Pelvic inflammatory disease by Dr.Shuchita chattree

1. PELVIC INFLAMMATORY DISEASES
And Its Therapeutics
By: Dr. SHUCHITA CHATTREE
M.D (PGR)
Department of Materia Medica
Homoeopathy University, Jaipur
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2. UTERUS AND APPENDAGES
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3. Defination:
Pelvic Inflammatory Disease refers to the inflammation of
Upper Genital Tract involving fallopian tubes as well as
ovaries.
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4. EPIDEMIOLOGY:
A crude marker of PID in
developing countries can be
obtained from the reported
hospital admission rates .
It accounts for 3-10% in India
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5. Estimates of the annual incidence of PID
according to W.H.O.:
Between 9.5 to 14 cases per
1,000 fertile women, with a
higher rate of 18 to 20 per
1,000 among women aged
15 to 24 years.
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6. Etiology:
• Post Abortal and Peuperal Sepsis.
• Hysterosalpingiography can cause ascending infection.
• Manual Removal of Plecenta and evacuation of products of
conceptions.
• Use of IUCD has increase the risk of pelvic infection by three folds.
• Pelvic peritonitis due to appendicitis and diverticulitis may spread to
involve fallopian tube of that side.
• Tuberculosis is blood borne in most of the cases.
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7. Risk Factors:
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8. 11/09/14 8

