Gyn - PID

Question 1

24 years old patient, suddenly has lower abdominal pain associated with fever etc. Admitted to A&E. history & PE?

Answer 1

History
HPI: SOCRATES, Fever/vomiting, PV discharge/bleed, urinary symptom
menstrual history, PGH (PID/STD, pap smear), sexual history, PT
PMH/surgery
NSND

PE
Vitals
Abd: tenderness/guarding
Speculum: bleed, discharge/pus, lesion
Bimanual exam: adnexal tenderness/mass, cervical excitation, uterine size

Question 2

Investigations?

Answer 2

CBC (white cell)

Gynaecological:
PID (triple swab, std screening, hiv)
ruptured ectopic pregnancy, miscarriage - PT, serial beta hcg
USG for tubo-ovarian abscess, IU sac, adnexal mass, free fluid

Non-gynaecological:
UTI (MSU, Septic workup)
acute appendicitis, IBD

Question 3

Given patient PT –ve, in fever, cervical excitation, adnexal tenderness. USG found 3cm tubo-ovarian
abscess. What is your DDX?

Answer 3

Acute PID with tubo-ovarian abscess

Question 4

Management?

Answer 4

Admit
Monitor vitals and WBC
Give antibiotics IV and analgesics

Plan for surgical drainage if no improvement in 48h
Ix: LRFT, T/S XM, ECG, CXR

Explain diagnosis and counsel patient for safe sex
Contact tracing of partners