Upper Female Reproductive Tract and Systemic Infections Flashcards
when does endometritis occur?
after instrumentation, c/s, IUD placement
what finding will be present in endometrial bx of a non-puerperial pt w/endometritis?
plasma cells
tx of endometritis
clindamycin IV if severe, cephalosporin IV if mild. Continue until pt is asx’c and/or afebrile for 48h.
if chronic, doxycycline for 3w
how to make dx of endometritis?
uterine tenderness, fever, elevated WBC
what age group is PID most common?
15-19 year-olds b/c of increased high-risk sexual behavior, lack of routine gyn care
how to dx PID?
fever, elevated WBC, pelvic pain, cervical motion tenderness, adnexal tenderness
laparoscopy is definitive dx, only used when appendicitis cannot be r/o
Fitzhugh-Curtis syndrome
perihepatitis froma scending infection from PID infecting liver
tx of PID:
hospitalize for IV cefoxitin or cefotetan until pt is asx’c for 48h. Then 10-14d doxycycline PO.
if compliant, can do outpt IM ceftriaxone until sx’s resolve followed by PO doxycycline
what are the major sequelae of PID?
increased rates of ectopic pg’ies
infertility
how is a tubo-ovarian abscess not really an abscess?
it is not walled-off :. more responsive to abx
when should you consider TOA?
when PID is not responsive to tx
dx of TOA?
elevated WBC, ESR, adnexal or posterior cul-de-sac fullness. Puss on culdocentesis.
U/s to distinguish b/w TOA and TOC
tx of TOAs?
IV broad-spec abx - cefoxitin + doxycycline
if that doesn’t work, expand using amp + gent + clinda or metronidazole
until afebrile for 48h
surgery if abx don’t work
causative organism of TSS?
s. aureus that produces TSST-1 (toxin)
cp of TSS:
high fever rash w/desquamation of skin hypotension myalgias GI upset low plts azotemia blood cx w/b neg
