PID

It is an inflammation of upper genital tract involving the fallopion tubes as well as the ovaries.

ATIOLOGY:
1. Sexually transmitted disease: gonococcal n chlamydial infection r most common. They traval with motile sperm in piggy back fashion n reach fallopion tubes n causes salpingo oopharitus.
2. Other organism causing PID
 ¡. Mycoplasm
 ¡¡. E. Coli
 ¡¡¡. Viruses
 ¡V. Tubesculi bacili
3. Post obortal n puerpural sepsis
4. Minor operative procedure like D/C n hysterosalpigogram manual removal of placenta n evacuation of products of conception.
5. Introduction of IUCD incidence of PID
6. Pelvic peritonits
7. Tuberculosis is blood borne.

-it is disease of sexuly active women, reproductively active n frequent changes of sexul parters is cause in devloped countries.
-In developing countries puerperal sepsis n septic obortions are imp. Cause.

PATHOLOGY
1. Acute salpingitis: fallopion tube is swollen, odematous n hxeramic wit visible,dilated vessles on the peritonial surface.
-dicharge of seropurulunt fluid from the fimbrial end of the tube.
-mucous memb. Is edematous wit infiltration of the leucocyte n plasma cells.
2. In ascending inf. Like gonorrohea.
-mucous memb. 1st to get invove.
-inflamatory exudate is discharge into lumen wich drain at ampullary end.
-ulceration lead to adhesion n tubal blockge or narrowing of lumen.
-pus in the pelvic cavity through fimbrial end causes pelivic abscess.
-wall of the tube is thickend n tense.
3. PID Following post bact. n puepural inf.
-inf. Spread through cervix via lymphatics to cellur tissue in the broad lig. Couses cellulitis.
-wall is thickended.

STAGING
1. stage ¡: Acute salpingitis witout peritonitis
2 stage ¡¡:Acute salpingitis with peritonitis
3 stage ¡¡¡: Acute salpingitis with superimposed tubal oclusion or tubo ovarian complex.
4 stage ¡v :rupture tubo ovarian abscess
5 stage v: tubercular salpingitis.

SYMPOTMS
Young, sexully active women is prone to PID
1 ABODMINAL PAIN which ir bilatral, rertricted to lower abdomen sever in acute stage with fever
2 dysuria
3 vagimal discharge
4 uterine bleeding
5 fever, diarrhoea in case of pelvic abscess.

SINGS
1 high temp n toxic look
2 tachycardia
3 tongue shows sings of dehydration
4 abdo. Distended, tender
5 speculun exm^ shows purulen discharge
6 cervicl movement r tender
7 pelvic abscess- floctuating tender swelling in pouch of douglus.

D/D
1 acute appendisits- temp. Is not high as in PID., no vaginal discharge, irregularities in mc
2 ectopic gastation-vaginal discharge, leucocytosis, rised esr is absent.
3 diverticulosis
4 twist overian cyst-pyrexia abscent. Vaginal discharge abscent.
5 rupture endometral cyst
6 septic abortion.

INVESTIGATION
1 Hb, Tcl, ESR
2 Cervical n high vaginal swab culture.
3 blood culture
5 blood urea n serum electolytes
6 culdountrsis
7 USG, CT, MRI

TREATMENT
1 MILD treat at home wit antibiotics.
2 MODERATE-SEVER -hospitalization
-medical treatment with antibiotics
tetracycline 500mg q.i.d x 10days
doxycline 100mg b.d x 10days
erxthromycin 500mg q.i.d x 7 days

-SURGICAL
minimal invasive surgery includes
1 laproscopic drainage of tubo ovrian absbess
2 ultrasound guided aspiration of pelvic absess
3 precutaneous absesr drainge

COMPLICATIONS
1 recurrence
2 chronic PID
3 Tubal blockege
4 pelvic pain

CHRONIC PID
failure of acute pelvic infection to resolve result in chronic tubovarian masses. Thes manifaest in the form of
  hydrosalpinx
  chronic pyosalpinx
  chronic interstitiaj salpingitis
  tuboovaria cyst
  tuberculous form
SYMPOTMS
1 Constant low abdominal pain which worse before mc
2 vaginal discharge may absent
3 menorrhagia, polymenorrhagia, n congestive dymenorrhoea.
4 infertility may due to blockage of fallopian tube.
5 rectal irritation
SINGS
1 in pelvic exam^ shows apendages r found to b tender, thickended n fixed
2 uterus n appendages are densely adhernt to echa other.
D/D
1 ectopic gestation
2 uterine firoboids
3pelvic endometiosis
4 ovarian tumour
5 tubercular tubo ovarian mass
 TREATMENT
IT need surgicl treatment
1 in young women conservativi surgery in form of salpingectomy n salpingo oophorectomy is performed.
2 in extensive damage abdominal hysterectomy wit bilatral salpingo oopherectomy is needed.
3 tuboplasty it require in tubal blockage. Laparoscopic breaking of external adhesion either by laser or electrocoutery is indicated if the tubal blocge is due to ext. Adhesions.
Hystoscopic balloonoplasty.