PID Flashcards
(30 cards)
_____ is a clinical syndrome associated with ascending spread of microorganisms from the vagina or cervix to the endometrium, fallopian tubes, ovaries, and contiguous structures.
Pelvic Inflammatory dz
Pelvic Inflammatory dz Comprises a spectrum of inflammatory disorders including any combination of ___, ____, ____, and _____.
endometritis
salpingitis
tubo-ovarian abscess
pelvic peritonitis
what are RF for PID? (there’s a lot.. 9 to be exact)
Adolescence Hix of PID Gonorrhea or chlamydia Multiple partners Current douching Insertion of IUD BV Demographics (socioeconomic status) Oral contraceptive use (in some cases)
Most cases of PID are _____ (i have no good hints for this)
polymicrobial
What are common pathogens involved in PID?
N. gonorrhoeae
- cervix in 30%-80% of women with PID
C. trachomatis
- cervix in 20%-40% of women with PID
N. gonorrhoeae and C. trachomatis are present in combination in approximately 25%-75% of patients
what are less common pathogens involved in PID?
E.coli (aerobic gram (-) rod)
Bacteroides spp., Prevotella spp., Peptostreptococcus spp. (anareobes, especially associated with BV)
Streptococcus spp (Gram-positive organisms)
Mycoplasma genitalium and Ureaplasma urealyticum
what is the pathway of ascendant infection for PID?
Cervicitis–> endometritis –> Salpingitis/oophoritis/tuboovarian abscess –> peritonitis
when there is infection (PID) there is a destruction of ___ (structure) histologiclaly
cilia
___ is thought to be present 60% of the time, notable because it lacks symptoms. women usually complain of dyspareunia, dysuria, irregular bleeding, GI sxs
Subclinical disease (PID)
___ is overt mild to moderate PID, women may complain of lower abdominal pain or pelvic pain, cramping, or dysuria. They may also exhibit signs such as intermittent or post-coital bleeding, vaginal discharge, or fever.
symptomatic (PID)
what PE signs may be present in symptomatic PID
Uterine tenderness
cervical motion pain
adnexal tenderness (may be most sensitive sign)
___ occurs when women appear very ill with fever, chills, purulent vaginal discharge, nausea, vomiting, and elevated white blood cell count (WBC). Other laboratory indicators, such as erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), may also be elevated.
Severe PID
subclinical PID occurs ___% of the time
mild-moderate sx ___%
Severe sxs ___%
60%
36%
4%
Approximately ___% of women with a single episode of PID will experience sequelae, such as ___, ____, ____, or ____
25
ectopic pregnancy, infertility, or chronic pelvic pain
Ectopic pregnancy is increased __-___x after PID
6-10x
Tubal infertility occurs in…
___% of women after one episode of PID
___% of women after two episodes
___% of women after three episodes
8%
20%
50%`
what other (obscure) clues may suggest a pt has PID? Temperature >\_\_\_\_ Abnormal cervical or vaginal \_\_\_\_\_ Presence of \_\_\_\_ on saline wet prep Elevated \_\_\_\_\_ and \_\_\_\_\_\_ \_\_\_ or \_\_\_ test positive
Temperature >38.3°C (101°F)
Abnormal cervical or vaginal mucopurulent discharge
Presence of WBCs on saline wet prep
Elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP)
Gonorrhea or chlamydia test positive
what can you ude to dx PID?
Endometrial biopsy
Transvaginal sonography or MRI
Laparoscopy
What is a sign you may see on U/S that suggests the pt has PID?
TOA (tubal ovarian abscess)
____ is a complication of gonococcal or chlamydial salpingitis.
Fitz-Hugh-Curtis Syndrome
Fitz-Hugh-Curtis Syndrome is characterized by ____ pain in association with acute salpingitis, indicating ___.
right upper quadrant pain
perihepatitis
what can Fitz-Hugh-Curtis Syndrome be mistaken for?
Acute cholecystitis
what is the criteria for hospitalization for PID?
pregnancy
non-response to oral therapy
severe illness, N/V, hihg fever, TOA
HIV with low CD4 count
What is the tx for PID?
Ceftriaxone + Doxy/metronidazole
Cefoxitin +Doxy/metronidazole
(IV: Cefotetan + Doxy or Cefoxitin + doxy, Clindamicin + gentamicin)
