Tubo-ovarian abscess - Revision history

Rossdonaldson1: /* Management */

2021-05-27T16:51:19Z

Management

← Older revision		Revision as of 16:51, 27 May 2021
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	==Management==		==Management==
	*OB/GYN consult for possible operative drainage.		===Operative Drainage===
			*OB/GYN consult for possible operative drainage
	*Majority (60-80%) resolve with [[antibiotics]] alone		*Majority (60-80%) resolve with [[antibiotics]] alone
	*Predictors of antibiotic treatment failure and possible indications for IR drainage upon admission to Ob<ref>Huma F et al. Inpatient Management of Tubo-Ovarian Abscesses: What Is the Threshold of Parenteral Antibiotic Treatment Failure? Obstetrics & Gynecology: May 2015</ref>		*Predictors of antibiotic treatment failure and possible indications for IR drainage upon admission to Ob<ref>Huma F et al. Inpatient Management of Tubo-Ovarian Abscesses: What Is the Threshold of Parenteral Antibiotic Treatment Failure? Obstetrics & Gynecology: May 2015</ref>

2021-05-27T16:43:20Z

Management

2021-05-27T16:38:22Z

Management

← Older revision		Revision as of 16:38, 27 May 2021
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	===Outpatient===		===Outpatient===
	{{PID antibiotics}}		{{PID antibiotics}}

	~~===Inpatient===~~
	*[[Cefoxitin]] 2gm IV q6hr '''OR''' [[cefotetan]] 2gm IV q12hr) + [[doxycycline]] PO or IV 100mg q12hr '''OR'''
	*[[Clindamycin]] 900mg IV q8h + [[gentamicin]] 2mg/kg QD '''OR'''
	*[[Ampicillin-sulbactam]] 3gm IV q6hr + [[doxycycline]] 100mg IV/PO q12hr

	==Disposition==		==Disposition==

2021-05-27T16:35:31Z

Outpatient

← Older revision		Revision as of 16:35, 27 May 2021
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	===Outpatient===		===Outpatient===
	*[[Ceftriaxone]] 500mg IM once '''PLUS''' [[doxycycline]] 100mg PO BID x14 days		{{PID antibiotics}}
	*[[Metronidazole]] 500mg PO BID x14 days now recommended empirically by European guidelines <ref>Ross J, Guaschino S, Cusini M, Jensen J, 2017 European guideline for the management of pelvic inflammatory disease. Int J STD AIDS. 2018 Feb;29(2):108-114. doi: 10.1177/0956462417744099. Epub 2017 Dec 4.</ref>. Supported by CDC. Definitely give if suspicion of bacterial [[vaginitis]] or gynecological instrumentation in preceding 2-3 wks

	===Inpatient===		===Inpatient===

2021-05-25T17:48:57Z

Outpatient

← Older revision		Revision as of 17:48, 25 May 2021
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	===Outpatient===		===Outpatient===
	*[[Ceftriaxone]] ~~250mg~~ IM once '''PLUS''' [[doxycycline]] 100mg PO BID x14 days		*[[Ceftriaxone]] 500mg IM once '''PLUS''' [[doxycycline]] 100mg PO BID x14 days
	*[[Metronidazole]] 500mg PO BID x14 days now recommended empirically by European guidelines <ref>Ross J, Guaschino S, Cusini M, Jensen J, 2017 European guideline for the management of pelvic inflammatory disease. Int J STD AIDS. 2018 Feb;29(2):108-114. doi: 10.1177/0956462417744099. Epub 2017 Dec 4.</ref>. Supported by CDC. Definitely give if suspicion of bacterial [[vaginitis]] or gynecological instrumentation in preceding 2-3 wks		*[[Metronidazole]] 500mg PO BID x14 days now recommended empirically by European guidelines <ref>Ross J, Guaschino S, Cusini M, Jensen J, 2017 European guideline for the management of pelvic inflammatory disease. Int J STD AIDS. 2018 Feb;29(2):108-114. doi: 10.1177/0956462417744099. Epub 2017 Dec 4.</ref>. Supported by CDC. Definitely give if suspicion of bacterial [[vaginitis]] or gynecological instrumentation in preceding 2-3 wks

