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39 Cards in this Set
- Front
- Back
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PID, Inflammation of the upper genital tract not associated with
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pregnancy or intraperitoneal pelvic operations
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Infection of any or all of the ff:
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Endometrium (endometritis), Uterine wall (myometritis), Fallopian tube/oviduct (salpingitis), Ovary (oophoritis), Uterine serosa & broad ligaments (parametritis), Pelvic peritoneum
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Usually starts as
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endocervicitis -> endometritis -> salpingitis -> oophoritis -> parametritis
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PID Rare in women who are
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amenorrheic or not sexually active
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Chronic infection of the uterine lining
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Endometritis
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Classic symptom: intermenstrual vaginal bleeding
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Endometritis
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- Dx: endometrial biopsy & culture, Inflammatory reaction of monocytes & plasma cells in endometrial stroma
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Endometritis
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- Tx: oral Ofloxacin 400mg BID for 14 days + Metronidazole 500mg BID for 14 days
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Endometritis
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< 25 y/o
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RISK FACTORS of UPPER GENITAL TRACT INFECTIONS
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Barrier devices (condom, diaphragm)
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RISK FACTORS of UPPER GENITAL TRACT INFECTIONS
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IUD use (risk highest in the 1st 3 weeks of placement)
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RISK FACTORS of UPPER GENITAL TRACT INFECTIONS
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Previous acute PID
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RISK FACTORS of UPPER GENITAL TRACT INFECTIONS
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Age at first intercourse
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RISK FACTORS of UPPER GENITAL TRACT INFECTIONS
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Number of sex partners
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RISK FACTORS of UPPER GENITAL TRACT INFECTIONS
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Instrumentation of uterus
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RISK FACTORS of UPPER GENITAL TRACT INFECTIONS
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2 most common Etiologies of UPPER GENITAL TRACT INFECTIONS
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STD (more common) and Post instrumentation
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Etiologic agents: Neisseria gonorrhea, Chlamydia trachomatis
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STD
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rapid onset, pain after start of menstruation
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N gonorrhea
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slow onset, less pain & fever
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C trachomatis
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o Acquired via mucosal spread from lower genital tract to endometrial cavity
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STD
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o Procedures that can break the cervical mucus barrier -> allows vaginal flora to colonize upper genital tract
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Post – instrumentation
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o Ex. endometrial biopsy, curettage, IUD insertion, hystero – salpingography, hysteroscopy
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Post – instrumentation
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most common presenting manifestation
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Pelvic pain
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PID, pain is usually characterized as:
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Bilateral, Difficult to localize/diffuse, Lower quadrant tenderness, Constant & dull
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Accompanied by fever & general malaise, Patient is toxic – looking
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signs and symptoms of PID
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PID will present as an acute abdomen but it is NOT surgically managed unless w/ complications like
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tubo–ovarian abscess
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Speculum exam: Swollen, erythematous cervix, Purulent discharge from endocervical canal (mucoid discharge usually Chlamydia)
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PID
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(+) cervical motion tenderness
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Bimanual Exam
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o When you insert fingers into cervix, observe for facial grimacing -> wiggling tenderness signifying peritoneal irritation due to discharge accumulating in pelvic peritoneum
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Bimanual Exam
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o Also seen in ectopic pregnancy (rupture causes accumulation of blood in peritoneal cavity)
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Bimanual Exam
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In PID, what accumulates is
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purulent discharge
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(+/-) uterine tenderness
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Bimanual Exam
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Bilateral adnexal tenderness
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Bimanual Exam
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Some may present with adnexal mass (usually tubo – ovarian abscess)
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Bimanual Exam
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o Unsure diagnosis
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Indications for hospitalization
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o Too ill to tolerate oral treatment
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Indications for hospitalization
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o No improvement with oral treatment
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Indications for hospitalization
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o (+) tubo–ovarian abscess or pregnancy
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Indications for hospitalization
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o Surgical emergencies
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Indications for hospitalization
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