pelvic disease
Introduction
Introduction to pelvic diseases Female pelvic diseases mainly refer to inflammatory diseases such as pelvic adhesions, pelvic fluids and pelvic inflammatory disease. Among them, pelvic inflammatory disease is the most common pelvic disease in life, mainly including endometritis, salpingitis, fallopian tube ovarian abscess, pelvic peritonitis. Inflammation can be limited to one site, or several sites can be involved at the same time, with salpingitis and tubal ovarian inflammation being the most common. Pelvic inflammatory diseases are more active, women with menstruation, pelvic inflammatory disease rarely occurs before menarche, postmenopausal or unmarried women. If pelvic inflammatory disease occurs, it is often the spread of inflammation of adjacent organs. Pelvic disease must be diagnosed early and early, otherwise it will affect fertility for a long time. basic knowledge Proportion of disease: according to different pelvic diseases, the proportion of illness is different Susceptible people: married women Mode of infection: non-infectious Complications: irregular menstruation, infertility
Cause
Causes of pelvic diseases
Female pelvic diseases mainly refer to inflammatory diseases such as pelvic adhesions, pelvic fluids and pelvic inflammatory disease.
One type of pelvic adhesion is caused by inflammation, such as pelvic inflammatory disease or a history of tuberculosis. The other is endometriosis. And adhesions caused by abdominal surgical diseases.
Pelvic fluid
1. Menstrual period does not pay attention to hygiene: female friends in the menstrual cramps, the endometrium will fall off, so that the sinusoid inside the uterine cavity is open, and there will be solidified blood clots, etc. Very suitable for the breeding of bacteria. Therefore, if female friends do not pay attention to their personal hygiene when menstruating, or do not use sanitary napkins, toilet paper, etc., or have sex during menstruation, they provide good breeding and infection for bacteria. The opportunity to cause a situation of female pelvic inflammatory disease.
2. Adjacent organ inflammation spread: Some female friends will suffer from appendicitis or inflammation of the peritoneum, while the female reproductive organs are nearby. If the inflammation is not treated in time, it will easily lead to the spread, which will eventually lead to women. Inflammation of the pelvic area. Some female friends suffer from chronic cervix inflammation, which causes blood circulation through the lymph, and eventually causes inflammation of the connective tissue in the pelvic area of women.
3. Postpartum, post-abortion infection: Female friends in the production and abortion, because the body suffered a lot of damage, so the body is very weak, the body's resistance, immunity is also relatively low, and at this time the female's cervix The mouth is also in an expanded state. If you do not pay attention to your personal hygiene, then all the bacteria in the vagina and cervix may continue to rise and cause infection in the female pelvic cavity.
4. Infection after gynecological surgery: When female friends perform some artificial surgery, ring surgery, fallopian tube angiography, etc., if the disinfection during the operation is not very strict, it is easy to cause female infection after surgery. And if women do not pay attention to personal hygiene after surgery, do not resume treatment according to the doctor's sputum, too early sexual life after treatment, etc., will lead to the continuous growth of bacteria and lead to female pelvic infection, causing female pelvic cavity The occurrence of inflammation. Therefore, female friends must pay attention to personal hygiene during surgery to avoid infection.
Pelvic inflammatory disease
The pathogens causing pelvic inflammatory disease are: staphylococcus, Escherichia coli, anaerobic bacteria, sexually transmitted pathogens (such as gonococcus, Chlamydia trachomatis, mycoplasma, herpes virus), the main cause of acute pelvic inflammatory disease is postpartum or abortion infection, intrauterine Infection after operation, poor menstrual period, direct inflammation of adjacent organs, acute pelvic inflammatory disease can cause acute endometritis and acute myositis, acute salpingitis, tubal empyema, fallopian tube ovarian abscess, acute pelvic connective Tissue inflammation, acute pelvic peritonitis, sepsis and sepsis, chronic pelvic inflammatory disease is often not completely treated for acute pelvic inflammatory disease, or the patient's physical condition is poor, the course of disease is delayed, it can cause chronic salpingitis and tubal accumulation in the body. Water, tubal oophoritis and fallopian tube ovarian cysts, chronic pelvic connective tissue inflammation.
