Pelvic inflammatory disease Flashcards
Main bacteria of the vagina.
Lactobacilli
Function of lactobacilli.
Hydrogen pyroxide.
keeps acidic
protects against other infection
Pathogenesis of PID.
colonisation of tubo-ovarian complex.
Pathogenic bacteria ascends up the endo-cervix and into the uterus.
Can fallopian tubes can rupture and the pus can spread to the abdominal cavity.
generalised peritonism.
Reason for broad spectrum antibiotics.
Polymicrobial infection
Primary invaders.
Ascends without help (such as breaching the endocervix)
Neisseria gonorrhoea. (fulminant- sudden)
Chlymadia Trachomatis (chronic tubal damage.
Mycoplasma genitalum.
Anaerobic bacteria.
Secondary invaders.
After ascending infection caused damage to the tissue.
E. Coli
S. Faecalis.
anaerobes such as normal flora.
Vagina vs Upper genital tract.
Vagina- non sterile
UGT- Sterile
Gainesville system for Staging PID.
Stage 1: Early salpingiti- mild-moderate tenderness and VD
Stage 2: Late salpingitis- Pelvis peritonitis.
Stage 3: Tubo-ovarian comples (Abscess)
Stage 4: Ruptured TOC- generalised tenderness and septicaemia
Symptoms
Pain: Lower abdo, dyspareuria
Foul smelling VD
Abdnormal Uterine bleeding
fever
Urinary Symptoms: frequency and pain.
Signs
Well –> unwell
normal–> shock
Lower abdominal tenderness
Pelvic Peritonism (cervical excitation tenderness, peritoneum stretch on cervical manipulation (acute pain)
Right Upper quadrant tenderness ( Fitz Hugh-Curtis Syndrome)
Differentials
Appendicitis
Ovarian cyst rupture or torsion
UTI
Ectopic pregnancy
investigation
Urine Dipstix
Preg
US
HIV, Syphillis and Pap smear
Stage 1 management and goal.
Treat infection
Oral antibiotics at home review in 2-3 days
Stage 2 management and goal.
Save tube
admit, oral + IV
Stage 3 and stage 4 management and goal.
3- save ovaries
4- life
admit, oral + IV
Laparotomy no improvement in 48 hours
