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55 Cards in this Set
- Front
- Back
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What is the differential diagnosis of pelvic inflammatory disease?
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-Pelvic Inflamatory Disease
-Acute Salpingitis -Tubo-ovarian abscess -Pelvic Abscess |
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What are the etiologies of acute salpingitiis?
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Gonococcal & nongonococcal
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What is the most common cause of acute salpingitis?
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-Gonococcal (GC) & Chlamydia
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What is the next most common cause of acute salpingitis?
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Mixed organisms - 30-40% cases result of normal flora in vagina & rectum.
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What Happens in tubo-ovarian abscess & What is the result of tubo-ovarian abscess
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-Large collection of pus
-inevitable infertility |
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What are the process of PID?
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Acute, subacute, or chronic infection of tubes, ovaries, & adjacent tissues.
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What is the source of infection in PID?
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Most are bacterial
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What are the three pathways of infection?
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-Intra-abdominal spread
-Lymphatic spread -Hematogenous spread |
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What organism is associated with intra-abdominal spread
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Gononrrhea
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What organism is associate with hematogenous spread?
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tuberculosis
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What is another route for bacteria to spread?
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Lymphatic spread
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What is the CDC minimum criteria for the diagnosis of pelvic inflammatory disease (PID)?
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-Lower abdominal tenderness
-Adnexal tenderness -Tenderness with cervical motion |
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What are the CDC additional criteria for the diagnosis of pelvic inflammatory disease (PID)?
note: Patients with PID should have 1 or more of these. |
-Oral temperature of more than 101〫F.
-Abnormal cervical and vaginal discharge. -Elevated Erythrocyte sedimentation Rate (ESR) -Elevated C-reactive protein Level -Laboratory documentation of cervical infection with N gonorrhoreae or C trachomatis. |
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What are the CDC elaborate criteria (additional findings) in pelvic inflammatory disease (PID) ?
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-Histopathic evidence of endometritis at endometrial biopsy
-thickened fluid-filled tubes with or without free pelvic fluid or a tubo-ovarian complex on transvaginal sonograms or other images -Laparoscopic abnormalites with PID. |
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-Sudden onset that usually follows menses;
-Heavy vaginal discharge; -Generalized abdominal & pelvic tenderness; -Plus one or more of the following; --Temp > 101 F --leukocytosis > 10,000 --Inflammatory mass on exam or sonogram. |
Acute Salpingitis
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Cervi is dilated; endometrial cavit is raw & open. This is ____ bacteria culture conditions
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Good
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This is a hysterectomy of both tubes. They are clubbed & closed. It is ______ to do a hyserectomy for only tubes.
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unusual
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What you do with purulent material from culdocentesis or laparoscopy?
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Take it & culture it
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If gram negative diplococci are found, what bug has the patient been infected with?
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Neisseira gonnorhea.
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-purulent material on culdocentesis or laparoscopy
-elevated sed rate -gram negative diplococci What is the disease? |
Acute salpingitis.
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If you find blood on culdocentesis, what are the implications for diagnosis?
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-Ruptured ectopic pregnancy
-Hemorrhage from corpus luteum -Retrograde menstruation -Rupture of spleen or liver. -Gastrointestinal bleeding -Acute salpingitis |
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If you find pus on culdocentesis, what are the implications for diagnosis?
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-Ruptured tubo-ovarian abscess.
-Ruptured appendix or viscus. -Rupture of diverticular abscess -Uterine abscess with myoma. |
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If you find cloudy fluid on culdocentesis, what are the implications for diagnosis?
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-Pelvic peritonitis (such as is seen with acutegonococcal salpingitis.)
-Twisted adnexal cyst. -Other causes of peritonitis: (appendicitis, pancreatitis, cholecystitis, perforated ulcer carcinomatosis, echinococcosis.) |
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What are the signs and symptoms of pelvic inflammatory disease (PID)?
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-Pelvic pain
-purulent discharge -fever, consider other pathology if fever is not present. |
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What labs are consistent with a diagnosis of PID?
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-Leukocytosis with left shift (inc. # of immature WBC)
-luid from culdocentesis positive. |
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What imaging studies are used in work up of PID?
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-Abdominal x-ray
-vaginal ultrasound |
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What is the differential dx of PID?
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-Acute appendix
-ectopic pregnancy -ruptured corpus luteum cyst -Diverticulitis -Adnexal torsion -endometriosis -acute UTI -colitis |
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What can a patient who has a history of diverticulitis have?
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A ruptured diverticuli.
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What are the complications of PID?
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-Peritonitis
-Pelvic thrombophlebitis -abscess formation -adnexal destruction with resultant infertility(due to destruction of fimbriae externi) -intestinal adhesions and obstruction |
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How do you prevent acute salingitis?
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-Early recognition and treatment of minimal disease
-Empiric therapy is started as soon as presumptive diagnosis is made. |
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What therapy does most acute salingitis respond to?
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Most acute salpingitis responds to outpatient antibiotics.
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What scenarios are patients treat in the hospital?
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-Severe cases or if diagnosis is uncertain,or
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What does in-patient therapy include?
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IV Antibiotics, Analgesics, bed rest & removal of IUD if present.
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What does IV antibiotic therapy consist of?
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A single injection of ceftriaxone or spectromycin for GC
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Who requires in patient therapy?
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-patient with an abscess(patient can hardly move)
Patient with temperature > 102.2° F -PT with marked abdominal guarding or rebound tenderness (peritoneal signs) -pt who does not respond to outpatient therapy (Outpatient Antibiotics unable to penetrate abscess) |
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What are components of inpatient treatment?
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Bed rest, IV antibiotics & possible surgical exploration.
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What is prognosis based on?
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Out come is related to prompt treatment with adequate meds.
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How many episodes of salingitis are required to cause infertility?
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A single episode can cause infertility.
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How often does a single episode of acute salingitis cause infertility?
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l2 - l8% of cases
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what are patients with acute sapingitis at greater risk for?
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ectopic pregnancy
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By restoring patentcy of the uterine tubes in a laparoscopic procedure, does this make the tube functional?
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No and there is an increased risk of ectopic pregnancy.
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What findings are seen in this sonograph?
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septated; scar tissue encompasses abscess
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What is this?
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Large tubovarian abscess.
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What structure has the fluid-air line?
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Bladder
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What procedure is being performed?
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culdocentesis
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What do we see on this cartoon?
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This is what an ovarian cyst looks like and we see scar tissue filling and is thick.
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What is Tubo-ovarian abscess the result of?
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It is usually the result of acute or recurrent salpingitis
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What can rupture of an tubo-ovarian result in?
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Rupture may result in cul-de-sac abscess.
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Fever, cash. desquamation of palms & soles of feet (looks sunburn, shock
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Toxic Shock Syndrome
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What is the key to TSS?
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PT is menstruating and using tampons
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what does the rash look like?
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Sun burn on face, trunk, and proximal extremities
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What tampons are a greater risk and why?
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super-absorbant; They dry out the vaginal wall. Making it susceptible to bacterial attack
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what kind of therapy is required by patients with toxic shock syndrome?
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Aggressive therapy includes fluids, antibiotics, steroids, blood products
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what is the morbidity & mortality of toxic shock syndrome. ?
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3-6% mortality
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What is cervical motion tenderness?
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Pain when the cervix is moved by the doctor's examining finger.
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