Salpingitis

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Salpingitis
File:Scheme female reproductive system-en.svg
Fallopian tubes labeled at top center.
ICD-10 N70
ICD-9 614.2
DiseasesDB 9748

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Salpingitis is an infection and inflammation in the fallopian tubes. It is often used synonymously with PID, although PID lacks an accurate definition and can refer to several diseases of the female upper genital tract, such as endometritis, oophoritis, myometritis, parametritis and infection in the pelvic peritoneum[1] . In contrast, salpingitis only refers to infection and inflammation in the fallopian tubes. [1]

Epidemiology

Over one million cases of acute salpingitis are reported every year in the U.S., but the number of incidents is probably larger, due to incomplete and untimely reporting methods and that many cases are reported first when the illness has gone so far that it has developed chronic complications. For women aged 16-25, salpingitis is the most common serious infection. It affects approximately 11% of the female of reproductive age.[1] Salpingitis has a higher incidence among blacks and members of lower socioeconomic classes. However, this is thought of being an effect of earlier sex debut, multiple partners and decreased ability to receive proper health care rather than any independent risk factor for salpingitis. As an effect of an increased risk due to multiple partners, the prevalence of salpingitis is highest for people aged 15-24 years. Decreased awareness of symptoms and less will to use contraceptives are also common in this group, raising the occurrence of salpingitis.

Acute and chronic salpingitis

There are two types of salpingitis: Acute salpingitis and chronic salpingitis.

Acute salpingitis causes the fallopian types to become red and swollen. The inner walls get adhered to each other, causing a block in the tube. The fallopian tube can also get stuck to the surrounding intestine.

In contrast, the chronic salpingitis is milder, showing lesser symptoms. It often comes after an attack of acute salpingitis, and lasts longer than the former. [2] Chronic salpingitis may result in a hydrosalpinx.

Causes and pathophysiology

The infection usually has its origin in the vagina, and ascends to the fallopian tube from there. Because the infection can spread via the lymph vessels, infection in one fallopian tube usually leads to infection of the other. [2]

Differential diagnosis

Diseases Symptoms Signs Diagnosis Comments
Abdominal pain Bowel habits Rebound tenderness Guarding Genitourinary signs Lab findings Imaging
GI diseases Colorectal cancer LLQ Constipation - - - CT scan, x-ray and MRI used to show metastasis
Inflammatory bowel disease LLQ Bloody diarrhea - - -
  • Leukocytosis
Colonoscopy and tissue sampling are recommended for differentiating between Crohn's disease and ulcerative colitis.
Diverticulitis LLQ Constipation

Or

Diarrhea

- + + CT scan shows evidence of inflammation
Appendicitis LLQ / RRQ Constipation + + - Ultrasound shows evidence of inflammation Nausea & vomiting,decreased appetite
Strangulated hernia LLQ - - - -
  • No specific tests
  • CT scan used to detect the hernia and to show if it is single or multiple
Gentiourinary diseases Cystitis LLQ - + -
  • Suprapubic tenderness
  • X ray is done to probe the suspicion of emphysematous cystitis.
  • CT scan shows gas in the bladder in cases of emphysematous cystitis.
Prostatitis LLQ

Groin pain

- - -
  • Tender and enlarged
Pelvic inflammatory disease Bilateral - + -
  • Purulent vaginal discharge
Transvaginal utrasonography
Gynecological diseases Endometritis LLQ - + - +
  • No specific tests
  • Ultrasound is helpful to rule out other differential diagnosis such as pelvic abscess, thrombosis and masses
  • Vaginal discharge
  • Vaginal bleeding
Salpingitis LLQ/ RLQ +/- +/-
  • Leukocytosis
Pelvic ultrasound
  • Vaginal discharge


Classification of acute abdomen based

on etiology

Presentation Clinical findings Diagnosis Comments
Fever Rigors and Chills Abdominal Pain Jaundice Hypotension Guarding Rebound Tenderness Bowel sounds Lab Findings Imaging
Common causes of

Peritonitis

Spontaneous bacterial peritonitis + Diffuse Hypoactive
  • Ascitic fluid PMN>250 cells/mm³
  • Culture: Positive for single organism
Ultrasound for evaluation of liver cirrhosis -
Perforated gastric and duodenal ulcer + Diffuse + + + N
  • Ascitic fluid
    • LDH > serum LDH
    • Glucose < 50mg/dl
    • Total protein > 1g/dl
Air under diaphragm in upright CXR Upper GI endoscopy for diagnosis
Acute suppurative cholangitis + + RUQ + + + + ±
Acute cholangitis + RUQ + N Abnormal LFT Ultrasound shows biliary dilatation Biliary drainage (ERCP) + IV antibiotics
Acute cholecystitis + RUQ + Hypoactive Ultrasound shows gallstone and evidence of inflammation Murphy’s sign
Acute pancreatitis + Epigastric ± N Increased amylase / lipase Ultrasound shows evidence of inflammation Pain radiation to back
Acute appendicitis + RLQ + + Hypoactive Leukocytosis Ultrasound shows evidence of inflammation Nausea & vomiting, decreased appetite
Acute diverticulitis + LLQ ± + Hypoactive Leukocytosis CT scan and ultrasound shows evidence of inflammation
Hollow Viscous Obstruction Small intestine obstruction Diffuse + ± Hyperactive then absent Leukocytosis Abdominal X ray Nausea & vomiting associated with constipation, abdominal distention
Gall stone disease/Cholelithiasis ±
Volvulus - Diffuse - + - Hypoactive Leukocytosis CT scan and abdominal X ray Nausea & vomiting associated with constipation, abdominal distention
Biliary colic - RUQ + - - N Increased bilirubin and alkaline phosphatase Ultrasound Nausea & vomiting
Renal colic - Flank pain - - - N Hematuria CT scan and ultrasound Colicky abdominal pain associated with nausea & vomiting
Vascular Disorders Ischemic causes Mesenteric ischemia ± Periumbilical - - - Hyperactive Leukocytosis and lactic acidosis CT scan Nausea & vomiting, normal physical examination
Acute ischemic colitis ± Diffuse - + + Hyperactive then absent Leukocytosis CT scan Nausea & vomiting
Hemorrhagic causes Ruptured abdominal aortic aneurysm - Diffuse - - - N Normal CT scan Unstable hemodynamics
Intra-abdominal or retroperitoneal hemorrhage - Diffuse - - - N Anemia CT scan History of trauma
Gynaecological Causes Fallopian tube Acute salpingitis + LLQ/ RLQ ± ± N Leukocytosis Pelvic ultrasound Vaginal discharge
Ovarian cyst complications and endometrial disease Torsion of the cyst - RLQ / LLQ - ± ± N Increased ESR and CRP Ultrasound Sudden onset severe pain with nausea and vomiting
Endometriosis - RLQ/LLQ - +/- +/- N Normal Laproscopy Menstrual-associated symptoms, pelvic

