Pelvic Inflammatory Disease Flashcards
(78 cards)
1
Q
What is pelvic inflammatory disease (PID) a result of?
A
Infection ascending from the endocervix
2
Q
What does PID cause?
A
- Endometritis
- Salpingitis
- Parametritis
- Oophoritis
- Tubo-ovarian abscess
- Pelvic peritonitis
3
Q
What is endometritis?
A
Inflammation of the lining of the uterus (endometrium)
4
Q
What are the common complications of PID?
A
Endometritis and salpingitis
5
Q
What can salpingitis cause?
A
Pain and loss of function
6
Q
What is salpingitis?
A
Inflammation of the fallopian tubes
7
Q
What is a serious complication of PID?
A
Tubo-ovarian abscess
8
Q
What causes a tubo-ovarian abscess?
A
Inflammatory exudate fills the lumen. If there are adhesions, abscesses can form
9
Q
What can happen to the inflamed tube in a tubo-ovarian abscess?
A
It can become attached to the pelvic sidewall
10
Q
Why is the prevalence of PID underestimated?
A
Because a large proportion of cases are asymptomatic
11
Q
Who is the biggest group of PID sufferers?
A
Sexually active women
12
Q
At what age is the peak prevalence of PID?
A
20-30
13
Q
What is the incidence rate of PID in primary care?
A
˜280 in 100,000 py
14
Q
What are the risk factors for PID?
A
Those for STIs;
- Younge age
- Lack of use of barrier contraception
- Multiple sexual partners
- Low socioeconomic class
And IUCD
15
Q
When does IUCD increased the risk of PID?
A
When putting it in, and removing it
16
Q
What is the aetiology of PID?
A
Often polymicrobial
17
Q
What % of diagnoses of PID are accounted for by STIs?
A
25%
18
Q
What microbes can cause PID?
A
- C. trachomatis D-K
- N gonorrhea
- Microbes causing bacterial vaginosis
19
Q
What microbes cause bacterial vaginosis?
A
- Gardnella vaginalis
- Mycoplasma hominis
- Anaerobes
- Actinomycosis
20
Q
What is the pathophysiology of PID?
A
Ascending infection from the endocervix. Infection causes inflammation, which causes damage, and thus damaged tubal epithelium and adhesions
21
Q
What is the endocervix the site for?
A
Lower genital tract infection
22
Q
Does the tubal epithelium recover following PID?
A
Some recovery, but not totally
23
Q
What is the result of the long term damage to the tubal epithelium in PID?
A
Risk of infertility and ectopic pregnancy
24
Q
What do adhesions cause in PID?
A
- Functions of tube inhibited
- Can lead to development of abscesses
25
What is the problem with diagnosing PID?
* A large majority of cases are asymptomatic
* Poor specificity of symptoms
26
What features of history suggest PID?
* Pyrexia
* Pain; lower abdominal pain and deep dysparunia
* Abnormal vaginal/cervical discharge
* Abnormal vaginal bleeding
* Sexual history and prior STI
* Contraceptive history
27
What is dysparuenia?
Pain when having sex
28
Describe the vaginal/cervical discharge in PID?
* Offensive smelling
* Purulent
29
What abnormal vaginal bleeding might be experienced with PID?
* Intermenstrual bleeding
* Post coitus bleeding
30
When might a prior PID history be a cause for concern?
When it was not properly treated
31
What features on examination are suggestive of PID?
* Fever over 28 degrees
* Lower abdominal tenderness
* Tenderness on bimanual examination
* Abnormal speculum examination
32
What is usually true of the lower adominal tenderness in PID?
It is usually bilateral
33
How is a bimanual examination conducted?
One hand on abdomen, 2 in vagina to deviate gynacological organs towards the abdomen
34
What tenderness would be detected on a bimanual examination with PID?
* Adnexal tenderness (tubes of the ovaries)
* Cervical motion tenderness
35
What can a speculum examination detect?
Lower genital tract infections
36
What may be found on a speculum examination with a person with PID?
* Purulent cervical discharge
* Cervicitis
37
What are the categories of differential diagnoses with PID?
* Gynacological
* Gastrointestinal
* Urinary
* Functional pain
38
What are the gynacological differential diagnoses of PID?
* Ectopic pregnancy
* Endometriosis
* Ovarian cyst complications
39
Why should an ectopic pregnancy be considered in a PID differential?
Because they have similar risk factors
40
What ovarian cyst complications may cause PID like symptoms?
Rupture
41
How can PID be differentiated from an ovarian cyst rupture?
