Pelvic inflammatory disease differential diagnosis: Difference between revisions

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__NOTOC__
__NOTOC__
{{Pelvic inflammatory disease}}
{{Pelvic inflammatory disease}}
{{CMG}}
{{CMG}}; {{AE}} {{MehdiP}}


==Overview==
==Overview==
Pelvic inflammatory disease must be differentiated from [[ectopic pregnancy]], [[ovarian torsion]], [[ovarian tumor]], ruptured [[ovarian cysts]], [[appendicitis]], and  [[urinary tract infection]].
Pelvic inflammatory disease must be differentiated from [[ectopic pregnancy]], [[ovarian torsion]], [[Ovarian cyst|ovarian cyst hemorrhage]], ruptured [[ovarian cysts]], [[appendicitis]], [[endometriosis]], [[diverticulitis]] and  [[urinary tract infection]].
 
==Differentiating Pelvic inflammatory disease from other Diseases==
==Differentiating Pelvic inflammatory disease from other Diseases==


{| style="border: 0px; font-size: 90%; margin: 3px;" align=center
{| style="border: 0px; font-size: 90%; margin: 3px;" align=center
|+
|+
! style="background: #4479BA; width: 120px;" | {{fontcolor|#000|Disease}}
! style="background: #4479BA; width: 180px;" | {{fontcolor|#000|Disease}}
! style="background: #4479BA; width: 550px;" | {{fontcolor|#000|Findings}}
! style="background: #4479BA; width: 650px;" | {{fontcolor|#000|Findings}}
|-
| style="padding: 7px 7px; background: #DCDCDC;" | '''[[Ectopic pregnancy]]'''
| style="padding: 7px 7px; background: #F5F5F5;" | History of missed menses, positive [[pregnancy test]], [[ultrasound]] reveals an empty [[uterus]] and may show a mass in the [[fallopian tubes]].<ref name="pmid27720100">{{cite journal |vauthors=Morin L, Cargill YM, Glanc P |title=Ultrasound Evaluation of First Trimester Complications of Pregnancy |journal=J Obstet Gynaecol Can |volume=38 |issue=10 |pages=982–988 |year=2016 |pmid=27720100 |doi=10.1016/j.jogc.2016.06.001 |url=}}</ref>
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Ectopic pregnancy]]'''
| style="padding: 7px 7px; background: #DCDCDC;" |'''[[Appendicitis]]'''
| style="padding: 5px 5px; background: #F5F5F5;" | History of missed menses, positive pregnancy test, ultrasound reveals an empty uterus and may show a mass in the fallopian tubes.<ref name="pmid27720100">{{cite journal |vauthors=Morin L, Cargill YM, Glanc P |title=Ultrasound Evaluation of First Trimester Complications of Pregnancy |journal=J Obstet Gynaecol Can |volume=38 |issue=10 |pages=982–988 |year=2016 |pmid=27720100 |doi=10.1016/j.jogc.2016.06.001 |url=}}</ref>
| style="padding: 7px 7px; background: #F5F5F5;" |Pain localized to the [[right iliac fossa]], [[vomiting]], [[Ultrasound|abdominal ultrasound]] [[Sensitivity (tests)|sensitivity]] for diagnosis of [[acute appendicitis]] is 75% to 90%.<ref name="pmid8259423">{{cite journal |vauthors=Balthazar EJ, Birnbaum BA, Yee J, Megibow AJ, Roshkow J, Gray C |title=Acute appendicitis: CT and US correlation in 100 patients |journal=Radiology |volume=190 |issue=1 |pages=31–5 |year=1994 |pmid=8259423 |doi=10.1148/radiology.190.1.8259423 |url=}}</ref>
