PID - DIFFERENTIAL DIAGNOSIS FOR MEDICAL STUDENTS.pptx

PID - DIFFERENTIAL DIAGNOSIS

1. A PRACTICAL APPROACH ON PELVIC INFLAMMATORY DISEASE PRESENTED BY DR. A. T. AHAMED MOHIDEEN M.D. (HOM) PAEDIATRICS PART - I

2. HOW THEY PRESENT? Bilateral lower abdominal or pelvic pain – dull in nature. Sudden onset of pain – N. gonorrhea Associated with Pain in right hypochondrium – liver is involved – Fitz Hugh Syndrome Fever, lassitude, headache . Irregular, excessive vaginal bleeding Abnormal vaginal discharge – copious or purulent Nausea and vomiting Dyspareunia Diarrhoea of loose stools with rectal irritation – Pelvic abscess Clinical Features of Acute PID

3. In case of chronic, it presents as: Constant lower abdominal pain Backache Dypareunia Menstrual abnormalities Infertility Rectal irritation

4. Who are prone to get this disease? Menstruating females Multiple sexual partners Absence of contraceptive pills History of previous infection IUCD users Due to increased STD prevalence RISK FACTORS

5. Who can’t get this condition? People using contraceptive measures Female having Male partner who had done vasectomy Pregnant ladies Post menopausal women Females who are not menstruating If husband has azoospermia

6. How it is prevented normally? Hymen Acidity of vaginal secretion Narrow cervical canal with mucous plug Downward ciliary movement of endometrial and cervical lining

7. Ailments from? After – abortion - menstruation - delivery After insertion of IUCD After an operative intervention

8. Why it happens? Cervical canal widens Shedding of endothelium of endometrium Raw surface of uterine cavity Vaginal pH becomes alkaline

9. Now, what is actually PID? It is the Inflammation of Upper Genital Tract including Uterus, fallopian tubes and ovaries. Usually bilateral, sometimes may be unilateral It always occurs as a result of ascending infection Since it fails to pinpoint organs it is better to call individually as Salpingitis , Oophoritis , Endometritis . Cervicitis is not included in this condition Its incidence has increased due to increased sexual activity, failure of contraceptive methods and invasive procedures

10. What causes PID? Primarily by Organisms like Neisseria gonorrhea, Chlamydia trachomatis , Mycoplasma hominis Secondarily by aerobics such as E.coli , Group B streptococcus, staphylococcus Anaerobics like bacteroides , fragilis , peptococcus

11. What happens in this condition?

12. What are the Findings? Vitals -Temperature – more than 38⁰C, Tachycardia, Tachypnoea Abdominal Exam – tenderness on palpating both lower quadrants of abdomen Vaginal exam – abnormal vaginal discharge, congested external urethral meatus Speculum exam – congested cervix Bimanual palpation – bilateral tenderness on fornix

13. Laboratory Findings Identification of organisms through culture Blood – leucoctyosis . Neutrophilia in acute, lymphocytosis in chronic. ESR is increased. C Reactive Protein is increased Laparoscopy – violin string like adhesion in pelvis – indicates Chlamydia infection Culdocentesis – pelvic infiltration Sonography – limited value. Fluid filled tubes in Douglas Pouch, Adnexal Mass

14. DIAGNOSTIC CRITERIAS: Increased Temperature Lower abdominal Tenderness Tenderness on movement of cervix Adnexal Mass in USG Blood report, laparoscopy.

15. What could be other possibilities? Acute appendicitis – location of pain, vomiting is increased . Temperature is not so high Ectopic Pregnancy – Pain is Unilateral. Temperature is not high. Pregnancy test is positive . Signs of internal hemorrhage is present Twisted Ovarian Tumor – sudden pain , vomiting. No fever Ruptured Ovarian Cyst – acute pain with no fever and no discharge Septic Abortion – history of Amenorrhea Degenerative fibroids – looks similar if it adheres to pelvic organs

16. General Management Education about preventive measures Antibiotics Surgery in case of peritonitis, pelvic abscess, tubo ovarian abscess Prevention of further infection

17. THANK YOU FOR YOUR PATIENT LISTENING AND OBSERVING