Pelvic Inflammatory Disease (Repro)

Question 1

What is PID?

Answer 1

Pelvic Inflammatory Disease

• -> Result of infection ascending from endocervix causing:
• Endometritis
• Salpingitis
• Parmetritis
• Oophritis
• Tubo-ovarian abscesses
• Pelvic peritonitis

Question 2

Pathophysiology of PID

Answer 2

• -> Infection ascends from endocervix and vagina into uterus
• -> Inflammation causes adhesions of mucosa to form and damage tubal epithelium

Question 3

Can two main microorganisms can cause PID?

Answer 3

1. Chlamydia trochomatis (Main cause in western world)

2. Neisseria gonorrhoea

Question 4

Behavioural Risk Factors for PID?

Answer 4

• Sexual behaviour; Multiple partners, unsafe sex etc.
• Type of contraception used: IUD increases risk in 1st week of insertion
• Alcohol/drug use: (More likely to have unsafe sex)

Question 5

Clinical Features of PID (7)

Answer 5

• Pyrexia
• Pain: Bilateral lower abdominal tenderness
• Adnexal tenderness
• Cervical excitation
• Deep dyspareunia (painful sex)
• Abnormal vaginal discharge
• Abnormal vaginal bleeding

Question 6

Investigations for PID

Answer 6

• Endocervical swab: gonorrhoea/chlamdyia
• High vaginal swab; bacterial vaginosis, trichomonas vaginalis, candida is picked up but NOT causative of PID.
• Positive swabs support diagnosis but negative swabs do not exclude it.

Question 7

when to admit PID patient to hospital?

Answer 7

If:

• Tubo-ovarian abscess present
• PID in pregnancy (although very rare as fetus is in the way)
• Lack of response to oral therapy

Question 8

When is Laparoscopy/Laparotomy considered for PID?

What is an alternative to this?

Answer 8

When;

• There is no response to therapy
• Clinically severe disease
• Tubo-ovarian abscess

Alternative: An ultra-sound guided aspiration of pelvic fluid - less invasive.

Question 9

Patients with PID are at increased risk for what?

Answer 9

• Ectopic pregnancy
• Chronic pelvic pain
• Fitz-Hugh-Curtis syndrome

Question 10

What is Fitz-Hugh-Curtis Syndrome?

Answer 10

Perihepatitis - adhesions by the liver.

• Present with RUQ pain - acute in onset and sharp
• Due to transabdominal spread of infection from PID.
• Spread may be due to draining of fluid along paracolic gutter - infracolic compartment of greater sac.
• It may be due to lymphatic drainage or via bloodstream.

Question 11

Gynaecological causes of pelvic pain other than PID?

Answer 11

• Ectopic pregnancy
• Endometriosis HOWEVER history will be of cyclical pain - before periods.
• (In PID pain is continuous)
• Complications of ovarian cyst HOWEVER pain tends to be unilateral due to unilateral involvement (PID is BILATERAL PAIN)

Question 12

GI causes of pelvic pain?

Answer 12

• Acute appendicitis

- IBS

Question 13

Renal causes of pelvic pain?

Answer 13

• UTI

Question 14

Treatment of PID

Answer 14

Antibiotics used for 14 days.

Antibiotics can include:

• Ceftriaxone (used for gonorrhoea)
• Doxycycline (used for chlamydia)
• Metronidazole (also used for trichmonas vaginalis)