Case presentation

1. Diwakar Chudal
4th year student.
Bachelor of pharmacy
Maharajgunj medical campus, IOM

2. Mrs Tamang
25 years
Married
Hindu
Housewife
Nuwakot

3.  Lower abdominal pain for 7 days
 Foul smelling vaginal discharge for 7 days
 Fever for 4 days

4. Following MVA done for incomplete abortion 2
weeks back
 Lower abdominal pain for 1 week, more in
suprapubic region, continuous, non radiating
 Vaginal discharge- foul smelling, greyish
white
 Fever- high grade, continuous, maximum
recorded upto 103 F

5. Menstrual history
 K-14 yrs ,4-5/28-32 days, Regular
Dysmennorhoea -ve
 Dyspareunia -ve
 Post coital bleeding -ve
 Intermenstrual bleeding -ve

6. Obstetrics history
 Married for 2 years
 Had spontantanous miscarriage 2 weeks back
which was incomplete, underwent MVA
Contraceptive history
 None

7. Past history
 No any significant medical and surgical
history
Family history
 No h/o HTN ,DM,PTB

8. Personal history
 Non smoker
 Non alcoholic
 Mixed diet
 Sleep
 Appetite
Drug and allergy history
none

9. General condition –ill looking
Pallor -ve
Icterus –ve
Cyanosis -ve
No lymphadenopathy
Edema -ve

10. Vitals
 Pulse 110/min regular
 BP 100/70 mm of Hg
 Temp-102 F
 RR 18/min

11. Per abdomen
 Soft, tenderness present in suprapubic region
Per speculum
 Cervix – Nulliparous
 Normal looking
 foul smelling Discharge present

12. Per vaginum
 Uterus normal size
 Cervical motion tenderness present

13.  Hb-12.2gm/dl
 TC-20900/mm3
 Platelet-404000/mm3
 RFT-normal

14. Diagnosis :
Pelvic inflammatory disease
Management :
Admission
Cap doxylene 100mg p/o BD 14 days
INJ metron 500mg ivTDS
Tab Niko 500 mg p/oTDS

15.  Patient afebrile after 2 days
 Discharged on oral antibiotics

16. Pelvic inflammatory disease (PID)
A general term used to refer to infection and
inflammation of the upper genital
tract in women

17.  Neisseria gonorrhoeae is a common cause
 Most cases are the result of a polymicrobial
infection
 Ascending infection from the vagina and
cervix to infect the lining of the endometrium
and fallopian tube

18.  85% of cases are natural, noniatrogenic
occurring infections in sexually active women of
reproductive age.
 The remaining 15% of infections occur after
procedures that break the cervical mucous
barrier, such as placement of an intrauterine
device(IUD), endometrial biopsy, or uterine
curettage, which allow vaginal flora to infect the
upper genital tract