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" |'''[[Appendicitis]]'''
| style="padding: 7px 7px; background: #DCDCDC;" | '''Ruptured[[ ovarian cyst]]'''
| style="padding: 5px 5px; background: #F5F5F5;" |Pain localized to the right iliac fossa, vomiting, abdominal ultrasound sensitivity for diagnosis of acute appendicitis is 75% to 90%.<ref name="pmid8259423">{{cite journal |vauthors=Balthazar EJ, Birnbaum BA, Yee J, Megibow AJ, Roshkow J, Gray C |title=Acute appendicitis: CT and US correlation in 100 patients |journal=Radiology |volume=190 |issue=1 |pages=31–5 |year=1994 |pmid=8259423 |doi=10.1148/radiology.190.1.8259423 |url=}}</ref>
| style="padding: 7px 7px; background: #F5F5F5;" |Usually spontaneous, can follow history of trauma; mild chronic lower abdominal discomfort may suddenly intensify, [[ultrasound]] is diagnostic.<ref name="pmid19299205">{{cite journal |vauthors=Bottomley C, Bourne T |title=Diagnosis and management of ovarian cyst accidents |journal=Best Pract Res Clin Obstet Gynaecol |volume=23 |issue=5 |pages=711–24 |year=2009 |pmid=19299205 |doi=10.1016/j.bpobgyn.2009.02.001 |url=}}</ref>
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Asthma]]'''
| style="padding: 7px 7px; background: #DCDCDC;" | '''[[Ovarian cyst ]]torsion'''
| style="padding: 5px 5px; background: #F5F5F5;" |Presents with cough, dyspnea and wheezing and typically is a chronic condition which has started from childhood.<ref name="pmid21875745">{{cite journal |vauthors=Busse WW |title=Asthma diagnosis and treatment: filling in the information gaps |journal=J. Allergy Clin. Immunol. |volume=128 |issue=4 |pages=740–50 |year=2011 |pmid=21875745 |doi=10.1016/j.jaci.2011.08.014 |url=}}</ref>
| style="padding: 7px 7px; background: #F5F5F5;" |Present with acute severe unilateral [[Lower abdominal pain|lower quadrant abdominal pain]], [[nausea and vomiting]], tender adnexal mass palpated in 90%, [[ultrasound]] is diagnostic.<ref name="pmid26760839">{{cite journal |vauthors=Bhavsar AK, Gelner EJ, Shorma T |title=Common Questions About the Evaluation of Acute Pelvic Pain |journal=Am Fam Physician |volume=93 |issue=1 |pages=41–8 |year=2016 |pmid=26760839 |doi= |url=}}</ref>
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Gastroesophageal Reflux Disease]]'''
| style="padding: 7px 7px; background: #DCDCDC;" | '''Hemorrhagic [[ovarian cyst]]'''