Prevention
Pelvic disease prevention
Pelvic adhesion
1. Do a good job of contraception and minimize the trauma of abortion. Strict aseptic operation should be performed during surgery to avoid the invasion of pathogenic bacteria.
2. Pay attention to the amount, quality, color and taste of the leucorrhea. The amount of leucorrhea is large, the color is yellow, thick, and smelly, indicating that the condition is heavier. For example, the leucorrhea changes from yellow to white (or light yellow), the amount is changed from small to small, and the taste tends to be normal (slightly sour), indicating that the condition has improved. .
3. Menstrual period, post-operative flow, and gynecological surgery such as upper and lower ring surgery, there is bleeding in the vagina. Sex life must be prohibited. Swimming, bathing, washing of sauna, and sanitary napkins are required. Therefore, the body's resistance is reduced and the disease is caused. The bacteria easily enter the plane and cause infection.
4. Pay attention to diet and nutrition.
5. Stop all infections and keep the perineum clean and dry.
Pelvic fluid
1. Women should pay attention to hygiene during menstruation, pregnancy, childbirth and puerperium to prevent infection.
2. Women prevent the abuse of antibiotics and anti-inflammatory drugs. Antibiotics, whether oral or injection, inhibit the lactobacilli in the vagina, disturb the natural ecological balance of the vagina, change the microenvironment of the vagina, and cause pathogenic bacterial pathogens to multiply, eventually leading to local candidal vaginitis episodes, which in turn An inflammatory fluid causes pelvic fluid.
3, prevention is important in the cleaning of the house. In female genital inflammation, attachment inflammation, pelvic inflammatory disease, unclean sex is an important cause of disease. Because some sexual partners are so excited before the sexual intercourse, they ignore the local hygiene and rush into battle without cleaning. Inflammation can be limited to one site, or several sites can occur at the same time, causing pelvic effusion at the same time in several sites.
4, women should wash the vagina correctly. Some women often use medicated lotion to clean the vagina in order to maintain hygiene. This is easy to destroy the acid and alkali environment of the vagina, but it is easy to get infected with candida vaginitis. The correct flushing is to rinse with clean water.
5. Seek medical attention in time. After the onset of reproductive system diseases, most people will have different symptoms. Acute inflammation may cause serious consequences such as diffuse peritonitis, sepsis and septic shock, chronic pelvic inflammatory disease. Sometimes there are low fever and susceptibility to fatigue. Some patients have symptoms of neurasthenia due to long course of disease, such as insomnia, lack of energy, and general discomfort. Lower abdomen bulge, pain and soreness in the lumbosacral region, often worsened after exertion, after sexual intercourse, before and after menstruation. Due to chronic inflammation, pelvic congestion, menorrhagia, ovarian dysfunction, menstrual disorders, tubal adhesions can cause infertility.
6, if the accidental pregnancy, to do a good preoperative preparation for gynecological surgery. Pay attention to keep the vulva clean, avoid sexual intercourse three days before surgery; pay attention to vulva and vaginal cleansing after surgery, wash the vulva with warm water, replace the perineal pad and underwear in time, and prohibit sexual intercourse within 2 to 3 weeks.
7, suffering from acute genital inflammation, annex inflammation. Pelvic inflammatory disease should be completely cured to prevent chronic changes. This causes water to accumulate and build up fluid.
8, pay attention to gynecological examination.
9, exercise, enhance physical fitness, increase nutrition, pay attention to work and rest, improve the body's resistance.
Pelvic inflammatory disease
1, gynecological examination, childbirth, abortion, abortion, pay attention to cleanliness, utensils and equipment should be strictly disinfected to prevent infection.
2, should pay attention to the health of sexual life, both husband and wife should clean the vulva, to prevent pathogens such as bacteria, mold, trichomoniasis and other pathogens into the vagina, and then cause pelvic inflammatory disease, sexual life within 60 days of menstruation and postpartum.
3, usually clean the vulva, change underwear frequently, often maintain the hygiene of the vulva, while strengthening nutrition, pay attention to rest, regulate emotional, appropriate exercise, enhance physical fitness and disease resistance.
Complication
Pelvic disease complications Complications, irregular menstruation, infertility
Complications caused by pelvic adhesions:
1, the systemic symptoms are not obvious, sometimes there may be low fever, susceptible to fatigue. The course of the disease is longer, and some patients may have symptoms of neurasthenia.
2, lower abdomen bulge, pain and lumbosacral pain, often tired, sexual intercourse, increased pain before and after menstruation. 3, menstruation increased, ovarian function damage may have menstrual disorders, tubal adhesions can cause infertility.
Complications caused by pelvic fluid:
1. If the pelvic effusion is not properly treated, its harmfulness is large, which may lead to pelvic adhesions, blockage of the fallopian tubes, etc., leading to infertility. Such as normal lower abdominal pain, lumbosacral pain, increased vaginal discharge, gynecological examination of lower abdomen tenderness, strip-like thickening, etc., considering chronic pelvic inflammatory disease, the need for active treatment to prevent increased inflammation, increased fluid volume.
2. Most pelvic fluids are caused by inflammation, which is caused by chronic pelvic inflammatory exudation. There are also a small number of ruptures due to ectopic pregnancy, corpus luteum rupture, pelvic abscess, chocolate cysts, and ovarian cancer. The effusion caused by pelvic inflammatory disease is best for post-Qianlong puncture examination to identify the nature of the liquid.
3, if there is a chronic infection, it may be inflammation of the gynecological system such as ovary, fallopian tube, may also be caused by tuberculosis or tumor. Pelvic inflammatory disease should be treated early, and prolonged exposure will affect fertility.
Complications caused by pelvic inflammatory disease:
Acute pelvic inflammatory disease, after fatigue, sexual intercourse and pre-menstrual aggravation, severe cases of irregular menstruation, infertility and other complications, chronic pelvic inflammatory disease common complication of pelvic fluid.
Symptom
Symptoms of pelvic disease Common symptoms Lower abdominal pain, leucorrhea, abnormal leucorrhea, increased waist, soreness and weakness, lower abdominal bulge, lower abdomen, rebound pain, anal bulge, menstrual irregular menstruation
Pelvic adhesion
1, the systemic symptoms are not obvious, sometimes there may be low fever, susceptible to fatigue. The course of the disease is longer, and some patients may have symptoms of neurasthenia;
2, chronic inflammation caused by scar adhesion and pelvic congestion, can cause lower abdomen bulge, pain and lumbosacral pain, often in fatigue, sexual intercourse, before and after menstruation;
3, due to pelvic blood stasis, patients may have increased menstruation, ovarian function damage may have menstrual disorders, tubal adhesions can cause infertility.
Pelvic fluid
Pelvic effusion caused by acute and chronic pelvic inflammatory disease, accompanied by lower abdominal pain (bilateral or unilateral), lumbosacral pain, backache, lower abdomen pain, falling pain, backache, etc., or standing for a long time , overwork, sexual intercourse, or aggravation in the early stage, and the heavy ones affect the work. Or lower abdominal pain, or increased leucorrhea, menstrual disorders, menstrual blood loss, dysmenorrhea, sexy unpleasant; patients feel very uncomfortable, should be actively treated immediately, until the effusion absorbs, dissipates. Once you find pelvic effusion, you should go to a regular hospital for treatment.
Pelvic inflammatory disease
1. The symptoms of acute pelvic inflammatory disease are: acute illness, severe illness, lower abdominal pain, fever, chills, headache, loss of appetite. The patient is found to have acute illness, high body temperature, fast heart rate, and muscle tension in the lower abdomen. , tenderness and rebound pain. Pelvic examination: There is a lot of purulent secretion in the vagina, there is obvious tenderness in the sputum, tenderness in the uterus and double attachments, rebound pain, or thickening of the attachment on one side.
2, the symptoms of chronic pelvic inflammatory disease are: slow disease, long course of disease, systemic symptoms are not obvious, may have low fever, susceptible to fatigue, with lower abdomen and low back pain. During the examination, it was found that the uterus often showed a posterior position, limited mobility, or adhesion fixation.
Examine
Examination of pelvic diseases
Pelvic adhesion
1. Laparoscopy: Laparoscopy is performed by inserting a laparoscope into the abdominal cavity from the abdominal wall to observe the shape and location of the lesion. The accuracy rate can reach 90-95%. The uterus, ovary and fallopian tube shape can be directly observed in laparoscopy. There is no adhesion to the surrounding tissue.
2, uterus, fallopian tube angiography: pelvic adhesions can be done by uterine fallopian tube iodine angiography to confirm the diagnosis, observe the tubal patency, about 1 minute can produce results, more convenient than iodide angiography, at the same time, no pain .
Pelvic fluid
The location of pelvic effusion occurs in the lower part of the pelvic cavity such as the uterus rectal sag. The effective examination method commonly used in gynecology is B-ultrasound, which can accurately judge the amount of effusion.
Pelvic inflammatory disease
1, the direct smear sample of secretion can be for the vagina, cervical secretions, or urethral secretions, or peritoneal fluid (after sputum, abdominal wall, or by laparoscopy), do a direct thin smear, after drying to the United States Blue or Gram staining, where Gram-negative diplococcus is seen in polymorphonuclear leukocytes, it is gonorrhea infection, because the detection rate of cervical gonococcal is only 67%, so smear negative can not exclude gonorrhea, but positive The smear is very specific. The fluorescein monoclonal antibody dye can be used for the microscopic examination of Chlamydia trachomatis. Any fluorescent spot that is observed by a fluorescence microscope is a positive.
2. The source of the pathogen culture specimens is the same as above. It should be inoculated on Thayer-Martin medium immediately or within 30s, and cultured in a 35 °C incubator for 48 hours. Glycolysis is used for bacterial identification, and a new relatively rapid chlamydial enzyme assay is substituted. The traditional method for detecting chlamydia can also be used to detect Chlamydia trachomatis antigen in mammalian cell culture. This method is an enzyme-linked immunoassay with an average sensitivity of 89.5% and a specificity of 98.4%.
Bacterial cultures can also be used to obtain other aerobic and anaerobic strains and serve as a basis for the selection of antibiotics.
3, after puncture puncture puncture is one of the most commonly used and valuable diagnostic methods for gynecologic acute abdomen, through the puncture, the content of the abdominal cavity or the content of the uterus rectal fossa, such as normal peritoneal fluid, blood (fresh, stale, coagulation Silk, etc., purulent secretions or pus can make the diagnosis more clear, and the microscopic examination and culture of the puncture is more necessary.
4, ultrasound examination is mainly B-type or gray-scale ultrasound scanning, filming, this technique is 85% accurate for identifying the mass or abscess formed by the fallopian tube, ovary and intestinal adhesion, but mild or moderate Pelvic inflammatory disease is difficult to show in B-mode ultrasound images.
5, laparoscopic examination is not diffuse peritonitis, the general condition of the patient is still good, laparoscopic examination can be performed in patients with pelvic inflammatory disease or suspected pelvic inflammatory disease and other acute abdomen, laparoscopic examination can not only confirm the diagnosis and differential diagnosis, but also the pelvic cavity The degree of inflammation is initially determined.
6, male partner's examination This is helpful for the diagnosis of female pelvic inflammatory disease, may be taken with male urethral secretions for direct smear staining or culture of gonorrhea, if found positive, it is a strong evidence, especially in asymptomatic or Symptoms are mild, or more white blood cells can be found. If men with all PID patients are treated, regardless of whether they have urethritis symptoms, it is obviously very meaningful to reduce recurrence.
