Pelvic Inflammatory Disease A case study at the Port Moresby General Hospital

1. Pelvic inflammatory disease:
Case study level1
Level 1 Satellite Pharmacy: Case
presentation#1
Presenter: Heni Oala (Pharmacy Intern)
Preceptor: Omega Manua

2. Outline
• Identification of the patient
• Summary of significant findings:
– History
– Investigation
• Summary of Management
• Learning issue
• Conclusion

3. Identification of patient
• Patient name: SG
• Medical record number: 313801
• Age: 47/F
• Nationality: Papua New Guinea
• Marital status: Married
• Date of admission: 26th June 2018 to W:2A

4. Summary of significant findings
History
• SW had a Laparatomy for PID: 2015
• 2 abcess formed on abdomen post surgery:
– Infra umbilical
– Supra umbilical

5. Summary of significant findings
Investigation
• FBC values w/i normal ranges
• Lipid tests
• Lipid
Ur Cr Na K Cl
5.1 125 147 N/A 116
Chol Trig HDLC LDL VLDL
5.3 3.09 0.77 3.14 1.41

6. Summary of significant findings
Investigation
• BP elevated: 180-200/ 90-102
• Heart Rate elevated: 55 bpm

7. Summary of Management
1. Enalapril 5mg ‘o’ daily1/12
2. Review on 4th July 2018
3. Non- Pharmacological management
• < fatty foods & high cholesterol foods
• More fruits and vegetables
• Light exercise- walking
• Rest

8. Learning Issue
Pelvic Inflammatory Disease

9. Learning Issue: PID
• Inflammation of female pelvic structures
• Ascending spread of infection →cervix →
uterus →fallopian tubes →ovaries
→peritoneum
• Infection of Upper genital tract
• Not infection in vagina or vulva

10. Learning Issue: PID
Brinsweek, M (2015)

11. Learning Issue: Types of PID
• Acute
– Patient generalised symptoms
– Lasts for a few days
– May recur in episodes
– Infectious
• Chronic
– Patient may show no symptoms
– >months/years
– Progressive damage to organs

12. Learning issue: Prevalence of PID
• 1 in 8 women are infected Worldwide
• Common cause of menstrual problems
• Chronic damage causes infertility
• Predisposition to ectopic pregnancy
• Affect baby during birth
– Eye infections
– Lung infections

13. Learning Issue: Cause of PID
• 85%-95% specifically sexually transmitted
organisms
– N. Gonorrhoea
– C. Trachomatis
– others. Mycoplasma
• 5-15% after reproductive tract damage
– Pregnancy
– Surgical procedures
– IUD insertions
• <1% Blood borne spread after TB

14. Learning issue: Risk factors
• Age of 1st intercourse/ frequency of
intercourse
• Number of sexual partners/ contact
• Cultural practices
– Polygamy
– Prostitutes
– Attitudes towards pregnancy and menstruation
• IUCD
• Exposure to antibiotics

15. Learning issue: Diagnosis of PID
• Patient is High risk when there is:
– Lower abdominal pain
– Fever
– Mucopurulent discharge from cervix
– Pelvic tenderness
– Vomiting (in severe)
• Tests
– ↑ WCC
– Ultrasound
– Laparoscopy

16. Learning issue: Differential Diagnosis
• Endometriosis
• Appendicicitis
• Ectopic pregnancy (6-10 fold↑ risk)
• UTI or stone
• Ovarian cysts
• Lower genital tract infections

17. Learning Issue: Treatment
• Antibiotics
– Appropriate needs based on spectrum of activity
– Specific/ broad spectrum
– Issue of patient compliance
– Route of administration (oral/parenteral)
• Surgical
– Draining abscess
• Rest

18. Learning Issue: Treatment of PID
• Mild
– Amoxicillin 500mg TDS oral for 5 days
– Metronidazole 400mg TDS/ Tinidazole 1g BD x
2days
– Doxycycline BD for 10 days
• Sexual Partner to be prescribed regime
• Severe
– IV normal saline, pethidine/codeine/paracetamol
– CMP 1g IV →PO QID for 7 days

19. Learning Issue: Treatment of PID
– Metronidazole 500mg supp. or ‘O’ for 7
day/Tinidazole 1g for 3 days
– Followed by 10 days Doxycycline 100g BD or
Azithromycin 1g stat
• Partners
– Doxycycline 100mg bd for 10 days (Azithromycin
1g stat)
– Tinidazole 2g stat

20. Learning Issue: Treatment of PID
• Chronic cases
– Antibiotics as for Mild cases
– Referral to SMO

21. Learning Issue: Prevention of PID
• Screening and treating disease: Id & prompt
treatment
• Sexual health counselling
• Improving education and status of women
• Progestin-based contraception
– Depo provera
• Barrier contraceptives
• Sexual abstinence

22. Conclusion
• SW presented with Abscesses after
laparotomy due to PID: 2015
• PID affects affects 1in 8 women in PNG
• Early identification and Prevention of PID
• Treatment includes antibiotics, surgical, rest
and NSAIDs: patient information on the
disease

23. References
• Fauci AS, Kasper DL, Longo DL, Braunwald E, Hauser SL, Jameson JL.
2008. Harrisons Principles of Internal Medicine, McGraw Hill, New York 16th
Edition
• Walker R, Whittlsea C.2012. Clincial Pharmacy and therapeutics, Churchill
livingston, Elsevier. New York. 5th Edition
• Australian Medicines Handbook, Computer program. 2010 Version.
Pharmaceutica Society of Australia
• Beale JM, Block JH. Wilson and Gisvolds textbook of Organic medicinal and
pharmaceutical chemistry. 12e. Lippincott, William and Wilkins. 2011. New
York
• Brinsmead M, 2015. Pelvic Inflammatory Disease (PID). Seminar
presentation.
• Editor Dr. Glen Mola. Manual of standard management in Obstetrics and
Gynaecology for Doctors, H.E.Os and nurses in Papua New Guinea. 2010.
6th Edition. National Department of Health