A complete informative chapter to understand .v.nice.@Dr. Rajesh Gupta sir.
Nice article post.
अति महत्वपूर्ण एवं उपयोगी जानकारी हेतु आभार व्यक्त करता हूं।
P what a beautiful informative post sir. Thanks a lot.
Nice informative post Dr. Agree with my beloved honorable Dr. S. K. Mudgal sir.
Nice update sir
Merc sol 30 Informative post
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Friends today I am discussing about gale problem known as Pelvic Inflammatory Disease (PID). What is pelvic inflammatory disease? Pelvic inflammatory disease (PID) is an infection of the reproductive organs in women. The pelvis is in the lower abdomen and includes the fallopian tubes, the ovaries, the cervix, and the uterus. According to the U.S. Department of Health and Human Services, this condition is common and affects about 1 million women each year in the United States. Several different types of bacteria can cause PID, including the same bacteria that cause the sexually transmitted infections (STIs) gonorrhea and chlamydia. What commonly occurs is that bacteria first enter the vagina and cause an infection. As time passes, this infection can move into the pelvic organs. PID can become extremely dangerous, even life-threatening, if the infection spreads to your blood. If you suspect that you may have an infection, see your doctor as soon as possible. Risk factors for pelvic inflammatory disease Your risk of pelvic inflammatory disease increases if you have gonorrhea or chlamydia. However, you can develop PID without ever having an STI. Other factors that can cause pelvic inflammatory disease include: having sex and being under the age of 25 having sex with different people having sex without a condom using an intrauterine device (IUD) to prevent a pregnancy douching having a history of pelvic inflammatory disease Symptoms of pelvic inflammatory disease Some women with pelvic inflammatory disease don’t have symptoms. For the women who do have symptoms, these can include: pain in the lower abdomen (the most common symptom) pain in the upper abdomen fever painful sex painful urination irregular bleeding increased or foul-smelling vaginal discharge tiredness Pelvic inflammatory disease can cause mild or moderate pain. However, some women have severe pain and symptoms, such as: sharp pain in the abdomen vomiting fainting a high fever (greater than 101°F) If you have severe symptoms, call your doctor immediately or go to the emergency room. The infection may have spread to your bloodstream or other parts of your body. Once again, this can be a life-threatening condition. Tests for pelvic inflammatory disease Diagnosing PID Your doctor may be able to diagnose PID after hearing your symptoms. In most cases, your doctor will run tests to confirm the diagnosis. Tests include: pelvic exam to check your pelvic organs cervical culture to check your cervix for infections urine test to check your urine for signs of blood, cancer, and other diseases After collecting samples, your doctor sends these samples to a laboratory. Assessing damage If your doctor determines that you have pelvic inflammatory disease, they may run more tests and check your pelvic area for damage. PID can cause scarring on your fallopian tubes and permanent damage to your reproductive organs. Additional tests include: pelvic ultrasound: imaging test that uses sound waves to create pictures of your internal organs endometrial biopsy: outpatient procedure where a doctor removes and examines a small sample from the lining of your uterus laparoscopy: outpatient procedure where a doctor inserts a flexible instrument through an incision in your abdomen and takes pictures of your pelvic organs Treatment for pelvic inflammatory disease Your doctor will likely have you take antibiotics to treat PID. Because your doctor may not know the type of bacteria that caused your infection, they may give you two different types of antibiotics to treat a variety of bacteria. Within a few days of starting treatment, your symptoms may improve or go away. However, you should finish your medication, even if you are feeling better. Stopping your medication early may cause the infection to return. If you are sick or pregnant, can’t swallow pills, or have an abscess (pocket of pus caused by the infection) in your pelvis, your doctor may send you to the hospital for treatment. Pelvic inflammatory disease may require surgery. This is rare and only necessary if an abscess in your pelvis ruptures or your doctor suspects that an abscess will rupture. It can also be necessary if the infection does not respond to treatment. The bacteria that cause PID can spread through sexual contact. If you are sexually active, your partner should also get treated for PID. Men may be silent carriers of bacteria