A CASE PRESENTATION ON ACUTE
PELVIC INFLAMMATORY DISEASE
PRESENTATION BY:
V.PRAVALLIKA,
PHARM D – INTERNSHIP,
14441T0024,
PRRMCP-KADAPA.
PATIENT DEMOGRAPHICS
Patient Name : Mrs. X
Age/Gender : 31 Years / Female
Admission No (IP) : 12942
Department : Gynecology( Pre-ope) unit –I
Date of Admission : 18/3/2019
Date of Discharge : 27/3/2019
Consultant Doctor : Dr. Lakshmi Susheela Madam
Provisional Diagnosis : Chronic Cervicitis
SUBJECTIVE EVALUATION:
A 31 years female patient of height 5 feet 2 inches &
weight 61 Kg’s was admitted in Gynecology unit-I with
Chief complaints of excessive white discharge per vagina
since 9 years , foul smelling not associated with pruritus
but associated with dull aching pain in lower abdominal
region , no complaints of fever & menstrual irregularities.
On past medical History reveals that patient came to
RIMS on 25-feb-2019 with complaints of white discharge
,itching & foul smelling& diagnosed with Chronic
Cervicitis. Treated with KIT-6,Tab.Cyclopam-
BD,Tab.Rantac-BD for 1 week.
Past surgical History shows Tubectomy scar +
Past Menstrual history shows that patient had attained
menarche at 13 years of age with regular cycles 3-5/30
days not associated with clots but associated with
Dysmenorrhea .
Marital history – Marital life of 19 years ,
Non –Conssagious marriage.
Obstetric History- G3P3L3
1st-FTNVD at home/mch /17 yrs- active & healthy
2nd-FTNVD at home/mch /14 yrs- active & healthy
3rd-FTNVD at hospital/Fch /10 yrs- active & healthy
On past history interview , No allergies were
reported in patient due to food , medications &
environment etc.
Personal History shows that the patient had a
mixed diet & normal appetite & sleep & Normal
bowel and bladder habits.
Family history of the patient is irrelevant with her
present condition.
OBJECTIVE EVALUATION :
On General examination – Patient was conscious &
coherent
On physical examination - B.P-120/80 mm of Hg ,P.R-
80 beats/min,R.R-21Cpm,Temp-Afebrile, patient was
Pallor
On systemic examination – CVS-S1S2+,R.S-
BLAE+,CNS-NAD, P/A-soft, non-tender , Tubectomy
scar +.
Local Examination- P/S-Cervix- Hypertrophied &
Erosion positive on both lips
BME- Uterus – Anteverted , regular , mobile , No
fornicular tenderness
Parameter Obtained Reference
value value
Hemoglobin 9 gms/dl 12-15 gms/dl
↓
Platelets 1.5Lakhs 1.5-4.0 lakh/cu
mm
ESR 32mm/hr 0-20mm/hr
T.Bilirubin 0.5 mgs/dl 0.3-1.2 mgs/dl
Creatinine 0.7 mgs / dl 0.5-1.5mg/dl
Blood group A+
Hbs Ag Negative
HIV Non-Reactive
USG: Thickened Endometrium 17mm
Based on Subjective evaluation (White discharge per
vagina with foul smelling , lower abdominal pain & Past
medical history) & Objective evaluation (System
examination , Bimanual examination & Elevated ESR &
USG abdomen & pelvis)the patient was diagnosed with
“ACUTE PELVIC INFLAMMATORY
DISEASE”
The condition is Acute.
The cause of this condition is infection ( Chronic
Cervicitis ).
Generally it is curable on regular medication , if left
untreated it may lead to complications like Chronic PID,
Ectopic Pregnancy.
DAY I Rx
O/E 2ʘBlood transfusion
Pt was conscious & 1ʘBlood Reserve
coherent Cap. Doxycycline -100 mg-
pallor-present BD
BP-120/80mm of Hg Tab.Metrogyl-400mg-TID
PR-80 bpm, temp- Tab.B.C/Tab.IFA/TabVIT.C/
Afebrile Tab.Calcium-OD
CVS-NAD,RS-BLAE Protein diet
Thyroid , breast , spine –
Normal
P/A-soft & nontender
Rx
High protein diet
DAY-2-4 Plenty of oral fluids
O/E pt was conscious & Inj.Taxim-1gm-IV-BD
coherent Inj.Metrogyl-0.5gm/100ml-IV-
Pallor+ TID
P.R-84bpm,B.P-120/80 Inj.Cyclopam-200mg/2ml-IM-
mm of Hg,RS,CVS- BD
NAD,P/A-soft ,nontender IVF-1 RF,1NS,1 DNS
DAY 5 Rx
O/E High protein diet
Pt was conscious & Plenty of oral fluids
coherent
Inj.Taxim-1gm-IV-BD
pallor-present
Inj.Metrogyl-0.5gm/100ml-IV-
BP-110/80mm/Hg
PR-80bpm, temp- Afebrile TID
CVS-NAD,RS-BLAE Inj.Cyclopam-200mg/2ml-IM-
Thyroid , breast , spine – BD
Normal IVF-1 RF,1NS,1 DNS
Rx
Medication error: No Anti
CST
Blood transfusion done ulcerative were prescribed
TIME(3:00-6:00pm) ADR: Antibiotics induced
P.R-84 bpm Dyspepsia & Abdominal
B.P-110/80 discomfort
RS/CVS-NAD Intervention: Advised to
Other reactions-Nill house surgeon
DAY 6 Rx
C/o Generalized CST
weakness Dyspepsia & IVF-1NS,1 DNS @ 100ml/hr
Abdominal discomfort Inj.Pantop-40 mg-IV-OD
O/E pallor + Plan for cervical biopsy
tomorrow.
