Pelvic inflammatory disease ppt

BY MEENAKSHI KAUSHIK, PGIMS, ROHTAK.

1. PELVIC INFLAMMATORY DISEASE.

2. DEFINITION-- Pelvic inflammatory disease(PID) is an inflammatory condition of the pelvic cavity that may involve the uterus ,fallopian tubes, ovaries, pelvic peritoneum, or pelvis vascular system. Infecetion which may be acute , subacute, recurrent,or chronic and localized or widespread, is usually caused by— Bacteria. Virus. fungus or parasites.

3. Contd.... Organism most commonly associated are.. GONORRHEAL. CHLAMYDIAL. MYCOPLASMA.

4. INCIDENCE RATE-- About 1 million women are diagnosed with PID each year in U.S. Most are younger than 25 years of age. One fourth of them have serious sequelae e.g..infertility, ectopic pregnancy. Rupture of tubo ovarian abscess has a 5% to 10% mortality rate. Many of them need a total hystrectomy.

5. CAUSE’S The exact cause is not determined. It is presumed that organisms usually enter the body through the vagina, and move upword through the cervical canal, colonize the endocervix, and move upward into uterus. This all usually occurs after- Childbirth. Abortion. Surgical procedures. Sexually transmitted. IUD insertion. Endometrial biopsy.

6. RISK FACTOR’S-- Early age at first intercourse. Multiple sexual partner’s. Frequent intercourse. Sex with a partner with an STD. History of STD and previous pelvic infection.

7. Pathophysiology- In PID organisms usually ascends from lower tract to upper side , this commonly occurs during pregnancy, becuse there is increased blood supply to the organs. These post partum and post abortion infectiontend to be unilateral. Infection can cause perihepatic inflammation when the organisms invades the peritoneum. In gonorrheal infection, the gonococci pass through the cervical canal into the uterus especially during menstruation, when the environment is favourable.

8. Cont.. In rare cases the infection spread through the blood stream from the lungs.

9. Clinical manifestation- Vaginal discharge. Lower abdominal, pelvic pain and tenderness that occurs after menses. Pain usually increase during voiding or defecation. Others are –fever, general malaise, anorexia. Nausea , headache, possibly vomiting. Symptoms may be actue or severe.

10. DIAGNOSIS- History taking. Physical examination of gyanecological importance(it reveals tenderness on palpation and movement of cervix and uterus) Blood culture. Sonography.

11. MANAGEMENT- Patient’s with mild infection are treated in out patient department but hospitalization may be necessary in some cases. Bed rest. Intravenous fluids. Broad spectrum iv antibiotic are started. If patient has abdominal distension than nasogastric intubation and suction are intiated. Treatment of sexual partner is also needed.

12. NURSING MANAGEMENT- Monitoring vital signs. Maintaing bed rest and fowler’s position during hospital stay. Note amount and characterstics of vaginal discharge. Health education regarding safe sex and on personal hygiene.

13. OVARIAN CYST The ovary is a common site for cysts, which may be simple, enlargementof normal ovarian constituents, the graffine follicle, or corpuse lutem, or they may arise from abnormal growth of the ovarian epithelium. Cysts are usually soft, surrounded by thin capsule, and are seen mainly duringthe reproductive age.

14. TYPES OF OVARIAN CYSTS:- Follicular ovarian cysts. Corpus luteum cysts. Dermoid cysts. Serous tumours. Endometrial tumours.

15. Corpus luteum cyst.:-- Less common variety. Associated with normal ovarian fx.or elevated progesterone. Avg. Diameter 4cm. May appear purplish red due to bleeding within corpus luteum. Mennorrhagia is common. Follicular ovarian cysts:-- These are most common form of cyst. Frequently multiple, range in size from a few mm to as large as 15cm in diameter. Depend on gonadotropine for growth.

16. Dermoid cysts:-- These are tumors that are thought to arise from parts of the ovum that normally disappear with ripening. Their origin is unidentified, and they consists of undifferentiated embryonal cells. They grow slowly and found during surgery to contain a thick yellow sebaceous material arising from skin material. Hair ,teeth, bone may found inside the cysts.

17. Endometroid tumors:-- Small lesion , purplish blue in color. Large tumors are called CHOCOLATE CYSTS, because they contain chocolate color clots. Very loe malignancy potential.

