Inflammation of the uterus and appendages (fallopian tubes and ovaries) in the scientific literature is usually called "inflammatory diseases of the pelvic organs in women" (PID). This group of diseases, in addition to inflammation of the uterus itself and the appendages, includes inflammatory processes of the pelvic peritoneum and adipose tissue of the small pelvis.
PID include:
Endometritis - inflammation of only the inner surface of the uterus, or its mucous membrane, which is called the endometrium.
Myometritis - inflammation of the muscular layer of the uterus, or myometrium.
Endomyometritis - simultaneous inflammation of the endometrium and myometrium.
Salpingitis - inflammation of the fallopian tube; can be one- and two-sided.
Oophoritis - inflammation of the ovary; can be one- and two-sided.
Salpingo-oophoritis, or adnexitis - simultaneous inflammation of the fallopian tube and ovary; can be one- and two-sided.
Pelvioperitonitis - inflammation of the pelvic peritoneum. The peritoneum in the form of a film lines the inside of the abdominal and pelvic cavity and covers the internal organs.
However, this article will use the term "uterine and appendage inflammation" for the sake of simplicity.
The cause of inflammation of the uterus and appendages various microorganisms that penetrate the genital tract serve: viruses, fungi, protozoa and bacteria. According to the frequency of detection in patients with inflammation of the uterus and appendages, these microorganisms can be arranged in the following order: gonococci, chlamydia, streptococci, staphylococci, mycoplasmas, Escherichia coli, enterococci, Proteus, bacteroids, spirochetes, protozoa, herpes simplex viruses, etc. -4 anaerobes (microorganisms living in an oxygen-free environment) with 1-2 aerobes (oxygen is required for their development and reproduction). Many women suffer venereal diseases before inflammation of the uterus and appendages. For example, gonorrhea or chlamydia.
As a rule, inflammation of the uterus and appendages occurs at a young age, taking a severe course in 60-80% of patients. Often the onset of the disease coincides with the onset of sexual activity.
Risk factors for inflammation of the uterus and appendages:
A woman has a large number of sexual partners;
The presence of a large number of sexual partners in a sexual partner;
Use of intrauterine contraceptives (coils);
Douching (contributes to the "washing out" of the normal microflora from the vagina and its replacement with opportunistic);
Past inflammation of the uterus and appendages or sexually transmitted diseases;
Violation of the protective mechanisms caused by the mucous plug of the cervical canal (contains antibacterial substances), in particular, with endocervicitis;
Ectropion (eversion of the mucous membrane) of the cervix is \u200b\u200ba condition that occurs as a result of unnoticed ruptures of the cervix during labor
Besides, the development of inflammation of the uterus and appendages contribute common diseases; great physical activity and mental strain, stressful situations; endocrine disorders; allergic factors; the presence in the body of a dormant (latent) infection.
TO factors that lead to infection of the internal genital organs of a woman, relate:
Cesarean section;
Artificial and spontaneous abortion;
Vaginal examinations;
Menstruation (the integrity of the integument of the genitals is violated);
Sexual intercourse during menstruation;
Intrauterine interventions (endometrial biopsy, spiral placement, etc.);
Diagnostic curettage of the uterus and cervical canal;
Cervical biopsy
The risk of inflammation of the uterus and appendages is reduced:
When using oral contraceptives;
When using barrier methods of contraception (reduce the risk of gonorrhea and chlamydia);
After ligation of the fallopian tubes (there is an obstacle to the penetration of microorganisms into their lumen and, further, to the uterine appendages).
Symptoms of inflammation of the uterus and appendages:
Pain in the pelvis and lower abdomen (this is the most common symptom of the disease);
An increase in body temperature (with a suppurative nature of the disease, chills are often observed) and an increase in heart rate;
Bleeding or bleeding from the vagina, not associated with menstruation, or appearing after intercourse;
Other vaginal discharge (serous, serous-pus-like, bloody, purulent);
Pain during intercourse (dyspareunia);
Violation of urination;
Discomfort in the epigastrium (sometimes with nausea and vomiting), pain in the right hypochondrium (these signs of the disease are not always found)
Traditionally, inflammation of the uterus and appendages is divided into acute, subacute and chronic. After infection, clinical signs of acute endometritis appear on the 3-4th day, the acute stage lasts about 7-10 days. In old age, pus (pyometra) usually accumulates in the uterus. With adequate treatment, acute endometritis is cured, less often it turns into a subacute or chronic form. The main symptom of chronic endometritis is uterine bleeding. It is impossible to distinguish between acute salpingitis and oophoritis by the manifestations of the disease, and this is not necessary, because with these diseases, the same type of treatment is carried out. Therefore, they speak of acute salpigophoritis, or adnexitis. In acute purulent adnexitis, there may be signs of pelvioperitonitis or even diffuse peritonitis. In such cases, the abdomen, especially in the lower parts, becomes tight, tense, and the doctor determines the symptoms of muscle protection. Sometimes the appendages of the uterus take on a shape that looks like a tumor. In such cases, they speak of hydrosalpinx or pyosalpinx (the fallopian tube is filled with fluid or pus, respectively). The contents of the hydro- and pyosalpinx can periodically be poured through the uterus into the vagina. Sometimes a tubo-ovarian (tubo-ovarian) tumor-like formation (abscess) is formed. With proper treatment, an acute inflammatory process, if it has not caused significant anatomical changes, ends with a complete recovery, otherwise it becomes subacute or chronic. In chronic adnexitis, the main complaint is aching or dull pain in the iliac regions (in the projection of the uterine appendages), the intensity of which increases under the influence of triggering (triggering) factors, which include hypothermia, menstruation, excessive physical exertion and other adverse effects on the woman's body. This pain can take on a reflected character and spread to the vagina, sacrum region, lower back. If the disease recurs often, then symptoms of neurosis are also added to its characteristic manifestations. With a prolonged course of chronic adnexitis, the function of the ovaries decreases, anovulatory menstrual cycles appear (without the release of an egg), as a result of which abundant, scanty or very painful menstruation is observed (polymenorrhea, oligomenorrhea and algomenorrhea). Often, there are little-symptomatic or erased forms of inflammation of the uterus and appendages, proceeding without any clinical manifestations. Therefore, women may not even be aware of their illness. This is evidenced by an interesting observation. Of all women in whom, during laparoscopy (a method that is used to examine the abdominal organs or perform operations through small incisions of the anterior abdominal wall), reliable signs of the transferred inflammation of the uterus and appendages (adhesions, deformation of the fallopian tubes, inflammatory changes in the ovaries, etc.) ), two-thirds did not even suspect that they had ever suffered an inflammation of the uterus or its appendages. This is due to the fact that the disease was asymptomatic. Based on these data, we can conclude about the insidious course of inflammation of the uterus and appendages and that even with an asymptomatic course of the disease, the internal genital organs are exposed to harmful effects and, ultimately, anatomical and functional changes develop in them, which lead to complications (see . below).
