tuberculous pelvic inflammatory disease
Introduction
Introduction to tuberculous pelvic inflammatory disease Female genital inflammation caused by Mycobacterium tuberculosis is called genital tuberculosis, also known as tuberculous pelvic inflammatory disease. More commonly found in women aged 20 to 40, can also be seen in postmenopausal elderly women. Tubal tuberculosis is the most common, accounting for 85% to 95% of female genital tuberculosis, followed by endometrial tuberculosis, and other types of disease. The vast majority of genital tuberculosis is a secondary infection, and tuberculosis lesions often secondary to tuberculosis, intestinal tuberculosis, peritoneal tuberculosis, and mesenteric lymph nodes can also be secondary to bone tuberculosis or urinary tuberculosis. Primary female reproductive system tuberculosis is rare. The treatment of tuberculous pelvic inflammatory disease is mainly supportive therapy and anti-tuberculosis treatment. It can be cured after treatment, but the course of treatment is longer, and it needs to be reviewed regularly. If the condition changes, it is recommended to treat it in time. The key to prevention is the prevention of tuberculosis. For genital tuberculosis, the most important problem is early detection and timely implementation of regular anti-tuberculosis treatment, mainly to enhance physical fitness, to do BCG vaccination, and actively prevent tuberculosis, lymphatic tuberculosis and intestinal tuberculosis. basic knowledge The proportion of illness: 0.001% Susceptible people: more found in women aged 20 to 40 Mode of infection: non-infectious Complications: amenorrhea, dysmenorrhea, infertility
Cause
Causes of tuberculous pelvic inflammatory disease
It is generally believed that female genital tuberculosis infection is mainly caused by secondary infections of tuberculosis such as lung or peritoneum. Tuberculosis often first affects the fallopian tube in the reproductive organs, and then spreads to the endometrium, which is more common in the cervix and ovaries.
Prevention
Tuberculous pelvic inflammatory disease prevention
The key to prevention is the prevention of tuberculosis. For genital tuberculosis, the most important problem is early detection and timely implementation of regular anti-tuberculosis treatment, mainly to enhance physical fitness, to do BCG vaccination, and actively prevent tuberculosis, lymphatic tuberculosis and intestinal tuberculosis.
Complication
Tuberculous pelvic inflammatory disease Complications amenorrhea dysmenorrhea infertility
Amenorrhea, dysmenorrhea, infertility.
Symptom
Tuberculous pelvic inflammatory symptoms Common symptoms Night sweats menstrual cycle changes Lower abdominal pain Low fever Lower abdomen bulge Lower abdominal pain Lack of night night sweats pelvic pain
1, menstrual disorders
Early factors of endometrial congestion and ulcers may have more menorrhagia. Most patients have been sick for a long time at the time of treatment, and the endometrium has been damaged to varying degrees, which is characterized by rare menstruation or amenorrhea.
2, lower abdomen pain
Due to pelvic inflammation and adhesions, there may be varying degrees of lower abdominal pain and increased menstruation.
3, systemic symptoms
If it is active, there may be general symptoms of tuberculosis, such as fever, night sweats, fatigue, loss of appetite, weight loss, etc., sometimes only menstrual fever.
4, infertility
Due to destruction and adhesion of the oviduct mucosa, the lumen is often blocked; or due to adhesion around the fallopian tube, the lumen remains partially patency. However, the mucociliary is destroyed, the fallopian tube is stiff, the peristalsis is limited, its transport function is lost, and it cannot be conceived. Therefore, most patients are infertile. Genital tuberculosis is often one of the main causes in patients with primary infertility.
5, systemic and gynecological examination
Due to the difference in the extent and extent of the lesions, more patients were diagnosed with endometrial tuberculosis due to infertility and no obvious signs and other symptoms. In patients with severe cases, if there is peritoneal tuberculosis, the abdomen may have a sense of flexibility or ascites during the examination. When the effusion is formed, the cystic mass may be touched, the boundary is unclear, inactivity, and the surface is blocked due to intestinal adhesion. The uterus is generally poorly developed and often has limited mobility due to adhesions around it. If the attachment is involved, the lumps of different sizes and irregular shapes can be touched on both sides of the uterus, which are hard, uneven, and nodular infection.
Examine
Tuberculous pelvic inflammatory disease
1. Laparoscopy: It can directly observe the presence of chestnut-like nodules on the surface of the uterus and fallopian tubes, and can be taken for biopsy or culture.
2, tuberculosis examination: take menstrual blood or intrauterine scraping or peritoneal fluid for smear acid-fast staining to find bacteria or bacterial culture, this method is accurate, but often 1-2 months to get results. Molecular biology methods, such as PCR techniques, are fast and simple, but may have false positives.
3, endometrial pathology: endometrial pathology is the most reliable basis for the diagnosis of endometrial tuberculosis.
4, X-ray inspection:
(1) Chest X-ray film, if necessary, for digestive tract or urinary system X-ray examination, in order to find the primary lesion.
(2) pelvic line examination, found isolated calcification points, suggesting that there were pelvic lymph node lesions.
Diagnosis
Diagnosis and diagnosis of tuberculous pelvic inflammatory disease
diagnosis
Diagnosis can be based on medical history, clinical symptoms, and laboratory tests.
Differential diagnosis
First, chronic non-specific attachment inflammation and chronic pelvic inflammatory disease patients are often infertile, pelvic signs and internal genital tuberculosis are very similar, but the former has a history of childbirth, abortion and acute pelvic inflammatory disease; menstrual volume is generally more, rarely amenorrhea When the chronic attachment inflammation is cured for a long time, it can be done by hysterosalpingography or diagnosis to eliminate genital tuberculosis.
Second, endometriosis: ovarian endometriosis and genital tuberculosis clinical manifestations have more similarities. Such as infertility, low fever, abnormal menstruation, lower abdominal pain, pelvic cavity tenderness, fixed mass and so on. However, patients with endometriosis often have progressive dysmenorrhea, and often reach 1 or 2 or more hard nodules in the uterus rectal fossa, uterine ligament or posterior wall of the cervix. If there is no such clinical manifestation, the diagnosis can be confirmed by laparoscopy when the diagnosis is difficult.
Third, ovarian tumors: tuberculous encapsulated effusion, sometimes misdiagnosed as ovarian cysts or ovarian cystadenoma. Through the medical history, clinical symptoms, and the surface of the tuberculous accessory mass is not smooth, inactive, and the surrounding fibrous fibrosis thickening and other signs are easier to identify.
Patients with advanced ovarian cancer often have cachexia, fever, and erythrocyte sedimentation rate. In addition to the accessory mass, metastatic lesions can appear at the bottom of the pelvic cavity. It is difficult to identify pelvic tuberculosis with tubal ovarian tuberculous mass. Clinically, ovarian cancer is often mistaken for tuberculosis. Long-term use of anti-caries treatment, resulting in delays in the disease, endangering the patient's life; also mistakenly diagnosed pelvic tuberculosis as advanced ovarian cancer and gave up treatment. Under the guidance of B-ultrasound, fine needle puncture can be used to find acid-fast bacteria and cancer cells. If it is unreachable, when the laparoscopic examination or laparotomy is performed according to the situation, the diagnosis should be confirmed early, and appropriate treatment should be obtained to save the patient's life.
