37. Pelvic Inflammatory Disease
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Questions and Answers

What is the most common age group for PID occurrence?

  • 45-55 years
  • 15-25 years (correct)
  • 35-45 years
  • 25-35 years

    • What is a significant risk factor for PID?

  • Using contraceptive pills
  • Unprotected sexual intercourse (correct)
  • Having only one sexual partner
  • Having a history of PID

    • What is the initial cause of PID in most cases?

  • Bacterial vaginosis
  • Vaginal flora microorganisms
  • Douching
  • Sexually transmitted organisms (correct)

    • Why do women who douche have a higher risk of getting PID?

    <p>Douching upsets the bacterial ecology</p> Signup and view all the answers

    What is true regarding the pathogenesis of pelvic inflammatory disease (PID) according to the text?

    <p>PID can be caused by ascension of microorganisms from the lower genital tract</p> Signup and view all the answers

    What is the role of gonococci and chlamydia in the pathogenesis of PID as per the text?

    <p>They may initially penetrate the cervical barrier and cause mucopurulent endocervicitis</p> Signup and view all the answers

    What is the significance of disturbance of the cervical barrier in the pathogenesis of PID according to the text?

    <p>It provides vaginal bacteria access to the upper genital organs, leading to infection of the endometrium and other structures</p> Signup and view all the answers

    What is the nature of tuboovarian abscesses in the context of PID, as mentioned in the text?

    <p>They virtually always contain a mixture of facultative and anaerobic bacteria</p> Signup and view all the answers

    How do diagnostic and therapeutic procedures contribute to the development of PID according to the text?

    <p>They disrupt the protective cervical barrier, introducing bacteria into the endometrial cavity</p> Signup and view all the answers

    What is the function of the endocervical canal in the context of the pathogenesis of PID according to the text?

    <p>It functions as a barrier protecting the normally sterile upper genital tract from the organisms of the dynamic vaginal ecosystem</p> Signup and view all the answers

    What is the role of Gardnerella vaginalis and Mycoplasma hominis in the compromise of normal host immunity as per the text?

    <p>They participate in the compromise of normal host immunity</p> Signup and view all the answers

    What is the characteristic feature of PID in terms of infection, based on the information provided in the text?

    <p>It assumes the features of a mixed (facultative and anaerobic) polymicrobial infection</p> Signup and view all the answers

    Which infection is most frequently documented in individuals with subclinical salpingitis and PID?

    <p>C. trachomatis</p> Signup and view all the answers

    What is considered the gold standard for the diagnosis of subclinical PID, as mentioned in the text?

    <p>Endometrial biopsy demonstrating endometritis</p> Signup and view all the answers

    What would confirm the diagnosis of acute salpingitis if women with the clinical diagnosis were to undergo routine laparoscopy, based on the information provided?

    <p>Visual evidence of acute tubal inflammation</p> Signup and view all the answers

    What is the most common symptom in patients with mild-to-moderate PID?

    <p>Bilateral lower abdominal pain</p> Signup and view all the answers

    What is a common clinical physical finding in patients with mild-to-moderate PID?

    <p>Mucopurulent or purulent vaginal discharge</p> Signup and view all the answers

    What is a common laboratory finding in patients with severe PID?

    <p>Peripheral leukocytosis</p> Signup and view all the answers

    What is the most common imaging result for acute PID?

    <p>Normal ultrasonographic results</p> Signup and view all the answers

    When is laparoscopy typically performed in the diagnosis of PID?

    <p>When the patient has failed antibiotic therapy</p> Signup and view all the answers

    What are the two general categories of laparoscopic findings in women with acute salpingitis (PID)?

    <p>Free exudate in the pelvis and tubal occlusion without free exudate</p> Signup and view all the answers

    What is the characteristic of patients with free exudate in the pelvis, as observed during laparoscopy?

    <p>Peritoneal signs</p> Signup and view all the answers

    What is the characteristic of patients with tubal occlusion without free exudate, as observed during laparoscopy?

    <p>All of these</p> Signup and view all the answers

    What should be done during the speculum examination to aid in the diagnosis of PID?

