PID TUboovarian Complex

7/26/2019 PID TUboovarian Complex

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A Case of Pelvic Inammatory Disease1

Silliman University Medical

SchoolSubmitted by: Pasuquin, Alvin

01!"!01"

Submitted to:Dr# $em Austria

$ynecolo%y &or'sheet

REPRESENTATIVE CASE

(his is a case of )*$, a !+yearold female, sin%le, -ili.ino, /oman Catholic, an nline o2

3o'er from Ma%2anua, 4antayan, Duma%uete City, 5e%ros riental 3ho came in at Silliman

University Medical Center on anuary 16, !01" due to .ersistent hy.o%astric .ain#

(he source of information is the .atient herself 3ith 708#

HISTORY OF PRESENT ILLNESS

The patient wa appa!ent"y we"" unti" # hou! p!io! to admiion$ the patient had

an onet o% &ene!a"i'ed abdomina" pain de(!ibed a (!ampin& in (ha!a(te!$ !ated

a )*+, in a pain (a"e- No othe! ymptom we!e noted u(h a %e.e!$ nauea and

.omitin&- No medi(ation we!e ta/en- Pain !eo".ed pontaneou"y$ 0 hou! a%te!-

1 hou! p!io! to admiion$ the patient %e"t anothe! di(om%o!t$ "o(a"i'ed at the

hypo&at!i( a!ea de(!ibed a pu"atin& and (!ampin&$ !ated at +,*+, in a pain

(a"e- No othe! ymptom we!e noted- Patient too/ 2e%enami( a(id whi(h

a3o!ded tempo!a!y !e"ie%- Pe!iten(e o% hypo&at!i( pain p!ompted (onu"tation$

and wa ube4uent"y admitted-

O567YNE HISTORY

The patient had he! mena!(he at ++ yea! o"d whi(h "ated %o! 861 day$

(onumin& 98 pad a day$ mode!ate"y oa/ed$ ao(iated with o((aiona"

dymeno!!hea- Sube4uent ment!uation we!e o% !e&u"a! inte!.a" o% 8,6day6

(y("e "atin& %o! 861 day$ (onumin& 8 pad a day$ mode!ate"y oa/ed$ ao(iated

with o((aiona" dymeno!!hea-

Coita!(he at + yea! o% a&e- Patient ("aim to be e;ua""y a(ti.e with (u!!ent"y +

e;ua" pa!tne! but had mu"tip"e e;ua" pa!tne! in the pat- No hito!y o% e;ua""y

t!anmitted dieae$ a ("aimed- No hito!y o% o!a" (ont!a(epti.e ue-

He! O5 (o!e i 7,- He! L2P wa on +0*+0*+!t hopita"i'ation wa in O(tobe! 0,+8 due to A(ute Sinuiti- No othe!

/nown (ondition u(h a hype!tenion$ diabete me""itu$ b!on(hia" athma$

tube!(u"oi and hea!t dieae- No p!e.iou hopita"i'ation- She ha no /nown

%ood and d!u& eniti.itie- No hito!y o% t!auma$ in?u!y o! a((ident- No p!e.iou

u!&e!ie-

FA2ILY HISTORY


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A Case of Pelvic Inammatory Disease!

2ate!na" ide: @B HPN$ @6B =2$ @6B 5A$ @6B 2a"i&nan(y

Pate!na" ide: @B HPN$ @6B =2$ @6B 5A$ @6B 2a"i&nan(y

PERSONAL and SOCIAL HISTORY

She i not a (i&a!ette mo/e! but an a"(oho"i( be.e!a&e d!in/e!- She (onume to

bott"e o% bee! pe! wee/- He! "at a"(oho" inta/e wa on anua!y +$ 0,+#- No

hito!y o% i""i(it d!u& ue-REVIED OF SYSTE2S7ene!a": no wei&ht "o$ no %ati&ue$ no %e.e!$ no wea/ne$ no di(u"ty "eepin&$

S/in: no !ahe$ no "ump$ no it(hin&$ no d!yne

HEENT: no heada(he$ no head in?u!y$ no ne(/ pain$ no ea!a(he$ no d!aina&e$ no

.iion (han&e$ no eye pain$ no !edne$ no b"u!!in& o% .iion$ no tune$ no

di(ha!&e$ no it(hin&$ no noeb"eed$ no inu tende!ne$ no b"eedin&$ no d!y

mouth$ no o!e th!oat$ no hoa!ene$ no th!uh$ no o!e

Ne(/: no pain$ no ti3ne

Repi!ato!y: no (ou&h$ no putum$ no hemoptyi$ no ho!tne o% b!eath

Ca!dio: no (het pain$ no (het di(om%o!t$ no (het ti&htne$ no pa"pitation

7at!ointetina": no wa""owin& di(u"tie$ no hea!t bu!n$ no (han&e in appetite$with o((aiona" nauea$ no (han&e in bowe" habit$ no !e(ta" b"eedin&$ no

dia!!hea$ no (ontipation$

!ina!y: no %!e4uen(y$ no u!&en(y$ no dyu!ia$ no hematu!ia$ no in(ontinen(e$

Va(u"a!: no (a"% pain with wa"/in&$ no "e& (!ampin&

2u(u"o/e"eta": no mu("e o! ?oint pain$ no ti3ne$ no ba(/ pain$ no tin&"in&$

no t!emo!

