Adnexitis - is inflammation of the joint (the fallopian tubes and ovaries) uterine infectious nature, often associated with infectious-inflammatory process in the uterus.Like all other infectious inflammation, adnexitis can exist in two classical clinical forms - acute and chronic, whereas subacute adnexitis manifests exacerbation of a chronic process.
in the structure of gynecological diseases of infectious origin adneksit occupies a leading position.The cause of inflammation may serve gonorrheal or opportunistic infection, therefore, according to origin, all adnexitises divided into specific and nonspecific.The initial localization of the pathogen are often downstream uterus, cervix or vagina, but another way is possible and the spread of infection, when it is "down" to the appendages through the blood or lymphatic vessels.
overestimate value of the uterus is simply impossible.Ovary - a steam iron hormone, ensures the implementation of three important functions: fertility (gen
tasks like hormonal ovarian cancer are realized through the secretion of hormones: estrogen and progesterone.They are synthesized in a cyclic rhythm, giving the leading influence in accordance with the phases of the cycle: the first (follicular) phase is controlled by estrogen, and the second (luteal) phase are replaced by progesterone.
in the ovaries mature egg each month.For the comfort of its special anatomical structure is formed - a small cavernous formation having a thin capsule and filled with fluid (a follicle).The first half of the cycle is completed the end of oocyte maturation and its release from the follicle.When the wall of the follicle is destroyed, and the egg is released into the pelvic cavity for potential fertilization (ovulation), the ovaries begin to produce progesterone.It is synthesized temporarily formed from the remnants of the destroyed follicle hormone structure - the corpus luteum.
After fertilization (if held) need to get the egg into the uterine cavity.To do this, and are the fallopian tubes - a kind of tubular formation, open on one side into the abdominal cavity near the ovary, and the other - in the uterine cavity (area uterine angles).The wall of each fallopian tube is able to make undulations and promote the egg in the uterine cavity, which is made possible thanks to the "atrial" epithelium lining the tube cavity.It is covered with lots of tiny "cilia" when they move (flicker), egg rushes after wave of cuts in the right direction.
If the infection gets into the epididymis, deformed ordered the menstrual cycle.Every fifth patient with a history of adnexitis diagnosed infertility and increased risk of ectopic pregnancy.
delimited infectious inflammation or only in the tubes or ovaries diagnosed only infrequently due to their close anatomical and physiological connection.As a rule, initially ranked in the fallopian tube infection exists there in isolation for a brief period, and then strikes and ovarian tissue.
clinical picture of acute adnexitis presented symptoms of acute infectious inflammation: severe pain, fever, possible abnormal vaginal discharge.Pain in adnexitis not have specific differences and similar to those in any acute pelvic inflammatory disease.Generally, inflammation is a one-sided shape.Right-sided adnexitis more common, due to a better blood supply to the pelvic cavity on the right.
Chronic adnexitis manifests itself only in the period of exacerbation of symptoms malosimptomno subacute inflammation.
adneksit sometimes possible to diagnose already at the stage of pelvic examination, however, to establish the cause without a bacteriological examination is impossible.
At the heart of any origin adnexitises therapy is antibiotic therapy.After complete elimination of infection was a personal plan to restore hormonal and reproductive function.
Chronic adnexitis remission phase is treated without antibiotics.
Unfortunately, if the infection is in the long appendages, to get rid of its impact is not always possible.
acute nonspecific (negonoreyny) appendages inflammation provoked by pathogenic and opportunistic microbes.Among the "culprits" of inflammation may be present staphylococci (Staphylococcus epidermidis and), Streptococcus B, enterococci, E. coli, chlamydia, Bacteroides, and so on.Most adnexitis is not the only microbe and microbial association.A list of disease-causing microbes in the associations is ambiguous, so it can be argued that each patient there is only a "set" of pathogens.
