PID, Vag Discharge, UTI,STIs Flashcards

Question

Management of PID

Answer 1

Mgt- 1. Determine if patient needs admission or not so you’ll admit depending on the clinical scenario 2. If admission,.Pain meds- first line para, or diclo or morphine if you can’t do diclo 3.Antipyretics- first line para 4. Wide bore cannulas and iv fluids Take Samples for labs such as malaria, FBC and other things that can cause the fever and do IV hydration 5. Do pelvic scan 6. Give antibiotics. So you do poly pharmacy. Since you can’t wait for the c/S, give empirical antibiotics ( treating for Gono) 7. 3rd generation cepha - 2g stat IV cefritraxone or 4th generation if 3rd generation isn’t there, 8. 500mg tds IV metronidazole 9. Azithromycin 1g stat or doxycycline 100mg bd for 2 weeks 10. Take secretion for C/S high Vaginal swab Pharmacological treatment A. For Pelvic inflammatory Disease (mild cases) 1st Line Treatment y Ciprofloxacin, oral, 500 mg 12 hourly for 3 days And Evidence Rating: [B] y Doxycycline, oral, 100 mg 12 hourly for 14 days And y Metronidazole, oral, 400 mg 12 hourly for 14 days B. For Pelvic inflammatory Disease (severe cases) y Ceftriaxone, IM, 250 mg daily for 3 days And y Doxycycline, oral, 100 mg 12 hourly for 3 days And y Metronidazole, IV, 500 mg 8 hourly for 3 days Then y Doxycycline, oral, 100 mg 12 hourly for 14 days And y Metronidazole, oral, 400 mg 12 hourly for 14 days Why are you doing 4th or 3rd generation cephalo : cuz it can go intracellular and are bacteriocidal cuz they interfere with protein synthesis then you cause destabilization of cell membrane so it can’t Protect itself. 3rd generation can also enter into the epithelium cells. Bacterio something -Stops bacterial proliferation Bacteriocidal- kills bacteria Check for comorbidities of patients and treat

Answer 2

Early-sepsis, septic shock,generalized peritonitis, Late- tubo-ovarian abscess, infertility(due to removal or tying of tubes due to ectopic pregnancy) , ectopic pregnancy(chlamydia trachomatis causes adhesions of tubes by secretions and reduces lumen of tubes ), recurrent PID or chronic lower abd pain, Fitz-Hugh-Curtis syndrome (FHCS), (or perihepatitis, is a chronic manifestation of pelvic inflammatory disease (PID). [1] It is described as an inflammation of the liver capsule, without the involvement of the liver parenchyma, with adhesion formation accompanied by right upper quadrant pain.) Vaginal douching- excessive washing of vagina will rid the vagina of the normal PH and is a risk factor for candidiasis. Cuz acidity restricts the candidiasis from causing infection m. Douching removes the cells that cause the acidity and causes candidiasis proliferation lactobacillus are part of normal flora of vagina so they can’t cause an infection there Smelly vagina: Dehydration 3.8-5.0 ph of vagina Cells responsible for Vaginal pH1

Answer 3

Clinical manifestation due to Colonization by bacteria of the lower Urianry tract . UTI is defined as the presence of at least 100,000 organisms per milliliter of urine in an asymptomatic patient, or as more than 100 organisms/mL of urine with accompanying pyuria (> 7 white blood cells [WBCs]/mL) in a symptomatic patient. A diagnosis of UTI should be supported by a positive culture for a uropathogen, particularly in patients with vague symptoms. [1] Asymptomatic bacteriuria Asymptomatic bacteriuria is commonly defined as the presence of more than 100,000 organisms/mL in 2 consecutive urine samples in the absence of declared symptoms. Cm of urethra in women- 4.8-5.1cm or 3.5-5cm Cm of urethra in men- 17-20cm or 7 inches Why women have more UTIs than men: Wider surface area of the vagina or genital so bacteria can easily be colonized and can easily get into the external orifice urethra Shorter urethra : men have longer so their urine flushes the thing out before the bacteria gets to the external orifice Women retain more urine cuz they don’t like using public what what do they get it more Pregnancy: UTIs are more common in pregnancy due to dilation of upper renal tract and urinary stasis. Hormonal and mechanical changes can promote urinary stasis and vesicoureteral reflux. These changes, along with an already short urethra (approximately 3-4 cm in females) and difficulty with hygiene due to a distended pregnant belly, help make UTIs the most common bacterial infections during pregnancy. The high levels of progesterone cause smooth muscle relaxation and reduced peristalsis in the renal collecting system. The decreased detrusor tone of the bladder leads to incomplete emptying and increased capacity. Pyelonephritis can cause pre term labour

