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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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PID, continued …
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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PID, Gonoccoccal, continued …
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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PID, continued …
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, 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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PID, continued …
3. Size: 3 or 4 cm to full term
4. Bilateral: NO
5. Margin: Placental Villi
6. Age: Reproductive
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PID, Ectopic Pregnancy, continued …
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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