Essence of pelvic inflammatory disease by Dr.Madam Suvarchala Partap .Very useful for general practitioners and lady doctors who have never gone to the basics of Obstetrics and Gynaecology. Dr.Rajesh Gopal MBBS IMA PMC Reg no.35726.Ludhiana.
Thanks fr sharing mam. Very nice and helpful info.
Thank you for sharing useful information.
Very good information.thankyou
Good information .thanx
Thank u mam useful post
Very good dr.
Madam ,Morning you agree with my answer on your post which still appears in my notification .But now I noted agree answer is not there .what is going on .Yes when I answered that your post is useful for those lady doctors who don't know basics of Obstetrics and Gynaecology ,I am absolutely right as come to rural areas ,floor cleaners in gynae hospitals are doing deliveries and put the word lady doctor in front of their name ,come Madam ,I will show you and even my request to Curofy team that they should verify a person's qualification and then should allow him or her your Curofy App . Dr.Rajesh Gopal .MBBS IMA PMC Reg no 35726 .Ludhiana .
Cases that would interest you
- Login to View the image
Pelvic Inflammatory Disease(PID) Pelvic inflammatory disease (PID) may be the inflammation of the upper genital tract relating to the fallopian tubes as well as the ovaries. The soreness is often bilateral because most from the PID is caused by the ascending or blood borne infection and also the close anatomic association from the ovaries with the fallopian tubes favors the bilateral involvement, though one tube might be more affected compared to other. The Pelvic inflammatory disease treatment aims to lessen this inflammation and stop further damage to the organs. Pelvic inflammatory disease causes The most typical cause of PID is std's (STD) Most common being gonococcal and chlamydial infections 60-75% of PID is brought on by STD, of which gonorrhea accounts for about 30% within the developed countries Gonoccoci and Chlamydia travel in the genital tract across the mucous membrane to reach the fallopian salpingo-oophoritis Other organisms directly ascend across the lining of the genital tract Other organisms that create PID include mycoplasma, tubercular bacillus, viruses and E. coli. Both aerobes and anaerobes are implicated in PID Pelvic inflammatory disease Pathology Acute Salpingitis The fallopian tube is swollen, edematous and hyperaemic with visible dilated vessels around the peritoneal surfaces. The sure manifestation of salpingitis (inflammation of the fallopian tube) may be the discharge of seropurulent fluid in the fimbrial end of the tube. The inflammatory exudate is discharged in to the lumen of the tube resulting in adhesions and tubal blockage or narrowing from the lumen which may be the cause of ectopic pregnancy or infertility. Pelvic abscess might be formed due to pus collection within the pelvic cavity. The ovaries are participating and a tubo ovarian abscess or mass may result. In rare cases the problem may spread upwards to result in generalized peritonitis, paralytic ileus and even sub diaphragmatic and perinephric abscess. In PID following postabortal and puerperal infection, the problem spreads through the cervix via lymphatics towards the cellular tissue causing cellulitis. The fallopian tube is affected externally and the mucous membrane last but not least. Pelvic inflammatory disease treatment within the acute stage helps limit the problem and prevent long term harm to the fallopian tube and ovaries resulting in adhesions formation, infertility etc. In early stage pelvic inflammatory disease treatment may require administration from the antibiotics but in the later stage surgical drainage from the abscess and adhesions breakdown may be required. Pelvic inflammatory disease symptoms and signs The most typical symptom of acute PID is gloomier pelvic pain. Pain is bilateral and limited to lower abdomen. Pain spreads upwards if general peritonitis ensues. Pain is severe in acute stage and it is followed by a high temperature. Vomiting could also follow. Discharge from the vagina and dysuria also occur. Menstrual irregularity if any, is a result of preceding endometritis in case of ascending infection in order to the antecedent abortion or delivery. The patient may develop uterine bleeding at any given time when menstruation isn't expected and the bleeding is usually profuse and prolonged. In case of pelvic abscess, the individual develops severe diarrhea