salpingitis
Introduction
Introduction to salpingitis Salpingitis is more common in infertile women. The cause is caused by pathogen infection. The pathogens are mainly caused by staphylococcus, streptococcus, Escherichia coli, Neisseria gonorrhoeae, Proteus, Pneumococcal and Chlamydia. The most common time for infection is postpartum, post-abortion or post-menstrual. Injury of the birth canal and placental stripping surface during labor or abortion or wounds of the endometrial exfoliation during menstruation are all ways in which the pathogen infects the internal genitalia. Sometimes infections are associated with less stringent aseptic procedures, such as the placement of intrauterine devices, curettage, tubal fluid, and lipiodol. Sexual life is too frequent, sexual intercourse during menstruation, can also cause infection and fallopian tube inflammation. A small number of patients are caused by the direct spread of inflammation of adjacent organs. For example, appendicitis or other parts of the body are transmitted through the bloodstream to the fallopian tubes to cause infection. basic knowledge The proportion of illness: 0.03% Susceptible people: women Mode of infection: non-infectious Complications: ectopic pregnancy infertility
Cause
Causes of salpingitis
Environmental factors (30%):
Unclean sexual life between husband and wife is very likely to lead to inflammation of the fallopian tube, especially if the husband and wife sex life is too frequent, or during the menstrual period, it is likely to cause fallopian tube infection, resulting in inflammation of the fallopian tube.
Bacterial infection (30%):
Women are very susceptible to infection when doing abortion, especially in some irregular hospitals. The flow of people not only causes inflammation of the fallopian tube due to infection, but also may damage other reproductive organs, which directly leads to infertility in women. Therefore, women must treat the flow of people with care, and must be careful before preparing for the child. Do a good job of contraception.
Disease factors (20%):
Inflammation of tissues or organs around the fallopian tube is likely to cause spasm and fallopian tubes, leading to inflammation of the fallopian tubes. Inflammatory retrograde infections such as cervicitis and endometritis are likely to eliminate the fallopian tubes and cause inflammation of the fallopian tubes, eventually leading to women. Suffering from tubal infertility. Therefore, it is recommended that women with pelvic inflammatory disease should be treated promptly and effectively, so as to better prevent tubal inflammation.
Pathogen infection (10%):
Some pathogen infections are very likely to cause women with tubal inflammation. These pathogens are mainly: streptococcus, staphylococcus, gonococcal, proteobacteria and pneumococcal. Female friends must pay attention to these in their daily life. Pathogen infection. A variety of pathogenic microorganisms such as Neisseria gonorrhoeae, Chlamydia trachomatis, Mycoplasma, and viruses are mixed and infected.
Other factors (10%):
Unclean sex after abortion, postpartum, and menstruation; after abortion, one month after childbirth, there is no sexual life during menstruation. During this period, the cervix is open and susceptible to bacteria.
Prevention
Salpingitis prevention
First, women should pay attention to the personal hygiene of themselves and their sexual partners when they have sex. Before the trip, it is necessary to clean the external genitalia of both men and women to prevent the smooth invasion of germs. When women have bleeding symptoms in the vagina, they should refrain from sexual life.
Second, women should pay attention to their vulva hygiene and personal hygiene; pay attention to prevent infections from sanitary ware and toilets.
Third, the majority of women should pay attention to their own nutrition and health care, strengthen the nutrition after menstruation, after abortion, after childbirth; enhance their physical fitness, increase resistance, immunity, reduce the chance of illness.
Fourth, the need for artificial abortion, childbirth, access to intrauterine device, and other official cavity surgery, should be strictly disinfected, to avoid the bacteria into the vagina and uterus by surgery, artificial infection.
5. Female patients with acute fallopian tube disease should take a semi-recumbent rest to prevent and limit the flow of inflammatory fluids due to changes in body position. Eat high-nutrient, digestible, vitamin-rich foods.
6. Once a woman has an attachment disease, she should abide by the principle of treatment, take a positive attitude, thoroughly treat, and control the condition as soon as possible to prevent chronic changes.
Complication
Salpingitis complications Complications, ectopic pregnancy, infertility
First, triggering ectopic pregnancy, clinical data show that about 98% of ectopic pregnancy occurs in the fallopian tube, when women with salpingitis will cause luminal occlusion, water accumulation or adhesion, will hinder the operation of sperm, egg or fertilized eggs, resulting in fertilized eggs An ectopic pregnancy occurs when the uterine cavity is reached.
