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V An infection of

j terus (
Endometritis)
j Cervix (Cervicitis)
j Fallopian tubes
( Salpingitis)
j Ovaries (oophoritis),
j Pelvic peritonitis
j Tubo-ovarian
abscess
V A common and serious complication of
STDs (Sexual Transmitted Diseases)
V Typically, women have pain in the lower
abdomen, a vaginal discharge, and
irregular vaginal bleeding.
V îost common cause of PID is bacterial
invasion
Ê Chlamydia trachomatis

Ê Neisseria gonorrhoea
Ê tends to sudden and severe symptoms,
Ê high fever and abdominal pain ¯acute PID 
acteria move upward from vagina or
cervix into reproductive organs.
V Age < 25 are more likely to develop PID
than those older
V îore sex partners
V Partner has more than one sex partner
V Who do not use a barrier contraceptive
V Douching regularly
V ID
V Who have a sexually transmitted disease or
bacterial vaginosis
V Lower socioeconomic status
V lower abdomen pain, may worse when move
V pain during or after sex
V bleeding between periods or after sex
V lower back pain
V sense of pressure or swelling in the lower abdomen
V fever (often with chills)
V feeling tired or unwell
V abnormal vaginal discharge
V nausea, vomiting and dizziness
V leg pain
V increased period pain
V increased pain at ovulation
V dysuria, frequently urination
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V Æ

  
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V Perihepatic adhesions
( Fitz-Hugh-Curtis syndrome)
V Perihepatic adhesions ¯arrow usually associated
with pelvic gonorrhoeal or chlamydial infection
¯FitzHughCurtis syndrome 
V Appendicitis
V Gastroenteritis
V Cholecystitis
V Irritable bowel syndrome
V Ectopic pregnancy
V Hemorrhagic ovarian cyst
V Ovarian torsion
V Endometriosis
V Nephrolithiasis
V Somatization
Symptoms alone are not a good predictor , and clinical diagnosis alone is
difficult
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V histopathologic evidence of endometritis
on endometrial biopsy
V transvaginal sonography or other
imaging techniques showing thickened
fluid-filled tubes with or without free
pelvic fluid or tubo-ovarian complex
V laparoscopic abnormalities consistent
with PID
V   3    
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V Laboratory may be entirely normal
V An elevated leukocyte count does not distinguish
PID from other diagnoses
V Cervical cultures for gonorrhea or Chlamydia
require 3-7 days for results
V HIV and syphilis testing should be recommended
V Pelvic ultrasonography can detect pelvic
abscesses
V Laparoscopy when the diagnosis is unclear or
when the patient fails to improve.
V surgical emergencies (e.g., appendicitis)
cannot be excluded
V is pregnant
V does not respond to oral antimicrobial
therapy
V unable to tolerate an outpatient oral
regimen
V has severe illness, nausea and vomiting, or
high fever
V has a tubo-ovarian abscess.
V Support patient nutritionally and
administer antibiotic therapy as
prescribed
V Note vital signs, nature and amount of
vaginal discharge
V Prevent transmission of infection to others
by impeccable use of universal
precaution and hospital guidelines for
disposing of contaminated articles
V Inform patient that IDs may increase risk
for infection
V se proper perineal care, wiping from front
to back
V Avoid douching, which can reduce natural
flora
V Consult with health care provider if unusual
vaginal discharge or odor is noted
V Have a gynecological exam at least once
a year
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V ¦upture abscess invade to peritonium
V Failure medical treatment 48-72 hr
V Abscess does not go away after 2-3
week with persistent abdominal pain
V îale sex partners of women with PID
should be examined and treated
V îale partners of women who have PID
caused by " 
and/or 
  frequently are
asymptomatic.