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ESA 4 - Reproductive System > Pelvic Inflammatory Disease > Flashcards

Pelvic Inflammatory Disease Flashcards

1
Q

What is pelvic inflammatory disease (PID) a result of?

A

Infection ascending from the endocervix

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2
Q

What does PID cause?

A
  • Endometritis
  • Salpingitis
  • Parametritis
  • Oophoritis
  • Tubo-ovarian abscess
  • Pelvic peritonitis
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3
Q

What is endometritis?

A

Inflammation of the lining of the uterus (endometrium)

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4
Q

What are the common complications of PID?

A

Endometritis and salpingitis

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5
Q

What can salpingitis cause?

A

Pain and loss of function

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6
Q

What is salpingitis?

A

Inflammation of the fallopian tubes

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7
Q

What is a serious complication of PID?

A

Tubo-ovarian abscess

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8
Q

What causes a tubo-ovarian abscess?

A

Inflammatory exudate fills the lumen. If there are adhesions, abscesses can form

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9
Q

What can happen to the inflamed tube in a tubo-ovarian abscess?

A

It can become attached to the pelvic sidewall

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10
Q

Why is the prevalence of PID underestimated?

A

Because a large proportion of cases are asymptomatic

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11
Q

Who is the biggest group of PID sufferers?

A

Sexually active women

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12
Q

At what age is the peak prevalence of PID?

A

20-30

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13
Q

What is the incidence rate of PID in primary care?

A

˜280 in 100,000 py

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14
Q

What are the risk factors for PID?

A

Those for STIs;

  • Younge age
  • Lack of use of barrier contraception
  • Multiple sexual partners
  • Low socioeconomic class

And IUCD

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15
Q

When does IUCD increased the risk of PID?

A

When putting it in, and removing it

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16
Q

What is the aetiology of PID?

A

Often polymicrobial

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17
Q

What % of diagnoses of PID are accounted for by STIs?

A

25%

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18
Q

What microbes can cause PID?

A
  • C. trachomatis D-K
  • N gonorrhea
  • Microbes causing bacterial vaginosis
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19
Q

What microbes cause bacterial vaginosis?

A
  • Gardnella vaginalis
  • Mycoplasma hominis
  • Anaerobes
  • Actinomycosis
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20
Q

What is the pathophysiology of PID?

A

Ascending infection from the endocervix. Infection causes inflammation, which causes damage, and thus damaged tubal epithelium and adhesions

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21
Q

What is the endocervix the site for?

A

Lower genital tract infection

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22
Q

Does the tubal epithelium recover following PID?

A

Some recovery, but not totally

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23
Q

What is the result of the long term damage to the tubal epithelium in PID?

A

Risk of infertility and ectopic pregnancy

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24
Q

What do adhesions cause in PID?

A
  • Functions of tube inhibited
  • Can lead to development of abscesses
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25
Q

What is the problem with diagnosing PID?

A
  • A large majority of cases are asymptomatic
  • Poor specificity of symptoms
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26
Q

What features of history suggest PID?

A
  • Pyrexia
  • Pain; lower abdominal pain and deep dysparunia
  • Abnormal vaginal/cervical discharge
  • Abnormal vaginal bleeding
  • Sexual history and prior STI
  • Contraceptive history
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27
Q

What is dysparuenia?

A

Pain when having sex

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28
Q

Describe the vaginal/cervical discharge in PID?

A
  • Offensive smelling
  • Purulent
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29
Q

What abnormal vaginal bleeding might be experienced with PID?

A
  • Intermenstrual bleeding
  • Post coitus bleeding
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30
Q

When might a prior PID history be a cause for concern?

A

When it was not properly treated

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31
Q

What features on examination are suggestive of PID?

A
  • Fever over 28 degrees
  • Lower abdominal tenderness
  • Tenderness on bimanual examination
  • Abnormal speculum examination
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32
Q

What is usually true of the lower adominal tenderness in PID?

A

It is usually bilateral

33
Q

How is a bimanual examination conducted?

A

One hand on abdomen, 2 in vagina to deviate gynacological organs towards the abdomen

34
Q

What tenderness would be detected on a bimanual examination with PID?

A
  • Adnexal tenderness (tubes of the ovaries)
  • Cervical motion tenderness
35
Q

What can a speculum examination detect?

A

Lower genital tract infections

36
Q

What may be found on a speculum examination with a person with PID?

A
  • Purulent cervical discharge
  • Cervicitis
37
Q

What are the categories of differential diagnoses with PID?

A
  • Gynacological
  • Gastrointestinal
  • Urinary
  • Functional pain
38
Q

What are the gynacological differential diagnoses of PID?

A
  • Ectopic pregnancy
  • Endometriosis
  • Ovarian cyst complications
39
Q

Why should an ectopic pregnancy be considered in a PID differential?

A

Because they have similar risk factors

40
Q

What ovarian cyst complications may cause PID like symptoms?

A

Rupture

41
Q

How can PID be differentiated from an ovarian cyst rupture?

A

There is a similar type of pain, but ruptures have a more acute onset, whereas PID develops over a couple of days

42
Q

What are the gastrointestinal differential diagnoses of PID?