DAY 7
Pre-op Instructions Cervical Biopsy Performed
NBM from 6 am onwards Findings:
Consent for biopsy Mucoplurulent discharge
Inj.Ceftriaxone-1gm-IV 1 present.
hr before surgery Cervix Hypertrophid
Inj.TT 0.5 cc IM Bleeding on touch +
Local parts preparation P/v-RV,NS,Mobile,FT
DAY 8
O/E
Pt was conscious Rx
&coherent CST
pallor –present
PR-84 bpm
BP-120/80 mm /Hg
CVS-NAD, RS-BLAE
P/A-Soft, nontender DISCHARGEMEDICATION
Rx
Cap. Doxycycline -100 mg-BD
Tab.Metrogyl-400mg-TID
Tab.Cyclopam-335mg BD
Tab.Pantop -40mg OD
DAY 9: Sucralfate Suspension-10ml-TID
Planned to discharge as it High protein diet
takes time to get biopsy
report X 5 days
Review : After getting Biopsy reports
Drug Indication normal Prescribe Freq RO Start-
Dose d Dose uency A End
I.Taxim To treat PID 50mg/kg 1 gm BD IV Day 2-8
I.Metrogyl To treat PID 7.5 mg/kg 0.5 TID IV Day 2-8
gm/100ml
I.Cyclopam To treat Abdominal 4-12 mg/day 200mg/2m OD IM Day 2-8
pain l
DRUG CHART
I.Pantop To treat dyspepsia & 1.0-2.0 40mg OD IV Day 6-8
abdominal mg/kg
discomfort
T.Iron Folic To maintain Hb Daily rqmnt: 335.5mg OD P.O Day 1
Acid levels 17.0-18.9
mg/day
T.B.Complex To strengthen & 1-15 mg /kg 67mg OD P.O Day1
nourish the body .
T.Vitamin C To promote healing Daily rqmnt: 500mg OD P.O Day 1
& for iron 65-90mg/day
absorption
T.Calcium To enhance Bone Daily rqmt: 500mg OD P.O Day1
strength 1000mg/day
C.Doxycycline To treat PID 1-3mg/kg 100mg BD P.O Day 1
CLINICAL PHARMACIST CARE
ISSUES :
The prescription was found to be “IRRATIONAL”
because ADR occurred due to Medication Error
ADR: Antibiotics induced Abdominal discomfort &
Dyspepsia
MEDICATION ERROR: No Anti ulcerative were
prescribed for 5 days , even though the prescription
contains 2 antibiotics
INTERVENTION: On intervention , antibiotics
were prescribed.
The prescription contains minor potential drug –drug
interaction between Sucralfate Suspension &
Cap.Doxycycline-Sucralfate decreases the absorption
of Doxycycline from GIT.
PATIENT COUNSCELLING :
REGARDING DISEASE:
I have counseled the patient that PID is the inflammation of
genital tract i.e Cervix, fallopian tubes & ovary.
I have said to the patient that it has symptoms like Vaginal
Discharge , Lower abdominal pain, Vomiting's , irregular
menstrual cycle..
I have said to the patient that the cause of this condition is due
to infections ( chronic Cervicitis).
I have said to the patient that this condition is curable with
medications ,if untreated it may lead to complication like
Chronic pelvic inflammatory disease & Ectopic Pregnancy ,
Infertility.
I have counseled the patient that improper maintenance of
personal hygiene & presence of STD’s are some of the risk
factors of AUB.
CAP. DOXYCYCLINE:
I have advised the patient to take Cap.Doxycycline
of 100mg twice a day after intake of food orally
with glass full of water up to 5 days.
I have said the patient that it is given to treat PID
I have advised the patient to store it in a room
temperature away from sunlight & Moisture.
I have said the patient , not to take any of the milk
products along with this medication.
I have advised the patient that it may have side
effects like Hypersensitivity , Photo sensitivity ,
Diarrhea , Temporary staining of teeth in adults.
