Pelvic Inflammatory Disease

Question 1

Definition:

Answer 1

Inflammatory and infectious disease of the female upper genital tract

Question 2

Involved organs:

Answer 2

Uterus, uterine tubes, adjacent pelvic and perihepatic structures

Question 3

Risk factors:

Answer 3

-25y, Multiple sex partners, Non contraception use, Use of intrauterine device,

Question 4

Etiology:

Answer 4

Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma, Gardnerella vaginalis and Haemophilus influenzae

Question 5

30-40% of cases the etiology is:

Answer 5

Polymicrobial

Question 6

Pathophysiology:

Answer 6

Infection of the vagina and cervix that ascends to the upper genital tract

Question 7

Pelvic or Lower abdominal pain, Abnormal vaginal discharge, Unanticipated vaginal bleeding, Fever, Nausea and vomiting:

Answer 7

Presentation

Question 8

Pelvic or Lower abdominal pain characterization:

Answer 8

Constant, accentuated by motion, exercise, or coitus, that lasts about 7d

Question 9

Critérios diag (Maiores ou Mínimos):

Answer 9

Dor pélvica, à mobilização do colo e à palpação dos anexos

Question 10

The most sensitive physical examination finding, ~95% sensitivity:

Answer 10

Adnexal tenderness

Question 11

Laboratory exams:

Answer 11

CBC, beta-HCG, PCR, VHS, SU, Urinocultura, VDRL, HbsAg, Anti-HBs e Anti-HIV

Question 12

Laboratory finds:

Answer 12

+WBC, +ESR, +CRP, Urinanalysis, Vaginal secretion treated with potassium hydroxide, Test for Syphilis, Hepatitis and HIV

Question 13

Imagine exams:

Answer 13

Culdocentesis and TV-US —> CT —> MRI —> Laparoscopy and Endometrial biopsy

Question 14

Transvaginal US finds:

Answer 14

Colar de contas e roda dentada

Question 15

DDx:

Answer 15

Appendicitis, Cervicitis, Endometriosis, Abortamento febril, Ectopic pregnancy, Adnexal tumors and Urinary tract inf.

Question 16

PID + Right upper quadrant tenderness + jaundice:

Answer 16

Fitz-Hugh-Curtis Syndrome

Question 17

Treatment:

Answer 17

(Clindamicina 900mg EV 8/8h
+
Gentamicina 2mg/kg dose de ataque -> Gentamicina 1,5mg/kg 8/8h) por +48h

-> Doxiciclina 100mg VO 12/12h por 14d

Question 18

Ambulatorial Treatment:

Answer 18

Ceftriaxone 250mg IM or EV dose única -> Doxiciclina 100mg VO 12/12h + Metronidazol 500mg VO 12/12h por 14d

Question 19

Complications:

Answer 19

Endometritis, Ooforitis, Peritonitis, Salpingitis, Perihepatitis and Ovarian tube abscess, chronic pelvic pain, ectopic pregnancy, tubal factor infertility

Question 20

DIP s/ peritonite (Classificação de Monif):

Answer 20

Estágio 1

Question 21

TTo ambulatorial se Monif:

Answer 21

Estágio 1

Question 22

DIP c/ peritonite (Monif):

Answer 22

Estágio 2

Question 23

Oclusão tubária ou abscesso tubo-ovariano (Monif):

Answer 23

Estágio 3

Question 24

Abscesso +10cm ou Roto (Monif):

Answer 24

Estágio 4

Question 25

TTo ambulatorial:

Answer 25

Ceftriaxona IM + Doxiciclina VO + Metronidazol VO

Question 26

TTo hospitalar:

Answer 26

Clinda + Genta EV

Question 27

Critérios diag (Menores ou Adicionais):

Answer 27

Corrimento, Massa pélvica, Tax +38,3°C, Leucocitose, +PCR ou VHS, +5 Leuco/campo em sec. da endocérv. e Comprovação de inf. por gonococo, clamídia ou micoplasma

Question 28

Critérios diag (Elaborados ou Definitivos):

Answer 28

Biópsia c/ Endometrite, Abscesso tubo-ovariano ou em fundo de saco, VLSC c/ evidência de DIP

Question 29

beta-HCG p/ excluir:

Answer 29

Gravidez ectópica e Abortamento febril

Question 30

Cultura da secreção cervical em meio de Thayer-Martin:

Answer 30

Gonococo

Question 31

Cultura da secreção cervical em meio de McCoy:

Answer 31

Clamídia

Question 32

Critérios Diagnósticos (Medcurso, 2015):

Answer 32

3 crit. maiores + 1 menor
ou
1 elaborado

Question 33

Critérios Diag (CDC, 2006):

Answer 33

Pelvic Pain + 1+ (Cervical motion, Uterine or Adnexal tenderness)