In a healthy female body ovaries and fallopian tubes are sterile, so adnexitis may develop only after the penetration of infection from adjacent structures (uterine cavity, the vagina), or from remote pockets of chronic inflammation through the blood or lymph.Most cases of adnexitis triggered by infection is not foreign, and their own, dwelling in the vagina, pathogenic microflora.Vaginal environment characterized by constant microbial composition: preferential amount (98%) belongs to the Lactobacillus opportunistic pathogens present in the mucous membranes of the vagina in small, non-hazardous amounts.Lactoflora is responsible for the production of lactic acid than maintains a constant level pH, which prevents unwanted microbial flora proliferate and induce inflammation.When the consistency of the vaginal environment is disturbed, opportunistic microbes begin to vegetate vigorously, becoming pathogenic (disease-causing) microorganisms.
adnexal protected and able to withstand the majority of infectious diseases.A healthy body is able to cope with episodes of infectious aggression.Therefore, to the association of conditionally pathogenic microorganisms could trigger inflammation, you must be precipitating factors, namely:
- Reduced immune defense mechanisms.It occurs when expressed colds, especially during menstruation.Also significantly deplete the body's defenses strong stress, neuroses, chronic fatigue.
- The presence of a source of chronic infection in the body when tonsillitis, otitis, appendicitis, pyelonephritis, and so on.Pathogenic microbes can get from these centers to the appendages through the blood or lymphatic system.In addition, the continued presence of a chronic infection in the body significantly depletes his immune system and contributes to the formation of the inflammatory process in appendages after infection.
- Genital infections.Most acute purulent adnexitis formed with the participation of the causative agent of gonorrhea (gonorrhea), which has a pronounced ability to overcome all the protective barriers of the genital tract and mucous introduced into the uterine cavity, and then - in the tubes and ovaries.
- inflammation of the uterus (endometritis and endomyometritis) and / or the cervical canal (endocervicitis).If pathogenic bacteria are in the cervical or uterine cavity and they can penetrate into the fallopian tube.
- Mechanical trauma mucous during abortion, curettage, aspiration biopsy, hysteroscopy and other tools of interventions.Infection relatively easily (if poor immune defense) penetrates through the wound and mucous begins to multiply followed by inflammation.
- IUD.Infrequently mucous around the site of the introduction of the spiral become inflamed and lose their protective qualities, so a subsequent inflammation can join the infection.Provided poor local immunity, it is able to climb into the cavity of the fallopian tube.If the presence of a spiral in the uterus, vagina infectious inflammation occurs, germs are able to climb into the uterine cavity of the spiral filaments.
- hormonal dysfunction on the background of endocrine diseases (diabetes, hypothyroidism).
Adnexitis can provoke and physiological reasons.These include:
- Pregnancy.For the quantitative changes of pregnancy natural microbial composition of the vaginal microflora, changing the acidity of the medium, as well as the depletion of the immune defense.
- menstruation.After the rejection of the internal mucous layer (endometrium) in the uterus is an extensive, unprotected wound surface.During this period the uterine cavity is vulnerable to germs.
Thus, the development of an infectious inflammation of the appendages on the background of a good immune system, even if the short-term presence of pathogens in the body, is formed rarely.
Symptoms and signs adneksita
When adnexitis inflammation is present in the ovaries and tubes.Infection is initially localized in the cavity of the fallopian tubes, and then relatively quickly rises to the ovaries.Therefore, the inflammatory process in both structures develop on a single scenario.
initially infectious agents penetrate into the cavity of the tube and embedded in the thickness of its walls.Formed local inflammation (salpingitis) interferes with the normal microcirculation, and mucosa due to pronounced inflammatory edema thickens.As a result, the pipe becomes elongated and skinny.During this period, palpation in the projection of the fallopian tubes becomes painful.Rising infection swelling distorts the function of ciliated epithelium, and the contents of the tube with the infection rushes into the abdominal cavity, where the spreads on the outside, serous, shell tube (periadneksit) and adjacent areas of the peritoneum.
to infection could penetrate into the tissue of the ovary, must have land damage on its surface.Such a situation provokes ovulation, when the follicle is destroyed, releasing an egg in its shell there is a small wound that can skip infection.After infection, inflammation develops in the ovary.
