INTRODUCTION
Pelvic inflammatory disease [PID] is a bacterial infection of the female upper genital tract , including the womb, fallopian tubes and ovaries. Pelvic inflammatory disease is considered the major gynecologic health problem in the united states.PID is an infectious process that may involve one or more pelvic structures although the most common site is the fallopian tube. It is most leading cause of infertility.
DEFINITION
Pelvic inflammatory disease is an inflammatory condition of the pelvic cavity that may begin with cervicitis and involve the uterus[endometritis] fallopian tube [salpirgitis], ovaries [oophoritis] pelvic peritoneum, or pelvic vascular system. burner and suddarthis
The term pelvic inflammatory disease refers to ascending pelvic infection that involves the upper genital tract. JOYCE.M.BLACK
INCIDENCE
* PID is estimated that at least 13 in 1000women. * The ages of 14-34 years. * Younger women are at high risk, with two third of all cause accruing in women younger than 25 years. * 1995 us study 11% African American women treated I PID reproductive years. * 1988-11-17%people will suffered. * 1 million people suffer with PID in us every year. * 2,00,000-3,00,000 of them reauise hospitalization. * Situation is worse in developing countries where health care is not readily accessible. * World wide * The total number of new cases find in adults 15-49 years. Estimated to be 498.9 million * 105.2 million cases of C.trachomatism,chlamydia * 106.1 million cases of N.gororuhoeae,nisseria * 10.6 million cases of syphilis. * 276.4 million cases of T.vaginalis,truchoma. * INDIA WIDE * Approximately 12%of women are infertile after single episode of PID. * 25% after two episodes. * 50% after three or more episodes. * 15-20% of women t PID they reauise surgical intervention.
Anatomy and physiology
The reproductive organs in female are those which are concerned with copulation, fertilization, growth and development of fetus and it's subsequent exit to outer world.
External genital organs * Mons veneris [mons pubis] * Labia miajora * Labia minors * Clitoris * Vestibule-4 opening, a) Urethral opening b) Vaginal orfice and hymen c) Opening of bartholin glands d) Skenes glands * Internal genitial organs. It includes vagina ,uterus ,fallopian tubes, ovaries * Vagina * Vagina is a fibro masculine bra nous sheath communicating the uterine cavity with the exterior at the vulva. * Structure * Mucous coat * Submucous layer * Mucous layer * Fibrous coat * * * Blood supply: * Arteries: cervicovaginal branch of uterine artery * Vaginal artery * middle and rectal artery * Internal pudendalartery * Veins: drain into internal iliac veins and internal pudendal vein. * Uterus: * The uterus is a hollow pyriform muscular organ situated in the peluis between the bladder infrant and the rectum behind. * Parts: * Body or corpus a. Parametrium b. Myametrium c. Endometrium * isthmus * Cervix * Blood supply * Artery: * Uterine artery one on each side * Ovarians and vaginal aretery. * Veins: internal ileac veins. * Fallopian tubes * Parts : Intramurals or interstitial * Isthmus * Ampulla * Infundibullum. * * * Layers: serous * muscular * mucous membrane a. columanar ciliated epithelial cells b. secretory columnar cells c. peg cells. * BLOOD SUPPLY: Uterines,ovarian. * Pampiniform plexus into ovarian veins. * OVARY:Ovaries are paired sex glands or gonads in female with are concerned for i. germ cell maturation ii. steroidogenesis. * STRUCTURES: * cortex * medulla * BLOOD SUPPLY : * ARTERY:Ovarian artery * Abdominal aorta. * VEINS:Ovarian veins * left renal vein * ETIOLOGY: * Three sexually transmitted organisms are most often responsible for PID. * chlamydia trachoma. * neisseria gonorhoea. * mycoplasma hominis. * other organisms are staplylococci,gonococci, streptocaccl,pyogenic organisms. * aerobic and anaerobic organism. * * Risk factors: * Untreated bacterial infection are STB's. * Lack of condom use. * At age of 24 years. * Who have multiple sex partners or new sex partners. * Use of JUP. * History ofPID. * Nulliparity. * Low socio economic status. * Non caucasionethnic origin. * A