Pelvic inflammatory disease Flashcards
What is pelvic inflammatory disease
Inflammation and infection of organs of pelvis, caused by infectiosn spread from cervix
What is PID a significant cause of
Chronic pelvic pain
Tubular infertility
What is salpingitis? oophoritis?
Inflammation of fallopain tubes
0oo - ovaries
What is parametritis
Inflamamtion of the parametrium - CT around uterus
Causes of PID STIs
Neissiera gonorrhoeae - more severe PID
Chlamydia trachomatis
Mycoplasma genitalium
What non STIs can cause PID
Less common
Gardnella vaginalis - ass w BV
H.influenzae - ass with resp infections
Ecoli - UTIs
Risk factors for PID
Same as for any other STI
* Not using barrier contraception
* Multiple sexual partners
* Younger age
* Existing sexually transmitted infections
* Previous pelvic inflammatory disease
* Intrauterine device (e.g. copper coil)
Presentation of PID
Pelvic.lower abdo pain
Abnormal dischare
Abnormal bleed - intramenstrual, postcoital
Pain during sex, dyspareunia
Fever
Dysuria
Examination findings PID
Pelvic tenderness
Cervical motion tenderness - cervical excitation
Inflamed cervic - cervicitis
Purulent discharge
Fever, signs sepsis
Investigations with PID
Test for causative organisms
NAAT swabs for gonorrhoea and chlamydia
NAAT swabs for mycoplasma genitalium if available
Syphilis test
HIV test
What can a high vaginal swab be used for
Bacterial vaginosis, candidiasis, trichomoniasis
What would exclude PID on microscope from swabs
Absence of pus cells
What need to exclude in women presenting with abdominal pain
Ectopic pregnancy - preganncy test
What bloods will help PID diagnosis
Raised CRP and ESR
Management of PUD
Empirical antibiotics then change depending on swab results
Ceftriaxone, doxycycline
Treatment for chlamydia
Doxycycline 100mg twice daily for 14 days
What guideline suggests treatment for PID
BASSH - multiple regimes to cover possible causative organisms eg
IM ceftriaxone - gon
Doxycycline - chlam
Metronidazole - anaerobes eg gardnella
Complications of PID
Sepsis
Abscess
Infertility
Chronic pelvic pain
Ectopic pregnancy
Fitz-Hugh-Curtis syndrome
When admit someone with PID to hospital
Sepsis
Pregnancy
What is Fitz hugh curtis syndrome caused by
Inflammation and infection of liver capsule- glissons capsule -> adhesions between liver and peritoneum -> bacteria spreads from pelvid via periotneal cavity, lymphatic sustem or blood
What symptoms have in fitz hugh curtis syndrome
RUQ pain - referred to R shoulder tip if diaphragmatic irritation
Management of fitz hugh curtis syndrome
Laparoscopy
Adhesiolysis can treat at same time
