pelvic inflammatory disease is the infectious disease in the female upper genital organ and its causes discomfort to the patient and knowledge of this ppt can help the patients and nurses to know the disease process well and can apply this knowledge into their clinical practices

1. PELVIC INFLAMMATORY DISEASE
DEPARTMENT
OF
MEDICAL SURGICAL NURSING

2. LEARNING OBJECTIVE
At the end of this lecture, students should be able
to:
define PID
enlist the causes of PID
discuss the pathophysiology of PID
list down the clinical manifestation and
investigation of PID
discuss the complication and treatment of PID

3. DEFINITION
• Pelvic inflammatory disease is a spectrum of
infection and inflammation of the upper genital
tract organs
• typically involving the Endometrium, fallopian
tubes, ovaries, pelvic peritoneum and
surrounding structures.

5. CAUSES
Contracep
tive
practices
Microbial
infection
Risk factors

6. • Many types of bacteria can cause PID, but gonorrhea or
chlamydia infections are the most common.
• unprotected sex.
• Child birth, miscarriage, abortion
• Being a sexually active woman younger than 25 years
old
• Having multiple sexual partners
• Being in a sexual relationship with a person who has
more than one sex partner
• Douching regularly, which upsets the balance of good
versus harmful bacteria in the vagina and might mask
symptoms
• Having a history of pelvic inflammatory disease or a
sexually transmitted infection

7. PATHOPHYSIOLOGY
• The involvement of the tubes is almost
bilateral
• The pathogical process is initiated primarily in
the endosalpinx.
• There is gross destruction of the epithelial
cells, cilia and microvilli.

8. • In severe infection, it invades all the layers of
the tube and produces acute inflammatory
reaction, becomes edematous and hyperemic.
• Closure of both the ostia results - the exudates
inside the tube.

9. • The exudates pours through the abdominal
ostum to produce pelvic peritonitis
• and pelvic abscess or may affects the ovary
producing ovarian abscess.
• Thus a tube ovarian abscess.

10. CLINICAL FEATURES
SYMPTOMS
• Bilateral lower abdominal and pelvic pain
• Fever, lassitude(mental and physical wearing, lack
of energy), headache
• Irregular and excessive vaginal bleeding
• Abnormal vaginal discharge

11. • Nausea and vomiting.
• Dyspareunia - difficulty or painful intercourse
• Pain and discomfort in the right
hypochondrium.

12. CLINICAL FEATURES
• SIGNS
• Temperature – 38.30 c
• Tenderness on both quadrants of lower
abdomen
• Liver enlarged and tender.
• Vaginal examination reveals

13. • Abnormal vaginal discharge – purulent.
• Congested external urethral meatus
• Bimanual examination reveals
- bilateral tenderness on fornix palpation
- thickening or a definite mass felt through the
fornices.

14. INVESTIGATIONS
IDENTIFICATION OF ORGANISMS
• Discharge from the urethra or Bartholin’s gland
• Cervical canal
• Collected pus from the fallopian tubes during
laparoscopy or laparotomy

15. BLOOD
• Leukocyte count -10,000 per cu mm and
• an elevated ESR value of more than 15mm per
hour.
• Serological test

16. LAPAROSCOPIC FINDINGS AND SEVERITY OF PID
• Hyperaemia and edema of the tubes
• Purulent exudates from the fimbrial ends
SONOGRAPHY
• Dilated and fluid- filled tubes,
• fluid in the pouch of Douglas or
• adnexal mass are suggestive of PID

17. COMPLICATIONS
IMMEDIATE
• Pelvic peritonitis or generalized peritonitis
• Septicaemia – producing arthritis or myocarditis
LATE
• Dyspareunia
• Infertility
• Chronic pelvic inflammation

18. TREATMENT
Essential Steps In The Prevention
• Community based approach
• Prevention of sexually transmitted disease
• Liberal use of contraceptives
• Routines screening of high-risk population

19. The Principles of Therapy
• To control the infection energetically
• To prevent infertility and late sequelae.
• To prevent reinfection
• Out Patient Therapy
• Antibiotic therapy

20. IN- PATIENT THERAPY
• Hospitalization for antibiotic therapy
• Bed rest
• oral feeding is restricted
• Dehydration and acidosis - to be corrected

21. In patient antibiotic therapy
• Cefoxitin 2mg IV 4 times a day for 2-4 days
• Gentamycin 2 mg / kg IV ( loading dose )
following by 1.5 mg / kg IV (maintenance dose)
every 8 hours.
• Metronidazole 500 mg IV every 8 hours.

22. Indication Of Surgery
• Generalized peritonitis
• Pelvic abscess
• Tubo- ovarian abscess

23. Summary
So far we have discussed about definition,
causes, pathophysiology, clinical
manifestations, investigations, complications
and managements of PID.

24. Bibliography
• Lewis et al, Medical Surgical Nursing, Mosby
Elsevier,7th edition.
• Joyce.M.Black et al, Medical Surgical Nursing,
Saunders publication.
• Brunner and Siddhartha, Medical Surgical
Nursing, Lippincott Williams and Wilkins.

25. Thank You