Pelvic Inflammatory Disease

Question 1

What is inflammation of the Fallopian tubes called?

Answer 1

Salpingitis

Question 2

How can the patency of the uterine tubes be tested?

Answer 2

Passage of radio-opaque dye from uterine cavity

Hysterosalpingography

Question 3

Give some examples of the symptoms of pelvic inflammatory disease.

Answer 3

• fever/pyrexia
• lower abdominal pain (bilateral)
• deep dyspareuria (painful sexual intercourse)
• adnexal tenderness (over ovary)
• nausea/vomiting
• proctitis
• mucopurulent/cervical discharge
• abnormal vaginal bleeding

Question 4

Give some differential diagnoses for pelvic inflammatory pain.

Answer 4

Urinary:

• UTIs
• kidney stones
• interstitial cystitis

GI:

• appendicitis
• gastroenteritis
• irritable bowel syndrome
• Crohn’s or ulcerative colitis

Gynaecological:

• ectopic pregnancy
• cervicitis
• endometriosis
• adnexal tumour (cystic mass on ovary)
• ovarian cysts
• ovarian torsion

Question 5

What investigations should be performed to confirm pelvic inflammatory disease?

Answer 5

• PREGNANCY TEST (rule out ectopic pregnancy)
• cervical swabs for chlamydia/gonorrhoea (note: negative result does not exclude PID) —> NAAT
• blood test for CRP & UBCs
• urinalysis & culture (exclude UTIs)
• high vaginal swabs (Candida/bacterial vaginosis)
• endometrial biopsy/ultrasound
• laparoscopy (visualise Fallopian tubes)

Question 6

What organisms are involved in pelvic inflammatory disease?

Answer 6

Chlamydia trachomatis
Neisseria gonorrhoeae
Genital mycoplasmas

Others:

• bacterial vaginosis
• Gardnerella vaginalis
• Mycoplasma hominis
• Mobiluncus spp.
• endogenous vaginal flora
• aerobic Strep.
• Mycobacterium tuberculosis

Question 7

What is the management of pelvic inflammatory disease?

Answer 7

• analgesia
• antibiotics = broad spectrum + specific (esp. anaerobic coverage)
• bed rest in Semi-Fowler position to drain pus into the pelvis (lie in bed in supine position with head of bed at ~30 degrees)

note: use aggressive antibiotics in nulliparous women (never been pregnant)

Question 8

Give some examples of complications of pelvic inflammatory disease.

Answer 8

• chronic recurring infection
• infertility
• increased risk of ectopic pregnancy
• chronic pelvic pain
• Fitz-Hugh-Curtis syndrome
• Reiter’s syndrome (reactive arthritis)
• increased risk of preterm delivery and maternal & foetal morbidity
• perinatal transmission of chlamydia/gonorrhoea —> opthalmia neonatorum, chlamydial pneumonitis

Question 9

What is Fitz-Hugh-Curtis syndrome?

Answer 9

Acute = PID (usually Chlamydia trachomatis) spreads through abdomen to liver, causing perihepatitis (RUQ pain, sometimes diaphragmatic —> referred to shoulder tip)

Spread may be via paracolic gutters, lymphatics, or blood

Chronic = adhesions form between anterior liver capsule and anterior abdominal wall (“violin string” appearance)