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Pelvic Inflammatory Disease

Pelvic Inflammatory Disease

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  • 1. Pelvic Inflammatory Disease OB / GYN Rotation LJCMC 25 July 2005 JAMES RATLIFF
  • 2. Table of Topics <ul><li>PID - Pelvic Inflammatory Disease </li></ul><ul><li>Common Female Infections </li></ul><ul><li>PID Symptoms </li></ul><ul><li>PID Common Organisms </li></ul><ul><li>PID Causative Organism Facts </li></ul><ul><li>PID Diagnosis </li></ul><ul><li>PID Consequences </li></ul><ul><li>Gonococcal Inflammation </li></ul><ul><li>Chlamydia: Chlamydia trachomatis </li></ul><ul><li>PID – Douche Frequency </li></ul><ul><li>PID – Contraception </li></ul><ul><li>Bibliography </li></ul>PID
  • 3. Common Female Infections
  • 4. Pelvic Inflammatory Disease <ul><li>New concept  about 10 years </li></ul><ul><li>Common term for any inflammation of female genital tract involving pelvic peritoneum </li></ul><ul><li>Vast majority of genital inflammations </li></ul><ul><li>Usually involves more than one genital organ </li></ul>PID
  • 5. PID - Symptoms <ul><li>Pelvic pain </li></ul><ul><li>Vaginal discharge </li></ul><ul><li>Adnexal Tenderness  MC complaint </li></ul><ul><li>Fever </li></ul>PID
  • 6. PID Common Organisms <ul><li>Gonococcus - MCC </li></ul><ul><li>Chlamydia </li></ul><ul><li>Enteric Bacteria </li></ul><ul><li>Puerperal Infections - Post Spontaneous / Induced Abortions / Normal or Abnormal Delivery </li></ul><ul><ul><li>Staphylocci </li></ul></ul><ul><ul><li>Streptococci </li></ul></ul><ul><ul><li>Coliform </li></ul></ul><ul><ul><li>Clostridium Perfringens </li></ul></ul>PID
  • 7. Major Causative Organism Facts <ul><li>Chlamydia-4 million people annually </li></ul><ul><li>Gonorrhea - 800,000 people annually </li></ul><ul><li>PID leading cause of preventable infertility </li></ul><ul><li>Chronic pelvic pain. </li></ul><ul><li>Potentially fatal ectopic (tubal) pregnancy </li></ul><ul><li>Ectopic pregnancy - leading cause of first-trimester pregnancy-related deaths in African American women. </li></ul><ul><li>70% of chlamydia- and 50% of gonorrhea-infected women asymptomatic </li></ul>PID
  • 8. PID Diagnosis <ul><li>Based on Clinical findings </li></ul><ul><li>Cultures for Organism </li></ul><ul><li>Ultrasound </li></ul><ul><li>Laproscopy </li></ul><ul><li>Biopsy </li></ul>PID
  • 9. Consequences of PID <ul><li>General term that refers to infection of upper genital tract: </li></ul><ul><ul><li>Untreated PID can lead to serious consequences </li></ul></ul><ul><ul><li>Infertility :1 in 8 become infertile </li></ul></ul><ul><ul><li>ectopic pregnancy </li></ul></ul><ul><ul><li>abscess formation </li></ul></ul><ul><ul><li>chronic pelvic pain. </li></ul></ul><ul><ul><li>Death </li></ul></ul>PID
  • 10. Consequences of PID <ul><li>Peritonitis </li></ul><ul><li>Adhesions  ileus – Intestional Obstruction </li></ul><ul><li>Bacteremia  sepsis </li></ul><ul><li>Endocarditis </li></ul><ul><li>Meningitis </li></ul><ul><li>Arthritis </li></ul>PID
  • 11. Pelvic Inflammatory Disease with Tubo-Ovarian Complexes Copyright © 1999 by W. B. Saunders Company All rights reserved. Produced in the United States of America ISBN: 0-7216-8462-9
  • 12. PID - Gonorrhea <ul><li>Still the Number One! </li></ul><ul><li>Transmission exclusively by sexual contact </li></ul><ul><li>Adult vagina  more resistant </li></ul><ul><li>Immature vagina  extremely susceptible  immature epithelium </li></ul><ul><li>Begins in vestibular glands </li></ul><ul><li>Ascending spread </li></ul><ul><li>Less obvious in female than male </li></ul>PID
  • 13. &nbsp;
  • 14. PID - Gonorrhea <ul><li>Acute suppurative inflammation </li></ul><ul><li>Confined mainly to superficial layers </li></ul><ul><li>Ascending spread </li></ul><ul><ul><li>Acute salpingitis </li></ul></ul><ul><ul><li>Salpingo-oophoritis </li></ul></ul><ul><ul><li>Tubo-ovarian abscess </li></ul></ul><ul><ul><li>Pyosalpinx </li></ul></ul>PID
  • 15. Gonorrhea PID Acute purulent inflammation