because of rectal irritation. Investigations in Pelvic inflammatory disease Haemoglobin, leucocyte count and ESR. Cervical and vaginal swab culture for both aerobic and anaerobic organisms. Blood culture if bacteraemia takes hold. C reactive protein distinguishes between infective and non infective mass. Ultrasound: Tubo-ovarian abscess appears around the ultrasound. Computed tomography shows a spherical or tubular structure having a low attenuation center. Pelvic inflammatory disease treatment Pelvic inflammatory disease treatment aims to lessen the inflammatory process thereby arresting the development of the organisms resulting in the disease. Since 60-75% of PID come from Sexually transmitted diseases, treatment consists of pharmacological therapy (antibiotics) to eradicate the causative organisms together with supportive therapy for the control over other symptoms. Surgical treatment are usually necesary in case of extensive damage. Pelvic inflammatory disease treatment in Acute stage: Pelvic inflammatory disease treatment within the acute stage includes removal of the causative organisms by proper administration from the antibiotics. Mild cases are treated at home with antibiotics. Moderate and severe cases of Pelvic inflammatory diseases may require hospitalization. Hospital management includes: Rest Intravenous fluids within the presence of dehydration or vomiting and correction of electrolytic imbalance. Antibiotics are mandatory to become instituted at the earliest for the pelvic inflammatory disease treatment before the diagnosis is made. Initially, intravenous route is resorted to, however when the infection settles down, oral therapy might be started. Antibiotics like tetracycline, erythromycin, doxycycline, clindamycin work against both aerobic and anaerobic bacteria. Newer antibiotics include cefoxitin, cefotetan, doxycycline etc can be utilized for the pelvic inflammatory disease treatment. Surgical treatment may be required in the following conditions: Drainage of the pelvic abscess. Dilatation and evacuation of septic products of conception or for haemorrhage in postabortal sepsis. Acute spreading peritonitis and intestinal obstruction. Physiotherapy management within the acute pelvic inflammatory disease aims to lower the pain and inflammation combined with the pharmacological therapy. In mild and moderate cases of Pelvic inflammatory disease in which the patient does not need hospitalization, pain relieving modality like short wave diathermy could be given. Short wave diathermy is really a deep heating modality, produces heat both in deep and superficial tissues. Within the acute stage very mild or pulsed short wave diathermy can be used to promote healing and lower pain. For the Pelvic inflammatory disease treatment short wave diathermy could be given for 5-10 minutes for a time of three days a week while using cross- fire method of diathermy. Cross-fire method involves moving the electrodes to some position at right angles for their previous position midway through the treatment. Half the Pelvic inflammatory disease treatment is offered antero-posteriorly through the pelvis using the patients in the lying position and 2nd half in the side lying using the legs curled up or perhaps in sitting position and also the electrodes placed over the pelvic outlets and also the lumbo-sacral area of the spine. Pelvic inflammatory disease treatment in Chronic stage: Physiotherapy control over the pelvic inflammatory disease within the chronic stage is aimed at:- Relieving pain. Promote healing round the area. Treat existing musculoskeletal dysfunction or prevent further musculoskeletal dysfunction. Increase function. Pelvic inflammatory disease treatment modalities contain:- Short wave diathermy: it's widely known that short wave diathermy may be used to reduce pain and swelling, accelerate the soreness process and promote healing in tissues with chronic inflammation. It results in increased circulation round the area by vasodilatation resulting in better healing. Additionally, it increases the metabolic activity from the area leading to more nutrients, more cellular activity and healing and increasing collagen extensibility. It will help in the repair of pelvic microcirculation, thus enabling lysis of scar tissues, relaxation of contracted muscles within the pelvis and pelvic floor. For the pelvic inflammatory disease treatment within the chronic stage short wave diathermy is offered