| style="padding: 5px 5px; background: #F5F5F5;" | May present with chronic, dry cough but the typical symptom is [[heart burn]].<ref name="pmid19969583">{{cite journal |vauthors=Singh A |title=Asthma in older adults |journal=CMAJ |volume=181 |issue=12 |pages=929 |year=2009 |pmid=19969583 |pmc=2789137 |doi=10.1503/cmaj.109-2049 |url=}}</ref><ref name="pmid16428686">{{cite journal |vauthors=Irwin RS, Baumann MH, Bolser DC, Boulet LP, Braman SS, Brightling CE, Brown KK, Canning BJ, Chang AB, Dicpinigaitis PV, Eccles R, Glomb WB, Goldstein LB, Graham LM, Hargreave FE, Kvale PA, Lewis SZ, McCool FD, McCrory DC, Prakash UB, Pratter MR, Rosen MJ, Schulman E, Shannon JJ, Smith Hammond C, Tarlo SM |title=Diagnosis and management of cough executive summary: ACCP evidence-based clinical practice guidelines |journal=Chest |volume=129 |issue=1 Suppl |pages=1S–23S |year=2006 |pmid=16428686 |pmc=3345522 |doi=10.1378/chest.129.1_suppl.1S |url=}}</ref>
| style="padding: 7px 7px; background: #F5F5F5;" |Presents with [[Abdominal pain|localized abdominal pain]], [[nausea and vomiting]]. [[Hypovolemic shock]] may be present; [[abdominal tenderness]] and guarding are physical exam findings, [[ultrasound]] is diagnostic.<ref name="pmid26760839">{{cite journal |vauthors=Bhavsar AK, Gelner EJ, Shorma T |title=Common Questions About the Evaluation of Acute Pelvic Pain |journal=Am Fam Physician |volume=93 |issue=1 |pages=41–8 |year=2016 |pmid=26760839 |doi= |url=}}</ref>
|-
| style="padding: 7px 7px; background: #DCDCDC;" | '''[[Endometriosis]]'''
| style="padding: 7px 7px; background: #F5F5F5;" |Present with cyclic pain that is exacerbated by onset of menses and during the [[luteal phase]]; [[dyspareunia]], [[transvaginal ultrasound]] is suggestive, [[Laparoscopy|laparoscopic]] exploration is diagnostic.<ref name="pmid26760839">{{cite journal |vauthors=Bhavsar AK, Gelner EJ, Shorma T |title=Common Questions About the Evaluation of Acute Pelvic Pain |journal=Am Fam Physician |volume=93 |issue=1 |pages=41–8 |year=2016 |pmid=26760839 |doi= |url=}}</ref>
|-
| style="padding: 7px 7px; background: #DCDCDC;" | '''[[Diverticulitis]]'''
| style="padding: 7px 7px; background: #F5F5F5;" |Present with bowel symptoms in older women
|-
| style="padding: 7px 7px; background: #DCDCDC;" | '''[[Acute cystitis]]'''
| style="padding: 7px 7px; background: #F5F5F5;" |Features with increased [[frequency]] and [[urgency]], [[dysuria]], and suprapubic pain.<ref>{{Cite journal
| author = [[W. E. Stamm]]
| title = Etiology and management of the acute urethral syndrome
| journal = [[Sexually transmitted diseases]]
| volume = 8
| issue = 3
| pages = 235–238
| year = 1981
| month = July-September
| pmid = 7292216
}}</ref><ref>{{Cite journal
| author = [[W. E. Stamm]], [[K. F. Wagner]], [[R. Amsel]], [[E. R. Alexander]], [[M. Turck]], [[G. W. Counts]] & [[K. K. Holmes]]
| title = Causes of the acute urethral syndrome in women
| journal = [[The New England journal of medicine]]
| volume = 303
| issue = 8
| pages = 409–415
| year = 1980
| month = August
| doi = 10.1056/NEJM198008213030801
| pmid = 6993946
}}</ref>
|-
|-
|}
|}
<small>
<div style="width: 75%;">