Clinic adneksita no different specificity, similar to other inflammatory illnesses of the pelvic organs and depends on several factors:
- The nature of the infectious agent.The most vivid clinical picture of acute purulent adnexitis usually provokes a specific inflammation.Gonococcal infection begins acutely and quickly seizes the area of appendages.Similarly, it takes septic inflammation provoked by staphylococcal and streptococcal flora.
Adnexitis chlamydial origin limited scant symptoms.
- forms of the disease.The quantity of active duration of clinical signs of infection in proportion.Acute first emerged inflammation has always expressed clinic and chronic adnexitis may exist for many years.
- Related gynecological pathology.The presence of disease hormonal origin (endometriosis, uterine fibroids, polyps, cysts, etc.) considerably reduce immunity, and foci of infection (endometritis, endocervicitis, colpitis) increase the risk of infection in the epididymis.
- Neginekologicheskie endocrine and infectious diseases in some cases, facilitate the processes of infection appendages.
adneksita The first symptom is pain of any origin.Its characteristics depend on the form of the disease.Acute adnexitis always shown strong pelvic pain and exacerbation of chronic adnexitis different from acute process moderate, mild pain, often without a clear localization.
frequent companion adneksita are abnormal vaginal discharge and menstrual irregularities.The degree of their severity also depends on the duration of the disease and its causes.
active symptoms of inflammation of the appendages appear a few days after the onset of infection either directly (in the first hours) after exposure.The first symptom of acute adnexitis is severe pain.Pain in adnexitis often localized infection on the affected side of the appendages.If the involved peritoneum inflammation, pain aggravated by movements of the body.In the area of the appendages runs a lot of blood and lymphatic vessels, so the infection relatively quickly "recaptures" new territory, striking appendages surrounding structures.As the migration of infection beyond the appendages, the pain lose local character, spreading throughout the abdomen on numerous nerve endings, often irradiiruya in sacral and / or lumbar region, provoke disorder urination and defecation.
Acute purulent adnexitis, in addition to severe pain, accompanied by severe fever and symptoms of intoxication, which makes it similar to any acute inflammation of the abdominal cavity and hampers the primary diagnosis.It is because of the clinic "acute abdomen" right-adnexitis often mimics acute appendicitis or a right renal colic.
duration of pain in acute adnexitis varies considerably from a few hours to two weeks.Stihaniya pain sometimes mistaken for women "recovery" or positive self.Meanwhile, the infection penetrates deeper, and a few months later acquires the features of a chronic infection.
«Sputnik" adneksita are also pathological leucorrhoea and menstrual disorders.The nature and number of cables determined in the first place, the nature of infection and the stage of the pathological process.Acute adnexitis accompany abundant pus-like discharge, often with an unpleasant odor.
Menstrual dysfunction in acute adnexitis associated with ovarian tissue damage and hormonal imbalance.
Typically, a patient with severe acute inflammation of the clinic are subject to hospitalization.
Unfortunately, patients do not always seek help at the first sign of acute adnexitis and try to heal yourself.Resorting to symptomatic treatment, they get rid of anxiety symptoms, but the infection thus continues to evolve, acquiring traits malosimptomno subacute inflammation which six months later becomes chronic.
Sometimes chronic adnexitis is the result of late or incorrect treatment of acute inflammation.So what happens if the pathogen was not found, or if the patient took an independent decision to interrupt the treatment.
Symptoms exacerbation of chronic adnexitis is virtually absent.Indirectly, a chronic inflammation of the appendages to indicate dull aching abdominal pain of unknown localization, worse during menstruation, and abnormal discharge.Exacerbation of chronic adnexitis also different brightness clinics, often manifested increased pain, low fever and malaise.
Every second patient provokes chronic adnexitis menstrual dysfunction.Menstruation lose the rhythm, they are long and heavy, or, on the contrary, short and scanty.
Chronic adnexitis, in addition to these symptoms, combined with serious complications, which leaves behind an acute inflammation.Every fifth patient with chronic inflammation of the tubes and ovaries formed infertility.It is caused by pathological processes in the fallopian tubes or hormonal dysfunction on the background of structural defects in tissues of the ovary.
probability of ectopic pregnancy with adneksita increased almost tenfold.