103 Pelvic Inflammatory Disease Flashcards
Common an atypical causes a pelvic inflammatory disease
Gonorrhea, chlamydia herpes trichomonas gardnerella.A typical causes our Mycobacterium tuberculosis, schistosomes, actinomyces especially patients with IUDs
What is actinomyces puppy inflammatory disease associated with
Intrauterine device
What is pelvic inflammatory disease
This is really just a spectrum of infections in the upper female reproductive tract such as endometritis, salpingitis, myometritis, oophritis, toa
How far can pelvic inflammatory disease extend
Especially pregnant patients I can go past the endometrium. I can also extend an infected appendix and bowel or peritonitis or perihepatitis
Does pregnancy increase or decrease the risk for PID
It decreases it because the cervical arse is protected by the mucous plug
Why iuds associated with having inflammatory disease
Just associate with an increased risk for STI
What are the three main Complications of Pelvic and flam a Tory disease
To ovarian abscess, atomic pregnancy, and a fertility is increased by 12 to 50%.
Clinical signs and symptoms of pelvic inflammatory disease?
Pain exasperated by movement, vaginal discharge Postcoital bleeding, adnexal tenderness, mucopurulent cervicitis, elevated ESR
How to diagnose puppy inflammatory disease?
The diagnosis is mostly history and clinical findings.
Considerations for a treatment of pelvic inflammatory disease?
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.
Group 1 minimum criteria for empiric treatment of Pelvic inflammatory disease
Uterine or adnexal tenderness cervical motion tenderness
Group to additional criteria improving diagnostic specificity for pelvic inflammatory disease
Oral temperature greater than 101, abnormal cervical or vaginal secretions, elevated ESR/CRP, laboratory evidence of cervical infection with neisseria gonorrhea or chlamydia trachomatis
Group 3 specific criteria for PID
Laparoscopic confirmation, transvaginal ultrasound or MRI showing thickened fluid filled tubes or TOA, endometrial biopsy results showing endometritis
Lab testing for suspected PID? Imaging?
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.
Treatment for PID?
NSAIDs are very useful for pain, antibiotics. No difference between IV or oral.
Parenteral Antibiotic regimen for PID?
- Cefotan 2 g IV every 12 hours or cefoxitin 2 grams IV every six hours Plus doxycycline 100 mg PO every 12 hours
- 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
- Levofloxacin plus flagyl
Oral antibiotics for outpatient public inflammatory disease?
Ceftriaxone 250 mg IM once.
And probenecid. Alternatively, another third generation cephalosporin plus doxycycline with our without metronidazole.
Lastly levofloxacin with or without Flagyl
Should you remove an IUD for PID infection?
The CDC currently recommends against it because the device is usually not the source of infection.
Management of HIV with PID
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.
Why is azithromycin may be better for P IDs and doxycycline?
Has a long half life so there is less doses per day leading to better success rates
What population is more likely to develop to ovarian abscess from PID?
HIV patients because it takes longer for them to resolve the infection.
What is a crucial consideration to prevent repeated episodes of PID?
Safe sex practices of course and more importantly partner treatment
What should be used as empiric partner treatment
Probably use doxycycline to avoid increasing resistance to mycoplasma genitalium