Diagnosis of inflammation of the uterus and appendages
Only a gynecologist can make a correct diagnosis of inflammation of the uterus and appendages. To do this, he collects complete information about complaints, the onset and further course of the disease and pays special attention to the nature of pain and discharge from the genital tract, as well as previous general and gynecological diseases. A complete examination by clinical (physical examination) and auxiliary (laboratory instrumental) methods may be required. For this, a therapist and other specialists may be involved. During examination of the small pelvis through the vagina and the anterior abdominal wall (two-handed vaginal-anterior abdominal, or bimanual examination), as well as through the rectum (rectal examination), the doctor assesses the state of the uterus and its appendages, determines their consistency and the presence of fluid (normally not determined ) in the posterior cavity (the space between the uterus and the rectum), draws attention to pain when the cervix is \u200b\u200bdisplaced. It is imperative that discharge from the vagina, the cervical canal of the cervix and the urethra is taken to detect the microorganisms that caused the disease. If necessary, sowing is performed to determine the sensitivity of pathogens to antibiotics. Ultrasound examination (ultrasound) is informative in those cases of inflammation of the uterus and appendages, in which the uterus and its appendages are enlarged, there are tubo-ovarian tumor-like formations (abscesses), accumulation of fluid (for example, pus) in the small pelvis, thickening or deformation of the endometrium and myometrium. It is possible that the doctor may recommend examination of sexual partners with whom the patient has had sexual intercourse recently, even if they have no complaints. It should be remembered that without treatment of sexual partners, a woman can again get sick with inflammation of the uterus and appendages.
Treatment of inflammation of the uterus and appendages
Acute forms of inflammation of the uterus and appendages are treated in a hospital. Antibiotics in such cases usually lead to a complete recovery. In some conditions (tubo-ovarian abscess; ovarian abscess, or pyovarium), various surgical interventions may be required, for example, laparoscopic sanitation of the small pelvis, during which pus is evacuated, the uterine appendages are irrigated with saline with antibiotics, adhesions between organs are dissected, and the uterine orifices are freed from adhesions. tubes to prevent their obliteration (closure of the lumen). It should be remembered that the treatment of inflammation of the uterus and appendages is complex and, in addition to antibiotics, includes intravenous detoxification therapy (treatment aimed at removing toxins from the body), physiotherapy, etc. It follows that you should never self-medicate when symptoms of uterine inflammation appear and its appendages. In all cases, even with the appearance of mild symptoms, you should consult a doctor.
Complications of inflammation of the uterus and appendages
Inflammation of the uterus and appendages leads not only to disability, but often to deprivation of the happiness of motherhood, which is associated with the development of both primary and secondary infertility due to the appearance of adhesions between the ovaries and fallopian tubes, obliteration (disappearance) of the lumen of the latter, as a result which sperm cannot enter the abdominal cavity and fertilize the egg. Postponed inflammation of the uterus and appendages can cause chronic pain in the pelvic area, ectopic pregnancy (due to impaired movement of the fertilized egg into the uterus) and other dangerous complications in the development of uterine pregnancy - disorders of the uteroplacental circulation, spontaneous miscarriage, premature birth, infection fetus. Sometimes the infectious process from the uterus and its appendages spreads into the abdominal cavity, causing the formation of adhesions on the outer surface of the liver, which leads to the development of perihepatitis (Fitz-Hugh-Curtis syndrome), which is accompanied by pain in the right hypochondrium. The later treatment is started, the higher the chance of complications.
Forecast
The prognosis is favorable for those patients with inflammation of the uterus and appendages, in whom the disease was diagnosed on time and adequate treatment was carried out.
Ovarian inflammation ( oophoritis) is an acute or chronic pathological process that affects the tissue of the female genital glands, causing a disorder of their function. In the overwhelming majority of cases, this ailment does not develop independently, but in combination with the inflammatory process within the fallopian tubes ( so-called adnexitis). In foreign literature, acute inflammation of the ovaries is usually combined with inflammation of the fallopian tubes ( salpingitis) into one common clinical syndrome - inflammation in the small pelvis.
In most cases, inflammation of the ovaries and uterine appendages occurs due to the penetration of various infectious agents, more often - the causative agents of sexually transmitted diseases. For this reason, oophoritis and salpingitis usually develop in young women under the age of 25, who are sexually active and who do not use barrier methods of contraception ( condoms).
Inflammation of the ovaries, provoked by pathogenic bacteria or viruses, is a dangerous and serious ailment that causes reproductive disorders ( infertility), as well as hormonal disruptions due to changes in endocrine activity ovaries... With an aggressive course of the disease, local or widespread purulent complications may occur that pose an immediate threat to a woman's life.
Interesting Facts
- inflammation in the ovaries and fallopian tubes is one of the most common causes of female infertility;
- inflammation of the ovaries quite often occurs against the background of the asymptomatic course of certain sexually transmitted diseases ( chlamydia);
- inflammatory process in the pelvic area is more common among young women;
- isolated damage to the ovaries by an infectious or inflammatory process practically does not occur;
- inflammation of the ovaries can occur in response to an inflammatory process in other organs;
- hormonal disruptions increase the likelihood of penetration of infectious agents into the upper parts of the female reproductive system;
- stress is a factor that significantly weakens the protective potential of the female body and increases the risk of damage to the fallopian tubes and ovaries.
Anatomy of the uterine appendages
The female genital organs are conventionally divided into upper and lower sections. This division simplifies the systematization of the clinical manifestations of some genital infections, and also allows a better understanding of the mechanisms of penetration of pathogenic agents. The lower sections of the female genital organs are represented:
- Vulva. The vulva is the labia majora and labia majora, which act as the entrance to the vagina, clitoris, and the mouth of the urethra.
- Vagina.The vagina is a tubular muscular-elastic organ that performs sexual, reproductive, protective and excretory functions. Normally, the vaginal environment is not sterile and is formed by Doderlein bacilli and a number of other saprophytic ( non-pathogenic) microorganisms. Due to this, the vagina has its own microflora, which contributes to its protection in the event of any infections entering and developing.
- Cervix.The cervix is \u200b\u200bthe portion of the uterus located between the vagina and the uterine cavity. A canal passes through the cervix, which is normally closed and contains cervical mucus that protects the overlying structures from infection.
- The ovaries.The ovaries are paired female sex glands that are located in the pelvic cavity and perform reproductive and hormonal functions. Produce sex steroid hormones ( estrogen and progesterone). The process of maturation of the egg takes place in the ovaries.
- Uterus.The uterus is a muscular organ located in the pelvic cavity. Performs reproductive function ( carrying a pregnancy) and menstrual ( detachment of the inner mucous membrane). Through the fallopian tubes, the uterus connects with the abdominal cavity, and through the cervical canal - with the vagina and the external environment.
- Uterine ( fallopian) pipes.The fallopian tubes are a paired organ that is located in the pelvic cavity and connects the uterus to the abdominal cavity. In the lumen of the fallopian tubes fertilization of the egg takes place, and their main function is to transport the embryo or egg into the uterine cavity.
The ovaries are supplied with blood by the ovarian artery, which originates from the abdominal aorta, and also by the branches of the uterine artery. Venous blood flows through the ovarian vein, which forms the ovarian plexus, into which blood also flows from the fallopian tubes. Knowledge of the characteristics of the blood supply allows a better understanding of the possible mechanisms of penetration of infectious agents to the ovaries.
The ovaries are innervated by the branches of nerves from the lower hypogastric plexus. The ovaries are not covered with the peritoneum, but they are in close contact with it. These facts are of great importance for understanding the mechanisms of the onset of pain during the development of the inflammatory process.
Next to the ovaries is the bladder, bowel loops, appendix, rectum. These formations may not be directly adjacent to the ovaries, but in some conditions they can serve as the initial source of infection or inflammation.
