5 - PID, PCOS, masses Flashcards
What are the risk factors for PID?
1) youth,
2) multiple partners,
3) unprotected intercourse
4) h/o PID
5) Instrumentation (bx, IUD)
6) Lower GU inf (GC/CT/BV)
What organisms often precede initial PID infection?
GC/CT for first infection
then damaged fallopian tubes are more susceptible to subsequent infections by normal vaginal flora
What kinds of symptoms would you expect in a patient with PID?
fever, purulent vaginal d/c (yellow), pelvic pain, peritoneal irritation (rebound), pelvic mass (TOA)
What labs would you order to narrow down your DDx if you suspected PID?
1) HCG to r/o ectopic
2) CBC to look for bleed or infection
3) PCR to look for GC/CT
4) pelvic US to look for PID or r/o mass
(finally laparoscopy if none of the above tests are conclusive)
How will you treat PID in an outpatient setting?
1) Levofloxacin OR Ofloxacin + Metronidazole
2) Ceftriaxone + Doxycycline +/- Metronidazole
14 day course
How will you treat PID for an inpatient?
1) Cefotetan + Doxy
2) Clindamycin + Gentamicin
until afebrile x 48hrs, then switch to oral meds for the remainder of 14 days
What are 3 long term consequences of PID?
1) infertility
2) chronic pelvic pain
3) ectopic pregnancy (PID is biggest risk factor for ectopic)
________________is a common but complex disorder caused by abnormalities in the hypothalamus, pituitary, and ovary
polycystic ovarian syndrome
What are the common manifestations of PCOS?
1) irregular menses
2) infertility
3) androgen excess (hirsutism, acne)
4) obesity
5) carbohydrate intolerance
6) umm, cystic ovaries
You believe your patient has PCOS. If you are right, her LH levels will be _____________
elevated. Remember LH acts on theca cells to make androgens/testosterone (aka man hair)
If you suspect PCOS, but your lab results come back showing normal LH levels, but elevated FSH, what can you determine?
Premature menopause
If your patient does, in fact, have PCOS and her testosterone levels are increased; you can determine the cause of androgen excess is the ______________. Conversely, if the DHEA levels are elevated, the source of excess androgens is ____________.
elevated testosterone = ovarian cause
elevated DHEA = adrenal cause
Elevated levels of _____________ can cause amenorrhea
prolactin
In addition to elevated prolactin, a dx of hypothyroidism can also cause amenorrhea. In hypothyroidism, TSH levels would be ___________
elevated
If PCOS goes untreated, the long term consequences include:
1) infertility
2) endometrial hyperplasia
3) endometrial cancer
What treatment options would you recommend for a PCOS patient who did not want to get pregnant?
1) Withdraw using Provera Q2months (does not offer contraception)
2) Oral birth control
What tx option would you recommend for a PCOS patient who wishes to get pregnant?
1) Clomid to induce ovulation in mild cases
2) Bromocriptine (GnRH agonist) in more severe cases with elevated Prolactin
3) Consider combining above with Metformin
What are the most common masses in women of reproductive age?
functional cysts
What type of cyst is hormonally active?
stromal cyst
What type of cyst is somewhat common in the elderly and is typically large and unilateral?
Mucinous epithelial
What type of cyst is most common in the elderly and is typically bilateral?
Serous epithelial
What type of cyst is most common among young women?
dermoid cyst/cystic teratoma of the germ cell
What imaging test should you order to evaluate an ovarian neoplasm?
US
also MMG and colonoscopy to eval for mets
How would you treat an ovarian mass that turned out to be malignant?
Sx (ranges from removing ovary to total hysterectomy)
radiation and chemo are options based on severity