for 15-30 minutes, two times a day for thrice per week using the cross-fire method of treatment. Electrical stimulation as Transcutaneous electrical nerve stimulation (TENS) towards the low back for the symptomatic elimination of low back pain can be given. TENS works at both spinal-cord level and higher brain centres to inhibit the transmission of nocioceptors thus relieving the thought of pain. Moist hot pack could be given the low back to alleviate pain in the back. The pelvic floor muscles in females in the chronic PID might be in the hypertonic state because of pain, delayed healing, scarring adhesions or generalized spasm through the pelvic floor tissues. Pelvic floor rehabilitation is suggested for the pelvic inflammatory disease treatment such patients. Teaching control and relaxation from the pelvic floor musculature is important during these patients. Biofeedback including surface EMG may be used to induce relaxation during these muscles. For strengthening the pelvic floor musculature instruct the individual to tighten the pelvic floor as though attempting to stop the the flow of urine. Hold for 3-5 seconds and relax. Repeat Ten times per session. These exercises are through with empty bladder. Elevator exercises : instruct the girl to visually imagine traveling in an elevator. As the elevator goes in one floor to the other, contract the muscles a bit more. Relax the muscles gradually, as though the elevator were descending one floor at any given time. For treating a woman with hypertonus, boost the rest time between your pelvic floor contractions and sets. Focus on relaxation is equally important for weight training in these clients. Utilization of surface EMG for feedback is invaluable for enhancing understanding of holding patterns and resting tone. Instruct the girl to contract the pelvic floor as with the strengthening exercises then allow total voluntary release and relaxation from the pelvic floor muscles. This activity could be coordinated with breathing. Instruct the girl to concentrate on a slow deep breath slowly and allow the pelvic floor to totally relax. Surgical treatment might be indicated in the chronic pelvic inflammatory disease in which the extent of damage is much more. Tubal damage may require tuboplasty. Laproscopic breaking of adhesions is indicated when the tubal blockage is due to external adhesions. Overall surgery depends on the age and parity from the patient, the symptoms and pelvic pathology.For prevention against Pelvic inflammatory disease, delivery should be conducted in the hospitals, contraceptive devices like barrier methods can be used to prevent sexually transmitted diseases and also the young women should be educated concerning the risk of STDs and its preventionKirti Yadav16 Likes21 Answers
- Login to View the image
PELVIC INFLAMMATORY DISEASE : DEFINITION : PID is defined as a spectrum of inflammatory disorders of the upper female genital tract , including any combination of endometritis, salpingitis,tubo-ovarian abscess and pelvic peritonitis. It is a serious complication of some STD's , especially chlamydia and gonorrhea. PID can damage the fallopian tubes and tissues in and near the uterus and ovaries. PID leads to serious consequences including infertility ,ectopic pregnancy,abscess formation and chronic pelvic pain. CAUSATIVE ORGANISMS : Causative organisms are bacteria ,fungi,virus and parasites Sexually transmitted organisms are implicated in most cases.especially N.GONORRHEA & C.TRACHOMATIS. Microorganisms that comprise the vaginal flora also have been associated with PID. Gardnerella vaginalis. Haemophilus influenza. Enteric gram negative rods. Streptococcus agalactiae. Other organisms involved are Cytomegalovirus. M.hominis. U.urealyticum. M.genitilium. RISK FACTORS : *H/O STDs,especially gonorrhea &chlamydia. *Teenage sex. *Multiple sexual partners. *Intra uterine device. *Prior episodes of PID. *HIV. TYPES: ACUTE PID : Patient has generalized symptoms. Lasts few days. May recur in episodes. Very infectious. CHRONIC PID : Patient may be asymptomatic. Occurs over months and years. Progressive organ damage. SYMPTOMS : 1.Lower abdominal pain,may worse when move 2.Dyspareunia 3.Dysuria. 4.Dysmenorrhoea. 5.Post coital bleeding /metrorrhagia. 6.Low back ache. 7.Fever . 8.Feeling of tiredness. 9.Abnormal vaginal discharge. 10.Nausea ,vomiting . SIGNS : 1.Lower abdominal tenderness. 2.Adnexal and cervical tenderness on bimanual palpation. 3.Muco purulent vaginal discharge. 4.Cervicitis seen on speculum examination. 5.May find palpable adnexal mass. 6.Pyrexia.Dr. Suvarchala Pratap13 Likes19 Answers
