Inflammation of appendages
Inflammation of appendages – the inflammatory process in a small basin localized in ovaries and pipes (appendages). The bacteria and viruses getting into appendages, and to the major provocative factors - overcooling are the reasons of pathology owing to what the general and local immunity decreases. The disease is shown by various symptomatology: from nagging pains in the bottom of a stomach and poor allocations before failures of a menstrual cycle and the sharp inflammatory phenomena. Therefore only comprehensive diagnostics including laboratory, differential and tool methods of a research helps to make the correct diagnosis. The main link of treatment is specific etiotropny therapy, out of a sharp stage an important role is played by prevention. The disease has also other medical designations – adneksit, salpingooforit (from a combination of terms "salpingit" – an inflammation of fallopian (uterine) pipes and "ooforit" – an inflammation of ovaries).
Inflammation of appendages
The inflammation of appendages can be both bilateral, and unilateral, localized on the right or at the left. Now physicians note prevalence of a disease. Among patients young women and girls aged up to 30 years meet more often, they make also the greatest risk group. First of all, it is connected with bigger sexual freedom, a significant amount of the sexual partners, use the COOK who replaced the barrier methods of contraception significantly reducing risk of hit in a genital tract of causative agents of a disease.
Craftiness of a problem consists also in a possibility of course of an inflammation of appendages in the erased, latent form. Consequences of such phenomenon the most terrible – extra-uterine pregnancies, not incubation, infertility. According to the practicing gynecologists and scientific experts, the inflammation of appendages is one of urgent problems of modern gynecology and requires the closest attention. In order to avoid the heavy, difficult giving in to treatment complications, in the present and the future each woman has to have regular examinations at the gynecologist and report to him during the visit about all factors causing alarm or doubts.
Reasons of an inflammation of appendages
The viruses, bacteria and other pathogenic microorganisms getting into the top departments of a female reproductive system (ovaries, fallopiyeva of a pipe and a sheaf) are various ways etiologies. Most often the ascending way of spread of an infection meets. In this case the causative agent of pathology gets from the lower departments of a female reproductive system – a neck of a uterus, a vagina, and also from the infected close located bodies – urethras, mochetochnik, a rectum. Most often in this case as activators colibacillus, gonokokk, hlamidiya, strepto-, staphylococcus, fungi and their associations act. DST (disease sexually transmitted), non-compliance with hygienic norms, chaotic sex life breaking normal flora and local protective immunity of a vagina are the frequent reason of the ascending infection.
Much less often the descending or secondary way of hit of an infection meets. It is possible in case of existence of sharp inflammatory process near bodies of a small pelvis, for example the appendicitis complicated by peritonitis. The hematogenic way is considered one more rare way of spread of an infection (through the infected blood). It is accompanied by the beginning or developed sepsis. Also the genital tuberculosis caused by the specific activator – Koch's stick can become the reason of hematogenic infection of appendages.
The processes localized on the one hand most often are caused by such activators as colibacillus, streptococci and staphylococcus. Koch's stick and lead to an inflammation of appendages from two parties more often. The infectious agent, getting into a mucous membrane of fallopian (uterine) pipes one of above-mentioned ways, takes root into it, then – quickly extends to adjacent serous and muscle fibers. Further process takes an epithelium of ovaries and a peritoneum of a basin. At broader defeat including an ovary and all uterine tube formation of tuboovarialny abscess is possible. As the investigation of an inflammation of appendages serve the multiple solderings limiting mobility, normal activity of a resnitchaty epithelium and sokratitelny ability of uterine tubes.
The major factors provoking a demonstration of an adneksit are the overcoolings, stresses, other states which are negatively influencing immunity. Nevertheless, they do not act as the prime cause of an inflammation of appendages and in the absence of an infection in an organism cannot in itself provoke developing of pathology.
Classification of an inflammation of appendages
The disease can have both a sharp, and chronic current (with a possible recurrence or without them).
