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16 Cards in this Set
- Front
- Back
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What is PID? |
An ascending infection of female UGT which may be acute or chronic with the spectrum of disease including: Endometritis Salpingitis Oophoritis Tub-ovarian comlpex/abscess Local/pelvic and generalised peritonitis i.e. acute salpingo-oophoritis |
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What protects against PID? |
Barrier contraception COC Tubal Ligation Pregnancy |
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What is the pathogenesis in PID? |
Primary invaders introduced during sex. Secondary invasion occurs due to immunosuppressed state, normally normal flora. This leads to progressive inflammation, swelling and hyperaemia of fallopian tubes impairing mobility and causing adhesion to surrounding structures. Pyolsalpinx or tubo-ovarian abscess/complex may occur Infective portion: self limiting or may be interrupted by medical intervention Anatomical disruction |
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What are examples of primary invades? |
Chlamydia trachomatis Neisseria gonorrhoea Anaerobes (Gardnerella vaginalis and mycoplasma hominis) |
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What are the symptoms of PIC? |
Lower abdominal pain Mucopurulent, offensive vaginaldischarge Fever Frequency and dysuria Irregular vaginal bleeding`` |
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What are the signs of PID? |
Ill looking patient Pyrexial, tachycardic(hypotensive and tachypnoeic in severe cases) Lower abdominal tenderness,pelvic and later general peritionitis Mucopurulent vaginal discharge Cervical motion/excitationtenderness Uterine tenderness Bilateral adnexal tenderness |
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What are the Ddx for PID? |
Ectopic pregnancy Appendicitis UTI with cystitis and Pyelonephritis Complications of ovarian cyst |
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What is Fitz-Hugh-Curtis Syndrome |
PID complicated by peri-hepatitis (RUQ pain) Flimsy adhesions to liver and surroundings seen on abdo exam |
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Outline the Gainesville classification of PID |
STAGE I: Early salpingitis, mild to moderate tenderness located to adnexa (usually apyrexial) STAGE II: Late salpingitis, severe adnexal tenderness and pelvic peritonitis (often pyrexial) STAGE III: Evidence of pyosalpinx or tubo-ovarian abscess/complex STAGE IV Ruptured tubo-ovarian complex, general peritonitis, septicaemia STAGE V ARDS (Adult respiratory distress syndrome) |
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What are the side room investigations for PID? |
· urine pregnancy test · urine dipstix analysis · white cell count (not always raised in HIV +patients) · HIV and syphilis testing (should be routine screeningin the presence of all STIs) · pap smear · transvaginal ultrasound (not always indicated) |
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What are the goals as you treat PID? |
S1: Eliminate symptoms and infectivity S2: Preserve tubal function S3: Preserve ovarian function S4: Preserve life |
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How do you treat PID? |
S1: Hospital admission not usually required. Empiric oral antibiotics and oral analgesia. S2: Usually require hospital admission. Empiric oral and IV antibiotics. Often need opiate analgesia. S3&4: Hospital admission always. Empiric oral and IV antibiotics. Opiate analgesia. Allow 48 hours to respond to treatment. Surgical intervention if too unwell to allow 48 hours to respond to antibiotic therapy. Surgery if no response after 48 hours of medical therapy. |
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What are the indications for admission in PID?
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· acute PID with signs of local or generalperitoneal irritation (severe tenderness, guarding and rebound) · suspected stage III disease or higher · temperature > 38° C · nausea and vomiting, · failure to respond to oral therapy, · intolerance to oral medication, · uncertain diagnosis, HIV Unreliable to follow up |
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What is the oral regimen for PID treatment? |
Cefixime Doxycyline Metronidazole |
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What is the IV regimen for PID treatment? |
Ampicillin Gentamycin Metronidazole (if Px cannot tolerate oral) |
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What surgical methods are used in PID? |
Laparotomy Laparoscopy USS guided pus drainage Posterior colpotomy |