TAB. METRONIDAZOLE:
I have advised the patient to take Tab.
Metronidazole of 400mg thrice a day after intake
of food orally with glass full of water up to 5 days.
I have said the patient that it is given to treat PID
& for prophylaxis to treat both aerobic & anaerobic
infections.
I have advised the patient to store it in a room
temperature away from sunlight & Moisture.
I have advised the patient that it may have side
effects like Metallic Taste , Abdominal cramps,
Disulfuram like reactions when taken with alcohol.
TAB. CYCLOPAM:
I have advised the patient to take Tab. Cyclopam
of 335mg twice a day after intake of food orally
with glass full of water up to 5 days.
I have said the patient that it is given to treat
Abdominal pain.
I have advised the patient to store it in a room
temperature away from sunlight & Moisture.
I have advised the patient that it may have side
effects like Abdominal Bloating, Dry mouth,
Blurry vision , Constipation , Fluctuations in heart
rate.
TAB. PANTOP:
I have advised the patient to take Tab. Pantop of
40mg once a day after intake of food orally with
glass full of water up to 5 days.
I have said the patient that it is given to treat
Abdominal discomfort & dyspepsia.
I have advised the patient to store it in a room
temperature away from sunlight & Moisture.
I have advised the patient that it may have side
effects like flatulence , Diarrhea /Constipation ,
bloating.
SUCRALFATE SUSPENSION:
I have advised the patient to take Sucralfate
Suspension of 10ml thrice a day 30 min before
intake of food orally up to 5 days.
I have said the patient that it is given to treat
Abdominal discomfort & dyspepsia.
I have advised the patient to store it in a room
temperature away from sunlight & Moisture.
I have advised the patient to wash the cap of the
bottle thoroughly with water after use.
I have advised the patient that it may have side
effects like flatulence , Diarrhea /Constipation ,
bloating.
I have said to the patient ,that incase of occurrence of
any side effects report to physician immediately.
LIFE STYLE MODIFICATIONS :
I have advised the patient to take Iron rich foods like
jaggery , ground nuts , red meet , liver , leafy
vegetables, banana ,dry fruits.
I have advised the patient to avoid oily & foods .
I have advised the patient to take Vit.C rich foods like
citrus fruits , Amla , Lemon.as they enhances iron
absorption & advised to take garlic ,apples .
Advised to maintain good personal hygiene &
maintain adequate measures for prevention of STD’s.
Advised to strictly adhere to medication regimen
DEFINITION:
Pelvic Inflammatory disease implies the
inflammation of Upper genital tract involving fallopian
tubes & ovaries due to infections.
ETIOLOGY & PATHOPHYSIOLOGY:
Alteration of natural barriers
• Intact hymen prevents ascending infections
• Acidity of vaginal secretions
• Ciliary movement is directed downwards ,
prevents the upward spread of non-motile
organisms to the cavity of uterus.
These natural barriers are altered during
menstruation , After Abortion / delivery… Because
Cervical canal gets dilated & protective Endometrium
sheds & alterations in PH , makes condition more
favorable for spread of infections.
Etiology:
• IUD’s
• D&C
• Sexually transmitted infections ( Gonococci &
chlamydial )
• Other Aerobes & Anaerobes( B.fragilis ,actinomyces).
CLINICAL FEATURES:
• Abdominal Pain ( Bilateral & restricted to lower
abdomen )
• Pain is severe in acute stages and accompained with high
body temperature.
• Vomitings
• Dysuria & Vaginal discharge
• Menstrual irregularities.
INVESTIGATIONS :
• Patients complaints
• By clinical diagnosis
• Elevated Leucocyte count
• Elevated ESR
• Urine test for chlamydial infection.
• Laproscopic Examination.
• It is important to test women with PID for HIV testing
and other sexually transmitted infections.
MANAGEMENT:
Goals:
• To treat & minimize patients complaints
• To prevent Complications
• To minimize tubal damage
• To prevent Adhesions.
• To rationalize Drug therapy.
• To minimize side effects from Drug therapy.
Mild cases of acute PID are treated at home with
antibiotics.
Moderate & Severe cases of PID need Hospitalization ,
Those who need the diagnosis to be confirmed also to
be admitted for investigations.
HOSPITAL MANAGEMENT:
• IV fluids ( if Dehydration , vomiting , electrolyte
imbalance )
• Analgesics ( Once diagnosis is confirmed)
• Antibiotics ( It is mandatory to initiate antibiotic
therapy as early as possible , not to wait for culture
reports).
• In many cases of PID, both aerobes & anaerobes form
the bacterial flora & it is essential to administer more
than 1 antibiotic to cure the disease & prevent the
damage to fallopian tubes.
OUT-PATIENT TREATMENT :
THANKING YOU
