Pelvic Inflammatory Disease

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i) What causes PID and what happens to the body when someone gets it?

Pelvic Inflammatory Disease (PID) occurs when an infection of the cervix, or to a lesser extent the vagina progresses into the upper genital tract, PRODIGY (2005). Warell (2003) defines an infection as an invasion of the body by harmful organisms (or pathogens) such as bacteria, fungi, protozoa or viruses. In the case of PID the two most common causes of the initial infection are the bacterium Chlamydia Trachomatis or Neisseria Gonnorhoeae. These two bacteria are most commonly referred to as the sexually transmitted infections (STIs) chlamydia and gonnorhea and are commonly passed through unprotected vaginal intercourse. Both infections present similarly, as inflammations of the cervix and urethra with the associated symptoms of pain on urination and vaginal discharge. Some infected women however experience no symptoms (Caroline, 2008). Prodigy (2005) discusses how cervical mucus provides a relative barrier to the spread of the pathogens and the associated infections, but virulent microbes can traverse cervical mucus, which in any case, is lost during menses. Other factors that may influence the spread of bacteria up the genital tract are, pregnancy terminations and the complications arising from dilatation and currettage. Wyatt (2003), discusses, in reference to PID, how once an infection spreads beyond the cervix it can present in various regions of the genital tract: uterus (endometritis), fallopian tubes (salpingitis), ovaries (oophoritis), peritoneum (peritonitis). The assocaited infections/inflammations can cause various symptoms: Pelvic or lower abdominal pain. Dyspareunia (pain during or after intercourse) Turbo-ovarian abscesses Abnormal vaginal discharge Pelvic peritonitis Perihepatitis (inflammation of the peritoneum attached to the liver) The severity ranges from chronic low grade infection (with relatively mild symptoms) to acute infection (with severe symptoms) which may result in abscess formation. Salpingitis, or infection of the Fallopian tubes, is a particularly significant feature of PID because of the long term effects after PID including infertility, ectopic pregnancy and pelvic pain. 10% of women develop tubal infertility after a single episode, 20% after a second and 40% after three episodes (Prodigy, 2005). In summary PID is a collective term that encompasses a variety of infections of the upper female genital tract.

ii) what investigations are considered at hospital and what medications might be prescribed?

Warrell (2003), states that there is no symptom, clinical sign, or labratory result that is is pathognomonic (exclusive/unique) in the testing and subsequent diagnosis of PID. The hospital will therefore use a variety of investigations to rule out the likelihood of other diagnosis and allow the most appropriate treatment for cases of suspected PID. Wyatt (2003), advises Accident and Emergency (A&E) staff to first consider whether a patient is presenting with any signs/symptoms of shock. If the infection has progressed and there are indications of sceptic or hypovalaemic shock such as tachycardia, pyrexia and assocaited blood pressure abnormalities then the initial treatment is to raise the patient’s legs, resuscitate with IV fluids and immediately begin IV broad spectrum antibiotics. Sanders (2006) advises other routine tests to help with the differential dianosis for PID which include; appendicitis, endometriosis, ovarian cysts, ectopic pregnancy, other STIs, HIV, urinary tract infection. These tests include: Urinalysis which can to help diagnose and/or rule out the presence of a UTI. A vaginal swab picks up a sample of cells from the vagina which are usually sent to a laboratory for testing. A full blood count (FBC) tests the levels of red cells, white cells and platelets. Abnormalities in these readings can help differentiate between the presence of bacterial or viral infections and/or parasitic/fungal infections. Blood...
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