A case of massive exudative hemorrhagic ascites occurring as a serious complication of chronic pelvic inflammatory disease (PID) is presented. The clinical manifestations, simulating diffuse carcinomatosis in a young female patient, are described. [ncbi.nlm.nih.gov]

Classic Presentation Women typically present with bilateral lower abdominal pain, purulent vaginal discharge, or less frequently with abnormal vaginal bleeding. [saem.org]

And early presentation for the diagnosis and treatment of pelvic pain should be a key message of all sexual health promotion programs. [theconversation.com]

Case Presentation A 44 year old para 2012 presented to a local emergency room with a three day history of progressive lower abdominal pain and nausea. [austinpublishinggroup.com]

• Abdominal Pain

  RESULTS: Patients with irritable bowel syndrome suffered significantly more upper abdominal pain, colicky pain and exacerbation of pain by food or stress. They also experienced more disturbance of bowel habit, distension and nausea. [ncbi.nlm.nih.gov]

  […] eyes Dry mouth Anorexia Infertility Abdominal pain Anxiety Spontaneous sweating or night sweats with fever Dry eyes Hypochondriac pain Anorexia Somnolence Insomnia Aching shoulders Five sole Heat Earache Premenstrual tension Hot flashes Fatigue Lassitude [americandragon.com]

  Tags: abdominal pain chronic recurrent abdominal pain dysuria Ovarian Torsion sexual transmitted disease Sean M. Fox I enjoy taking care of patients and I finding it endlessly rewarding to help train others to do the same. [pedemmorsels.com]

  Patients usually present during their menstruation, another clue towards PID as the cause of abdominal pain. Pelvic pain is exacerbated by intercourse, motion or exercise. [lecturio.com]

  […] mild non-specific abdominal pain, vaginal discharge, bleeding or dyspareunia) among sexually active patients who may be at risk for PID. [pedsinreview.aappublications.org]

• Subcutaneous Nodule

  Secondary outcomes include the recurrence rate and side effects, such as pneumothorax, bleeding, serious discomfort, subcutaneous nodules, and infection. [ncbi.nlm.nih.gov]

• Pelvic Pain

  BACKGROUND: Chronic pelvic inflammation disease (PID) is a difficult-to-treat gynecological disorder with complex etiologies. Acupuncture has been applied widely for treating chronic pelvic inflammation or chronic pelvic pain symptoms in China. [ncbi.nlm.nih.gov]

  When they are present they may include : lower abdominal or pelvic pain abnormal vaginal discharge irregular menstrual bleeding fever pain during sexual intercourse painful or increased urination. [theconversation.com]

  It can also cause chronic pelvic pain and ectopic pregnancy. [livescience.com]

  Treatment of PID Related Pain After PID has been treated, pelvic pain can remain for some women. Pain may be caused by adhesions and scar tissue, which is not treated by the antibiotics. [verywell.com]

• Adnexal Tenderness

  The most common physical exam findings are bilateral adnexal tenderness and purulent cervical discharge. Cervical motion, uterine, and lower abdominal tenderness may also be present. [saem.org]

  Uterine Tenderness Adnexal Tenderness The following add support for the diagnosis: Fever (>101°F / >38.3°C) Mucopurulent cervical discharge or friability Wet prep with abundant WBC We always consider: Chlamydia trachomatis Neisseria gonorrhea Rates of [pedemmorsels.com]

  […] or uterine tenderness or adnexal tenderness. [mshc.org.au]

  The major criteria include: 1) uterine tenderness, 2) cervical motion tenderness (CMT), and 3) adnexal tenderness. Minor criteria may increase the clinician’s suspicion and improve the specificity of exam findings for the diagnosis of PID. [clinicaladvisor.com]

  Clinical Diagnostic Criteria for PID One or more of the following minimum criteria must be present on pelvic examination to diagnose PID: Cervical motion tenderness Uterine tenderness Adnexal tenderness The following criteria can improve the specificity [aafp.org]