Ovarian inflammation causes
The most common cause of inflammation in the ovaries is infection. However, this is far from the only reason that can provoke this ailment. The inflammatory process is a defense mechanism that arises in response to the action of any damaging factor and is aimed at reducing damage. Based on this, it can be assumed that the inflammatory response can occur in response to many pathological situations. Ovarian inflammation can occur in the following situations:
- Infections.In the vast majority of cases, the inflammatory process in the ovaries occurs due to the penetration of an infection, which can be bacterial, viral or fungal in nature. Most often, oophoritis is associated with sexually transmitted diseases, but it can also occur with tuberculosis, and with some nonspecific infectious processes. It should be understood that the infection rarely covers only the ovaries and usually affects either the uterus, or the fallopian tubes, or both organs at the same time and only then covers the ovaries. However, in some cases, the infection can penetrate into the ovaries and from other organs by direct contact with an infectious-inflammatory focus or by the introduction of pathogenic agents along with the blood stream.
- Mechanical damage.Trauma to the ovaries, fallopian tubes or uterus can cause an inflammatory process that can cover the ovaries, as well as significantly weaken local immunity and become a factor predisposing to infection.
- Inflammation of adjacent organs.The ingress of biologically active pro-inflammatory substances into the ovaries can provoke some inflammatory reaction.
- Necrosis and inflammation of neoplasms ( tumors). With the development of some tumors, a necrotic process can occur, which can trigger an inflammatory reaction.
Sexually transmitted infections
In most cases, the inflammatory process in the pelvic cavity, covering the fallopian tubes and ovaries, is associated with sexually transmitted infections. Most often, the disease is associated with bacterial lesions caused by pathogens of gonorrhea or chlamydia, but other pathogenic agents may also occur.Oophoritis can be caused by the following pathogens:
- Gonococci.Gonococci are the causative agents of gonorrhea, one of the most common sexually transmitted diseases. These microorganisms enter the reproductive system during unprotected sex with an infected partner. Initially, they affect the lower parts of the genital tract, however, with a weakening of local or general immunity, as well as with the development of a number of predisposing factors, they can penetrate into the uterine cavity, go to the fallopian tubes and cause infection of the ovaries.
- Chlamydia.Chlamydiae are the causative agents of chlamydia, a common venereal disease characterized by a latent course. Like gonorrhea, this ailment is transmitted during unprotected sex, but unlike it, chlamydia rarely causes any severely disturbing symptoms. For this reason, this infection is often diagnosed already at the stage of development of various complications, including oophoritis.
- Trichomonas.Vaginal Trichomonas is the causative agent of trichomoniasis - a genital infection, which, according to the World Health Organization, is the most common among humans. As well as chlamydia, trichomoniasis of the lower genital tract is quite often asymptomatic or with minor clinical manifestations. This creates the prerequisites for the spread of the infectious process into the uterine cavity and its appendages. Trichomoniasis rarely affects the ovaries, but the damage to the fallopian tubes caused by it can, one way or another, cause an inflammatory reaction in the female gonads with a violation of their function.
- Mycoplasmas.Mycoplasmas are small bacteria that can cause mycoplasmosis. These microorganisms are conditionally pathogenic, in other words, they can cause a disease only with a significant violation of the general condition of a woman and with a decrease in her local or general immunity. They are transmitted during sexual intercourse, as well as in some types of household contacts. Mycoplasmosis is characterized by a chronic malosymptomatic course. Penetration into the upper parts of the reproductive system is accompanied by the appearance of signs of severe damage to the genital organs.
Initially, the infectious process affects the external genital organs ( small and large labia and adjacent glands), as well as the urethra and vagina. It should be noted that normally the vagina is inhabited by Doderlein bacilli, which form its normal environment and perform a protective function, since they do not allow pathogenic microorganisms to colonize this organ. However, in some situations, the vaginal microflora and its protective potential can be violated, which creates the prerequisites for the development of infection.
Risk factors for infection of the lower genital organs are:
- incorrect intake of antibiotics;
- douching the vagina;
- lack of personal hygiene;
- stress;
- diseases of the immune system;
- frequent change of sexual partners;
- unprotected sex.
The risk factor for the spread of infection to the upper sections of the female reproductive system are:
- abortion;
- therapeutic or diagnostic curettage of the uterus;
- installation of intrauterine contraceptives ( spirals);
- spontaneous abortion;
All these factors are due to the fact that the expansion of the cervical canal and the removal of the mucous plug opens the way for infectious agents located in the vaginal cavity.
In the future, the infectious process covers the lining of the uterus, and then the fallopian tubes and ovaries. In some conditions, pathogenic agents can cause the formation of purulent infectious and inflammatory foci in the uterine appendages, which is fraught with a serious violation of the general condition and is associated with a high risk of developing systemic complications.
Additionally, the hematogenous route of penetration of infectious agents into the ovaries is considered. This is due to the peculiarities of the blood supply to the ovaries, which receive part of the arterial blood from the branches of the uterine artery. Due to this, pathogens that can be in the blood of a person for a short or long time can be brought into the ovaries along with the bloodstream from the lower parts of the reproductive system.
Viral lesion
It is assumed that the inflammatory process in the ovaries can be triggered not only by bacteria, but also by viruses. There are a number of studies that indicate that at least two sexually transmitted viral infections can provoke inflammation in the uterine appendages.Ovarian inflammation can be caused by the following pathogens:
- Herpes simplex virus type 2... Herpes simplex virus type II, also known as genital herpes, can enter the body through defects in the skin, as well as through the mucous membranes of the genitals during unprotected sexual contact with an infected person. It has the ability to integrate into human cells, due to which a complete cure becomes impossible. Because of the scanty symptoms, genital herpes is a fairly common infection. During the activation period, the virus causes local foci of necrosis of the mucous membrane, which provokes an acute inflammatory reaction.
- Cytomegalovirus. Cytomegalovirus comes from the same family as herpes simplex virus. It is capable of affecting many organs, including the genitourinary system. In most cases, it does not pose a particular danger, however, against the background of reduced immunity, it can cause serious complications. It can cause inflammation of the pelvic organs, both alone and in combination with a number of other pathogens ( usually bacterial).
Separately, it is necessary to mention the human immunodeficiency virus ( HIV), which does not independently affect the upper sections of the female reproductive system, but due to its ability to weaken the immune system creates the prerequisites for infection with other pathogens. In addition, against the background of HIV infection, especially at the stage of acquired immunodeficiency syndrome ( AIDS), optimal conditions are created for the infection of the genitals, including the ovaries, not only with aggressive pathogenic microorganisms, but also with opportunistic pathogens, which are normally harmless to humans.
Tuberculous lesion
Tuberculosis is a common infectious disease caused by Mycobacterium tuberculosis. In most cases, this disease affects the lungs, but in some cases, the formation of foci in other organs is possible.Typically, TB infection occurs by inhalation of sputum particles containing a tuberculosis bacillus ( airborne transmission), however, it is possible for the pathogen to penetrate when eating contaminated food ( milk and dairy products), as well as through the skin ( rarely). In conditions of reduced immunity or impaired body resistance, the tubercle bacillus begins to multiply and develop in the lung tissues, provoking a specific inflammatory reaction. As a result, a primary complex is formed, from which pathogens, along with the blood flow, can enter the bones, kidneys, eyes, skin and genitals.
The penetration of mycobacterium tuberculosis into the genitals is due to the peculiarities of their blood supply. Since the fallopian tubes and ovaries receive blood from the branches of the uterine and ovarian arteries, at their intersection ( so-called anastomoses) the speed of blood flow slows down, and this creates ideal conditions for the penetration of bacteria into these organs. The hematogenous path of spread is associated with a predominantly bilateral lesion of the uterine appendages.
