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MATERNAL HEALTH > PELVIC INFLAMMATORY DISEASE > Flashcards

PELVIC INFLAMMATORY DISEASE Flashcards

1
Q

What is PID

A

A polymicrobial infection of the upper genital tract (cervix, uterus, fallopain tubes, ovaries, parametrium and pelvic peritoneum)

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2
Q

Inflammatory cascade in PID

A

Cervicitis
Endometritis
Parametritis
Salpingitis
Oophoritis
Pelvic peritonitis

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3
Q

Complications of PID

A

Tubo-ovarian abscess
Hydrosalpinx
Pelvic peritonitis
Perihepatitis or Fitz-Hugh Curtis syndrome
Chronic pelvic pain
Infertility
Ectopic pregnancy

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3
Q

Implicated organisms

A

Neisseria gonorrhae
Chlamydia trachomatis
Mycobacterium genitalium

Anaerobes: Prevotella spp and Leptotrichia and Atopobium
Organisms in bacterial vaginosis: G. vaginalis, M. hominis, U. urealyticum

Respiratory organisms: H. influenzae, Streptococcus, Staphylococcus

Enteric pathogens: E. coli, Bacteroides fragillis, Group B streptococcus

Viral: CMV

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3
Q

Risk factors for PID

A

Age > 25 yeras
History of STI or PID
Multiple sexual partners
New sexual partner
History of
Assisted reproductive technologies
History of abortion
Early coitarche
Unprotected sex
History of IUD insertion within past 6 weeks
Hysterescopy
Saline infusion sonography

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4
Q

Symptoms of PID

A

Abnormal bleeding
Lower abdominal pain
Dyspareunia
Dysuria
Offensive vaginal discharge
Right upper quadrant pain (perihepatitis)
Rectal pain (pelvic abscess)

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5
Q

Signs of PID

A

Fever >38
Cervical motion tenderness
Uterine tenderness
Adnexal tenderness
Adnexal mass

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6
Q

Investigations in PID

A

Elevated CRP
Elevated ESR
Elevated WBC on saline microscopy
NAAC for N. gonorrhae and C. trachomatis
Ultrasonography
MRI
CT scan
Dopple studies
Laparoscopy-gold standard
Pregnancy test
Pelvic examination
Speculum examination
Test for syphilis and HIV
Endometril biopsy

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7
Q

Differentials of PID

A

Appendicitis
Urinary Tract Infections
Ectopic pregnancy
Endometriosis
Complications of ovarian cyst
Irritable bowel syndrome
Functional pain

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8
Q

Purpose of endometrial biopsy in PID

A

To identify endometritis

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9
Q

Findings on speculum examination

A

Shows a mucopurulent vaginal discharge

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10
Q

Differentiate between PID and irritable bowel syndrome

A

IBS presents with disturbance in bowel habit

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11
Q

Differentiate between PID and endometriosis

A

Dyschezia is moslty present in endometriosis
Symptoms related to menstrual cycle in endometriosis

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12
Q

Differentiate between PID and UTI

A

More common dysuria, haematuria and urinary frequency in UTI

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13
Q

Differentiate between PID and appendicitis

A

Nausea and vomiting are more common in appendicitis
Cervical motion tenderness is less common in appendicitis

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14
Q

Differentiate between PID and complications of ovarian cysts

A

Sudden onset of symptoms and unilateral pain in omplications of ovarian cysts

15
Q

STG management of mild PID

A

Ciprofloxacin 500mg BD for 3 days
Doxycycline 100mg bd for 14 days
Metronidazole 400mg bd for 14 days

16
Q

STG management of severe PID

A

IM Ceftriaxone 250mg daily for 3 days
Doxycycline 100mg bd for 3 days
then
Doxycycline 100mg bd for 14 days
Metronidazole 400mg bd for 14days

17
Q

Metronidazole in PID

A

Used for anaerobes
Not require when a second gen. cephalosporin is used
Can be removed from management of severe infections in hospitals by IV therapy with good outcome

18
Q

Role of moxifloxacin in PID

A

Preferred when M. genitalium is implicated

18
Q

European guidelines management for PID, 2017, outpatient

A

IM ceftriaxone 500mg single dose
Doxycycline 100mg bd for 14 days
Metronidazole 500mg bd for 14days
or
PO Ofloxacin 400mg bd for 14 days
Metronidazole 500mg bd for 14days
or
PO Levofloxacin 500mg daily for 14 days
Metronidazole 500mg bd for 14days
or
PO Moxifloxacin 400mg daily for 14 days

