Pelvic inflammatory disease

1 Overview

Pelvic inflammatory disease refers to inflammation of the female pelvic reproductive organs, the connective tissue around the uterus and the pelvic peritoneum. Chronic pelvic inflammatory disease is often delayed due to incomplete treatment in the acute phase. Its onset lasts for a long time and the condition is more stubborn. Bacterial retrograde infection travels through the uterus and fallopian tubes to the pelvic cavity. But in real life, not all women will suffer from pelvic inflammatory disease, only a minority will suffer from it. This is because the female reproductive system has a natural defense function. Under normal circumstances, it can resist bacterial invasion. Only when the body's resistance decreases or a woman's natural defense function is destroyed due to other reasons will pelvic inflammatory disease occur. occurrence of inflammation.

Two causes

1. Postpartum or post-abortion infection: The mother is weak after delivery, the cervix is ??not closed in time due to lochia flowing out, and there is a peeling surface of the placenta in the uterine cavity. Or the birth canal is damaged due to childbirth, or there is residual placenta, fetal membranes, etc., or there is sexual intercourse too early after delivery, and pathogens invade the uterine cavity and easily cause infection; vaginal bleeding lasts too long during spontaneous abortion or medical abortion, or there is tissue Post-abortion infection can occur if it remains in the uterine cavity or if the aseptic operation of the abortion surgery is not strict.

2. Infection after intrauterine surgical procedures: such as placement or removal of intrauterine ring, dilation and curettage, fallopian tube drainage, hysterosalpingography, hysteroscopy, submucosal uterine fibroid removal Surgery, etc., due to preoperative sexual life or lack of strict surgical disinfection or improper selection of preoperative indications, acute infection occurs and spreads after surgery; some patients do not pay attention to personal hygiene after surgery, or do not follow medical advice after surgery, which can also cause Bacterial ascending infection causes pelvic inflammatory disease.

3. Poor menstrual hygiene: If you do not pay attention to menstrual hygiene, use unclean sanitary napkins and panty liners, menstrual bathing, menstrual sexual intercourse, etc., pathogens can invade and cause inflammation.

4. Inflammation of adjacent organs spreads directly: the most common ones are appendicitis and peritonitis, because they are adjacent to female internal reproductive organs, inflammation can spread directly, causing pelvic inflammation; when suffering from chronic cervicitis, Inflammation can also cause pelvic connective tissue inflammation through lymph circulation.

5. Others: acute attacks of chronic pelvic inflammatory disease, etc.

Three categories

1. Hydrosalpinx and fallopian tube ovarian cyst

After the fallopian tube is inflamed, the fimbriae end is adhesions and atretic, and the tube wall exudes serous fluid and pools. It slips into the lumen of the tube to form hydrosalpinx; sometimes hydrosalpinx can also form after the pus from pyosalpinx is absorbed; if the ovaries are involved at the same time, a fallopian tube ovarian cyst is formed.

2. Salpingitis

It is the most common pelvic inflammatory disease; the fallopian tube mucosa and stroma are destroyed by inflammation, causing the fallopian tube to become thickened and fibrotic, resulting in a cord-like shape or further causing the fallopian tube to become thickened and fibrotic. The ovaries and fallopian tubes adhere to surrounding organs, forming a hard and fixed mass.

3. Chronic pelvic connective tissue inflammation

It is most common for inflammation to spread to the parametrial connective tissue and uterosacral ligaments; the local tissue thickens, hardens, and spreads outward in a fan-shaped manner. Directly reaching the pelvic wall, the uterus is immobilized or pulled toward the affected side.

Four clinical manifestations

There are two types of pelvic inflammatory disease: acute and chronic:

1. Acute pelvic inflammatory disease

The symptom is lower abdominal pain , fever, increased vaginal discharge, abdominal pain that is persistent and aggravated after activity or sexual intercourse. If the condition is severe, chills, high fever, headache, and loss of appetite may occur. People with the disease during menstruation may experience increased menstrual flow and prolonged menstruation. If pelvic inflammatory disease wraps up and forms a pelvic abscess, it may cause local compression symptoms. Compression of the bladder may cause frequent urination, painful urination, and difficulty in urination; compression of the rectum may cause tenesmus, etc. The further development of acute pelvic inflammatory disease can cause diffuse peritonitis, sepsis, and septic shock, which can be life-threatening in severe cases.

Acute pelvic inflammatory disease is mostly a mixed infection of aerobic and anaerobic bacteria. The main causes of acute pelvic inflammatory disease are: 1) Postpartum or post-abortion infection 2) Infection after intrauterine surgery 3) Poor menstrual hygiene 4) Direct spread of inflammation in adjacent organs 5) Acute attack of chronic pelvic inflammatory disease, etc.

2. Chronic pelvic inflammatory disease

It is caused by the failure of complete treatment of acute pelvic inflammatory disease or the protracted course of the disease due to poor physical condition of the patient. The symptoms of chronic pelvic inflammatory disease are distension of the lower abdomen. Pain and soreness in the lumbosacral region often worsen after exertion, sexual intercourse, and before and after menstruation. Followed by abnormal menstruation, irregular menstruation. Over a long period of time, some women may develop symptoms of neurasthenia such as lack of energy, general discomfort, and insomnia. It often persists for a long time and relapses, leading to infertility and fallopian tube pregnancy, seriously affecting women's health.