Infection with tuberculosis sexually is considered impossible, since the vaginal environment is extremely unfavorable for mycobacterium tuberculosis. However, if the pathogen enters the injured or inflamed mucous membranes of the lower parts of the reproductive system, primary infection of the genitals can occur.
The main problem of tuberculous lesions of the fallopian tubes and ovaries is that this disease in the vast majority of cases is asymptomatic. Women rarely seek medical help for this infection. This leads to the fact that, against the background of a long course of the disease, various complications and irreparable structural and functional damage develop.
Mechanical damage to the mucous membrane of the uterus and fallopian tubes
The inflammatory process, as mentioned above, is a kind of protective reaction of the body, which is aimed at reducing the damaging effect of any traumatic factor. Thus, the inflammatory reaction in the uterine appendages can be triggered not only by a bacterial or viral infection, but also by mechanical damage.Mechanical damage to the ovaries and fallopian tubes is possible in the following situations:
- Blows to the abdomen.Exposure to a short but strong impulse can cause contusion of many internal organs, including the uterus, fallopian tubes and ovaries. Under the influence of a damaging factor, local structural damage can occur, partial or complete destruction of blood vessels with impaired local blood circulation is possible. To minimize the effects, the body triggers an inflammatory response, which in some cases can cause even more severe damage.
- Penetrating wounds in the abdomen.Penetrating wounds to the abdomen can damage the upper sections of the female genital organs, which can lead to inflammation. In addition, most penetrating wounds are potentially infectious.
- Surgical interventions on the abdominal and pelvic organs.Any surgical intervention, no matter how minimally invasive it may be, traumatizes the internal organs to one degree or another. Strong pressure on the genitals through surgical instruments, cutting or burning them can provoke an inflammatory reaction. In addition, do not forget about foreign materials that may be in the area of \u200b\u200bthe operation ( suture material, various prostheses, stents, gases and solutions) and also cause inflammation.
- Invasive gynecological procedures.Gynecological procedures that involve instrumental effects on the internal genital organs ( abortion, curettage) are associated with some injuries, which directly provoke an inflammatory response. In addition, they reduce local immunity and create prerequisites for the penetration of infectious agents.
Inflammation of adjacent organs
The defeat of the ovaries may be associated with an inflammatory process that has engulfed neighboring organs. Most often this is caused by the passage of bacteria from the primary infectious focus through the organ wall, but it can also occur for a number of other reasons.The ovaries can be involved in the inflammatory process when the following organs are damaged:
- Colon.Inflammation of the large intestine, known as colitis, usually results from an imbalance between normal and pathogenic intestinal microflora ( pathogenic bacteria begin to dominate). In some cases, the intestinal wall can be depleted, ulcers and even through holes can form in it ( which leads to the development of peritonitis and is extremely dangerous). In addition, intestinal inflammation is accompanied by edema, slowing blood flow and dysfunction. Under the influence of these factors, there is a risk of pathogens passing through the intestinal wall to neighboring organs - the peritoneum, ovaries and fallopian tubes, other parts of the intestine.
- Appendix.Inflammation of the appendix ( appendicitis) is one of the most common surgical pathologies. There are several theories explaining the mechanism of development of this disease, but regardless of the initial cause, the developing inflammatory reaction affects the entire thickness of the muscular wall of the organ and covers part of the serous membrane covering it. The resulting pathological reaction is quite massive, and in contact with other organs can cover them.
- Bladder.Bladder infection ( cystitis) in some cases can cause an inflammatory process in the ovaries. However, in the vast majority of cases, the ovaries are involved in the inflammatory process not because of contact with the bladder, but because of the parallel lesion of the internal genital organs and the bladder by sexually transmitted infections.
- Peritoneum.The peritoneum is the serous membrane that covers most of the abdominal organs and lines the walls of the abdominal cavity itself. Despite the fact that the ovaries are not covered by the peritoneum, an infectious and inflammatory process on the surface of the peritoneum can cause damage to the ovaries. However, much more often everything happens the other way around, and inflammation of the ovaries causes local inflammation of the peritoneum - pelvioperitonitis. It should be understood that peritonitis ( inflammation of the peritoneum) is an extremely serious condition that requires immediate medical treatment.
Ovarian inflammation symptoms
The clinical manifestations of ovarian inflammation are quite diverse, but they are non-specific, as they are similar to the symptoms of diseases of other pelvic organs. The symptoms of ovarian inflammation are formed by the inflammatory reaction itself, which, one way or another, changes the function and structure of the organ, as well as infectious agents, which in most cases are the cause of oophoritis.
Ovarian inflammation is accompanied by the following symptoms:
- lower abdominal pain;
- increased body temperature;
- violation of the gastrointestinal tract;
- violation of the menstrual cycle;
- painful sexual intercourse;
- hormonal disorders;
- infertility;
- pain in the upper abdomen;
- muscle tension of the anterior abdominal wall.
Lower abdominal pain
Lower abdominal pain is the main symptom of acute inflammation of the ovaries and fallopian tubes. Pain occurs due to a slight increase in organ size due to edema, as well as due to the effect of pro-inflammatory biologically active substances on sensitive nerve endings. Since the ovaries are innervated by the branches of the hypogastric plexus, the pain that occurs is usually a pulling, aching character. When involved in the inflammatory process, visceral ( covering organs) of the peritoneum, the intensity of pain increases slightly, and reflex vomiting may occur. If the infectious-inflammatory focus covers the parietal ( parietal) the peritoneum, the pain increases significantly, becomes sharp, reflex muscle tension occurs.The duration of the pain varies depending on the activity of the inflammation and on the treatment taken. Pain is usually present for at least 2 to 3 days, but not more than 3 to 4 weeks.
Increased body temperature
An increase in body temperature is a nonspecific reaction of the body that occurs in response to the penetration of any foreign protein. Fever is aimed at creating conditions that are unfavorable for the pathogenic agent, but optimal for the functioning of the immune system. The body temperature rises as a result of the effect of a number of biologically active substances formed in the focus of inflammation on the structures of the central nervous system. Fragments of pathogens, particles of foreign proteins, as well as pyrogenic ( substances that can increase body temperature), formed during immune reactions.There are three stages in the development of fever:
- The rise in temperature.The rate of temperature rise depends on the nature and properties of the pathogen. With a sharp rise, a feeling of chills arises, which indicates the activation of heat-saving mechanisms ( reduced sweating, "goose bumps", peripheral vascular contraction). Body temperature rises due to increased thermogenesis ( muscle tremors, accelerated metabolism of nutrients).
- Plateau stage.At the plateau stage ( keeping body temperature) the feeling of chills disappears and the body temperature stabilizes. Depending on the pathogen, the body temperature with inflammation of the ovaries can rise to 37.5 - 38 or even up to 39 degrees. With the development of complications, the body temperature can exceed 39 degrees.
- Decrease in temperature.A decrease in body temperature can occur either gradually or abruptly. The body temperature decreases after the elimination of the action of pyrogenic substances, when taking certain medications, as well as when the body is severely depleted.
Disruption of the gastrointestinal tract
Inflammation of the ovaries or other parts of the upper genital tract can cause various disorders of the gastrointestinal tract.The following disorders of the gastrointestinal tract may occur:
- Nausea and vomiting. Nausea and vomiting occur reflexively, in response to intense painful stimulation of the hypogastric plexus. In addition, nausea is one of the possible consequences of an increase in temperature and general intoxication of the body. Vomiting is usually mild, not associated with food intake. Abundant vomiting that does not bring relief indicates the possible development of complications ( peritonitis).
