Pelvic inflammatory disease by Dr.Shuchita

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PELVIC INFLAMMATORY DISEASESAnd Its Therapeutics

• By Dr. SHUCHITA CHATTREE
• M.D (PGR)
• Department of Materia Medica
• Homoeopathy University, Jaipur

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UTERUS AND APPENDAGES
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Defination

• Pelvic Inflammatory Disease refers to the
  inflammation of Upper Genital Tract involving
  fallopian tubes as well as ovaries.

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EPIDEMIOLOGY
A crude marker of PID in developing countries can
be obtained from the reported hospital admission
rates . It accounts for 3-10 in India
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Estimates of the annual incidence of PID
according to W.H.O.
Between 9.5 to 14 cases per 1,000 fertile women,
with a higher rate of 18 to 20 per 1,000 among
women aged 15 to 24 years.
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Etiology

• Post Abortal and Peuperal Sepsis.
• Hysterosalpingiography can cause ascending
  infection.
• Manual Removal of Plecenta and evacuation of
  products of conceptions.
• Use of IUCD has increase the risk of pelvic
  infection by three folds.
• Pelvic peritonitis due to appendicitis and
  diverticulitis may spread to involve fallopian
  tube of that side.
• Tuberculosis is blood borne in most of the
  cases.

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Risk Factors
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The most common etiologic agents in PID are

• Neisseria gonorrhoeae
• Chlamydia trachomatis
• Anaerobic bacterial species found in the vagina,
  particularly Bacteroides
• Anaerobic gram-positive cocci, (
  Peptostre-ptococci),
• E.coli
• Mycoplasma hominis and M.urealyticum.
• NOTE
• These organisms initially cause lower genital
  tract infections and then spread in to the
  genital tract via the endometrium.

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Note
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PID History Examination

• Abdominal pain (usually bilateral and in the
  lower quadrants),
• Abnormal Vaginal discharge,
• Fever, and/or chills Nausea or vomiting
• Dysuria,
• Menometrorrhagia,
• Onset of pain in association with menses,
• Dyspareunia

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• Backache
• General malaise
• Loss of appetite
• Tachycardia
• Tongue coated (shows dehydration)

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EXAMINATION

• Abdominal Examination
• Speculum Examination
• Bimanual Examination

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Investigations of PID

• Haemoglobin count may be low
• Leucocyte count raised (gt10,000 percumm)
• Erythrocyte sedimentation rate (ESR) raised
• C-reactive protein is increased to 20 to 30 mg/dl
  or more.
• Culture of cervical and high vaginal swab for
  both aerobic and anaerobic organisms.
• If gonorrhoea is suspected urethral swab culture.

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• Direct Chlamydial smear enzyme immunoassay and
  direct immunofluorescence examination of the
  smear.
• If bacteraemia sets in-Blood culture.
• Blood urea serum electrolytes
• Serological test for syphilis should be carried
  out for both partners.
• Culdocentesis - To rule out an ectopic pregnancy
  and to establish the diagnosis of a pelvic
  abscess.
• Laproscopic examination-The pus extruding from
  the fimbrial end adhesions are sure signs of PID.

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• Ultrasound It is of limited value. It is helpful
  in distinguishing an adenexal abscess.
• C T scan
• MRI does not give more specific information
  than USG and is expensive

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CT SCAN
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LAPROSCOPIC VIEW
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LAPROSCOPIC VIEW
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CULDOCENTESIS
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Diagnosis of Acute PID CDC Criteria

• Cervical motion tenderness and uterine and
  adnexal tenderness, along with WBCs seen on
  vaginal wet mount.
• Additional supportive criteria to increase the
  specificity
• Oral temperature higher than 101ºF (38.3ºC).
• Abnormal cervical or vaginal mucopurulent
  discharge.
• Elevated erythrocyte sedimentation rate.
• Elevated C-reactive protein level.
• Laboratory documentation of cervical infection
  with N.gonorrhoeae or C trachomatis

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Chronic PID History and Examination

• Symptoms suggestive of chronic PID include
• History of previous pelvic infection.
• Constant lower abdominal pain which get worse
  before menses.
• Low backache.
• Dyspareunia.

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• Vaginal discharge may be absent.
• Menorrhagoea.
• Polymenorrhoea
• Congestive dysmenorrhea.
• Infertility.
• Rectal irritation.
• Poor general health.

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PELVIC EXAMINATION

• Appendages are found to be tender, thickened and
  fixed.
• At times the uterus and appendages are densely
  adherent to each other and a fixed hard mass
  along with pelvic cellulitis-known as Frozen
  pelvis.

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PID Postmenopausal Women

• Exact mechanism unclear.
• Direct extension from adjacent viscera.
• Uterine instrumentation
• Structural abnormalities (stenosis, polyps, etc)
• Forgotten IUD.
• Degenerating Myomas.
• Postmenopausal vaginal flora (anaerobic)

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• Presenting symptoms include
• Vaginal spotting,
• Bleeding,
• Pain,
• Fever,
• Nausea,
• Change in bowel habits
• Majority have tubo-ovarian abscess USG or CT

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Sequelae of Pelvic Inflammatory Disease

• Reported sequelae occurs in up to 25 of cases
• Infertility (12 to 50)
• Ectopic Pregnancy (6 to 10 fold increase)
• Chronic pelvic pains (18)
• Psychological disorders

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Differential Diagnosis

• Acute PID

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Differential DiagnosisChronic PID
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Miasmatic Analysis
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• The most frequent location of the sycotic
  manifestations in women is in the pelvic organs.
• Pelvic inflammations such as oophoritis,
  salpingitis in fact,all the inflammatory disease
  of the female pelvis may be traced to this taint.
• In the more chronic types we get cystic
  degeneration of the ovaries, the uterus and the
  fallopian tubes.
• Syphilitic miasm seldom attacks the ovaries or
  uterus.
• (The principles and art of cure by homoeopathy
  Herbert A . Robert )

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• Sycosis is generally understood to be the
  gonorrhoeal poison. We should make the
  distinction clear between gonorrhoea sycosis.
• Gonorrhoea is the acute infection of the
  gonococci, which takes from 5 to 10 days to
  develop a urethritis after an exposure. During
  this incubation period it is purely an infection
  then the local manifestations are thrown outward
  by nature at the point of attack as a resentment
  of the vital energy to the infection.
• If the gonorrhoea thoroughly completely cured,
  practically no sycosis ever develops.

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• Sycosis is established after a suppressed
  gonorrhoea, when the acute infection is driven in
  upon the vital energy by external methods of
  suppression, and it then become a systematic
  stigma.
• PID Sycotic
  manifestation
• (The principles and art of cure by homoeopathy
  H.A.Roberts)

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HOMOEOPATHIC THERAPEUTICS
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ACONITE

• Ovaries congested and painful , sharp shooting
  pain in uterus.
• Fever with dry, hot skin and burning thirst for
  large quantities of cold water.
• Cold stage most marked , sweat gt

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APIS MELIFICA

• Ovaritis worse in rt. Ovary , endometritis with
  soreness burning , stinging pain suddenly
  migrating from one part to another.
• Incontinence of urine with great irritation of
  the parts.
• Thirstless except during chill stage before fever
• Pt. Is hasty ,awkward, drops thing while
  handling. Indifferent weeping tendency.
• ltwarmheated room , gtcold water,open air ,
  uncovering.

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ARSENIC ALBUM

• Burning pain in ovarian region, stitching pain in
  pelvis extending down the thigh.
• Leucorrhoea acrid , burning ,offensive and thin ,
  causes great fatigue.lt least exertion gtwarm room.
• Burning thirst without special desire to drink,
  takes little quantity of cold water often, just
  to moisten dry mouth.
• High fever with marked exhaustion, mental
  restlessness and fear of death. Pt. thinks it is
  useless to take medicine with aversion to meet
  people.

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AURUM MURIATICUM NATRONATUM

• Useful in chronic PID ,Chronic metritis
  prolapse.
• Uterus fills up whole pelvis, ulceration of neck
  of womb vagina, cervix ovaries indurated,
  ossified uterus.
• Leucorrhoea with spasmodic contraction of vagina.
• Young girls with palpitation

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BELADONNA

• Acute inflammatory condition.
• Cervical mucous membrane is very congested and
  red.
• Pressing downwards as if the contents of abdomen
  would issue from the vulva gt standing and sitting
  erect worse morning.
• Dryness and heat of vagina .
• Menses bright red, too early, too profuse and HOT
  and offensive.
• Fever with burning heat and without thirst.
• Superficial blood vessels distended.

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CALCAREA CARBONICA

• Leucophlegmatic constitution tendency to
  obesity.
• Useful in pelvic abscess, tendency to form
  abscess in deep muscles , uterus easily
  displaced. Before menses- headache,colic
  ,chilliness , leucorrhoea(milky). breast tender
  swollen .
• During menses cutting pain in uterus.
• Menses too early,too profuse,too long with
  vertigo, toothache cold, damp feet.
• The least mental excitement causes profuse return
  of menses.

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MEDORRHINUM

• For women with chronic ovaritis, salpingitis ,
  pelvic cellulitis, fibroids, cysts, post
  menopausal PID.
• Pelvic abscess as a result of STDs or due to
  septic abortion.
• Adhesions of the surrounding organs , tendency to
  outgrowth and malignant changesOvarian pain worse
  lt. side or from ovary to ovary. Infertility.

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• Menses offensive, profuse, dark, clotted, stains
  difficult to wash out. Metrorrhagia .Intense
  dysmenorrhoea. Leucorrhoea thin, acrid
  excoriating, fishy odour.
• Sycotic warts on genital, burning palms soles ,
  ravenous hunger immediately after eating with
  constant thirst.

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MERCURIUS SOLUBILIS

• Chronic cervicitis ovaritis, suppressed STDs.
• Stinging pain in ovaries, sensation of rawness in
  parts.
• Menses profuse with abdominal pain. Leucorrhoea
  excoriating, greenish bloody.
• Sweetish metallic taste , profuse salivation,
  tongue large ,flabby ,shows imprint of teeth ,
  intense thirst with moist mouth.

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PLATINA

• Intense vaginismus with chronic cervicitis.
• Platina lady is prone to get recurrent urogenital
  infections resulting in oophoritis, salpingitis
  endometritis resulting in sterility.
• Sexual organs exceedingly sensitive, cannot bear
  the napkin to touch her, will go in to spasm from
  an examination, vulva painfully sensitive during
  coitus, will faint during coitus nymphomania,
  excessive sexual development.

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SABINA

• Inflammation of ovaries or uterus after abortion,
  premature labor . Pt. tendency to
  miscarriages,esp. at 3rd month.
• Haemorrhage from the uterus flow partly pale
  red, partly clottedworse from least motion gt by
  walking ,pain extending from sacrum to pubes.
• Menses too early, too profuse, too protracted
  in women who menstruated very early in life flow
  in paroxysms with colic labor like pain .
  Menorrhagia - during climacteric.

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MUREX PURPUREA

• Useful in post menopausal PID, chronic
  Endometritis with displacement in nervous,
  lively, affectionate women.
• Sore pain in uterus a distinct sensation of a
  womb.
• Bearing down sensation,as if internal organs
  would be pushed out, must sit down cross limbs
  togt pressure.

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• Menses irregular, early profuse, protracted,
  large clots.
• Leucorrhoea green or blood , happier when
  leucorrhoea is worse.
• Nymphomania least contact of parts,causes
  violent sexual excitement.

