Week 6.1 - Pelvic inflammatory disease

Question 1

What is endometritis?

Answer 1

-Inflammation and infection of the endometrium resulting in plasma cell infiltration and granuloma formation

Question 2

What is salpingitis?

Answer 2

-Inflammation and infection of the uterine tubes

Question 3

Name a complication of salpingitis

Answer 3

-Tubo-ovarian abscess

Question 4

How does a tubo-ovarian abscess form?

Answer 4

• Inflammatory exudate fills the lumen on the salpinx causing inflamamtion of the serosa and pus leaks from the tube
• Causes adhesions of the tube to the pelvic sidewall leading to blockage and further swelling of the tube with the infection confined by the omenta

Question 5

Describe the pathophysiology of PID

Answer 5

-The infection ascends from the vagina and endocervix and causes inflammation of the tubes -> pain and damage to tubal eipthelium resulting in adhesions

Question 6

Describe the aetiology of PID

Answer 6

-Often polymicrobial from STIs such as chlamydia, gonorrhoea, gardnerella vagialis

Question 7

What are the risk factors for PID?

Answer 7

• Young
• Lack of barrier contraception
• Multiple sexual partners
• On insertion/removal of IUD

Question 8

Outline the management of PID

Answer 8

• Empirical treatment for 14 days to cover all microbes involved eg ceftriaxone + doxycycline + metronidazole
• IV antibiotics or sugery for severe PID

Question 9

What classifies severe PID?

Answer 9

-Signs of peritonitis, tubo-ovaran abscess or sepsis

Question 10

When is surgical management indicated?

Answer 10

-When there is no response to therapy, it is clinically severe or an abscess is present

Question 11

List some possible complications of PID

Answer 11

• Infertility
• Ectopic pregnancy
• Chronic pelvic pain
• Fitz-hugh-curtis syndrome
• Reiter syndrome

Question 12

What is fitz-hugh-curtis syndrome?

Answer 12

• Rare complication of PID characterised by perihepatitis and adhesions
• Can manifest as shoulder tip pain, RUQ pain and tenderness

Question 13

What is reiter syndrome?

Answer 13

-Disemminated chlamydial infection characterised by conjunctivitis, urethritis and arthritis
(can’t see, can’t pee, can’t bend at the knee)

Question 14

Describe the typical history of PID

Answer 14

-Pyrexia
-lower abdo pain
-Deep dysparenia
-Abnormal discharge
bleeding

Question 15

Describe what will be found on examination of PID

Answer 15

• Lower abdo tenderness
• fever
• adnexal tenderness
• cervical motion tenderness
• Cervicitis and discharge on speculum examination

Question 16

Name 3 differential diagnoses of PID

Answer 16

• IBS/appendicitis
• UTI
• Ectopic pregnancy

Question 17

What investigations are done in suspected PID?

Answer 17

• Pregnancy test
• STI swab
• Bloods -> WBC and CRP

Question 18

Define PID

Answer 18

-The result of infection ascending from endocervix causing endometritis, salpingitis, parametritis, oophritis, tubo-ovarian abscess and/or pelvic peritonitis