Diagnosis
Diagnosis and diagnosis of pelvic diseases
Pelvic adhesion
1, uterine probe examination General uterus probe inserted into the cervix about 1-3 cm where there is a sense of resistance, about 2 cm is the most common. The resistance can vary according to the adhesion tissue. Only the endometrial adhesion probe is easy to insert. When the muscle layer is stuck, the probe should be inserted with a little force in the direction of the uterus. If the tissue is tough and the probe is not easy to insert, it should not be blind. Use force. So as not to cause uterine perforation. After the probe enters the uterine cavity, the fan can be swept left and right to sweep the official cavity to test the size of the uterine cavity and the extent of adhesion. A severely adherent person may feel a narrow tube in the uterine cavity, and the probe has a small range of motion or cannot be penetrated at all.
2, hysteroscopy can understand the presence or absence of intrauterine adhesions, and determine the location, extent, extent and adhesion of adhesions. The characteristics of adhesion in each group are: endometrial adhesion is very similar to the surrounding endometrium; muscle fiber adhesion is the most common, characterized by a thin layer of endometrium covering the surface with many gland openings; and connective tissue adhesion is the surface No endometrial formation.
3, uterine lipiodol angiography is characterized by:
1 There may be one or more contours in the uterine cavity, sharp edges, abnormal shape, irregular filling defect shadows, and not subject to the pressure or amount of contrast agent injected.
2 The local edge of the uterine cavity is not neat.
3 often appear fine mesh-like blood vessels, which is too much pressure due to the injection of lipiodol during angiography, so iodized oil from the stripping surface into the uterine blood vessels.
4 Some uterus that adheres to the uterus, with high flexion or flexion, often overlaps the image of the uterus and the cervix. The uterus is olive-shaped. In this case, the cervical canal can be used to pull the cervix to stretch the uterus, and the uterus image can be changed from olive to triangle. In order to prevent chronic inflammation caused by oil plugs and oils, water-soluble contrast agents can also be used. Mild adhesion can be separated by contrast.
4. The basal body temperature is biphasic.
5, vaginal exfoliation cell examination has periodic changes.
6, serum progesterone, urine gestationaldiol determination has periodic changes, and ovulation.
7, cervical mucus crystals can appear as fern-like crystals and ellipsoids.
8, hormone therapy test estrogen, progesterone or artificial cycle treatment, repeated withdrawal cycles without withdrawal.
9. Hysteroscopy In recent years, hysteroscopy has been used as a method for diagnosing and treating uterine cavity adhesions.
Pelvic fluid
The location of pelvic effusion occurs in the lower part of the pelvic cavity such as the uterus rectal sag. The effective examination method commonly used in gynecology is B-ultrasound, which can accurately judge the amount of effusion.
It can be combined with medical history, symptoms and physical symptoms to determine whether it is normal effusion or abnormal effusion. If the diagnosis is abnormal, it is necessary to clarify the cause of effusion, and it is the key to remove the cause.
The effusion is a Western medicine examination or symptomatic treatment, and should not be done frequently. Because the simple effusion will not cure the pelvic fluid, it will also increase the effusion.
Pelvic inflammatory disease
According to the history, symptoms, signs can often make a diagnosis, in addition to necessary tests, such as hematuria, erythrocyte sedimentation rate, cervical secretion culture and drug susceptibility test; blood culture and drug susceptibility test when the body temperature is above 39 °C , combined with B-ultrasound, CT examination, if necessary, after the puncture, such as the pus can be diagnosed.
The main differential diagnosis of acute pelvic inflammatory disease: acute appendicitis, ectopic pregnancy, ovarian cyst torsion, etc.; the main differential diagnosis of chronic pelvic inflammatory disease: endometriosis and ovarian cancer.
The main differential diagnosis of acute pelvic inflammatory disease: acute appendicitis, ectopic pregnancy, ovarian cyst torsion, etc.; the main differential diagnosis of chronic pelvic inflammatory disease: endometriosis and ovarian cancer.
