Adnexitis: Symptoms and Treatment

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Adnexitis

Adnexitis (salpingooforiitom) called inflammation of the uterus, ie, ovaries and fallopian tubes. Typically, this process is one way, less affected appendages on right and left sides.

The main causes of acute and chronic adnexitis

Trigger the development of infection in the uterine appendages can practically any microorganism. The most common causative agents of inflammation of the appendages:

gram-positive (Streptococcus, Staphylococcus aureus, Streptococcus pneumoniae);
Gram-negative flora (Klebsiella, Pseudomonas aeruginosa, Enterococcus);
atypical microflora ( gardnerella , mycoplasma , chlamydia);
specific pathogens of infectious diseases of the genital tract (gonococcus, treponema pale);
viral agents (herpesvirus type).

Uterine appendages are in the pelvic cavity and in direct contact with the environment and therefore to have no microbial agents. Infectious agents can penetrate into the fallopian tube and then in the following ways:

through the cervix (upward path);
with inflammation of digestive tract adjacent (downstream);
when drift microbe bloodstream from other inflammatory lesions (hematogenous path) or lymph (lymphogenous path).

Cervix contains mucous plug which performs the function of a barrier, preventing the penetration of the microbial cells. However, the integrity of this barrier can be broken during menstruation, unprotected intercourse, long wearing IUD after an abortion in the early postpartum period. Adnexitis often affects women, who have more than one sexual partner and not using protection during sexual intercourse. In this case, it adnexitis called specific pathogen or genital tract infections, atypical or agent.

Inflammation of the lower digestive tract (the sigmoid or rectum) can spread to surrounding connective and adipose tissue, thus reaches the uterine appendages inside (on the side of the abdominal cavity). Often in this case, gram-negative pathogen from the group of microbes.

Hematogenous dissemination and lymphogenous germs from other anatomic bodies is possible in the case of systemic weakening of the immune defense, that is, in the case of sepsis. It is also possible spread of infection during extensive surgical intervention on the abdominal organs.

The infectious agent causes swelling of the tissues of uterine appendages, it appears pain. Provided serous or purulent secretion, sometimes mixed with blood. If acute adnexitis treated properly or not treated, is the formation of chronic inflammation. In this case, the main manifestations of the pathological process is the formation of connective tissue adhesions and decrease the lumen of the fallopian tube. That is why the most common outcome of chronic adnexitis - no clearance in the pipe and the so-called tubal infertility.

Symptoms adneksita

Symptoms of acute and chronic adnexitis options are somewhat different, but the overall clinical picture adneksita is similar with many other pathologies of the reproductive sphere. Therefore, a careful attention to the health of women and a thorough implementation of all stages of diagnosis by the doctor.

Symptoms of acute adnexitis

Acute adnexitis characterized by both general and local symptoms.

Among the general notes:

temperature rise, sometimes to high numbers;
weakness, overall fatigue;
reduction or complete loss of appetite.

Among the local symptoms are distinguished:

pain of various nature and intensity of the abdomen, sometimes extending to the hip or lower back;
a significant decrease in sexual desire, discomfort on the right or left during intercourse;
genital discharge of mucous or purulent character (whites), sometimes mixed with blood.

Symptoms of chronic adnexitis

Chronic adnexitis manifested mainly local symptoms. Chief among them - this is a chronic pain syndrome, or the so-called pelvic pain syndrome. A woman complains of persistent pain in the abdomen, which can be aggravated by physical exertion or during sexual intercourse.

Often, the woman did not pay enough attention to the acute phase of adnexitis, the process becomes chronic. Not every woman has expressed the pain significantly, and not intensive pain a woman simply does not pay. This is actually a variant of chronic asymptomatic adneksita shows up as an accidental find in infertility women.

Trying to get pregnant will be completely in vain if salpinx impassable or partially passable. The egg just can not get into the uterus and needed a way to infiltrate the endometrium. Particularly serious and adverse prognosis, if there is a bilateral lesion of uterine appendages.

Not the best variant of chronic adnexitis - ectopic pregnancy. There it is in the case of partial tubal patency, when the fertilized egg is embedded in the mucous membrane of the tube instead of the uterus. With increasing gestational pipe increases in size and at a certain point breaks. In this case, developing intra-abdominal bleeding and peritonitis (inflammation of the peritoneum).

Diagnostics

In the diagnosis of adnexitis (and acute and chronic), an important point is to collect the complaints of women, because it is the details of the disease and to rule out other soft signs are similar in manifestations of the disease.

The next necessary step - it is an internal bimanual gynecological examination. The study reveals gynecologist enlarged and painful uterine appendages.

To assign adequate and effective antimicrobial treatment is necessary to produce a crop of the vagina and urethra. This will not only set a specific microbial agent that caused the development of adnexitis, but its sensitivity to certain antimicrobial agents for antibiotikogramme.

For the diagnosis of chronic adnexitis, various instrumental studies to determine the prevalence of the process, tubal patency and planning possible treatment. These include:

ultrasound with a special vaginal probe;
X-ray examination with contrast medium (hysterosalpingography);
Computer contrast imaging of the pelvic organs;
diagnostic laparoscopy.

adnexitis Treatment

Adnexitis Treatment should be comprehensive, aimed not only at the exciter, and all the main elements of the pathological process.

