W10_06 PID

Question 1

define PID

Answer 1

inflammation of the endometrium, fallopian tubes, pelvic peritoneum and or contiguous structures. Above the cervix

Question 2

what are the risk factors of PID?

Answer 2

young age @ first intercourse;
multiple and/or high risk sexual partners;
prior episode of PID;
recent IUD insertion;
upper genital tract instrumentation

Question 3

how does the squamous/columnar border of the cervix change with age?

Answer 3

area of columnar gets smaller and smaller

Question 4

which organisms can cause PID?

Answer 4

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

Question 5

what’s the proportion of women who develop PID from cervicitis?

Answer 5

10-40%

Question 6

note: PID can cause damage to the ciliated cells of the fallopian tube

Answer 6

this causes infertility and ectopic pregnancies

Question 7

how does PID cause closure of the fallopian tube?

Answer 7

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

Question 8

note: PID is an infection. Can be due to things like STD, or ruptured appendix, etc

Answer 8

ok

Question 9

what’s a common DDx of lower pelvic pain? (obs-gyn)

Answer 9

appendicitis;
ectopic pregnancy;
ruptured corpus luteum cyst;
endometriosis

Question 10

what are some common complaints of PID presentations?

Answer 10

abnormal vagina discharge;
dyspareunia;
dysuria;
abnormal uterine bleeding;
nausea, vomiting;
right upper quadrant pain (rare)

Question 11

what’s the significance of cervical motion tenderness?

Answer 11

it always hurts on palpation, but if the patient jumps off the table on palpation - sign of peritonitis

Question 12

note: purulent cervical discharge is not always there in PID. Want to catch them before this happenes

Answer 12

ok

Question 13

what are some physical findings of PID?

Answer 13

lower abdominal tenderness;
cervical motion tenderness;
adnexal tenderness;
purulent cervical discharge (<30%);
fever

Question 14

what are some investigations to order in PID?

Answer 14

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

Question 15

note: only a small proportion of PID is associated with positive cultures

Answer 15

STD and cervicitis doesn’t necessarily point to PID!

Question 16

what’s fitz hugh curtis syndrome?

Answer 16

a complication of PID where adhesions occur in the right upper quadrant, causing localized pain and referred shoulder tip pain

Question 17

what are the minimum criteria of PID?

Answer 17

lower abdominal tenderness, adnexal tenderness, cervical motion tenderness

Question 18

what are complications of PID?

Answer 18

recurrent PID;
chronic pelvic pain;
infertility (with increasing episodes);
ectopic pregnancy;
tubo-ovarian abscess

Question 19

how to treat someone, sexually active, with symptoms of abdominal, adnexal, and cervical motion tenderness?

Answer 19

give antiobiotics. For n.gonorrhea, chlamydia, aerobic gram negative enteric bacilli, enteric anaerobes

Question 20

how to manage someone with IUD and pelvic disease?

Answer 20

probably want to take the IUD out (after 2 doses of antibiotics), but can leave it in if considered high risk for pregnancy

Question 21

how to manage someone with PID and is pregnant?

Answer 21

unlikely to get PID while pregnant, so more likely a past infection. Can’t use doxycycline in pregnancy, so use clinda and genta

Question 22

how to manage someone with PID and tubo-ovarian abscess?

Answer 22

add anaerobic antibiotics;drainage - guided with US or CT, or laparoscopic;remove tube and ovary - might need to do both sides

Question 23

what’s the ideal management for someone with TOA?

Answer 23

no rupture, immediate laparoscopic drainage within 24 hours and medical management for pregnancy rates between 32-63%