  • 16. Tubo-ovarian Abscess PID
  • 17. Gonorrhea Clinical Course <ul><li>ABX – Ceftriaxone DOC </li></ul><ul><li>Early diagnosis  imperative </li></ul><ul><li>Usually  chronic resistant condition due to inappropriate treatment </li></ul><ul><li>Substantial cause of sick-days </li></ul>PID
  • 18. Gonococcal Inflammation <ul><li>Usually begins in Bartholin / Vestibular / Periurethral Glands </li></ul><ul><li>Cervix involvement common </li></ul><ul><li>Often Asymptomatic </li></ul><ul><li>Ascending Spread to include </li></ul><ul><ul><li>Fallopian Tubes </li></ul></ul><ul><ul><li>Tubo Ovarian Region </li></ul></ul><ul><ul><li>Adults More Resistant than Children </li></ul></ul>PID
  • 19. Gonorrhea Complications <ul><li>Intratubal adhesions </li></ul><ul><ul><li>Follicular inflammation </li></ul></ul><ul><ul><li>Glandular inflammation </li></ul></ul><ul><li>Infection subsides </li></ul><ul><ul><li>Hydrosalpinx </li></ul></ul><ul><ul><li>Obliteration  extrauterine gravidity </li></ul></ul><ul><ul><li>Sterility </li></ul></ul><ul><li>Rare chronic gonorrhea </li></ul><ul><ul><li>Purulent arthritis  metastasis </li></ul></ul>PID
  • 20. Gonoccoccal Morphology <ul><li>Inflammatory Changes Occur 2 to 7 Days post exposure </li></ul><ul><li>Largely Confined to Superficial Mucosa and Underlying Submucosa </li></ul><ul><li>Culture Required to Confirm </li></ul><ul><li>Smear will show G- Diplococcus </li></ul><ul><li>Endometrium Usually Spared in Spread </li></ul>PID
  • 21. Gonoccoccal Morphology <ul><li>Tubal Involvement causes Acute Suppurative Salpingitis – filling with a purulent exudate </li></ul><ul><li>In days to weeks the Fimbriae may become Sealed to the Ovary resulting in Salpingo-OOphoritis </li></ul><ul><li>Tubo-Ovarian Abcess </li></ul><ul><li>Pyosalpinx ( Tubal Lumen Abcess) </li></ul>PID
  • 22. Chlamydia: Chlamydia trachomatis <ul><li>L1-L3 immunotype </li></ul><ul><ul><li>Lymphogranuloma Venereum </li></ul></ul><ul><ul><ul><li>Complications </li></ul></ul></ul><ul><ul><ul><ul><li>Perirectal abscess </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Perianal Fistula </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Women develop fistula between vagina and rectum </li></ul></ul></ul></ul>PID
  • 23. Chlamydia: Facts <ul><li>1 in 20 teenage girls and women </li></ul><ul><li>&gt; 2 % of the general population infected </li></ul><ul><li>2003, 877,478 cases of chlamydia were reported in the United States, making it the most commonly reported STI </li></ul>PID
  • 24. Chlamydia: Chlamydia trachomatis <ul><li>L1-L3 immunotype </li></ul><ul><ul><li>Lymphogranuloma Venereum </li></ul></ul><ul><ul><ul><li>Sexually transmitted infection </li></ul></ul></ul><ul><ul><ul><li>Rare in the United States </li></ul></ul></ul><ul><ul><ul><li>Lab </li></ul></ul></ul><ul><ul><ul><ul><li>Culture </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Biopsy the node aspirate </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Complement titer &gt; 1:64 </li></ul></ul></ul></ul>PID
  • 25. Chlamydia: Chlamydia trachomatis <ul><li>L1-L3 immunotype </li></ul><ul><ul><li>Lymphogranuloma Venereum </li></ul></ul><ul><ul><ul><li>Symptoms </li></ul></ul></ul><ul><ul><ul><li>Fever </li></ul></ul></ul><ul><ul><ul><li>Chills </li></ul></ul></ul><ul><ul><ul><li>Headache </li></ul></ul></ul><ul><ul><ul><li>Myalgias </li></ul></ul></ul><ul><ul><ul><li>Arthralgia </li></ul></ul></ul>PID
  • 26. Chlamydia: Chlamydia trachomatis <ul><li>L1-L3 immunotype </li></ul><ul><ul><li>Lymphogranuloma Venereum </li></ul></ul><ul><ul><ul><li>Tetracycline [contraindicated in pregnancy] </li></ul></ul></ul><ul><ul><ul><li>Erythromycin [DOC in pregnancy] </li></ul></ul></ul><ul><ul><ul><li>Abx Tx for 21 days </li></ul></ul></ul>PID