There is a similar type of pain, but ruptures have a more acute onset, whereas PID develops over a couple of days
42
What are the gastrointestinal differential diagnoses of PID?
* IBS
* Appendicitis
43
How can PID be differentiated from appendicitis?
With appendicitis, most people have nausea and vomiting, whereas only about half of PID patients do
44
What are the urinary differential diagnoses of PID?
UTI
45
What must be done to investigate the possibility of a UTI when taking a PID history?
Must check urinary symptoms, e.g. dysuria and frequency
46
What is the problem with functional pain when diagnosing PID?
Can be hard to differentiate between this and chronic PID
47
What is chronic PID?
When you get scarring and adhesions without active inflammation
48
What investigations should be done when PID is suspected?
* Urinary and/or serum pregnancy test
* Endocervical and high vaginal swabs
* Blood tests
* Screening for other STIs, including HIV
* Diagnostic laproscopy
49
Why is it important to do a pregnancy test when a patient presents with PID?
Because significant complications if PID during pregnancy
50
What can be determined from endocervical and high vaginal swabs in PID?
Presence of chlamydia or gonorrhoea supports diagnosis, *but absence does not exclude diagnosis*
51
What is being looked for in blood tests with PID?
* WBC
* CRP
52
What is the negative predictive value of absence of pus cells with PID?
95%
53
What is the problem with using the presence of pus cells as a diagnostic tool in PID?
Their presence is not specific
54
What is the advantage of using diagnostic laproscopy in PID?
Can use to treat adhesions and drain abscesses
55
What are the problems with diagnostic laproscopy in PID?
* Risks, including bleeding and infection
* May not see any inflammation on outside, as may all be inside tubes and womb
56
What % of women you think have PID actually do on laproscope?
65%
57
What is the problem with diagnosis of PID?
Underdiagnosis is high, with a low pickup rate on investigation
58
How high is the threshold for empirical treatment of PID?
Low
59
Why is there a low threshold for empirical treatment of PID?
Because delayed treatment increases long-term complications
60
What is the empirical treatment for PID?
Analgesia and rest
61
What does severe PID require?
* IV antibiotics
* Admission for observation and possible surgical intervention
62
What is severe PID indicated by?
* Pyrexia over 38 degrees
* Signs of tubo-ovarian abscess
* Signs of pelvic peritonitis
63
Other than severe disease, when may admission be necessary for PID?
* When not responding to tablets
* Pregnancy
64
What is the problem with severe PID?
Increased risk of long term sequelae
65
How long is antibiotic therapy given for PID?
14 days
66
What is the antibiotic regime for outpatient treatment of PID?
* IM ceftriaxone 500mg STAT (one of dose ASAP)
* PO doxycycline 100mg BD
* PO metronidazole 400mg BD
67
What is the antibiotic regime for inpatient treatment of PID?
* IV ceftriaxone 500mg STAT
* IV/PO doxycycline 100mg BD
* IV metronidazole 400mg BD
* PO doxycycline 100mg BD
* PO metronidazole 400mg BD
68
When is laparoscopy/laparotomy considered in the treatment of PID?
* No response to therapy
* Clinically severe disease
* Presence of tubo-ovarian abscess
69
What is the advantage of ultrasound guided aspiration of pelvic collections over laparoscopy/laparotomy in treatment of PID?
It is less invasive
70
Why is contract tracing important in PID?
To reduce the spread of STIs
71
What are the potential complications of PID?
* Ecoptic pregnancy
* Infertility
* Chronic pelvic pain
* Fitz-Hugh-Curtis Syndrome
* Reiters syndrome
72
What causes chronic pelvic pain in PID?
Adhesions
73
What happens in Fitz-Hugh-Curtis syndrome?
Get RUQ pain and peri-hepatitis following chlamydial PID
74
In what % of cases does Fitz-Hugh-Curtis syndrome occur?
10-15%
75
What is Reiters syndrome associated with?
Chlamydia
76
What kind of pathology is Reiters syndrome?
Immune mediated
77
What does Reiters syndrome cause?
* Arthritis
* Conjunctivitis
* Urethritis
78
What should a patient with PID be told?
* What the diagnosis is
* What treatment they are having
* Possible side effects
* Especially with alcohol
* Headaches
* Flushing
* Importance of completing antibiotics
* What complications they are at risk of
* Risk of these increases with repeat episodes
* How to reduce the risk of further episodes
* Contact tracing
* Empirical treatment of partners
* Abstinence until antibiotic course and follow up complete
* Follow up at 48 hours and 2 weeks