Answer 4

Acute cystitis- Pollakiuria (Pollakiuria means frequent, abnormal urination during the day. frequent urination like very frequent) , having urge to pee but when you go it doesn’t come or it comes small but you feel you haven’t peed all Organisms cystitis- 1.Why E. coli is more common -cuz it’s part of the normal flora of the lower GIT tract . Fecal contamination of perineum with other things that’s why it’s more common . Proteus mirabilis (PM) is a Gram-negative rod-shaped bacterium and widely exists in the natural environment, and it is most noted for its swarming motility and urease activity. PM is the main pathogen causing complicated urinary tract infections (UTIs), especially catheter-associated urinary tract infections. Pseudomonas 2.Klebsiela Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, Enterococcus faecalis and Staphylococcus saprophyticus. 3. Urea plasma urealyticum Ureaplasma urealyticum

Answer 5

The pregnancy itself If woman is immunocompromized If woman has DM Sexual activities Personal hygiene Long term antibiotic use History of previous infection ( in previous pregnancy or outside pregnancy) Renal stones Poly cystic kidneys Congenital anomalies of renal tract Neuropathic bladder Post partum risks mainly associated with catheterization: Prolonged labour Prolonged 2nd stage C/S Pre eclampsia Immunosuppression Pre-existing diabetes Sickle cell anemia Neurogenic bladder Recurrent or persistent UTIs before pregnancy Tobacco use Age < 20 years Late presentation for prenatal care

Answer 6

Dysuria Urinary urgency and frequency A sensation of bladder fullness or lower abdominal discomfort Suprapubic tenderness or LAP Flank pain and costovertebral angle tenderness (may be present in cystitis but suggest upper UTI) Bloody urine Fevers, chills, and malaise (may be noted in patients with cystitis, but more frequently associated with upper UTI) Exam: Renal angle tenderness-Examination- right flank tenderness (palpate first then put hand on kidneys location and ball the other one into a fist then you hit on the other hand) Pelvic examination is recommended in all symptomatic patients (with the exception of third-trimester patients with bleeding) to rule out vaginitis or cervicitis. In patients with cystitis, tenderness can often be elicited with isolation of the bladder on pelvic examination. Patients with pyelonephritis have fever (usually > 38°C), flank tenderness upon palpation, and an ill appearance. Flank tenderness occurs on the right side more frequently, and is present in more than half of patients. Pain may also be found suprapubically with palpation. Assessment of the fetal heart rate on the basis of gestational age should be included as part of the evaluation. Often, owing to maternal fever, the fetal heart rate is elevated to more than 160 beats/min. The presence of toxic fever, chills, nausea, and vomiting suggests pyelonephritis rather than cystitis; The clinician may appreciate signs of dehydration, such as dry mucous membranes and tachycardia. Clammy extremities and symptomatic orthostasis suggest poor vascular tone due to gram-negative bacteremia rather than simple cystitis. Most adult women with simple lower UTI have suprapubic tenderness. Pelvic examination should be performed to exclude vaginitis, cervicitis, or pelvic tenderness (eg, cervical motion tenderness, which suggests pelvic inflammatory disease).