9. The most common etiologic agents in PID
are:
• Neisseria gonorrhoeae
• Chlamydia trachomatis
• Anaerobic bacterial species found in the vagina, particularly
Bacteroides
• Anaerobic gram-positive cocci, ( Peptostre-ptococci),
• E.coli
• Mycoplasma hominis and M.urealyticum.
NOTE:
• These organisms initially cause lower genital tract infections and then
spread in to the genital tract via the endometrium.
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10. Note:
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11. PID History & Examination:
• Abdominal pain (usually bilateral and in
the lower quadrants),
• [Abnormal] Vaginal discharge,
• Fever, and/or chills Nausea or vomiting
• Dysuria,
• Menometrorrhagia,
• Onset of pain in association with menses,
• Dyspareunia
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12. • Backache
• General malaise
• Loss of appetite
• Tachycardia
• Tongue coated (shows dehydration)
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13. EXAMINATION:
•Abdominal Examination
•Speculum Examination
•Bimanual Examination
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15. Investigations of PID:
• Haemoglobin count may be low
• Leucocyte count raised (>10,000 percumm)
• Erythrocyte sedimentation rate (ESR) raised
• C-reactive protein is increased to 20 to 30 mg/dl or
more.
• Culture of cervical and high vaginal swab for both
aerobic and anaerobic organisms.
• If gonorrhoea is suspected urethral swab culture.
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16. • Direct Chlamydial smear enzyme immunoassay and
direct immunofluorescence examination of the
smear.
• If bacteraemia sets in-Blood culture.
• Blood urea serum electrolytes
• Serological test for syphilis should be carried out for
both partners.
• Culdocentesis - To rule out an ectopic pregnancy
and to establish the diagnosis of a pelvic abscess.
• Laproscopic examination-The pus extruding from
the fimbrial end adhesions are sure signs of PID.
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17. • Ultrasound– It is of limited value. It is helpful in distinguishing
an adenexal abscess.
• C T scan
• MRI – does not give more specific information than USG and
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is expensive
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18. CT SCAN:
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19. LAPROSCOPIC VIEW:
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20. LAPROSCOPIC VIEW:
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21. CULDOCENTESIS:
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22. Diagnosis of Acute PID – CDC Criteria:
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• Cervical motion tenderness and uterine and adnexal
tenderness, along with WBCs seen on vaginal wet mount.
• Additional supportive criteria to increase the specificity:
• Oral temperature higher than 101ºF (38.3ºC).
• Abnormal cervical or vaginal mucopurulent discharge.
• Elevated erythrocyte sedimentation rate.
• Elevated C-reactive protein level.
• Laboratory documentation of cervical infection with
N.gonorrhoeae or C trachomatis
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23. Chronic PID: History and Examination:
23
• Symptoms suggestive of chronic PID
include:
• History of previous pelvic infection.
• Constant lower abdominal pain which
get worse before menses.
• Low backache.
• Dyspareunia.
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24. • Vaginal discharge may be absent.
• Menorrhagoea.
• Polymenorrhoea
• Congestive dysmenorrhea.
• Infertility.
• Rectal irritation.
• Poor general health.
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25. PELVIC EXAMINATION:
• Appendages are found to
be tender, thickened and
fixed.
• At times the uterus and
appendages are densely
adherent to each other and
a fixed hard mass along
with pelvic cellulitis-known
as “Frozen pelvis”.
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26. PID: Postmenopausal Women:
• Exact mechanism unclear.
• Direct extension from
adjacent viscera.
• Uterine instrumentation
• Structural abnormalities
(stenosis, polyps, etc)
• “Forgotten” IUD.
• Degenerating Myomas.
• Postmenopausal vaginal
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27. Presenting symptoms include:
•Vaginal spotting,
•Bleeding,
•Pain,
•Fever,
•Nausea,
•Change in bowel habits
•Majority have tubo-ovarian abscess – USG or CT
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28. Sequelae of Pelvic Inflammatory Disease
• Reported sequelae occurs in
up to 25% of cases:
• Infertility (12% to 50%)
• Ectopic Pregnancy (6 to 10
fold increase)
• Chronic pelvic pains (18%)
• Psychological disorders
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30. Differential Diagnosis
Acute PID
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33. ACUTE APPENDICITIS:
Pain is initially central around the umbilicus and then radiate to Rt.iliac
fossa.
The sequence of symptoms,viz. pain, vomiting and temperature (Murphy’s
syndrome).
Vomiting severe and fever is less ( cf. PID ).Tenderness at McBurney’s point.
Vaginal discharge and menstrual irregularities absent.
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34. Differential Diagnosis
Chronic PID
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37. MMiiaassmmaattiicc
AAnnaallyyssiiss
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38. The most frequent location of the sycotic manifestations in
women is in the pelvic organs.
Pelvic inflammations such as oophoritis, salpingitis; in fact,all
the inflammatory disease of the female pelvis may be traced
to this taint.
In the more chronic types we get cystic degeneration of the
ovaries, the uterus and the fallopian tubes.
Syphilitic miasm seldom attacks the ovaries or uterus.
(The principles and art of cure by homoeopathy – Herbert A .
Robert )
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39. • Sycosis is generally understood to be the gonorrhoeal poison.
We should make the distinction clear between gonorrhoea &
sycosis.
•Gonorrhoea is the acute infection of the gonococci, which
takes from 5 to 10 days to develop a urethritis after an
exposure. During this incubation period it is purely an
infection; then the local manifestations are thrown outward
by nature at the point of attack as a resentment of the vital
energy to the infection.
• If the gonorrhoea thoroughly & completely cured, practically
