chronic pelvic inflammatory disease
Introduction
Introduction to chronic pelvic inflammatory disease Chronic pelvic inflammatory disease (chronic pelvic inflammation) refers to the chronic inflammation of the female genitalia and its surrounding connective tissue, pelvic peritoneum. Often acute pelvic inflammatory disease is not completely treated, in the case of poor patient physique, the course of acute pelvic inflammatory disease can be prolonged and recurrent, resulting in chronic pelvic inflammatory disease; but there may be no history of acute pelvic inflammatory disease, such as Chlamydia trachomatis infection Salpingitis. Chronic pelvic inflammatory disease is more stubborn, which can lead to menstrual disorders, increased vaginal discharge, waist and abdomen pain and infertility. If chronic annexitis has formed, the tumor can be touched. basic knowledge The proportion of illness: 0.0521% Susceptible people: adult women Mode of infection: non-infectious Complications: chronic pelvic pain, infertility, peritonitis
Cause
Causes of chronic pelvic inflammatory disease
Immunity factor (10%):
When natural defense function is destroyed, or the body's immune function declines, endocrine changes or exogenous pathogens invade, it can also cause inflammation.
Conditional migration (15%):
If acute pelvic inflammatory disease is not completely treated, chronic pelvic inflammatory disease occurs due to prolonged course of disease; it may also spread due to inflammation of adjacent organs, such as appendicitis and peritonitis, which may cause chronic pelvic inflammatory disease. The pathogen is mainly Escherichia coli.
Chlamydia infection (10%):
Some patients may have no history of acute pelvic inflammatory disease, but are caused by Chlamydia trachomatis infection.
Pathological changes (10%):
Some chronic pelvic inflammatory disease is a pathological change left by acute pelvic inflammatory disease, and no pathogen exists.
Pathogens enter the wound after postpartum, abortion and gynecological surgery (8%):
Such as curettage, tubal sputum, hysterosalpingography, hysteroscopy, artificial abortion and other surgical and invasive examinations that have certain damage to the pelvic cavity, or do not strictly adhere to the principle of sterility, can cause genital mucosal damage , hemorrhage, necrosis, causing ascending infection of the pathogens of the endogenous flora of the lower genital tract.
Related to sexual activity and age (10%):
Pelvic inflammatory disease occurs mostly in sexually active women, especially those who are younger at first sexual intercourse, have multiple sexual partners, have sexual intercourse, and have sex with sexual partners.
According to US data, the high incidence of pelvic inflammatory disease is 15 to 25 years old. Pelvic inflammatory disease in young people may be associated with frequent sexual activity, physiological outward displacement of the cervical columnar epithelium, and poor mechanical defense function of cervical mucus.
Lower genital tract infection (10%):
Sexually transmitted diseases of the lower genital tract, such as Neisseria gonorrhoeae cervicitis, chlamydial cervicitis, and bacterial vaginosis, can connect to the pelvic cavity through the lower genital tract, which leads to pelvic inflammation.
Poor sexual hygiene (8%):
Due to sexual behavior during menstruation, the use of unclean menstrual pads, baths, etc., can cause pathogens to invade and cause inflammation. In addition, the incidence of pelvic inflammatory disease is high in those who do not pay attention to sexual health care and neglect to perform vaginal washing.
Pelvic inflammatory disease (PID) is again acute (5%):
PID caused by extensive pelvic adhesions, fallopian tube damage, fallopian tube defense ability, easy to cause re-infection, recurrent episodes, leading to acute episodes of chronic pelvic inflammatory disease.
Pathogenesis
1. Chronic endometritis:
Chronic endometritis can occur after postpartum, after abortion or after cesarean section, because of placenta, residual fetal membranes or poor uterine involution, it is highly susceptible to infection; also seen in elderly women with low estrogen after menopause, due to the uterine endometrium, Susceptible to bacterial infection, severe cervical adhesions form uterine empyema. Endometrial congestion, edema, interstitial mass plasma cells or lymphocytes infiltration.
2, chronic salpingitis and hydrosalpinx:
Chronic salpingitis is mostly bilateral, the fallopian tube is mild or moderately enlarged, the umbrella end can be partially or completely locked, and adheres to the surrounding tissue. Sometimes the oviductal islet mucosa epithelium and fibrous tissue hyperplasia, so that the fallopian tube is multiple, nodular thickening, called isthmic nodular salpingitis.
When the inflammation of the fallopian tube is light, the umbrella end and the isthmus adhere to the atresia, and the serous exudate accumulates to form the hydrosalpinx; sometimes the fallopian tube becomes chronic, the pus gradually absorbs, and the serous fluid continues to ooze from the wall and fill the lumen. It can also form hydrosalpinx.