The picture of an acute inflammation of appendages is characterized by the expressed symptoms. It is the acute pain localized on the party of defeat of bodies or poured on all abdominal cavity, giving to a rectum, a sacrum, a back, substantial increase of temperature (38-40 degrees), allocations, including purulent. Data of laboratory analyses show the pathological shift of a blood count with sharp increase of SOE and increase in leukocytes to the left. The palpation at survey on a chair reveals "a sharp stomach", the mechanism of muscular protection, strong tension. The general clinical manifestations of infectious defeat – vomiting, diarrhea, weakness, falling HELL and pulse, change are possible from cardiovascular system, emergence of symptoms of a renal failure.
The clinical signs of a chronic inflammation of appendages – pulling, times amplifying painful feelings in the lower departments of a stomach, periodic insignificant or moderate rise in body temperature (to 38 degrees), allocations of various degree of intensity and an okrashennost. Signs appear and disappear cyclically, a recurrence lasts up to seven days. In half of cases violation of a menstrual cycle is diagnosed. Menorragiya – periods with considerable blood loss are possible; metrorragiya – bleedings out of a cycle, can develop .
Symptoms of an inflammation of appendages
The inflammation of appendages has a phasic current, both at sharp, and at a chronic form of a disease. The symptomatology and treatment at each stage are specific. The sharp current, as a rule, gives a clear picture of an inflammation which can be traced on patognomonichny symptoms of a disease at each stage.
The toxic stage is characterized by organism intoxication symptoms. Are characteristic moderately raised, high, sometimes – very high temperature of a body (to 40-41 degrees). The fever, swelling and morbidity of a stomach, dizurichesky frustration (the broken urination), the dispepsichesky phenomena (a diarrhea, vomiting) is observed. From a reproductive system plentiful allocations, the severe, localized or poured pains are noted, bleedings are possible. The symptomatology remains within 1-1,5 weeks, then transition of a disease to the second (a septic stage), an absolute recovery (is possible at adequate therapy of an inflammation of appendages) or synchronization of pathology (at partial operation of mechanisms of internal immune protection).
The septic stage is characterized by aggravation of symptoms, weakness, dizzinesses, joining of anaerobe bacterias with formation of purulent tuboovarialny education with perforation threat. Perhaps further distribution of inflammatory process on bodies of a small pelvis and a peritoneum with emergence of a pelvioperitonit, life-endangering patients.
Symptoms of an inflammation of appendages in a synchronization phase in some cases have not expressed character. The stupid, amplifying pains arise periodically, coincide with this or that phase of a cycle. Slight increase of temperature, disorder of menstrual function, a sexual problem (painful sexual intercourse, decrease in a libido etc.), deterioration in the general health and decrease in working capacity are observed. At it is long the proceeding chronic inflammation of appendages without treatment there can be gastrointestinal diseases (colitis and so forth) and secretory system (the pyelonephritises recuring cystitis etc.).
Complications of an inflammation of appendages
Peritonitis can become a terrible complication of an acute inflammation of appendages at out of time begun therapy. The chronic inflammation of appendages often is complicated by infertility. Infertility of the mixed genesis which reason the inflammation of appendages also is very difficult gives in to treatment. It is caused by the fact that hormonal dysfunction owing to damage of ovaries joins decrease in physiological function of fallopian pipes (sokratitelny ability, to violation of activity of a resnitchaty layer) or their full impassability. Failures in a menstrual cycle, lack of an ovulation lead to serious functional and anatomic changes in a female reproductive system.
Formation of infiltrates – a frequent consequence of a chronic inflammation of appendages can be complicated by development of processes of a sklerozirovaniye in uterine tubes. It is the main reason for ektopichesky (extra-uterine) pregnancy, formation of painful solderings. Spread of pathology on the next bodies often causes development of cholecystitis (sharp and chronic), colitis, pyelonephritis.