  • 27. Chlamydia: Chlamydia trachomatis <ul><li>L1-L3 immunotype </li></ul><ul><ul><li>Lymphogranuloma Venereum </li></ul></ul><ul><ul><ul><ul><li>Genital Lesions- Usually small painless vesicle that disappears quickly and often goes unnoticed </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Rectal lesion or inflammation of the rectum [proctitis] </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Inguinal syndrome </li></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Painful Inguinal Lymphadenopathy </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Most often unilateral </li></ul></ul></ul></ul></ul>PID
  • 28. Chlamydia: Chlamydia trachomatis <ul><li>D-K immunotype </li></ul><ul><ul><li>Cervicitis – </li></ul></ul><ul><ul><ul><li>Vaginal discharge ay be profuse/ odor </li></ul></ul></ul><ul><ul><ul><li>persistent </li></ul></ul></ul><ul><ul><ul><li>gray, white or yellow color </li></ul></ul></ul><ul><ul><ul><li>Abnormal vaginal bleeding </li></ul></ul></ul><ul><ul><ul><ul><li>after intercourse </li></ul></ul></ul></ul><ul><ul><ul><ul><li>between periods </li></ul></ul></ul></ul><ul><ul><ul><li>A sense of pelvic pressure </li></ul></ul></ul><ul><ul><ul><li>Painful sexual intercourse </li></ul></ul></ul>PID
  • 29. Chlamydia: Chlamydia trachomatis <ul><li>D-K immunotype </li></ul><ul><li>Complications </li></ul><ul><ul><li>Pelvic inflammatory disease [PID] </li></ul></ul><ul><ul><li>Infertility </li></ul></ul><ul><ul><li>Salpingitis – inflammation of the fallopian tubes </li></ul></ul><ul><ul><li>Preterm labor </li></ul></ul><ul><ul><li>Transmission to newborn via the birth canal </li></ul></ul><ul><ul><ul><li>Chlamydia conjunctivitis </li></ul></ul></ul><ul><ul><ul><li>Neonatal pneumonia </li></ul></ul></ul>PID
  • 30. Chlamydia: Chlamydia trachomatis <ul><li>D-K immunotype </li></ul><ul><ul><li>Symptoms in Women </li></ul></ul><ul><ul><ul><li>Cervicitis </li></ul></ul></ul><ul><ul><ul><li>Vaginal discharge </li></ul></ul></ul><ul><ul><ul><li>Pelvic pain </li></ul></ul></ul><ul><ul><ul><li>Untreated may persist for months </li></ul></ul></ul><ul><ul><ul><li>Usually asymptomatic Urethritis </li></ul></ul></ul><ul><ul><ul><li>Persistent dsyuria </li></ul></ul></ul>PID
  • 31. <ul><li>D-K immunotype </li></ul><ul><ul><li>Lab </li></ul></ul><ul><ul><ul><li>Chlamydia culture </li></ul></ul></ul><ul><ul><ul><ul><li>Not routinely performed </li></ul></ul></ul></ul><ul><ul><li>Ligase chain reaction </li></ul></ul><ul><ul><li>Urinalysis test </li></ul></ul>Chlamydia: Chlamydia trachomatis PID
  • 32. Chlamydia: Chlamydia trachomatis <ul><li>D-K immunotype </li></ul><ul><li>Pneumonia in a newborn due to chlamydial infection is most likely acquired during the passage through the birth canal at vaginal delivery </li></ul>PID
  • 33. Chlamydia: Chlamydia trachomatis <ul><li>D-K immunotype </li></ul><ul><li>Newborn pneumonia </li></ul><ul><ul><li>Appears 2-12 weeks after birth </li></ul></ul><ul><ul><li>Most common cause of neonatal pneumonia </li></ul></ul><ul><ul><li>Characterized by a staccato cough </li></ul></ul><ul><ul><li>Usually no fever </li></ul></ul><ul><ul><li>Tachypnea [rapid breathing] </li></ul></ul>PID
  • 34. PID and Douche Frequency <ul><li>Women who douche once or twice a month may be more likely to have PID than those who douche less than once a month. </li></ul><ul><li>Douching may push bacteria into the upper genital tract. </li></ul><ul><li>Douching also may ease discharge caused by an infection, so the woman delays seeking health care </li></ul>PID
  • 35. PID - Contraception <ul><li>Depo Provera Appears to Increase Risk for Chlamydial and Gonococcal Infections </li></ul><ul><li>Women using DMPA had approximately 3½ times the risk of developing a chlamydia or gonorrhea infection than did women who were not using a hormonal contraceptive. </li></ul>PID
  • 36. Bibliography <ul><li>G:Pathology slidesWebPathRobbins </li></ul><ul><li>http://pathcuric1.swmed.edu/ </li></ul><ul><li>http://www.nlm.nih.gov/medlineplus/news/fullstory_25750.htm </li></ul><ul><li>http://www.nih.gov/news/pr/aug2004/nichd-23.htm </li></ul><ul><li>http://www.ashastd.org/advocacy/wompos.html </li></ul><ul><li>http://www.niaid.nih.gov/factsheets/stdpid.htm </li></ul>PID

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