The surface of the hydrosalpinic oviduct is smooth and the wall of the tubal is very thin. Because the tubal mesangium can not be extended with the growth of the wall of the oviduct tubal, the hydrocephalus is curved to the mesangial side, resembling a dachshund or a retort in the shape of a curved neck. The curl is backwards and can be free or have a film-like adhesion to the surrounding tissue.
3, fallopian tube ovarian inflammation and fallopian tube ovarian cysts:
When the fallopian tube is inflamed, it affects the ovary. The fallopian tube and the ovary adhere to each other to form an inflammatory mass, or the umbrella end of the fallopian tube adheres to the ovary and penetrates. The liquid exudates to form the fallopian tube ovarian cyst. It can also be absorbed by the pus of the fallopian tube ovarian abscess and replaced by exudate. And formed.
4, chronic pelvic connective tissue inflammation:
The inflammation spreads to the ligament of the uterus, causing the fibrous tissue to proliferate, harden, and even lose its normal function. If the spread is wide, the uterus can be fixed and the paracervical tissue can be thickened. Palpation revealed that the uterus is often biased to the pelvic connective tissue on the affected side.
Prevention
Chronic pelvic inflammatory disease prevention
1) Strengthen women's health care work, pay attention to diet and nutrition, eat more fresh fruits and vegetables, increase vitamin intake, enhance physical fitness, and improve the body's ability to infect.
2) Adult women should pay attention to contraception, avoid or reduce abortion surgery, and perform strict aseptic operation in the reproductive system to prevent bacteria from invading the pelvic cavity.
3) Strengthen health education and education, teach the public the knowledge of preventing pelvic infection, educate women to pay attention to menstruation and puerperal hygiene, try to avoid vaginal lavage, pay attention to postpartum hygiene, and avoid postpartum infection.
Complication
Chronic pelvic inflammatory disease Complications chronic pelvic pain infertility peritonitis
1, chronic pelvic pain: associated with the omentum and intestinal adhesion.
2, leading to infertility or ectopic pregnancy: chronic pelvic inflammatory disease may lead to obstruction of the fallopian tube, tubal ovarian adhesions form tubal ovarian mass, hydrosalpinx or empyema, easily lead to infertility, the incidence rate is 20-30%, may also occur In ectopic pregnancy, the incidence is between 1% and 25%, which is 8 to 10 times that of normal women.
3. Peritonitis: related to the upward migration of inflammation.
4, sepsis: patients with chronic pelvic inflammatory disease may have decreased immunity, low physical quality, can cause systemic infection, and then lead to sepsis.
5, intestinal obstruction: related to intestinal pelvic adhesion caused by chronic pelvic inflammatory disease. Can cause intestinal ischemic necrosis.
Symptom
Chronic pelvic inflammatory symptoms Common symptoms Chronic pelvic pain bilateral lower abdomen pain under the abdomen dull pain and soreness female lower abdominal pain body discomfort menstrual cycle change uterus has limited tenderness tenderness chronic pelvic pain lumbosacral sore tubal adhesions
Symptom
(1) Chronic pelvic pain: scar adhesion caused by chronic inflammation and pelvic congestion, often cause lower abdomen bulge, pain and lumbosacral pain, often tired, after sexual intercourse and before and after menstruation.
(2) infertility and ectopic pregnancy: tubal adhesions can cause infertility and ectopic pregnancy, the incidence of infertility after acute pelvic inflammatory disease is 20% to 30%.
(3) abnormal menstruation: endometritis often irregular menstruation; pelvic congestion can cause increased menstrual flow; ovarian dysfunction can cause menstrual disorders.
(4) systemic symptoms: more or less obvious, sometimes only low fever, easy to feel tired, due to longer duration of the disease, some patients may have symptoms of neurasthenia, such as lack of energy, general discomfort, insomnia, etc., when the patient's resistance is poor, Easy to have an acute or subacute attack.
2. Signs
If it is endometritis, the uterus enlarges, tenderness; if it is salpingitis, it will touch the thickened fallopian tube in the form of a strip on one side or both sides of the uterus, and there is mild tenderness. If it is hydrosalpinx or fallopian tube Ovarian cysts, cystic masses are touched on one or both sides of the pelvis, and the activity is limited. If it is pelvic connective tissue inflammation, the uterus often shows a posterior tilting and flexion, limited mobility or adhesion fixation, one or both sides of the uterus. There are flaky thickening on the side, tenderness, and the ligament of the uterus is often thickened, hardened, and tender.
3, check
A large amount of inflammatory cell infiltration of tissue was observed under the microscope.
4, diagnosis
The diagnosis of chronic pelvic inflammatory disease can be diagnosed based on the history, symptoms and signs. Patients with a history of acute pelvic inflammatory disease and obvious signs and symptoms have no difficulty in diagnosis. However, sometimes patients have more symptoms, and no obvious history of pelvic inflammatory disease and positive signs, should be more careful diagnosis of chronic pelvic inflammatory disease, a differential diagnosis, so as not to make a diagnosis to cause the patient's ideological burden.