{|
|-style="background: #DCDCDC; color; text-align: center;"
! rowspan="2" |<small>Diseases</small>
! colspan="3" |<small>Diagnostic tests</small>
! colspan="4" |<small>Physical Examination</small>
| colspan="5" |<small>'''Symptoms'''</small>
! colspan="1" rowspan="2" |<small>Past medical history</small>
! rowspan="2" |<small>Other Findings</small>
|- style="background: #DCDCDC; text-align: center;"
!<small>Urinalysis</small>
!<small>Urine Culture</small>
!<small>Gold Standard
!<small>Fever</small>
!<small>Tenderness</small>
!<small>Discharge</small>
!<small>Inguinal Lymphadenopathy</small>
!<small>Hematuria</small>
!<small>Pyuria</small>
!<small>Frequency</small>
!<small>Urgency</small>
!<small>Dysuria</small>
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Urethritis]]
| style="background: #F5F5F5; padding: 5px;" |
*Positive [[leukocyte esterase]] test or >10 [[White blood cells|WBCs]]
*Mucous threads in the morning [[urine]]


| style="background: #F5F5F5; padding: 5px; text-align:center" | -
| style="background: #F5F5F5; padding: 5px;" |
[[Gram stain]]
&
Mucoid or [[purulent]] [[discharge]]
| style="background: #F5F5F5; padding: 5px; text-align:center" | +
| style="background: #F5F5F5; padding: 5px;text-align:center" | -
| style="background: #F5F5F5; padding: 5px;text-align:center" |[[Urethral discharge]]
| style="background: #F5F5F5; padding: 5px; text-align:center" | +
| style="background: #F5F5F5; padding: 5px; text-align:center" | -
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px; text-align:center" | -
| style="background: #F5F5F5; padding: 5px; text-align:center" | -
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
* Prior [[STD]]s
* [[Urinary tract infection|Urinary tract infections]]
* New sexual partner
* Recent intercourse
* Recent [[catheterization]]
| style="background: #F5F5F5; padding: 5px;" |
*[[Purulent]] [[discharge]] may suggest [[gonorrhoea]]
*Exclusive [[dysuria]] suggest [[Chlamydia]]
*Painful genital [[ulcers]] with [[dysuria]] suggest [[HSV]]
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Pyelonephritis]]
| style="background: #F5F5F5; padding: 5px; text-align:center" |
*[[Leukocytes]]
*Positive [[Nitrite test|nitrite]]
| style="background: #F5F5F5; padding: 5px;" |Identifies causative [[bacteria]]
| style="background: #F5F5F5; padding: 5px;" |Imaging and [[Culture medium|culture]]
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |[[Flank pain|Flank]] or [[costovertebral angle]]
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |-
| style="background: #F5F5F5; padding: 5px;" |-
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
* History of [[pyelonephritis]]
* Recent history of [[hospitalisation]]
* [[Nephrolithiasis]]
* [[Immunosupression]]
| style="background: #F5F5F5; padding: 5px;" |
* [[Flank pain|Costovertebral angle tenderness]]
* Patient is in acute distress
* Look for obstructive causes
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" | [[Cystitis]]
|style="background: #F5F5F5; padding: 5px;" |
*Positive [[Nitrite test|nitrite]] 


*[[Leukocyte esterase|Positive leukocyte esterase]]


*[[White blood cells|WBCs]]


*[[RBCs]]
|style="background: #F5F5F5; padding: 5px; text-align:center"|>100,000CFU/mL
| style="background: #F5F5F5; padding: 5px;" |[[Urine culture]]
|style="background: #F5F5F5; padding: 5px; text-align:center" | +
|style="background: #F5F5F5; padding: 5px; text-align:center" |Suprapubic
| style="background: #F5F5F5; padding: 5px;text-align:center" | -
| style="background: #F5F5F5; padding: 5px; text-align:center" | +
|style="background: #F5F5F5; padding: 5px; text-align:center" | +
|style="background: #F5F5F5; padding: 5px; text-align:center" | +
| style="background: #F5F5F5; padding: 5px;" | +
|style="background: #F5F5F5; padding: 5px;" | +
|style="background: #F5F5F5; padding: 5px;" | +
|style="background: #F5F5F5; padding: 5px;" |
*Recent catheterisation
*[[Pregnancy]]
*recent intercourse
*[[Diabetes]]
*Personal or [[family history]] of [[UTI]]
*Known abnormality of the [[urinary tract]]
*[[BPH]] or [[HIV]]
|style="background: #F5F5F5; padding: 5px;" |
* Imaging studies help differentiate the various types
* May acompany [[back pain]], [[nausea]], [[vomiting]] and [[chills]]
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Prostatitis]]
| style="background: #F5F5F5; padding: 5px;" |
*10-20 [[leukocytes]] for acute and chronic [[bacterial]] subtypes
| style="background: #F5F5F5; padding: 5px; text-align:center" | Identifies causative [[bacteria]] (in [[bacterial]] subtypes)
| style="background: #F5F5F5; padding: 5px;" |
[[Urine culture]]
| style="background: #F5F5F5; padding: 5px; text-align:center" | +
| style="background: #F5F5F5; padding: 5px;text-align:center" | -
| style="background: #F5F5F5; padding: 5px;text-align:center" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px; text-align:center" | -
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px; text-align:center" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
* [[Urogenital]] disorders
* Recent [[catheterization]] or other [[genitourinary]] instrumentation
* History of [[UTI|UTIs]]
| style="background: #F5F5F5; padding: 5px;" |
* In [[acute prostatitis]], [[palpation]] reveals a [[Tenderness|tender]] and [[enlarged prostate]]<sup>[[Prostatitis physical examination|[1][3]]]</sup>
* In chronic [[prostatitis]], [[palpation]] reveals a tender and soft (boggy) [[prostate]]<sup>[[Prostatitis physical examination|[1]]]</sup>
* A [[prostate massage]] should never be done in a patient with suspected [[acute prostatitis]], since it may induce [[sepsis]]
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" | [[Vulvovaginitis|Bacterial Vulvovagintis]]


| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px; text-align:center" | -
| style="background: #F5F5F5; padding: 5px;" |
[[Gram stain]]
&
Culture of discharge
| style="background: #F5F5F5; padding: 5px; text-align:center" | +
| style="background: #F5F5F5; padding: 5px;text-align:center" | -
| style="background: #F5F5F5; padding: 5px;text-align:center" | [[Vaginal discharge]] 
| style="background: #F5F5F5; padding: 5px; text-align:center" | +
| style="background: #F5F5F5; padding: 5px; text-align:center" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px; text-align:center" | -
| style="background: #F5F5F5; padding: 5px; text-align:center" | -
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
* Number and type of sexual partners (new, casual, or regular)
* Prior [[STDs]]
* Previous history of symptomatic BV in female partner (in [[homosexual]] women)
| style="background: #F5F5F5; padding: 5px;" |
* Fishy [[odor]] from the [[vagina]] (Whiff test)
* Thin, white/gray homogeneous [[vaginal discharge]]
* [[Microscopy]] (wet prep) and vaginal [[pH]] 
* [[Clue cell|Clue cells]]


|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" | [[Cervicitis]]
| style="background: #F5F5F5; padding: 5px; text-align:center" | -
| style="background: #F5F5F5; padding: 5px; text-align:center" | -
| style="background: #F5F5F5; padding: 5px; text-align:center" |culture for [[gonococcal]] cervicitis
| style="background: #F5F5F5; padding: 5px; text-align:center" | +
| style="background: #F5F5F5; padding: 5px; text-align:center" |Cervical
| style="background: #F5F5F5; padding: 5px; text-align:center" |
endocervical exudate
| style="background: #F5F5F5; padding: 5px; text-align:center" | -
| style="background: #F5F5F5; padding: 5px; text-align:center" | -
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px; text-align:center" | -
| style="background: #F5F5F5; padding: 5px; text-align:center" | -
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px; text-align:center" |
* Abnormal [[vaginal bleeding]] after intercourse or after [[menopause]]
* Abnormal [[vaginal discharge]]
* Painful sexual intercourse
* Pressure or heaviness in the [[pelvis]]
| style="background: #F5F5F5; padding: 5px; text-align:center" |
*[[Purulent]] or [[mucopurulent]] endocervical exudate


*Sustained endocervical bleeding easily induced by a cotton swab


*[[]]
*>10 [[WBC]] in vaginal fluid, in the absence of [[trichomoniasis]], may indicate endocervical [[inflammation]] caused specifically by [[C. trachomatis]] or [[N. gonorrhea]]
*[[Ectopic pregnancy]] - a sensitive serum pregnancy test should be obtained to rule out ectopic pregnancy.
|-
*Hemorrhagic [[ovarian cyst]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Epididymitis]]
*Ruptured [[ovarian cysts]]
| style="background: #F5F5F5; padding: 5px;" |
*[[Myoma]]
*[[Hematuria]] may be seen
*[[Ovarian torsion]]
| style="background: #F5F5F5; padding: 5px;" |+
*[[Ovarian tumor]]
| style="background: #F5F5F5; padding: 5px;" | [[Culture medium|Culture]]
*[[Septic]] [[abortion]]
| style="background: #F5F5F5; padding: 5px;" |+
*[[Urinary Tract Infection]]
| style="background: #F5F5F5; padding: 5px;text-align:center" |
*Twisted [[ovarian cyst]]
[[Testicular]]
*Degeneration of a [[myoma]]
&
*Acute [[enteritis]]
Suprapubic
*[[Urinary Tract Infection]] <ref>Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016</ref> <ref>Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X</ref>
| style="background: #F5F5F5; padding: 5px;" | +/- [[urethral discharge]]
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px; text-align:center" | +
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
*[[Scrotal pain]]:  starts gradually, is usually unilateral and [[Localized disease|localized]] posterior to the testis
*[[Scrotal swelling]]
*[[Scrotum|Scrotal]] wall [[erythema]]
*Constitutional symptoms: feeling warm, [[chills]], [[nausea and vomiting]]


