Pelvic Inflammatory Disease
Pelvic inflammatory disease (PID) is an umbrella term that refers to any acute, subacute, recurrent, or chronic infection of the oviducts and ovaries, with adjacent tissue involvement. It includes inflammation of the cervix (cervicitis), uterus (endometritis), fallopian tubes (salpingitis), and ovaries (oophoritis), which can extend to the connective tissue lying between the broad ligaments (parametritis).
About 60% of cases result from overgrowth of one or more of the common bacterial species found in the cervical mucus. Early diagnosis and treatment help prevent damage to the reproductive system, as does well-planned nursing care. Untreated PID may be fatal.
Pelvic Inflammatory Disease is caused by a bacterial infection that moves from the lower genital tract, which consists of the vagina and cervix. It then moves into the uterus, up the fallopian tubes and finally, into the ovaries. The bacterial infection causes inflammation of the tissues, leaving them red and swollen.
Several organisms can cause Pelvic Inflammatory Disease. In most cases, it is caused by chlamydia or gonorrhea, two very common sexual transmitted diseases. However, other kinds of bacteria and bacterial infections, such as bacterial vaginosis, anaerobes, enteric gram-negative rods and streptocci, can be associated with Pelvic Inflammatory Disease.
Signs and Symptoms
The patient with PID may complain of profuse, purulent vaginal discharge, sometimes accompanied by low-grade fever and malaise (particularly if gonorrhea is the cause). She may also describe lower abdominal pain and vaginal bleeding. Vaginal examination may reveal pain during movement of the cervix or palpation of the adnexa.
Gram stain of secretions from the endocervix or culde-sac indicates the causative agent.
Culture and sensitivity testing aids selection of the appropriate antibiotic. Urethral and rectal secretions may also be cultured.
C-reactive protein, a blood test to detect inflammation, is highly sensitive for detecting PID and aids diagnosis.
Ultrasonography, computed tomography scanning, and magnetic resonance imaging may help to identify and locate an adnexal or uterine mass.
Culdocentesis is used to obtain peritoneal fluid or - pus for culture and sensitivity testing.
Diagnostic laparoscopy is used to identify fluid in the cul-de-sac, tubal distention, and masses in pelvic abscess and is indicated if the diagnosis is uncertain or if the patient is unresponsive to therapy.
Differential diagnosis should rule out ectopic pregnancy, ruptured corpus lutein cyst, pyelonephritis, appendicitis, endometriosis, adrenal mass tension, or leiomyoma degeneration.
To prevent progression of PID, antibiotic therapy begins immediately after culture specimens are obtained. Such therapy can be reevaluated as soon as laboratory results are available (usually after 24 to 48 hours). Infection may become chronic if treated inadequately.
The Centers for Disease Control and Prevention recommends inpatient antibiotic therapy for PID. This includes doxycycline alone or a combination of clindamycin and gentamicin. Outpatient therapy consists of a single dose of cefoxitin given concurrently with probenecid or a single dose of ceftriaxone. Each of these regimens is given with doxycycline.
Supplemental treatment for patients with PID may include bed rest, analgesics, and I.V. fluids as needed.
Development of a pelvic abscess necessitates adequate drainage. A ruptured pelvic abscess is a life-threatening condition. If this complication develops, the patient may need a total abdominal hysterectomy with bilateral salpingo-oophorectomy.
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