PID Flashcards
A nonspecific term for a spectrum of upper genital tract conditions ranging
from acute bacterial infection to massive adhesions from old inflammatory scarring.
PID
MC initial organisms for PID
The most common initial organisms are chlamydia and gonorrhea
What is the usual initial infection in pts with PID
The initial infection starts with invasion of endocervical glands with chlamydia
and gonorrhea.
How does Acute salpingo-oophoritis occur in pts with PID
Usually after a menstrual period with breakdown of the cervical mucus barrier, the pathogenic organisms ascend through the uterus, causing an endometritis, and then the bacteria enter the oviduct where acute salpingo-oophoritis
develops.
RF for PID
The most common risk factor is female sexual activity in adolescence, with multiple
partners.
PID is increased in the month after insertion of an IUD, but this is probably exacerbation of preexisting subclinical infection
Mx of Cervicitis
Single dose orally of cefixime and azithromycin
What is the dx?
Bilateral lower abdominal-pelvic pain may be variable ranging from minimal to
severe.
Onset may be gradual to sudden, often after menses. Nausea and vomiting may be found if abdominal involvement is present
Acute salpingo-oophoritis
PE of Acute salpingo-oophoritis
Mucopurulent cervical discharge, cervical-motion tenderness, and bilateral
adnexal tenderness are present
Minimal criteria for Acute salpingo-oophoritis
– Sexually active young woman
– Pelvic or lower abdominal pain
– Tenderness: cervical motion or uterine or adnexal
Supportive criteria for Acute salpingo-oophoritis
– Oral temperature >101°F (>38.3°C)
– Abnormal cervical or vaginal mucopurulent discharge
– Presence of abundant WBC on vaginal fluid saline microscopy
– Elevated erythrocyte sedimentation rate
– Positive lab findings of cervical N. gonorrhoeae or C. trachomatis
– Most specific criteria for diagnosis:
– Endometrial biopsy showing endometritis
– Vaginal sono or MRI imaging showing abnormal adnexae
– Laparoscopic abnormalities consistent with PID
Abx for Acute salpingo-oophoritis
Ceftriaxone IM x 1 plus doxycycline po bid for 14 days with/without metronidazole
po bid for 14 days
______ is the accumulation of pus in the adnexae forming an inflammatory mass involving the oviducts, ovaries, uterus, or omentum
TOA
PE of TOA
Abdominal examination shows peritoneal signs, guarding, and rigidity.
Pelvic examination may show such severe pain that a rectal examination
must be performed. Bilateral adnexal masses may be palpated
Cervical cultures for TOA
Cervical cultures are positive for chlamydia or gonorrhea
Blood cultures for TOA
Blood cultures may be positive for gram-negative bacteria and anaerobic organisms such as Bacteroides
fragilis.
DDx for TOA
Septic abortion, diverticular or appendiceal abscess, and adnexal torsion
Mx of TOA
Inpatient IV clindamycin and gentamicin should result in fever defervescence
within 72 hours.
Sx MX of TOA
Exploratory laparotomy with possible
TAH and BSO or percutaneous drainage through a colpotomy incision may be required
SSx of chronic PID
Chronic bilateral lower abdominal-pelvic pain is present, varying from minimal to severe.
Other symptoms may include history of infertility, dyspareunia, ectopic pregnancy,
and abnormal vaginal bleeding. Nausea and vomiting are absent.
UTZ for chronic PID
Sonography may show bilateral cystic pelvic masses consistent with hydrosalpinges.
Dx of PID
This is based on laparoscopic visualization of pelvic adhesions
_____refers to recurrent, crampy lower abdominal pain, along with nausea, vomiting, and diarrhea, that occurs during menstruation in the absence of pelvic pathology
Primary dysmenorrhea
Primary dysmenorrhea severity categorized into a grading system based on?
menstrual pain, presence of systemic symptoms, and impact on daily activities.
Sx of primary dysmenorrhea from?
Symptoms appear to be caused by excess production of endometrial prostaglandin
F2α resulting from the spiral arteriolar constriction and necrosis that follow progesteronewithdrawal as the corpus luteum involutes
effect of PG to the uterus
The prostaglandins cause dysrhythmic
uterine contractions, hypercontractility, and increased uterine muscle tone, leading to
uterine ischemia.
The effect of the prostaglandins on the ______also can account
for nausea, vomiting, and diarrhea via stimulation of the gastrointestinal tract
gastrointestinal smooth muscle
_______ is a benign condition in which endometrial glands and stroma are
seen outside the uterus. This is not a premalignant condition.
Endometriosis
Although the etiology of endometriosis is not known, the most accepted theory of explanation is that of Sampson, which is ________
retrograde menstruation.
The most common site of endometriosis is the ______
ovary,
because this is functioning endometrium, it bleeds on a monthly basis and can create adnexal enlargements known as endometriomas, also known as a ____
chocolate cyst.
The second most common site of endometriosis is the______, and in this area the endometriotic nodules grow on the uterosacral ligaments, giving the characteristic
_____ and tenderness appreciated by rectovaginal examination
cul-de-sac
uterosacral ligament nodularity
Endometriosis
_______of endometriotic nodules or endometriomas is the definitive way of making the diagnosis
laparoscopic identification
Mx of EM
___can be helpful to endometriosis because there is no menstruation and also the dominant hormone is progesterone,
which causes atrophic changes in the endometrium
Pregnancy
Mx of EM
______achieves this goal through preventing progesterone withdrawal
bleeding
Pseudopregnancy
How to achieve pseudopregnancy
Continuous oral medroxyprogesterone acetate (MPA [Provera]), subcutaneous medroxyprogesterone acetate (SQ-DMPA [Depo Provera]), or combination oral contraceptive pills (OCPs) can mimic the atrophic changes of pregnancy.
Mx of EM
_____achieves this goal by making the ectopic endometrium atrophic.
The treatment is based on inhibition of the hypothalamic–pituitary–ovarian axis to
decrease the estrogen stimulation of the ectopic endometrium
Pseudomenopause
Meds for Pseudomenopause
– Testosterone derivative (danazol or Danocrine)
– Gonadotropin-releasing hormone (GnRH) analog (leuprolide or Lupron)
The best inhibition of the hypothalamic–pituitary–ovarian axis is achieved by____
GnRH analogs
GnRH stimulates the pituitary in a____, and GnRH analogs stimulate by ______ which produces a condition known as down-regulation of the pituitary
pulsatile fashion
continuous
stimulation,
EM Tx
Patients on Lupron therapy for >3–6 months can complain of
menopausal symptoms, such as hot flashes, sweats, vaginal dryness, and personality
changes
Lupron medication is continued for 3–6 months’ duration, and then a more acceptable medication for the inhibition of the axis can be used, such as _____
birth control pill
medication.
An alternative to Lupron is _____, which also suppresses FSH and LH but does not result in vasomotor symptoms
DMPA (Depo Provera)
Conservative Mx of EM
__________ may allow
adherent fimbria to function and achieve pregnancy
Lysis of paratubal adhesions
Conservative Mx of EM
Ovarian cystectomies as well as
______ can be treatment for endometriomas.
oophorectomies
Aggressive MX of EM
If fertility is not desired, particularly if severe pain is present because of diffuse adhesions, definitive surgical therapy may be carried out through a
total abdominal hysterectomy (TAH) and bilateral salpingo-oophorectomy (BSO).
Endometriosis is not a malignant condition but is associated with higher risk of
________ mechanism unclear
ovarian carcinoma;
