Female genital mutilation and its environs within the connective tissue, peritoneal pelvic inflammation, known as pelvic inflammatory disease (pelvic inflammatory disease). For the most common gynecologic pelvic inflammatory disease. Inflammation can be confined to one site, but also several positions at the same time the incidence. Its pathogenesis, clinical manifestations can be divided into acute and chronic two. Acute inflammation can cause diffuse peritonitis, sepsis resulting septic shock, and other serious consequences; Jiuchibuyu chronic inflammation due to repeated attack. And the impact of women’s physical and mental health and caused pain to the patients, therefore, we must attach importance to prevention and treatment of pelvic inflammatory disease.
As in the female reproductive tract anatomy, physiology, the characteristics of a relatively perfect natural defense mechanism to enhance the defense of the infection, and thus the health of women in the vagina can be certain pathogens exist, but not necessarily cause inflammation.
[Female genital natural defense mechanism]
First, on both sides of the labia minora natural closure, I cover the vagina, urethra.
Second, because the role of pelvic floor muscles to prevent crossing closed, vaginal anterior and posterior wall close to prevent the pollution of the outside world. In the maternal, as vaginal relaxation, the poor defense function.
Third, in the vaginal epithelial ovarian secretion of estrogen under the influence hyperplasia thicken, increase the ability to resist invading pathogens, and epithelial cells contain abundant glycogen in the vagina to the effects of Bacillus, divided into lactic acid, maintain normal vaginal acidic environment (pH4.2 ~ 5), adapted to alkaline environment inhibited reproduction of the pathogen, known as the role of vaginal self-purification.
4, cervical mucus secreted by the endometrium mucus suppository form, plug the neck, mouth and cervix, usually closed, and prevent invasive pathogens. According to reports cervical mucus suppository 1 / 3 to identify bacteria, and the 2 / 3 found no bacteria.
5, women of childbearing age endometrial cyclical stripping, but also the elimination of the favorable conditions Guankong infection.
6, tubal ciliated epithelial cells of the uterine cavity and fallopian tube swing the direction of the movement, both help to prevent the invasion of pathogens.
[Main cause of the Miao and its sensitivity to antibiotics] main cause pelvic inflammatory genital pathogens as Staphylococcus aureus, Streptococcus, E. coli, anaerobes.
1, Streptococcus Gram-positive streptococcus many different types, A, B, C three categories. B hemolytic chain
Cocci pathogenic strong, and can produce a variety of hemolysin, the easy proliferation of infection, and cause septicemia, wound pus relatively thin, pink, volume more, but generally not with metastatic abscess. Come out before antibiotics, blood lost due to puerperal infection of maternal deaths, about 75 per cent are from group A hemolytic streptococcus infection caused by Group B. This bacteria sensitive to penicillin, after application of penicillin, maternal mortality basically under control.
Second, Gram-positive Staphylococcus aureus, post-natal, post-operative wound infection and genital inflammation pathogens, often along the vagina, uterus, fallopian tube uplink mucosal infection. Gold yellow, white, Chumengse Staphylococcus three have pathogenicity, with Staphylococcus aureus virulence of the strongest. Wound pus-yellow silk thick, smelly, accompanied metastatic abscess on the general common antibiotics-resistant, according to drug-sensitive test drug is better. Penicillin-resistant Staphylococcus aureus on the vanguard adriamycin Ⅰ, vancomycin, chlorine lincomycin (clindamycin), chloramphenicol sensitive.
3, E. coli Gram-negative for the normal intestinal inhabitants generally not pathogenic, but the body extremely debilitating trauma, such as invasive or parenteral tissues or organs can cause serious infections, and some have even endotoxic shock, and often with other mixed infection pathogens. E. coli wound pus does not smell, when mixed infection, a thick silk wound pus and skatole. Can be applied kanamycin, gentamicin, Pioneer adriamycin I, carboxymethyl benzylpenicillin, but easy to produce drug-resistant strains, would be best for the sensitivity test, select sensitive drugs. Gram-positive bacteria infection can be serious combination of penicillin G and ampicillin, tetracycline, etc..
4, anaerobes because anaerobic culture and technological progress, since the 1970s, more and more anaerobic bacteria to note the importance of the pelvic infection, the main digestive Streptococcus (peptostreptococcus), digestion, MI (peptococcus), and vulnerability B. (bacteroidisfragilis). These bacteria mainly comes from the colon, rectum, vagina and oral mucosa. Based culture in general and not for positive results. Some of the past pelvic abscess wound pus culture no colony growth are likely to anaerobic infection, and since then anaerobic culture technology constraints have not been positive results. According to the reported 70% ~ 80% can develop pelvic abscess anaerobes. Pelvic infection can separate anaerobic infections, can be mixed with aerobic bacteria infection, therefore, attention should be paid to the choice of antibiotics balance control anaerobic necessary. Streptococcus digest of penicillin, Pioneer-like (cephalosporins) in the cephalosporin (cepha 10thin), chloramphenicol, metronidazole are sensitive.
