Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Salpingitis


Related Terms

  • Acute Salpingitis
  • Chronic Salpingitis
  • Fallopian Tube Abscess
  • Perisalpingitis
  • Pyosalpinx
  • Tubo-ovarian Abscess
  • Tubo-ovarian Inflammatory Disease

Differential Diagnosis

Specialists

  • General Surgeon
  • Gynecologist
  • Infectious Disease Internist
  • Obstetrician/Gynecologist

Comorbid Conditions

  • Immune system disorders
  • Other sexually transmitted diseases

Factors Influencing Duration

Length of disability depends on the severity and extent of the infection, and the method and response to treatment.

Medical Codes

ICD-9-CM:
614.0 - Inflammatory Disease of Ovary, Fallopian Tube, Pelvic Cellular Tissue, and Peritoneum, Salpingitis and Oophoritis, Acute; Abscess of Fallopian Tube, Ovary, Tubo-Ovarian; Perioophoritis; Perisalpingitis; Pyosalpinx; Salpingo-oophoritis; Tubo-ovarian Inflammatory Disease
614.1 - Inflammatory Disease of Ovary, Fallopian Tube, Pelvic Cellular Tissue, and Peritoneum, Salpingitis and Oophoritis, Chronic; Abscess of Fallopian Tube, Ovary, Tubo-Ovarian; Perioophoritis; Perisalpingitis; Pyosalpinx; Salpingo-oophoritis; Tubo-ovarian Inflammatory Disease
614.2 - Inflammatory Disease of Ovary, Fallopian Tube, Pelvic Cellular Tissue, and Peritoneum, Salpingitis and Oophoritis Not Specified As Acute, Subacute, or Chronic; Abscess of Fallopian Tube, Ovary, Tubo-Ovarian; Perioophoritis; Perisalpingitis; Pyosalpinx; Salpingo-oophoritis; Tubo-ovarian Inflammatory Disease

Overview

© Reed Group
Salpingitis refers to inflammation of the fallopian tube. About 4 to 6 inches in length, the fallopian tube lies adjacent to the ovary and transports an egg from the ovary to the uterus and is the site of fertilization of the egg. When infected, fallopian tubes often develop scar tissue. This scarring can create a blockage that prevents an egg from reaching the uterus. Salpingitis also greatly increases the risk of tubal (ectopic) pregnancy. It is often seen in individuals with pelvic inflammatory disease (PID).

Inflammation of a fallopian tube is usually caused by an infection that has spread upward from the vagina, cervix, or uterus. The most common infections are chlamydia and gonorrhea, both sexually transmitted diseases. Salpingitis can also result from an infection following childbirth, miscarriage, or abortion. An inflammation of the abdominal lining (peritonitis) or even a blood-borne infection such as tuberculosis can also cause salpingitis.

Mucus and other secretions normally help prevent the spread of any infections coming from the cervix or vagina. During ovulation and menstruation, these defenses are less effective. If menstrual blood flows backwards from the uterus into the fallopian tubes, it can carry infectious organisms with it. This may explain why symptoms of salpingitis begin immediately after menstruation more often than at other times.

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Incidence and Prevalence: In the US greater than 1 million cases of acute salpingitis occur in a year; it is hard to approximate the incidence of salpingitis worldwide; according to the World Health Organization there are 31 million cases of gonorrhea and 22.5 million cases of chlamydia infection internationally and is very prevalent in Africa and Asia (Meiner).

Source: Medical Disability Advisor



Causation and Known Risk Factors

It is more common in unmarried, underprivileged women. Other risk factors include early age of first sexual experience, multiple sexual partners and lack of condom use. Sexually active females 15 to 24 years old have an increased incidence of salpingitis (Meiner). The annual incidence of acute salpingitis for women ages 15 to 34 is roughly 1%; a teenager who is sexually active has a 1 in 8 chance in developing the disease (Meiner).

Source: Medical Disability Advisor



Diagnosis

History: Symptoms include severe lower abdominal and pelvic pain which is usually bilateral, frequent urination, headache, and a vague feeling of being sick (malaise), nausea with possible vomiting, and often an abnormal purulent vaginal discharge. Since the abdomen is very tender, the woman may report that she is most comfortable lying on her back with her legs bent at the knee. Even though it can seriously damage the fallopian tubes, infection caused by chlamydia may produce only minor symptoms or no symptoms at all. Usually, the patient has had complaints of pain for less than 7 days when seeking initial diagnosis and treatment (Meiner).

Physical exam: The exam may determine the location and nature of the pain. Although a vaginal examination may be very painful, it can reveal the presence of any abnormal vaginal or cervical discharge and any evidence of infection on the cervix itself. A fever may or may not be present. The Centers for Disease Control and Prevention (CDC) have established minimum criteria that are needed to make this diagnosis on exam: lower abdominal tenderness, adnexal tenderness and cervical motion tenderness. Additional CDC criteria include fever greater than 101° F (38.3° F), abnormal vaginal/cervical discharge, elevated blood levels of C-reactive protein, elevated sedimentation rate (ESR), cultures positive for N gonorrhea or C trachomatis.

Tests: Cultures are done to identify the organisms responsible for the infection. Although rapid lab tests done in the doctor's office (using stains and a microscope) can identify many organisms, they may be slightly less accurate than cultures, since more than one organism may be simultaneously present and consequently overlooked. Therefore, many doctors prefer to use both the rapid lab test to determine a faster initial diagnosis and the cultures to objectively document an accurate diagnosis.