that cause pelvic inflammatory disease. Your infection can recur if your partner doesn’t receive treatment. You may be asked to abstain from sexual intercourse until the infection has been resolved. Ways to prevent pelvic inflammatory disease You can lower your risk of PID by: practicing safe sex getting tested for sexually transmitted infections avoiding douches wiping from front to back after using the bathroom to stop bacteria from entering your vagina Long-term complications of pelvic inflammatory disease Make a doctor’s appointment if you think that you have PID. Other conditions, such as a urinary tract infection, can feel like pelvic inflammatory disease. However, your doctor can test for PID and rule out other conditions. If you don’t treat your PID, your symptoms can worsen and lead to problems, such as: infertility: inability to conceive a child ectopic pregnancy: pregnancy that occurs outside the womb chronic pelvic pain: pain in the lower abdomen caused by scarring of the fallopian tubes and other pelvic organs The infection can also spread to other parts of your body. If it spreads to your blood, it can become life-threatening. Homeopathic Medicines for Pelvic Inflammatory Disease (PID) Sepia Succus – Natural Medicine for PID with Pain in Lower Abdomen/ Pelvic Area Sepia Succus is an excellent homeopathic medicine for treating PID with marked pain in lower abdomen or pelvic area. Along with pelvic pain, a prominent bearing down sensation in the pelvis assist. In some cases needing Sepia Succus, burning or griping in the uterus is present. Vaginal discharge of yellowish or greenish may also arise that may be offensive. Merc Sol – Effective Homeopathic Medicine for PID with Vaginal Discharge Merc Sol is a natural medicine for PID with excessive vaginal discharge. The symptoms that indicate the need for Merc Sol include acrid, excoriating, and itchy discharges that cause a burning sensation in the vagina. The discharges may be purulent, yellow or green. The discharges tend to get worse upon urination. In some cases, a stitching uterine pain may be present. Additionally, there may be a stinging ovarian pain. Phosphorus – Natural Remedy for PID with Bleeding from Uterus between Periods Phosphorus is a beneficial homeopathic medicine for treating PID cases where there is bleeding from the uterus between periods. The uterine bleeding tends to be profuse. Weakness usually follows the menstrual bleeding. Other symptoms include ovarian pain (specifically left-sided). The ovarian pain is felt the most during menses. Leucorrhoea of white or watery mucus may be present. A weak sensation in the abdomen may be present along with leucorrhoea. Sabina Officinalis – Effective Homeopathic Treatment for PID with Heavy Periods Sabina Officinalis is a well-indicated homeopathic medicine for pelvic inflammatory disease with heavy periods. The periods are profuse and gushing in nature. The bleeding is bright red colored with dark clots in it. The blood may have an offensive odor. Motion tends to worsen the blood flow. Pain in the sacral back extending to pubes is a primary accompanying symptom. This remedy is also recommended for inflammation of uterus and ovaries that may occur following childbirth or an abortion. Medorrhinum – Natural Homeopathic Medicine for PID with Painful Periods Medorrhinum is a significant homeopathic medicine for PID where the woman experiences intensely painful periods. There is an excruciating pain the pelvic area along with ovarian pains that get better with pressure. The menstrual bleeding is copious, dark and offensive. Vaginal discharge of acrid nature and a fish-like odor is also present in some cases. Kreosotum – Natural Treatment for Pelvic Inflammatory Disease with Pain during Intercourse Kreosotum is a natural medicine PID when there is pain during intercourse (dyspareunia). Burning in the genitalia is felt along with pain. Kreosotum is also useful in cases of pelvic inflammatory disease where there is bleeding after intercourse. Along with the above symptoms, there may be offensive, itching, corrosive leucorrhoea. The leucorrhoea worsens in between menses and often leaves a yellow stain on clothes.Dr. Rajesh Gupta4 Likes3 Answers
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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 Pratap10 Likes10 Answers
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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 preventionDr. Kirti Yadav (Pt)17 Likes27 Answers
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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 Pratap15 Likes25 Answers
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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 Vasanthakumar7 Likes11 Answers