saem m4 curriculum 2
PID cause - ANS originates as a cervical infection with Neisseria gonorrhea and/or Chlamydia
trachomatis, and becomes polymicrobial as it ascends into the uterus, fallopian tubes and
ovaries.
3 sx PID - ANS -lower abd pain
-purulent vag d/c
-vag bleed
when getPID sx - ANS Symptoms begin shortly after the start of the menstrual cycle, when there
are fewer defenses by the cervical mucosal barrier to ascending infections.
PID with gonococcal - ANS more likely to appear toxic (fever, N/V)
don't forget one risk factor pid - ANS -recent instrumentation of uterus
common exam findings pid - ANS -b/l adnexal tenderness
-cervical d/c
cervical motion tenderness
-uterine tender
-lower abd tenderness
if pain is u/l think more - ANS TOA
if RUQ tender think - ANS Fitz-Hugh Curtis (perihepatitis, inflamation of liver capsule)
best test for gonorrohea and chlaymida - ANS NAAT with PCR or DNA probes (either urine or
cervical secretions)
if suspect TOA get - ANS US
ruptured ovarian cyst shows - ANS free fluid in pouch of douglas
ovarian torsion shows - ANS absence of blood flow to one ovary on pelvic ultrasound with
doppler
why US>CT - ANS CT cannot eval for torsion bc there is no doppler
who gets abx for PID - ANS -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
,complications of pid - ANS -chronic pelvic pain
-infertility
-ectopic
-toa
-fitz-hiugh curtis
toa process - ANS walled-off abscess that originates in the infected fallopian tube and extends
to involve the ovary
how confirm dx of Fitz hugh curtis - ANS elevated liver fxn tests
inpatient abx pid - ANS -cefoxitin + doxy
or
-cefotentan + doxy
or
clinda+gentamycin
outpatient abx pid? add _____ if 2 - ANS -ceftriaxone
-doxy
-add metro if severe infection or hx of uterine instrumentation
who getsa dmitted - ANS -toa
-fitz hugh curtis
-septic
-peritontiis
-pre-pubertal kid
-iud (which needs to be removed)
-pregnant
d/c with PID need what testing - ANS test for other STD
describe whats going on in ovarian torsion - ANS ovary, and often the fallopian tube as well
(adnexal torsion) become twisted around their vascular pedicle.
progression of torsion - ANS twisting initially obstructs venous flow, which causes engorgement
and edema. The engorgement can progress until arterial flow is compromised, leading to
ischemia and infarction
risk factors for torsion - ANS ovary with a mass or cyst is more prone to twisting by virtue of its
asymmetry
, classic present torsion - ANS 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.
intermittent torsion - ANS several episodes of pain over the course of hours, days, or even
weeks,
why does current pregnancy inc risk of torsion - ANS corpus lutem cyst on ovary
tests for torsion - ANS There are no laboratory tests which are helpful in establishing the
diagnosis of adnexal torsion
best way to dx torsion - ANS US
careful with US: - ANS important to note that the presence of Doppler blood flow does not
exclude the diagnosis of torsion
signs of torsion on US - ANS -enlargement/edema of ovary
-ovrian mass or cyst
-free pelvic fluid
what does CT torsion show - ANS finding an enlarged ovary or ovarian mass
-assocaited free fluid
-thick fallopian tube
-deviation of uterus to the affected side
definitively dx torsion - ANS OR
tx torsion - ANS or (try and salvage ovary but testicle just gets removed)
torsion sotry often sounds like - ANS kidney story
testicular torsion is - ANS twisting of the testis and spermatic cord within the scrotum, with
resulting in occlusion of venous return and and edema which can progress to arterial occlusion
and ischemia
normal testicle anatomy and issue with torsion - ANS anchored within the scrotum by the tunica
vaginalis, 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 rotate about the spermatic cord within
the tunica vaginalis if a firm posterior scrotal attachment is lacking.
bell clapper deformity - ANS When the tunica vaginalis attaches higher up on the spermatic
cord, the testicle can move and twist within the scrotum. inc risk of torsion
PID cause - ANS originates as a cervical infection with Neisseria gonorrhea and/or Chlamydia
trachomatis, and becomes polymicrobial as it ascends into the uterus, fallopian tubes and
ovaries.
