Acute pelvic inflammatory disease

Acute pelvic inflammatory disease is a relatively common gynecological disease. It is quite uncomfortable when it occurs. The lower abdomen is often swollen and painful. It hurts when the sides of the lower abdomen are pressed. You may even be unable to stand up all the time. This is especially obvious during menstruation and sexual intercourse. If you have frequent sexual intercourse and are usually tired at work, the disease will recur. At this time, you need to seek medical attention in time and use medication reasonably to control the disease.

If acute pelvic inflammatory disease is delayed in treatment, it can easily turn into chronic pelvic inflammatory disease, which will be more likely to recur. During the treatment period, special attention should be paid to diet. Spicy and irritating foods should not be eaten, and cold foods should not be touched. Do not overwork, try to avoid sexual life, eat more nutritious foods and regulate your body well. The following is an introduction to the relevant content of acute pelvic inflammatory disease.

Causes

1. Infection after intrauterine surgery.

2. Lower genital tract infections are mainly sexually transmitted diseases of the lower genital tract, such as gonorrhea, Neisseria gonorrhoeae, cervicitis, chlamydia, and bacterial vaginosis, which are closely related to pelvic inflammatory disease (PID).

3. Poor menstrual hygiene, such as using unclean menstrual pads and having sexual intercourse during menstruation, can allow pathogens to invade and cause inflammation. The pathogens of the above infections are mainly pathogens of the endogenous flora of the lower reproductive tract, such as Staphylococcus, Streptococcus, Escherichia coli, anaerobic bacteria, etc.

4. Infection with sexually transmitted diseases. People with a history of unclean sexual life, early sexual intercourse, multiple sexual partners, and frequent sexual intercourse may be invaded by pathogens of sexually transmitted diseases and cause pelvic inflammation. Common pathogens include Neisseria gonorrhoeae, Chlamydia trachomatis, or combined aerobic and anaerobic infections.

5. Direct spread of inflammation from adjacent organs, such as appendicitis, peritonitis, etc., mainly caused by Escherichia coli.

6. Acute attack of chronic pelvic inflammatory disease.

7. Intrauterine contraceptive devices can cause pelvic inflammation. First, within 10 days of placement of the intrauterine contraceptive device, it can cause acute pelvic inflammatory disease, at which time the infection is mainly caused by Staphylococcus, Streptococcus, Escherichia coli, and anaerobic bacteria; second, after long-term placement of the intrauterine contraceptive device, secondary infection forms chronic inflammation, which can sometimes have acute attacks.

Clinical manifestations

The clinical manifestations may vary depending on the severity and extent of the inflammation. When the disease occurs, there is lower abdominal pain and fever. If the condition is serious, there may be chills, high fever, headache, and loss of appetite. If the disease occurs during menstruation, there may be increased menstrual flow and prolonged menstruation. If the disease occurs outside of menstruation, there may be increased leucorrhea. If there is peritonitis, digestive system symptoms such as nausea, vomiting, abdominal distension, diarrhea, etc. will appear. If an abscess is formed, there may be a lower abdominal mass and local compression and irritation symptoms; if the mass is located in the front, bladder irritation symptoms may occur, such as difficulty urinating and frequent urination. If it causes cystomyositis, there may also be urinary pain. If the mass is located in the back, there may be rectal irritation symptoms, and if it is outside the peritoneum, it may cause diarrhea, tenesmus and difficulty defecation. The clinical manifestations vary depending on the infecting pathogen. Neisseria gonorrhoeae infection has an acute onset, usually with high fever, peritoneal irritation signs and vaginal purulent discharge within 48 hours. Non-gonococcal Neisseria pelvic inflammatory disease has a slow onset, with no obvious high fever or peritoneal irritation signs, and is often accompanied by abscess formation. If it is an anaerobic infection, it is prone to multiple recurrences and abscess formation. The patient is older, often over 30 years old. The course of Chlamydia trachomatis infection is long, with mild lower abdominal pain, long-term persistent low fever, and irregular vaginal bleeding. The patient presents with acute illness, fever, accelerated heart rate, abdominal distension, tenderness, rebound pain and muscle tension in the lower abdomen, and weakened or disappeared bowel sounds. Pelvic examination: The vagina may be congested and have a large amount of purulent secretions. Wipe off the secretions on the surface of the cervix. If purulent secretions are seen flowing out of the cervical opening, it indicates that there is acute inflammation of the cervical mucosa or uterine cavity. There is obvious tenderness in the fornix, and attention should be paid to whether it is full; the cervix is ​​obviously congested, edematous, and painful when lifting; the uterus is slightly enlarged, tender, and has limited movement; there is obvious tenderness on both sides of the uterus. If it is simple salpingitis, the thickened fallopian tube can be touched, and there is obvious tenderness; if it is tubal pyosalpinx or tubo-ovarian abscess, a mass can be touched and the tenderness is obvious; in case of parametrial connective tissue inflammation, flake-like thickening can be felt on one or both sides of the parametrium, or the uterosacral ligaments on both sides are highly edematous and thickened, with obvious tenderness; if an abscess is formed and is located lower, a mass and a sense of fluctuation can be felt in the posterior fornix or lateral fornix. The triple examination can often help to further understand the pelvic condition.

