adnexitis

Adnexitis (syn .: oophoritis) - inflammation of the uterus (uterine tubes and ovaries).

Adnexitis caused by streptococcus, staphylococcus, chlamydia, gonococcus, Escherichia coli, Mycobacterium tuberculosis. Germs get into appendages of the uterus from the vagina, cervix and uterus body; more rarely, they can spread blood and lymphatic vessels (eg for tuberculosis). Infection most often occurs during the abortion, dilatation and curettage and other intrauterine manipulation. The inflammatory process is usually initially involved fallopian tubes (salpingitis), then the ovaries (oophoritis). In some cases, the process extends to the surrounding peritoneum (periadneksit). The accumulation of inflammatory exudate in the lumen of the fallopian tube leading to the formation of saccular formation (saktosalpinksa). Trapped in the lumen of the fallopian tube exudate can be transparent (hydrosalpinx) or purulent (piosalpinks). Adnexitis is one-sided and two-sided.

The clinical picture and the course adneksita depend on the pathogen and reactivity. So, adnexitis caused by staphylococcus, streptococcus, gonococcus, acutely or chronically leaking, for chlamydia and tuberculosis typically chronic adnexitis.

Acute adnexitis characterized by severe pain in the abdomen and sacrum. In some cases, pain may be accompanied by bloating, nausea, vomiting, delayed stool. On palpation revealed a sharp pain in the lower abdomen, sometimes with severe symptoms of muscle protection. Body temperature can rise to 39 ° C. In the blood revealed leukocytosis , leukocyte formula shift to the left, increasing the ESR. The most serious complication during this period - the transition process in the pelvic peritoneum pelvioperitonita the development and formation of an abscess in Douglas (utero-rectal) space. In the case of education piosalpinks greater danger is the gap of the fallopian tube, accompanied by penetration of pus in the abdomen and the development of peritonitis. In uncomplicated cases of acute adnexitis events held 7 - 10 days, then the pain gradually subsides, body temperature and blood counts are normalized.

Chronic adnexitis develops independently or is the outcome of an acute process. Patients report pain in the abdomen and in the groin area, extending to the sacrum and anus, which is usually caused by the formation of adhesions around the fallopian tubes and ovaries. Adhesions in the fallopian tubes can lead to violation of their patency and infertility. In chronic adnexitis often observed menstrual irregularities, manifest abundant and prolonged bleeding. Often, especially in chronic adnexitis, the only sign of the disease is infertility . Chronic adnexitis any etiology occurs with remissions and relapses, which are caused by the activation of dormant infection under the influence of fatigue, hypothermia and other non-specific factors.

Diagnosis is based on history data, the nature of pain, their localization, fever, pelvic exam results (with a two-handed study noted an increase in the uterus and disturbance of mobility due to the formation of adhesions).

To identify the cause of the inflammatory process is carried out bacteriological examination discharge urethra, cervix and vagina; to avoid gonorrhea conducted provocative tests. If you suspect a tuberculous etiology adnexitis used diagnostic curettage, sowing menstrual blood metrosal-pingografiyu, tuberculin skin test - Mantoux test, Koch. Gonococcus, mycobacterium tuberculosis and chlamydia usually cause bilateral, streptococcus, staphylococcus and E. coli - sided adnexitis.

With the introduction into clinical practice of laparoscopy differential diagnosis of impaired tubal pregnancy (see. Ectopic pregnancy), parametritis, appendicitis, pelvioperitonitom greatly simplified. In case of acute abdominal symptoms (abdominal pain, nausea , vomiting , a symptom of muscle protection and others.) Paramedic is required to organize an urgent and gentle transport of the patient on a stretcher to a nearby hospital.

Treatment of acute exacerbations of chronic and expressed adneksita spend in the hospital. Patients prescribed bed rest, mechanically and chemically gentle diet ice on the abdomen, antibiotics, sulfa drugs, painkillers. With the elimination of the acute effects can be applied physiotherapy (ultrasound, ultrasound irradiation, electrophoresis of drugs, diathermy, paraffin baths). In chronic adnexitis, as well as at the end of the acute period (not earlier than 4 weeks) treatment is indicated in the mud spas and resorts with the hydrogen sulfide and radon waters. When tuberculosis treatment adnexitis specific, carried out in the TB clinic or hospital.

The prognosis for uncomplicated adnexitis usually favorable, but in some cases may develop persistent infertility, menstrual dysfunction, increased risk of ectopic pregnancy.

Prophylaxis is aimed at preventing abortions, proper management of post-partum period (infection prevention). For the prevention of relapse adneksita avoid hypothermia, fatigue and increased physical activity, especially during menstruation. It must be remembered that promiscuous sexual contacts are a source of infection and diseases adnexitis.