18. CAUSES:--

19. CLINICAL MANIFESTATION Ovarian cysts are often asymptomatic until they are large enough to cause pressure in the pelvis, constipation, menstrual irregularities, urinary frequency. A feeling of fullness in the abdomen. Anorexia and peripheral edema. Pelvic pain. More severe in twisted ovarian cysts.

20. DIAGNOSIS:-- History of chronic pelvic pain . Other causes are excluded. Palpation of pelvic organs during examination reveals the presence of any mass or enlargement of ovary. Increase in abdominal girth in case of large tumour. Ultrasonography. CT SCAN.

21. MANAGEMENT:-- Many ovarian cysts resolve spontaneously . If the cyst does not decrease in size oral contraceptive are prescribed to shrink the cysts. SURGICAL MANAGEMENT:-- Surgery is recommended only when the cysts are larger than 8cm. A cystectomy rather than oopherectomy is performed.

22. NNURSING MANAGEMENT Assurance. Education regarding disease process. All routine post operative care. Advise to use abdominal binder after surgery. Follow up care.

23. OVARIAN CANCER

24. OVARIAN CANCER Ovarian cancer is very distressing disease to patients and health care provider because of its silent feature it came in diagnosis usually in later stages. It causes more death then any other cancer of female reproductive system disorder.About 75% cases detected in later stage. Malignant neoplasma of ovary can occur at any age, including infancy and childhood. Most frequent in women between 55 to 65 years of age. Higher incidence in industrialised countries excepts JAPAN.

25. Cusative factors:-- Exact etiology is not know but several risk factors are there to dispose women to ovarian cancer these are following:-- Hereditary Endocrine Industrialized exposure Women having BRCA-1 GENE mutation have higher chances. Exposure to talk , asbestos, diet high in meat and animal fats and high milk consumption all these linked to ovarian cancer. Nulliparity,infertility, anovulation.

26. FAVOURABLE FACTORS:-- Breast feeding. Multiple pregnancies. Oral contraceptive use. Early age at first birth.

27. Women with ovarian cancer has a three fold to four fold increase in risk for breast cancer or vice versa. No early screening mechanism pressent till now.

28. PATHOPHYSIOLOGY:-- The four main type of ovarian cancer are:-- Epithelium; serous, mucinous. Germ cell: Gonadal stroma Mesenchyma. They are having two pattern of metastasis; lymphatic and direct. Primary lymphatic drainage of the ovary is thought the retroperitoneal nodes surroundin the renalilium. Secondry drainage is through the inguinal lymphatics.ovarian cancer directly metastasizes to the abdominal cavity.

29. STAGES:-- STAGE 1 Limited to ovaries. STAGE 2 Involving one or both ovary with pelvic extension. STAGE 3 Involving one or both ovary with intraperitoneal metastasis outside pelvis or positive lymph nodes. STAGE 4 Involving one or both ovaries with distinct metastasis to liver or lungs.

30. CLINICAL MANIFESTATION Usually it is asymptomatics. In later stage Pelvic discomfort, lower back pain, breast tenderness Weight change , abdominal pain, gastroesophageal reflux. Nausea vomiting, constipation and urinary frequency. Increase in abdominal girth. Bowel and bladder dysfunction, dysparenuia Menstrual irregularties. Ascites , abnormal uterine bleeding.

31. Diagnosis:-- Clinical history. Physical examination. USG & TVS. MRI. CT SCAN. Laparotomy Tumor marker. CA 125. Screeing for BRCA 1,2

32. TREATMENT:-- SURGERY;-- surgery is the primary therapeutic approach and usually involves TAH BSO.Ascites fluids or washing are submitted for cytology. All the tissue of pelvis are carefully observed and sent for cytology. ADJUVANT THERAPY:-- STAGE 1 ST :--CHEMOTHERAPHY. STAGE 2 ND :--INSTILLATION OF RADIOACTIVE PHOSPHORUS into the peritoneal cavity or combined chemotheraphy. STAGE 3 RD :--SURGICAL REMOVAL OF TUMOR.

33. PHARAMOCOLIGICAL MX. CHEMOTHERAPHY:-- cyclophosphomide cisplatin carbop lastin PACLITAXEL

34. NURSING AMNAGEMENT-- Emotional support to the patient. Comfort measures. Imaprting information. Pre operative management— Bowel preparation. Interavenous fluid support. Pre operative medicines.