The treatment is preferably carried out in a hospital. Recommended bed or polupostelnogo compliance regime. Position the patient in bed with raised head end to prevent the spread of the process up.

The main link in the treatment of acute adnexitis is antimicrobial therapy. As a rule, a wide range of prescribers in the middle, but the maximum dose rate of at least 1-2 weeks. Women should be understood that the brake of course independent of antibiotics or dose reduction would lead to deterioration of the process and \ or its transition into a chronic course. Appointment of an antimicrobial agent is based on an antibiogram.

In severe cases, in addition to antibiotic therapy administered specific immunoglobulins (antibodies contain certain microbes), for example, antistaphylococcal, antiherpetic.

Detoxification therapy is needed to remove the body of a woman of toxic waste products of microorganisms. For this purpose, appointed by the low molecular weight plasma expanders: reopoligljukin, neogemodez, neokompensan. The total volume of fluid injected is determined by the severity of condition and the body weight of women. To improve perfusion in small vessels using preparations improving flow properties of blood (heparin fraksiparin), and aminocaproic acid.

The analgesic component includes the appointment of NSAIDs: ibuprofen, diclofenac, meloxicam. Positive influence local dosage hypothermia: hardware or ice for 10 minutes three times a day.

Local treatment is carried out by assigning baths or douching disinfectants (furatsilin, dimexide, dioxidine, hlorofillipt) and decoction of herbs (celandine, marigold, rose petals, chamomile, sage, yarrow, etc.).

In the absence of progression of inflammation physiotherapy treatments are appointed in 10-15 days: ultraviolet therapy, magnetic therapy, diadynamic currents.

Treatment of chronic adnexitis only in some cases, provides for the appointment of antibacterial agents. Drug therapy should be kept to a minimum. All appointments are aimed at eliminating pain and reducing the manifestations and consequences of chronic adnexitis.

Eliminating chronic pain syndrome in the following ways:

are the same NSAIDs if their efficacy is maintained (indomethacin, celecoxib);
microclysters with a warm solution of novocaine;
microclysters with 5% potassium iodide solution, especially when the adhesive process in the pelvis;
Presacral novocaine blockade.

In the treatment of chronic adnexitis reduce the activity of the inflammatory process makes extensive use of physical therapy, such as:

galvanization (electrophoresis K, Ag vaginal or intrauterine);
electric currents (darsonvalization, diathermy, inductothermy);
UHF, SHF;
ultrasound, phonophoresis, peloidofonoforez;
magnetic therapy;
acupuncture.

Some women may need correction of hormonal background: cervical electrostimulation of 5 to 23 day menstrual cycle, electrophoresis with vitamin B1, laser stimulation, vitamin (vitamin B1, 1 ml per day in the I phase of the cycle, vitamin C - Phase II), the ineffectiveness of nonhormonal are assigned sex therapy and gonadotropic hormones, depending on the imbalance of menstrual function.

Often drugs are prescribed effect protein destabilization pathological center, amino acids and mixtures (alvezin, polyamine aminosterol), bacterial polysaccharides (and prodigiozan pirogenal) depending on the reaction rate at 10-15 injections. When the temperature rises, accompanied by changes in the blood picture, prescribe antibiotics. In the absence of changes in the blood picture, the temperature rise should be regarded as the center of the inflammatory response, the woman does not require the appointment of antibacterial therapy.

Often in the case of chronic adnexitis holds immunosuppression (immunosuppression). Stabilization of the immune response, especially of cell allows to achieve some success in the treatment. Can be used are synthetic adjuvants as likopid, timalin, timogeksin and biostimulants (aloe torfot, vitreous mabistin, peloidodistilat).

When infertility is due to adnexitis and obstruction of the fallopian tubes, used enzymes (lidasa, chymotrypsin, ronidaza), which can be assigned as a complement to physiotherapy or as a standalone drug.

Certainly a positive effect brings a woman visiting spa resorts, where it is possible not only topical application of certain natural factors, but also the overall calming effect. Spa treatment (with the obligatory account of hormonal), combines the action of a number of factors:

sanatorium mode (except for the daily conditions of work and life, calm, balanced diet);
climatic conditions (climatotherapy);
sunbathing (heliotherapy);
mud with thermal factor (natural or artificial heating mud);
vaginal irrigation and mineral baths (carbon dioxide, chloride, sodium, having a part of arsenic, brackish) that diversify act on the body, destabilizing the pathological center, improve blood circulation in it, enhance estrogenic activity of the ovaries. Mud combined with physiotherapy, potentiating each other.

Besides conservative therapies treat adnexitis, also used surgical. The indications for surgery are the following conditions:

diffuse peritonitis (inflammation of the abdominal cavity of the inner wall);
piosalpinks gap;
lack of effect within days after drainage of the abdomen laparoscopically.

Routinely in remission performed surgery to remove the appendages modified purulent inflammation of the silo bags inflammatory tumor. The volume of the operation depends on the age of the patient, the nature and distribution of the destructive process, potential onkonastorozhennosti.

In step it should be the most wary of the ovary in all age periods woman keeping parallel with the principle of maximum oncological alertness. In younger patients, usually produced partial or complete removal of only the diseased organ. In older patients the operation can be extended to the complete removal of the uterus, possibly with appendages.

prevention

As in many other cases, much better and easier to prevent disease than to deal with its treatment. To do this, the woman should follow a few simple rules: