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16 Cards in this Set
- Front
- Back
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Define Pelvic Inflammatory Disease (PID) |
Clinical syndrome attributed to the ascendingspread of organisms, unrelated to surgery andpregnancy, from the vagina and cervix to theendometrium and fallopian tubes and contiguousstructures
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What pathology can cause PID? |
Inflammation and infection
Endometritis Salpingitis Peritonitis Tubo-ovarian abscesses |
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What are the risk factors for PID? |
Young sexually active women
Multiple sex partners Other STI’s HIV |
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What is the aetiology and pathophysiology of PID? |
Pathogens (Chlamydia and Neisseria) inthe vagina spreads ascendingly leading to secondary invasion by organismsnormally present in the genital tract
Causes polymicrobal disease Secondary invaders gram negative andanaerobes Fallopian tubes initially swollen and red but stillmotile and open In severe disease abscessand spread to adjacent pelvic peritoneum Results in severe scarring of pelvic organs Tubo-ovarian complexes or hydrosalpinx canform and become chronic salpingitis |
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What are the symptoms of PID? |
Lower abdominal pain
Vaginal discharge Fever Flu-like symptoms are common Dysuria and frequency |
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What are the clincial findings in PID? |
Fever and tachycardia
Lower abdominal tenderness Rebound tenderness lower abdomen only orwhole abdomen Purulent discharge from the cervical os Cervical excitation tenderness Adnexal tenderness |
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How is PID diagnosed? |
Clinical diagnosis correct in 60%
This leads to over treatment in some lowrisk patients Can result in missed diagnosis in somewith pretty bad consequences |
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What are the stages of PID? |
Stage I– Early salpingitis with local tenderness
– No rebound and guarding Stage II– Salpingitis with pelvic guarding and reboundStages Stage III– Same as II but with adnexal masses Stage IV– Abscesses have ruptured with free pus inabdomen and generalised peritonitis – Very ill patient - Life threatening |
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What is the differential diagnosis in PID? |
Pregnancy complications
UTI Appendix abscess Bowel peforation |
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How is Stage I PID managed? |
Syndromic Management: - Azithromycin 2 g single oral dose - Cefixime 400 mg single oral dose - Tinidazole 2 g single oral dose ormetronidazole 400 mg tds x 7days or 2 g stat - Doxycycline 100 mg 12 hourly oral dose - Ceftriaxone 250 mg single IMI dose - Metronidazole 2 g single oral dose or 400mg tds x 7 days |
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How are Stages II and III PID managed? |
Admit
Analgesia IVI antibiotics - Cephalosporin + Metronidazole + Doxycycline - Add Gentamycin if no response Discharge on oral antibiotics If no response on antibiotics - surgery |
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How is Stage IV PID managed? |
Laparotomy
Adnexectomy and drainage of abscesses inpelvis Antibiotics as for III |
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How are hospitalized patients managed according to CDC guidelines? |
- Cefoxitin 2 g 6hourly IVI or Cefotetan 2 g12 hourly IVI + Doxycycline 100 mg 12hourly orally
- Clindamycin 900 mg 8 hourly IVI +Gentamycin 240 mg IVI daily Alternative: Ampicillin-sulbactam 3 g 6 hourly IVI +Doxycycline 100 mg 12 hourly orally Cefoxitin: Mefoxin® Cefotetan: Cefotan® Clindamycin: Dalacin® |
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How are outpatients managed according to CDC guidelines? |
To be given with or without metronidazole 400mg 8 hourly x 14 days:
– Ceftriaxone 250 mg IMI single stat dose +doxycycline 100 mg 12 hourly orally x 14 days or – Cefoxitin 2 g IMI single stat dose + probenicid 1 gsingle stat oral dose + doxycycline 100 mg 12 hourlyorally x 14 days Alternative: Azithromycin in place of doxyycline Azithromycin (Zithromax®) 2 g stat +cefixime 440 mg stat + tinadazole 2 gstat Ceftriaxone: Rocephin® Cefoxitne: Mefoxin® |
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How do we treat Gonorrhoea in PID? |
First line treatment:
– Cefixime 400 mf single oral doseOr – Ceftriaxone 250 mg single IMI dose Severe penicillin allergy: – Azithromycin 2 g single oral dose (1st choice) – Gentamycin 240 mg single IMI dose (2nd choice) |
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What are the reproductive health consequences of PID? |
Tubal factor infertility
– 15% risk after one episode – 90% after 4 episodes Ectopic pregnancy Loss of reproductive organs including ovaries Chronic PID – ASO V |
