Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Y4 - GOSH > Pelvic Inflammatory Disease > Flashcards

Pelvic Inflammatory Disease Flashcards

1
Q

What is pelvic inflammatory disease (PID)?

A
  • inflammation + infection of the organs of the pelvis
  • caused by infection spreading up through the cervix
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What organs can become inflamed in PID?

A

endometritis:

  • inflammation of the endometrium

salpingitis:

  • inflammation of the fallopian tubes

oophoritis:

  • inflammation of the ovaries

parametritis:

  • inflammation of the parametrium

peritonitis:

  • inflammation of the peritoneal membrane

parametrium = connective tissue around the uterus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the 3 most common causes of PID?

A
  • Neisseria gonorrhoeae produces a more severe PID
  • Chlamydia trachomatis
  • Mycoplasma genitalium
  • as most cases of PID are caused by an STI, always treat as an STI
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the less common causes of PID?

A

Gardnerella vaginalis:

  • associated with bacterial vaginosis

Haemophilus influenzae:

  • often associated with RTIs

Escherichia coli:

  • commonly associated with UTIs

Mycobacterium tuberculosis

it is also possible to get pathogen negative PID

  • this is where the swabs do not pick up the pathogen
  • there is a pathogen present, it is just not picked up
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the less common causes of PID?

A

Gardnerella vaginalis:

  • associated with bacterial vaginosis

Haemophilus influenzae:

  • often associated with RTIs

Escherichia coli:

  • commonly associated with UTIs

Mycobacterium tuberculosis

it is also possible to get pathogen negative PID

  • this is where the swabs do not pick up the pathogen
  • there is a pathogen present, it is just not picked up
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the RFs for PID?

A
  • unprotected sex
  • younger age
  • multiple sexual partners
  • existing STI
  • previous PID
  • presence of an IUD

(the same as for any other STI)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the typical symptoms associated with PID?

A
  • fever
  • dysuria
  • deep dyspareunia (pain during sex)
  • abnormal bleeding (IMB / PCB / menorrhagia)
  • abnormal vaginal discharge (often purulent)
  • pelvic / lower abdominal pain that is BILATERAL
  • secondary dysmenorrhoea

pain can be unilateral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the difference between superficial and deep dyspareunia?

A

superficial:

  • pain when the penis inserts into the vagina
  • associated with vulval conditions / thrush

deep:

  • pain is deep within the abdomen
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How can the nature of the dyspareunia be used to distinguish PID from other conditions?

A
  • there is deep dyspareunia in PID
  • it is constant
  • deep pelvic pain is intermittent in IBS and cyclical in endometriosis
  • the pain is a menstrual type pain

ectopic pregnancy / cysts produce a similar pattern of pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the 3 areas to cover in history of presenting complaint?

A
  1. pain
  2. bleeding
  3. other (incl. sexual health)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What features need to be covered in the pain HPC?

A
  • SOCRATES to describe the pain
  • presence of dysuria
  • presence of DEEP dyspareunia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What features need to be covered in the bleeding HPC?

A
  • last menstrual period (LMP) to consider chance of ectopic pregnancy
  • presence of postcoital bleeding (PCB)
  • presence of intermenstrual bleeding (IMB)
  • recent onset menorrhagia (heavy menstrual bleeding)
  • dysmenorrhoea (painful menstrual bleeding)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What other questions need to be asked in the HPC?

A
  • change in vaginal discharge
  • change in bowel habit
  • presence of a fever
  • sexual history - including recent change in sexual partner
  • current contraception (can explain some of the bleeding)

if fever:
* consider UTI, appendicitis + severe PID

if change in BH:
* consider IBS, IBD and endometriosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the onset of symptoms like in PID?

A

recent onset of symptoms (< 30 days)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What examinations would be performed in PID?

A

abdominal examination:

  • including examination of inguinal LNs

bimanual examination

  • also check temperature as fever can occur in moderate-severe disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the typical findings on examination?

A

abdominal examination:

  • lower abdominal / pelvic tenderness that is usually bilateral

bimanual examination:

  • adnexal tenderness
  • cervical motion tenderness / uterine tenderness
  • may note the presence of purulent discharge
16
Q

What is the first-line investigation in PID?