- Diarrhea. Diarrhea occurs due to intoxication of the body, as well as due to irritation of the intestines with an inflammatory focus.
- Desire to defecate. Frequent urge to defecate occurs due to irritation of the ampullar part of the rectum with an inflammatory focus in the genitals and in the area of \u200b\u200bthe peritoneum located in the small pelvis.
Pathological discharge from the genital tract
Normally, discharge from the genital tract is a small amount of odorless transparent or whitish mucus, the release of which is not accompanied by any unpleasant sensations.In the presence of infectious and inflammatory foci within the upper or lower genitals, various pathological vaginal discharge often occurs, indicating an ailment. The nature of the discharge depends on the nature and properties of the pathogen, as well as on the localization of the lesion and the body's resistance.
It should be understood that discharge can form in the vagina, cervix, and uterine cavity. An infectious-inflammatory process limited to the fallopian tubes or ovaries is extremely rarely accompanied by discharge from the genital tract, since more often in this case, pathological fluids are drained into the pelvic cavity.
The following options for pathological discharge from the genital tract are possible:
- Purulent discharge. Purulent discharge is a specific symptom indicating the bacterial nature of pathogens. They are a yellowish-green viscous liquid, the amount of which can vary depending on the severity of the process and the aggressiveness of the pathogen. Purulent discharge is characterized by an unpleasant smell of rotten fish. When anaerobic microflora is attached, purulent discharge becomes foamy, since these microorganisms produce gas, which foams the pus.
- Serous discharge. Serous discharge is characteristic of viral lesions of the cervix and uterus. They arise due to vasodilation and the release of part of the plasma from the bloodstream during an inflammatory reaction. Usually, such discharge is transparent or slightly yellowish, odorless.
- Bloody issues. Bloody discharge occurs when the vessels are melted by pathogenic agents or when their integrity is destroyed during an inflammatory reaction. Bloody discharge is usually scanty, not abundant, represented by dark blood, occurs regardless of the menstrual period. Discharge may be accompanied by pain in the lower abdomen.
Disruption of the menstrual cycle
The menstrual cycle is a periodic change in a woman's genitals, aimed at maintaining readiness for conception. This process is regulated by hormones of the ovaries, hypothalamus and pituitary gland.At the heart of the menstrual cycle is the periodic renewal of the uterine lining and the maturation of the egg. This happens in several phases, each of which is regulated by certain hormones. First, there is a detachment of the uterine mucosa ( endometrium), which is accompanied by bleeding. Subsequently, under the action of sex hormones, the regeneration of the mucous layer begins in the uterine cavity, and a dominant follicle is formed in the ovaries. Subsequently, by the time of ovulation, when the follicle ruptures and the level of estrogen and progesterone rises, the uterine mucosa thickens significantly, and the egg released from the follicle ( which at this stage it is more correct to call the first-order oocyte) migrates through the fallopian tubes into the uterine cavity. If fertilization does not occur during this period, then this cycle is repeated again.
With inflammation of the ovaries, the menstrual cycle can be disrupted for the following reasons:
- damage to the lining of the uterus;
- a decrease in the level of sex hormones due to dysfunction of the ovaries;
- ovulation disorders;
- violation of endometrial regeneration.
- lack of discharge during menstruation;
- scanty discharge during menstruation;
- profuse discharge during menstruation;
- long menstrual cycle;
- pain during menstruation.
Painful intercourse
The inflammatory process in the pelvic cavity is often accompanied by pain during intercourse. This is usually associated with damage to the vagina, but it can also occur with damage to the upper reproductive system.Soreness during intercourse is associated with excessive vaginal dryness, which occurs either due to an inflammatory lesion of the vagina itself, or due to a decrease in the level of the sex hormone estrogen. As a result, due to insufficient moisture, friction increases and a painful sensation arises during sex. This leads to the fact that the woman's sexual desire decreases ( decreased libido), mood is disturbed, depression may develop.
Hormonal disorders
Hormonal disorders during inflammation of the ovaries are not always found, but in some situations they are quite possible. They arise due to structural and functional rearrangements of the organ, which leads to a decrease in the synthesis of sex hormones ( estrogen and progesterone).Since one normally functioning ovary is able to maintain the level of sex hormones within the physiological norm, hormonal disorders occur only with bilateral organ damage or with damage to the only working ovary.
Hormones are known to regulate many physiological processes in the human body. With a decrease in the level of sex hormones, a disorder of sexual and reproductive function occurs, as well as disorders of the central nervous system ( mood changes, depression, manic-depressive states), of cardio-vascular system ( heart rhythm disturbances, high blood pressure) and from the side of metabolism ( obesity occurs, cholesterol levels rise). Of course, some of these manifestations can develop only in the case of a protracted course of the inflammatory process, accompanied by hormonal disruption.
Infertility
Infertility is one of the most frequent consequences of the inflammatory process in the area of \u200b\u200bthe uterine appendages and often acts as the main reason for a woman to seek medical help.Infertility with damage to the ovaries is associated with a violation of egg production, as well as with developing hormonal disorders. However, much more often infertility occurs due to damage to the fallopian tubes, which in the vast majority of cases accompanies oophoritis. Due to the inflammatory reaction, the fallopian tubes are narrowed, functional and structural changes occur in them, which lead to partial or complete obstruction for the egg and sperm.
Muscle tension of the anterior abdominal wall
The tension of the muscles of the anterior abdominal wall occurs when the parietal is involved in the inflammatory process ( parietal) the peritoneum. Muscle contraction occurs reflexively, in response to strong painful stimulation emanating from the inflammatory focus. Due to muscle tension, tension and irritation of the peritoneum decreases, which makes it possible to somewhat alleviate the pain sensation.In addition to the symptoms listed above, the inflammatory process with localization in the ovaries and fallopian tubes can be accompanied by a number of other signs, which in most cases arise already at the stage of development of complications.
Inflammation of the uterine appendages may be accompanied by the following signs of a complicated course:
- Pain in the upper abdomen and in the right hypochondrium.A painful sensation in the right hypochondrium, which arose against the background of pain in the lower abdomen, temperature and other signs of damage to the female reproductive system, indicates the occurrence of perihepatitis - inflammation of the liver capsule ( fitz-Hugh-Curtis syndrome). It is characterized by some dysfunction of the liver, an increase in the level of liver enzymes, and sometimes by yellowness of the skin and mucous membranes.
- Swelling of the abdomen from the side of the lesion.The appearance of abdominal swelling on the side of the affected ovary, which can be determined visually or during palpation, indicates the development of a tubo-ovarian abscess, a cavity filled with purulent contents. It is a potentially dangerous condition that requires surgical treatment.
Diagnosis of ovarian inflammation
Diagnosis of ovarian inflammation is a difficult task due to the fact that this disease has symptoms similar to some other ailments, and also due to the fact that the inflammatory response is extremely rarely limited to the ovaries alone, involving the fallopian tubes, uterus and other parts of the genital systems. This creates additional difficulties in diagnosing the disease. Before starting any diagnostic procedures, a conversation with a doctor is conducted, during which the main symptoms, the time of their onset, intensity, and main characteristics are clarified. Data is collected on previous surgical operations, on known acute and chronic diseases. The doctor finds out whether the menstrual cycle is regular, when were the last menstruation, what is the amount of discharge during menstruation, whether the menstrual period is accompanied by pain or discomfort.
