PID - Pelvic Inflammatory Disease Information PDF

¢Definition:Upper genital tract infection. *Types: Often acute except in cases of TB or _ actinomycosis where it becomes chronic. Pelvic inflammatory disease (PID) Fallopian 3. Bacteria enter fallopian tube tubes and ovaries, which can become infected —— Ovaty + * 2. Bacteria may 4. Infecti...

¢Definition:Upper genital tract infection. *Types: Often acute except in cases of TB or _ actinomycosis where it becomes chronic. Pelvic inflammatory disease (PID) Fallopian 3. Bacteria enter fallopian tube tubes and ovaries, which can become infected —— Ovaty + * 2. Bacteria may 4. Infection can pass through cervix leave fallopian and enter uterus tubes and spread to other parts of body 1. STD-causing Cervix bacteria may enter vagina with semen ¢Incidence: ee Acute PID occurs in about 1-2% of young sexually active female each year. ee About 85% of cases are naturally occurring infection in sexually active females of reproductive age & the remaining 15% of infections occur after procedures that break cervical mucus barrier (as IUCD insertion & endometrial curettage). * Organisms: PID is usually polymicrobial infection & the most common organisms are: * A) Neisseria gonorrhea: 2/3 of cases (commonest). * B) Chlamydia trachomatis: 20% of cases (the commonest STD). * C) Aerobes: Staphylococci, group B streptococci & E.coli. * D) Anaerobes: Bacteroids & peptococci. * E) Mycoplasma hominis. * F) Actinomyces israelii: Related to IUCD. ¢ G) TB: Suspected if PID in virgin. ¢ Risk factors: * A) Age: Incidence of acute PID || é tft age. * B) STDs: There is strong correlation ( ) exposure to STDs & PID. ¢ C) Contraception: * 1) Barrier methods: Protective. * 2) OCs: || risk of PID by: * a) Thick cervical mucus produced by progesterone. * b) || duration of menstrual flow. ¢3) IUCD: ft risk of PID due to: ea) Septic instrumentation during insertion. *-b) Threads tt incidence of ascending infection. °c) tt menstrual flow e IUCD. ¢D) Procedures: IUCD insertion, endometrial curettage, HSG & hysteroscopy. °E) Past history of acute PID: About 25% of women e acute PID develop another acute tubal infection due to: ¢1) Loss of tubal natural protective mechanisms against organism. ¢ 2) Reinfection from untreated male partner. -Pathology: -1) Endometritis. ¢2) Salpingo-oophoritis. ¢ 3) Parametritis (pelvic cellulitis): °@ Infection of loose cellular tissue in base of broad ligament lateral to cervix & upper vagina. °@ Usually caused by staphylococci & E.coli. °@ May results from lymphatic or direct spread after labor or Surgical operations & may be bilateral or unilateral. °@ There is formation of inflammatory exudate which starts at base of broad ligament & may reach large size & shift uterus to other side. °@ The swelling becomes gradually more firm due to fibrin deposition & it heals by fibrosis which may pull uterus to the same side. *@ Sometimes, parametric abscess may develop & it may point & open above inguinal ligament or in vagina, bladder or rectum. * 4) Peritonitis: Usually localized in pelvis & may lead to formation of pelvic abscess but it may be generalized. ¢ 5) Pelvic thrombophlebitis: Can results in septicemia. - B) Chronie PID (chronic salpingitis): 1ts pathological types are: * 1) Hydrosalpinx: *@Pathogenesis: Catarrhal salpingitis + obstruction of both interstitial & fimbrial ends of tube — tube is filled € serous exudate é or eout leaking. *@ Shape: Retort shape mass posterolateral to uterus. *@Main complications: Torsion (more liable to occur due to minimal peritubal adhesions), 2ry infection & rupture. *@ Organism: More common é gonorrhea. ¢2) Pyosalpinx: °-@ Pathogenesis: Suppurative salpingitis + obstruction of both interstitial & fimbrial ends of tube — tube is filled € pus + marked adhesions é thick wall. *@Shape: Retort shape mass posterolateral to uterus. ¢3) Chronic interstitial salpingitis: Thick fibrous wall + stenosed lumen. © * 4) Salpingitis isthmica nodosa: Microscopic presence of tubal epithelium in myosalpinx or beneath tubal mucosa (it may be caused by non_ specific granulomas, TB & endometriosis). - 5) Tubo-ovarian cyst: Hydrosalpinx communicating e ovarian cyst. *6) Tubo-ovarian abscess: Pyosalpnix communicating e ovarian cyst. ¢ 7) Chronic specific salpingitis: TB salpingitis. © Complications: A) Chronic pelvic pain: Due to hydrosalpinx or adhesions. B) Infertility: Due to peritubal & periovarian adhesions & tubal obstruction. © C) Ectopic pregnancy: Due to entrapment of ovum & interference e€ ovum transport as a result of: 1) Absent cillliary movement of tubes. 2) Adhesions, narrowing & development of strictures or diverticulae. D) Parametritis, peritonitis & pelvic thrombophlebitis. E) Hydrosalpinx & pyosalpinx. F) Tubo-ovarian abscess. G) Fitz Hugh Curtis syndrome: e Definition: Acute PID + perihepatitis. e Incidence: Occurs in 1-10% of patients e acute PID. e Etiology: Vascular or transperitoneal dissemination of N.gonorrhea or C.trachomatis. e C/P: Rt upper quadrant pain + pleuritic pain + tenderness in Rt upper quadrant when liver is palpated. e D.D.: Acute cholecystitis & pneumonia. H) Mortality: 5-10% in ruptured tubo-ovarian abscess. Diagnosis: Center for Disease Control (CDC) criteria for diagnosis of acute PID are: A) Minimum (major) criteria: 1) Lower abdominal pain: Commonest symptom (occurs in > 90% of patients). e Usually described as constant & dull & tt by motion & sexual activity. e Generally, pain is of recent onset (usually < 7 days). 2) Lower tenderness + rebound. 3) Tender cervical motion. 4) Adnexal tenderness (unilateral or bilateral). B) Routine (minor) criteria: 1) Oral temperature > 38.3°C. 2) Abnormal cervical or vaginal discharge. 3) tt leukocytic count, CRP & ESR. 4) +ve cervical culture for N.gonorrhea or C.trachomatis. 5) Fluid in Douglas pouch or pelvic abscess. C) Sure criteria: 1) Histopathological evidence of endometritis in endometrial biopsy. 2) Tubo-ovarian abscess on_ ultrasound or_ other radiological tests. 3) Laparoscopic abnormalities consistent e PID (laparoscopy is the most accurate method of confirming diagnosis of acute PID + it excludes other surgical emergencies). LAPAROSCOPY ADHESIONS Laparotomy : Bilé