Flashcards in Pelvic Inflammatory Disease Deck (17):
What is endometritis?
Inflammation and infection of the endometrium
Pathophysiology of PID?
Ascending infection from the endocervix and vagina
Causes inflammation which causes damage to tubal epithelium and adhesions form
Complications of PID?
Chronic pelvic pain
Fitz-Hugh-Curtis syndrome - right upper quadrant pain and peri-hepatitis following chlamydial PID
Aetiology of PID?
STIs - C trachomatis, N gonorrhoeae
Others - Gardenerella vaginalis, Mycoplasma, anaerobes
Epidemiology of PID?
Sexually active women, peak from 20-30yrs
Incidence rate in primary care approx 280/100,000 person-years
Risk factors for PID?
No barrier contraception
Multiple sexual partners
Low socko-economic class
Intra-uterine contraceptive device (within 1 week of implantation)
History for PID?
Abnormal vaginal bleeding
Abnormal vaginal/cervical discharge
Sexual history and prior STI
Examination for PID?
Lower abdominal tenderness which is usually bilateral
Bimanual exam - adnexal tenderness and cervical motion tenderness
Speculum exam - purulent cervical discharge and cervicitis
Differential diagnoses of PID?
-complications of an ovarian cyst
-functional pain (pain of unknown physical origin)
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
Management of PID?
-mild/moderate disease: oral
Admit to hospital if tubo-ovarian abscess, PID in pregnancy, lack of response to oral therapy
Outpatient antibiotics for PID?
Inpatient treatment of PID?
Continue for 14 days
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
What is Fitz-Hugh Curtis syndrome?
RUQ pain and peri-hepatitis - follows chlamydial PID in 10-15% of patients
What increases the risk of Fitz-Hugh Curtis syndrome?
Repeated episodes of PID