Week 9 - Pelvic Inflammatory Disease

Question 1

What is PID?

Answer 1

Inflammation ascending from the endocervix, causing salpingitis, endometritis, tubo-ovarian abscess

Question 2

What is endometritis?

Answer 2

Inflammation of endometrium

Question 3

What is salpingitis?

Answer 3

Inflammation of fallopian tube
Fills tubes with pus, formation of adhesions and fibrin which block off the tubes, abscess forms, abscess can spread through fimbrial ends to ovaries

Question 4

Possible causes of PID?

Answer 4

Gonorrhea, chlamydia, bacterial vaginosis, copper coil

Question 5

Symptoms of PID?

Answer 5

Pyrexia, abdo pain, deep dyspareunia, abnormal discharge, abnormal vaginal bleeding, lower abdominal tenderness, speculum shows lower GTI and cervical discharge

Question 6

Differential diagnosis for PID?

Answer 6

Ectopic pregnancy, appendicitis, IBS, UTI, endometriosis

Question 7

Investigations for possible PID?

Answer 7

Pregnancy test, endocervical and high vaginal swabs, blood tests (WBC &CRP), HIV blood test, diagnostic laparoscopy is gold standard but try antibiotics first

Question 8

Management of PID?

Answer 8

Treat- antibiotics

If severe IV antibiotics and admission, possible surgery, contact tracing,

Question 9

Which antibiotics for PID?

Answer 9

14 days

IM ceftriaxone, PO doxycycline, PO metronidazole

Question 10

Why are antibiotics for PID given for 14 days?

Answer 10

Because penetration is poor, particularly into abscesses

Question 11

When would surgery be considered?

Answer 11

Laparascopy if no response to therapy, clinically severe disease, presence of tubo-ovarian abscess

Question 12

Complications of PID?

Answer 12

Ectopic pregnancy, infertility, chronic pelvic pain, Reiter syndrome (a SARA, e.g. from chlamydia), Fitz-Hugh-Curtis syndrome

Question 13

What is Fitz-Hugh-Curtis syndrome?

Answer 13

RUQ pain and peri-hepatitis following chlamydial PID