PELVIC INFLMMATORY DISEASE

Question 1

What is pelvic inflammatory disease ?

Answer 1

is a spectrum of inflammatory conditions of the upper genital tract.

Question 2

What are the disorders that can be under pelvic inflammatory disease ?

Answer 2

Endometritis
salpingitis
tubo-ovarian abscess
peritonitis

Question 3

What are the RISK FACTORS of the pelvic inflammatory disease ?

Answer 3

★Infection :
➤ common organism : Chlamydia trachomatis ,
Neisseria gonorrhoea , Mycoplasma hominis ,
Bacterial vaginosis.

➤ May occur : After pelvic surgery or following
uterine instrumentation

★Multiple sexual partner - x5 times at risk of developing PID than were monogamous.

★Uterine or cervical instrumentation or douching , such as : endometrial biopsy , Hysterosalpingography , intrauterine contraceptive device placement.

★ Intrauterine contracepive device (IUCD) use is primarily confined to the first 3 weeks
after insertion.

★Sexual transmitted disease due to*failure to use contraception that protect against PID.

★Cigarette smoking

★Recent history of IUCD insertion

Question 4

What are the ATIOLOGY of pelvic inflammatory disease ?

Answer 4

1. Ascending infection of the microorganism from lower genital tract ( Endometrium,fallopian tubes and adnexa ).
2. Sexually transmitted infections , such as : Neisseria gonorrhoeae and Chlamydia trachomatis
3. Bacterial vaginosis - the non- STD microorganism causes of acute PID

Question 5

What are the hypothesis that is proposed to explain the pathogenesis of the PID ?

Answer 5

1st Hypothesis : The process of tissue damage initiated by sexually transmitted organisms altering the internal milieu of cervix and vagina allowing further superinfection of anaerobe and aerobes.

2nd Hypothesis : Polymicrobial nature of the infection from the outset as salpingitis demonstrated in the absence of infection with sexually transmitted organisms in the endocervix - The enzymes produced by the anaerobes assist the passage of bacteria through the cervical mucus plug

Question 6

What are the CLINICAL FEATURES of pelvic inflammatory disease ?

Answer 6

▶ SYMPTOMS :

1. Pelvic pain and tenderness
2. Muscular guarding or rebound tenderness.
3. Fever or chills
4. lower abdominal pain
5. Abnormal vaginal discharge
6. Irregular bleeding
7. Deep dyspareunia

▶ SIGNS :

1. Lower abdominal tenderness
2. Adnexal tenderness.
3. Cervical motion tenderness
4. Fever > 38 degree Celsius.
5. Elevated white blood cell .
6. Purulent cervical discharge - should be sampled for gram stain and culture.

Question 7

What are the diagnostic criteria for Pelvic inflammatory disease ?

Answer 7

Must have all of the three :
Abdominal tenderness
Adnexal tenderness
Cervical tenderness

Must at least have one of them :
Positive Gram Stain or Laboratory documentation of cervical infection with

Question 8

What are the complications of Pelvic inflammatory disease ?

Answer 8

1. Subfertility .
2. Ectopic pregnancy
3. chronic pelvic pain