treat

1. Supportive care

Bed rest or semi-recumbent position is conducive to the accumulation of pus in the rectouterine pouch and thus localize the inflammation. Give high-calorie, high-protein, high-vitamin liquid or semi-liquid food and replenish fluids. Pay attention to correcting electrolyte disorders and acid-base imbalances, and give a small amount of blood transfusion when necessary. Use physical cooling when the fever is high. Try to avoid unnecessary gynecological examinations to prevent the spread of inflammation. If abdominal distension occurs, gastrointestinal decompression should be performed.

2. Medication

In recent years, new antibiotics have been continuously introduced, and the advancement of anaerobic bacteria culture technology and the coordination of drug sensitivity tests have enabled the rational use of drugs in clinical practice, taking into account the control of both aerobic and anaerobic bacteria, making the treatment of acute pelvic inflammatory disease significantly effective. With active treatment in the acute phase of pelvic inflammatory disease, most cases can be completely cured. In the past, the treatment of adnexal abscess was mainly surgical. However, the clinical treatment results in recent years have shown that if the treatment is timely and the medication is appropriate, 73% of adnexal abscesses can be controlled until the mass disappears completely and surgery is avoided (especially those with abscess diameter <8cm). This shows that drug treatment of acute pelvic inflammatory disease occupies an important position. The selection of antibiotics based on drug sensitivity tests is more reasonable, but before the test results are obtained, it is necessary to speculate on the pathogen based on the medical history and clinical characteristics, and select the medication based on what antibiotics have been used after the onset of the disease. Since the pathogens of acute pelvic inflammatory disease are mostly mixed infections of aerobic bacteria, anaerobic bacteria and chlamydia, and aerobic bacteria and anaerobic bacteria are divided into Gram-negative and Gram-positive, combination therapy is often used in the selection of antibiotics.

3. Surgery

(1) If drug treatment is ineffective and pelvic abscess is formed, and the body temperature does not drop after 48 to 72 hours of drug treatment, or the patient's poisoning symptoms worsen or the mass increases, surgery should be performed promptly to avoid abscess rupture.

(2) If tubal pyosalpinx or tubo-ovarian abscess improves with medication and inflammation is controlled for several days, but the mass does not disappear but becomes localized, surgical resection should be performed to avoid another acute attack in the future that will require surgery.

(3) Abscess rupture may lead to sudden worsening of abdominal pain, chills, high fever, nausea, vomiting, abdominal distension, and refusal to press the abdomen or signs of toxic shock. Abscess rupture should be suspected and immediate laparotomy is required. Surgery can be performed through the abdomen or laparoscopy depending on the situation. The scope of surgery should be comprehensively considered based on the extent of the lesion, the patient's age, general condition, and other conditions. The principle is to remove the lesion. Young women should try their best to preserve ovarian function, with conservative surgery as the main approach; for older women, those with bilateral adnexal involvement or repeated adnexal abscesses, total hysterectomy and bilateral salpingo-oophorectomy should be performed; the scope of surgery for extremely debilitated and critically ill patients must be determined based on specific circumstances. If it is a pelvic abscess or pelvic connective tissue abscess (extraperitoneal abscess), it can be drained through the vagina or lower abdomen according to the location of the abscess. If the abscess is located low and protrudes toward the posterior fornix of the vagina, it can be drained through the vagina and antibiotics can be injected at the same time. If the abscess is located higher and more superficial, such as a pelvic extraperitoneal abscess that extends upward beyond the pelvic cavity, when a mass can be felt in the iliac fossa, an extraperitoneal incision and drainage can be performed above the inguinal ligament.

We all know about acute pelvic inflammatory disease. During the illness, you should rest as much as possible, avoid excessive exercise, and pay attention to personal hygiene. Only by taking good care of yourself in all aspects can you recover faster. I hope you can recover as soon as possible.