PELVIC INFLMMATORY DISEASE - PROF AZAM

Question 1

What is the definition of the Pelvic Inflammatory disease ?

Answer 1

Is an infection and inflammatory disorder of the upper female genital tract , including the uterus , fallopian tubes , ovary and adjacent pelvic structures.

Question 2

What are the phatophysiology of tge Pelvic inflammatory disease

Answer 2

★1st STAGE - Gaining the vaginal or cervical infection.

★2nd STAGE - direct ascent of microorganisms from the vagina or cervix to the upper genital tract.

✤ FIRST STAGE :
 ✦Vaginal or cervical 
  infection.
 ✦ Transmitted 
  through sexual 
  intercouse 
 ✦Some 
 asymptomatic 

✤ SECOND STAGE :
✦ Direct ascent of microorganism from the vagina or cervix to the upper genital tract.

Question 3

What are the possible the mechanism for pelvic inflammatory disease ?

Answer 3

1. the efficacy of cervical barrier may be decreased by vaginal inflammation and by hormonal changes that occur during ovulation and menstruation.
2. Opening of the cervix during menstruation , along with retrogradate menstrual flow , facilitate ascent of microorganism.
3. Rhythmic uterine contractions occurring during orgasm.
4. Bacteria carried along with sperm into the uterus and fallopian tubes.
5. Infection extend via spillage of purulent materials from the fallopian tubes.
6. Infection spread lymphatic beyond the pelvis.

Question 4

What is the commonest organism involved in Pelvic inflammatory disease ?

Answer 4

Commonest organism =

1. Chlamydia trachomatis .
2. Neisseria gnorrhoea.
3. Bacterial vagonosis ( Ureoplasma urealyticum .

Question 5

What are the risk factors of the Pelvic Inflammatory

Answer 5

1. History of Multiple sexual partner
2. History of Sexual transmitted disease.
3. History of sexual abuse .
4. Gynecological surgical procedures-Hysteroscopy
5. Intrauterine device- has been linked to a x2 - x9 fold increase risk for PID.

Question 6

What are the complications of pelvic inflammtory disease ?

Answer 6

The sequelae of endometrial and fallopian tube inflammation and damage :

1. Infertility
2. Ectopic pregnancy
3. Chronic pelvic pain
4. Right upper quadrant pain - due to perihepatitis is an usual complication called FITZ-HUGH-CURTIS SYNDROME.
5. Tubo-ovarian abscess .
6. Sepsis with shock.

Question 7

What are the classical symptoms ?

Answer 7

1. Pain - lower bilateral abdominal pain & dyspareunia.
2. Discharge - altered vaginal discharge.
3. Bleeding - intermenstrual bleeding / postcoital bleeding.
4. Systemic symptoms of infection, such as : Fever , Fatigue.

Question 8

What are the ACUTE and CHRONIC presentation ?

Answer 8

Acute presentation:

1. Sepsis with tubo-ovarian abscess.
2. Acute pertinotis with septic shock and high grade fever .

Chronic presentation

1. Chronic pelvic pain.
2. Chronic vaginal discharge
3. Infertility.

Question 9

What are the INVESTIGATIONS that you would like to performed ?

Answer 9

FBC
Swabs for culture and sensitivity - High vaginal & intracervical
Septic workout for acute presentation - blood culture and peritoneal fluid for culture and infective tissue for culture during operation .
Sexual transmitted infections screening , for example : VDRL , smear for gonorrhea , serology for chlamydia & HIV
CRP and lactate acid as septic marker if acute presentation

IMAGING
Ultrasound :
A. Transabdominal US
B. Transvaginal US