PID Flashcards

1
Q

def. PID

A

inflammation of the endometrium, fallopian tubes, pelvic peritoneum, and or contiguous structures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what is PID epi

A

1: 7 lifetime risk

- chlam and gon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

main group with STD

A

young peopel

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

ris factors for PID

A
  1. young age at first intercourse
  2. multiple or risk partners
  3. prior episode of PID
  4. recent IUD insertion
  5. upper gential tract manipulation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

reason for young women getting more

A

more cervical columnar epi

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

etiology of PID

A

microbial infections

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

patho of PID

A

10-40% of untreated cerivicitis

  • acends into uterus and tubes
  • additional bact. may then ascend further in damaged tissues
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what happens to tissues

A
  • epithelial degen. and deciliation of the tissues

- edema of tubes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

outcomes of PID

A
  • obstruction of tibes lead to infert. or ectopics

- peritonitis occurs characterized by fibrinoid exudate on serosal surfaces

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

5 key points

A
  1. PID not and STD and not reportable
  2. common
  3. affects young
  4. polymicrobial infection
  5. causes damage to the upper genital tract anatomy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

clinical presnetaion of PID

A
  • may be sublte

- lower abdo/pelvic pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

DDx (4)

A

1 appendicitis

  1. ectopic preg.
  2. ruptured corpus luteum cyst
  3. endometriosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

6 associated findings

A
  1. abnormal discharge
  2. dyspareunia
  3. dysuria
  4. abnormal uterine bleeding
  5. nausea vomiting
  6. right upper quadrant pain (rarely)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

5 physical presentations

A
  1. lower abdo tenderness
  2. cervical motions tenderness
  3. adnexal tenderness
  4. purulent cervical discharge
  5. fever
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

4 invesigations for PID

A
  1. vulvovaginal swabs with NAAT
  2. PCR on urine samples
  3. B-HCG to rule out preg
  4. CBC and ESR/reactive
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what is key with cultrure

A

very few are culture +ve - and fever is uncommon in those that are

17
Q

3 possible investigations

A
  1. US for adnexal mass
  2. laprascopy if unable to exclude other diagnosis
  3. endometrial biopsy (rare)
18
Q

what is fitz-hugh curtis

A

rare complication of PID leads to RUQ pain

19
Q

3 minimum finding we want to be able to diagnose based on

A
  1. lower abdo tenderness
  2. adnexal tenderness
  3. cervical motion tenderness
20
Q

5 complications of PID

A
  1. recurrent PID
  2. chronic pelvic pain
  3. infertility
  4. ectopic preg
  5. tubo-ovarian abscess
21
Q

2 key points

A
  1. early presentation can vary widely

2. early intervention is imperative

22
Q

8 indications of hospitalization

A
  1. uncertain diagnosis
  2. haven’t ruled out surgical emerg. - append, ectopic
  3. preg.
  4. pelvic abscess
  5. patient not compliant with outpatient treatment
  6. severely ill
  7. failure to respond to outpatient for 72 hours
  8. cannot ensure follow-up
23
Q

mgmt of PID

A
  • low threshold for MGMT

- Ab to cover gon, trach., aerobic gr-, enteric

24
Q

outpatient AB regimen

A

ceftriaxone and doxycyline +/- metronidazole

25
in patient AB regimen
1. IV cefalosporin wiht act against anaerobes 2. clindamycin plus gentamycin 3. ofloxin (if resistant) and metronidazole
26
what is mgmt after AB (8)
1. step down to oral AB after 48hours 2. sexual contacts in last 60 days 3. treat partners for gon and chlam 4. no sex for 7 days 5. mandatory reassess at 48-72 hours 6. screen for other infectoins 7. counsel on safe sex 8. surg to drain abscess if need be
27
4 special mgmt cases
1. IUD users 2. preg. 3. immunocompromised 4. tubo ovarian abcess
28
mgmt for IUD
- remove after 2 doses of AB | - can leave in if high preg. risk
29
mgmt if preg
- uncommon - in hosp - IV clindamycin and gentamycin - no doxy
30
mgmt for immuno compromised
- possible increase abscess | - delayed response
31
mgmt for abscess
- include anaerobes AB in step down - laprascopic drainage - conservative extirpation
32
what is important about abscess and fert.
need to treat and drain early