chronic endometritis
Introduction
Introduction to chronic endometritis Clinically, except for tuberculous and senile endometritis, other lesions are actually rare. Even with a wide range of chronic accessory inflammation, the endometrium may still be completely normal, mainly due to good drainage conditions and periodicity of the uterine cavity. Endometrial exfoliation, so that there is very little chance of inflammation staying in the endometrium for a long time, so the lesions gradually reduce and disappear, but if the acute phase treatment is not complete, or often there is still a source of infection, it can be repeated. The clinical manifestations of chronic endometritis are not special, but if combined with the history of infection, vaginal discharge and menstrual flow, pelvic area pain and dysmenorrhea, these four symptoms are of great value to the diagnosis. Diagnosis can determine the cause of the disease and eliminate malignancy. Lesion. basic knowledge The proportion of illness: 2% - 4% Susceptible people: women Mode of infection: non-infectious Complications: uterine empyema secondary peritonitis
Cause
Causes of chronic endometritis
Basal layer inflammation (20%):
Although the endometrium is periodically exfoliated, its basal layer does not peel off. Once the basal layer has chronic inflammation, it can infect the functional layer of the intima for a long time, leading to chronic endometritis.
Pathogen infection (30%):
After menopause, due to the significant decrease in estrogen levels in the body, the endometrium and vaginal mucosa become thin and vulnerable to pathogens, leading to inflammation. Clinically, endometritis and vaginitis often coexist.
Placenta residue, etc. (15%):
A small amount of placenta remains after childbirth or abortion, or the incompleteness of the placenta attachment is often the cause of chronic endometritis.
External factors (10%):
Intrauterine devices can cause chronic endometritis.
Uterine factors (10%):
Uterine submucosal fibroids and mucosal polyps can also cause chronic endometritis; severe cervicitis can also cause chronic endometritis.
Long-standing tubal oophoritis can lead to chronic endometritis.
Chronic endometritis with no obvious cause may also be present. Most of the pathogens come from the flora in the vagina.
Prevention
Chronic endometritis prevention
1. Hygiene: Pay attention to menstrual hygiene, and prohibit sexual life during menstruation to prevent pathogenic bacteria from invading.
2. Reproductive education: pay attention to contraception, avoid unnecessary abortion, childbirth and intrauterine surgery, should be done in a regular hospital with strict disinfection to prevent direct contamination during surgical operations.
3. Prevention of infection: Women with a possibility of infection should be treated with preventive anti-inflammatory treatment.
4. Postpartum attention: premature delivery in the same room, it is easy to bring bacteria into the wife's reproductive organs, causing endometritis or pelvic inflammatory disease, light or treatment in time, can still fully recover, but many people have caused in the uterus Membrane destruction or fallopian tube occlusion leads to life-long infertility. Even in the acute phase, bacteria invade from the wound surface and become life-threatening with the spread of blood flow into sepsis.
5. Patients with acute endometritis should be treated promptly and thoroughly to avoid prolonged unhealed and chronic.
6. You should always maintain a good mood, pay attention to nutrition, work and rest, enhance your resistance and improve your physical fitness.
Complication
Chronic endometritis complications Complications uterine empyema secondary peritonitis
Possible complications include uterine empyema or uterine perforation.
1. Uterine empyema, that is, pus accumulation in the uterine cavity. When suffering from chronic endometritis, the cervix is blocked, the drainage is not smooth, and the secretions are retained in the uterus, and uterine empyema can occur.
2. Uterine perforation, gynecological disease, refers to the full thickness of the uterine wall caused by intrauterine surgery, resulting in the uterine cavity and the abdominal cavity, or other organs. Perforation can occur in the fundus, isthmus or cervical canal, of which the most common is found in the isthmus. Can also penetrate into the broad ligament, the posterior wall of the bladder, intestinal fistula, and even pull out the omentum, leading to internal hemorrhage, hematoma in the broad ligament and secondary peritonitis.
