PID

Question 1

def. PID

Answer 1

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

Question 2

what is PID epi

Answer 2

1: 7 lifetime risk

- chlam and gon

Question 3

main group with STD

Answer 3

young peopel

Question 4

ris factors for PID

Answer 4

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

Question 5

reason for young women getting more

Answer 5

more cervical columnar epi

Question 6

etiology of PID

Answer 6

microbial infections

Question 7

patho of PID

Answer 7

10-40% of untreated cerivicitis

• acends into uterus and tubes
• additional bact. may then ascend further in damaged tissues

Question 8

what happens to tissues

Answer 8

• epithelial degen. and deciliation of the tissues

- edema of tubes

Question 9

outcomes of PID

Answer 9

• obstruction of tibes lead to infert. or ectopics

- peritonitis occurs characterized by fibrinoid exudate on serosal surfaces

Question 10

5 key points

Answer 10

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

Question 11

clinical presnetaion of PID

Answer 11

• may be sublte

- lower abdo/pelvic pain

Question 12

DDx (4)

Answer 12

1 appendicitis

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

Question 13

6 associated findings

Answer 13

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

Question 14

5 physical presentations

Answer 14

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

Question 15

4 invesigations for PID

Answer 15

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

Question 16

what is key with cultrure

Answer 16

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

Question 17

3 possible investigations

Answer 17

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

Question 18

what is fitz-hugh curtis

Answer 18

rare complication of PID leads to RUQ pain

Question 19

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

Answer 19

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

Question 20

5 complications of PID

Answer 20

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

Question 21

2 key points

Answer 21

1. early presentation can vary widely

2. early intervention is imperative

Question 22

8 indications of hospitalization

Answer 22

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

Question 23

mgmt of PID

Answer 23

• low threshold for MGMT

- Ab to cover gon, trach., aerobic gr-, enteric

Question 24

outpatient AB regimen

Answer 24

ceftriaxone and doxycyline +/- metronidazole

Question 25

in patient AB regimen

Answer 25

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

Question 26

what is mgmt after AB (8)

Answer 26

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

Question 27

4 special mgmt cases

Answer 27

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

Question 28

mgmt for IUD

Answer 28

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

Question 29

mgmt if preg

Answer 29

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

Question 30

mgmt for immuno compromised

Answer 30

- possible increase abscess | - delayed response

Question 31

mgmt for abscess

Answer 31

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

Question 32

what is important about abscess and fert.

Answer 32

need to treat and drain early