Pelvic Inflammatory Disease Flashcards
What is pelvic inflammatory disease
Ascending infection from the vagina through the endocervix leading to inflammation of the female reproductive tract
Have inflammatory changes within the reproductive tract
Describe salpingitis
Inflammation of the fallopain tubes
Can have significant clinical complications due to long-term damage to ciliated epithelium of fallopian tubes
Inflammatory exudate causes tube to fill with pus -> obstruction and adhesions
Tubo-ovarian abscesses may form
Typically remains within fallopian tube but can affect other structures and spread to cause peritonitis
What are the causes of PID
Infective organisms like Neisseria gonorrhea and Chlamydia trachomatis
Non-sexually transmitted infections like Gardnerella vaginalis
Inserting or removing an IUCD
What are the risk factors for PID
Sexually active women between 20-30
Multiple sexual partners
Lack of barrier contraception
Low socio-economic status
IUCD
What are the symptoms of PID
Asymptomatic
Chronic pelvic pain - lower abdominal and/or deep dyspareunia
Infertility problems
General features of inflammation - pyrexia/fever
Abnormal vaginal/cervical discharge
Abnormal vaginal bleeding
What may be found on examination
On bimanual examination may find: tenderness of cervix or adnexa, palpable mass (tubo-ovarian abscess)
Discharge on speculum exam
Name some differential diagnoses for PID
Prengnant - normal or ectopic
Endometriosis
Ovarian cysts
Appendicitis
IBS
UTI
Functional pain
What investigations can be performed to look for PID
Urinary and/or serum pregnancy test
Endocervical and high vaginal swab to detect NG/CT
Blood tests - WBC and raised CRP
Screening for STIs
Diagnostic laparoscopy
How is PID managed
Empirical treatment with antibiotics - include partner. Antibiotics should cover anaerobic organisms and chlamydia and gonorrhoea. Course should be >14 days
STI screen
Systemic management with analgesia and rest
Laparoscopy if no response to treatment
Ensure compliancy to treatment and educate patient to help prevent further episodes
What are some complications of PID
Chronic response to inflammation is fibrin deposition -> can have scarring and adhesions within reproductive tract - increases risk of ectopic prengancy and infertility
Chlamydia infections can lead to Fitz-Hugh-Curtis syndrome
Disseminated chlamydia infections can cause Reiter syndrome - conjunctivitis, urethritis and arthritis
What is Fitz-Hugh-Curtis syndrome
Inflammation of the liver capsule causing peri-hepatitis and RUQ pain
Causes scarring between liver and diaphragm
More common with chlamydia but can occur with gonorrhoea