An inflammatory process in the area of \u200b\u200bthe uterine appendages is suspected in the presence of the following signs:
- lower abdominal pain;
- pathological discharge from the genital tract;
- increased body temperature;
- hormonal disorders;
- violation of the menstrual cycle;
- recently transferred sexually transmitted diseases;
- frequent change of sexual partners;
- age under 25;
- non-use of barrier contraception methods ( condoms);
- the presence of an intrauterine device;
- recently transferred intrauterine manipulations ( abortion, curettage, installation of the spiral).
Oophoritis diagnosis is based on the following procedures:
- gynecological examination;
- Ultrasound of the pelvic organs;
- microbiological research.
Gynecological examination
A gynecological examination involves a visual examination of the external genital organs, the vagina and the vaginal part of the cervix. This procedure is performed when a woman is in a gynecological chair with divorced legs. The doctor inserts a special instrument called a vaginal speculum into the vagina, which allows you to move the walls of the organ apart, make a visual examination and take the necessary materials for further tests.With isolated inflammation of the ovaries, a gynecological examination does not reveal any abnormalities. However, since in the vast majority of cases with this ailment, other parts of the reproductive system are involved in the infectious and inflammatory process, a number of nonspecific signs are determined during examination.
During a gynecological examination, the following signs are revealed:
- redness of the vaginal mucosa;
- swelling of the vaginal mucosa and the vaginal part of the cervix;
- the presence of ulcers on the surface of the vaginal mucosa;
- the presence of purulent or foamy discharge in the vaginal cavity or in the posterior fornix of the vagina;
- traces of pathological discharge at the mouth of the cervical canal.
By bimanual palpation in women with a sufficiently thin anterior abdominal wall, the ovaries can be palpated, which in case of inflammation are enlarged and painful.
Ultrasound of the pelvic organs
Ultrasound examination of the pelvic organs is an extremely informative method that allows you to determine the degree of damage to internal organs without surgery.Ultrasound examination of the pelvic organs reveals the following changes:
- Enlargement of the ovaries in size.During the inflammatory reaction, edema occurs, which leads to an increase in organ size. Normal ovaries are 25 mm wide, 30 mm long, and 15 mm thick on average.
- Thickening of the fallopian tubes.Since the inflammatory process that has engulfed the ovaries, in most cases, also involves the fallopian tubes, ultrasound reveals signs of salpingitis ( inflammation of the fallopian tubes). Normally, the fallopian tubes are almost invisible on ultrasound, however, due to the thickening of the wall during inflammation, they become noticeable.
- Smoothness of the ovarian surface.Normally, the surface of the ovaries is slightly bumpy due to the forming follicles. In case of dysfunction of the ovaries, as well as due to edema, the surface of the organ is smoothed.
- Enhancing the echo structure.Strengthening of the echostructure of the ovaries occurs due to the formation of areas of fibrosis in the thickness of the ovaries.
- Signs of inflammation in the uterine cavity.Inflammation in the uterine cavity is a common symptom that accompanies oophoritis. This is revealed on ultrasound by the thickening of the endometrium, by areas of fibrosis in the uterine cavity, as well as by hypoechoic formations in the wall of the organ.
It should be noted that ultrasound examination can be performed in two ways - through the anterior abdominal wall and through the vagina. The latter method is more sensitive and informative.
Laparoscopy
Laparoscopy is a minimally invasive diagnostic method that allows direct visualization of the ovarian surface, and which allows some therapeutic operations to be performed immediately.Laparoscopy is performed by inserting a camera and some manipulators into the abdominal cavity through small punctures in the anterior abdominal wall. Due to gas injection ( during diagnostic operations - oxygen, during surgical interventions - carbon dioxide) and the presence of an optical system with illumination, the doctor can directly examine the organs of interest. This procedure is performed in a sterile operating room under general anesthesia.
When diagnosing inflammation of the uterine appendages, laparoscopy is the "gold standard", as it allows you to quickly establish a diagnosis, determine the degree of structural changes in organs, and carry out the necessary surgical intervention. In addition, after this study, patients quickly return to their normal activities.
Laparoscopy allows you to detect the following signs of damage to the uterine appendages:
- pus in one of the fallopian tubes;
- fresh ( easily separable) adhesions in the uterine appendages;
- sticky ( fibrous exudate) on the surface of the ovaries and fallopian tubes;
- an increase in the size of the ovaries;
- ovarian bleeding when pressed.
Despite all the advantages of laparoscopy as a method for diagnosing oophoritis and other inflammatory diseases of the upper genital tract, its use as a routine examination method is irrational. This is due, firstly, to the rather high cost of the procedure, and secondly, to a number of risks and possible side effects.
Microbiological examination
Microbiological examination of the contents of the cervical canal, vaginal cavity or uterine cavity is an extremely informative method of laboratory diagnostics. This procedure allows you to establish the nature of the pathogen and, based on these data, plan treatment.There are the following methods for detecting and identifying pathogenic agents:
- Bacterioscopic method. At the heart of bacterioscopy is the study of stained smears obtained by placing the test material on a glass slide under a light microscope. This method allows you to identify gonococci, chlamydia, Trichomonas, and some other pathogens. In addition, smear microscopy can assess the extent of the inflammatory response.
- Bacteriological method. The bacteriological method makes it possible to very accurately identify pathogens and reveal their sensitivity to antimicrobial drugs, but it takes a lot of time. A bacteriological study is carried out by inoculating the pathological material received from the patient on special media, which are placed in a thermostat for several days. In this case, pathogenic bacteria begin to multiply actively, which allows them to be identified in the future by a number of signs.