divorced or separated marital status. * pathophysiology * The pathogenic organisms enter into the lower genital tract * These organisms migrate from the endoceruix through endometrial cavity to the fallopian tubes. * Infection will spread to upper genital tract. * Through direct contact with mucosal surfaces or through the fimbriated ends of tubes to the ovaries parametrium peritonias cavity. * Due to inflammatory response complex inflammatory process * PID * * CLINICAL MANIFESTATION * Lower abdominal tenderness. * Acute sharp, severe aching pain both sides of abdomens pelvis. * Intensity-Mild to severe. * Duration-gradually and is constant. * Movement-walking can increase pain. * Sporting after intercouse and abdominal vaginal discharge are common. * Irregular bleeding. * COMMON SYMPTOMS * Malaise * Fever 101F(38.3c) * Chills * Anorexia * Nousea, vomiting * Aching (pain) * Tachycardia (increased heartbeat) * DIAGNOSTIC FINDINGS * History collection * Physical examination * Gynecological examination $ cervical motion tenderness, uterine tenderness, adnexal tenderness * Blood test * Pregnancy test * Ultrasound test * Laparoscopy * MRI * CT * * Management * Medical management: * Cefotetan 2g IV every 12 hrs. * Cefoxitin 2g IV every 6hrs. * Doxycyclin 100mg oral or 1v every 12 hrs. * Clindamycin 900mg IV every 8hrs. * Gentamycn loading dose 1v or IM (2mg 1kg body out) * Maintenance dose (1.5 mg 1kg ) every 8hrs. * Ampicillin 3g 1v 6hrs. * Doxycyclin 100mg artery IV Q12hrs. * Surgical management: * Laprotomy * Salpingectomy. * Nursing management: 1. Impaired thermo regulation related to infection as evidenced by increased body temperature. 2. Pain related to the effects of the infectious process as evidenced by irritable facial expression. 3. Serial days function related to the effects of the infectious process. 4. Fluid electrolyte imbalance related to gastric irritation as evidenced by nausea vomiting. 5. Self esteem disturbance related to guilt of having PID. 6. Anxiety related to possible infertility as a result of infect. 7. Altered health maintenance related to knowledge deficit about risk, prevention, symptoms, treatment effected pills. * * * * * * COMPLICATION * Septic shock * Short term complications * Fitz-hugh-curitis syndrome * Acute perihepatitis. * Pelvic or tubo ovarian abcess * Thromboflebitis * longterm complication * ectopic pregnancy * Infertility * Chronic pelvic pa. * Terminology: 1. Adenexa: the fallopian tube and ovaries. 2. Dyspareunia: difficult or painful sexual intercourse. 3. Endocervicitis: inflammation of the mucosa and the glands of the cervix. 4. Endometritis: inflammation of uterus. 5. Hysteroscopy:a procedure performed using a long telescope like instruments inserted through the servix to diagnose uterine problems. 6. Oophoritis: inflammation of ovaries. 7. Salpingitis: inflammation of fallopian tubes. 8. Salpingo -oophorectomy: removal of ovary and it's fallopian tube [removal of the fallopian tube alone is asalpingectamy] * * BIBLIOGRAPHY 1. B.T. BASANANTHAPPA,,A TEXT BOOK OF "PATHOGIC BASIS DISEASE",VOLUME -1,7TH EDITION,2008;SAUNDERS PUBLICATION. 2. JOYCE.M.BLOCK,A TEXT BOOK OF "MEDICAL SURGICAL NURSING"7TH EDITION 2009;NEW MOSBY PUBLICATIONS. 3. LEWIS ,A TEXT BOOK OF "MEDICAL SURGICAL NURSING",6TH EDITION,VOLUME -2,2004,MOSBY PUBLICATIONS. 4. LIPPINCOTT,A REVIEW SERIES OF "MEDICAL SURGICAL NURSING",4TH EDITION,2006,LIPPINCOTT WILLIAMS AND WIKINS PUBLICATIONS. 5. SMELTZER ,A TEXT BOOK OF "MEDICAL SURGICAL NURSING",VOLUME-2,11TH EDITION 2009,WOLTER KLUMERS PUBLICATIONS NEW DELHI. 6. S.S.RANDHAWA,A TEXT BOOK OF "ANATOMY AND PHYSIOLOGY",4TH EDITION 2010,S.VIKAS AND MEDICAL PUBLISHERS,JALANDHAR CITY. * DICTIONARYS: 1. BARBARA;F.WELLER,BAILERS NURSES DICTIONARY,23RD EDITION 2000,BAILLIER'S PUBLICATIONS , DELHI. 2. GUPTA;POCKET MEDICALDICTIONARY WITH 500 ILLUTRATIONS,3RD EDITION,A.ITB.S PUBLISHERS ,NEW DELHI. 3. PROF.DR.OA.SARMA;ENCYCLOPEDIC MEDICAL DICTIONARY,12TH EDITION,2012,NEELKAMAL PUBLICATIONS,DELHI. * WEBSITES: 1. http//www.encyclopedia.com 2. http//www.google.com 3. http//www.medplus.com 4. http//www.wikipedia.com * * * *