Repro: Pelvic Inflammatory Disease Flashcards
What is pelvic inflammatory disease?
Ascending infection from the endocervix causing:
- endometritis (inflammation of endometriosis), salpingitis (infection of Fallopian tubes) (2 most common)
- tubo-ovarian abscess (most severe)
- and/or pelvic peritonitis
What is endometritis?
Inflammation and infection of the endometrium
What is salpingitis?
Inflammation of the fallopian tubes and/or ovaries
painful
What is a turbo-ovarian abscess?
An abscess of the fallopian tubes - the tube can adhere to the lateral walls of the pelvic cavity due to exudate
What are some complications of pelvic inflammatory disease?
- increased risk of ectopic pregnancy
- infertility
- chronic pelvic pain
- fitz-hugh-curtis syndrome (RUQ pain and peri-hepatitis following chlamydial pelvic inflammatory disease)
What are some causes of pelvic inflammatory disease?
- often polymicrobial
- STIs: C trachomatis, N gonorrhoea (cause 70-90% of cases)
- Others: gardnerella vaginalis, mycoplasma, anaerobes
What are some risk factors for PID?
Risk factors for STIs:
Young, lack of barrier contraception, multiple partners, low socioeconomic class
Inta-uterine contraceptive device
What are some symptoms of PID?
Pyrexia
Lower abdo pain, pain during intercourse
Abnormal discharge
Abnormal bleeding
What are some signs of PID?
Lower abdo tenderness which is usually bilateral
Cervical motion tenderness
Purulent cervical discharge, cervicitis
How would you investigate suspected PID?
- HCG to rule out pregnancy
- high vaginal/cervical swab to test for chlamydia and gonorrhoea
- CRP and white blood count
- screen for other STIs such as HIV
How do you treat PID?
Antibiotics for 14 days
Outpatient:
IM cefratrioxone, oral doxycycline and metronidazole
In patient:
IV cefratrixone, IV doxycycline, IM metronidazole
What do you do if there’s no response to antibiotics?
Possible laparoscopy however ultrasound guided aspiration of pelvic collections is less invasive