Infection may be confirmed by a complete blood test (CBC) that indicates a high number of white blood cells. An erythrocyte sedimentation rate (ESR) and C-reactive protein are also helpful laboratory tests. Rapid plasma reagin (RPR) test is helpful to rule out syphilis. Urinalysis and urine culture may also be done to rule out a urinary tract infection. A pregnancy test may be needed to rule out a tubal pregnancy. Imaging studies can be useful to rule out a tubo-ovarian abscess with an ultrasound. Ultrasound can assist in eliminating other causes of bilateral pelvic pain. CT scan and MRI can also be useful if ultrasound is not helpful.

A laparoscopy may be done to confirm the diagnosis and rule out conditions with similar symptoms such as tubal pregnancy or appendicitis. Laparoscopy is a surgical procedure where a small, lighted endoscope is inserted through a tiny incision into the abdomen. This allows the doctor to visually examine the fallopian tubes and surrounding area. When diagnosing salpingitis, biopsies of the endometrium have a greater than 90% sensitivity and specificity (Meiner).

Source: Medical Disability Advisor



Treatment

Treatment usually includes antibiotics, pain medication, increased fluids, and bed rest. Because more than one organism may be responsible for the infection, several antibiotics may be given at the same time. Since the symptoms may go away before the infection is completely cured, it is very important that the complete course of antibiotics is finished as prescribed. Individuals should be re-evaluated after treatment begins to be sure the antibiotics are effective. All sexual partners should be examined for sexually transmitted diseases and promptly treated as well. Untreated salpingitis can further develop into pelvic inflammatory disease (PID). Certain circumstances may require hospitalization for IV antibiotic treatment. This is likely if the patient has a surgical emergency, is pregnant, does not respond to oral antibiotic treatment, is noncompliant with outpatient treatment, has a tubo-ovarian abscess (TOA), an impaired immune system or severe illness with high temperature and emesis.

A salpingectomy may be necessary to correct complications (drain abscesses) or to remove damaged fallopian tubes that do not respond to antibiotic therapy. This sometimes involves removing the uterus and ovaries as well (hysterectomy with salpingo-oophorectomy).

Source: Medical Disability Advisor



Prognosis

A favorable outcome is directly related to the promptness of appropriate treatment. Infections sometimes persist despite treatment and can result in persistent backache, abdominal pain, pelvic pain, frequent heavy menstrual periods, and pain during sexual intercourse. Patients usually respond to antibiotics within 48 to 72 hours with decreased pain (Meiner). Sixty to eighty percent of patients with TOA have an improvement in their symptoms with only antibiotic therapy; another 20% to 40% needs further drainage of the abscess surgically, or by needle aspiration, with hospitalization necessary for 20% of females with infected fallopian tubes (Meiner).

Patients have a 5% to 10% chance of dying of a TOA if it ruptures and 25% of patients with salpingitis have long term complications such as ectopic pregnancy, chronic pelvic pain and infertility (Meiner).

Source: Medical Disability Advisor



Complications

Pus may collect within the fallopian tube (pyosalpinx), sometimes followed by fluid collecting in the fallopian tube (hydrosalpinx). Pus collecting within the abdominal cavity can cause a pelvic abscess. Abscesses may need to be surgically drained. Approximately 10% - 15% of females in the hospital with salpingitis develop TOA (Meiner). Patients can also develop infertility, ectopic pregnancy, chronic pelvic pain, pain during intercourse, menstrual difficulties and pelvic adhesions. Death occurs in 0.29 people ages 15 to 44 with salpingitis and /or pelvic inflammatory disease per 100,000 cases (Meiner). Fitz-Hugh-Curtis syndrome is an inflammation of the area around the liver that affects 5% to 10% of salpingitis patients (Meiner).

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Work responsibilities may need to be adjusted depending on the individual's job requirements. If a surgical procedure was necessary, light or sedentary work may be appropriate.

Source: Medical Disability Advisor



Failure to Recover

If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case.

Regarding diagnosis:

  • Does individual complain of severe lower abdominal and pelvic pain on both sides? Does frequent urination occur? Headache or a vague feeling of being sick (malaise)?
  • Is there abnormal vaginal discharge? If so, were cultures taken to identify the organism(s) responsible for the infection? What organism(s) is responsible for the infection?
  • Has individual had a complete blood count (CBC)? Was a laparoscopy performed to confirm the diagnosis?

Regarding treatment:

  • Is individual taking antibiotics exactly as prescribed? Are antibiotics treating the infection successfully?
  • Were all sexual partners examined and treated?
  • Were the tubes damaged to the point of requiring removal? Does individual require removal of the uterus and tubes?

Regarding prognosis:

  • Was antibiotic therapy appropriate for the organism(s) identified? Is additional antibiotic therapy recommended?
  • Have any associated conditions or complication developed such as abscess or pelvic inflammatory disease that could impact length of recovery?
  • Has adequate time elapsed for recovery?
  • Has individual developed an abscess? Does it need to be surgically drained?
  • Has individual developed pelvic inflammatory disease? If so, was it addressed in the treatment plan?

Source: Medical Disability Advisor



References

Cited

Meiner, Evan M., and William H. Shoff. "Salpingitis." eMedicine. Eds. Bruce A. Meyer, et al. 10 Nov. 2004. Medscape. 4 Jan. 2005 <http://emedicine.com/med/topic2059.htm>.

Source: Medical Disability Advisor






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