Pelvic Inflammatory Disease Flashcards
What is PID?
Infection of Upper genital tract in females
What organs does PID affect? (3 things)
- Uterus
- Fallopian tubes
- Ovaries
What age group is PID most common in?
15-24 yrs
What is the general cause of PID?
Spread of bac infection from vagina / cervix upwards
What are the most common organisms that cause PID? (3 things)
STI’s:
- Neisseria gonorrhoea
- Chlamydia trachomatis
- Mycoplasm genitalium
Which organism causes the most severe PID?
Neisseria gonorrhoea
What are the RF for PID? (5 things)
- Sexually active (esp without protection)
- Recent partner change
- Age 15-24
- Hx of STIs / PID
- IUD
What are the CF of PID? (7 things)
- Fever (advanced)
- Pelvic / lower abd pain
- Dyspareunia (pain @ intercourse)
- Post-coital bleeding
- Abn discharge (purulent / foul smelling)
- Menstrual abn (menorrhagia / dysmenorrhoea)
- Dysuria
What are the CF of PID @ examination? (4 things)
- Palpable mass
- Pelvic / cervical tenderness
- Inflamm cervix
- Purulent discharge
What are some differential Dx that present similarly to PID? (4 things)
- Endometriosis
- Ectopic pregnancy
- Ruptured ovarian cyst
- UTI
What investigations should be done for sus PID? (6 things)
- Endocervical (NAAT) swabs
- Full STI screen
- Urine dipstick / MSU
- Pregnancy test (to exclude ectopic pregnancy)
- Inflamm markers (CRP / ESR) (raised)
- Transvaginal US
- Laparoscopy
What are you testing for in Endocervical (NAAT) swabs? (3 things)
- Gonorrhoea
- Chlamydia
- Mycoplasm genitalium
What are you testing for in a Full STI screen? (5 things)
- HIV
- Syphilis
- Gonorrhoea
- Chlamydia
- Mycoplasm genitalium
What is the point of a Urine dipstick / MSU in sus PID?
To exclude UTI’s
When are Transvaginal US / Laparoscopy indicated in sus PID?
Severe cases where there is diagnostic uncertainty
What is the point of Laparoscopy for investigating PID? (2 things)
- Observe gross inflamm changes
- Peritoneal biopsy
What is the Tx for PID?
14 day broad spec abx course (w good anaerobic coverage)
When should abx course for PID be started?
Immediately, even before swabs results are back
What are the abx options for PID? (2 things)
- Doxycycline + Ceftriaxone + Metronidazole
- Ofloxacin + Metronidazole
How should you manage pain in PID?
Paracetamol
What are signs the pt has severe PID / needs further Tx? (3 things)
- Sepsis signs
- Pelvic abscess
- Pregnant
What further treatment is given to patients with severe PID who are admitted?
IV abx
What is the Tx when a Pelvic abscess develops in PID?
Drainage (by interventional radiologist / surgeon)
What are the complications of PID? (6 things)
- Sepsis
- Abscess
- Infertility (10%)
- Chronic pelvic pain
- Ectopic pregnancy
- Fitz-Hugh-Curtis syndrome
Why is the risk of Ectopic pregnancy increased after having PID?
Bc narrowing + scarring of fallopian tubes
What is Fitz-Hugh-Curtis syndrome? (2 steps)
- Inf of liver capsule (aka Glisson’s capsule)
- Leads to adhesions between Liver + peritoneum
What are the CF of Fitz-Hugh-Curtis syndrome? (2 things)
- RUQ pain
- Referred R shoulder pain (if diaphragm irritated)
What is used to visualise and treat adhesions of Fitz-Hugh-Curtis syndrome?
Laparoscopy (adhesiolysis)