    <p>Cervical cultures for C. trachomatis and N. gonorrheae</p> Signup and view all the answers

    What should laboratory studies include in the diagnosis of PID?

    <p>Urine or serum pregnancy test</p> Signup and view all the answers

    What is depicted as fluid-containing tubal distention in ultrasonography for acute PID?

    <p>Hydrosalpinx</p> Signup and view all the answers

    What is the characteristic histological feature of chronic salpingitis?

    <p>Plicae adhering to each other</p> Signup and view all the answers

    What is the gross appearance of the fallopian tube in acute suppurative salpingitis?

    <p>Swollen, edematous, and congested</p> Signup and view all the answers

    What is the manifestation of endometrial infection by C. trachomatis and N. gonorrhoeae?

    <p>All of these</p> Signup and view all the answers

    What is the lining of the normal fallopian tube's tubal folds?

    <p>Ciliated columnar epithelium</p> Signup and view all the answers

    What is the characteristic feature of pyosalpinx?

    <p>Thinning of the tubal wall and a lumen filled with pus</p> Signup and view all the answers

    What is the result of resorption of purulent exudate concurrent with the quiescence of the inflammatory process in the fallopian tube?

    <p>Formation of hydrosalpinx</p> Signup and view all the answers

    Which structure may become attached to the surface of the ovary during the evolution of salpingitis?

    <p>Fimbria</p> Signup and view all the answers

    What is the nature of a tubo-ovarian abscess in the context of PID?

    <p>A loculated mass consisting of purulent material and surrounded by fibrous and granulation tissue</p> Signup and view all the answers

    What is the result of the acute inflammatory exudate being gradually replaced by lymphocytes, plasma cells, and granulation tissue in a tubo-ovarian abscess?

    <p>Formation of fibrosis and pelvic adhesions</p> Signup and view all the answers

    What results if the purulent exudate escapes from the tubes or ovaries into the peritoneal cavity?

    <p>Pelvic peritonitis</p> Signup and view all the answers

    What is the characteristic feature of pelvic peritonitis?

    <p>Elevated leukocyte count in the peritoneal fluid</p> Signup and view all the answers

    What is the outcome of the purulent exudate becoming organized in the rectouterine pouch?

    <p>Formation of fibrotic adhesions between adjacent pelvic structures</p> Signup and view all the answers

    What is the characteristic histological feature of chronic salpingitis?

    <p>Fibrin exudation into the tubal lumen resulting in plicae adhering to each other</p> Signup and view all the answers

    What is the gross appearance of the fallopian tube in acute suppurative salpingitis?

    <p>Swollen, edematous, and congested</p> Signup and view all the answers

    What is the result of acute salpingitis that is severe in nature?

    <p>Chronic inflammation and scarring</p> Signup and view all the answers

    What is the nature of tubo-ovarian abscess?

    <p>Loculated mass containing purulent material</p> Signup and view all the answers

    What is the outcome of the purulent exudate becoming organized in the rectouterine pouch?

    <p>Development of pelvic adhesions</p> Signup and view all the answers

    What is the characteristic feature of the lining of the normal fallopian tube's tubal folds?

    <p>Epithelium-lined dilated channels</p> Signup and view all the answers

    Which test is recommended for assessing antibiotic susceptibilities of Neisseria gonorrhoeae when resistance is suspected?

    <p>Culture testing</p> Signup and view all the answers

    What is the classic appearance of N. gonorrheae on gram stain and microscopy?

    <p>Gram negative rods with mucoid capsule</p> Signup and view all the answers

    What is the purpose of using Giemsa stain in the diagnosis of Chlamydia infections?

    <p>To demonstrate intracellular inclusions in epithelial cells</p> Signup and view all the answers

    Which test is necessary to confirm a clinical isolate identified as Neisseria gonorrhoeae from culture?

    <p>Immunochemical confirmatory identification</p> Signup and view all the answers

    What is the classic test for presumptive diagnosis of gonorrhea?

