Pelvic Inflammatory Disease

Question 0

How does the cervix prevent infection?

Answer 0

Mucus plug

Question 1

Columnar Epithelium susceptible to?

Answer 1

Infection with STIs such as chlamydia or gonorrhoea

Question 2

Nabovium Follicles

Answer 2

Squamous cells over mucus producing cells. Forming white, hard parts

Question 3

Postcoital Bleeding

Answer 3

Bleeding after sex

Question 4

PID pathogenesis

Answer 4

Infection goes up from the cervix. Uncomplicated infection becomes complicated. Infection of the female genital tract - endometritis, salobingitis, tubo-ovarian absess

Question 5

What infections cause PID

Answer 5

Chlamydia Trachiominas, Gonorrhoea, Mycoplasma - they can get through the cervical protective mucus due to enzymes present. // Anaerobic organisms don’t have the same enzymes and so require a breakdown in the mucus plug

Question 6

Fallopian tube damage due PID

Answer 6

Delayed hypersensitive reaction. Irreversible.

Question 7

Risk of PID

Answer 7

IUD / Sexual contact (unprotected sex, multiple sexual partners / young people / previous PID (behavioural, contacts aren’t treated correctly

Question 8

Symptoms of PID

Answer 8

Lower abdopain / deep dysparunia / abnormal vaginal bleeding secondary to cerci it’s or endometritis (post coital, inter menstrual, menorrhagia) / Abnormal Vaginal discharge

Question 9

Examination

Answer 9

Lower Abdo pain / RIF (right paragutic gutter - infection can track up to the liver) / Adnexal ,ass suggesting tubo ovarian absess / Pelvic examination (purulent cervical discharge, cervical motion tenderness, adenexal tenderness) / peritonitis mimicking an acute surgical abdomen

Question 10

Differential Diagnosis

Answer 10

Appendicitis / Ectopic pregnancy (permanency test must be done!) / UTI / Ovarian torsion / Endometriosis (cyclical bleeding) / IBS

Question 11

Diagnosis

Answer 11

Mainly clinical / STI screen (vaginal wall sample to look for vaginal commensals, Volvo-vaginal acid application test for both chlamydia and gonorrhoea / Temperature / ESR and CRP / USS

Question 12

Treatment

Answer 12

Chalmydia - Ofloxacin (400mg bd 2 weeks) / LOOK UP

Question 13

admitting to hospital

Answer 13

Systemically unwell / Pain / IV antibiotic (vomiting) / Pregnancy (>20 weeks) / Diagnostic uncertainty

Question 14

IUD Removal

Answer 14

Should be remov in severe disease / Better recovery rate when the coil is removed

Question 15

Complications

Answer 15

Ectopic pregnancy increases (due to smaller tube and less likely the fertilised egg can’t get through) /Infertility due to tubal occlusion, increases with each episode of PID / Chronic pelvic pain - due to adhesions, 18% higher after a single episode, 8x increase in rate of hysterectomy / Endometriosis 6x more common due to damaged epithelium

Question 16

Fitz-Hugh-Curtis syndrome

Answer 16

Right upper quadrant pain / 10-20 % women with PID / right parabolic gutter …MORE

Question 17

Chlamydia screening programme

Answer 17

18-34 yo / Decrease in PID nationally…MORE

Question 18

Likely good of infertility after 2 episodes after PID

Answer 18

20%

Question 19

Appropriate treatment for PID

Answer 19

Metronidazole, Ofolaxin (LOOK THIS Up)

Question 20

Having a coil increases risk of PID?

Answer 20

No

Question 21

HIV positive gives a worse prognosis

Answer 21

False

Question 22

Male partner of a women with PID only needs treating if an infection is identify once he’s screened

Answer 22

False - empirical treatment is required

Question 23

Risk incident of PID of infertility on first encounter

Answer 23

10 % risk of infertility