Culdocentesis will differentiate hemoperitoneum (ruptured [[ectopic pregnancy]] or hemorrhagic [[cyst]]) from pelvic sepsis ([[salpingitis]], ruptured [[pelvic abscess]], or ruptured [[appendix]]).
| style="background: #F5F5F5; padding: 5px;" |
*[[Ultrasound]] in patients with [[Testicular pain|acute testicular pain]] to assess for [[testicular torsion]]
*If equivocal do surgical exploration
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Syphilis]] ([[STDs|STD]])
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |[[Dark field microscopy|Darkfield microscopy]]
| style="background: #F5F5F5; padding: 5px;" | +/-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |
* History of [[STD]]
* [[HIV AIDS|HIV]]
* [[Immunosupression]]
* Previous history of [[chancre]]
| style="background: #F5F5F5; padding: 5px;" |
* May be asymptomatic
* Painless [[chancre]] in [[primary syphilis]]
* [[Secondary syphilis]] may have generalised features and [[Condyloma latum|condylomata lata]]
* [[Tertiary syphilis]] can have [[neurosyphilis]], [[cardiovascular syphilis]] and [[Gumma|gummas]]
|}


{| class="wikitable"
!
!Clinical Features
!Physical Examination
!Diagnostic Findings
|-
|[[Endometriosis]]
|
*[[Dysmenorrhea]]
*[[Dyspareunia]]
*[[Infertility]]
*Common in women between 25 to 35 years
|
*Nodules in the [[posterior fornix]]
*Adnexal masses
*Fixed retroverted [[uterus]]
*Lateral displacement of the [[cervix]]
|
*Increased [[CA-125|serum cancer antigen-125]] 
*Nodules of the [[Rectovaginal fascia|recto vaginal]] septum and hypoechoic, vascular mass on [[MRI]]
*Laproscopic visualization confirms the diagnosis
|-
|[[Adenomyosis]]<ref name="pmid16782099">{{cite journal| author=Parker JD, Leondires M, Sinaii N, Premkumar A, Nieman LK, Stratton P| title=Persistence of dysmenorrhea and nonmenstrual pain after optimal endometriosis surgery may indicate adenomyosis. | journal=Fertil Steril | year= 2006 | volume= 86 | issue= 3 | pages= 711-5 | pmid=16782099 | doi=10.1016/j.fertnstert.2006.01.030 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16782099  }}</ref>
|
*[[Abnormal uterine bleeding]]
*[[Dysmenorrhea]]
*Common in women aged 40 and 50 years
|
* Diffuse uterine enlargement always less than size corresponding to less than 12 weeks of [[gestation]]
|
*Asymmetric thickening of the [[myometrium]] on [[MRI]]
|-
|Submucous uterine [[Leiomyoma|leiomyomas]]<ref name="pmid26477496">{{cite journal| author=Donnez J, Donnez O, Matule D, Ahrendt HJ, Hudecek R, Zatik J et al.| title=Long-term medical management of uterine fibroids with ulipristal acetate. | journal=Fertil Steril | year= 2016 | volume= 105 | issue= 1 | pages= 165-173.e4 | pmid=26477496 | doi=10.1016/j.fertnstert.2015.09.032 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26477496  }}</ref>
|
*[[Menorrhagia]]
*Pelvic pressure and pain
*[[Infertility]]
*Peak age of onset 25 to 44 years of age
|
*Mobile [[uterus]] with an irregular contour
|
*[[Transvaginal ultrasound]] will demonstrate the presence of myomas
|-
|[[PID|Pelvic Inflammatory disease]]<ref name="pmid24216035">{{cite journal| author=Ross J, Judlin P, Jensen J, International Union against sexually transmitted infections| title=2012 European guideline for the management of pelvic inflammatory disease. | journal=Int J STD AIDS | year= 2014 | volume= 25 | issue= 1 | pages= 1-7 | pmid=24216035 | doi=10.1177/0956462413498714 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24216035  }}</ref>
|
*Seen in patients with history of [[sexually transmitted disease]]
*History of multiple sexual partners 
*Common in women younger than 25 years of age
|
*[[Abdominal tenderness]] 
*Acute [[Cervical motion tenderness|cervical motion]], [[Uterus|uterine]], and adnexal tenderness
*Visualization of purulent endocervical discharge 
|
*Positive [[Nucleic acid test|Nucleic acid amplification tests]] for [[Chlamydia trachomatis]] and [[Neisseria gonorrhoeae|N. gonorrhoeae]]
*Gram negative [[diplococci]] on [[gram stain]]
|-
|Pelvic congestion Syndrome<ref name="pmid11133549">{{cite journal| author=Rozenblit AM, Ricci ZJ, Tuvia J, Amis ES| title=Incompetent and dilated ovarian veins: a common CT finding in asymptomatic parous women. | journal=AJR Am J Roentgenol | year= 2001 | volume= 176 | issue= 1 | pages= 119-22 | pmid=11133549 | doi=10.2214/ajr.176.1.1760119 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11133549  }}</ref>
|
*Shifting lower abdominal pain
*Deep [[dyspareunia]]
*Post-coital pain
*Exacerbation of pain after prolonged standing 
|
*Bimanual tenderness
*[[Cervical motion tenderness]]
|
*Pelvic [[varicosities]] on ultrasound with reduced blood flow
|}
==References==
==References==
{{reflist|2}}
{{reflist|2}}
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[[Category:Emergency mdicine]]
[[Category:Disease]]
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[[Category:Infectious disease]]
[[Category:Infectious disease]]
[[Category:Gynecology]]
[[Category:Gynecology]]
[[Category:Abdominal pain]]
[[Category:Sexually transmitted diseases]]
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Latest revision as of 23:37, 29 July 2020