5, sexually transmitted pathogens such as gonococcus, Chlamydia trachomatis, Mycoplasma there may be other, herpes virus.
[Mode of transmission:
First, the bacteria spread through the lymphatic system vulva, vagina, cervix and uterus trauma of the pelvic lymphatic invasion of connective tissue and other parts of the genitalia, is puerperal infection, abortion infection after infection and certain IUD the proliferation of the main ways.
Second, the mass circulation argue invasive human pathogens to other systems, the blood circulation to genital infection,
Mycobacterium tuberculosis infection is the main way.
Third, upstream along the genital mucosa spread pathogens invasive genital, vaginal, along the mucosa of the cervix, endometrium, ovary and fallopian tube and peritoneal endometrium. Staphylococcus aureus, gonococcus along this route proliferation.
Fourth, direct intraperitoneal spread of infection in other organs, direct spread to the genitals, such as appendicitis can cause salpingitis.
Acute pelvic inflammatory disease
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[Causes]
Caused a major cause of acute pelvic inflammatory disease are as follows:
1, and after childbirth or abortion after maternal infection after physical weakness, cervical I not been satisfactorily closed, such as maternity or injury caused birth canal with a placenta, fetal membranes residues, pathogens Guankong invasive, easily cause infection; abortion during bloody long time , or organized residues in the uterine cavity, or aseptic surgical operation can be generated not strictly post-abortion infection.
Second, Guankong postoperative infection in surgical operations such as placing IUD, curettage of, tubal of ventilation, tubal uterine angiography, and endoscopic examinations officer, surgical sterilization is not strict or improper choice of preoperative indication, the original reproductive tract Chronic inflammation, and the interference caused by surgery and acute proliferation. —
Third, menstrual health bad menstrual phase endometrium-stripping, and the expansion of sinusoids coagulation block, a good breeding ground for bacteria, such as the pay no attention to health, the use of unclean menstrual pads, sex, etc. can menstrual invasive pathogens and cause inflammation.
4, Near organs such as the spread of the inflammation directly appendicitis, peritonitis, etc..
5, acute exacerbation of chronic pelvic inflammatory disease
[Pathological]
First, Jixingzi intrauterine uveitis and acute polymyositis was particularly prevalent in the abortion uterus after childbirth.
Second, acute salpingitis, tubal empyema, tubal ovarian abscess acute suppurative Salpingitis primarily by bacteria caused by cervical lymph node spread to the adjacent uterus ti organizations, first of all, transgression and serosal layer, a tubal inflammation around, and then involved myometrium, and intimal layer tubal involvement may very light. Its lumen often under pressure because of muscle wall thickening narrows, but can still maintain patency. Tubal mesenchymal lesions to inflammation mainly light to tubal only mild hyperemia and edema, slightly thickened; weight, tubal obvious thickening, thinning, cellulose of purulent exudate, causing the surrounding adhesion.
Such as inflammation and progressive extension of the endometrium, the first from the tube uveitis, tubal endometrial swelling, interstitial edema. Congestive and a large number of neutral polymorphonuclear leukocyte infiltration, weight, can occur epithelial degeneration into tablets or detached from the Ovductal adhesion, leading to tubal occlusion-lumen and umbrella, if wound pus accumulated in the formation of the fallopian tube lumen empyema.
Individual ovarian little inflammation, tunica albuginea is a very good defensive barrier, ovarian inflammation of the fallopian tubes and more than umbrella-adhesion and inflammation around in ovarian, fallopian tube ovarian said Yan, also known as Annex inflammation. Inflammation can be broken through ovulation-invasive ovarian ovarian abscess formation in real terms, such as abscess wall and tubal adhesions penetrating empyema, or tubal ovarian abscess formation. Tubal ovarian abscesses can occur in the fallopian tube ovarian acute inflammation after the initial onset, it is often repeated in chronic inflammation annex formed on the basis of the attack. Abscess located in the uterus or uterine rear, the broad ligament and the posterior lobe of intestinal adhesion, can be broken into the vagina or rectum, if broken into the abdominal cavity caused diffuse peritonitis.
3, acute inflammation of connective tissue in the pelvic genital acute inflammation, or the vagina, cervix traumatic, pathogens could enter the pelvic lymphatic connective tissue caused connective tissue congestion, edema, neutrophil infiltration. Uterine inflammation of connective tissue adjacent to the most common, local organizations began thickening, soft texture, borders unclear, after the two sides Penbi infiltration into fan-shaped, such as the Organization of purulent retroperitoneal abscess formation can be broken into spontaneous vaginal or rectal .
