PID/PCOS/ENDOMETRIOSUS Flashcards
ascending spread of microorganism and contiguous structures from vagina or cervix to endometrium, tubes, ovarious
PID
60% of PID is ___
subclinical or silent
examples of PID RF
adolescence GC or CHL or HX of GC/CT Multiple partners Inserting IUD Demographic SES Hx of PID Male Partners w/ GC or Chl BV OCP in some cases
top 2 most common pathogens with PID
N. gonorrhoeae
C. trachomatis
what are some sx women with subclinical PID may experience?
- dyspareunia
- irregular bleeding
- dysuria
- GI sx
what bacteria is implicated with subclinical PID presentation?
C. trachomatis
most common sign on pelvic exam in pt with moderate PID
uterine, cervical motion, and adnexal TTP
Chandelier sign
what s/s indicate severe PID
high WBC and ESR/CRP
very ill: fever, chills, purulent d/c, N/V
risk of ectopic pregnancy is __ higher after PID
6-10 times higher after PID
tubal infertility rates after __ episodes of PID
1: 8% of women
2: 20% of women
3: 50% of women
what is fitz hugh Curtis syndrome
RUQ pain associated with acute salpingitis
indicating perihepatitis
what is fitz hugh Curtis syndrome mistaken for?
acute cholecystitis may be suspected but signs of PID show up quickly
PID dx criteria
uterine TTP or cervical motion TTP (w/ no other explanation)
Other add on signs:
- temp 38.3
- abnormal discharge
- WBC on saline wet prep
- Gonorrhea or chlamydia test
Mucopurulent Cervical discharge + test
5 reasons to admit PID pt
- cant r/o appendicitis ectopic
- Pregnancy
- No response to output antimicrobial tx 48-72 hrs
- severe illness (N/V, fever, TOA)
- HIV infxn with low CD4 count
1st line PID tx
ceftriaxone 250mg IM + doxy 100 mg BID for 14 days
OR
Ceftriaxone 250mg IM + Metronidazole 500mg BID X 14 days
if choosing cefoxitin instead of ceftriaxone what po med would you pair it with for PID tx
cefoxitin 2g IM + Probenecid 1 g PO administered
PLUS
doxy or metronidazole
parenteral PID tx
cefotetan 2gIV q 12 hr plus doxy
women with PID sex?
no wait until tx is done, sx resolved and partners are treated
all women with PID need to be tested for..
HIV, GC, HIV and Chl (NAAT)
PID pts should show improvement with tx in ___
72 hrs
all women dx with GC/Chl should be retested ____after tx regardless of whether their partner has been treated
3mo
all pregnant women in 1st trimester are screened for___
PID
when is screening for chlamydia recommended
all women that are active and under 25, and all those active over 25 that are high risk
t/f male partners of women with PID should be examined and tx if they had contact within 60 days prior to sx onset
true!
male partners of PID women are often asymptomatic when the bacteria etiology is…
c trichamatis and N. gonorrhoaea
how treat PID sexual partners?
empirically for c. trachomatis or N. gonorrhoeae
t/f gonorrhea and chlamydial is reportable in all states
TRUE
3 main complications of pID
- ectopic preg
- chronic pelvic pain
- Infertility
PCOS 3 main characteristics
hyperandrogenism
ovulatory dysfunction
polycystic ovaries
what are some secondary cause of hyperaldosteronism to r/o before dx PCOS
- adult onset CAH
- Hyperprolactinemia
- Androgen secreting neoplasms
what is link between hyperinsulinemia and PCOS?
high levels of insulin in blood lead to low levels of sex hormone binding globulin
this increases levels of free androgens = hyperadnrogenism
3 main U/s findings of PCOS
12+ follicles in each ovary
follicles 2-9mm in diameter
high ovarian volume over 10 mL
TX PCOS menstrual irregularities
- Combined OCP
- Progestins also option
- Insulin Sensitizing agents
what DM meds good for PCOS
Biguanides (metformin)
OR
thiazolidinediones (pioglitazone, rosiglitazone)
what dose of combined OCP is best for PCOS?
low dose for insulin sensitivity etc
tx for hirsutism
laser therapy, combo therapies
medical methods will help as well - spironolactone with OCP
what OCP do you not want to give with spironolactone
one that contains drospirenone
from spironolactone family as well.. retain too much K+?
how does spironolactone help with PCOS sx?
- androgen receptor antagonist
- competes for androgen receptors on follicles
- inhibits 5 aphla reducatse
what does 5 alpha reducatase do?
converts testosterone into dihydrotestosterone
what is dihydrotestosterone?
DHT
Responsible for male sexual maturation and secondary sexual characteristics
what do flutamide and finasteride do for PCOS?
for hirsutism.. yet high risk of teratogenicity
Eflornithine role
FDA med for female facial hirsutism
ADR: stinging, burning, erythema,
is laser or electrolysis better for hirsutism?
laser therapy
adding eflornithine on top of laser is even better as well
benign condition, endometrial glands and stroma present outside uterus
endometriosus
typical endometriosus pt
30s, nulliparous, infertile but can present throughout reproductive yrs
endometriosus is found in ___ fraction of women with chronic pelvic pain
1/3
3 theories of endometriosus pathology
- Retrograde menstration: fragments transport out via fallopian tubes during menses
- Mullerian metaplasia theory: metaplastic transformation of pelvic peritoneum
- lymphatic spread: substances released/shed from endometrial induce formation of endometriosus
what is sampsons therory
retrograde menstration - endometriosus
what is Meyers theory
mullerian or coelomic metaplasia theory for endometriosus
what is halbans theory
lymphatic spread theory of endometriosus
where is most common location of endometrial deposits?
ovary (chocolate cysts)
classic triad of endometriosus
dysmenorrhea, dyspareunia, dyschezia
DX of endometriosus
direct visualization: laparotomy or laproscopy
histologic and gross findings consisitent with dx
US findings for endometriosus
adnexal mass of complex echogenicty, internal echos consistent with blood
ca125 test
for endometriosus.. not sensitive or specific
1st line tx for endometriosus
NSAIDS, OCP, Progestins trial for 3-6mo
2nd line tx for endometriosus
levonorgestrel (mirena IUD), GnRH agonist (Lupron), high dose progestin, danazol
what is important about using Lupron for tx
do no give w/o laparoscopy first.. relief of pain does not make the dx
ADR: hotflashes, bone loss, depression
what is danazol
2nd line tx option endometrioses
androgenic derivative suppresses LH and FSH
previously the gold standard for endometriosus
danazol
not anymore due to ADR: weight gain, hirsutism, acne, deep voice, pseudomenopause - anovulation and hypergonadism
how to protect fertility for endometrioses pt
- laparoscopic w/ ablation of implants / adhesions
2. should remove endometrioses over 3 cm in diameter
most definitive tx endometrioses
hysterectomy ..yet still risk of reoccurrence
how decrease risk of endometrioses
min. menses flow and suppress ovarian cycling
