Pelvic Inflammatory Disease

Age: ‍ years old

Gender: female



HISTORY:

Presents with a ‍-‍day history of ‍lower abdominal painpelvic painvaginal discharge

Symptoms include:

‍lower abdominal pain

‍pelvic pain

‍vaginal discharge, ‍clear, ‍thin, ‍withwithout fishy odor

‍fever, up to ‍°, over ‍ ‍hoursdays

‍chills

‍irregular menstrual bleeding

‍painful intercourse

‍painful urination

‍nausea

‍vomiting, ‍ episodes ‍per day, ‍, ‍hematemesis

‍changes in bowel movements



Worsening factors: ‍none

Alleviating factors: ‍none, ‍effectiveineffective



Contributing factors:

‍unprotected sex

‍multiple sexual partners

‍recent IUD insertion

no history of: ‍sexually transmitted infections, ‍previous episodes of PID, ‍endometriosis, ‍ovarian cyst, ‍ectopic pregnancy

no use of: ‍recent antibiotics, ‍contraceptives, ‍hormone replacement therapy





EXAM:

General appearance: ‍well-appearing, ‍apparent distress

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

Neck: ‍normal, ‍lymphadenopathy, ‍, c-spine ‍

Heart: ‍RRR, ‍MRG, ‍normal S1 and S2

Lungs: ‍clear bilaterally, ‍abnormal sounds, ‍retractions

Abdomen: ‍soft, ‍non-tender ‍, ‍non-distended, ‍guarding, bowel sounds ‍normal, ‍, ‍CVA tenderness ‍

Anorectal: DRE ‍normal, ‍blood, ‍mass, anus ‍

Pelvic:

- External genitalia: ‍normal, ‍rashlesions, ‍inguinal lymphadenopathy

- Vagina: ‍normal, ‍lesions, discharge ‍normal, ‍foul-smelling

- Cervix: ‍normal, ‍, ‍IUD strings visualized

- Bimanual exam: ‍normal, uterus ‍tendernessmass, adnexa ‍tendernessmass ‍on righton left, ‍cervical motion tenderness

- Tests performed: ‍Pap smearHPV test, ‍vaginal culturechlamydia/gonorrhea screeningHSV sample, pH ‍< 4.5 (normal)> 4.5, KOH sniff test ‍negative

- ‍Pelvic exam performed with chaperone 





ASSESSMENT:

‍Pelvic inflammatory disease ‍likelysuspectedpossible

DDx: pelvic inflammatory disease, tubo-ovarian abscess, chlamydia, gonorrhea, ectopic pregnancy, ovarian cyst rupture, ovarian torsion, endometriosis, uterine fibroids, urinary tract infection, functional pelvic pain, miscarriage, irritable bowel syndrome, inflammatory bowel disease, diverticulitis, constipation, appendicitis, interstitial cystitis, kidney stones, inguinal hernia, colorectal cancer, chronic pelvic pain syndrome





PLAN:

Investigations:

- Blood work: ‍CBC, ‍electrolytes, ‍creatinine, ‍CRP, ‍ESR

- Urinalysis

- Urine culture

- Pelvic ultrasound

Treatments:

- ‍Antibiotics

- ‍Analgesics

- Sexual partners treatment

- Abstinence until treatment completed and symptoms resolved

- Counseling on condom use

- Consider IUD removal in some cases

Further care:

- Referral to gynecologist

- Referral to infectious disease specialist

- Follow-up in ‍ ‍daysweeks

- Return if symptoms worsen or if new symptoms develop such as fever, vomiting, or increased pain