65. Pelvic inflammatory disease.

Question 1

what is the cause of PID ?

Answer 1

polymicrobial- anaerobic (bactericides) and aerobic (strep)
C.TRACHOMATIS, N.GONORRHOEAE, AND GENITAL MYCOPLASMAS , ecoli

small number - TB

SEXUALLY TRASMITTED - most cases

Question 2

what is PID?

Answer 2

is an infection of the upper part of the female reproductive system
uterus,
fallopian tubes
ovaries

Question 3

what are the signs and symptoms of PID

Answer 3

fever,

mucopurulent vaginal discharge

lower abdominal pain - BILATERAL

painful intercourse

uterine and adnexal tenderness

abnormal vaginal bleeding - menorrhagia ,

nausea vomiting

fitz hugh and curtis syndrome :
right upper quadrant pain result from ascending pelvic inflammation due to inflammation of liver capsule or diaphragm - confused for cholecystitis

may manifest with symptoms of appendicitis due to periappendicitis

Question 4

how to diagnose PID ?

Answer 4

history taking - sex life
characteristic complaints : bilateral lower abdominal pain is charecteritic of PID

inspection - mucopurulent cervical discharge

bimanual pelvic examination -
cervical motion tenderness

blood - raised WCC

endocervical swab -
the standard for diagnosing gonorrhea and chlamydia was previously by culture; however, several studies have reviewed the role of nucleic acid amplification tests (NAATs) on both urine and vaginal swab specimens. The sensitivity of urine NAATs for chlamydia and gonorrhea is high

Question 5

what are the clinical stages of inflammation ?

Answer 5

acute - generalised symptoms that lasts a few days , may reoccur
very infectious

subacute

chronic 
asymtpomatc 
occurs over months and years 
progressive orhan damage and change 
may burn out

Question 6

what is the antibiotic therapy for gonorrhoea ?

Answer 6

cephalosporin-ceftriaxone

Question 7

what is the antibiotic therapy for chlamidya ? and mycoplasma ?

Answer 7

not cephalosporins - doxycycline or erythromycin/azithromycin

mycoplasma - azithromycin

Question 8

what is the antibiotic therapy for anaerobes ?

Answer 8

metronidazole and clindamycin

Question 9

complications of PID?

Answer 9

ectopic pregnancy

cause infertility

chronic menstrual problems

pregnancy - fetus has lung inflammation and eye infection and there can be PROM

septicemia

pelvic abscess,
pelvic peritonitis,
periappendicitis
perihepatitis.

sSherman

Question 10

what are the mechanism of protection of meal genital tract from infection

Answer 10

labiales maoris and minois

hymen

bartholin glands - producing antibodies

peeling of epithelium where nucleoses are rich in glycogen and the doderline bacillus decompose glycogen to lactic acid - for an acidic vaginal flora

cervix - producing mucus
producing antibodies

Question 11

what i the antibiotic therapy for beta haemolytic strep and coli

Answer 11

penicillins

tetracycline

Question 12

prevention of PID ?

Answer 12

sexual health counselling

contraceptive

progestin based contraceptives

Question 13

what is dd for PID

Answer 13

appendicitis
ectopic pregnancy
hemorrhagic or ruptured ovarian cyst
gastroenteritis

Question 14

empirical treatmnet for PID?

Answer 14

Ceftriaxone 250 mg intramuscularly in a single dose plus doxycycline 100 mg orally twice a day for 14 days, with or without metronidazole

Question 15

risk factors for pid?

Answer 15

Multiple sexual partners, unprotected sex
History of prior STIs and/or adnexitis
Intrauterine devices [3]
Risk is lower during pregnancy; PID development during pregnancy increases the risk of maternal morbidity and preterm births.
Vaginal dysbiosis