Pelvic inflammatory disease (Complete)

Question 1

Define PID

Answer 1

Pelvic inflammatory disease (PID) is a condition that arises when an infection spreads from the vagina to the cervix, and subsequently to the upper genital tract.

Question 2

What is the peak incidence of PID?

Answer 2

20-30 years

Question 3

What is the most common causative organism of PID?

Answer 3

Chlamydia trachomatis

Question 4

List 4 causes of PID

Answer 4

Chlamydia trachomatis

Neisseria gonorrhoeae

Mycoplasma genitalium

Mycoplasma hominis

Question 5

What are the main clinical features of PID?

Answer 5

Lower abdominal pain:
* Tends to be bilateral

Fever

Vaginal discharge (due to STD)

Deep dyspareunia

Post-coital bleeding

Adnexal tenderness

Cervical motion tenderness (aka cervical excitation)

Question 6

What signs on examination are suggestive of PID?

Answer 6

Adnexal tenderness

Cervical motion tenderness on binmanual examination,

Question 7

What investigations should be done for patients suspected of PID?

Answer 7

Bedside:
Basic obs: Check for fever
Pregnancy test: exclude ectopic pregnancy
Swabs for gonorrhoea and chlamydia

Bloods:
FBC: Check for raised inflammatory markers (E.g. WBC)
ESR/CRP: Check for inflammation
LFTs: Rule out stones if patient present with RUQ due to Fitz-Hugh-Curtis Syndrome

Imaging:

Transvaginal ultrasound: Rule out other causes

Question 8

What findings on ultrasound are suggestive of PID?

Answer 8

Tubal wall thickness >5 mm

Incomplete septae within the tube

Fluid in the cul-de-sac

Cogwheel appearance on the cross-section of the tubal view

May also see tubo-ovarian abscess

Question 9

What is the management of PID?

Answer 9

Always have a low-threshold for treatment if PID suspected

Medicine:
Intramuscular ceftriaxone + oral metronidazole + oral doxycyline

OR

Oral ofloxacin + oral metronidazole

Conservative/preventative:
Treatment of sexual partners for chlamydia/ghonorrhoea

Question 10

What are some complications of pelvic inflammatory disease?

Answer 10

Chronic pelvic pain (40% cases)

Infertility (15%)

Ectopic pregnancy (1%)

Fitz-Hugh-Curtis Syndrome (10%)

Question 11

What is Fitz-Hugh-Curtis syndrome?

Answer 11

Complication of PID characterised by adhesions between anterior liver capsule and anterior abdominal wall

Question 12

What are the main features of Fitz-Hugh-Curtis syndrome?

Answer 12

Right upper quadrant pain (may be confused with cholecystitis)

Normal liver function tests and abdominal ultrasound (rules out stones)

Question 13

How is Fitz-Hugh-Curtis syndrome diagnosed and treated?

Answer 13

Laparoscopy and antibiotics

Question 14

Fitz-Hugh-Curtis syndrome is alternatively known as?

Answer 14

Perihepatitis