PID Flashcards Preview

Undeleted > PID > Flashcards

Flashcards in PID Deck (32):
1

def. PID

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

2

what is PID epi

1:7 lifetime risk
- chlam and gon

3

main group with STD

young peopel

4

ris factors for PID

1. young age at first intercourse
2. multiple or risk partners
3. prior episode of PID
4. recent IUD insertion
5. upper gential tract manipulation

5

reason for young women getting more

more cervical columnar epi

6

etiology of PID

microbial infections

7

patho of PID

10-40% of untreated cerivicitis
- acends into uterus and tubes
- additional bact. may then ascend further in damaged tissues

8

what happens to tissues

- epithelial degen. and deciliation of the tissues
- edema of tubes

9

outcomes of PID

- obstruction of tibes lead to infert. or ectopics
- peritonitis occurs characterized by fibrinoid exudate on serosal surfaces

10

5 key points

1. PID not and STD and not reportable
2. common
3. affects young
4. polymicrobial infection
5. causes damage to the upper genital tract anatomy

11

clinical presnetaion of PID

- may be sublte
- lower abdo/pelvic pain

12

DDx (4)

1 appendicitis
2. ectopic preg.
3. ruptured corpus luteum cyst
4. endometriosis

13

6 associated findings

1. abnormal discharge
2. dyspareunia
3. dysuria
4. abnormal uterine bleeding
5. nausea vomiting
6. right upper quadrant pain (rarely)

14

5 physical presentations

1. lower abdo tenderness
2. cervical motions tenderness
3. adnexal tenderness
4. purulent cervical discharge
5. fever

15

4 invesigations for PID

1. vulvovaginal swabs with NAAT
2. PCR on urine samples
3. B-HCG to rule out preg
4. CBC and ESR/reactive

16

what is key with cultrure

very few are culture +ve - and fever is uncommon in those that are

17

3 possible investigations

1.US for adnexal mass
2. laprascopy if unable to exclude other diagnosis
3. endometrial biopsy (rare)

18

what is fitz-hugh curtis

rare complication of PID leads to RUQ pain

19

3 minimum finding we want to be able to diagnose based on

1. lower abdo tenderness
2. adnexal tenderness
3. cervical motion tenderness

20

5 complications of PID

1. recurrent PID
2. chronic pelvic pain
3. infertility
4. ectopic preg
5. tubo-ovarian abscess

21

2 key points

1. early presentation can vary widely
2. early intervention is imperative

22

8 indications of hospitalization

1. uncertain diagnosis
2. haven't ruled out surgical emerg. - append, ectopic
3. preg.
4. pelvic abscess
5. patient not compliant with outpatient treatment
6. severely ill
7. failure to respond to outpatient for 72 hours
8. cannot ensure follow-up

23

mgmt of PID

- low threshold for MGMT
- Ab to cover gon, trach., aerobic gr-, enteric

24

outpatient AB regimen

ceftriaxone and doxycyline +/- metronidazole

25

in patient AB regimen

1. IV cefalosporin wiht act against anaerobes
2. clindamycin plus gentamycin
3. ofloxin (if resistant) and metronidazole

26

what is mgmt after AB (8)

1. step down to oral AB after 48hours
2. sexual contacts in last 60 days
3. treat partners for gon and chlam
4. no sex for 7 days
5. mandatory reassess at 48-72 hours
6. screen for other infectoins
7. counsel on safe sex
8. surg to drain abscess if need be

27

4 special mgmt cases

1. IUD users
2. preg.
3. immunocompromised
4.tubo ovarian abcess

28

mgmt for IUD

- remove after 2 doses of AB
- can leave in if high preg. risk

29

mgmt if preg

- uncommon
- in hosp
- IV clindamycin and gentamycin
- no doxy

30

mgmt for immuno compromised

- possible increase abscess
- delayed response

31

mgmt for abscess

- include anaerobes AB in step down
- laprascopic drainage
- conservative extirpation

32

what is important about abscess and fert.

need to treat and drain early

Decks in Undeleted Class (589):