Pelvic inflammatory disease Microchapters

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Seyedmahdi Pahlavani, M.D. [2]

Overview

Pelvic inflammatory disease must be differentiated from ectopic pregnancy, ovarian torsion, ovarian cyst hemorrhage, ruptured ovarian cysts, appendicitis, endometriosis, diverticulitis and urinary tract infection.

Differentiating Pelvic inflammatory disease from other Diseases

Disease Findings
Ectopic pregnancy History of missed menses, positive pregnancy test, ultrasound reveals an empty uterus and may show a mass in the fallopian tubes.[1]
Appendicitis Pain localized to the right iliac fossa, vomiting, abdominal ultrasound sensitivity for diagnosis of acute appendicitis is 75% to 90%.[2]
Rupturedovarian cyst Usually spontaneous, can follow history of trauma; mild chronic lower abdominal discomfort may suddenly intensify, ultrasound is diagnostic.[3]
Ovarian cyst torsion Present with acute severe unilateral lower quadrant abdominal pain, nausea and vomiting, tender adnexal mass palpated in 90%, ultrasound is diagnostic.[4]
Hemorrhagic ovarian cyst Presents with localized abdominal pain, nausea and vomiting. Hypovolemic shock may be present; abdominal tenderness and guarding are physical exam findings, ultrasound is diagnostic.[4]
Endometriosis Present with cyclic pain that is exacerbated by onset of menses and during the luteal phase; dyspareunia, transvaginal ultrasound is suggestive, laparoscopic exploration is diagnostic.[4]
Diverticulitis Present with bowel symptoms in older women
Acute cystitis Features with increased frequency and urgency, dysuria, and suprapubic pain.[5][6]

Diseases Diagnostic tests Physical Examination Symptoms Past medical history Other Findings
Urinalysis Urine Culture Gold Standard Fever Tenderness Discharge Inguinal Lymphadenopathy Hematuria Pyuria Frequency Urgency Dysuria
Urethritis -

Gram stain & Mucoid or purulent discharge

+ - Urethral discharge + - + - - +
Pyelonephritis Identifies causative bacteria Imaging and culture + Flank or costovertebral angle + + + + - - +
Cystitis >100,000CFU/mL Urine culture + Suprapubic - + + + + + +
Prostatitis Identifies causative bacteria (in bacterial subtypes)

