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Learning medicine is hard work! Osmosis makes it easy. It takes your lectures and notes to create
a personalized study plan with exclusive videos, practice questions and flashcards, and so
much more. Try it free today! Pelvic inflammatory disease, or PID, is an
infection of the upper female reproductive system, including the uterus, fallopian tubes,
and ovaries. It can cause a number of serious complications,
including infertility. The female reproductive system includes all
of internal and external organs that help with reproduction. The internal sex organs are the ovaries, which
are the female gonads, the fallopian tubes, two muscular tubes that connect the ovaries
to the uterus, and the uterus, which is the strong muscular sack that a fetus can develop
in. The neck of the uterus is called the cervix,
and it protrudes into the vagina. At the opening of the vagina are the external
sex organs, and these are usually just called the genitals and they’re in the vulva region.They
include the labia, the clitoris, and the mons pubis. The vagina, uterus, and fallopian tubes all
have a mucosa, which is a layer of epithelial cells that lines the inside of these organs. PID usually develops from a bacterial infection
in the vagina or cervix which causes inflammation of this mucosal layer. About 60 percent of the time, this changes
the composition of the bacterial flora in the vagina, also called bacterial vaginosis. Because the reproductive tract is essentially
one long tunnel that starts at the ovaries and ends at the external sex organs, the infection
can travel up the tract pretty easily. Some mechanisms can make it even easier! For example, the cervical mucus, which normally
acts as a barrier preventing bacteria from entering the uterus, may become less effective. The mucus can become thinner as a result of
normal variations throughout the menstrual cycle, or alternatively, it can become less
effective in the context of bacterial vaginosis, which is when the normal balance of the vaginal
flora is altered, and anaerobic bacteria proliferate and degrade the cervical mucus. Other factors contributing to an infection
may be retrograde menstruation, which is when menstrual blood flows back through the fallopian
tubes and into the pelvic cavity instead of out of the body, and also sexual intercourse. Now, PID is most problematic when the infection
reaches the fallopian tubes, in which case it’s called salpingitis. If it also affects the ovaries, it’s called
salpingo-oophoritis. The infection triggers a response from the
body, which sends in neutrophils, plasma cells, and lymphocytes into the fallopian tubes. That sounds like a good thing, right? But this actually damages the tubal epithelium
and the tubes become filled with pus. When scar tissue forms to repair the damage,
areas with damaged epithelium tend to stick to one another, creating closed-off pockets
and little dead-end pouches in the fallopian tubes. This scarring in the fallopian tubes can lead
to a number of complications related to PID. If pus builds up in the tube and ovary, it
can turn into an tubo-ovarian abscess, which can be life-threatening if it ruptures. If a watery fluid builds up in a pocket created
by scar tissue in the tubes, this is called hydrosalpinx and it can cause the affected
area to become swollen. In general, because of the structural damage
it causes in the fallopian tubes, individuals who have had PID tend to have more difficulty
getting pregnant, and have a higher risk for ectopic pregnancy and chronic pelvic pain. One last complication is Fitz-Hugh-Curtis
syndrome, which occurs when the inflammation from PID spreads to the peritoneum, and, from
there, to Glisson’s capsule, which surrounds the liver. This results in “violin string” adhesions,
or thin strings of scar tissue that attach the liver to the peritoneum. There are many different bacteria that are
associated with PID, but the most common are Neisseria gonorrhoeae and Chlamydia trachomatis,
which are responsible for the sexually transmitted infections gonorrhea and chlamydia, respectively. Occasionally, PID can be caused by other forms
of bacteria introduced in the reproductive tract by surgery, abortion, or even normal
vaginal childbirth. Most of the time the infection is caused only
by one type of bacteria but in about 30-40% of cases it becomes polymicrobial. Essentially, the original infection makes
it easier for other bacteria to settle into the reproductive tract. Because of the relationship with chlamydia
and gonorrhea infections, sexually active females, particularly those who have multiple
sexual partners and do not use condoms, are most at risk of developing PID. Some women will have few or no symptoms of
PID. When there are noticeable symptoms, they include
pelvic pain, tenderness around the ovaries and fallopian tubes, fever, and abnormal vaginal
discharge. Diagnosis of PID is usually based on clinical
findings – particularly pelvic pain and cervical motion tenderness, which is when mobilizing
the cervix during a vaginal exam causes pain or discomfort. Tenderness in the right upper quadrant of
the abdomen is also common if Fitz-Hugh-Curtis syndrome has developed. There’s no specific test for PID, but there
are some that can support the diagnosis, like testing vaginal discharge for signs of bacterial
vaginosis, doing a nucleic acid amplification test to look for chlamydia and gonorrhea DNA
in a sample taken from the inside of the vagina or cervix, or doing a laparoscopy of the fallopian
tubes. An ultrasound can show if there is fluid in
the fallopian tubes, and whether a tubo-ovarian abscess or hydrosalpinx is present. Treatment involves giving a mix of antibiotics,
usually an injection of ceftriaxone or cefotetan followed by 14 days of oral doxycycline and
metronidazole, to treat the bacterial infection responsible for PID. Acetaminophen can be given to manage the pain
until the antibiotics have treated the infection. Occasionally, surgery will be done to remove
adhesions that are causing pain or to treat complications of PID, such as tubo-ovarian
abscesses and hydrosalpinx. All right, as a quick recap… Pelvic inflammatory disease is an infection
of the upper female reproductive system. It caused inflammation of the mucous membrane
of the inner reproductive tract, which damages the epithelium and results in scarring and
adhesions, particularly in the fallopian tubes. It is usually caused by Neisseria gonorrhoeae
and Chlamydia trachomatis, which are the bacteria responsible for chlamydia and gonorrhea. Complications include infertility, ectopic
pregnancies, and tubo-ovarian abscesses.

12 thoughts on “Pelvic inflammatory disease – causes, symptoms, diagnosis, treatment, pathology

  1. PID is one of the most common causes of inflammation and discomfort in women! Good to spread this knowledge 😏👍

  2. Sir previously in YouTube all your videos was classified according to the subject now we couldn't able to see that can u pls make all ur videos as category wise if u do that I will be very helpful for us thank you
    Osmosis team great job

  3. Is it possible for a woman to have PID even though it was about a year since her last sex, and what may be the other causes of PID if sex is excluded and abortion, i have a friend who had this no child and single and wondering the cause

  4. One of my nephews had a Paget's disease in his genitals and was afraid & embarrassed to disclose it to his parents, but being of almost my age he confessed his trouble with me. I took him to various hospitals, but all proved to be useless and his condition was further deteriorating. One day while watching YouTube on my mobile, I saw a person who got healed from Planet Ayurveda by Dr. Vikram Chauhan. I took out his whats-app no: (+91) 842-786-4030 and placed the order for a cure that came very soon. A diet chart also came along asking to be followed sincerely. He did follow the prescriptions and after about 6,7 months he was an absolutely fine body. A big THANKS!!!

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