A

!! PREGNANCY TEST !!

  • should be performed in ALL sexually active women with lower abdominal pain
  • rules out ectopic pregnancy
17
Q

What other investigations are performed in suspected PID?

A
  • urine dipstick + MSU (if positive)
  • temperature
  • NAAT from a vulvovaginal swab (VVS)
  • endocervical swab
  • blood tests for HIV + syphilis
  • consider FBC, CRP/ESR, LFTs
18
Q

What is tested for on the NAAT VVS?

A
  • NAAT swabs for gonorrhoea + chlamydia
  • NAAT swabs for trichomonas if SYMPTOMATIC (itching / discharge / soreness around vulva)
  • NAAT swab for Mycoplasma genitalium (if available)

NAAT = nucleic acid amplification test

19
Q

Why is an endocervical swab performed?

A

gonorrhoea culture

  • this looks at sensitivities to ensure correct antibiotics are given
20
Q

If a microscope is available, what additional tests may be performed?

A
  • microscopy for the presence of bacterial vaginosis / endocervical pus cells
  • swabs taken from vagina or endocervix
  • the absence of pus cells excludes PID
21
Q

What are the potential complications of PID?

A
  • tubal factor infertility
  • chronic dyspareunia + pelvic pain (18%)
  • Fitz Hugh Curtis syndrome
  • tubo-ovarian abscess
  • ectopic pregnancy
22
Q

How is the risk of infertility related to PID?

A
  • the risk of tubal factor infertility increases with number of episodes of PID
  • the risk also increases if treatment is delayed
23
Q

How might someone present if they have a tubo-ovarian abscess as a result of PID?

A
  • systemically unwell
  • fever
  • palpable mass
  • lack of response to treatment

  • this is an abscess within the adnexa
  • adnexa = region adjoining the uterus containing the ovary, fallopian tube + vessels, ligaments, connective tissue
24
Q

When is treatment started in PID?

A
  • antibiotics are started immediately before swab results
  • this avoids a delay (which increases risk of infertility)
25
Q

What advice is given to patients about management of PID?

A
  • rest and analgesia
  • NO SEX until both they and their partner(s) have completed treatment + follow up
26
Q

What is involved in the antibiotic management of PID?

A

ceftriaxone:

  • 1g IM stat - given as an injection into the buttocks
  • covers for gonorrhoea

doxycycline:

  • 100mg PO BD for 14 days
  • covers for chlamydia

metronidazole:

  • 400mg PO BD for 14 days
  • covers for anaerobes (e.g. Gardnerella vaginalis)
27
Q

What is not covered for in the antibiotic management of PID?

A

Mycoplasma genitalium

  • this requires moxifloxacin 400mg OD for 14 days
28
Q

When might hospital admission be required in PID?

A
  • if no improvement 72 hours after antibiotics started
  • signs of sepsis
  • patient is pregnant
  • development of pelvic abscess

admission for IV abx / drainage of abscess is required

29
Q

What is the treatment for a partner of someone with PID?

A
  • a full sexual health screen should be performed
  • they are given doxycycline 100mg PO BD for 7 days
30
Q

When should empirical antibiotic treatment for suspected PID be offered?

A
  • any sexually active patient with bilateral lower abdominal pain
  • this is associated with tenderness on bimanual exam

AND

  • pregnancy has been excluded

the risk of PID is highest in women < 25 not using barrier contraception and with a history of a new sexual partner

31
Q

What is Fitz-Hugh-Curtis syndrome?

A
  • inflammation + infection of the liver capsule (Glisson’s capsule)
  • resulting in adhesions between the liver and peritoneum
32
Q

How does Fitz-Hugh-Curtis syndrome present?

A
  • RUQ pain
  • the pain is referred to the right shoulder tip if there is diaphragmatic irritation
  • this is typically related to chlamydia infection
33
Q

What is the management for Fitz-Hugh-Curtis syndrome?

A

laparoscopy:

  • can be used to visualise the adhesions and treat them via adhesiolysis

Y4 - GOSH (62 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions