nama : Vondy Holianto

2014

A.

NIM : 004011381419157

Kelas : Gamma

Pelvic Inflamatory Desease ( PID )

PID is an ascending infection that begins in the vulva or vagina and spreads
upward to involve most of the structures in the female genital system, resulting
in pelvic pain, adnexal tenderness, fever, and vaginal discharge. Two sexually
transmitted diseases (STDs)gonorrhea and chlamydiaare the main cause of
PID. Gonorrhea and chlamydia may cause vague symptoms or even no
symptoms in a woman. The organisms ascend through the endocervical canal to
the endometrial cavity, and then to the tubes and ovaries. The endocervical
canal is slightly dilated during menstruation, allowing bacteria to gain entrance
to the uterus and other pelvic structures. After entering the upper reproductive
tract, the organisms multiply rapidly in the favorable environment of the
sloughing endometrium and ascend to the fallopian tube (Fig. 46-6).
Besides these two organisms, infections after spontaneous or induced abortions
and normal or abnormal deliveries (called puerperal infections) are important
causes of PID. In these situations the infections are typically polymicrobial and
may be caused by staphylococci, streptococci, coliform bacteria, and Clostridium
perfringens.
With gonococcus, inflammatory changes start to appear approximately 2 to 7
days after inoculation. Endocervical mucosa is the most common site of initial
involvement. Gonococcal inflammation may also begin in the Bartholin gland and
other vestibular, or periurethral, glands. From any of these sites, the organisms
may spread upward to involve the fallopian tubes and tubo-ovarian region. The
non-gonococcal bacterial infections that follow induced abortion, dilation and
curettage of the uterus, and other surgical procedures of the female genital tract
are thought to spread from the uterus upward through the lymphatics or venous
channels rather than on the mucosal surfaces. Therefore, these infections tend to

produce less mucosal involvement but more reaction within the deeper layers of
the organs.

Factors that predispose women to the development of PID include an age of 16

to 24 years, nulliparity, history of multiple sexual partners, and previous history
of PID. Although the use of an IUD has been associated with a three- to fivefold
increased risk for development of PID, studies have shown that women with only
one sexual partner who are at low risk of acquiring STIs have no significant risk
for development of PID from using an IUD.

B.

Morphology

Wherever it occurs, gonococcal disease is characterized by marked acute

inflammation largely confined to the superficial mucosa. Smears of the
inflammatory exudate disclose the intracellular gram-negative diplococcus;
however, definitive diagnosis requires culture, or detection of gonoccocal RNA or
DNA. If spread occurs, the endometrium is usually spared for unclear reasons.
Once the infection reaches the tubes, an acute suppurative salpingitis
ensues. The tubal mucosa becomes congested and diffusely infiltrated by
neutrophils, plasma cells, and lymphocytes. Gonococcal lipopolysaccharide and
inflammatory mediators such as TNF cause epithelial injury and sloughing of the
plicae. The tubal lumen fills with purulent exudate that may leak out of the
fimbriated end. The infection may further spill over to the ovary to create a
salpingo-oophoritis. Collections of pus within the ovary and tube (tuboovarian abscesses) or tubal lumen (pyosalpinx) may occur ( Fig. 22-4 ). In the
course of time the infecting organisms may disappear, leaving the sequelae of
chronic follicular salpingitis and hydrosalpinx (dilated, fluid-filled fallopian
tube). The tubal plicae, denuded of epithelium, adhere to one another and slowly
fuse in a reparative, scarring process that forms glandlike spaces and blind
pouches, referred to as chronic follicular salpingitis. The lumen of such tubes
may be impenetrable for the oocyte, resulting in infertility or ectopic pregnancy.
Hydrosalpinx develops as a consequence of the fusion of the fimbriae and the
subsequent accumulation of the tubal secretions and tubal distention.
Hydrosalpinx is another cause of post-PID infertility, since lack of flexible tubal
fimbriae prevents uptake of the oocyte after ovulation.

C.Complication
Pelvic inflammatory disease can lead to serious, long-term problems:
1.

Infertility

One in ten women with PID becomes infertile. PID can cause scarring of the
fallopian tubes. This scarring can block the tubes and prevent an egg from being
fertilized.

2.

Ectopic pregnancy

Scarring from PID also can prevent a fertilized egg from moving into the
uterus. Instead, it can begin to grow in the fallopian tube. The tube may rupture
(break) and cause life-threatening bleeding into the abdomen and pelvis.
Emergency surgery may be needed if the ectopic pregnancy is not diagnosed
early.
3.

Chronic pelvic pain

Pelvic inflammatory disease can cause pelvic pain that may last for months or
years. Scarring in your fallopian tubes and other pelvic organs can cause pain
during intercourse and ovulation.

4.

Abscesses

An abscess is a painful collection of pus, usually caused by a bacterial

infection. ID can sometimes cause collections of infected fluid called

abscesses to develop, most commonly in the fallopian tubes and ovaries

D.

Symptom

Signs and symptoms of pelvic inflammatory disease may include:

Pain in your lower abdomen and pelvis

Heavy vaginal discharge with an unpleasant odorv
Irregular menstrual bleeding
Pain during intercourse
Fever
Painful or difficult urination

PID may cause only minor signs and symptoms or none at all. PID with mild or no
symptoms is especially common when the infection is due to chlamydia.

E.Diagnosis
Doctors diagnose pelvic inflammatory disease based on signs and symptoms, a
pelvic exam, an analysis of vaginal discharge and cervical cultures, or urine
tests.
During the pelvic exam, your doctor uses a cotton swab to take samples from
your vagina and cervix. The samples are sent to a lab for analysis to determine
the organism that's causing the infection.(pap smear)
To confirm the diagnosis or to determine how widespread the infection is, your
doctor may recommend other tests, such as:

Ultrasound. This test uses sound waves to create images of your

reproductive organs.
Endometrial biopsy. During this procedure, your doctor removes a small
piece of your uterine lining (endometrium) for testing.
Laparoscopy. During this procedure, your doctor inserts a thin, lighted
instrument through a small incision in your abdomen to view your pelvic
organs.

DAFTAR PUSTAKA

anonym . http://www.mayoclinic.org/diseases-conditions/pelvic-inflammatorydisease/basics/tests-diagnosis/con-20022341
anonym. http://www.mayoclinic.org/diseases-conditions/pelvic-inflammatorydisease/basics/complications/con-20022341
anonym. http://www.nhs.uk/Conditions/Pelvic-inflammatorydisease/Pages/Complications.aspx
anonym. http://www.acog.org/Patients/FAQs/Pelvic-Inflammatory-Disease-PID
Kumar, V. ROBBINS AND COTRAN PATHOLOGIC BASIS OF DISEASE, 8/E.
Philadelphia ; Saunders Elsevier . 2010

Porth, C.M. Pathophysiology; concept of altered health 8th edition. China ;

wolters kluwer. 2009