Second, the infertility, resulting in female infertility, many of them, but infertility caused by fallopian tube disease accounted for about 30% to 44%, and tubal blockage caused by salpingitis is the biggest culprit of female infertility.
Third, other complications, experts believe that salpingitis is generally associated with the merger, suffering from salpingitis will cause pus and leucorrhea, bilateral abdominal pain, lumbosacral pain, menstrual disorders, etc., seriously endangering the physical and mental health of women with salpingitis.
Symptom
Symptoms of fallopian tube symptoms common symptoms menstrual abdominal pain dysmenorrhea pelvic abscess menstrual period during lumbar pain lower abdomen rebound pain lower abdominal pain menstrual period delayed tubal distortion uterus rectal fossa effusion pus leucorrhea
First, the symptoms of acute salpingitis
1, the symptoms of acute salpingitis usually show lower abdominal pain, bulge, frequent urination pain, vaginal discharge pus and blood; may be associated with chills fever, may also have bloating, constipation or diarrhea. If the disease occurs during the menstrual period or after abortion, the amount of bleeding increases and the menstrual period is prolonged.
2, acute salpingitis patients may also have high body temperature, pulse rate, lower abdominal muscles may have muscle tension or resistance, tenderness, rebound pain and other symptoms. Gynecological examination may have vaginal cervix and purulent discharge, cervical congestion, easy bleeding, and pain. The attachment area is tender and may touch a painful mass. A small amount of purulent fluid can be withdrawn from the posterior malleolar puncture.
Second, the symptoms of chronic salpingitis
1. Abdominal pain: Patients with chronic salpingitis have different degrees of pain in the lower abdomen, mostly hidden discomfort, soreness in the lower back and ankle, swelling, and falling feeling, often exacerbated by fatigue. Due to pelvic adhesions, there may be bladder, rectal filling pain or pain when emptying, or other bladder rectal irritation symptoms, such as frequent urination, urgency and so on.
2, dysmenorrhea: due to pelvic congestion caused by blood stasis dysmenorrhea, mostly in the first week before menstruation, there is abdominal pain, the closer to the menstrual period, the more menstrual cramps.
3, irregular menstruation: the fallopian tube and the ovary adjacent, the general fallopian tube disease does not affect the function of the ovary, the amount of menstrual flow has no effect, but when the inflammation affects the ovarian function of the ovary damage, menstrual abnormalities will occur. The most frequent menstrual frequency and excessive menstrual flow may be the result of pelvic congestion and ovarian dysfunction. Menorrhagia can be caused by uterine fibrosis, uterine insufficiency or adhesion to the uterus due to chronic inflammation.
4, infertility: the fallopian tube itself is affected by the disease, resulting in obstruction and infertility, secondary to infertility is more common.
5, other: chronic salpingitis women will also appear such as increased vaginal discharge, painful intercourse, gastrointestinal disorders, fatigue, labor affected or not durable, mental symptoms and mental depression.
Examine
Salpingitis examination
1, pathological histological examination: cervical histopathological examination, endometrial pathological examination should pay attention to the bilateral horns of the uterus, cervical blood should be a biopsy, positive can determine the nature of the lesion.
2, hysterosalpingography: chronic angiography showed tubal spasm, blockage, adhesion water. The uterine horn is not filled, and the uterus shows a round shadow and is completely obstructed.
3, ultrasound examination: the tubal water is a typical liquid dark area, the accumulation of pus in the dark area scattered in the light spot. When a small amount of fluid is accumulated, there is a long dark area in the fallopian tube, and the tube wall is thick and not smooth; the medium amount of fluid is a dark area of the sausage, and the wall is thin; a large amount of fluid is an elliptical or round dark area, and the wall is thin. smooth. Fallopian tube effusion can sometimes be segmented. The fallopian tube ovarian cysts continue in the dark area of the liquid and the ovary.
4, CT examination: tubal effusion or fallopian tube ovarian cyst can not be identified with other cystic mass in most cases. Tubal-ovarian abscess needs to be >2cm or more in diameter to be easily detected.
Diagnosis
Diagnosis and differentiation of salpingitis
Diagnosis of salpingitis
(1) Clinical manifestations
1. Symptoms: After the fallopian tube infection, the body temperature is not necessarily high, the severe person has chills and fever, the body temperature can reach 39-40 ° C, and even sepsis, accompanied by severe pain on both sides of the lower abdomen, increased vaginal discharge or irregular vaginal bleeding; Sometimes accompanied by frequent urination, dysuria and other symptoms.