- Login to View the image
A PRACTICAL APPROACH TO THE DIAGNOSIS OF PELVIC INFLAMMATORY DISEASE: The diagnosis of PID is usually based on clinical criteria.Although diagnostic accuracy is advocated,antibiotic therapy should be instituted if there is a diagnosis of cervicitis or suspicion of acute PID. The clinician should maintain a high index of suspicion for the diagnosis as she evaluates the lower genital tract for inflammation and pelvic organs for tenderness in women with genital tract symptoms and a risk for sexually transmitted infections. This approach should minimize treating women without PID with antibiotics and optimize the diagnosis in a practical and cost effective way. Acute PID is associated with cervicitis, endometritis,salpingitis and peritonitis. The sigificant sequelae are tubal factor infertility,ectopic pregnancy and chronic pelvic pain. If pelvic examination fails to reveal evidence of inflammation(if there is no leukorrhoea),then the diagnosis of PID is much less likely and antibiotic treatment can be withheld while the remaining diagnostic workup defines the diagnosis. EVIDENCE OF LOWER GENITAL TRACT INFLAMMATION AND PELVIC ORGAN TENDERNESS SUGGESTS THE ADVISABILITY OF INITIATING THE ANTIMICROBIAL THERAPY SYMPTOMS: 1.Abdominal pain. 2.Abnormal discharge. 3.Metrorrhagia. 4.Post coital bleeding. 5.Fever. 6.Dysuria. 7.Low back ache. 8.Nausea,vomiting. CLINICAL CRITERIA: The diagnosis of PID should be considered in all sexually active women. Abdominal tenderness may/may not be present. Bimanual pelvic examination reveals pelvic organ tenderness. Uterine tenderness=endometritis. Adnexal tenderness=salpingitis. Cervical tenderness=cervicitis. Per speculum examination:look for green/yellow mucopus and friability. Microsopy of vaginal secretions should be performed looking for leucorrhea. (>>1 LEUCOCYTE/EPITHELIAL CELL) Evaluation of bacterial vaginosis (vaginal pH,clue cells&whiff test) Nucleic acid amplification test(NAAT) for gonorrhea and chlamydia should be performed. Empiric antibiotic treatment should be initiated in sexually active women,especially those at risk for STDs with lower abdominal or elvic pain ,if no other causes other than PID can be identified and if the following minimum criteria are present on pelvic examination. 1.Lower genital tract inflammation. cervicitis on clinical examination. More than one leukocyte/epithelial cell on microscopy of vaginal secretions. 2.Pelvic organ tenderness. cervical motion tenderness. Uterine tenderness. Adnexal tenderness.Dr. Suvarchala Pratap9 Likes9 Answers
- Login to View the image
Fitz-Hugh–Curtis syndrome is a rare complication of pelvic inflammatory disease (PID) involving liver capsule inflammation leading to the creation of adhesions. The condition is named after the two physicians, Thomas Fitz-Hugh, Jr and Arthur Hale Curtis who first reported this condition in 1934 and 1930 respectively. The major symptom and signs include an acute onset of right upper quadrant abdominal pain aggravated by breathing, coughing or laughing, which may be referred to the right shoulder. Surprisingly there is often no or only minimal pelvic pain, vaginal discharge or cervical motion tenderness, which may lead to the diagnosis being missed. This may be due to infectious bacteria bypassing pelvic structures on the way to the liver capsule . Ultrasound and LFT are normal . Testing for gonorrhea and chlamydia should be performed to make the diagnosis. An endocervical or low vaginal swab should be taken to test for these organisms. Most the times this clinical condition mimics other conditions they are missed. Laparoscopy helps to detect the “ violin string adhesions” . I have seen many of these cases while doing laparoscopy for infertility or for other reasons. They come as incidental findings . Primary peritonitis ( where there is no specific cause ) around puberty also show these findings . Generally I don’t do anything , because it’s unnecessary meddling .Dr. Sripathy Vasanthakumar6 Likes9 Answers
- Login to View the image