Diagnostics of an inflammation of appendages
Primary consultation of the gynecologist is directed to assessment of an overall picture inherent in an inflammation of appendages, on the basis of anamnestichesky data of the patient. At the same time existence of abortions, Naval Forces (an intrauterine spiral), complications in labor is considered, the number of sexual partners, the general of data on the state of health, the shown complaints is unsuccessful ended pregnancies. Gynecologic survey on a chair (a two-handled internal research) reveals signs, characteristic of an inflammation of appendages. They are shown as unilateral or 2-sided painful increase in appendages of a uterus.
With antibiotikogrammy and the microscopic research of dab of a vagina, the tservikalny channel and an urethra allow to identify bacteriological crops on flora infecting agents, and also to define their caption (concentration). According to these data it is possible to estimate extent of process of an inflammation in a small basin. Ultrasound (ultrasonography of bodies of a small pelvis) finds existence of inflammatory formations of appendages, their localization (, ).
Tool methods of diagnostics of an inflammation of appendages can be applied: the diagnostic laparoscopy helps to reveal purulent educations in fallopian pipes, to exclude or confirm existence of adhesive process. The procedure allows to unite diagnostic testing with carrying out medical manipulations. By means of a radiographic research of a uterus existence of pathological changes of pipes decides on use of contrast – gisterosalpingografiya and their passability is estimated.
Treatment of an inflammation of appendages
The inflammation of appendages in a sharp phase is treated in stationary conditions with observance by the patient of a bed rest, physical and mental rest, a diet on the basis of digestible food, the adequate drinking mode with assessment of secretory function. The main treatment of an adneksit – antibacterial etiotropny therapy depending on the diagnosed causative agent of a disease: penicillin, tetratsiklina, macroleads, aminoglycosides, ftorkhinolona. At the available risk of accession of an anaerobic infection the combination of various groups of antibiotics is appointed, for example, metronidazole is added to above-mentioned medicines (intravenously, orally).
Conservative therapy also includes the anesthetizing medicines, means removing the phenomena and consequences of intoxication (infusional therapy). At a purulent complication of an inflammation of appendages expeditious treatment is applied. First of all, preference is given to low-traumatic gynecologic surgery – to laparoscopic manipulations, evacuation of purulent contents of meshotchaty education by means of a puncture of the back arch of a vagina with possible subsequent introduction of medicines. At far come inflammation when there is a risk of purulent fusion, surgical removal of appendages is shown.
After leveling of sharp signs of an inflammation of appendages the course of physiotherapeutic procedures is appointed: ultrasound, with use of the medicines Mg, K, Zn, vibromassage. The same methods, along with etiotropny antibacterial therapy, are shown at treatment of an inflammation of appendages in a chronic form. The sanatorium rehabilitation treatment promoting a rassasyvaniye of adhesive process and interfering formation of solderings is appointed. Resorts in which as medical procedures mud-therapy, parafinolecheny, medical bathtubs and irrigations is used by sulfide and hloridno-sodium mineral waters are preferable.
Forecast and prevention of an inflammation of appendages
At timely primary address with symptomatology of an acute inflammation of appendages and adequate therapy absolute clinical recovery occurs approximately in 10 days. Adneksit in a stage of synchronization demands regular surveys and the supporting therapy, sanatorium and rehabilitation actions, systematic control of a condition of the patient.
For prevention of emergence of a recurrence of an inflammation of appendages, especially patients need to exclude the factors provoking a disease from risk group (the using Naval Forces having unsuccessful pregnancies and abortions in the anamnesis) – overcoolings, stresses, infections, sexually transmitted. It is recommended to use rational methods of contraception, in due time to carry out complex adequate therapy of diseases of bodies of a small pelvis, considering causative agents of pathology. Visit of antenatal clinic at least for routine inspection of the gynecologist has to become once a year a norm for each woman caring for the health.