PID_Flashcards
What is Pelvic Inflammatory Disease (PID)?
PID is infection and inflammation of the female pelvic organs including the uterus, fallopian tubes, ovaries, and the surrounding peritoneum, usually resulting from ascending infection from the endocervix.
What are the causative organisms of PID?
Chlamydia trachomatis (most common cause), Neisseria gonorrhoeae, Mycoplasma genitalium, Mycoplasma hominis.
What are the common features of PID?
Lower abdominal pain, fever, deep dyspareunia, dysuria, menstrual irregularities, vaginal or cervical discharge, cervical excitation.
What initial investigation should be done to exclude ectopic pregnancy in suspected PID?
A pregnancy test.
What tests should be done for PID diagnosis?
High vaginal swab, screen for Chlamydia and Gonorrhoea.
What is the general approach to managing PID?
Consensus guidelines recommend having a low threshold for treatment due to the difficulty in making an accurate diagnosis and the potential complications of untreated PID.
What are the first-line treatment options for PID?
Oral ofloxacin + oral metronidazole or intramuscular ceftriaxone + oral doxycycline + oral metronidazole.
What do the RCOG guidelines suggest about intrauterine contraceptive devices in mild cases of PID?
They may be left in.
What do the BASHH guidelines suggest about intrauterine contraceptive devices in PID?
Removal should be considered and may be associated with better short-term clinical outcomes.
What are the complications of PID?
Perihepatitis (Fitz-Hugh Curtis Syndrome), infertility, chronic pelvic pain, ectopic pregnancy.
What is Fitz-Hugh Curtis Syndrome?
A complication of PID characterized by right upper quadrant pain, occurring in around 10% of cases, and may be confused with cholecystitis.
What is the risk of infertility after a single episode of PID?
The risk may be as high as 10-20%.
SUMMARISE PID
Pelvic inflammatory disease
Pelvic inflammatory disease (PID) is a term used to describe infection and inflammation of the female pelvic organs including the uterus, fallopian tubes, ovaries and the surrounding peritoneum. It is usually the result of ascending infection from the endocervix.
Causative organisms
Chlamydia trachomatis
+ the most common cause
Neisseria gonorrhoeae
Mycoplasma genitalium
Mycoplasma hominis
Features
lower abdominal pain
fever
deep dyspareunia
dysuria and menstrual irregularities may occur
vaginal or cervical discharge
cervical excitation
Investigation
a pregnancy test should be done to exclude an ectopic pregnancy
high vaginal swab
these are often negative
screen for Chlamydia and Gonorrhoea
Management
due to the difficulty in making an accurate diagnosis, and the potential complications of untreated PID, consensus guidelines recommend having a low threshold for treatment
oral ofloxacin + oral metronidazole or intramuscular ceftriaxone + oral doxycycline + oral metronidazole
RCOG guidelines suggest that in mild cases of PID intrauterine contraceptive devices may be left in. The more recent BASHH guidelines suggest that the evidence is limited but that ‘ Removal of the IUD should be considered and may be associated with better short term clinical outcomes’
Complications
perihepatitis (Fitz-Hugh Curtis Syndrome)
occurs in around 10% of cases
it is characterised by right upper quadrant pain and may be confused with cholecystitis
infertility - the risk may be as high as 10-20% after a single episode
chronic pelvic pain
ectopic pregnancy
A 23-year-old woman presents to her GP complaining of a two-day history of severe pain in the right upper quadrant and shoulder tip, accompanied by headache, nausea, chills, and malaise. The pain worsens on movement and deep inspiration. Additionally, she reports mild lower abdominal pain every day for the past year.
She has a history of Chlamydia trachomatis infection, for which she has completed 3 courses of antibiotics in the past 2 years. She admits to drinking excessive alcohol, up to 1 bottle of vodka a day.
What is the most likely diagnosis?
Cholecystitis
Ectopic pregnancy
Pancreatitis
Perihepatitis
Pulmonary embolism
Pelvic inflammatory disease may progress to perihepatitis (Fitz-Hugh Curtis Syndrome), characterised by RUQ pain
Important for meLess important
The correct answer is perihepatitis. The patient’s history of recurrent Chlamydia infections and persistent lower abdominal pain suggests a diagnosis of pelvic inflammatory disease (PID). PID can lead to inflammation of the liver capsule, known as perihepatitis. This condition stimulates the liver capsule and the adjacent diaphragm, causing right upper quadrant pain and referred pain to the shoulder tip. Perihepatitis associated with PID is referred to as Fitz-Hugh-Curtis Syndrome, which manifests in approximately 10% of individuals with PID.
Cholecystitis is not the correct diagnosis. It is important to note that Fitz-Hugh-Curtis Syndrome can be easily confused with cholecystitis due to its similar presentation; both conditions can present with right upper quadrant pain with a pleuritic nature, along with chills, nausea, and vomiting. Nevertheless, considering the patient’s younger age and her sexual health history, perihepatitis is a more likely diagnosis.
Ectopic pregnancy is also an incorrect answer. While it is true that patients who have experienced PID have a heightened risk for ectopic pregnancies owing to chronic inflammation of the fallopian tubes, which could lead to shoulder tip pain, the clinical picture in this case (right upper quadrant pain with a pleuritic nature) is more suggestive of perihepatitis.
Pancreatitis is an incorrect answer. Although heavy alcohol consumption is a known predisposing factor for pancreatitis, this condition typically causes central abdominal pain rather than right upper quadrant discomfort.
Lastly, pulmonary embolism (PE) is an incorrect answer. PEs classically cause pleuritic pain in the chest rather than the right upper quadrant. Additionally, this patient has no obvious risk factors for a PE.