What are the main clinical manifestations of chronic pelvic inflammatory disease?

1) Systemic symptoms are mostly inconspicuous, sometimes with low-grade fever and susceptibility to fatigue. The course of the disease is long, and some patients may have symptoms of neurasthenia. 2) Scar adhesions and pelvic congestion caused by chronic inflammation can cause lower abdominal distension, pain and lumbosacral soreness, which are often aggravated by exertion, sexual intercourse, and before and after menstruation. 3) Due to pelvic blood stasis, patients may have increased menstruation, damaged ovarian function may cause menstrual irregularities, and fallopian tube adhesion and obstruction may cause infertility.

·The reason for the higher incidence of chronic pelvic inflammatory disease

Pelvic inflammatory disease, especially chronic pelvic inflammatory disease, is a very common gynecological disease.

In our country, due to limitations of personal hygiene and medical conditions, a lack of awareness of aseptic procedures in minor gynecological surgeries and family planning surgeries, and patients not paying attention to personal hygiene when intrauterine devices are widely used, the incidence of pelvic inflammatory disease has increased. The rate is very high. With the increasingly frequent foreign exchanges, the incidence of sexually transmitted diseases in our country is increasing year by year, and the number of pelvic inflammatory diseases caused by this is also increasing. This situation is more obvious in areas with weak sexual awareness, chaotic sexual life and high incidence of sexually transmitted diseases.

Five examinations

1. Direct smear of secretions

The sampling can be vaginal, cervical secretions, urethral secretions, or abdominal fluid (through posterior fornix, abdominal wall, or obtained through laparoscopy), make direct thin-layer smear, dry and stain with methylene blue or Gram. If gram-negative diplococci are seen in polymorphonuclear leukocytes, it is gonorrhea infection. Because the detection rate of cervical gonococci is only 67%, a negative smear does not rule out the presence of gonorrhea, while a positive smear is specific. Microscopic examination of Chlamydia trachomatis can use fluorescein monoclonal antibody dye. A star-like flashing fluorescent spot is observed under a fluorescence microscope, which is considered positive.

2. Pathogen culture

The source of the specimen is the same as above. It should be inoculated on Thayer-Martin medium immediately or within 30 seconds, and cultured in a 35°C incubator for 48 hours. Bacterial identification. The new relatively fast chlamydial enzyme assay replaces the traditional chlamydial detection method. Mammalian cell culture can also be used to detect Chlamydia trachomatis antigen. This method is an enzyme-linked immunoassay.

Bacteriological culture can also obtain other aerobic and anaerobic strains and serve as the basis for selecting antibiotics.

3. Posterior fornix puncture

Posterior fornix puncture is one of the most commonly used and valuable diagnostic methods for gynecological acute abdomen. Through puncture, the contents of the abdominal cavity or utero-rectal fossa obtained, such as normal peritoneal fluid, blood (fresh, old, clotted blood, etc.), purulent secretions or pus, can further clarify the diagnosis. Microscopic examination of the puncture material and training are even more necessary.

4. Ultrasound examination

Mainly B-mode or gray-scale ultrasound scans and films. This technology is useful for identifying masses or abscesses caused by adhesion of the fallopian tubes, ovaries and intestinal tubes. There is 85% accuracy. However, mild or moderate pelvic inflammatory disease is difficult to show on B-mode ultrasound images.

5. Laparoscopy

If it is not diffuse peritonitis and the patient is generally in good condition, laparoscopy can be performed on patients with pelvic inflammatory disease or suspected pelvic inflammatory disease and other acute abdomen. Microscopic examination can not only confirm the diagnosis and differential diagnosis, but also make a preliminary determination of the extent of pelvic inflammatory disease.

6. Examination of the male partner

This is helpful in the diagnosis of female pelvic inflammatory disease. The male's urethral secretion can be directly stained with a smear or cultured for diplococcus gonorrhoeae. If positive is found, it is strong evidence, especially in those with asymptomatic or mild symptoms. Or more white blood cells may be found.

Six diagnosis

1. Minimum standard

Cervical lifting pain or uterine tenderness or adnexal tenderness.

2. Additional criteria

The body temperature exceeds 38.3℃; mucopurulent secretions are present in the cervix or vagina; a large number of white blood cells are seen in the 0.9% NaCl smear of vaginal secretions; the erythrocyte sedimentation rate is increased; Elevated blood C-reactive protein; laboratory-confirmed positive cervical Neisseria gonorrhoeae or Chlamydia.

3. Specific criteria

Endometrial biopsy shows histological evidence of endometritis; transvaginal ultrasonography or magnetic resonance imaging shows fallopian tube wall thickening, Luminal effusion, concurrent or uncomplicated pelvic effusion, or fallopian tube and ovarian abscess; abnormal findings consistent with PID during laparoscopy.