2020-02-13T19:15:50Z

Outpatient

← Older revision		Revision as of 19:15, 13 February 2020
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	===Outpatient===		===Outpatient===
	*[[Ceftriaxone]] 250mg IM once '''PLUS''' [[doxycycline]] 100mg PO BID x14 days		*[[Ceftriaxone]] 250mg IM once '''PLUS''' [[doxycycline]] 100mg PO BID x14 days
	*~~Add~~ [[~~metronidazole~~]] 500mg PO BID x14 days if suspicion of bacterial [[vaginitis]] or ~~gyn~~ instrumentation in preceding 2-3 wks		*[[Metronidazole]] 500mg PO BID x14 days now recommended empirically by European guidelines <ref>Ross J, Guaschino S, Cusini M, Jensen J, 2017 European guideline for the management of pelvic inflammatory disease. Int J STD AIDS. 2018 Feb;29(2):108-114. doi: 10.1177/0956462417744099. Epub 2017 Dec 4.</ref>. Supported by CDC. Definitely give if suspicion of bacterial [[vaginitis]] or gynecological instrumentation in preceding 2-3 wks

	===Inpatient===		===Inpatient===

2019-10-04T01:32:42Z

Clinical Features

← Older revision		Revision as of 01:32, 4 October 2019
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	==Clinical Features==		==Clinical Features==
	*+/-[[Fever]]		*+/-[[Fever]]
	*~~Vaginal~~ [[discharge]]		*[[Vaginal discharge]]
	*Dyspareunia		*Dyspareunia
	*Disproportionate unilateral adnexal tenderness or adnexal mass or fullness		*Disproportionate unilateral adnexal tenderness or adnexal mass or fullness

2019-10-04T01:32:30Z

Clinical Features

← Older revision		Revision as of 01:32, 4 October 2019
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	==Clinical Features==		==Clinical Features==
	*+/-[[Fever]]		*+/-[[Fever]]
	*Vaginal discharge		*Vaginal [[discharge]]
	*Dyspareunia		*Dyspareunia
	*Disproportionate unilateral adnexal tenderness or adnexal mass or fullness		*Disproportionate unilateral adnexal tenderness or adnexal mass or fullness

2019-10-04T01:32:14Z

Risk factors

← Older revision		Revision as of 01:32, 4 October 2019
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	*Age 15-25 years old		*Age 15-25 years old
	*Prior history of [[PID]]		*Prior history of [[PID]]
	*IUD		*[[IUD]] (within 21 days of insertion<ref>https://www.cdc.gov/std/tg2015/pid.htm</ref>)
	*[[HIV]] infection		*[[HIV]] infection

2019-07-01T18:57:26Z

Evaluation

← Older revision		Revision as of 18:57, 1 July 2019
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	==Evaluation==		==Evaluation==
			[[File:PMC4603210 usg-15013-f11.png\|thumb\|Dilated, complex, fluid-filled tubular structure is consistent with hydro/pyosalpinx (A, B). Short-axis image (C) demonstrates the “cog-wheel” pattern of the endosalpingeal folds, indicative of tubal inflammation in pelvic inflammatory disease with a pyosalpinx or a hydrosalpinx. (arrows).]]
	*CBC		*CBC
	*ESR/CRP		*ESR/CRP
	*Transvaginal pelvic ultrasound (Sn 75-82%)		*Transvaginal pelvic ultrasound (Sn 75-82%)
	*CT pelvis (Sn 78-100%) - preferred in patients in whom associated GI pathology must be excluded		*CT pelvis (Sn 78-100%) - preferred in patients in whom associated GI pathology must be excluded

	==Management==		==Management==