Saturday, February 7, 2015

pelvic inflammatory disease (PID)

A 23-year-old woman presents with fever and bilateral lower quadrant abdominal pain for two
days. She complains of the onset of a mucopurulent vaginal discharge with her menses, which she states is yellowish in color. She has a new sexual partner and uses a nonbarrier method of contraception.

Her temperature is 103.2°F. She has bilateral lower quadrant tenderness with palpation, and pelvic examination reveals cervical and adnexal motion tenderness.

anatomy of female pelvis

A mass is palpable in the left adnexa. Which of the following is the most likely diagnosis?

a. Fitz-Hugh-Curtis syndrome
b. Pelvic inflammatory diseasec. Perihepatitis
d. Acute inflammation of Bartholin’s gland
e. Chancroid

The answer is b The patient most likely has pelvic inflammatory disease (PID) due to Neisseria gonorrhoeae. Infections typically occur during menstruation, and patients complain of abdominal pain and yellow mucopurulent vaginal discharge. 

Spread of the gonococci (or, in some cases, Chlamydia) into the upper abdomen may cause a perihepatitis or Fitz-Hugh-Curtis syndrome, and patients will complain of upper abdominal pain. Acute inflammation of Bartholin’s gland (an infected duct) would be visible in the labium majus. Chancroid is due to Haemophilus ducreyi; patients typically present with a painful ulcer that bleeds easily.


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