W10_06 PID Flashcards
define PID
inflammation of the endometrium, fallopian tubes, pelvic peritoneum and or contiguous structures. Above the cervix
what are the risk factors of PID?
young age @ first intercourse;
multiple and/or high risk sexual partners;
prior episode of PID;
recent IUD insertion;
upper genital tract instrumentation
how does the squamous/columnar border of the cervix change with age?
area of columnar gets smaller and smaller
which organisms can cause PID?
n.gonorrhea and chlaymidia;
genital mycoplasmas, including M.hominis, ureaplasma urealyticum, m. genitalium;
aerobic gram negative bacilli, including e.coli, anaerobes from GI and vagina
what’s the proportion of women who develop PID from cervicitis?
10-40%
note: PID can cause damage to the ciliated cells of the fallopian tube
this causes infertility and ectopic pregnancies
how does PID cause closure of the fallopian tube?
edema of the fallopian tube pushes the folds together, and the inflammation makes the lumen sticky. Note, as this progresses, more and more things get stuck together permanently - causing pain and associated issues
note: PID is an infection. Can be due to things like STD, or ruptured appendix, etc
ok
what’s a common DDx of lower pelvic pain? (obs-gyn)
appendicitis;
ectopic pregnancy;
ruptured corpus luteum cyst;
endometriosis
what are some common complaints of PID presentations?
abnormal vagina discharge;
dyspareunia;
dysuria;
abnormal uterine bleeding;
nausea, vomiting;
right upper quadrant pain (rare)
what’s the significance of cervical motion tenderness?
it always hurts on palpation, but if the patient jumps off the table on palpation - sign of peritonitis
note: purulent cervical discharge is not always there in PID. Want to catch them before this happenes
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what are some physical findings of PID?
lower abdominal tenderness;
cervical motion tenderness;
adnexal tenderness;
purulent cervical discharge (<30%);
fever
what are some investigations to order in PID?
chlamydia or gonorrhea swabs for NNAT in the vulvovagina, or culture for drug sensitivity testing;
PCR on urine samples;
beta-HCG to r/o preg;
CBC, differential, ESR/CRP good for TOA
note: only a small proportion of PID is associated with positive cultures
STD and cervicitis doesn’t necessarily point to PID!
what’s fitz hugh curtis syndrome?
a complication of PID where adhesions occur in the right upper quadrant, causing localized pain and referred shoulder tip pain
what are the minimum criteria of PID?
lower abdominal tenderness, adnexal tenderness, cervical motion tenderness
what are complications of PID?
recurrent PID;
chronic pelvic pain;
infertility (with increasing episodes);
ectopic pregnancy;
tubo-ovarian abscess
how to treat someone, sexually active, with symptoms of abdominal, adnexal, and cervical motion tenderness?
give antiobiotics. For n.gonorrhea, chlamydia, aerobic gram negative enteric bacilli, enteric anaerobes
how to manage someone with IUD and pelvic disease?
probably want to take the IUD out (after 2 doses of antibiotics), but can leave it in if considered high risk for pregnancy
how to manage someone with PID and is pregnant?
unlikely to get PID while pregnant, so more likely a past infection. Can’t use doxycycline in pregnancy, so use clinda and genta
how to manage someone with PID and tubo-ovarian abscess?
add anaerobic antibiotics;drainage - guided with US or CT, or laparoscopic;remove tube and ovary - might need to do both sides
what’s the ideal management for someone with TOA?
no rupture, immediate laparoscopic drainage within 24 hours and medical management for pregnancy rates between 32-63%
