OBG - PID

Question 1

What is pyosalpinx?

Answer 1

Inflammation of the fallopian tube that results in adhesions and obstructions of the fimbrial end; distends with pus, as it is unable to drain

Question 2

Most common causes of PID due to sexual transmission? Non-sexual transmission?

Answer 2

C. trachomatis, N. gonorrhea

Staph, strep, coliforms

Treated as a mxied polymicrobial infection

Question 3

List the 3 useful imaging modalities for PID.

Answer 3

1. Pelvic U/S
2. CT
3. MRI

Question 4

What is the utility of pelvic U/S in evaluating PID?

Answer 4

Sonographic findings consistent with PID, especially thickened, fluid-filled oviducts, are useful to support a clinical diagnosis. Absence of findings does not diminish probability and should not delay Rx.

Indicated if adnexal mass is suspected, diagnosis is in question, patient does not respond

Question 5

U/S is sensitive and specific for what sequelae of PID?

Answer 5

Tuboovarian abscess

Question 6

Utility of CT in PID?

Answer 6

If diagnosis is uncertain after pelvic U/S

R/o appendicitis

Question 7

Appropriateness Criteria for acute pelvic pain in the reproductive age female?

Answer 7

Both TV and TA pelvic U/S should be the initial studies with Doppler as adjunct

MRI if U/S is inconclusive/non-diagnostic

CT not recommended due to radiation risk

If known to be non-pregnant, CT for acute abdominal pain with fever or suspected abscess

Question 8

Imaging findings of PID on U/S?

Answer 8

-Pyosalpinx (fallopian tube dilated serpentine/tubular structure separate from the ovary filled with echogenic complex fluid; low level echoes represent the higher protein content of the debris. Fluid debris level may be seen)
-Pelvic inflammation may be seen as ill-defined uterus and increased echogenicity of pelvic fat
-Tubo-ovarian abscess - loss of distinction between tube and ovary; solid and cystic adnexal mass containing debris and complex fluid
Small amounts of free pellvic fluid

Question 9

CT findings of PID?

Answer 9

Pyosalpinx - tubular juxtauterine mass with complex internal fluid and thick enhancing walls
Tubo-ovarian abscess - solid/cystic adnexal mass, with area of low attenuation and enhancement of the wall and septa
Obscuration of normal pelvic floor fascial planes
Thickening of uterosacral ligaments
Accumulation of simple fluid
Reactive inflammation (pelvic fat stranding)

Question 10

Diagnostic algorithm for PID?

Answer 10

If clinical signs, give ABX
If failure to response or suspicion of abscess, pelvic U/S (procedure of choice is TV pelvic U/S)
If dx uncertain and patient is not pregnant, give ABX and get CT AP

Question 11

Risk factors for PID?

Answer 11

<25 y/o
Young age at first sex
Non-barrier contraception
New, multiple, or symptomatic sexual partners
OCs

Question 12

Factors that potentially facilitate PID?

Answer 12

Previous episode of PID
Sex during menses
Vaginal douching
BV
IUD

Question 13

Minimum criteria needed for clinical diagnosis fo PID?

Answer 13

Lower abdominal tenderness (cardinal symptom)
Adnexal tenderness
Cervical motion tenderness

Question 14

Additional criteria that increase dx speciicity?

Answer 14

Temp >101 F
Abnormal cervical or vaginal discharge
Abnormal uterine bleeding
Elevated ESR
Dyspareunia
Onset of pain shortly after menses
Cervical infection with gonorrhea/chlamydia