Ovarian inflammation treatment
Treatment of ovarian inflammation is a complex of therapeutic measures aimed at eliminating pathogenic agents, reducing the inflammatory response, and restoring the normal function of the organs of the reproductive system. Drug treatment
At the heart of drug treatment is the use of pharmacological drugs capable of destroying pathogens of the disease, as well as agents with anti-inflammatory and immunomodulatory effects.Drugs Used to Treat Ovarian Inflammation
| Pharmacological group | Main representatives | Mechanism of action | Mode of application |
| Antibiotics | Amoxicillin with clavulanic acid | Violates the synthesis of the cell wall of bacteria, thereby causing their death. Clavulanic acid inhibits bacterial enzymes ( beta-lactamase) capable of cleaving this antibiotic. | The drug is administered orally, intramuscularly or intravenously, depending on the severity of the patient's condition. The dosage is selected individually. Usually 500 mg is prescribed 3 times a day for 14 days. |
| Ceftriaxone | Violates the synthesis of components of the bacterial cell wall. It is resistant to beta-lactamase action. | It is prescribed intramuscularly or intravenously. It is used in a daily dose of 1 - 2 grams for 14 days. | |
| Ciprofloxacin | It is a broad-spectrum antibiotic. Inhibits enzymes responsible for the synthesis of bacterial genetic material, which causes cell death. | It can be administered orally and intravenously. It is used in a dose of 250 - 500 mg 2 - 3 times a day for two weeks. | |
| Gentamicin | Blocks the 30S ribosome subunit, thereby disrupting protein synthesis. | Injected intramuscularly or intravenously at a dose of 3 mg per kilogram of body weight per day in 2 - 3 doses for 10 - 14 days | |
| Azithromycin | Blocks the 50S subunit of ribosomes, slowing down the reproduction of bacteria and disrupting protein synthesis. | It is prescribed intravenously in the form of droppers at a dose of 250-1000 mg. | |
| Doxycycline | Disrupts protein synthesis by disrupting the function of ribosomes. | It is taken orally or intravenously at a dose of 100-200 mg. | |
| Anti-inflammatory drugs | Ibuprofen | Inhibits the enzyme cyclooxygenase, which is involved in the breakdown of arachidonic acid to prostaglandins - biologically active substances that stimulate the inflammatory response. Reduces body temperature. It has a pronounced analgesic effect. | Orally or rectally at a dose of 1200 - 2400 mg per day in 3-4 doses after meals. |
| Diclofenac | It is taken orally at a dose of 75 - 150 mg or rectally at a dose of 50 mg 2 times a day. | ||
| Meloxicam | It is administered orally at a dose of 7.5 - 15 mg once a day after or during meals. | ||
| Antihistamines | Clemastine | Blocks histamine receptors ( proinflammatory substance), thereby reducing the vasodilation in the focus of inflammation, reduces edema, and normalizes capillary permeability. | Inside, 1 mg 2 times a day. |
| Immunomodulators | Interleukin-1 beta | Stimulates the synthesis of immune cells, enhances the protective potential of lymphocytes and neutrophils. | Intravenous drip at a dose of 15 - 20 ng / kg. |
| Interferon alpha-2 | It prevents the penetration of viral particles into cells, activates the synthesis of antibodies, and enhances the phagocytic activity of immune cells. Violates the synthesis of viral genetic material in cells. | Prescribed rectally in a dose 500,000 IU 2 times a day for 7 to 10 days. |
|
| Combined oral contraceptives | Diane-35 | Have a contraceptive effect ( by suppressing ovulation and changes in the endometrial mucosa), and also contribute to the normalization of the secretory activity of the ovaries. | The drug is taken orally, one tablet a day, starting from the first day of the menstrual cycle. One package is designed for one menstrual cycle and contains 21 tablets. |
| Detoxification agents | Glucose solution | By increasing the volume of circulating blood, it accelerates renal filtration and stimulates the elimination of toxic substances from the body. | It is prescribed intravenously in the form of droppers. |
These drugs should be taken only as directed by a doctor, since their incorrect administration can be not only ineffective, but can provoke a number of severe complications and side effects.
Surgery
Surgical treatment of ovarian inflammation is indicated only in cases where drug therapy is either ineffective or does not allow to achieve the proper level of sanitation of the infectious-inflammatory focus.Surgical intervention is necessary in the following situations:
- Tubo-ovarian abscess. The presence of an accumulation of pus in the area of \u200b\u200bthe uterine appendages is a direct indication for surgical intervention, since until this pus is completely drained, drug treatment is not effective enough. For the treatment of this complication, the laparoscopic approach is preferable, since it is less traumatic and allows faster recovery after surgery. However, in the case of massive accumulation of pus or in the presence of adhesions in the abdominal cavity, a classical laparotomy may be required ( anterior abdominal incision).
- Peritonitis. The infectious and inflammatory process, covering the peritoneum, requires immediate surgical intervention, as it is a life-threatening condition. For the treatment of peritonitis, they resort to a laparotomy approach, since it allows better and more sanitation of the abdominal cavity.
Traditional methods of treatment
Methods of folk treatment for oophoritis, based on the use of various medicinal plants, can increase the body's protective potential and speed up the recovery process. However, it should be understood that traditional medicine cannot eradicate pathogens and, accordingly, is ineffective at the stage of acute infection.The following traditional medicine recipes can be used as additional therapy:
- Infusion of black currant. To prepare the infusion, you need to mix 4 tablespoons of black currant leaves with 2 tablespoons of yarrow herb, horsetail and barberry, and then pour 2 cups of boiling water and insist for one and a half to two hours. You should consume half a glass every 2 to 3 hours.
- Infusion of oats. To prepare the infusion, mix 4 teaspoons of sown oats with 3 tablespoons of birch leaves, 2 tablespoons of peppermint leaves, honey and lemon. The resulting mixture must be mixed and poured with 2 cups of boiling water, and then insist for 60 minutes. It is necessary to consume the resulting solution in 100 ml every 2 to 3 hours.
Prevention of ovarian inflammation
Prevention of ovarian inflammation includes:
- Timely diagnostics.Timely diagnosis of infectious and inflammatory diseases of the upper and lower parts of the reproductive system can reduce the risk of complications.
- Timely examinations.Timely and periodic examinations by a gynecologist allow diagnosing diseases at an early stage, which greatly facilitates and speeds up treatment.
- Protection against genital infections.Since genital infections are the main cause of ovarian inflammation, it is extremely important to use barrier contraception methods ( condoms), which reduce the risk of transmission of sexually transmitted diseases.
- Treatment of infections of adjacent organs.Timely treatment of infectious foci in the organs located near the ovaries reduces the risk of their involvement in the inflammatory process.
- Healthy lifestyle. To prevent oophoritis, exposure to toxic substances ( alcohol, nicotine), cold, exhaustion. It is necessary to eat right, practice physical exercises, as this helps to strengthen the immune system and helps to normalize the function of the whole body.
Ovarian pain - causes, symptoms and what to do?
The site provides background information for informational purposes only. Diagnosis and treatment of diseases must be carried out under the supervision of a specialist. All drugs have contraindications. A specialist consultation is required!
Svetlana Igorevna asks:
Is it possible to determine endometritis by ultrasound?
Ultrasound diagnostics endometritis is associated with a number of difficulties that are due to the peculiarities of the anatomical structure of the upper sections of the female genital organs, as well as the shortcomings of the method itself. Nonetheless, Ultrasound is a widespread non-invasive method diagnostics inflammatory diseases of the uterus and appendages.
Ultrasound allows detecting direct signs of inflammation only in 30-40% of cases. Indirect signs are detected more often, but they are less specific and can indicate many pathologies. However, since the diagnostic process is not limited to only one study, but involves a comprehensive assessment of the patient's condition and the results of her analyzes, the data obtained during an ultrasound examination in most cases is sufficient to confirm endometritis.
It must be understood that the diagnosis of acute endometritis is based on the identification of signs of the inflammatory process, which, in combination with the clinical picture and risk factors, make it possible to make a diagnosis. In chronic endometritis, ultrasound allows you to identify not so much the inflammatory process as its consequences, which are expressed in structural and anatomical changes in the uterus.
During an ultrasound examination, it is extremely important to clarify the risk factors, since in each specific situation, different echoes can be observed.
Risk factors for the development of endometritis are:
- installation of intrauterine contraceptives;
- diagnostic and therapeutic curettage of the uterine cavity;
- spontaneous abortion;
These signs, in combination with clinical manifestations, which usually occur no later than 3 to 5 days after intrauterine interventions, make it possible to very accurately diagnose an infectious lesion of the uterine mucosa.
For acute endometritis, the following symptoms are characteristic:
- an increase in body temperature up to 37 - 38 degrees ( rarely - up to 39);
- aching pains in the lower abdomen with irradiation to the groin, perineum, sacrum;
- serous-purulent vaginal discharge ( sometimes bloody);
- menstrual irregularities.
Chronic endometritis is a pathological condition in which the inflammatory process is rather sluggish and therefore cannot be detected by ultrasound. However, this ailment is accompanied by structural changes in the endometrium and uterus, which can be detected using ultrasound.
The following echoes correspond to chronic endometritis:
- Decreased endometrial thickness. A prolonged inflammatory process causes a noticeable thinning of the uterine lining, as the normal endometrium is replaced by connective tissue.
