PID Flashcards
def. PID
inflammation of the endometrium, fallopian tubes, pelvic peritoneum, and or contiguous structures
what is PID epi
1: 7 lifetime risk
- chlam and gon
main group with STD
young peopel
ris factors for PID
- young age at first intercourse
- multiple or risk partners
- prior episode of PID
- recent IUD insertion
- upper gential tract manipulation
reason for young women getting more
more cervical columnar epi
etiology of PID
microbial infections
patho of PID
10-40% of untreated cerivicitis
- acends into uterus and tubes
- additional bact. may then ascend further in damaged tissues
what happens to tissues
- epithelial degen. and deciliation of the tissues
- edema of tubes
outcomes of PID
- obstruction of tibes lead to infert. or ectopics
- peritonitis occurs characterized by fibrinoid exudate on serosal surfaces
5 key points
- PID not and STD and not reportable
- common
- affects young
- polymicrobial infection
- causes damage to the upper genital tract anatomy
clinical presnetaion of PID
- may be sublte
- lower abdo/pelvic pain
DDx (4)
1 appendicitis
- ectopic preg.
- ruptured corpus luteum cyst
- endometriosis
6 associated findings
- abnormal discharge
- dyspareunia
- dysuria
- abnormal uterine bleeding
- nausea vomiting
- right upper quadrant pain (rarely)
5 physical presentations
- lower abdo tenderness
- cervical motions tenderness
- adnexal tenderness
- purulent cervical discharge
- fever
4 invesigations for PID
- vulvovaginal swabs with NAAT
- PCR on urine samples
- B-HCG to rule out preg
- CBC and ESR/reactive
what is key with cultrure
very few are culture +ve - and fever is uncommon in those that are
3 possible investigations
- US for adnexal mass
- laprascopy if unable to exclude other diagnosis
- endometrial biopsy (rare)
what is fitz-hugh curtis
rare complication of PID leads to RUQ pain
3 minimum finding we want to be able to diagnose based on
- lower abdo tenderness
- adnexal tenderness
- cervical motion tenderness
5 complications of PID
- recurrent PID
- chronic pelvic pain
- infertility
- ectopic preg
- tubo-ovarian abscess
2 key points
- early presentation can vary widely
2. early intervention is imperative
8 indications of hospitalization
- uncertain diagnosis
- haven’t ruled out surgical emerg. - append, ectopic
- preg.
- pelvic abscess
- patient not compliant with outpatient treatment
- severely ill
- failure to respond to outpatient for 72 hours
- cannot ensure follow-up
mgmt of PID
- low threshold for MGMT
- Ab to cover gon, trach., aerobic gr-, enteric
outpatient AB regimen
ceftriaxone and doxycyline +/- metronidazole
in patient AB regimen
- IV cefalosporin wiht act against anaerobes
- clindamycin plus gentamycin
- ofloxin (if resistant) and metronidazole
what is mgmt after AB (8)
- step down to oral AB after 48hours
- sexual contacts in last 60 days
- treat partners for gon and chlam
- no sex for 7 days
- mandatory reassess at 48-72 hours
- screen for other infectoins
- counsel on safe sex
- surg to drain abscess if need be
4 special mgmt cases
- IUD users
- preg.
- immunocompromised
- tubo ovarian abcess
mgmt for IUD
- remove after 2 doses of AB
- can leave in if high preg. risk
mgmt if preg
- uncommon
- in hosp
- IV clindamycin and gentamycin
- no doxy
mgmt for immuno compromised
- possible increase abscess
- delayed response
mgmt for abscess
- include anaerobes AB in step down
- laprascopic drainage
- conservative extirpation
what is important about abscess and fert.
need to treat and drain early
