W10_06 PID Flashcards Preview

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Flashcards in W10_06 PID Deck (23)
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1
Q

define PID

A

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

2
Q

what are the risk factors of PID?

A

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

3
Q

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

A

area of columnar gets smaller and smaller

4
Q

which organisms can cause PID?

A

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

5
Q

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

A

10-40%

6
Q

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

A

this causes infertility and ectopic pregnancies

7
Q

how does PID cause closure of the fallopian tube?

A

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

8
Q

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

A

ok

9
Q

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

A

appendicitis;
ectopic pregnancy;
ruptured corpus luteum cyst;
endometriosis

10
Q

what are some common complaints of PID presentations?

A

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

11
Q

what’s the significance of cervical motion tenderness?

A

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

12
Q

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

A

ok

13
Q

what are some physical findings of PID?

A

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

14
Q

what are some investigations to order in PID?

A

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

15
Q

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

A

STD and cervicitis doesn’t necessarily point to PID!

16
Q

what’s fitz hugh curtis syndrome?

A

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

17
Q

what are the minimum criteria of PID?

A

lower abdominal tenderness, adnexal tenderness, cervical motion tenderness

18
Q

what are complications of PID?

A

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

19
Q

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

A

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

20
Q

how to manage someone with IUD and pelvic disease?

A

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

21
Q

how to manage someone with PID and is pregnant?

A

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

22
Q

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

A

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

23
Q

what’s the ideal management for someone with TOA?

A

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

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