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Flashcards in Pelvic Inflammatory Disease Deck (17):
1

What is endometritis?

Inflammation and infection of the endometrium

2

Pathophysiology of PID?

Ascending infection from the endocervix and vagina
Causes inflammation which causes damage to tubal epithelium and adhesions form

3

Complications of PID?

Ectopic pregnancy
Infertility
Chronic pelvic pain
Fitz-Hugh-Curtis syndrome - right upper quadrant pain and peri-hepatitis following chlamydial PID

4

Aetiology of PID?

Often polymicrobial
STIs - C trachomatis, N gonorrhoeae
Others - Gardenerella vaginalis, Mycoplasma, anaerobes

5

Epidemiology of PID?

Sexually active women, peak from 20-30yrs
Incidence rate in primary care approx 280/100,000 person-years

6

Risk factors for PID?

Young age
No barrier contraception
Multiple sexual partners
Low socko-economic class
Intra-uterine contraceptive device (within 1 week of implantation)

7

History for PID?

Pyrexia
Pain
-lower abdomen
-deep dyspareunia
Abnormal vaginal bleeding
Abnormal vaginal/cervical discharge
Sexual history and prior STI
Contraceptive history

8

Examination for PID?

Fever >38*C
Lower abdominal tenderness which is usually bilateral
Bimanual exam - adnexal tenderness and cervical motion tenderness
Speculum exam - purulent cervical discharge and cervicitis

9

Differential diagnoses of PID?

Gynaecological
-ectopic pregnancy
-endometriosis
-complications of an ovarian cyst

GI
-IBS
-acute appendicitis

Renal
-UTI

Other
-functional pain (pain of unknown physical origin)

10

Investigations for PID?

Endocervical swab for gonorrhoea and chlamydia
High vaginal swab for bacterial vaginosis, trichomonas vaginalis, Candida

Positive swabs support diagnosis
Negative swabs don't exclude it

11

Management of PID?

Analgesia
Antibiotics
-mild/moderate disease: oral
-severe: IV

Admit to hospital if tubo-ovarian abscess, PID in pregnancy, lack of response to oral therapy

12

Outpatient antibiotics for PID?

IM ceftriaxone
PO doxycycline
PO metronidazole

13

Inpatient treatment of PID?

IV ceftriaxone
IV/PO doxycycline
IV metronidazole
PO doxycycline
PO metronidazole
Continue for 14 days

14

Surgical management of PID?

Laparoscopy/laparotomy if there is no response to therapy, severe or an abscess
Ultrasound-guided aspiration of pelvic fluids is less invasive

15

What is Fitz-Hugh Curtis syndrome?

RUQ pain and peri-hepatitis - follows chlamydial PID in 10-15% of patients

16

What increases the risk of Fitz-Hugh Curtis syndrome?

Repeated episodes of PID

17

What is pelvic inflammatory disease?

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