SAEM M4 CURRICULUM 2
1. PID cause originates as a cervical infection with Neisseria
gonorrheaand/or Chlamydia trachomatis, and
becomes polymicrobial as it ascends into the
uterus, fallopian tubes and ovaries.
2. 3 sx PID -lower abd pain
-purulent vag d/c
-vag bleed
3. when getPID sx Symptom...
SAEM M4 CURRICULUM 2 1. PID cause originates as a cervical infection with Neisseria gonorrheaand/or Chlamydia trachomatis, and becomes polymicrobial as it ascends into the uterus, fallopian tubes and ovaries. 2. 3 sx PID -lower abd pain -purulent vag d/c -vag bleed 3. when getPID sx Symptoms begin shortly after the start of the menstrual cycle, when there are fewer defenses by the cervical mucosal barrier to ascending infections. 4. PID with gonnoccal more likely to appear toxic (fever, N/V) 5. dont forget one risk factor pid 6. common exam findings pid -recent instrumentation of uterus -b/l adenexal tenderness -cervical d/c cervical motion tenderness -uterine tender -lower abd tenderness 7. if pain is u/l think more TOA 8. if RUQ tender think Fitz-Hugh Curtis (perihepatitis, inflamation of liv- er capsule) 9. best test for gonorrohea and chlaymida NAAT with PCR or DNA probes (either urine or cervical secretions) 10. if suspect TOA get US 11. ruptured ovarian cyst shows free fluid in pouch of douglas 12. ovarian torsion shows absence of blood flow to one ovary on pelvic ultrasound with doppler SAEM M4 CURRICULUM 2 13. why US>CT CT cannot eval for torsion bc there is no doppler 14. who gets abx for PID -lower abdominal or pelvic pain coupled with adnexal, uterine or cervical motion tenderness on exam, in a patient at risk for STDs with no other discernible cause for the illness identified 15. complications of pid -chronic pelvic pain -infertility -ectopic -toa -fitz-hiugh curtis 16. toa process walled -off abscess that originates in the infected fallopian tube and extends to involve the ovary 17. how confirm dx of Fitz hugh curtis elevated liver fxn tests 18. inpatient abx pid -cefoxitin + doxy or -cefotentan + doxy or clinda+gentamycin 19. outpatient abx pid? add if 2 -ceftriaxone -doxy -add metro if severe infection or hx of uterine instrumentation 20. who getsa dmitted -toa -fitz hugh curtis -septic -peritontiis -pre-pubertal kid -iud (which needs to be removed) -pregnant 21. test for other STD d/c with PID need what testing 22. describe whats going on in ovarian torsion ovary, and often the fallopian tube as well (ad - nexal torsion) become twisted around their vas- cular pedicle. 23. progression of torsion twisting initially obstructs venous flow, which causes engorgement and edema. The engorge - ment can progress until arterial flow is compro - mised, leading to ischemia and infarction 24. risk factors for torsion ovary with a mass or cyst is more prone to twisting by virtue of its asymmetry 25. classic present torsion sudden onset of unilateral lower abdominal pain which is initially visceral in character (ie, vague and poorly localized) and may be accompanied by nausea and vomiting. It may radiate to the groin or flank. 26. intermittent torsion several episodes of pain over the course of hours, days, or even weeks, 27. why does current preg - nancy inc risk of torsion corpus lutem cyst on ovary 28. tests for torsion There are no laboratory tests which are helpful in establishing the diagnosis of adnexal torsion 29. best way to dx torsion US 30. careful with US: important to note that the presence of Doppler blood flow does not exclude the diagnosis of torsion 31. signs of torsion on US -enlargement/edema of ovary -ovrian mass or cyst -free pelvic fluid 32. what does CT torsion show finding an enlarged ovary or ovarian mass -assocaited free fluid -thick fallopian tube -deviation of uterus to the affected side 33. definitively dx torsion OR 34. tx torsion or (try and salvage ovary but testicle just gets removed) 35. torsion sotry often sounds like kidney story 36. testicular torsion is twisting of the testis and spermatic cord within the scrotum, with resulting in occlusion of ve - nous return and and edema which can progress to arterial occlusion and ischemia 37. normal testicle anatomy and issue with torsion anchored within the scrotum by the tunica vagi- nalis, which surrounds the testicle and attaches posteriorly to the scrotal wall and epididymis. The tunica vaginalis consists of a visceral and parietal layer with an interposed potential space. This potential space allows the testicle to ro - tate about the spermatic cord within the tunica vaginalis if a firm posterior scrotal attachment is lacking. 38. bell clapper deformity When the tunica vaginalis attaches higher up on the spermatic cord, the testicle can move and twist within the scrotum. inc risk of torsion 39. 2 most common ages get torsion 1st year of life and in puberty 40. hx of testicular torsion airly sudden, severe unilateral testicular pain, sometimes radiating into the abdomen, associ - ated with nausea and vomiting -may have urgency, freuqency, dysuria
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