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AIP: Abdominal pain > Pelvic inflammatory disease > Flashcards

Pelvic inflammatory disease Flashcards

1
Q

What is pelvic inflammatory disease?

A

Infective inflammation of the upper genital tract in females, which affects the endometrium uterus, fallopian tubes, ovaries and peritoneum

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2
Q

In which group of patients is the prevalence of PID highest?

A

sexually active women aged 15 to 24

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3
Q

What are 5 anatomical structures that can be affected by PID?

A
  1. Endometrium
  2. Uteris
  3. Fallopian tubes (salpingitis)
  4. Ovaries
  5. Peritoneum
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4
Q

What causes pelvic inflammatory disease?

A

spread of bacterial infection from the vagina or cervix to the upper genital tract

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5
Q

What 2 types of STI are responsible for 25% of cases of PID?

A
  1. Chlamydia trachomatis (commonest cause)
  2. Neisseria gonorrhoea
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6
Q

What are 4 types of bacteria which can cause PID?

A
  1. Chlamydia trachomatis
  2. Neisseria gonorrhoea
  3. Mycoplasma genitalium
  4. Mycoplasma hominis

(also streptococcus, anaerobes, bacteroides)

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7
Q

What are 7 risk factors for pelvic inflammatory disease?

A
  1. Sexually active
  2. Aged 15-24
  3. Recent partner change
  4. Intercourse without barrier contraceptive protection
  5. History of STIs
  6. Person history of PID
  7. Instrumentation of the cervix
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8
Q

How can instrumentation of the cervix lead to PID? What are 3 examples of instrumentation of the cervix?

A

Inadvertently introducing bacteria into female reproductive tract

  1. Gynaecological surgery
  2. Termination of pregnancy
  3. Insertion of intrauterine contraceptive device
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9
Q

What are 6 possible symptoms of PID? What are 3 further symptoms in advanced cases?

A
  1. Lower abdominal pain
  2. Deep dyspareunia
  3. Menstrual abnormalities e.g. menorhagia, dysmenorrhoea, IMB
  4. Post-coital bleeding
  5. Dysuria
  6. Abnormal vaginal discharge (especially if purulent or with unpleasant odour)

If advanced:

  1. Severe lower abdominal pain
  2. Fever >38oC
  3. Nausea and vomiting
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10
Q

What are 4 possible features on vaginal examination in PID?

A
  1. Tenderness of uterus/ adnexae
  2. Cervical excitation (on bimanual palpation)
  3. Palpable mass in lower abdomen
  4. Abnormal vaginal discharge
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11
Q

What are 4 possible differentials for pelvic inflammatory disease?

A
  1. Ectopic pregnancy
  2. Ruptured ovarian cyst
  3. Endometriosis
  4. UTI
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12
Q

What are 7 possible investigations for suspected PID?

A
  1. Endocervical swabs: for gonorrhoea and chlamydia
  2. High vaginal swab: trichomonas vaginalis and bacterial vaginosis
  3. Full STI screen - HIV, syphilis, gonorrhoea, chlamydia = minimum
  4. Urine dispstick ± MSU (UTI)
  5. Pregnancy test
  6. Transvaginal ultrasound scan - if diagnostic uncertainty or severe
  7. Laparoscopy - severe/uncertainty
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13
Q

How is testing from endocervical and high vaginal swabs performed in the UK and what should be remembered about this technique?

A

Testing is via nucleic acid amplification (NAAT)

negative swabs do not exclude the diagnosis

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14
Q

What 4 STIs should be screened for when investigating suspected PID as a minimum?

A
  1. Chlamydia
  2. Gonorrhoea
  3. HIV
  4. Syphilis
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15
Q

When might you consider performing transvaginal ultrasound scan for suspected PID?

A

If there is severe disease or diagnostic uncertainty

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16
Q

What is the difference between double and triple swabs?

A
  • Double swabs: endocervcial NAAT swab and high vaginal charcoal media swab
  • Triple swabs: endocervical NAAT swab, high vaginal charcoal media swab, endocervical charcoal media swab
17
Q

What 2 infections can the endocervical NAAT be used to detect?

A

chlamydia and gonorrhoea

18
Q

What can the endocervical charcoal media swab be used to detect?

A

gonorrhoea

19
Q

What 4 infections can the high vaginal charcoal media swab be used to detect?

A
  1. Trichomonas vaginalis
  2. Bacterial vaginosis
  3. Group B streptoccocus
  4. Candida
20
Q

What is laparoscopy used for in suspected PID and when should it be used?

A
  • used to observe gross inflammatory changes and to obtain peritoneal biopsy
  • indicated only in severe cases where there is diagnostic uncertainty
21
Q

What is the mainstay in the management of pelvic inflammatory disease?

A

Antibiotic therapy - 14 day course broad spectrum with good anaerobic coverage

22
Q

What kind of antibiotics are used to treat PID?

A
  • broad spectrum antibiotics with good anaerobic coverage for 14 days
  • Options include:
    • doxycycline, ceftriaxone and metronidazole
    • Ofloxacin and metronidazole
23
Q

When should antibiotics be started for PID?

A

Commence immediately, before result of swabs available

should have low threshold

24
Q

In addition to antibiotic management, what are 4 other aspects of management of PID?

A
  1. Anagesics e.g. paracetmol
  2. Rest and avoid sexual intercourse until abx course completed and partner(s) treated
  3. All sexual partners from past 6 months should be tested and treated to prevent recurrence and spread
  4. Sometimes admitted to hospital
25
Q

What are 5 situations when someone with PID should be admitted to hospital?

A
  1. Pregnant and especially if risk of ectopic
  2. Severe symptoms: nausea, vomiting, high fever
  3. Signs of pelvic peritonitis
  4. Unresponsive to oral antibiotics, need for IV therapy
  5. Need for emergency surgery or suspicion of alternative diagnosis
26
Q

What 2 things increase the risk of complications of PID?

A
  1. Repeated episodes of pelvic inflammatory disease (recurrent PID)
  2. Delaying treatment
27
Q

What are 5 possible complications of PID?

A
  1. Ectopic pregnancy
  2. Infertility
  3. Tubo-ovarian abscess
  4. Chronic pelvic pain
  5. Fitz-Hugh Curtis syndrome
28
Q

Why can ectopic pregnancy occur as a complication of PID?

A

due to narrowing and scarring of Fallopian tubes

29
Q

What proportion of women with PID suffer from infertility?

A

1 in 10

30
Q

What is Fitz-Hugh Curtis syndrome?

A

complication of PID; perihepatitis that typically causes right upper quadrant pain

31
Q

What are 3 aspects of counselling to consider for a patient being treated for PID?

A
  1. Offer advice regarding practice of safer sex and consistent use of condoms
  2. Regular STI screening should be encouraged
  3. Inform about potential long-term sequelae of PID
32
Q

For the 2 common antibiotic regimes to treat pelvic inflammatory disease, what route is each medication given?

A
  1. IM ceftriaxone, oral doxycycline, oral metronidazole
  2. oral ofloxacin + oral metronidazole
33
Q

What is the guidance about PID and intrauterine contraceptive devices?

A
  • NICE say in mild cases you can leave them in
  • BASHH guidance more recently says removal should be considered, may be associated with better short-term clinical outcomes
34
Q

What is thought to be the risk of infertility following a single episode of pelvis inflammatory disease?

A

as high as 10-20%

AIP: Abdominal pain (20 decks)

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