Repro; Ortmann Pid; Kct

Front 1

What are the 2 types of acute salpingitis?

Back 1

Gonococcal & Non-gonococcal

Front 2

What are some examples of non-gonococcal PID?

Back 2

peptostreptococcus and gardnerella which invade thru vagina & into tubes.

Front 3

What are the most common causes of PID?

Back 3

gonorrhea and chlamydia. (30-40% are mixed organisms)

Front 4

What are the 3 routes of infection leading to PID?

Back 4

1) Interabdominal spread of gonorrhea & other pathogenic bacteria.
2) Lymphatic spread of bacterial infection;
3) Hematogenous spread of bacterial infection (TB)

Front 5

What is the most common method of infection spread?

Back 5

intra-abdominal spread

Front 6

What is the least common method of infection spread?

Back 6

hematogenous spread

Front 7

According to the CDC, to diagnose someone w/ PID, which sx's MUST be present?

Back 7

1.lower abdominal tenderness,
2. adnexal tenderness,
3. tenderness w/ cervical motion

Front 8

What are some additional criteria that pts w/ PID should have 1 or more of?

Back 8

-oral temp > 101 F;
-Abnl cervical & vaginal discharge
-Elevated ESR
-Elevated C-reactive protein level.
-Lab documentation of cervical infection w/ N. gonorrhea or C. trachomatis.

Front 9

When does PID usually occur?

Back 9

sudden onset following menses; when menstrual cycle is just complete & vaginal fora has been altered, lots of blood there, so protein & other debris makes a good breeding group & cervix is opened to allow seepage of blood.

Front 10

According to Ortmann (not the CDC), what are the sx's of PID?

Back 10

acute salpingitis, sudden onset following menses, heavy vaginal discharge, generalized abdominal & pelvic tenderness, plus 1 or more of: temp>101F, WBCs >10,000, inflammatory mass on exam or sono, purulent material on culdocentesis,elevated sed rate, gram neg diplococci;

Front 11

What are the end results of a PID?

Back 11

loss of fimbriae, lots of adhesions, abscess, scar tissue build up causing everything to stick together;

Front 12

What imaging studies can be done for PID?

Back 12

1. Abdominal X-ray: not too helpful, but you can see fuzziness or evidence of inflammation in pelvis.
2. Vaginal US: very helpful; can see tube & loculations around tube.
3. Culdocentesis

Front 13

Whats the contraindication to doing a culdocentesis?

Back 13

if there's evidence of organs w/in pelvis being fixed indicating an adhesional process is going on.

Front 14

What is the differential diagnosis for PID?

Back 14

-acute appendix
-ectopic pregnancy
-ruptured corpus luteum cyst (all sx's except fever)
-diverticulitis: you'd see fever, pain, leukocytosis;
-adnexal torsion: same sx's but looks different on US.
-endometriosis: causes sx's w/o fever & leukocytosis; Abscess formations but they're actually endometriomas.
-Acute UTI
-Colitis: similar sx's but sporadic & they fade away.

Front 15

What are the complications of PID?

Back 15

1. Peritonitis
2. Pelvic Thrombophlebitis (bacteria cause veins to clot)
3. Abscess formation: can form anywhere in pelvis causing adnexal destruction w/ infertility.
4. Intestinal Adhesions & Obstruction

Front 16

What is the prevention for PID complications?

Back 16

recognize early & tx of minimal dz!

Front 17

What is the prognosis of someone w/ PID? What are its lifelong complications?

Back 17

-Outcome related to prompt tx w/ adequate meds;
-single episod eof salpingitis may cause infertility in 12-18%
-Pts @ greater risk for ectopic pregnancy b/c of destruction of internal architecture of tube.
-Tuboovarian abscess usually result of acute or recurrent salpingitis rupture may result in cul-de-sac abscess.

Front 18

What is the tx for most acute salpingitis thats outpatient?

Back 18

Abxs

Front 19

What is the tx for in hospital salpingitis?

Back 19

Abx, analgesics, bedrest, removal of IUD if present; Inpatient therapy if temp greater than 102 F, if they have marked abdom guarding or rebound tenderness, pt not responding to o/p therapy, IV Abx, possible surgical exploration;

Front 20

What type of surgical exploration can be done for pt w/ PID in hospital?

Back 20

Laparoscopy to diagnose and tx. You can drain abscesses even thru abdominal wall;

Front 21

What are the symptoms of TSS?

Back 21

fever 102 degrees, pelvic pain, rash, desquamation of palms & soles of feet, shock, acutely ill, (patient must be menstruating and using tampons)

Front 22

What does the rash of a TSS patient look like?

Back 22

sunburn on face,trunk, & proximal extremities.

Front 23

What is the tx for a pt w/ TSS?

Back 23

-aggressive therapy including fluids b/c usually come in w/ shock, Abxs. (Things usually not broken down by beta lactam since actually caused by Staph aureus), Steroids, Blood Products (including plasma products like fibrinogen so blood can clot again since they frequently go into DIC)

Front 24

What is the % mortality for TSS?

Back 24

3-6%

Front 25

What is the prevention for PID complications?

Back 25

recognize early & tx of minimal dz!

Front 26

What is the prognosis of someone w/ PID? What are its lifelong complications?

Back 26

-Outcome related to prompt tx w/ adequate meds;
-single episod eof salpingitis may cause infertility in 12-18%
-Pts @ greater risk for ectopic pregnancy b/c of destruction of internal architecture of tube.
-Tuboovarian abscess usually result of acute or recurrent salpingitis rupture may result in cul-de-sac abscess.

Front 27

What is the tx for most acute salpingitis thats outpatient?

Back 27

Abxs

Front 28

What is the tx for in hospital salpingitis?

Back 28

Abx, analgesics, bedrest, removal of IUD if present; Inpatient therapy if temp greater than 102 F, if they have marked abdom guarding or rebound tenderness, pt not responding to o/p therapy, IV Abx, possible surgical exploration;

Front 29

What type of surgical exploration can be done for pt w/ PID in hospital?

Back 29

Laparoscopy to diagnose and tx. You can drain abscesses even thru abdominal wall;

Front 30

What are the symptoms of TSS?

Back 30

fever 102 degrees, pelvic pain, rash, desquamation of palms & soles of feet, shock, acutely ill, (patient must be menstruating and using tampons)

Front 31

What does the rash of a TSS patient look like?

Back 31

sunburn on face,trunk, & proximal extremities.

Front 32

What is the tx for a pt w/ TSS?

Back 32

-aggressive therapy including fluids b/c usually come in w/ shock, Abxs. (Things usually not broken down by beta lactam since actually caused by Staph aureus), Steroids, Blood Products (including plasma products like fibrinogen so blood can clot again since they frequently go into DIC)

Front 33

What is the % mortality for TSS?

Back 33

3-6%