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DipGUM > Pelvic Inflammatory disease (PID) > Flashcards

Pelvic Inflammatory disease (PID) Flashcards

1
Q

How does PID occur?

A

Ascending infection/organism from endocervix

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2
Q

What comprises PID?

A 
Endometritis
Salpingitis
Parametritis
Oophoritis
Tubo-ovarian abscess
Pelvic peritonitis
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3
Q

What organisms are implicated in PID?

A 
Chlamydia trachomatis
Neisseria gonorrhoea
Gardnerella vaginalis
Anaerobes - prevotella, atopobium, leptotrichia
Mycoplasma genitalium
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4
Q

What is the most common organism implicated in PID?

A

Chlamydia

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5
Q

What proportion of PID is due to chlamydia?

A

14-35%

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6
Q

How long is there increased risk of PID following IUD insertion?

A

4-6 weeks

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7
Q

What increases the risk of PID following IUD insertion?

A

gonorrhoea or C. trachomatis infection

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8
Q

PID - SYMPTOMS?

A

lower abdominal pain - BILATERAL (can be unilateral)
Abnormal vaginal/cervical discharge
DEEP dyspareunia
Abnormal vaginal bleed - post coital, intermenstrual, menorrhagia
secondary dysmenorrhoea

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9
Q

PID - SIGNS?

A

lower abdominal tenderness
Adnexal tenderness on bimanual
cervical motion tenderness
Fever (moderat/severe disease)

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10
Q

When should a diagnosis of PID be considered?

A

Sexually active female
RECENT onset lower abdominal pain
ASSOCIATED with local tenderness on bimanual

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11
Q

What should be excluded in women who present with PID type symptoms?

A

PREGNANCY

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12
Q

What factors increase the risk of PID?

A

Women <25 yrs
NO barrier protection
NEW sexual partner

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13
Q

Fitz-Hugh Curtis syndrome - describe?

A

RIGHT UPPER QUADRANT pain

associated with PERIHEPATITIS

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14
Q

Which STI is most associated with Fitz-Hugh Curtis?

A

Chlamydia

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15
Q

When should tubo-ovarian abscess be suspected in PID?

A

Systemically UNWELL

SEVERE pelvic pain

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16
Q

When should abdominal imaging take place in PID?

A

Adnexal mass

Lack of response to treatment

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17
Q

What imaging modalities can be used in PID?

A

US
CT
MRI

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18
Q

PID + IUD - mild/moderate symptoms - management?

A

Leave in

Review 48-72 hours to ensure clinical improvement

19
Q

What other factors should be considered prior to removing a IUD for PID?

A

Risk of PREGNANCY

Timing of last unprotected sex

20
Q

What is the positive predictive value of clinical diagnosis vs laparoscopic?

A

65-90%

21
Q

What benefit are CRP and FBC in PID?

A

if raised support diagnosis

22
Q

When is CRP or WCC typically raised in PID?

A

Moderate or severe PID

23
Q

How does looking for endocervical or vaginal pus cells help in diagnosis of PID?

A

ABSENCE of pus cells good negative predictive value for PID

24
Q

What is US useful for in PID?

A

To identify abscess or hydrosalpinx

25
Q

Between CT & MRI what is preferred for imaging in PID? Why?

A

MRI
Good high resolution images
No radiation exposure for women of reproductive age

26
Q

What is the differential diagnosis for PID (6)?

A 
Ectopic pregnancy
Acute appendicitis
Endometriosis
Ovarian cyst - rupture or torsion
UTI
Irritable bowel syndrome
27
Q

What feature in clinical presentation makes appendicitis more likely than PID?

A

Nausea and vomiting

28
Q

What might help differentiate endometriosis from PID?

A

relationship between symptoms and menstrual cycle

29
Q

What feature in clinical presentation makes UTI more likely than PID?

A

dysuria

urinary frequency

30
Q

Why is a LOW threshold for treatment of PID indicated?

A

Significant complications if delayed treatment

lack of definitive diagnostic criteria

31
Q

Following treatment for PID what impact is there on pregnancy rate?

A

Similar or higher than general population

32
Q

When should IV therapy and hospital admission be considered for PID?

A

Fever
Clinical sign of tubo-ovarian abscess
Pelvic peritonitis
Lack of response to oral therapy

33
Q

What increases the risk of infertility with PID?

A

Repeat episodes of PID

34
Q

PID - first line treatment?

A

CEFTRIAXONE 1gram IM
+
DOXYCYCLINE 100mg twice daily oral 14 days
+
METRONIDAZOLE 400MG twice daily oral 14 days

35
Q

PID - what is an alternative treatment?

A

OFLOXACIN 400mg twice daily oral 14 days
+
Metronidazole 400mg twice daily oral 14 days

36
Q

Why is metronidazole used on PID?

A

To improve anaerobic cover

37
Q

When can metronidazole be discontinued? Why?

A

If NOT tolerated in MILD/MODERATE disease

anaerobes greater importance in severe PID

38
Q

When should ofloxacin or moxifloxacin be avoided in patients?

A

those high risk of GONOCOCCAL PID

39
Q

In the UK, what proportion of PID is due to gonorrhoea?

A

less than 3%

40
Q

What is the benefit of levofloxacin over ofloxacin?

A

L isomer of ofloxacin

once daily dosing

41
Q

What inpatient regimens are used in PID?

A 
IV ceftriaxone TWO gram
IV doxycycline if oral not tolerated
oral metronidazole
OR 
IV clindamycin 900mg three times daily
IV gentamicin
42
Q

When can IV therapy be switched to oral for PID?

A

After 24 hours of clinical improvement

43
Q

If PID occurs in pregnancy, how should it be managed?

A

With IV therapy and hospital admission

44
Q

How should pelvic fluid collections may managed in PID?

A

US guided aspiration
OR
laparascopic division adhesions and drainage of collections

DipGUM (39 decks)

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