Pelvic Inflammatory Disease Flashcards Preview

ESA 4 - Reproductive System > Pelvic Inflammatory Disease > Flashcards

Flashcards in Pelvic Inflammatory Disease Deck (78):
1

What is pelvic inflammatory disease (PID) a result of? 

Infection ascending from the endocervix 

2

What does PID cause? 

  • Endometritis 
  • Salpingitis
  • Parametritis
  • Oophoritis
  • Tubo-ovarian abscess
  • Pelvic peritonitis

 

3

What is endometritis? 

Inflammation of the lining of the uterus (endometrium)

4

What are the common complications of PID? 

Endometritis and salpingitis

5

What can salpingitis cause? 

Pain and loss of function

6

What is salpingitis?

Inflammation of the fallopian tubes

7

What is a serious complication of PID? 

Tubo-ovarian abscess

8

What causes a tubo-ovarian abscess?

Inflammatory exudate fills the lumen. If there are adhesions, abscesses can form

9

What can happen to the inflamed tube in a tubo-ovarian abscess?

It can become attached to the pelvic sidewall

10

Why is the prevalence of PID underestimated? 

Because a large proportion of cases are asymptomatic

11

Who is the biggest group of PID sufferers?

Sexually active women

12

At what age is the peak prevalence of PID? 

20-30

13

What is the incidence rate of PID in primary care? 

˜280 in 100,000 py

14

What are the risk factors for PID? 

Those for STIs;

  • Younge age
  • Lack of use of barrier contraception
  • Multiple sexual partners
  • Low socioeconomic class

And IUCD

15

When does IUCD increased the risk of PID? 

When putting it in, and removing it

16

What is the aetiology of PID? 

Often polymicrobial 

17

What % of diagnoses of PID are accounted for by STIs? 

25%

18

What microbes can cause PID? 

  • C. trachomatis D-K 
  • N gonorrhea
  • Microbes causing bacterial vaginosis

 

19

What microbes cause bacterial vaginosis? 

  • Gardnella vaginalis
  • Mycoplasma hominis
  • Anaerobes
  • Actinomycosis

 

20

What is the pathophysiology of PID? 

Ascending infection from the endocervix. Infection causes inflammation, which causes damage, and thus damaged tubal epithelium and adhesions

21

What is the endocervix the site for? 

Lower genital tract infection

22

Does the tubal epithelium recover following PID? 

Some recovery, but not totally

23

What is the result of the long term damage to the tubal epithelium in PID? 

Risk of infertility and ectopic pregnancy 

24

What do adhesions cause in PID? 

  • 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