Urine culture

+ - - - - + + + +
Bacterial Vulvovagintis - -

Gram stain & Culture of discharge

+ - Vaginal discharge  + - - - - +
  • Number and type of sexual partners (new, casual, or regular)
  • Prior STDs
  • Previous history of symptomatic BV in female partner (in homosexual women)
Cervicitis - - culture for gonococcal cervicitis + Cervical

endocervical exudate

- - + - - +
  • Sustained endocervical bleeding easily induced by a cotton swab
Epididymitis + Culture +

Testicular & Suprapubic

+/- urethral discharge + + - + + +
Syphilis (STD) - - Darkfield microscopy +/- - - + - - - - -
Clinical Features Physical Examination Diagnostic Findings
Endometriosis
Adenomyosis[7]
  • Diffuse uterine enlargement always less than size corresponding to less than 12 weeks of gestation
Submucous uterine leiomyomas[8]
  • Mobile uterus with an irregular contour
Pelvic Inflammatory disease[9]
  • Seen in patients with history of sexually transmitted disease
  • History of multiple sexual partners 
  • Common in women younger than 25 years of age
Pelvic congestion Syndrome[10]
  • Shifting lower abdominal pain
  • Deep dyspareunia
  • Post-coital pain
  • Exacerbation of pain after prolonged standing 

References

  1. ↑ Morin L, Cargill YM, Glanc P (2016). "Ultrasound Evaluation of First Trimester Complications of Pregnancy". J Obstet Gynaecol Can. 38 (10): 982–988. doi:10.1016/j.jogc.2016.06.001. PMID 27720100.
  2. ↑ Balthazar EJ, Birnbaum BA, Yee J, Megibow AJ, Roshkow J, Gray C (1994). "Acute appendicitis: CT and US correlation in 100 patients". Radiology. 190 (1): 31–5. doi:10.1148/radiology.190.1.8259423. PMID 8259423.
  3. ↑ Bottomley C, Bourne T (2009). "Diagnosis and management of ovarian cyst accidents". Best Pract Res Clin Obstet Gynaecol. 23 (5): 711–24. doi:10.1016/j.bpobgyn.2009.02.001. PMID 19299205.
  4. ↑ 4.0 4.1 4.2 Bhavsar AK, Gelner EJ, Shorma T (2016). "Common Questions About the Evaluation of Acute Pelvic Pain". Am Fam Physician. 93 (1): 41–8. PMID 26760839.
  5. ↑ W. E. Stamm (1981). "Etiology and management of the acute urethral syndrome". Sexually transmitted diseases. 8 (3): 235–238. PMID 7292216. Unknown parameter |month= ignored (help)
  6. ↑ W. E. Stamm, K. F. Wagner, R. Amsel, E. R. Alexander, M. Turck, G. W. Counts & K. K. Holmes (1980). "Causes of the acute urethral syndrome in women". The New England journal of medicine. 303 (8): 409–415. doi:10.1056/NEJM198008213030801. PMID 6993946. Unknown parameter |month= ignored (help)
  7. ↑ Parker JD, Leondires M, Sinaii N, Premkumar A, Nieman LK, Stratton P (2006). "Persistence of dysmenorrhea and nonmenstrual pain after optimal endometriosis surgery may indicate adenomyosis". Fertil Steril. 86 (3): 711–5. doi:10.1016/j.fertnstert.2006.01.030. PMID 16782099.
  8. ↑ Donnez J, Donnez O, Matule D, Ahrendt HJ, Hudecek R, Zatik J; et al. (2016). "Long-term medical management of uterine fibroids with ulipristal acetate". Fertil Steril. 105 (1): 165–173.e4. doi:10.1016/j.fertnstert.2015.09.032. PMID 26477496.
  9. ↑ Ross J, Judlin P, Jensen J, International Union against sexually transmitted infections (2014). "2012 European guideline for the management of pelvic inflammatory disease". Int J STD AIDS. 25 (1): 1–7. doi:10.1177/0956462413498714. PMID 24216035.
  10. ↑ Rozenblit AM, Ricci ZJ, Tuvia J, Amis ES (2001). "Incompetent and dilated ovarian veins: a common CT finding in asymptomatic parous women". AJR Am J Roentgenol. 176 (1): 119–22. doi:10.2214/ajr.176.1.1760119. PMID 11133549.

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