A
  • IBS
  • Appendicitis
43
Q

How can PID be differentiated from appendicitis?

A

With appendicitis, most people have nausea and vomiting, whereas only about half of PID patients do

44
Q

What are the urinary differential diagnoses of PID?

A

UTI

45
Q

What must be done to investigate the possibility of a UTI when taking a PID history?

A

Must check urinary symptoms, e.g. dysuria and frequency

46
Q

What is the problem with functional pain when diagnosing PID?

A

Can be hard to differentiate between this and chronic PID

47
Q

What is chronic PID?

A

When you get scarring and adhesions without active inflammation

48
Q

What investigations should be done when PID is suspected?

A
  • Urinary and/or serum pregnancy test
  • Endocervical and high vaginal swabs
  • Blood tests
  • Screening for other STIs, including HIV
  • Diagnostic laproscopy
49
Q

Why is it important to do a pregnancy test when a patient presents with PID?

A

Because significant complications if PID during pregnancy

50
Q

What can be determined from endocervical and high vaginal swabs in PID?

A

Presence of chlamydia or gonorrhoea supports diagnosis, but absence does not exclude diagnosis

51
Q

What is being looked for in blood tests with PID?

A
  • WBC
  • CRP
52
Q

What is the negative predictive value of absence of pus cells with PID?

A

95%

53
Q

What is the problem with using the presence of pus cells as a diagnostic tool in PID?

A

Their presence is not specific

54
Q

What is the advantage of using diagnostic laproscopy in PID?

A

Can use to treat adhesions and drain abscesses

55
Q

What are the problems with diagnostic laproscopy in PID?

A
  • Risks, including bleeding and infection
  • May not see any inflammation on outside, as may all be inside tubes and womb
56
Q

What % of women you think have PID actually do on laproscope?

A

65%

57
Q

What is the problem with diagnosis of PID?

A

Underdiagnosis is high, with a low pickup rate on investigation

58
Q

How high is the threshold for empirical treatment of PID?

A

Low

59
Q

Why is there a low threshold for empirical treatment of PID?

A

Because delayed treatment increases long-term complications

60
Q

What is the empirical treatment for PID?

A

Analgesia and rest

61
Q

What does severe PID require?

A
  • IV antibiotics
  • Admission for observation and possible surgical intervention
62
Q

What is severe PID indicated by?

A
  • Pyrexia over 38 degrees
  • Signs of tubo-ovarian abscess
  • Signs of pelvic peritonitis
63
Q

Other than severe disease, when may admission be necessary for PID?

A
  • When not responding to tablets
  • Pregnancy
64
Q

What is the problem with severe PID?

A

Increased risk of long term sequelae

65
Q

How long is antibiotic therapy given for PID?

A

14 days

66
Q

What is the antibiotic regime for outpatient treatment of PID?

A
  • IM ceftriaxone 500mg STAT (one of dose ASAP)
  • PO doxycycline 100mg BD
  • PO metronidazole 400mg BD
67
Q

What is the antibiotic regime for inpatient treatment of PID?

A
  • IV ceftriaxone 500mg STAT
  • IV/PO doxycycline 100mg BD
  • IV metronidazole 400mg BD
  • PO doxycycline 100mg BD
  • PO metronidazole 400mg BD
68
Q

When is laparoscopy/laparotomy considered in the treatment of PID?

A
  • No response to therapy
  • Clinically severe disease
  • Presence of tubo-ovarian abscess
69
Q

What is the advantage of ultrasound guided aspiration of pelvic collections over laparoscopy/laparotomy in treatment of PID?

A

It is less invasive

70
Q

Why is contract tracing important in PID?

A

To reduce the spread of STIs

71
Q

What are the potential complications of PID?

A
  • Ecoptic pregnancy
  • Infertility
  • Chronic pelvic pain
  • Fitz-Hugh-Curtis Syndrome
  • Reiters syndrome
72
Q

What causes chronic pelvic pain in PID?

A

Adhesions

73
Q

What happens in Fitz-Hugh-Curtis syndrome?

A

Get RUQ pain and peri-hepatitis following chlamydial PID

74
Q

In what % of cases does Fitz-Hugh-Curtis syndrome occur?

A

10-15%

75
Q

What is Reiters syndrome associated with?

A

Chlamydia

76
Q

What kind of pathology is Reiters syndrome?

A

Immune mediated

77
Q

What does Reiters syndrome cause?

A
  • Arthritis
  • Conjunctivitis
  • Urethritis
78
Q

What should a patient with PID be told?

A
  • What the diagnosis is
  • What treatment they are having
    • Possible side effects
      • Especially with alcohol
        • Headaches
        • Flushing
  • Importance of completing antibiotics
  • What complications they are at risk of
    • Risk of these increases with repeat episodes
  • How to reduce the risk of further episodes
  • Contact tracing
    • Empirical treatment of partners
    • Abstinence until antibiotic course and follow up complete
      • Follow up at 48 hours and 2 weeks

ESA 4 - Reproductive System (31 decks)

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