• Dyspareunia

  Occasionally, dyspareunia or dysuria occurs. Many women with inflammation that is severe enough to cause scarring have minimal or no symptoms. [merckmanuals.com]

  The woman usually presents with symptoms of pelvic pain, heavy and painful menstrual periods, pain with intercourse (dyspareunia) and/or infertility that triggers an evaluation that reveals extensive pelvic scar tissue. [haveababy.com]

  More common presentations include acute pelvic pain (of variable intensity), cervical motion tenderness, vaginal discharge, fever, dyspareunia, and leukocytosis. Right upper quadrant pain from perihepatitis in Fitz-Hugh-Curtis syndrome is possible. [radiopaedia.org]

  […] unexplained and untreated abdominal pain are significantly more likely to have tubal infertility than women without such history; therefore caution should be used in dismissing mild symptoms (mild non-specific abdominal pain, vaginal discharge, bleeding or dyspareunia [pedsinreview.aappublications.org]

  Other causes of dyspareunia - eg, endometriosis. Investigations Pregnancy test (pregnant women with PID should be admitted; ectopic pregnancy may be confused with PID). [patient.info]

• Pelvic Pain in Women

  If painkillers don't control your pain, you may be referred to a pain management team or a specialist pelvic pain clinic. [nhs.uk]

  It also can cause severe pain and make it difficult to become pregnant. How common is pelvic inflammatory disease (PID)? Each year, more than 1 million women in the United States have an episode of PID. [my.clevelandclinic.org]

  This damage can lead to serious health problems such as infertility (unable to have children) or chronic pelvic pain. Some women may even experience ectopic pregnancies (pregnancies outside of the womb). [bphc.org]

Diagnostic Work-up for Pelvic Inflammatory Disease The threshold to diagnose PID should be low to avoid possible complications, yet several diagnostic workup studies have been evaluated to improve the certainty of the diagnosis. [lecturio.com]

• Hemorrhagic Ascites

  A case of massive exudative hemorrhagic ascites occurring as a serious complication of chronic pelvic inflammatory disease (PID) is presented. The clinical manifestations, simulating diffuse carcinomatosis in a young female patient, are described. [ncbi.nlm.nih.gov]

A thermal dosage treatment lasting between 20 and 30 minutes (for each half of the cross-fire technique treatment) was administered. At the beginning of every treatment session, the patient rated her pain perception on a 10-point ratio scale. [ncbi.nlm.nih.gov]

In the early stages the emphasis of treatment is to eliminate the exogenous pathogenic evil. In the later stages the emphasis shifts to restoring or augmenting genuine Qi. [americandragon.com]

Surgical treatment is needed in approximately 20% of the cases. [lecturio.com]

Prognosis of pelvic inflammatory disease The prognosis of PID depends mostly on the awareness of adolescents to look for timely health care and to prevent future episodes of sexually-transmitted infections. [news-medical.net]

[…] become prominent due to infection draining in to lymphatics along the course of the gonadal veins MRI May show an ill-defined adnexal mass containing fluid with various signal intensities: T1+C (Gd): wall and surrounding tissues may enhance Treatment and prognosis [radiopaedia.org]

What Is the Prognosis? Antibiotic treatment successfully resolves most PID infections. [healthychildren.org]

Prognosis and outcome Prognosis and Outcome Approximately 25% of patients diagnosed with acute PID develop long-term sequelae. The risk for sequelae is increased if the patient has recurrent episodes of PID. [clinicaladvisor.com]

BACKGROUND: Chronic pelvic inflammation disease (PID) is a difficult-to-treat gynecological disorder with complex etiologies. Acupuncture has been applied widely for treating chronic pelvic inflammation or chronic pelvic pain symptoms in China. [ncbi.nlm.nih.gov]

Etiology of Pelvic Inflammatory Disease Pelvic inflammatory disease is an infectious disorder. Chlamydia trachomatis and Neisseria gonorrhoeae are the two most commonly identified etiological organisms of PID. [lecturio.com]