2. Signs: light abdominal distension, significant tenderness on one or both sides of the lower abdomen; severe abdominal muscle tension, lower abdominal tenderness and rebound tenderness. Gynecological examination: leucorrhea is purulent or bloody, the vagina has a burning sensation, the cervix has a lifting pain, there is tenderness on one or both sides of the uterus, and sometimes the swollen fallopian tube may be touched.
(2) Auxiliary inspection
1. Blood test: the total number of white blood cells is above 100/mm, and the number of neutrophils is above 80%.
2. Blood culture: There is chills, and those with high fever should be checked for blood culture to understand the condition, to determine the type of pathogenic bacteria and the sensitivity of the pathogenic bacteria to the drugs, so as to be targeted when applying antibiotics.
3. Smear or culture of the urethra or cervical secretions to understand the pathogens.
4. The posterior hernia puncture can puncture the exudate or pus.
(three) pathological examination
1. Acute gonococcal salpingitis, mainly due to oviduct mucositis.
(1) Giant examination: The fallopian tube is red and swollen and thick, and there may be thin fibrinous exudate around the fallopian tube, but the opening of the umbrella end is unobstructed. When the wall of the tube is squeezed, the purulent exudate in the cavity can flow out along the opening of the umbrella end.
(2) microscopic examination: mucosal folds and edema, blood vessels are obviously congested, neutrophil infiltration in the lower layer of the epithelium, leukocyte infiltration in the early stage of the lesion is mostly confined to the mucosal layer, and then can also affect the muscle layer, and even spread to the serosa layer.
2. Non-specific acute suppurative salpingitis
(1) Giant examination: The fallopian tube is significantly thickened and congested, and there is a fine fibrinous peritoneal adhesion around the fallopian tube, which may cover the opening of the umbrella end.
(2) microscopic examination: mucosal epithelium is basically normal, mild edema may occur, but the muscular layer has severe edema and a large number of neutrophil infiltration, and is often directly connected with inflammatory lesions in the oviductal mesentery.
Differential diagnosis of salpingitis
(A) acute appendicitis: fever, abdominal pain and other symptoms. However, the incidence of acute appendicitis is more urgent, and the fever does not exceed 38 °C. Abdominal pain begins with upper abdominal or total abdominal pain, umbilical pain, and is limited to the right lower abdomen after a few hours, often accompanied by nausea and vomiting. No vaginal bleeding. At the time of abdominal examination, there was tenderness and rebound tenderness at the Mac's point, and the abdominal muscles were tense, which was more significant than acute salpingitis. Gynecological examination revealed no abnormalities in the reproductive organs. Anal examination of the right upper intestinal area is resistant to tenderness. Laboratory tests showed an increase in the number of white blood cells and neutrophils. It is more difficult to identify the appendix perforation and peritonitis. At this time, abdominal pain, tenderness, abdominal muscle tension and the entire lower abdomen are very similar to acute salpingitis. The right side of the pelvic examination may have tenderness and resistance, while acute salpingitis is mostly bilateral pain.
(B) tubal pregnancy rupture: clinically also showed severe abdominal pain, accompanied by a small amount of vaginal bleeding embolism. However, the onset of the disease is sudden, with a history of menopause and early pregnancy reaction. Abdominal pain is characterized by severe pain on the lower abdomen, followed by total abdominal pain, often accompanied by hemorrhagic shock. Generally no fever. Abdominal examination revealed tenderness in the whole abdomen, severe tenderness on the lower abdominal side, rebound tenderness and moving dullness. During the gynecological examination, the cervix is tender, the back is full and tender, the uterus has a floating feeling, and one side of the attachment can touch the elastic tender mass. The total number of white blood cells is generally within the normal range, and the number of hemoglobin and red blood cells is reduced. A pregnancy test can be positive. The posterior malleolus is a dark red blood that does not solidify.
(C) acute pyelonephritis: female urethra is short and straight, bacteria are easy to invade. The onset of the disease is sudden, the body temperature is as high as 38 ° C or more, which may be accompanied by chills and abdominal pain. However, the pain of pyelonephritis is mainly in the upper abdomen and can also affect the entire abdomen. Most of them have obvious low back pain, limited lumbar pain, and there are significant tenderness and snoring pain in the ridge of the kidney. Most have bladder irritation such as frequent urination, urgency, and dysuria. Urine routine examination has pus and red blood cells. Urine bacterial culture is mostly positive.
