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25 Cards in this Set
- Front
- Back
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PID |
Upper reproductive tract infection, mostly in non pregnant women |
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Risk Factors for PID |
1- Previous PID 2- Sexually active young women 3- Multiple partners 4- Insertion of a IUCD, with a preexisting gonorrhea or chlamydia infection |
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Most common causative agents |
1- Chlamydia Trachomatis 2- Neisseria Gonorrhea -- PID could be polymicrobial |
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PID pathophysiology |
Ascending infection from.. 1- Cervicitis 2- Acute salpingo-oophoritis 3- Tubo Ovarian Abcess (TOA) 4- Chronic PID |
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Clinical Manifestation of Cervicitis |
Mostly Asymptomatic. - Could present with increase in vaginal discharge |
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Physical Examination in Cervicitis |
- Speculum Examination: Friable cervix - Palpation: No tenderness, no fever |
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Investigations in Cervicitis |
- Investigation:- Culture for chlamydia and gonorrhea, might be positive - WBC & ESR are normal |
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Treatment of cervicitis |
Cefixime (for gonorrhea) + Azithromycin (for chalmydia) - Single Oral dose |
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CDC criteria for Acute PID diagnosis |
1- Bilateral adnexal tenderness 2- Mucopurulent cervical discharge 3- Cervical motion tenderness 4- Elevated WBC 5- Elevated ESR 1-2-3 are clinical. 4-5 are labs |
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Acute Salpingo-Oophoritis: Clinical Presentation |
-Any of the 5 CDC criteria - Onset varies, but usually after menses - Depending on severity: Fever, Tachycardia, Abdominal tenderness |
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Investigations in Acute S-O |
-WBC & ESR + - Laparoscopy only done if diagnosis is not clear - Cervical cultures: +ve - Pelvic U/S: not done, unremarkable |
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Differential Diagnosis of Acute S-O |
1- Adnexal torsion 2- Ectopic pregnancy 3- Endometriosis 4- Appendicitis/Diverticulitis |
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Treatment of Acute S-O |
Outpatient: IF diagnosis is certain, no systemic involvement - Ceftriaxone IM once+Doxycycline oral for 14 days (with or without metronidazole) Inpatient: If there's signs of systemic involvement, outpatient TT failure, abcess. - Cefoxitin IV + Doxycycline IV OR - Clindamycin + Gentamycin IV |
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Tubo Ovarian Abcess (TOA) |
Accumulation of pus in adnexae forming an inflammatory mass. As a result of untreated Acute S-O, complicated by polymicrobes |
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Clinical presentation of TOA |
- Septic presentation (severe) - High fever, tachycardia, Hypotension (shock) - Peritoneal Guarding and rigidity - Bilateral adnexal mass may be palpated |
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Investigations |
- WBC & ESR +++ - Cervical & Blood cultures: Positive - CT: shows bilateral adnexal masses - Culdocentesis: Pus |
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Differential diagnosis of TOA |
- Septic abortion - Diverticular abcess - Adnexal torsion |
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Treatment of TOA |
Always Inpatient - Start by managing septic shock - Clindamycin + Gentamycin IV for 72 hrs - Monitor improvement, should improve in 72h IF no improvement: Exploration laparotomy & Drainage |
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Chronic PID |
As a result of untreated Acute S-O, that healed on its own, leaving adhesions. |
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Clinical presentation of Chronic PID |
1- Chronic pain 2- Associated with: infertility, ectopic pregnancy, recurrent abortions, abnormal vaginal bleeding |
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Examination of Chronic PID |
- Bilateral adnexal masses + motion tenderness - NO mucopurulent discharge (no active infx) - NO fever/ tachycardia |
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Investigations for Chronic PID |
WBC & ESR: Normal Cervical culture: Negative Pelvic U/S: Bilateral cystic pelvic masses (hydrosalpinx) |
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Definitive Diagnosis of Chronic PID |
Laparoscopy view of adhesions |
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Treatment of Chronic PID |
- Mild analgesics (to avoid analgesic addiction) + Tubal adhesion lysis - If severe: TAH-BSO, she should recieve Estrogen-replacement therapy afterwards |
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Fitz-Hugh-Curtis syndrome |
Complication of Chronic PID - Perihepatitis - Adhesions on liver (RUQ pain) - LFT elevations |
