.freelivedoctor.com
  • 17. Complications www.freelivedoctor.com
  • 18. Complications <ul><li>Tubo-ovarian abscess </li></ul><ul><ul><li>Can be diagnosed by ultrasound with 94% sensitivity. </li></ul></ul><ul><ul><li>Can attempt conservative management with antibiotics but often require drainage or excision via laparoscopy. </li></ul></ul><ul><ul><li>86-93% infertility rate following TOA. </li></ul></ul>www.freelivedoctor.com
  • 19. Complications <ul><li>Fitz-Hugh-Curtis Syndrome </li></ul><ul><ul><li>Extrapelvic manifestation of PID associated with RUQ pain due to inflammation of the liver capsule and diaphragm. </li></ul></ul><ul><ul><li>As with PID, it is mainly caused by N. gonorrhea and C. trachomatis . </li></ul></ul><ul><ul><li>Probably spreads via direct seeding into the peritoneal cavity, although hematogenous and lymphatic spread can’t be ruled out. </li></ul></ul><ul><ul><li>Occurs in 15-30% of women with PID worldwide though this is probably less in developed countries. </li></ul></ul>www.freelivedoctor.com
  • 20. Complications <ul><li>Fitz-Hugh-Curtis Syndrome </li></ul><ul><ul><li>Vague symptoms often make it a diagnosis of exclusion. </li></ul></ul><ul><ul><ul><li>Amylase/Lipase to r/o gallbladder disease </li></ul></ul></ul><ul><ul><ul><li>LFTs to r/o hepatitis </li></ul></ul></ul><ul><ul><ul><li>UA to r/o pyelonephritis or kidney stones </li></ul></ul></ul><ul><ul><ul><li>Hemoccult to r/o perforated ulcer </li></ul></ul></ul><ul><ul><ul><li>Ultrasound and CT to r/o other diseases </li></ul></ul></ul><ul><ul><li>Gold standard for diagnosis is laparoscopy and visualization of adhesions or inflammation. </li></ul></ul>www.freelivedoctor.com

×