10.2 Pelvic Inflammatory disease Flashcards
What is PID and what is it a result of?
Pelvic Inflammatory Disease: results from an ascending infection of the females upper genital tract (spreads upwards from endocervix)
List 4 conditions PID can lead too and state what each is
(Hint: can lead to an infection of EVERY part of female genital tract)
1) Endometritis: Inflammation of endometrium
2) Salpingitis: Inflammation of fallopian tubes
3) Parametritis: Inflammation of pelvic floor connective tissue aka “pelvic cellulitis”
4) Oophoritis: Inflammation of ovary
5) Tubo-ovarian abscess: abscess (collection of pus) of the fallopian tube and/or the ovary
6) Pelvic peritonitis: inflammation of the peritoneum (emergency!)
Give 4 common symptoms of PID
1) pelvic pain
2) lower abdominal pain (usually bilateral)
3) deep dysparenunia
4) abnormal vaginal bleeding
5) abnormal vaginal discharge
6) RUQ pain
7) secondary dysmenorrhoea
Give 4 gynaecological differentials for lower abdominal pain
- ectopic pregnancy
- endometriosis
- ovarian cyst rupture
- ovarian torsion
- mittleschmerz pain (mid-cycle cramping due to ovulation)
Give 2 GI differentials for for lower abdominal pain
- Irritable bowel syndrome
- diverticular disease
- apendicitis
Give one renal differential for lower abdominal pain + one other
Renal: UTI (especially if pain is bilateral)
Other: Functional pain (if there is no known cause)
Give 4 risk factors for development of PID
(Hint: same as STI risk factors)
- young <25 years
- early age first coitus
- multiple partners
- new partner < 3 months
- history of STIs (either patient or partner)
Give 4 infectious causes of PID (most common)
1) Chlamydia (most common)
2) Gonorrhoea
3) Mycoplasma genitalium
4) Pathogens in normal vaginal flora (anaerobes, G vaginalis, H influenze)
List 4 things you may look for on examination in patient with suspected PID
- lower (usually bilateral) abdominal tenderness
- cervical or uterine tenderness
- abnormal cervical or vaginal mucopurulent discharge (spectulum)
- fever >38 degrees (but may be afebrile)
List 4 investigations that can be done for suspected PID + explain why?
1) Pregnancy test to rule out ectopic pregnancy or threatened abortion
2) Triple swabs (high vaginal, endocervical and endocervical NAAT) to test for gonorrhoea, chlamydia and other bacteria infections
3) Bloods: check ESR, CRP, leucocyte count (raised levels support PID but are not specific). Also test bloods for HIV and Syphilis
4) Transvaginal ultrasound to check for hydrosalpinx or an abscess
5) CT/MRI to exclude other diagnoses
What are Emperical antibiotics?
antibiotics given to a person before the specific bacterium or fungus causing an infection is known (before swab returns)
How would you treat PID before admitting to hospital + what else MUST you do?
Treatment pre-admission: analgesias and empirical antibiotics (usually ceftriaxone, doxycycline, metronidazole)
MUST also refer to GUM clinic for contact tracing and review patient after 72 hours
When should you consider hsopital admission or alternative diagnosis and why?
After 72 hours If there little-no improvement, consider admission or alternative diagnosis.
This is because surgery (laproscopic) may be requiredif there is no response to antibiotics, a tubo-ovarian abscess or increasing severity
What is meant by “admission criteria” and 5 reasons for immediate admission of RUQ pain
Admission criteria: deciding whether patient needs to be treated as inpatient or outpatient when they present.
If any of the following apply they should be admitted immediately:
- can NOT exclude an ectopic pregnancy
- can NOT exclude another surgical emergency (eg. appendicitis)
- can NOT tolerate oral medications
- have severe signs and symptoms (febrile, nausea, vomiting etc)
- suspected pelvic peritonitis (tenderness in abdomen on soft touch)
If antibiotics are prescribed what is IMPORTANT to inform patient?
Explain the importance of completing entire course of antibiotics (even if swabs are negative)