no sycosis ever develops.
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40. Sycosis is established after a suppressed gonorrhoea, when
the acute infection is driven in upon the vital energy by
external methods of suppression, and it then become a
systematic stigma.
PID = Sycotic manifestation
(The principles and art of cure by homoeopathy – H.A.Roberts)
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44. 44
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45. 45
ACONITE:
Ovaries congested and painful , sharp shooting pain in uterus.
Fever with dry, hot skin and burning thirst for large quantities
of cold water.
Cold stage most marked , sweat >
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46. APIS MELIFICA:
46
Ovaritis worse in rt. Ovary , endometritis with soreness &
burning , stinging pain suddenly migrating from one part to
another.
Incontinence of urine with great irritation of the parts.
Thirstless except during chill stage before fever
Pt. Is hasty ,awkward, drops thing while handling. Indifferent &
weeping tendency.
<warm&heated room , >cold water,open air , uncovering.
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47. ARSENIC ALBUM:
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 Burning pain in ovarian region, stitching pain in pelvis extending down
the thigh.
 Leucorrhoea acrid , burning ,offensive and thin , causes great fatigue.<
least exertion >warm room.
 Burning thirst without special desire to drink, takes little quantity of cold
water often, just to moisten dry mouth.
 High fever with marked exhaustion, mental restlessness and fear of
death. Pt. thinks it is useless to take medicine with aversion to meet
people.
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48. AURUM MURIATICUM
NATRONATUM:
Useful in chronic PID ,Chronic metritis & prolapse.
Uterus fills up whole pelvis, ulceration of neck of womb &
vagina, cervix & ovaries indurated, ossified uterus.
Leucorrhoea with spasmodic contraction of vagina.
Young girls with palpitation
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49. BELADONNA:
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 Acute inflammatory condition.
 Cervical mucous membrane is very congested and red.
 Pressing downwards as if the contents of abdomen would issue from the
vulva > standing and sitting erect worse morning.
 Dryness and heat of vagina .
 Menses bright red, too early, too profuse and HOT and offensive.
 Fever with burning heat and without thirst.
 Superficial blood vessels distended.
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50. CALCAREA CARBONICA:
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 Leucophlegmatic constitution &tendency to obesity.
 Useful in pelvic abscess, tendency to form abscess in deep muscles , uterus
easily displaced. Before menses- headache,colic ,chilliness ,
leucorrhoea(milky). breast tender & swollen .
 During menses cutting pain in uterus.
 Menses too early,too profuse,too long with vertigo, toothache & cold,
damp feet.
 The least mental excitement causes profuse return of menses.
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51. MEDORRHINUM:
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For women with chronic ovaritis, salpingitis , pelvic cellulitis,
fibroids, cysts, post menopausal PID.
Pelvic abscess as a result of STDs or due to septic abortion.
Adhesions of the surrounding organs , tendency to outgrowth
and malignant changesOvarian pain worse lt. side or from
ovary to ovary. Infertility.
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52. 52
Menses offensive, profuse, dark, clotted, stains difficult to wash
out. Metrorrhagia .Intense dysmenorrhoea. Leucorrhoea thin,
acrid excoriating, fishy odour.
Sycotic warts on genital, burning palms & soles , ravenous
hunger immediately after eating with constant thirst.
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53. MERCURIUS SOLUBILIS:
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Chronic cervicitis & ovaritis, suppressed STDs.
Stinging pain in ovaries, sensation of rawness in parts.
Menses profuse with abdominal pain. Leucorrhoea excoriating,
greenish & bloody.
Sweetish metallic taste , profuse salivation, tongue large ,flabby
,shows imprint of teeth , intense thirst with moist mouth.
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54. PLATINA:
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Intense vaginismus with chronic cervicitis.
Platina lady is prone to get recurrent urogenital infections
resulting in oophoritis, salpingitis & endometritis resulting in
sterility.
Sexual organs exceedingly sensitive, cannot bear the napkin to
touch her, will go in to spasm from an examination, vulva
painfully sensitive during coitus, will faint during coitus
nymphomania, excessive sexual development.
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55. SABINA:
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Inflammation of ovaries or uterus after abortion, premature
labor . Pt. – tendency to miscarriages,esp. at 3rd month.
Haemorrhage from the uterus; flow partly pale red, partly
clotted;worse from least motion > by walking ,pain extending
from sacrum to pubes.
Menses – too early, too profuse, too protracted in women who
menstruated very early in life; flow in paroxysms ;with colic &
labor like pain . Menorrhagia - during climacteric.
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56. MUREX PURPUREA:
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Useful in post menopausal PID, chronic Endometritis with
displacement in nervous, lively, affectionate women.
Sore pain in uterus; a distinct sensation of a womb.
Bearing down sensation,as if internal organs would be pushed
out, must sit down & cross limbs to> pressure.
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57. 57
Menses : irregular, early profuse, protracted, large clots.
Leucorrhoea : green or blood , happier when leucorrhoea is
worse.
Nymphomania; least contact of parts,causes violent sexual
excitement.
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58. OTHER IMPORTANT MEDICINES:
Pulsatilla
Sepia
 Lachesis
Cimicifuga
 Kreosotum
 Lilium tigrinum
 Trillium
 Pyrogen
 Bryonia , etc .
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60. Synthesis rep.9.0
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FEMALE GENITALIA/SEX - PELVIC
inflammatory disease: sep.
-

