-IBIS-1.5.0-
tx
reproductive system
pelvic inflammatory disease
diagnoses

definition and etiology

definition:
Infection of the Fallopian tubes (salpingitis), uterus (endometritis), ovaries (oophoritis), pelvic peritoneum (peritonitis) and/or broad ligaments.

etiology:
PID may be primary (occurring spontaneously and spread through sexual relations); or, secondary, after invasive procedures (abortion, D&C), or during birth (especially Caesarean deliveries). PID is typically a disease of women under 25 years old, and is uncommon in women before their periods begin, during pregnancy, or after menopause.

Ascending spread from the lower genital tract into the upper genital tract via sexual relations with an infected individual is the most common introduction to the associated microorganism. The common infectious agents include Chlamydia trachomatis, Neisseria gonorrhea, Mycoplasma hominis, and others such as Bacteriodes and anaerobic Gram-(+) cocci. PID must be part of the differential in any young woman presenting with lower abdominal pain.

signs and symptoms

signs and symptoms: may range from asymptomatic to quite severe.
• History of sexual relations (or giving birth, abortion, IUD, or invasive intrauterine procedure).
• (+) Chandelier sign: severe pain on moving the cervix.
• Enlargement or mass palpated in pelvic region.
• Direct or rebound abdominal tenderness; abdominal pain.
• Normal or elevated temperature.
• Vaginal discharge with/without bleeding.
• Dyspareunia.
• Menometrorrhagia.
• Dysuria.
• Occasional nausea and/or vomiting.

lab findings:
• (+) culture and/or Gram stain of an organism.
• Leukocytosis.
• Increased ESR.

course and prognosis

PID can cause infertility from scarring and adhesions of the Fallopian tubes. Other complications include peritonitis from cyst rupture. Conventional treatment consists of antibiotic therapy.

differential diagnosis

• Ovarian torsion.
• Appendicitis.
• Ectopic pregnancy.
• Endometriosis.
• Corpus luteum bleeding.
• Ovarian tumor.
• Uterine fibroid.


footnotes