Acute Salpingitis

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Acute Salpingitis

• 8-18-04
• Matthew Collins

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CASE 1 Acute Salpingitis
An 18-year-old female presents to the emergency
room with severe abdominal pain, which has been
progressive over the last 3 days. Her menstrual
period was due about the time her symptoms
started. She admits to being sexually active with
several partners in the past 2 months with
inconsistent use of birth control. Physical
examination reveals marked lower abdominal/pelvic
tenderness and a purulent vaginal discharge. She
is febrile (39 C) at the time of exam. Her CBC is
significant for a white blood cell (WBC) count of
15 x 103/µL with 82 polymorphonuclear
neutrophils (PMN) and 6 bands and
metamyelocytes.
White Blood Cell Count (WBC) 4.1-10.9x103/µL
polymorphonuclear cells (polys)immature polys
(bands)
35-800-10
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Acute Salpingitis (PID)
Infection and inflammation of the oviducts 2
stages Symptoms Pain Vaginal
discharge. Abnormal vaginal bleeding Nausea and
vomiting Fever Perihepatic inflammation
(Fitz-Hugh-Curtis syndrome) End of menses or
early in the menstrual cycle Predisposing
conditions N gonorrhoeae and C trachomatis
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Systemic Manifestations of Inflammation
Acute phase reaction fever, decreased appetite,
slow-wave sleep, neutrophils, ACTH
and corticosteroids, circulation changes,
chills, malaise. Fever IL-1, IL-6,
TNF-a Leukocyte shift
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Terms for Inflammation
Transudate any fluid (solvent and solute) that
has passed through a presumably normal membrane,
such as the capillary wall, as a result of
imbalanced hydrostatic and osmotic forces
characteristically low in protein unless there
has been secondary concentration. Exudate any
fluid that has exuded out of a tissue or its
capillaries because of injury or
inflammation Edema an accumulation of an
excessive amount of watery fluid in cells,
tissues, or serous cavities
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INFLAMMATION IS A VASCULAR EVENT
Transient vasoconstriction followed by
vasodilation arterioles new capillary
beds Increased permeability Leukocytic
margination stasis Time course 15-30 min
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Increased Vascular Permeability
Venules 20 60 mm Differential receptor
expression Exception Direct injury Immediate
Transient response 15-30 min Histamine,
Bradykinin, Leukotrienes, Substance P, and more
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Cellular Events Extravasation
Margination, Rolling, and Adhesion
Pavementing Endothelial activation
selectins Integrin avidity immunoglobulin
(ICAM-1, VCAM-1 bind integrins) Transmigration
(diapedesis) PECAM-1 Migration in interstitial
tissue
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Chemotaxis Exogenous vs Endogenous (C5a, LTB4,
IL-8) Phospholipase C Pseudopodia Receptors
and gradients Phagocytosis Recognition and
Attachment Opsonins (IgG, C3b,
collectins) Receptors (FcgR, CR3,
C1q) Engulfment Killing or Degradation
Neutrophils (MPO) O2 independent BPI,
lysozyme, major basic protein
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Fallopian Tube
Normal, low
Normal, medium
Not normal
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Fallopian Tube
PID
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Incidence and Morbidity
Over 1 million cases annually in the US 20
require hospitalization Most common serious
infection of women aged 16-25 years (1) 1 in 8
Sexually active adolescents 11 of women of
reproductive age TOA occurs in 10-15 of women
hospitalized with salpingitis. Mortality Rate
0.29 patients per 100,000 Rupture of a TOA .
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Inflammation Morphology
Serous Fluid outpour Effusion Fibrinous
Fibrin Resolution or organization Suppurative
or Purulent Neutrophils, necrotic cells, and
edema Abscess collections of purulent
inflammatory tissue in confined space
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Lung
Chronic Inflammation
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Lasting Effects

• 25 of patients have long-term sequelae
• Tubal factor infertility and ectopic pregnancy
• Chronic pelvic pain, dyspareunia, menstrual
  disturbances, and pelvic adhesions

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Lasting Effects
Infertility 75,000-225,000 cases of infertility
annually 8-17 of all women with 1 episode of
disease 40-60 in women with 3 episodes of
disease Severity of scarring Ectopic
Pregnancy Half due to Salpingitis Increases the
risk 7- to 10-fold
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Regeneration
Labile cells Stem cells Stable cells Division
potential Permanent cells
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References
http//www.emedicine.com Robbins Pathological
Basis of Disease http//medlib.med.utah.edu/WebPat
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