PID Flashcards
what is PID
A bacterial infection that spreads beyond the cervix to the upper female reproductive tract and or peritoneal cavity
what can PID cause (7)
- Endometritis
- Salpingitis
- pyosalpinx/ hydrosalpinx
- Oophoritis
- tuboovarian abscess
- Parametritis
- Peritonitis.
what are common causes of PID (2)
- Chlamydia trachomatis
- Neisseria gonorrhoeae.
what are other causes of PID (3)
- E.coli
- ureaplasma
- mycoplasma
what are clinical features of PID (10)
- Pelvic pain – which may progress to an acute abdomen
- Adnexal tenderness on bimanual palpation
- Cervical motion tenderness
- Fever
- Abnormal vaginal discharge
- LAP
- Dyspareunia
- dysuria
- nausea and vomiting
- irregular menstrual bleeding ( HMB, PCB, spotting)
what are risk factors for PID (7)
- Multiple sexual partners
- unprotected sexual intercourse
- History of prior STIs
- Intrauterine devices
- Vaginal dysbiosis
- new sexual partner
- Douching
what is a common triad for PID
- LAP
- Adnexal tenderness
- cervical motion tenderness
Besides the normal triad for PID diagnosis what other things can accompany the triad (6)
- Temp> 38.3
- Purulent material in the pouch of douglas
- abnormal vaginal discharge
- Leukocytosis
- pelvic mass - tubo-ovarian abcess
- positive test for gonorrhea and chlamydia
what is a ddx for PID (8)
Gynecological
1. ectopic pregnancy
2. ovarian cyst rupture
3. ovarian torsion
4. endometriosis
Non-gynecological
1. Appendicitis
2. Kidney stones
3. IBS
4. diverticulitis
what investigations can you do (4)
- Pregnancy test- to rule out intrauterine/ ectopic pregnancy
- Blood tests
- HIV testing, RPR for syphilis
- FBC
- ESR - Imaging: Transvaginal USS
- Vaginal and/or cervical swab testing NAAT and/or culture for N.gonorrhoeae and C. trachomatis
what is the gainesville classification of acute PID (5)
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
what are the goals of PID treatment (5)
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
what is the treatment of PID (4)
- Gentamycin 240mg IM x1
- Doxycline 100mg q12hours x14 days
- Metronidazole 400mg q8 hours x14 days
- Also treat partner with gentamycin and doxycline
If not improved within 72 hours, not tolerating oral intake, signs of sepsis, or pelvic mass, what inpatient treatment do you give (2)
- Gentamycin 1.5mg/kg IV or IM q8 hours
- Clindamycin 900mg IV q8 hours
what are short term complications of PID (3)
- Pelvic peritonitis
- Fitz-Hugh syndrome- RUQ (violin string like adhesions)
- Tubo-ovarian abscess
what are indications for surgery (4)
- A proven tubo-ovarian abscess on ultrasound
- A ruptured tubo-ovarian abscess
- A patient still not improving on conservative management
- A patient in septic shock
what are long term complications of PID (3)
- Infertility
- Ectopic pregnancy
- Chronic pelvic pain- Intestinal adhesions between bowel and pelvic organs/ tubal adhesions/ ovarian adhesions
what causes fitzs Hugh Curtis syndrome
Purulent materials spills from tubes into abdomen directly or lympatically
what is Fitz hugh curtis syndrome
bacterial perihepatitis
what is usually normal in Fits-Hugh-Curtis syndrome
LFTs
what symptoms are found in fitz hugh curtis syndrome (2)
- RUQ
- shoulder pain
when doing a laparatomy what do you if there is fitz hugh curtis syndrome
violin string like adhesions
