Pelvic Inflammatory Disease Flashcards
What is it?
What 2 parts does it affect?
What STIs could cause 25% of ascending infections leading to PID?
Inflammation of the upper genital tract
Uterus
Adnexa
Gonorrhoea
Chlamydia
What investigative methods may lead to PID?
Uterine instrumentation:
- Hysteroscopy
- Insertion of IUCD
- TOP
Post-partum as well
What other diseases may it involve? - just read
Endometriosis
Salpingitis
Tubo-ovarian abscess
Pelvic peritonitis
Symptoms:
What does the severity vary between?
Pain:
- Site? - 2
- Bi/unilateral
- What may they have pain doing?
Systemic symptoms?
What type of discharge could they have?
What type of bleeding could they have? - 2
Asymptomatic to severe
Lower abdo + lower back
Usually bilateral but can be unilateral
Dyspareunia - deep
Fever
N&V
Mucopurulent discharge
PCM
IMB
Bimanual examination:
What sign would you find?
Cervical excitation - Tenderness in the uterus, adnexa and cervix
Risk factors - 2
The typical age range that increases risk?
Type of contraception that increases risk?
What is protective?
Sexually active, especially if unprotected
History of STIs
Age 18-25
IUCD
Contraception
Mirena
IUS
COCP
Investigations:
Initial tests:
- Bloods and why?
- Why is a vaginal/endocervical swab done? - 2
- Urine - What should be ruled out? - 2
FBC - WBC raised in inflammation
ESR/CRP - raised in inflammation
C and G - nucleic acid amplification test
UTI
Pregnancy test to rule out ectopic
Investigations:
Optional further tests:
- Why is a TVUS done?
- What imaging should be considered if it is severe?
What surgery can make a definitive diagnosis?
Fluid-filled fallopian tubes
Endometrial thickening
Tubo-ovarian abscess
Pelvic CT or MRI
Laparoscopy
Diagnosis:
What is needed for diagnosis?
Clinical picture \+ Negative swabs \+ Bloods +ve for inflammation
Outpatient management:
Antibiotics:
- What AB is given once - C/A
- What 2 ABs are given for 2 wks? - D + M
What if the symptoms are quite severe (e.g. >38*C, peritonitis, or abscess)?
Ceftriaxone or Azithromycin
Doxycycline PO
Metronidazole PO
Admit them
Inpatient management:
Antibiotics:
- What ABs are given IV? - C + D
- What 2 ABs are given for 2 wks? - D + M
What is important to google whenever you are treating someone with any disease?
Ceftriaxone + Doxycycline
Doxycycline PO
Metronidazole PO
Look at local guidelines
General management outside ABs:
What is given for pain?
What may be removed but risk needs to be balanced with pregnancy?
When should testing be repeated to ensure no recurrence?
Analgesia
IUCD
3-6 months
Complications:
Tubo-ovarian abscess - what is it and why is it so dangerous?
Fitz-Hugh Curtis syndrome - what is it? why does it happen? where is the pain?
Tubo-ovarian abscesses are one of the late complications of pelvic inflammatory disease (PID) and can be life-threatening if the abscess ruptures and results in sepsis.
Liver capsule inflammation with perihepatitis - RUQ pain
Microorganisms associated with PID are thought to spread through one of three ways:
Spontaneous ascending infection whereby microbes from the cervix or vagina travel to the endometrium, through the fallopian tubes, and into the peritoneal cavity.
Complications:
Why might they get chronic pain from an acute episode?
Obstetric complications - 2
Scarring and adhesions to nearby tissue/organs
Infertility
Ectopic pregnancy
Chronic PID:
Why does it become chronic?
They get:
- Pyosalpinx
- Hydrosalpinx
What are they?
Symptoms they get?
Inflammation > scarring and adhesions to nearby tissue/organs
P - Tubes distended with pus
H - Tubes distended with fluid
Pelvic pain Menorrhagia Secondary dysmenorrhoea Discharge Deep dyspareunia