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OTHER IMPORTANT MEDICINES

• Pulsatilla
• Sepia
• Lachesis
• Cimicifuga

• Kreosotum
• Lilium tigrinum
• Trillium
• Pyrogen
• Bryonia , etc .

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REPERTORIAL ANALYSIS
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Synthesis rep.9.0
FEMALE GENITALIA/SEX - PELVIC inflammatory
disease sep.
-
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Murphys Repertory
Diseases - PELVIC inflammatory disease,
uterus Acon. Agn. alum. APIS Arn. ARS. Aur-m.
Aur. BELL. Bry. bufo Cact. calc. CANTH. Carb-an.
carbn-s. caul. Cham. chin. cocc. Coff. coloc.
con. croc. ferr-ar. ferr. graph. Ham. Hep. hydr.
Hyos. hyper. ign. Iod. ip. iris kali-c. kali-p.
kreos. LAC-C. LACH. LYC. Lyss. mag-m. MED. Merc.
Nux-v. op. ph-ac. Phos. PULS. Rhus-t. Sabad.
SABIN. SEC. Sep. Sil. Stram. Sulph. TER. thuj.
Verat-v. Verat. vib. visc.
-.
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Murphys Repertory
Diseases - PELVIC inflammatory disease, uterus -
acute Acon. ant-i. Apis arn. Ars. Bell. Bry.
canth. cham. chin. Cimic. con. Gels. hep. hyos.
Iod. kali-c. kali-i. lach. lil-t. Mel-c-s.
Merc-c. nux-v. op. ph-ac. plat. Puls. rhus-t.
Sabin. Sec. Sep. Sil. stram. sulph. ter. til.
Verat-v.
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Murphys Repertory
Diseases - PELVIC inflammatory disease, uterus -
chronic alet. aloe Ars. Aur-m-n. Aur-m. borx.
Calc. carb-ac. caul. chinin-ar. Cimic. Con.
graph. Helon. Hydr. hydrc. inul. Iod. Kali-bi.
kali-c. kali-s. kreos. lach. Mag-m. Mel-c-s.
merc. Murx. nat-m. nit-ac. Nux-v. Ph-ac. phos.
plb. Puls. rhus-t. Sabin. Sec. Sep. sil. stram.
Sulph. visc.
-Murphys Repertory.
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Murphys Repertory

• Diseases - PELVIC inflammatory disease, uterus -
  bleeding, after ars. Chin. ham. led. phos. Sec.
  Thlas.
• Diseases - PELVIC inflammatory disease, uterus -
  chronic - congestion, with arterial bell. lil-t.
  Sabin.
• Diseases - PELVIC inflammatory disease, uterus -
  chronic follicular Hydr. hydrc. iod. merc.

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Kents Repertory

• FEMALE GENITALIA - INFLAMMATION - Uterus -
  emotional excitement, fromHyos.
• FEMALE GENITALIA - INFLAMMATION - Uterus - anger,
  afterCham.
• FEMALE GENITALIA - INFLAMMATION - Uterus
  -haemorrhage, after Chin.
• FEMALE GENITALIA - INFLAMMATION - Uterus -
  indignation, from Coloc.
• FEMALE GENITALIA - INFLAMMATION - Uterus joy,
  excessiveCoff.
• FEMALE GENITALIA - INFLAMMATION - Uterus - labor,
  after Nux-v. Sabin. Sec.

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References

• Homoeopathic materia medica and repertory- W.
  Boericke.
• Allens key notes.
• Gynaecology obstetric therapeutics Dr.
  Shrikant Kulkarni.
• Shaws textbook of Gynaecology.

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• Miasmatic diagnosis Dr. S K Banerjee.
• The principles and art of cure by homoeopathy-
  Herbert A .Robert
• http//www.cdc.gov.
• http//4women.gov.
• http//www.familydoctor.org.
• Synthesis Repertory9.0 Edition.
• Murphy Repertory.
• Kent Repertory.

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