Hemato"o&i(: no eay b!uiabi"ity$ no eay b"eedin&

Endo(!ine: no heat o! (o"d into"e!an(e$ no weatin&$ no %!e4uent u!ination$ no

thi!t$ no (han&e in appetite-PHYSICAL EGA2INATION7ene!a": E;amined awa/e$ (on(iou$ (ohe!ent$ !eponi.e to 4uetion$ not in

!epi!ato!y dit!eVita" Si&n: 5P: ,*#, mmH& RR: 01*min HR J *min Temp: 8#- KC O0

atu!ation:

S/in: no pa""o!$ no ?aundi(e$ no pi&mentation$ no a(ti.e "eion$ wa!m$ &ood /in

tu!&o! and mobi"ity$ CRT 9 0 e(ond

HEENT: ani(te!i( ("e!ae$ pin/ pa"peb!a" (on?un(ti.ae$ no eye di(ha!&e$ no inu

tende!ne$ moit "ip and o!a" mu(oae$ no toni""opha!yn&ea" (on&etion

Ne(/: upp"e ne(/$ no ne(/ .ein en&o!&ement$ no "ymphadenopathie$ no thy!oid

en"a!&ement

Chet and Lun&: Symmet!i( (het e;panion$ no !et!a(tion$ !eonant "un&$

("ea! b!eath ound

Hea!t: adynami( p!e(o!dium$ ditin(t hea!t ound$ no!ma" !ate and !e&u"a!

!hythm$ no mu!mu!

Abdomen: Mat$ nonditended$ no!moa(ti.e bowe" ound$ no o!&anome&a"y$ di!e(t

tende!ne in the hypo&at!i( a!ea

5PE: ("oed (e!.i;$ @B (e!.i(a" motion tende!ne upon "ate!a" wi&&"in& o%

e;aminin& >n&e!$ minima" mu(upu!u"ent "i&ht"y ma"odo!ou di(ha!&e

7T: Ne&ati.e /idney pun(h i&n$ bi"ate!a" no di(ha!&e

E;t!emitie: No &!o de%o!mitie$ pin/ nai" bed$ t!on& pe!iphe!a" pu"e$ %u""

!an&e o% motion


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PRI2ARY DORIN7 I2PRESSION: A(ute Pe".i( InMammato!y =ieae @Tubo6o.a!ian

Comp"e;B$ 7,Pelvic infammatory disease (PID) comprises a spectrum o infammatory disorders o the upper emale genital

tract, including any combination o endometritis, salpingitis, tubo-ovarian abscess, and pelvic peritonitis. Seually

transmitted organisms, especially !eisseria gonorrhoeae and "hlamydia trachomatis, are implicated in many

cases# ho$ever, microorganisms that comprise the vaginal fora (e.g., anaerobes, %ardnerella vaginalis,&aemophilus infuen'ae, enteric %ram-negative rods, and Streptococcus agalactiae) also have been associated $ith

PID. In addition, cytomegalovirus ("), ycoplasma hominis, and *reaplasma urealyticum may be the etiologic

agents in some cases o PID.

CLINICAL =IA7NOSTIC CRITERIA FOR PI=One o! mo!e o% the %o""owin& minimum (!ite!ia mut be p!eent on pe".i(

e;amination to dia&noe PI=: Cervical motion tenderness

Uterine tenderness

Adne:al tenderness

The %o""owin& (!ite!ia (an imp!o.e the pe(i>(ity o% the dia&noi:ral tem.erature ; 101#9


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assay H@)ISAor &estern 2lot? and counselin% should 2e oJered to all .atients 3ith sus.ected PID

or se:uallytransmitted disease =S(D?