3 sx PID - ANS -lower abd pain
-purulent vag d/c
-vag bleed
when getPID sx - ANS Symptoms begin shortly after the start of the menstrual cycle, when there
are fewer defenses by the cervical mucosal barrier to ascending infections.
PID with gonococcal - ANS more likely to appear toxic (fever, N/V)
don't forget one risk factor pid - ANS -recent instrumentation of uterus
common exam findings pid - ANS -b/l adnexal tenderness
-cervical d/c
cervical motion tenderness
-uterine tender
-lower abd tenderness
if pain is u/l think more - ANS TOA
if RUQ tender think - ANS Fitz-Hugh Curtis (perihepatitis, inflamation of liver capsule)
best test for gonorrohea and chlaymida - ANS NAAT with PCR or DNA probes (either urine or
cervical secretions)
if suspect TOA get - ANS US
ruptured ovarian cyst shows - ANS free fluid in pouch of douglas
ovarian torsion shows - ANS absence of blood flow to one ovary on pelvic ultrasound with
doppler
why US>CT - ANS CT cannot eval for torsion bc there is no doppler
who gets abx for PID - ANS -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
,complications of pid - ANS -chronic pelvic pain
-infertility
-ectopic
-toa
-fitz-hiugh curtis
toa process - ANS walled-off abscess that originates in the infected fallopian tube and extends
to involve the ovary
how confirm dx of Fitz hugh curtis - ANS elevated liver fxn tests
inpatient abx pid - ANS -cefoxitin + doxy
or
-cefotentan + doxy
or
clinda+gentamycin
outpatient abx pid? add _____ if 2 - ANS -ceftriaxone
-doxy
-add metro if severe infection or hx of uterine instrumentation
who getsa dmitted - ANS -toa
-fitz hugh curtis
-septic
-peritontiis
-pre-pubertal kid
-iud (which needs to be removed)
-pregnant
d/c with PID need what testing - ANS test for other STD
describe whats going on in ovarian torsion - ANS ovary, and often the fallopian tube as well
(adnexal torsion) become twisted around their vascular pedicle.
progression of torsion - ANS twisting initially obstructs venous flow, which causes engorgement
and edema. The engorgement can progress until arterial flow is compromised, leading to
ischemia and infarction
risk factors for torsion - ANS ovary with a mass or cyst is more prone to twisting by virtue of its
asymmetry
, classic present torsion - ANS 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.
intermittent torsion - ANS several episodes of pain over the course of hours, days, or even
weeks,
why does current pregnancy inc risk of torsion - ANS corpus lutem cyst on ovary
tests for torsion - ANS There are no laboratory tests which are helpful in establishing the
diagnosis of adnexal torsion
best way to dx torsion - ANS US
careful with US: - ANS important to note that the presence of Doppler blood flow does not
exclude the diagnosis of torsion
signs of torsion on US - ANS -enlargement/edema of ovary
-ovrian mass or cyst
-free pelvic fluid
what does CT torsion show - ANS finding an enlarged ovary or ovarian mass
-assocaited free fluid
-thick fallopian tube
-deviation of uterus to the affected side
definitively dx torsion - ANS OR
tx torsion - ANS or (try and salvage ovary but testicle just gets removed)
torsion sotry often sounds like - ANS kidney story
testicular torsion is - ANS twisting of the testis and spermatic cord within the scrotum, with
resulting in occlusion of venous return and and edema which can progress to arterial occlusion
and ischemia
normal testicle anatomy and issue with torsion - ANS anchored within the scrotum by the tunica
vaginalis, 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 rotate about the spermatic cord within
the tunica vaginalis if a firm posterior scrotal attachment is lacking.
bell clapper deformity - ANS When the tunica vaginalis attaches higher up on the spermatic
cord, the testicle can move and twist within the scrotum. inc risk of torsion
