27, F, 5 day crampy bilateral abdo pain

Question 1

27, F
PC: 5 day hx crampy lower abdo pain
HPC: bilateral, N+V, feverish, white smelly discharge
GHx: some dyspareunia, no PCB, IMB
Sexual hx: Split from BF, casual fling w 2 men, coil in 6 years ago, doesn’t use condoms, no prev STIs

DIFFERENTIALS

Answer 1

• PID
• Appendicitis
• Ectopic
• Endometriosis
• Ovarian cyst accident
• UTI

Question 2

27, F
PC: 5 day hx crampy lower abdo pain
HPC: bilateral, N+V, feverish, white smelly discharge
GHx: some dyspareunia, no PCB, IMB
Sexual hx: Split from BF, casual fling w 2 men, coil in 6 years ago, doesn’t use condoms, no prev STIs

INVESTIGATIONS

Answer 2

Bedside:
1) ABDO EXAM - peritonism, masses

2) BIMANUAL EXAM - cervical excitation, bilateral adnexal tenderness
3) SPECULUM EXAM (+ do swab)

4) BASIC OBS - raised temp, raised HR
5) URINE DIP

6) URINE PREGNANCY TEST

Lab:
1) CERVICAL SWAB - Chlamydia
2) BLOODS - FBC, CRP, ESR, U&Es

Imaging:
1) TVUSS (to ? fluid in fallopian tubes / adhesions)

Invasive:
1) LAPAROSCOPY w. FIMBRIAL BIOPSY (gold standard, not commonly performed)

Dx: PID

Question 3

27, F
PC: 5 day hx crampy lower abdo pain
HPC: bilateral, N+V, feverish, white smelly discharge
GHx: some dyspareunia, no PCB, IMB
Sexual hx: Split from BF, casual fling w 2 men, coil in 6 years ago, doesn’t use condoms, no prev STIs

MANAGEMENT

Answer 3

1) ANALGESIA

2) ANTIBIOTICS - doxycycline (or ofloxacin) + metronidazole

3) ADMIT IF FEBRILE FOR IV THERAPY

4) REVIEW IN 24H - no improvement –> LAPAROSCOPY –> DRAIN PELVIC ABSCESS IF PRESENT

Question 4

27, F
PC: 5 day hx crampy lower abdo pain
HPC: bilateral, N+V, feverish, white smelly discharge
GHx: some dyspareunia, no PCB, IMB
Sexual hx: Split from BF, casual fling w 2 men, coil in 6 years ago, doesn’t use condoms, no prev STIs

COMPLICATIONS

Answer 4

• Fitz-Hugh-Curtis syndrome- RUQ pain due to perihepatic adhesions
• Abscess formation
• Tubal obstruction🡪 subfertility
• Increased ectopic risk
• Tubal damage
• Chronic pelvic pain

Question 5

Signs/symps of PID

Answer 5

Symptoms:
- LOWER ABDO PAIN - which is typically bilateral
- DEEP DYSPARENURIA
abnormal
- VAGINAL BLEEDING - post coital, inter-menstrual, and menorrhagia,
- ABNORMAL SMELLY DISCHARGE

Signs:
- LOWER ABDO TENDERNESS - which is usually bilateral
- BIMANUAL EXAM - adnexal tenderness, cervical motion tenderness
- FEVER (>38°C)

Question 6

What is PID?

Answer 6

Sexually transmitted pelvic infection that ascends from the endocervix.

• Difference between acute and chronic:
  o Chronic: persisting infection and is the result of non-treatment or inadequate
  treatment: common symptoms- chronic pelvic pain, dysmenorrhoea,
  subfertility, chronic vaginal discharge.

Question 7

Causative organisms of PID?

Answer 7

• CHLAMYDIA (60%)
• Gonorrhoea
• Non-sexually transmitted bacteria eg BV,
  esp use of uterine instrumentation eg ERPC, laparoscopy, insertion of IUD