6# An elevated @S/ or C reactive .rotein su..orts the dia%nosis 11 2ut is nons.ecic

and often normal in mildmoderate PID

+# C4C @levation of the 3hite cell count =&4C? su..orts the dia%nosis 2ut can 2enormal in mild cases#

"# )a.arosco.y is the criterion standard for the dia%nosis of PID# It is si%nicantly more

s.ecic and sensitive than are clinical criteria alone# (he minimum criteria for

dia%nosin% PID la.arosco.ically include tu2al 3all edema, visi2le hy.eremia of the

tu2al surface, and the .resence of e:udate on the tu2al surfaces and m2riae#

*o3ever, it is not Kustied routinely on the 2asis of associated mor2idity, cost and the

.otential diLculty in identifyin% mild intratu2al inammation or endometritisE# @ndometrial 2io.sy may also 2e hel.ful 3hen there is dia%nostic diLculty># Urinalysis to rule out urinary tract infection =U(I?7# A .re%nancy test should 2e .erformed to hel. e:clude an ecto.ic .re%nancy10# (ransva%inal Sono%ra.hy Althou%h ultrasono%ra.hy is neither s.ecic nor sensitive

in distin%uishin% the cause of a .elvic mass, ndin%s of dilated and uidlled tu2es,free .eritoneal uid, and adne:al masses may 2e conrmatory of sym.toms and

.hysical si%ns# (hus, va%inal ultrasound has a hi%h .ositive .redictive value 3hen

used in a hi%hris' .o.ulation#

Patients resultUterus 9#+6 : 6#6+ : 9#"E cm, retroverted@ndometrium 1#69 cm, hy.erechoicCervi: !#1E : !#0" 3ithout na2othian cyst/ vary 9#09 : !#+> CM, lateral) vary 9#06 : 1#77 cm, .osterior

+indings

N @ndometrial and myometrial echoes a..ear homo%enous and intactN @ndometrium thic' and hy.oechoic 3ith intact su2endometrial haloN )eft ovary unremar'a2leN &ithin / vary is a thin 3alled, unilocular, cystic structure measurin% !#E1 :

!#!1 cm 3ith homo%enous lo3 level echoes 3ithinN Medial to / vary is a 2iloculated, tu2ular cystic structure +#99 : !#"6 cm

lled 3ith homo%enous lo3 level echoesN Minimal free uid at the .osterior cul de sac, left adne:al area 3ith thin

adhesions

PATHOPHYSIOLO7Y =IA7RA2

Ri/ Fa(to!

Ooun%er a%e

Multi.le se:

.artners

Fa%inal Inammation andhormonal chan%e durin%

ovulation or menstruation

PELVICINFLA22ATORY

=ISEASE

Ce!.i;

Muco.urulent Cervicitis

Sa"phin; and O.a!ie

Sal.hin%itisSterilitty


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A Case of Pelvic Inammatory Disease+

PATHOPHYSIOLO7Y

Acute PID is usually a .olymicro2ial infection caused 2y or%anisms ascendin% from the

va%ina and cervi: alon% the mucosa of the endometrium to infect the mucosa of the oviduct#

In many cases, no causative or%anism is found# (he t3o classic se:ually transmitted

or%anisms associated 3ith PID, 5# %onorrhoeae

and C# trachomatis, cause acute PID in many cases#

@Lcacy of the

functional 2arrier

.rovided 2y the cervical

Acquisition of va%inal or cervicalinfection throu%h se:ual contact

=infected e:udates and secretions?

7ono(o((u

Pili-attach to mucosal surace and prevents ingestion by

neutrophils

OPA proteins-adherence bet$een gonococcus and

ha oc tes romotin invasion into the host cell$onococcus and other 2acteriaadherin% to the @.ithelium may

Microor%anisms ascend from the lo3er %enital tractthrou%h rhythmic uterine contractions occurrin% durin%

or asm or 2acteria ma also 2e carried alon 3ith s erm

*y.erthermiaPain@rythema*eat and 4urnin% sensationS3ellin%

Inammation

/etro%rade s.read of the or%anisms

Va&inaFa%initis-ormationof Smalland lar%erA2scess

!eth!aUnrethritis

Tubo6O.a!ian

Sa"phin&o6oopho!iti


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A Case of Pelvic Inammatory Disease>

aminoacylt/5A to the m/5A and

inhi2itin% 2acterial .rotein synthesis#

Do:ycycline .revents the normal

function of the a.ico.last of

Plasmodium falci.arum, a malaria

causin% or%anism#

.rolon%ed e:.osure to sunli%ht or

tannin%

FOLLOD6P1# /evie3 at E! hours is recommended, .articularly for those 3ith a moderate or severe

clinical .resentation, and should sho3 a su2stantial im.rovement in clinical

sym.toms and si%ns# -ailure to do so su%%ests the need for further investi%ation,

.arenteral thera.y andor sur%ical intervention#!# -urther revie3 6 3ee's after thera.y may 2e useful to ensure

a. ade/uate clinical response to treatmentb. compliance $ith oral antibioticsc. screening and treatment o seual contactsd# advice on uture use o condoms to prevent recurrent PID

9# /e.eat testin% for %onorrhoea or chlamydia is a..ro.riate

a. in those $ith persistent symptomsb. $here antibiotic sensitivities are un0no$n or resistance is present

(gonorrhoea only)c. history o poor compliance $ith antibioticsd# inade/uate tracing o seual contacts $here there is a possibility o persisting

or recurrent inection.

PID TUboovarian Complex

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