Symptom
Chronic endometrial symptoms, common symptoms, lower abdominal pain, dysmenorrhea, primary dysmenorrhea, leucorrhea, dull pain, lumbosacral pain, uterine bleeding
The clinical manifestations of chronic endometritis are not special, but if combined with the history of infection, vaginal discharge and menstrual flow, pelvic area pain and dysmenorrhea, these four symptoms are of great value to the diagnosis. Diagnosis can determine the cause of the disease and eliminate malignancy. Lesion.
Senile endometritis is often diagnosed as endometrial cancer or cervical cancer, which must be diagnosed by curettage. Generally, senile endometritis rarely bleeds.
Uterine empyema sometimes has no systemic symptoms, but because of the often complicated senile vaginitis, sometimes it is easy to attribute the odorous leucorrhea to this lesion, special attention should be paid to the presence or absence of uterine cancer (implementation of curettage), and should also be careful not to swell The large soft uterus is misdiagnosed as an ovarian cyst.
(A) Pain in the pelvic area: About 40% of the patients complained of a pain in the lower abdomen during the menstrual interval and a soreness in the lumbosacral region.
(B) increased vaginal discharge: due to increased secretion of endometrial glands, generally thin watery, pale yellow, sometimes bloody leucorrhea.
(3) Menorrhagia: menstruation is still regular, but the amount of menstruation is doubled, and the bleeding period is also significantly prolonged. Only a very small number of patients cause anemia due to massive bleeding, which may be caused by thickening of the intima and inflammation and hyperemia. It is rare, sometimes it can be bleeding for a few hours or for 1 to 2 days.
(D) dysmenorrhea: more occur in unmarried women, but very few dysmenorrhea, may be due to excessive thickening of the intima, hinder the normal degeneration and necrosis of the tissue, stimulate the excessive contraction of the uterus.
Senile endometritis often associated with atrophic vaginitis and purulent vaginal discharge, and often contains a small amount of blood, often misunderstood as uterine malignant lesions, when uterine empyema occurs, the secretions are purulent and smelly, patients except In addition to abdominal dull pain, there may be symptoms of systemic inflammatory response, but there are also asymptomatic.
Signs: patients with mild inflammation, double diagnosis can be found without abnormalities, so the clinical diagnosis is dysfunctional uterine bleeding, some people in 1000 patients with dysfunctional uterine bleeding for pathological examination, found that 11% of the endometrium inflammation.
If there is uterine empyema, the uterus is spherically enlarged, soft, and even the mass can be found in the upper midline of the pubic symphysis. The tenderness, such as secretions, can be intermittently discharged through the neck tube, and bloody pus can be seen when the speculum is examined. Strange smell, often accompanied by acute vaginitis.
Examine
Chronic endometritis examination
The endometrium can be scraped under hysteroscopy for pathological examination. It can be seen that there are a large number of plasma cells and lymphocytes infiltrating in the endometrial stroma. The clinical manifestations of chronic endometritis are not special, but the combination of infection history, leucorrhea and menstrual flow, pelvic area pain and dysmenorrhea are four major symptoms, which is of great value to the diagnosis. Diagnosis can determine the cause of the disease and exclude malignant lesions.
Diagnosis
Diagnosis and diagnosis of chronic endometritis
1, physical signs: patients with mild inflammation, double diagnosis can be found without abnormal conditions. Some patients may have a slightly enlarged uterus and tender tenderness. If there is uterine empyema, the uterus is enlarged, soft and tender.
2, medical history: chronic endometrial inflammation often has long-standing attachment inflammation or cervix inflammation, long-term placement of intrauterine devices, unclean sexual intercourse history or age in menopause, more with senile vaginitis.
3, auxiliary examination: conditional can be scraped under the hysteroscopy of the endometrium for pathological examination, there can be a large number of plasma cells and lymphocytes infiltration in the endometrial stroma.
4, clinical manifestations: chronic endometritis mainly manifested as irregular menstruation, extended by Lang, lower abdomen pain or bulge, increased vaginal discharge with purulent secretions accompanied by odor, a small number of patients with low fever, due to inflammatory secretions have killed The intima of the spermatogenic and chronic endometritis should not be implanted in the pregnant egg, and the patient is infertile.
