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Obs&Gynae > PID > Flashcards

PID Flashcards

1
Q

what is PID

A

A bacterial infection that spreads beyond the cervix to the upper female reproductive tract and or peritoneal cavity

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2
Q

what can PID cause (7)

A
  1. Endometritis
  2. Salpingitis
  3. pyosalpinx/ hydrosalpinx
  4. Oophoritis
  5. tuboovarian abscess
  6. Parametritis
  7. Peritonitis.
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3
Q

what are common causes of PID (2)

A
  1. Chlamydia trachomatis
  2. Neisseria gonorrhoeae.
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4
Q

what are other causes of PID (3)

A
  1. E.coli
  2. ureaplasma
  3. mycoplasma
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5
Q

what are clinical features of PID (10)

A
  1. Pelvic pain – which may progress to an acute abdomen
  2. Adnexal tenderness on bimanual palpation
  3. Cervical motion tenderness
  4. Fever
  5. Abnormal vaginal discharge
  6. LAP
  7. Dyspareunia
  8. dysuria
  9. nausea and vomiting
  10. irregular menstrual bleeding ( HMB, PCB, spotting)
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6
Q

what are risk factors for PID (7)

A
  1. Multiple sexual partners
  2. unprotected sexual intercourse
  3. History of prior STIs
  4. Intrauterine devices
  5. Vaginal dysbiosis
  6. new sexual partner
  7. Douching
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7
Q

what is a common triad for PID

A
  1. LAP
  2. Adnexal tenderness
  3. cervical motion tenderness
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8
Q

Besides the normal triad for PID diagnosis what other things can accompany the triad (6)

A
  1. Temp> 38.3
  2. Purulent material in the pouch of douglas
  3. abnormal vaginal discharge
  4. Leukocytosis
  5. pelvic mass - tubo-ovarian abcess
  6. positive test for gonorrhea and chlamydia
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9
Q

what is a ddx for PID (8)

A

Gynecological
1. ectopic pregnancy
2. ovarian cyst rupture
3. ovarian torsion
4. endometriosis

Non-gynecological
1. Appendicitis
2. Kidney stones
3. IBS
4. diverticulitis

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10
Q

what investigations can you do (4)

A
  1. Pregnancy test- to rule out intrauterine/ ectopic pregnancy
  2. Blood tests
    - HIV testing, RPR for syphilis
    - FBC
    - ESR
  3. Imaging: Transvaginal USS
  4. Vaginal and/or cervical swab testing NAAT and/or culture for N.gonorrhoeae and C. trachomatis
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11
Q

what is the gainesville classification of acute PID (5)

A

Stage 1
- endometritis, salpingitis, no peritonitis
Stage 2
- acute salpingitis with peritonitis
Stage 3
- acute salpingitis with either tubal occlusion/ tubo-ovarian complex/abscess
Stage 4
- rupture of tubo-ovarian abscess
Stage 5
- associated with respiratory complications

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12
Q

what are the goals of PID treatment (5)

A

Stage I:
Eliminate symptoms and infectivity
Stage II:
Preservation of fallopian tube function
Stage III:
Preservation of ovarian function
Stage IV:
Preservation of patient’s life

NB : Stages I and II is treated conservatively with antibiotics while stages III to V is by laparotomy

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13
Q

what is the treatment of PID (4)

A
  1. Gentamycin 240mg IM x1
  2. Doxycline 100mg q12hours x14 days
  3. Metronidazole 400mg q8 hours x14 days
  4. Also treat partner with gentamycin and doxycline
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14
Q

If not improved within 72 hours, not tolerating oral intake, signs of sepsis, or pelvic mass, what inpatient treatment do you give (2)

A
  • Gentamycin 1.5mg/kg IV or IM q8 hours
  • Clindamycin 900mg IV q8 hours
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15
Q

what are short term complications of PID (3)

A
  1. Pelvic peritonitis
  2. Fitz-Hugh syndrome- RUQ (violin string like adhesions)
  3. Tubo-ovarian abscess
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15
Q

what are indications for surgery (4)

A
  1. A proven tubo-ovarian abscess on ultrasound
  2. A ruptured tubo-ovarian abscess
  3. A patient still not improving on conservative management
  4. A patient in septic shock
16
Q

what are long term complications of PID (3)

A
  1. Infertility
  2. Ectopic pregnancy
  3. Chronic pelvic pain- Intestinal adhesions between bowel and pelvic organs/ tubal adhesions/ ovarian adhesions
17
Q

what causes fitzs Hugh Curtis syndrome

A

Purulent materials spills from tubes into abdomen directly or lympatically

18
Q

what is Fitz hugh curtis syndrome

A

bacterial perihepatitis

19
Q

what is usually normal in Fits-Hugh-Curtis syndrome

A

LFTs

20
Q

what symptoms are found in fitz hugh curtis syndrome (2)

A
  • RUQ
  • shoulder pain
21
Q

when doing a laparatomy what do you if there is fitz hugh curtis syndrome

A

violin string like adhesions

Obs&Gynae (24 decks)

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