4, acute peritonitis pelvic organ in a serious pelvic infection, often spread to the pelvic peritoneum and inflammation of the peritoneal congestion, edema and a small amount of serous fiber exudative, and the formation of adhesions between the pelvic organs. When a large number of purulent exudate accumulated in the gap between the adhesive, can be formed in scattered small abscesses, rectal Xianao accumulated in the uterine pelvic abscess formation, see more. Abscess in front of the uterus, rectum back to the top of the omentum and intestine, rectal abscess can be broken into symptoms suddenly reduced abdominal cavity can be broken into diffuse peritonitis caused.
5, sepsis sepsis pathogens very high toxicity and the number of patients low resistance, often in sepsis. More common in serious puerperal infection, infection of abortion, in recent years, also reported at the Registry of IUD, tubal ligation organ damage caused by sepsis, if not promptly control of infection are often quickly shock or even death. After infection, such as other parts of the body found multiple abscess or inflammatory lesions, should consider sepsis exists, but yet confirmed by the train.
[Clinical manifestations - the severity of inflammation can be due to the size and scope of a difference. Onset, abdominal pain, with fever, a serious illness such as high fever, chills, headache, loss of appetite of not. If there is the digestive system of peritonitis such as nausea, vomiting, abdominal distension, diarrhea, etc.. For abscess formation of abdominal mass and can stimulate the local oppression symptoms mass at the front can stimulate the bladder symptoms, such as dysuria, frequency, such as myositis can also cause bladder have Niaotong; in before the mass have symptoms of rectal stimulation, as in the extraperitoneal Lijihouchong can cause diarrhea and flu and defecation difficult.
Patients with acute capacity, high temperature, rapid heart rate, abdominal distension, a lower abdominal muscle tension, tenderness and anti-Tao Tong, Chang Ming Yin weakened or disappeared. Pelvic examination: Road may congestive resistance, and a large number of purulent secretions, fornix obviously tenderness. Cervical congestion, edema, pain obvious move. Uterus slightly, tenderness, limitation of activities. The two uterine tenderness to a clear, and this can sometimes palpable mass. Uterine adjacent connective tissue inflammation, abdominal palpable to the side or on both sides of a sheet thickening. Or both sides of a high degree of edema Palace sacral ligament enlargement, abscess formation and location of low, and the posterior vaginal fornix palpable fornix or lateral mass and there is a sense of volatility. :
[Diagnosis] history, signs and symptoms of the diagnosis can be. In addition. Have to make some necessary laboratory tests, such as blood, urine, blood and cervical secretions of training (including anaerobic training) and drug-sensitive test, is not directly wound pus culture, there is a certain clinical reference value. If necessary, after the Kong Kong hole or side hole mass and there is a sense of volatility.
[] Differential diagnosis of acute pelvic inflammatory disease with acute appendicitis, ectopic pregnancy, ovarian Nang swollen reverse breakdown of acute abdomen or differentiate.
[Prevention]
First, do a good job menstruation, pregnancy and postpartum health propaganda
Second, strict obstetrics, gynecology surgical indication for preoperative preparation, the attention of sterile operations, including abortions, placed IUD, diagnostic operations such as curettage. For postoperative care, the prevention of infection.
Third, completely cured of acute pelvic inflammatory disease, and to prevent chronic.
[Treatment]
First, the general supportive therapy bed rest, L semi-supine to wound pus accumulation in the uterus rectal inflammation quality of the turtles correct pH balance disorder and, if necessary, a small amount of blood transfusion, using physical cooling heat, try to avoid unnecessary gynaecological examinations to avoid the proliferation of inflammation. For abdominal distension can give gastrointestinal decompression,
Second, according to antibiotic treatment drug sensitivity test is more reasonable use of antibiotics, the test results did not before, if the illness is not too serious Penicillium hydrogen can be used streptomycin; if serious condition required use broad-spectrum antibiotics, the drug efficacy, and Compatibility must be reasonable, fewer types of drug toxicity small, the results of bacterial culture, under the circumstances, to be replaced antibiotics. Intravenous route of administration to effect faster. Antibiotics application requirements to achieve adequate, and requires attention to the toxicity. The symptoms disappeared after two weeks to continue to consolidate the administration of, and strive to heal completely, in order to avoid a basin of chronic inflammation.
Penicillium cable G on anaerobic also effective, treatment with high-dose, according to the degree of seriousness to the daily 2.4 million to 1000, 10,000 IU intravenous drip, his condition improved after a day could be reduced to 1.2 million U ~ 2400001, intramuscular injection four times. If allergic to penicillin, erythromycin can be used intravenous drip 1.2 g daily, plus kanamycin each with 0.5 g, 2 times daily, intramuscular injection.