What is oophoritis? Oophoritis term refers to inflammatory condition of single or pair of ovaries. Oophoritis is generally used to describe the inflammatory condition of pelvic inflammatory disease. Usually oophoritis is associated with salpingitis, the infection affects fallopian tubes and gradually it spread internal pelvic organs including ovaries. Ovaries are responsible for egg production and oophoritis can interfere with fertility. What is salpingo oophoritis? Salpingo oophoritis term is used for describing the physical condition which is associated for both inflammatory condition of fallopian tubes and ovaries. From bacterial colonization, infection extends from the cervix to the uterus, fallopian tubes, and ovaries. The two responsible bacterial colonizations are Gonorrhea and Chlamydia lead to infection of the cervix and aid to develop other microorganism for invading the fallopian tubes and reach to the ovaries. This condition is known as a tubo-ovarian abscess (TOA) which gradually turns to salpingo oophoritis. Symptoms of oophoritis In the initial stage the following symptoms are considered: The lower abdominal pain on both the sides, especially during menstrual cycle. Heavy vaginal bleeding during menstrual cycle Discomfort and pain during sexual intercourse Foul odour vaginal discharge Polyurea (frequent urination) Burning sensation during micturition Malice During walking lower abdominal discomfort arises Pain extends up to the liver In advanced stage, following are the symptoms Need to hospitalize the patient due to severe abdominal pain and tenderness. Fever If tubo-ovarian abscess become ruptured, then general peritonitis occur. Causes This condition is common among young, sexually active females. The infectious agents are invading to the fallopian tubes and ovaries through the vaginal route. The following are the different possibilities through which infectious agents able to create tubo-ovarian abscess. The partner is having STDs Insertion IUD without following sterilization and also lack of personal hygiene cause the possibilities infectious agent’s entrance. Douching also promotes the infection of the uterus and gradually spread to the fallopian tubes and ovaries. Infections of the cervix also lead to tubo-ovarian abscess formation. Diagnosis Following tests help to identify the oophoritis: Thorough knowledge of the patient history and detailed knowledge of the sign and symptoms of the patient Pelvic examination Culture test for vaginal discharge, especially which is coming from the cervix Pelvic ultrasound is the conventional method for obtaining the images of the fallopian tubes and ovaries. This method is harmless, as it uses sound waves. Colpocentesis: this is a test conducted through a needle enters into the uppermost part of the vagina. This needle presses the tube and ovaries for secreting the accumulated fluid. Then collect the fluid and send for laboratory test to diagnose the infecting bacteria. Laparoscopic examinations: If other test results are not providing satisfactory result, then laparoscopy is conducted. In this test small abdominal insertion is required for entering the laproscope. This is a medical examining device which has a light at the tip, after entering it into the abdominal cavity; it provides a clear view of the pelvic organs. Treatment The treatment method is totally depends upon patient condition, How sever the infection and how much patient is affected. Initially patient is treated with antibiotic therapy to stop the microbial growth and also to kill the germs. For symptomatic relief, application of hot pad at the lower abdomen. This may helps to reduction of pain. Warm bath is also recommended for 2-3 time a day for 10-15 minutes for reduction of the symptoms. Avoidance of douching Avoidance of sexual activity till the infection becomes cure. Surgical therapy If above mentioned therapies are not providing improvement of the patient condition, the surgical intervention is recommended. The aim of the surgical intervention is different according to the patient condition, which include: Rapture of the tubo-ovarian abscess. Removal of the tubo-ovarian abscess. Removal of the ovaries (hystectomy). Pre-operative tests should be done appropriately such as heart condition, blood tests for glucose, total blood count and lung X-ray is also required. Before surgery patient and patient representative should inform about the treatment plan and also its outcome. During surgery, if general anesthesia is used, then proper care is required. After surgery patient need to analgesic treatment for lessen the pain, and other post operative care should follow properly. RefDr. Tapan Kumar Sau3 Likes9 Answers