caused by ascent of bacteria to vagina, endocervix, fallopian tubes, ovaries (cause - chlyd, gonorrhea, bacteroids, aerobic streptococci and anaerobic cocci
PID- Signs & Symptoms
lower abdominal/pelvic pain, distension, decreased bowel sounds, +/- rebound tenderness, usually bilateral, back pain may radiate down to legs, fever/chills, abnormal vaginal discharge, less common symptoms: (nausea/vomiting, vaginal bleeding, dysuria)
PID- Dx: what three do you absolutely need?
abdominal tenderness, adnexal tenderness, cervical motion tenderness (chandelier's sign)
PID- Dx: what one of more of the following do you need?
gram stain that's positive for gram - bacteria, temp>101 F, WBC> 10,000, elevated ESR, documented cervical infx of gonorrhea or chlamydia, pus on culdocentesis
CBC - leukocytosis w/left shift, culture w/gonorrhea or chlamydia, elevated esr, discharge=pus!, US shows enlarged tender fallopian tubes or cul-de sac fluid, do laparascopy to differentiate b/w conditions, cogwheel sign on us: thick wall
PID- What's the treatment for inpatient care?
regimen A: cifoxitin or cefotetan (gonorrhea) PLUS doxycycline (chlamydia) OR REGIMEN B: clindamycin PLUS gentamycin following by doxycycline
PID- What's the treatment for outpatient care?
Oral antibiotics: cefoxitin + probenicid or ceftriaxone plus doxycycline w/or without metronidazole
PID- What are the complications of PID?
1) tubo-ovarian abscess (tender, inflammatory mass, it's caused by reactivation of a past infection, rupture of TOA can cause peritonitis, use U/S to view + see black fluid, if dx is in doubt do laparascopy, incise and drain. 2) increased risk for ectopic pregnancy, 3) infertility (due to adhesions/fibers) 4) chronic pelvic pain, 4) endometritis (CITEE)