symptoms

Cyst rupture - RLQ / LLQ - +/- +/- N Increased ESR and CRP Ultrasound Sudden onset severe pain with nausea and vomiting
Pregnancy Ruptured ectopic pregnancy - RLQ / LLQ - - - N Positive pregnancy test Ultrasound History of missed period and vaginal bleeding
Functional Irritable Bowel Syndrome - Diffuse - - - - N

Clinical diagnosis

-

Risk factors

It's been theorized that retrograde menstrual flow and that the cervix opens during menstruation allows the infection to reach the fallopian tubes.

Other risk factors include: Surgical procedures, breaking the cervical barrier:

Another risk is factors that alter the microenvironment in the vagina and cervix, allowing infecting organisms to proliferate and eventually ascend to the fallopian tube:

Finally, sexual intercourse may facilitate the spread of disease from vagina to fallopian tube. Coital risk factors are:

  • Uterine contractions
  • Sperm, carrying organisms upwards.

Bacterial species

The bacteria most associated with salpingitis are

However, salpingitis usually is polymicrobal, involving many kinds of organisms. Other examples of organisms involved are:

Symptoms

The symptoms usually appear after a menstrual period. The most common are:

  • Abnormal smell and colour of vaginal discharge.
  • Pain during ovulation
  • Pain during sexual intercourse
  • Pain coming and going in periods
  • Abdominal pain
  • Lower back pain
  • Fever
  • Nausea
  • Vomiting [2]

Diagnosis

By Pelvic examination, blood tests and mucus swab a doctor can diagnose salpingitis.

Treatment

Salpingitis is most commonly treated with antibiotics. [2]

Prompt treatment and Contact-tracing minimizes complications, AdmitionBold text for Blood Culture and Iv Antibiotics if very Unwell(eg,Cefoxitin 2gr/6hrls slow IV with doxycyclin 100 mg/12h PO) initially then Doxycyclin 100 mg /12 h PO with Metronidazol 400 mg 12h PO until 14 days can cover gonorrhea and chlamydia infection. if less unwell Ofloxacin 400 mg/12 h PO and Metronidazole 400 mg/12 hr Po for 14 days.Trace contacts and ensure the patient and partner seek treatment is essential.

Complications

For the affected, 20% need hospitalization.

Regarding patients aged 15-44 years, 0,29 per 100.000 dies from salpingitis.[1]

However, salpingitis can also lead to infertility, because the eggs released in ovulation can't get contact with the sperm. Approximately 75.000-225.000 cases of infertility in the U.S. are caused by salpingitis. The more times one has the infection, the greater the risk of infertility. With one episode of salpingitis, the risk of infertility is 8-17%. With 3 episodes of salpingitis, the risk is 40-60%, although the exact risk depends on the severity of each episode.[1]

In addition, damaged oviducts increase the risk of ectopic pregnancy. Thus, if one has had salpingitis, the risk of a pregnancy to become ectopic is 7- to 10-fold as large. Every two ectopic pregnancies are due to a salpingitis infection.[1]

Other complications are:

  • Infection of ovaries and uterus [2]
  • Infection of sex partners [2]
  • An abscess on the ovary [2]

Histopathological Findings: Chronic salpingitis

References

  1. 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 emedicine.com
  2. 2.0 2.1 2.2 2.3 2.4 2.5 2.6 2.7 mamashealth.com
  3. Laurell H, Hansson LE, Gunnarsson U (2007). "Acute diverticulitis--clinical presentation and differential diagnostics". Colorectal Dis. 9 (6): 496–501, discussion 501-2. doi:10.1111/j.1463-1318.2006.01162.x. PMID 17573742.
  4. Hardin, M. Acute Appendicitis: Review and Update. Am Fam Physician".1999, Nov 1;60(7):2027-2034
  5. Hanauer SB (1996). "Inflammatory bowel disease". N Engl J Med. 334 (13): 841–8. doi:10.1056/NEJM199603283341307. PMID 8596552.
  6. Cystitis-acute. MedlinePlus.https://www.nlm.nih.gov/medlineplus/ency/article/000526.htm Accessed on February 9, 2016
  7. Prostatitis - bacterial. NLM Medline Plus 2016. https://www.nlm.nih.gov/medlineplus/ency/article/000519.htm. Accessed on March 2, 2016
  8. Ford GW, Decker CF (2016). "Pelvic inflammatory disease". Dis Mon. 62 (8): 301–5. doi:10.1016/j.disamonth.2016.03.015. PMID 27107781.



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