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33 Cards in this Set

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What are the 2 types of acute salpingitis?
Gonococcal & Non-gonococcal
What are some examples of non-gonococcal PID?
peptostreptococcus and gardnerella which invade thru vagina & into tubes.
What are the most common causes of PID?
gonorrhea and chlamydia. (30-40% are mixed organisms)
What are the 3 routes of infection leading to PID?
1) Interabdominal spread of gonorrhea & other pathogenic bacteria.
2) Lymphatic spread of bacterial infection;
3) Hematogenous spread of bacterial infection (TB)
What is the most common method of infection spread?
intra-abdominal spread
What is the least common method of infection spread?
hematogenous spread
According to the CDC, to diagnose someone w/ PID, which sx's MUST be present?
1.lower abdominal tenderness,
2. adnexal tenderness,
3. tenderness w/ cervical motion
What are some additional criteria that pts w/ PID should have 1 or more of?
-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.
When does PID usually occur?
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.
According to Ortmann (not the CDC), what are the sx's of PID?
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;
What are the end results of a PID?
loss of fimbriae, lots of adhesions, abscess, scar tissue build up causing everything to stick together;
What imaging studies can be done for PID?
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
Whats the contraindication to doing a culdocentesis?
if there's evidence of organs w/in pelvis being fixed indicating an adhesional process is going on.
What is the differential diagnosis for PID?
-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.
What are the complications of PID?
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
What is the prevention for PID complications?
recognize early & tx of minimal dz!
What is the prognosis of someone w/ PID? What are its lifelong complications?
-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.
What is the tx for most acute salpingitis thats outpatient?
Abxs
What is the tx for in hospital salpingitis?
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;
What type of surgical exploration can be done for pt w/ PID in hospital?
Laparoscopy to diagnose and tx. You can drain abscesses even thru abdominal wall;
What are the symptoms of TSS?
fever 102 degrees, pelvic pain, rash, desquamation of palms & soles of feet, shock, acutely ill, (patient must be menstruating and using tampons)
What does the rash of a TSS patient look like?
sunburn on face,trunk, & proximal extremities.
What is the tx for a pt w/ TSS?
-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)
What is the % mortality for TSS?
3-6%
What is the prevention for PID complications?
recognize early & tx of minimal dz!
What is the prognosis of someone w/ PID? What are its lifelong complications?
-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.
What is the tx for most acute salpingitis thats outpatient?
Abxs
What is the tx for in hospital salpingitis?
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;
What type of surgical exploration can be done for pt w/ PID in hospital?
Laparoscopy to diagnose and tx. You can drain abscesses even thru abdominal wall;
What are the symptoms of TSS?
fever 102 degrees, pelvic pain, rash, desquamation of palms & soles of feet, shock, acutely ill, (patient must be menstruating and using tampons)
What does the rash of a TSS patient look like?
sunburn on face,trunk, & proximal extremities.
What is the tx for a pt w/ TSS?
-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)
What is the % mortality for TSS?
3-6%