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8.09 Pelvic Inflammatory Disease


Presentation

A woman aged 15-30, possibly with a new sex partner, complains of lower abdominal pain. There may be associated vaginal discharge, malodor, dysuria, dyspareunia, menorrhagia or intermenstrual bleeding. Patients with more severe infections may develop fever, chills, malaise, nausea and vomiting. Women with severe pelvic pain tend to walk slightly bent over, holding their lower abdomen and shuffling their feet. Abdominal examination reveals lower quadrant tenderness, sometimes with rebound, and occasionally there will be right upper quadrant tenderness due to perihepatitis (Fitz-Hugh-Curtis syndrome). Pelvic examination demonstrates bilateral adnexal tenderness as well a uterine fundal and cervical motion tenderness.

What to do:

What not to do:

Discussion

Pelvic inflammatory disease (PID) is defined as salpingitis, often accompanied by endometritis or secondary pelvic peritonitis, that results from ascending genital infection. PID related to N. gonorrhoeae and C. trachomatis is more common within the first one or two weeks after the onset of menstuation. There is increased risk for this disease in sexually active adolescents compared with women over twenty years old. There is also increased risk with multiple sex partners, use of an interuterine device (IUD), previous history of PID and vaginal douching. The incubation period for PID varies from 1-2 days to weeks or months. Laparoscopy is indicated in severe cases, if diagnosis is uncertain or if there is inadequate response to initial antibiotic therapy. A diagnosis of PID in children or young adolescents should prompt an evaluation for possible child abuse.

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from Buttaravoli & Stair: COMMON SIMPLE EMERGENCIES
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