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SA reproductive > S9) Pelvic Inflammatory Disease > Flashcards

S9) Pelvic Inflammatory Disease Flashcards

1
Q

What is pelvic inflammatory disease?

A

- Pelvic inflammatory disease is the infection of the female upper genital tract which ascends from the endocervix

  • It presents with endometritis, salpingitis, parametritis, oophoritis, tubo-ovarian abscess and/or pelvic peritonitis
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2
Q

In four steps, describe the pathophysiology of Pelvic Inflammatory Disease

A

⇒ Ascending infection from the endocervix & vagina

⇒ Infection causes inflammation

⇒ Inflammation causes damage to tubal epithelium

⇒ Adhesions form

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3
Q

What is endometritis?

A

Endometritis is the inflammation and infection of the endometrium lining of the uterus

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4
Q

What is salpingitis?

A

Salpingitis is the inflammation and infection of the uterine tubes

they can fill with pus → tube-ovarian abscess

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5
Q

What is parametritis?

A

Parametritis is the inflammation of the uterine ligaments and parametrium (connective tissue adjacent to the uterus)

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6
Q

What is oophoritis?

A

Oophoritis is the inflammation of the ovaries, often arising due to infection and often accompanied with salpingitis

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7
Q

What is a tubo-ovarian abscess?

A
  • A tubo-ovarian abscess is an encapsulated pocket of pus which forms due to infection of the fallopian tubes and ovaries
  • It is a late complication of PID and can be life-threatening if the abscess ruptures and results in sepsis
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8
Q

What is pelvic peritonitis?

A

Pelvic peritonitis is the inflammation and infection of the peritoneum, which is the membrane that lines the abdomen in the pelvic area, often occurring as a complication of salpingitis

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9
Q

Identify the two commonest organisms which cause PID as they are the most common infective organisms

A

Sexually transmitted infections:

  • Chlamydia trachomatis
  • Neiserria gonorrhoeae
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10
Q

Identify 4 other organisms which commonly cause PID

A
  • Gardnerella vaginalis
  • Mycoplasma hominis
  • Anaerobes
  • Actinomycosis
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11
Q

Which group of people have a high incidence of PID?

A

Sexually active women (20-30 years old)

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12
Q

Identify 5 risk factors for pelvic inflammatory disease

A
  • Young age
  • Lack of use of barrier contraception
  • Multiple sexual partners
  • Low socioeconomic class
  • Intrauterine contraceptive device (IUCD)
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13
Q

Identify 6 symptoms of PID

A
  • Pyrexia
  • Lower abdominal pain
  • Deep dyspareunia
  • Abnormal vaginal/cervical discharge
  • Abnormal vaginal bleeding
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14
Q

Describe 5 features observed during the examination of a typical patient with PID

A
  • Fever
  • Lower abdominal tenderness (bilateral)
  • Lower genital tract infection
  • Purulent cervical discharge
  • Cervicitis
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15
Q

Provide a differential diagnosis of PID in terms of bladder, bowel and gynaecological conditions respectively

A
  • Bladder conditions – UTI
  • Bowel conditions – IBS, appendicitis
  • Gynaecological conditions – ectopic pregnancy, endometriosis, ovarian cyst complications
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16
Q

What investigations would one perform to establish the diagnosis of PID?

A
  • Urinary and/or serum pregnancy test
  • Endocervical and high vaginal swabs (NG/CT supports diagnosis)
  • Blood tests (WBC & CRP)
  • Screening for other STIs
  • Diagnostic laparoscopy (gold standard)
17
Q

Briefly outline the management of PID

A
  • Symptomatic management with analgesia and rest
  • Management of sepsis
  • Severe disease requires IV antibiotics, admission for observation and possibly surgical intervention
18
Q

Describe the surgical management of PID

A

Laparoscopy/laparotomy may be considered if:

  • No response to therapy
  • Clinically severe disease
  • Presence of a tubo-ovarian abscess
19
Q

Identify the 3 antibiotics used for the treatment of PID

A
  • Ceftriaxone
  • Doxycycline
  • Metronidazole
20
Q

Identify 5 complications of PID

A
  • Ectopic pregnancy
  • Infertility
  • Chronic pelvic pain
  • Fitz-Hugh-Curtis syndrome
  • Reiter syndrome

scarring and adhesion can occur in the reproductive tract as fibrin is usually deposited due to chronic inflammation

21
Q

what is chlamydia?

A
  • most common STI
  • typically asymptomatic
  • can cause testicular pain
22
Q

what is gonorrhoea?

A
  • it is an STI
  • gram negative
  • diplococci
  • 90% men are symptomatic
  • thick yellow discharge
23
Q

what is non-gonococcal urethritis (NGU)

A
  • STI
  • inflammation of the urethra
  • common in older men
24
Q

Urine samples are used to test for which STI’s?

A
  1. gonorrhoea
  2. chalmydia
  3. urethritis
25
Q

what is a urethral swab used to test for

A

gonorrhoea

26
Q

what is Treponema pallidum responsible for causing

A
  • syphilis
  • primary syphilis: painless ulcer in genitals, can be infectious but will usually dissapear
  • secondary → develop weeks later and show up as a rash
  • tertiary → can be latent and reappear randomly can be congenital
27
Q

what are Anogenital warts

A
  • most common viral STI
  • caused by human papilloma virus
  • painless warts that will go away by themselves
    *
28
Q

what is Herpes simplex virus

A
  • HSV-1 → can cause oral and genital herpes
  • HSV-2 → causes genital herpes and often reoccurs can potentially spread to child
  • can be treated with anti-virals acyclovir
29
Q

what is Trichomonas vaginalis

A
  • sexually transmitted protozoa
  • men → asymptomatic but can cause dysuria and discharge
  • women → vaginal discharge, typically yellow
30
Q

what’s the main way to test for STIs in men

A

urine sample: first catch for gonnorhea and chlamidya

31
Q

what is the main way to test for UTIs in women?

A

vaginal swab

High vaginal for trichomonas

Endocervical for chlamydia/gonorrhoea

Vulvovaginal (if asymptomatic) for chlamydia/gonorrhoea

32
Q

what are two non-sexually transmitted diseases

A

Bacterial Vaginosis (BV)

Vulvovaginal Candidiasis

33
Q

what is Bacterial Vaginosis (BV)

A
  • non-sexually transmuted disease
  • common cause for discharge in women
  • pH imbalance of the vagina
  • different bacteria start growing
  • can be due to Gardnerella vaginalis bacteria
  • diagnosed by vaginal swabs and treated with metronidazole
34
Q

what is Vulvovaginal Candidiasis

A
  • non-sexually transmitted disease
  • caused by Candida albicans most commonly
  • white non-offensive vaginal discharge with pain
  • can diagnose with a swab
  • treated with oral azoles

SA reproductive (22 decks)

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