Examine
Chronic pelvic inflammatory disease
At present, the main examination methods are B-ultrasound and lipiodol imaging.
First, B-ultrasound: You can investigate the widening, thickening, or inflammatory mass on both sides of the attachment.
Second, uterine tubal lipiodol angiography: can show the obstruction of the fallopian tube, including the location and extent of obstruction, is conducive to symptomatic treatment.
Third, histopathological examination: a large number of inflammatory hyperplasia of the examined tissue can be seen under the microscope.
Fourth, there are general inspection items including blood routine examination, vaginal secretion examination, tumor marker examination, and polymerase chain reaction detection.
In addition, colposcopy, laparoscopy, histopathology is also helpful in the diagnosis of chronic pelvic inflammatory disease.
Diagnosis
Diagnosis and diagnosis of chronic pelvic inflammatory disease
diagnosis
The diagnosis of chronic pelvic inflammatory disease can be diagnosed based on the history, symptoms and signs. Patients with a history of acute pelvic inflammatory disease and obvious signs and symptoms have no difficulty in diagnosis. However, sometimes patients have more symptoms, and no obvious history of pelvic inflammatory disease and positive signs, should be more careful diagnosis of chronic pelvic inflammatory disease, a differential diagnosis, so as not to make a diagnosis to cause the patient's ideological burden.
Differential diagnosis
Endometriosis
Endometriosis refers to a gynecological disease in which the endometrium with growth function grows and grows outside the uterus covering surface. The main manifestation is that the dysmenorrhea of endometriosis is secondary and progressively aggravated. If the posterior wall of the uterus, the humeral ligament of the uterus, and the recessed depression can touch the typical tender nodules, it is helpful for diagnosis. In addition, chronic pelvic inflammatory disease for long-term treatment should be considered endometriosis. B-mode ultrasound is helpful for identification. Laparoscopy should be performed when the identification is difficult.
2. Ovarian cysts
Ovarian cysts are a type of ovarian tumor in a broad sense, which can be affected by various ages, but are most common among women aged 20-50. Ovarian tumors are more common in cystic, and the degree of malignant transformation is high. Tubal ovarian cysts need to be differentiated from ovarian cysts. In addition to the history of pelvic inflammatory disease, the tubal ovarian cyst has a sausage shape, a thin wall and adhesion around it. The ovarian cyst is generally round or oval, with no adhesion around and free movement.
3. Ovarian tumor
Attachment inflammatory mass adheres to the surrounding, inactive, tender, sometimes confused with ovarian cancer, chronic inflammatory mass is mostly cystic; and ovarian cancer mass is mostly solid, hard, irregular surface, The uterus rectal fossa can be sputum and hard nodules, often with ascites. The patient is generally in poor condition and the disease develops rapidly. Sustained pain can occur regardless of the menstrual cycle. B-mode ultrasound is helpful for identification. When it is difficult to diagnose, it can be done by laparoscopy or pathological biopsy.
4. Old ectopic pregnancy
Refers to a long course of abortion or rupture of the tubal pregnancy, and the condition is gradually stabilized after repeated internal bleeding. At this time, the embryo died, the villi were degenerated, the internal hemorrhage stopped, and the abdominal pain was alleviated, but the hematoma formed gradually became hardened and adhered to the surrounding tissues and organs.
Older ectopic pregnancy patients can consult the history of repeated internal bleeding after menopause. The clinical features are irregular vaginal bleeding, paroxysmal abdominal pain, attachment lumps and low fever. Low fever is caused by the intra-abdominal blood absorption process, such as secondary infection, which is characterized by high fever. There are many cases of amenorrhea and vaginal bleeding, partial pain in the lower side of the affected side, gynecological examination of adhesions around the uterus, tenderness, laparoscopic examination is helpful for diagnosis.
5. Tuberculous pelvic inflammatory disease
It is also a chronic disease, with a history of tuberculosis in other organs, abdominal pain is often persistent, occasionally a history of amenorrhea, often endometrial tuberculosis, abdominal distension, occasional abdominal mass, X-ray examination of the lower abdomen visible calcification, mass The location is higher than chronic pelvic inflammatory disease, and a laparoscopic biopsy can confirm the diagnosis.
6, pelvic congestion syndrome
Pelvic Congestion Syndrome, also known as Ovarian Vein Syndrome, is one of the most important causes of gynecological pelvic pain. It is characterized by lumbosacral interstitial pain and abdominal pain, lower extremity radiation, long standing and Symptoms worsen after exertion. Check the cervix visible purple blue, but the uterine attachment is not abnormal, symptoms and signs do not match, can be diagnosed by pelvic venography.
7. Other situations
Sometimes pelvic congestion or wide ligament varicose veins can also produce symptoms similar to chronic pelvic inflammatory disease, should also pay attention to identification.
