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DISORDERS OF FALLOPIAN TUBES AND OVARIES (Oophoritis (Risk Factors…
DISORDERS OF FALLOPIAN TUBES AND OVARIES
Salpingitis
Causes
chlamydia
gonococcus which causes gonorrhoea
mycoplasma
staphylococcus and streptococcus
Pathophysiology
infection often starts in the vagina and spreads upwards to the fallopian tubes
as the infection may spread through the lymph vessels. infection in one fallopian tube may also cause infection in the other fallopian tube
infection reaches the fallopian tubes during retrograde menstrual flow and during the opening of cervix during menstruation
Risk Factors
sexually transmitted diseases
treatment with antibiotics
Defination
is the infection and inflammation of the fallopian tube
Assessment findings and Symptoms
foul-smelling vaginal discharge
pain during ovulation, menstruation, or sex
dull lower back pain
fever
frequent urination
Medical Management
a broad spectrum of antibiotics may be prescribed
bed rest, iintravenous fluids and intravenous antibiotics may also be prescribed
treatment of sexual partner to prevent reoccurance
Nursing Management
administer prescribed antibiotics
provide plenty of water to drink
promote comfort and monitor and accurately record vital signs
wash hands after attending to patient
Health Education
stress the importance of good personal hygiene
daily exercise and proper nutrition
encourage patient to wash hands after change of pads
Oophoritis
Defination
is the infection and inflammation of the ovaries
Risk Factors
sexually transmitted disease
pregnancy
abortion
childbirth
Causes
sexually transmitted infections like chlamydia
Pathophysiology
Infection ascends from bacterial colonization of the cervix and extends to the uterus, fallopian tubes, and the ovary
Gonorrhea and Chlamydia typically are colonized from the cervix in cases of oophoritis, but these pathogens are rarely isolated in ovarian tissue.
Rather, these organisms facilitate other bacteria to infect the adnexa
If left untreated, an abscess may form around the fallopian tubes and ovary, known as a tubo-ovarian abscess (TOA).
Assessment Findings and Symptoms
pain in lower abdomen and pelvis
heavy menstrual bleeding
pain or bleeding during intercourse
difficulty in urinating
Medical Management
women who have autoimmune oophoritis may benefit in hormonal replacement therapy
antibiotics may be prescribed
analegesia may be prescribed to alley pain
Surgical Management
Oophoritis may be managed with surgery when medical treatment has shown no amelioriation of symptoms after 48-72 hours
Surgical options may include laparoscopy with drainage of the abscess, removal of adnexa, and total abdominal hysterectomy-bilateral sagittal oophorectomy
Factors that influence the type of surgery used include the extent of the abscess, the degree of immunocompromise of the patient, and preservation of fertility for future child bearing potential
Interventional radiology can sometimes be used for drainage of abscesses in patients who are not surgical candidates.
Nursing Management
administer prescribed antibiotics
promote bed rest and comfort
encourage proper nutrition
Health Education
educate on the importance of good hygiene
hand wash after pad change or pad check
counselling is necessary for patients who have been diagnosed
Pelvic Inflammatory Disease
Defination
is an inflammatory condition of the pelvic cavity that may begin with cervicitis and may involve uterus fallopian tubes, ovaries and pelvic vascular system
Risk Factors
early age at first intercourse without condom
history of sexual transmitted disease
sex with a partner with a sexual transmitted disease
Causes
sexually transmitted disease
invasive procedure such as endometrial biopsy, surgical abortion
UID insertion
Pathophysiology
infection is usually acute, infecting organism colonize the vagina and cervix causing low grade vaginitis and cervicitis
infection ascends to the uterus and fallopian tube causing endometritis, salpingitis and oophoritis
endometrium may be necrotic
salpingitis and oophoritis cause tubes to become congested, oedematous and occluded with limited mobility
ovaries become inflamed and oedematous and may adhere to the fimbria of the tubes
inflammation of the tubes and ovaries may suppurate and develop into an abscess that will later burst into pelvic peritonealcavity, occassionally infection may be through bloodstream
Assessment Findings and Symptoms
vaginal discharge, dysparenia
lower abdominal pain
urinary frequency and urgency
if abscess forms, there is abdominal distention and rigidity
Medical Management
broad-spectrum antibiotic therapy is prescribed
intensive therapy may include bed rest, intravenous fluids and intravenous antibiotics therapy
if patient has abdominal distention, nasogastric intubation and suction are initiated
treating sexual partners is necessary to prevent re-infection
Nursing Management
maintain bed rest and usually place in a semi-Fowler's position to facilitate dependant drainage
accurate recording of vital signs ad characteristics and amount of vaginal discharge
administer analgesic agents as prescribed to relieve the pain
provide plenty of water to drink especially in the presence of pyrexia
wash hands after attending the patient
Health Education
stress the importance of good personal hygiene such as washing genitals daily and whenever necessary and a change of underclothes daily or more frequently
encourage daily exercise and proper nutrition
counselling will be necessary for patients diagnosed with pelvic infammatory disease
hand should be washed after each pad change or inspection
Surgical Management
in PID the use of diagnostic laparoscopy to confirm the possibility of acute salpingitis is recommended in young women
Ovarian Cyst
Defination
contain a yellowish material that is secreted by the sebaceous gland. suspended in this may be hair, teeth, muscle, cartilage and bone in their rudimentary state
Risk Factors
High hormone levels in a pregnant woman
heriditary
abnormal menstrual period
Causes
Most ovarian cysts develop as a result of your menstrual cycle (functional cysts)
Pathophysiology
reaching the menarche, the ovary forms follicles on a monthly basis in readiness for ovulation
if ovulation does not occur, the follicle may continue to enlarge to form a follicular cyst
similar, failure of the corpus luteum to regress may result in a cyst. the cyst can remain small or grow to be large
Assessment Finding and Symptoms
if cyst is small there is usually no symptoms
there is progressive abdominal distention with pain
cyst may exert pressure on neighboring structure
sudden excrutiating pain
Medical Management
oral contraceptive may be used to suppress ovarian activity and resolve cyst
Surgical Management
cyst will be surgically excised and a sizable amount of ovarian tissue has to be salvaged
oophorectomy wouldbe done when the cyst cannot be excised
where a bilateal oophorectomy is proposed, a hysterectomy is proposed
A laparoscopy is a minimally invasive surgical procedure that uses a laparoscope to view the ovary
Health Education
encourage patient to use contraceptives as it may reduce the risk and suppresses the hormones
Cancer of Ovaries
Defination
ovaries are a cmmon site of primary as well as metastatic lession from othercancers
Risk Factors
advanced age
high dietary fat intake
nulliparity
Causes
causes of ovarian cancer are unknown but condition tends to run in the family
Pathophysiology
risk is hih inwomen with a history of premenopausal breast or ovarian cancer in first or second degree relatives
there is also a tendency for the ovarian cancer to occur at much younder age than usual if cancer is related to inheritance
Assessment Findings and Symptoms
increased abdominal girth
pelvic pressure, bloating
indigestion, flatulence
Medical Management
hormonal suppression with oral contraceptives may be used for two months
Health Education
teach patients on having one child which is useful to prevent occurance of ovarian cancer
a use of contraceptives is considered to reduce the risk of the condition
Surgical Management
exploratory laparoctomy is recommended where all signs are positive. this procedure is diagnostic and therapeutic and may be done together with hysterectomy
Nursing Management
this includes supporting the family and patient through the treatment regime