10.2: PID Flashcards
What causes PID?
An infection that ascends to the upper genital tract spreading from the endocervix
Name six diseases/complications that PID can lead to?
Which is considered a surgical emergency
Essentially an infection of every part of the genital tract:
- Endometritis
- Salpingitis; inflammation of the Fallopian tubes
- Parametritis; inflammation of pelvic floor CT
- Oophoritis; inflammation of ovary
- Tubo-ovarian abscess; abscess (collection of pus) of the Fallopian tube and/or affecting the ovary
- Pelvic peritonitis; irritation of peritoneum* surgical emergency
What is another name for parametritis?
Pelvic cellulitis
Describe the areas that an individual with PID may experience pain
* 5 things
- Pelvic floor
- Lower abdominal; usually bilateral but can be unilateral
- RUQ
- Deep dyspareunia (especially if recent onset)
- Secondary dysmenorrhea: pain caused by disordered reproductive organs that starts earlier in the menstrual cycle and lasts longer than menstrual cramps
Other than types of pain, what other signs and symptoms might an individual with PID experience?
Abnormal vagina discharge and bleeding
List five gynaecological differentials for PID, star the two that are the most severe and must be dealt with quickly
- Ectopic pregnancy*
- Ruptured corpus lateral cyst
- Endometriosis
- Ovarian cyst rupture
- Ovarian torsion*
Name two potential GI differentials and one renal differential for PID
Other than any gynaecological, GI and renal differentials - what else is a differential for PID?
GI: IBS and diverticular disease
Renal: UTI (particularly if its unilateral pain and there’s associated dysuria)
Other: functional pain and appendicitis (especially if its R iliac fossa pain)
What is Mittleshmerz pain?
Another gynaecological differential for PID, its mid-cycle cramping due to ovulation which can be very severe
Name four risk factors for a PID specific to sexual behaviour
- Early age of first sexual intercourse
- Multiple partners
- New partner <3 months
- History of STIs (patient or partner)
Name three risk factors for a PID specific to instrumentation of the uterus
- Termination of a pregnancy
- IUD insertion within last 4-6 weeks (if so consider removing it after no response to antibiotics within 72 hours)
- Recent IVF
Name four bacterial causes for PID, which is the most common? Is there always a pathogen involved?
- Chlamydia- most common
- Gonorrhea
- Mycoplasma genitalium
- Overgrowth of natural vaginal flora; anaerobes, gardnerella vaginalis
*But it can also be pathogen negative
What would you expect to see in an abdominal, bimanual/pelvic and speculum (to see inside hollow body parts) examination of a patient with PID. What else might the patient present with?
Abdominal: lower (usually bilateral) abdominal tenderness
Bimanual: adnexal, cervical and uterine tenderness
Speculum: abnormal cervical and vaginal mucopurulent discharge
The patient may also have a fever
What is the adnexa?
Region adjacent to the uterus that includes the ovary, Fallopian tubes and associated structures
Name five major investigations you would do for a patient with suspected PID
- Pregnancy test
- Triple swab:
A) high vaginal swab to rule out bacterial infections and candidiasis
B) Endocervical swab for chlamydia and gonorrhea - Bloods: ESR, CRP, leukocyte count and check for HIV and syphilis
- Ultrasound: looking for hydrosalpinx (clear serous fluid within the Fallopian tube) or an abscess
- CT/MRI to exclude any other diagnosis
List three major/general things you would do as part of PID treatment
- GUM referral for advice, contact tracing, and screening current and recent partners within last 6 months
- Analgesia; i.e paracetamol, ibuprofen
- Empirical (not waiting for swabs to come back, treat quickly to avoid complications) antibiotics for 14 days
- outpatient and inpatient regime. The course of antibiotics must be finished even if the swabs come back negative
Name three antibiotics used as treatment for PID
Ceftriaxone, doxycycline, metronidazole
When would surgery be considered as treatment for PID
- Patient showing no response to antibiotics
- Severe disease
- Tubo-ovarian abscess
When should there be significant improvement after giving antibiotics? What should be considered if there isn’t?
Significant improvement should occur 72 hours after, if there isn’t consider admitting for IV antibiotics or further investigations
List 5 criteria for admitting a patient with a suspected PDI
- Ectopic pregnancy cannot be excluded
- Severe signs and symptoms (febrile, nausea, vomiting, etc)
- Pelvic peritonitis (SUPER tender)
- Another surgical emergency cannot be excluded (i.e acute appendicitis)
- Can’t tolerate oral medications
What is a test of cure? List four scenarios where you would perform one
When you retest after completion of antibiotics
To be done if
- Initial swabs for chlamydia, gonorrhea were positive
- Symptoms persist after treatment
- Poor compliance suspected
- Possibility of reinfection
List five complications that prompt empirical antibiotics are given to prevent! What might cause these complications?
- Tubal infertility
- Ectopic pregnancy
- Chronic pelvic pain
- Development of a tubo-ovarian abscess
- Fitz-Hugh-Curtis
Can form due to adhesions (scar tissue after inflammation or surgery)
What is fitz-Hugh Curtis and why can a PID cause one?
A liver capsular infection that forms without hepatic parenchymal involvement caused by the intra-abdominal spread of a PID (possibly using parabolic gutters, blood or lymph flow)
List three characteristics of acute fitz-Hugh Curtis and one characteristic for chronic, is it always symptomatic?
May be asymptomatic
Acute: sharp severe RUQ pain, may have pain in right shoulder tip (due to irritation along the diaphragm), systemically unwell (fever, nausea, vomiting, etc)
Chronic: Persistent dull RUQ pain
If a patient with asymptomatic fitz-Hugh-Curtis is sent for surgery what would you find?
Adhesions along the liver (violin string like adhesions)
How is Fitz-Hugh-Curtis investigated and what would you expect to see?
If the patient had fitz-Hugh-Curtis..
- Bloods: LFT (normal as there’s no hepatic parenchymal involvement), inflammatory markers (would be raised)
- Ultrasound: to exclude biliary stones, and would see violin string like adhesions
How is fitz-Hugh Curtis treated?
Same 2 week course of antibiotics used for PID
What does ESR measure and what is an abnormal finding?
Erythrocyte sedimentation rate: measures how quickly erythrocytes settle at the bottom of a test tube. A faster than normal rate may indicate inflammation.