61. Murphy’s Repertory
Diseases - PELVIC inflammatory disease, uterus
Acon. Agn. alum. APIS Arn. ARS. Aur-m. Aur. BELL. Bry. bufo Cact.
calc. CANTH. Carb-an. carbn-s. caul. Cham. chin. cocc. Coff. coloc.
con. croc. ferr-ar. ferr. graph. Ham. Hep. hydr. Hyos. hyper. ign. Iod. ip.
iris kali-c. kali-p. kreos. LAC-C. LACH. LYC. Lyss. mag-m. MED.
Merc. Nux-v. op. ph-ac. Phos. PULS. Rhus-t. Sabad. SABIN. SEC.
Sep. Sil. Stram. Sulph. TER. thuj. Verat-v. Verat. vib. visc.
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-.

62. Murphy’s Repertory
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Diseases - PELVIC inflammatory disease, uterus - acute
Acon. ant-i. Apis arn. Ars. Bell. Bry. canth. cham. chin. Cimic. con.
Gels. hep. hyos. Iod. kali-c. kali-i. lach. lil-t. Mel-c-s. Merc-c. nux-v. op.
ph-ac. plat. Puls. rhus-t. Sabin. Sec. Sep. Sil. stram. sulph. ter. til.
Verat-v.

63. Murphy’s Repertory
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Diseases - PELVIC inflammatory disease, uterus - chronic
alet. aloe Ars. Aur-m-n. Aur-m. borx. Calc. carb-ac. caul. chinin-ar.
Cimic. Con. graph. Helon. Hydr. hydrc. inul. Iod. Kali-bi. kali-c. kali-s.
kreos. lach. Mag-m. Mel-c-s. merc. Murx. nat-m. nit-ac. Nux-v. Ph-ac.
phos. plb. Puls. rhus-t. Sabin. Sec. Sep. sil. stram. Sulph. visc.
-Murphy’s Repertory.

64. MMuurrpphhyy’’ss RReeppeerrttoorryy
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 Diseases - PELVIC inflammatory disease, uterus -
bleeding, after: ars. Chin. ham. led. phos. Sec. Thlas.
 Diseases - PELVIC inflammatory disease, uterus -
chronic - congestion, with arterial: bell. lil-t. Sabin.
 Diseases - PELVIC inflammatory disease, uterus -
chronic – follicular: Hydr. hydrc. iod. merc.

65. Kent’s Repertory
 FEMALE GENITALIA - INFLAMMATION - Uterus - emotional
excitement, from:Hyos.
 FEMALE GENITALIA - INFLAMMATION - Uterus - anger,
after:Cham.
 FEMALE GENITALIA - INFLAMMATION - Uterus -haemorrhage,
after: Chin.
 FEMALE GENITALIA - INFLAMMATION - Uterus - indignation,
from: Coloc.
 FEMALE GENITALIA - INFLAMMATION - Uterus joy,
excessive:Coff.
 FEMALE GENITALIA - INFLAMMATION - Uterus - labor, after Nux-v.
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66. References:
Homoeopathic materia medica and repertory- W. Boericke.
Allen`s key notes.
Gynaecology & obstetric therapeutics – Dr. Shrikant Kulkarni.
Shaw`s textbook of Gynaecology.

67. Miasmatic diagnosis – Dr. S K Banerjee.
The principles and art of cure by homoeopathy- Herbert A .Robert
 http://www.cdc.gov.
http://4women.gov.
http://www.familydoctor.org.
Synthesis Repertory9.0 Edition.
Murphy Repertory.
Kent Repertory.

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