Repro CIS Flashcards
DDX for acute lower abd/pelvic pain
- PID
- appendicitis
- ectopic preggo
- ovarian cyst, tumor
- endometriosis
- pyelonephritis
- IBD
- Gastroenteritis
- Nephrolithiasis
- Cholecystitis
What are the 2 most important sexually transmitted organisms associated with acute PID?
- Chlamydia trachomatis
- N. Gonorrhea
Regardless of hx, what should we always obtain if woman is of reproductive age?
-pregnancy test
What needs to happen a little bit after tubal ligation when people have sex after?
-they need to use barrier contraception for a little bit
If someone has PID, what is one important thing that we must keep in ddx?
- sexual abuse
- screen for it
What organisms should we test for when someone has PID?
- C. trachomatis
- N. gonorrhea
- HIV
- hepatitis
- syphillis recommonded
Who else should be treated if a woman has PID?
-her male sex partner
Does negative endovervical screening for chlamydia and gonorrhea rule out upper tract infection?
-no!
clinical features of PID?
- lower abd pain
- pain during or shortly after menses
- new vaginal discharge
- dyspareunia
- abnormal bleeding
- pain with jarring movement
Indications for hospitalization in PID
- preggo
- lack of response to tx
- non-adherence
- inability to take oral meds due to N/V
- severe clinical illness
- complication with abscess
- possible need for surgical intervention or exploration
Complications of PID
- 10% have perihepatitis (Fitz-hugh Curtis syndrome)
- bartholin gland abscess
What is Fitz-hugh curtis syndrome
- infection of liver capsule and peritoneal surfaces of the RUQ
- violin string adhesions
What are some long term sequelae of PID?
- infertility
- ectopic preggo
- chronic pain
- pelvic abscess
- transvaginal US if suspected
Risk factors for PID
-up to 10% of untreated gonorrhea and 20% of untreated chlamydia may develop PID
STD risk factors
- young age at first sex
- non-barrier contraception
- multiple sex partners
factors that potentially facilitate PID
- previous PID
- sex during menses
- vaginal douching
- BV, IUD
tx options for PID
-2nd or 3rd generation cephalosporin (ceftriaxone) and azithromycin or doxycycline
What do we have to make sure we include in tx if there is a pelvic abscess?
- clindamycin or metronidazole
- this gives us anaerobic coverage: “below the diaphragm”
What is the buzz word for IUD?
- actinomyces israelii
- we have to cover that anaerobe!
What drug do we have to make sure we include if there is Trichomonas vaginalis in there?
-metronidazole
When should OMT be used in these patients?
-once abx have been started and fever has resolved
Symp for ovaries
-T10-11
Symp for uterus
-T9-L2
Symp for Fallopian tubes
-T10-L2
Symp for Colon
- same as uterus
- T9-L2
Parasymp for female urogenital tract and distal colon?
-S2-S4 (Pelvic splanchnic nerves)
parasymp for proximal to mid-transverse colon
-AA/OA
What does the right lymphatic duct drain?
- right head and neck
- right UE
- All lung lobes except upper left
- thoracic duct drains the rest
Sequence of lymphatic tx
- Thoracic inlet
- pelvic diaphragm
- Thoracic area
- Abdominal area
- UE or LE depending on which is more dysfunctional
- UE or LE
- Head and Neck
- Thoracic Inlet
