Pelvic Inflammatory Disease

Question 1

What is pelvic inflammatory disease?

Answer 1

inflammation of the reproductive tract beyond the cervix, usually due to bacterial infection

Question 2

What is endometritits?

Answer 2

inflammation of the uterus

Question 3

What is salpingitis?

Answer 3

inflammation of the fallopian tubes

Question 4

What is oophoritis?

Answer 4

inflammation of the ovary

Question 5

What causes pelvic inflammatory disease?

Answer 5

• polymicrobial (frequently Chlamydia, gonocci, staphylococci and streptococci groups of bacteria, also E. coli)
• often due to an untreated STI (10% gonorrhea, 20% chlamydia)

Question 6

What is the pathology of PID?

Answer 6

• microbes enter the cervix, which is dilated during menstruation
• endometrial slough is nutrient rich, bacteria multiply rapidly in this environment
• bacteria now progress in an ascending manner

Question 7

What are complications of PID?

Answer 7

• pelvic abscess when purulent exudate gets into the body cavity at the level of the infundibulum… can lead to peritonitis
• parametritis - inflammation of the mesentary anchoring the uterus, which is highly vascular… can lead to sepsis
• infertility due to scarring

Question 8

What does pyogenic mean?

Answer 8

pus-producing

Question 9

What are the manifestations of PID?

Answer 9

• normal signs and symptoms of infection
• lower abdominal pain that is acute in onset, may be sharp or achey
• heavy, purulent vaginal discharge
• dyspareunia = pain during intercourse
• adnexal tenderness (tenderness towards the uterus)
• fever
• abnormal vaginal bleeding (this can be any bleeding in a post-menopausal woman, or heavy bleeding, prolonged bleeding or bleeding outside of menses)
• leukocytosis

Question 10

How is PID diagnosed?

Answer 10

• presentation
• increased erythrocyte sedimentation rate (the increase in proteins during inflammation causes RBCs to cluster, they sediment more quickly in these groups because they weigh more)
• increased CRP
• laparoscopy to visualize which structures are implicated

Question 11

How is PID treated?

Answer 11

• broad spectrum antibiotics (more than one!) PO
• may need IV antibiotics
• evaluate and treat partner for STI?
• some cases (like abscesses) may need surgery (laparotomy)