The microbial etiology is linked to sexually transmitted microorganisms, including Chlamydia trachomatis, Neisseria gonorrheae, Mycoplasma genitalium, and bacterial vaginosis-associated microorganisms, predominantly anaerobes. [journals.lww.com]

Eschenbach DA, Buchanan T, Pollock HM et al. (1975) Polymicrobial etiology of acute pelvic inflammatory disease. N Engl J Med 293:166 Google Scholar 5. [link.springer.com]

[…] inflammatory disease (PID) -- usually a spontaneous infection that occurs among sexually active, menstruating, nonpregnant women -- covers: pathophysiology; microbial etiology (gonorrhea, chlamydia, genital mycoplasmas, and aerobic and anerobic bacteria); epidemiology [ncbi.nlm.nih.gov]

Epidemiology and trends in the United States 1975 and 1981. JAMA 251:2529–2533 Google Scholar 13. Westrom L (1980) Incidence, prevalence and trends of acute pelvic inflammatory disease and its consequences in industrialized countries. [link.springer.com]

Objectives After completing this article, readers should be able to: Describe the epidemiology and pathogenesis of pelvic inflammatory disease (PID). Recognize the clinical features of PID. [pedsinreview.aappublications.org]

Epidemiology of Pelvic Inflammatory Disease Pelvic inflammatory disease is a common condition in the United States and approximately 2.5 million women develop PID per year. Up to 150,000 patients are hospitalized per year because of PID. [lecturio.com]

Sexually transmitted diseases, pelvic inflammatory disease, and infertility: an epidemiologic update. Epidemiol Rev. 1990;12:199-220. Cates W Jr, Wasserheit JN. Genital chlamydial infections: epidemiology and reproductive sequelae. [std.uw.edu]

PIP: This discussion of acute pelvic inflammatory disease (PID) -- usually a spontaneous infection that occurs among sexually active, menstruating, nonpregnant women -- covers: pathophysiology; microbial etiology (gonorrhea, chlamydia, genital mycoplasmas [ncbi.nlm.nih.gov]

Pathophysiology of Pelvic Inflammatory Disease PID occurs in two subsequent steps or stages. At first, the patient develops a sexually transmitted infection that is usually chlamydial and asymptomatic. [lecturio.com]

This review paper in Obstetrics and Gynecology is an excellent up to date source for PID pathophysiology, diagnosis, treatment, and long-term outcomes.) Eschenbach, DA, Wolner-Hanssen, P, Hawes, SE, Pavletic, A, Paavonen, J, Holmes, KK. [clinicaladvisor.com]

C 28, 29 Pathophysiology The microorganisms that are implicated in PID are thought to spread in three ways: Intra-abdominally, traveling from the cervix to the endometrium, through the salpinx, and into the peritoneal cavity (causing endometritis, salpingitis [aafp.org]

Pathophysiology of abscess formation. Clin Obstet Gynecol 10:93, 1983 56 Moller BR, Freundt EA, Block FT, et al. Experimental infection of the genital tract of female grivet monkeys by Mycoplasma hominis. [glowm.com]

Resources: Division of STD Prevention (DSTDP) Centers for Disease Control and Prevention - www.cdc.gov/std CDC National Prevention Information Network (NPIN) 1-800-458-5231 - www.cdcnpin.org American Sexual Health Association (ASHA) 1-800-783-9877 - www.ashastd.org [healthcenter.indiana.edu]

The cervix produces mucus that normally prevents bacteria from spreading to the upper reproductive tract. [medbroadcast.com]

How can I prevent PID? Getting tested for STDs is one of the best ways to prevent PID, because PID is usually caused by chlamydia or gonorrhea. [plannedparenthood.org]

Centers for Disease Control and Prevention. (2015). PID. Centers for Disease Control and Prevention. (2015). 2015 Sexually Transmitted Diseases Treatment Guidelines: Pelvic Inflammatory Disease (PID). [womenshealth.gov]

Prevention of PID Seek medical advice for abnormal vaginal discharge, abnormal odor, fever, and bleeding between periods. Early treatment can prevent the development of PID. [healthcommunities.com]