Answer 7

Complications may include the following: Perinephric cellulitis and abscess Septic shock Renal dysfunction (usually transient, but as many as 25% of pregnant women with pyelonephritis have a decreased glomerular filtration rate) Hematologic dysfunction, including anemia or thrombocytopenia Hypoxic fetal events due to maternal complications of infection that lead to hypoperfusion of the placenta Preeclampsia [20] Preterm labor, and possible subsequent preterm delivery, leading to increased infant morbidity and mortality

Answer 8

a.Urine C/S( gold standard), Urine dipstick(what are you looking for in this? ) Ten things looked for in b. urine R/E 1.colour of urine hematuria in very bad or complicated UTI 2. Leociocyte esterase or number of leukocytes (up to plus 1. If you find traces of leukocytes the person may be asymptomatic) 3. Presence of bacteria in urine 4. Ketones ( increased means dehydration) 5. Epithelial cells ( high means compromised epithelium due to dehydration or colonization of bacteria ) 6. Yeast and other things 7. Presence of proteins c. FBC- Increased number of reticulocytes or immature neutrophils ( left shift. Immature WBCs move toward the left when there’s an infection. ) Leucocytosis with neutrophilia Percentages that indicate bacterial infection: 30-40 lymphocytes 70 neutrophils Infections that you do polypharmacy: TB HIV PUD Leprosy STI ESR- acute inflammatory markers CRP- acute inflammatory markers Ultrasound to rule out other causes such as a congenital abnormality, renal calculi, hydronephrosis (A condition characterised by excess fluid in a kidney due to a back-up of urine.Hydronephrosis is caused by a blockage in the tube that connects the kidney to the bladder (ureter). Possible causes include a kidney stone, an infection, an enlarged prostate, a blood clot or a tumour) Midstream urine- Whiles urinating you make patient take sample after first part of urine has come. Patient doesn’t stop urinating but the midstream is a true reflection of what’s in the bladder cuz the first urine removes the bacteria from the ureters

Answer 9

Pyelonephritis: Pregnancy pushes bladder up as it progresses and causes obstructive uropathy that’s why pyelonephritis is more likely in second and third trimester Right ureter prone to obstructions and right kidney pyelonephritis why? Calistea and urethral dilitations are common on right side and this causes stasis and leading to pyelonephritis Sigmoid colon pushes uterus What differentiates UTI(low grade fever and localized manifestations such as dysuria, urgency, frequency, hematuria, proteinuria and suprapubic pain ) from pyelonephritis ( presents with systemic features fever(high grade ), chills and vomiting,renal angle tenderness. More likely to end in sepsis)

Answer 10

Pyelonephritis- Asymptomatic-OPD 5-7days with metronidazole 400mg tds or 2-3rd gen cephalosporins Cefuroxime 500mg bd 5-7 days or Amxiclaf 1g bd for 5-7 days Tab Pmol tds for fever Oral hydration in house Review and so urine R/E on review date Inpatient mgt Forget sickle cell in pyelonephritis mgt Antibiotics-broadSpevtrum beta lactam such as ceftriaxone 2g daily 48hrs . Max is 4g ,Cefuroxime,iv metro 500mg tds 24-48hrs before you switch to orals Pmol 1g tds Iv hydration 3-4litres Vitals 4hrly No cipro in pregnancy (why?) cuz it can cause skeletal problems and no tetracyclines too cuz it can cause permanent staining of teeth and problems with skeletal development Why won’t you give sulfonamides in third trimester?(Co-trimoxazole is a combination of trimethoprim and sulfamethoxazole and is in a class of medications called sulfonamides) It increases risk of Kernicterus in neonates due to displacement of protein binding bilirubin Why should you be careful if gentamicin in pregnant women? It puts patient at risk of ototoxicity so you monitor levels to minimize this risk What Is Ototoxicity? Certain medications can damage the ear, resulting in hearing loss, ringing in the ear, or balance disorders. Why will you avoid trimethoprim in first trimester? It is a folate antagonist

PID, Vag Discharge, UTI,STIs Flashcards

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