103 Pelvic Inflammatory Disease

Question 1

Common an atypical causes a pelvic inflammatory disease

Answer 1

Gonorrhea, chlamydia herpes trichomonas gardnerella.A typical causes our Mycobacterium tuberculosis, schistosomes, actinomyces especially patients with IUDs

Question 2

What is actinomyces puppy inflammatory disease associated with

Answer 2

Intrauterine device

Question 3

What is pelvic inflammatory disease

Answer 3

This is really just a spectrum of infections in the upper female reproductive tract such as endometritis, salpingitis, myometritis, oophritis, toa

Question 4

How far can pelvic inflammatory disease extend

Answer 4

Especially pregnant patients I can go past the endometrium. I can also extend an infected appendix and bowel or peritonitis or perihepatitis

Question 5

Does pregnancy increase or decrease the risk for PID

Answer 5

It decreases it because the cervical arse is protected by the mucous plug

Question 6

Why iuds associated with having inflammatory disease

Answer 6

Just associate with an increased risk for STI

Question 7

What are the three main Complications of Pelvic and flam a Tory disease

Answer 7

To ovarian abscess, atomic pregnancy, and a fertility is increased by 12 to 50%.

Question 8

Clinical signs and symptoms of pelvic inflammatory disease?

Answer 8

Pain exasperated by movement, vaginal discharge Postcoital bleeding, adnexal tenderness, mucopurulent cervicitis, elevated ESR

Question 9

How to diagnose puppy inflammatory disease?

Answer 9

The diagnosis is mostly history and clinical findings.

Question 10

Considerations for a treatment of pelvic inflammatory disease?

Answer 10

Because it is based mostly on physical exam findings and history, the CDC recommends empiric treatment for any woman with lower abdominal pain adnexal tenderness and cervical motion tenderness. In general we prefer to over treat then under treat.

Question 11

Group 1 minimum criteria for empiric treatment of Pelvic inflammatory disease

Answer 11

Uterine or adnexal tenderness cervical motion tenderness

Question 12

Group to additional criteria improving diagnostic specificity for pelvic inflammatory disease

Answer 12

Oral temperature greater than 101, abnormal cervical or vaginal secretions, elevated ESR/CRP, laboratory evidence of cervical infection with neisseria gonorrhea or chlamydia trachomatis

Question 13

Group 3 specific criteria for PID

Answer 13

Laparoscopic confirmation, transvaginal ultrasound or MRI showing thickened fluid filled tubes or TOA, endometrial biopsy results showing endometritis

Question 14

Lab testing for suspected PID? Imaging?

Answer 14

NAAT for gonorrhea and chlamydia, elevated white blood cell count, ESR, CRP, RPR, HIV, hepatitis panel

For imaging, pelvic ultrasound for identification of TOA. Abdominal pelvic CT and MRI is a little overkill but can show general information. Cannot distinguish from appendicitis. Finally laparoscopy or trans cervical endometrial aspiration.

Question 15

Treatment for PID?

Answer 15

NSAIDs are very useful for pain, antibiotics. No difference between IV or oral.

Question 16

Parenteral Antibiotic regimen for PID?

Answer 16

1. Cefotan 2 g IV every 12 hours or cefoxitin 2 grams IV every six hours Plus doxycycline 100 mg PO every 12 hours
2. clindamycin 900 mg IV every eight hours Plus gentamicin 2 mg per kilogram IV initial followed by 1.5 mg per kilogram every eight hours
3. Levofloxacin plus flagyl

Question 17

Oral antibiotics for outpatient public inflammatory disease?

Answer 17

Ceftriaxone 250 mg IM once.
And probenecid. Alternatively, another third generation cephalosporin plus doxycycline with our without metronidazole.
Lastly levofloxacin with or without Flagyl

Question 18

Should you remove an IUD for PID infection?

Answer 18

The CDC currently recommends against it because the device is usually not the source of infection.

Question 19

Management of HIV with PID

Answer 19

It really should be the same as any other patient. Studies show that rates of improvement are the same for both unless city for accounts are really low. HIV status alone Does not make hospitalization necessary.

Question 20

Why is azithromycin may be better for P IDs and doxycycline?

Answer 20

Has a long half life so there is less doses per day leading to better success rates

Question 21

What population is more likely to develop to ovarian abscess from PID?

Answer 21

HIV patients because it takes longer for them to resolve the infection.

Question 22

What is a crucial consideration to prevent repeated episodes of PID?

Answer 22

Safe sex practices of course and more importantly partner treatment

Question 23

What should be used as empiric partner treatment

Answer 23

Probably use doxycycline to avoid increasing resistance to mycoplasma genitalium