    <p>Microscopy of a direct smear with Gram stain</p> Signup and view all the answers

    Which stain is used for the microscopic examination of Chlamydia infections?

    <p>Giemsa stain</p> Signup and view all the answers

    What is the purpose of using Thayer-Martin and Martin-Lewis media?

    <p>Culture testing from sites of exposure for gonococcal infections</p> Signup and view all the answers

    What is the major limitation of Nucleic Acid Amplification Tests (NAATs) for detecting N. gonorrhoeae and C. trachomatis?

    <p>They cannot determine if the bacteria causing infection are living</p> Signup and view all the answers

    What is the diagnostic test of choice for N. gonorrhoeae and C. trachomatis infection of the genitourinary tract?

    <p>Nucleic Acid Amplification Test (NAAT)</p> Signup and view all the answers

    What is the characteristic feature of molecular tests for N. gonorrhoeae and C. trachomatis?

    <p>They are more sensitive than culture, offer testing on a wider range of specimen types</p> Signup and view all the answers

    What is the recommended screening test for asymptomatic persons suspected of having N. gonorrhoeae infection?

    <p>Urine Nucleic Acid Amplification Test (NAAT) for males</p> Signup and view all the answers

    What is the purpose of using monoclonal or polyclonal antibodies in enzyme immunoassays (EIA) for the detection of chlamydial antigens?

    <p>To detect chlamydial lipopolysaccharide</p> Signup and view all the answers

    Which of the following is a long-term sequelae of pelvic inflammatory disease (PID) as mentioned in the text?

    <p>Chronic pelvic pain</p> Signup and view all the answers

    What is the characteristic feature of periappendicitis associated with PID?

    <p>Adherence of appendix to the right fallopian tube</p> Signup and view all the answers

    What is another term for perihepatitis associated with PID?

    <p>Fitz-Hugh-Curtis syndrome</p> Signup and view all the answers

    What is a common clinical presentation of periappendicitis associated with PID?

    <p>Fever and right lower abdominal pain</p> Signup and view all the answers

    Study Notes

    Pelvic Inflammatory Disease Overview

    • Pelvic Inflammatory Disease (PID) involves acute infection of the upper genital tract structures in women, often initiated by sexually transmitted agents and can affect the uterus, fallopian tubes, and ovaries.
    • 4.4% of women aged 18 to 44 in the United States reported a history of PID, with the condition most common in women aged 15 to 25.
    • Risk factors for PID include young age, multiple sex partners, unprotected intercourse, and douching, which can upset bacterial ecology and increase the risk of infection.
    • Common pathogens for PID include Chlamydia trachomatis, Neisseria gonorrhoeae, Prevotella spp., and Gardnerella vaginalis, leading to a mixed polymicrobial infection.
    • PID typically arises from the ascension of microorganisms from the lower genital tract, with the cervical mucus acting as a barrier protecting the upper genital tract.
    • PID can present with overt clinical infection or subclinical manifestations, with subclinical cases often identified in women with infertility and a history of C. trachomatis infection.
    • Acute overt salpingitis (PID) can range from mild to severe presentations, with symptoms including lower abdominal pain, cervical motion tenderness, uterine/adnexal tenderness, and purulent vaginal discharge.
    • Severe PID is associated with peritonitis or tuboovarian abscess, presenting with fever, chills, nausea, vomiting, purulent discharge, and elevated inflammatory markers.
    • Laboratory studies for PID may show leukocytosis, elevated ESR and CRP, and cervical cultures for common pathogens should be performed.
    • Imaging studies, such as ultrasonography, may show normal results or findings like tubal wall thickening, hydrosalpinx, and fluid in the cul-de-sac.
    • Laparoscopy is not typically performed for PID diagnosis unless antibiotic therapy fails, and findings may include free exudate in the pelvis or tubal occlusion without free exudate.
    • Acute salpingitis involves a spectrum of upper genital tract infections, including endometritis, salpingitis, oophoritis, and peritonitis, with specific histopathological features.

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    Test your knowledge of pelvic inflammatory disease with this quiz. Explore key concepts and clinical cases to enhance your understanding of the condition.

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