19
Q

European guideline inpatient management for PID, 2017

A

IV/IM Ceftriaxone 1g daily
PO/IV Doxycycline 100mg bd
then
PO/IV Doxycycline 100mg bd for + PO Metronidazole 500mg bd to complete 14 days
or
IV Clindamycin 900mg tds
IV/IM Gentamicin 3-6mg/kg
then
Oral Clindamycin 450mg qid/ Oral Doxycycline 100mg bd + Oral Metronidazole 500mg bd to complete 14 days
or
IV Ofloxacin 400mg bd
IV Metronidazole 500mg bd for 14 days
or
IV Ceftriaxone 500mg single dose
PO Azithromycin 1g then PO Azithrmycin 1g a week later

20
Q

Main CDC regimen for outpatient management for PID

A

IM Ceftriaxone 500mg single dose or
IM Cefoxitin 2g + Probenecid PO Ig as a single concurrent dose or
other parenteral cephalosporins (cefotaxime, ceftizoxime)
+ PO Doxycycline 100mg bd for 14 days
+/- PO Metronidazole 500mg bd for 14days

21
Q

Main CDC regimen for inpatient management for PID

A

IM Cefotetan 2g 12 hrly or
IM Cefoxitin 2g 8hrly
+
PO/IV Doxycycline 100mg bd
then
PO Doxycycline and PO Metro for 14 days

21
Q

Alternative CDC regimen for outpatient management for PID

A

PO Levofloxacin 500mg daily + PO Metronidazole 500mg bd for 14 days
or
IV Azithromycin 500mg daily for 1-2 doses
then PO Azithromycin 250mg daily for total of 7 days
or
PO Azithromycin 250mg daily
PO Metronidazole 500mg bd all for 12 -14 days
or
Moxifloxacin

22
Q

Alternative CDC regimen for inpatient management of PID

A
  1. IV Clindamycin 900mg tds+
    IV/IM Gentamycin 2mg/kg loading dose, then 1.5mg/kg tds or single daily dose of 3-5mg/kg
    then
    PO Clind. and PO Metro or PO Doxy and PO Metro.
    or
  2. Ampicillin/Sulbactam 3g IV every hours
    Doxycycline 100mg PO/IV bd
23
Q

Criteria for parenteral or inpatient management in PID

A

Pregnancy
Not able to tolertae oral regimen
Problems with adherence
Not able to return for follow-up
Presence of tubo-ovarian abscess
Surgical emergency cannot be excluded
Severe signs and symptoms
Clinical failure or oral therapy

23
Q

Severe signs and symtptoms in PID

A

Nausea
Vomiting
High fever

23
Q

Duration for parenteral therapy

A

For 24-72 hours or till 24 hours after clinical improvement

23
Q

Should IUD be removed

A

Do not remove IUD if patient is improving within 24-72 hours
Remove if patient doesn’t improve witin 72 hours

23
Q

Duration of treatment for PID

A

10 to 14 days

23
Q

Prophylactic management for sexual partners of PID patients

A

Doxycycline 100mg bd for a week

24
Q

Monitoring of inpatient therapy

A

C-reactive protein
WBC count

25
Q

Follow up for PID patients

A

Follow up after 48-72 hours of discharge and for outpatients to review effectiveness of therapy

25
Q

Concerns about penicillin allergy in PID management

A

Crossreactivity is with first and second gen. cephalosporins, third gen. ceph. can be given

Can also hospitalize and give IV clindamycin and Gentamycin

25
Q

When is retesting done for patients diagnosed with chlamydial or gonococcal PID

A

after 3 months

25
Q

Screening tests for PID

A

Annual screening for gonorrhea and chlamydia in women<25 yrs and women at high risk

26
Q

Taking care of patners of PID patients

A

Screen partners for chlamydia and gonorrhea

Advise partners to avoid unprotected sex till completion of treatment

Trace all sexual partners encountered within 6 months prior to presentation
if no sex within last six months, trace to last sexual partner

27
Q

Management of PID in pregnancy

A

IV Cectriaxone 2g od and IV Erythromycin 50mg/kg od and Metronidazole 500mg bd

MATERNAL HEALTH (25 decks)

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