For patients with a history of acute pelvic inflammatory disease and symptoms and signs, the diagnosis is usually easy. However, sometimes patients have more symptoms and no obvious history of pelvic inflammatory disease and positive signs. At this time, the diagnosis of chronic pelvic inflammatory disease must be cautious. , to avoid making hasty diagnoses and causing mental burden on patients. Sometimes pelvic congestion or varicose veins in the broad ligament can also produce symptoms similar to chronic inflammation. It is sometimes difficult to differentiate between chronic pelvic inflammatory disease and endometriosis. Dysmenorrhea is more pronounced in endometriosis. If typical nodules can be felt, it will help the diagnosis. Laparoscopy may be performed when identification is difficult. Hydrosalpinx or fallopian tube ovarian cysts need to be differentiated from ovarian cysts. In addition to a history of pelvic inflammatory disease, the former has a sausage-shaped mass with thin cyst walls and surrounding adhesions; while ovarian cysts are generally more round or oval in shape with no surrounding Adhesions, freedom of movement. Pelvic inflammatory adnexal masses are adherent to the surrounding areas and are inactive. They are sometimes confused with ovarian cancer. Inflammatory masses are cystic and ovarian cancer is solid. B-mode ultrasound examination is helpful for identification.

Acute and chronic pelvic inflammatory disease can be diagnosed based on medical history, symptoms, and signs. However, differential diagnosis must be done. The main differential diagnoses of acute pelvic inflammatory disease include: acute appendicitis, ectopic pregnancy, ovarian cyst pedicle torsion, etc.; the main differential diagnoses of chronic pelvic inflammatory disease include: endometriosis and ovarian cancer.

Seven differential diagnoses

1. Pelvic congestion syndrome

It manifests as lumbosacral pain and lower abdominal pain, radiating to the lower limbs, after standing for a long time and after exertion Aggravated. The cervix was purple-blue when examined, but there were no abnormalities in the uterus and appendages, which was inconsistent with the symptoms and signs of pelvic inflammatory disease. The diagnosis can be confirmed through B-ultrasound and pelvic venography.

2. Endometriosis

The main manifestations are secondary progressive dysmenorrhea, accompanied by menstrual irregularities or infertility. The diagnosis can be made if there are tender nodules on the posterior wall of the uterus, uterosacral ligaments, and posterior depressions. In addition, patients with chronic pelvic inflammatory disease who fail to respond to long-term treatment should consider the possibility of endometriosis.

3. Ovarian tumors

Ovarian malignant tumors can also appear as pelvic masses, which are adherent to the surrounding areas, immobile, tender, and easily confused with inflammatory masses. However, his general health condition is poor, his condition develops rapidly, and his pain is persistent and has nothing to do with the menstrual cycle. B-ultrasound examination shows an abdominal mass, which is helpful for diagnosis.

Eight treatments

1. Drug treatment

Antibiotics are the main treatment for acute pelvic inflammatory disease, including intravenous infusion, intramuscular injection or oral administration. way. Broad-spectrum antibiotics should be used in combination with anti-anaerobic drugs, and attention should be paid to an adequate course of treatment. And it can be combined with traditional Chinese medicine treatment in order to achieve better results.

2. Traditional Chinese medicine treatment. Our "Wenxi Pregnancy Aid Decoction" is a secret recipe of traditional Chinese medicine adapted by three generations of doctors. It is a combination of more than 40 years of painstaking medical experience and clinical verification practice, and is gradually perfected. It mainly regulates menstruation and assists pregnancy, nourishes qi and blood, and nourishes body fluid. It can regulate female endocrine, improve the body's immunity, resist pathogenic microbial infections in the reproductive system, promptly eliminate local congestion and edema in the appendages and surrounding tissues, and effectively solve difficult and chronic diseases such as pelvic inflammatory disease. It can adjust the endometrium, accelerate the growth rate of dominant follicles, improve cervical mucus secretion, increase the opportunity for sperm and egg to combine, and can effectively increase the implantation rate of fertilized eggs in a timely manner. This prescription is one of the most commonly used prescriptions by pregnancy media professors to treat infertility. Those who are satisfied with the results can see the results within one month, and the results are particularly good after two or three months.

3. Surgical treatment

Those with masses such as hydrosalpinx or fallopian tube ovarian cysts can be treated surgically; those with small infection foci and repeated inflammation are also suitable for surgical treatment. Surgery is based on the principle of complete cure to avoid the chance of recurrence of remaining lesions, and adnexectomy or fallopian tube resection is performed. For young women, ovarian function should be preserved as much as possible. Monotherapy for chronic pelvic inflammatory disease is less effective, and comprehensive treatment is appropriate.

4. Physical therapy

The benign stimulation of warmth can promote local blood circulation in the pelvis. Improve the nutritional status of tissues and increase metabolism to facilitate the absorption and resolution of inflammation. Commonly used methods include short wave, ultra-short wave, iontophoresis (various drugs can be added such as penicillin, streptomycin, etc.), wax therapy, etc. In traditional Chinese medicine, there are also methods for treating collapsing stains using traditional Chinese medicine.

5. Psychotherapy

General treatment relieves patients' ideological concerns, enhances confidence in treatment, increases nutrition, exercises, pays attention to the balance between work and rest, and improves the body's resistance.