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PELVIC INFLAMMATORY DISEASE

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PELVIC INFLAMMATORY DISEASE (PID)

A. Definition: Infection and inflammation of entire female tract,

especially Salpingitis.

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PELVIC INFLAMMATORY DISEASE (PID), con’t…

B. Etiology

1. Usually secondary to ascending bacterial infection.

2. Must be differentiated from ectopic pregnancy or acute

appendix.

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PELVIC INFLAMMATORY DISEASE (PID), con’t…

3. Causative organismsa. Gonococcus (40-60%)b. Tuberculosis PIDc. Nongonococcal e.g.

Staphylococcus Chlamydia

4. Can follow childbirth, abortion, insertion of IUD

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PID, continued …

C. Characteristics

1. Location: Cervix, Fallopian tubes

2. Bilateral: Usually

3. Age: Most often < 25 years

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D. Gonococcal (Gc) P.I.D.

1. Neisseria gonorrhea is causative organism

2. Symptoms

a. Inflamed Bartholin’s glands b. Purulent discharge Cervicitis

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PID, Gonococcal, symptoms, continued …

c. Fever and leukocytosis

d. Endometrium not involved

e. Lumens of fallopian tubes become filled with purulent

discharge/exudate =

Pyosalpinx (“pus tube”)

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PID, Gonococcal, symptoms, continued …

f. Eventually tubes become sealed with fibrous connective tissue

g. As pus accumulates, tube becomes distended. (pyosalpinx)

h. S/t 10 cm diameter

i. pelvic peritionitis, extensive adhesions sterility

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PID, Gonococcal, continued …

3. Complications

a. Liver capsule becomes inflamed

1. Ascites & Peri-hepatitis

2. S/t Pyosalpinx Hydrosalpinx

b. Sterility is permanent

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4. Diagnosis:

a. Pelvic exam/ cytology

b. Cervical movement causes pain.

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PID, continued …

E. Tuberculosis Salpingitis – increasing

1. TB in lung, then to blood, and eventually organs

2. may lodge in fallopian tube cells.

3. TB endometritis

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TB - PID, continued …

4. Tubes – Swollen. Caseous material in lumen

5. Tube becomes progressively disorganized by fibrous tissue

6. Abscesses may form

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F. Non Gonoccal PID

1. Usually follows:

a. childbirth

b. abortion

c. use of non-sterile gynecological instruments

d. anal – vaginal intercourse.

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Non Gc-PID, continued …

2. Common Organisms

a. Staphylococcus-skin

b. Streptococcus-skin

c. Coliforms-fecal matter

d. Clostridium perfrigens-soil

e. Chlamydia-STI

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PID, Non Gonoccal PID, continued …

4. Distinguishing Characteristics

a. Nonspecific inflammatory response

b. Less exudation

c. Cervix, uterus, parametrium, fallopian tubes

d. Spread through lymph or veins

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PID, Non Gonococcal PID, continued …

5. Symptoms

a. Pelvic discomfort

b. Dysmenorrhea, dysuria

c. S/t Acute abdomen

d. Fibrotic deformities of tubes sterility.

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PID: Scarring in the Pelvic Cavity may lead to Frozen Pelvis

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PID, Non Gonococcal, continued …

6. Prognosis

a. Sterility

b. Bacteremia or sepsis

c. May lead to

1. Meningitis

2. Endocarditis

3. Suppurative arthritis

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PID, continued …

G. Ectopic Pregnancy (often d/t PID)

1. Implantation of fertilized ovum in any site other than normal uterine position.

2. Incidence > 5% of pregnancy (1/20)

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3. Size: 3 or 4 cm to full term

4. Bilateral: NO

5. Margin: Placental Villi

6. Age: Reproductive

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7. Distinguishing Characteristics

a. Locations

1. Fallopian tubes – 90% Ampulla

2. Others are rare

b. Predisposing conditions: Any condition that slows ovum as it moves from ovary to uterus. (WHY??)

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PID, Ectopic Pregnancy,characteristics, continued …

c. Early development of fetus is normal

1. Problem arises when placenta develops

2. Villi penetrate wall, vessels

3. Tube can never accommodate the growth ruptures.

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PID, Ectopic Pregnancy, Distinguishing Characteristics, continued …

d. In tubes – Tube is weakened by placental implant, becomes distended

1. Visualize placental villi or fetus

2. Wall thickens & hemorrhages

3. Death of embryo

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PID, Ectopic Pregnancy, continued …

8. Symptoms and Prognosis

a. Tubal pregnancy - #1 cause of Hemosalpinxb. Embryo may die and be removed by phagocytic cells

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PID, Ectopic Pregnancy, continued …

c. Embryo may die and become calcified = Lithopedian

d. Pregnancy may continue to develop, rupture at 2-6 weeks

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PID, Ectopic Pregnancy, Sx and Px, continued …

e. Prompt surgical intervention is lifesaving (for mom)

f. Abdominal pregnancy may go full-term 1. this is rare 2. usually in cul-de-sac

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PID, Ectopic Pregnancy, Sx and Px, continued …

g. Heterotopic pregnancy: IUP that co-exists with an ectopic

1. 1:6000

2. up from 1:30,000 d/t “assisted reproduction”

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PID, Ectopic Pregnancy, Sx and Px, continued …

g. Symptoms: ectopic pregnancy

1. Tender abdomen

2. Spotting or cramping

3. Uterus small for dates

4. Maybe shock

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PID, Ectopic Pregnancy, continued …

9. Mnemonic device: “SPAS”

* Sudden onset

* Intense Abdominal Pain

* Acute Abdomen

* Profound Shock

10. Treatment: surgery, methotrexate