(D) ovarian cyst pedicle torsion: there may be cramps on the lower abdomen, nausea, vomiting. However, the ovarian cyst is reversed and the onset is sudden, often associated with sudden changes in body position. Some patients have a history of lower abdominal mass, no fever, no vaginal bleeding. The original mass can increase after the pain occurs. Abdominal examination can touch the mass in the lower abdomen, and the tenderness is obvious. During the gynecological examination, the accessory area on one side touched the cystic mass, the surface was smooth, the activity was obvious, the tenderness was obvious, and the ipsilateral uterine horn had tenderness. The number of white blood cells is increased or normal.
(5) Acute mesenteric lymphadenitis: may have high fever, abdominal pain, and tenderness in the lower abdomen during abdominal examination. However, acute mesenteric lymphadenitis is more common in children and often has a history of respiratory infections. Abdominal pain starts in the lower right abdomen and vomiting is rare. During the abdominal examination, there is tenderness in the right lower abdomen, and the range is wide. The tenderness is consistent with the direction of the mesenteric root, that is, it is extended from the right lower abdomen to the left side of the upper midline, and sometimes the enlarged lymph nodes are touched.
(6) Acute colitis: There is abdominal pain and tenderness in the abdominal examination. However, this disease has a history of unclean food, accompanied by vomiting, diarrhea, abdominal pain, a feeling of defecation, abdominal pain after bowel movements appeared temporary relief. There was no abdominal muscle tension during abdominal examination. Pit cells can be found by stool examination. No abnormalities were found in the gynecological examination.
(7) Localized ileitis: abdominal pain and fever in acute attacks, tenderness in the abdominal examination and increased white blood cells. However, the disease is characterized by paroxysmal pain, similar to intestinal obstruction and multiple seizures, often with diarrhea. Abdominal examination is tender, abdominal muscles are more extensive, the most obvious part of tenderness, and sometimes change with body position. No abnormalities were found in the gynecological examination.
(8) Allergic purpura: abdominal pain, tenderness in the lower abdomen, and abdominal muscle tension. However, allergic purpura is more common in children and adolescents, mostly after upper respiratory tract infection. The site of abdominal pain at each episode was not fixed, and the abdominal symptoms and signs were inconsistent. In addition, most have diarrhea, nausea, vomiting, rash, blood in the stool, hematuria, joint pain, and increased eosinophils in the blood. If you ask carefully, you will have a history of allergies.
(9) Ovarian follicles or corpus luteum rupture can cause abdominal pain, tenderness in the lower abdomen, tension in the abdominal muscles, and mild increase in white blood cells. However, the abdominal pain of this disease is caused by bleeding, sudden onset, and it starts to be more intense, and then can be alleviated. When there is more bleeding, abdominal pain is often persistent, paroxysmal aggravation, and may radiate to the shoulder. There is a sense of falling down. During the gynecological examination, the cervix is tender, the sputum is full, and the uterus has a floating feeling. The posterior malleolar puncture can extract non-clotting fluid. Questioning the medical history is extremely important for diagnosis. Ovarian follicular rupture occurs during ovulation and is often in the middle of two menstrual periods. The rupture of the corpus luteum is in the middle of the menstrual period, about 14 days before the next menstrual period.
(10) Omental torsion or infarction: abdominal pain, low fever, abdominal pain in the lower abdomen, abdominal muscle tension, and moderate white blood cells. However, the course of retinal torsion or infarction is not as fast as acute inflammation. Abdominal pain is manifested as abdominal pain in the right lower abdomen or around the umbilicus. Abdominal pain is often relieved when lying or bending. If there is more omental tissue, a lump can be touched.
(11) Fallopian tube abscess: This disease is derived from the development of salpingitis. Clinically, the fallopian tube ovarian abscess is more common, and the clinical symptoms and signs are similar to acute salpingitis. However, the gynecological examination often touches the enlarged fallopian tube. The mass is cystic, but it adheres to the surrounding tissue and does not move. After the sensation, the cystic feeling is gradually not obvious.
(12) Acute pelvic peritonitis and acute peritonitis: systemic symptoms are obvious, peritoneal irritation is obvious, and even toxic shock symptoms, high fever, abdomen stiffness, tenderness, rebound tenderness, gynecological examination of the cervix, uterus and posterior Both have obvious tenderness. The total number of white blood cells and neutrophils are significantly increased, and the pus liquid can be worn through the abdominal or posterior malleolar puncture.
