Salpingitis

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Salpingitis
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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 . In contrast, salpingitis only refers to infection and inflammation in the fallopian tubes.

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. 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. 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.

Differential diagnosis

• Salpingitis must be differentiated from other diseases that cause lower abdominal pain and fever like appendicitis, diverticulitis, inflammatory bowel disease, cystitis, colorectal cancer and endometritis.

Diseases		Symptoms		Signs			Diagnosis		Comments
		Abdominal pain	Bowel habits	Rebound tenderness	Guarding	Genitourinary signs	Lab findings	Imaging
GI diseases	Colorectal cancer	LLQ	Constipation	-	-	-	Serum carcino-embryogenic antigen  Low Vit b12 Hypercalcemia	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	-	+	+	Leukocytosis	CT scan shows evidence of inflammation
	Appendicitis	LLQ / RRQ	Constipation	+	+	-	Leukocytosis	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	Pyuria Presence of nitrites and leukocyte estrase	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	Serum PSA elevated Leukocytosis Elevated CRP	CT scan shows edema and enlarged prostate Abscess may be observed
	Pelvic inflammatory disease	Bilateral	-	+	-	Purulent vaginal discharge	Nucleic acid amplification tests is the best laboratory test for PID.	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 Hyperbilirubinemia Leukocytosis 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 ROME III/IV criteria Pharmacologic studies based criteria - High dietary fiber Osmotic laxatives Antispasmodicdrugs 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: endometrial biopsy curettage hysteroscopy 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: antibiotic treatment ovulation menstruation sexually transmitted disease (STD) 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 N. gonorrhoeae C. trachomatis Mycoplasma Staphylococcus Streptococcus However, salpingitis usually is polymicrobal, involving many kinds of organisms. Other examples of organisms involved are: Ureaplasma urealyticum anaerobic and aerobic bacteria. 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 Diagnosis By Pelvic examination, blood tests and mucus swab a doctor can diagnose salpingitis. Treatment Salpingitis is most commonly treated with antibiotics. 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. 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. 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. Other complications are: Infection of ovaries and uterus Infection of sex partners An abscess on the ovary Histopathological Findings: Chronic salpingitis {{#ev:youtube|VS9WqzRQp5k}} References Template:WikiDoc Sources