Pelvic inflammatory disease Flashcards
What causes PID?
Chronic inflammation of the pelvic structures can be caused by infection to the pelvis e.g. chlamydia and gonorrhoea
Endometriosis can also lead to PID
What symptoms are experienced in PID?
Can be none or can be severe Pelvic pain Can have fever Cervical motion tenderness Adnexal tenderness Lower abdo pain and tenderness on exam Change in discharge Deep dyspareunia Irregular bleeding
What are some complications of PID?
Sub-Fertility (tubal)
Chronic pain
Increases risk of ectopic pregnancy
If a woman with know history of pelvic pain / PID started experiencing pain in the RUQ what might you suspect?
FITZ-HUGH CURTIS SYNDROME
- Peri-hepatic inflammation and scarring
How should PID be treated?
Use antibiotics to clear any underlying infection - always treat as if it is an STI (most likely) CEFTRIAXONE, DOXYCYCLINE and METRONIDAZOLE
Use analgesics to cover pain
Can consider explorative laparoscopy to rule out other causes
How should we investigate PID?
NAAT Serology to test for syphilis and HIV Urine dip and MSU Temp Endocervical swab for gonorrhoea BLOODS: FBC, U&E, LFTs Pregnancy test ?Microscopy of discharge USS or ExLap
What information should you give to a woman with PID?
25% caused by STI which is why we’re investigating
Most women will go on to get pregnant and have a normal pregnancy
No sex until her and her partner have been fully investigated
What is endometriosis?
When there is ectopic endometrial tissue found elsewhere in the body (in the myometrium=adenomyosis), can be in tubes, ovaries or in the abdomen
What are some common symptoms experienced by women with endometriosis?
Menorrhagia
Dysmenorrhoea (some pain before menstruation then during menstruation it gets worse and then disappears after)
Dyspareunia - deep and might last for several hours after sex
May have anal/rectal sx
Bloating/constipation (cyclical pattern)
History of CS/TOP
Is there any associations between endometriosis and reduced fertility?
Yes - thought to be due to the formation of adhesions
How should we investigate a woman who has suspected endometriosis?
ExLAP - GOLD STANDARD
O/E: tenderness, fixed uterus (not mobile)
USS
***degree of endometriosis i.e. how much ectopic tissue there is does not appear to tally with severity of symptoms
How should we manage endometriosis?
NSAIDs
Oral contraceptive inhibit ovulation and thus proliferation of endometrium which helps ease symptoms
Mirena IUS
GnRH analogues (ovarian suppression)
Danazol
SURGERY (ablation, resection of lesions, laparoscopy oophorectomy, Laparoscopy uterine nerve ablation, hysterectomy)