- Increased endometrial thickness. In some cases, under the influence of biologically active substances from the inflammatory focus, endometrial hyperplasia occurs, which manifests itself as a thickening of the mucous membrane.
- The formation of cavities in the endometrium. In the thickness of the endometrium, cavities can form, which arise either due to the vital activity of microorganisms, or due to the formation of cystic enlargements.
- Increase in the body of the uterus in size. When studying women in the proliferative phase of the menstrual cycle, a slight increase in the size of the body of the uterus may be revealed, which occurs due to the accumulation of fluid in the uterine cavity.
- Change in the normal anatomical position of the uterus. The adhesion process in the pelvic cavity can change the normal position of the uterus. This can lead to infertility as well as chronic pelvic pain syndrome.
- Adhesions in the uterine cavity. With a prolonged course of the disease, an adhesive process may develop in the uterine cavity, which, during ultrasound examination, is detected as multiple structures of increased echo density.
Learn more on this topic:
- Blood test for antibodies - detection of infectious diseases (measles, hepatitis, Helicobacter pylori, tuberculosis, lamblia, treponema, etc.). Blood test for the presence of Rh antibodies during pregnancy
- Blood test for antibodies - types (ELISA, RIA, immunoblotting, serological methods), norm, interpretation of results. Where can you take it? Research cost.
- Examination of the fundus - how is the examination going, results (norm and pathology), price. Fundus examination in pregnant women, children, newborns. Where can I get tested?
- Examination of the fundus - what shows which structures of the eye can be examined, which doctor prescribes? Types of fundus examination: ophthalmoscopy, biomicroscopy (with a Goldman lens, with a fundus lens, on a slit lamp).
Ultrasound diagnostics has firmly entered medicine as a study that allows you to find out many important nuances. With this manipulation, the doctor can see the structure, location and functioning of organs.
Unlike X-rays, ultrasound is a more accurate examination. It, contrary to popular belief, does absolutely no harm. All age groups of the population are subjected to diagnostics: children, people of reproductive age, elderly patients. Pregnant and lactating women were no exception. The most common procedure of all ultrasound diagnostics is considered in women.
What organs are examined by a specialist?
The study of ultrasound diagnostics in women is carried out in several ways. Depending on the state of health, the abdominal, vaginal or rectal route of sound wave delivery is chosen.
Less commonly, diagnostics through the perineal region are used. The most informative examination in non-pregnant women is It is not carried out in virgins, during menstruation and with allergy to latex.
What can be seen during the diagnosis? With the help of a conductor sensor and a special gel that improves contact, sound waves are sent that are inaudible to the human ear; they are reflected from the surface of organs and formations, after which they are transferred to the device screen in the appropriate form. The sonologist can see echogenic, hyperechoic, and other features. Based on the indicators obtained, a protocol is drawn up.
Ultrasound diagnostics of the small pelvis includes examination of the rectum and part of the large intestine, examination of the bladder, ureter, but most often there is a need to examine the state of the reproductive organs. These include the uterus with the cervical canal and the cervix. Here is what an ultrasound of the pelvic organs in women shows.
During the examination, the condition of the woman's genitals is examined, such as the uterus, ovaries, fallopian tube, etc.
Rates at the beginning of the cycle
Basically, an ultrasound scan is performed immediately after the end of your period. Doctors choose a period from 3 to 7 days of the cycle.It is set depending on the intensity of bleeding and its duration. What can you see during it?
If you want to know if there are pathologies and malfunctions in the reproductive function, then you should. the following indicators:
- the height of the genital organ is about 5 cm, and the width is 5, the thickness varies from 3 to 4 cm; after the onset of menopause (after about 10 years), the height and width decrease by 1 cm, while the thickness remains the same or decreases slightly;
- the genital organ is defined by smooth and clear contours, and its echogenicity is usually uniform;
- the state of the internal cavity can change every day (in women with a long cycle, the endometrium is not yet visualized, while with a period of 21 days or less it is already noticeable), additional inclusions and neoplasms are not detected;
- the size of the appendages (ovaries) is 3/2 / 2.5 cm (normally, one organ may be slightly larger than the other);
- the cervical canal is tightly closed, the neck is without features and additional inclusions.
Ultrasound can be considered ideal, in the conclusion of which it is indicated "normal" or "without deviations." But this is not always the case. If you are sent for research at the beginning of the cycle, then they expect to see some pathology. This is the best time to diagnose diseases such as ovarian cysts, uterine polyps. What can you see if you have them?
Cyst
This neoplasm differs from the flesh of the epididymis by its echogenicity. In the conclusion of a specialist, it is usually indicated "in the left (usually right) ovary."
You should not panic if you see one during your research. Cysts are different. It will not be possible to reliably establish the nature of the neoplasm during the study. In the presence of good equipment, one can assume which cyst is: functional or non-functional. Further tactics are chosen taking into account this fact.
Cyst is the most common condition among women of childbearing age. This disease does not have pronounced symptoms, however, it is easily detected during regular examinations by a gynecologist
Fibroids, polyps
These formations are easy to see at the beginning of the menstrual cycle, when the mucous membrane has separated, and the genital organ from the inside has become "naked". Pathologies are determined by a thickening of the layers of the uterus, which causes its uneven contour and changes in position.
And fibroids are often due to hormonal imbalances, but may have other causes. Treatment methods are established depending on the indicators, the size of the neoplasm and the woman's well-being.
What can be seen on an ultrasound scan before ovulation?
An ultrasound examination, which is scheduled for the period from 7 to 17 days of the cycle, provides for the determination of ovarian pathologies. During this period, their active work begins: which are of a larger or smaller size.
The largest are called "dominant". They will be the suppliers of eggs in this cycle. It is quite difficult to establish the normal size of the ovaries for this period, since the values \u200b\u200bchange every day.
It is important to know what pathologies can be established by a specialist during this period:
- polycystic disease (characterized by a large number of follicles in the ovary and the small size of the uterus);
- anovulatory cycle (there are no dominant follicles, the mucous membrane of the genital organ does not correspond to the day of the cycle);
- follicular cyst (an overgrown follicle that can no longer perform its function, as a result of which it will develop backwards).
In the middle of the cycle, mainly pathologies of hormonal origin are established.
Shortly before menstruation: what will the examination show and who needs it?
What can the diagnostics after ovulation show? This period is the least often chosen for the survey. More often, an ultrasound scan before menstruation is necessary for women with pregnancy or those planning to conceive.
Normally, the second part of the cycle is characterized by an increase in the size of the uterus and a thickening of its inner layer - the endometrium. One of the ovaries also acquires a greater volume (due to the formation of a corpus luteum in it).
The pathologies that the sonologist detects may be as follows:
- luteal cyst (excessively large yellow body);
- endometrioma (a cyst that takes on a large size just before menstruation);
- endometrial hyperplasia (its excessive growth in the cavity of the genital organ);
- endometriosis (foci of the endometrium in places that are not typical for it).
Before menstruation, the specialist can or suggest it. But this is only possible with the help of modern equipment. Old ultrasound diagnostic devices will show the presence of the ovum in the uterus only after a delay.
Signs of deviation
Decryption of the data obtained should be carried out by an experienced gynecologist. On your own, you will not be able to give a sensible assessment of the situation found, compare some indicators with others and make a diagnosis. But some clue words can give you the idea of \u200b\u200bthe presence of some kind of pathology.
So what can you see during your research?
Inflammation of the uterus and its appendages
This condition is characterized by an increase in the size of organs and their inconsistency with the existing day of the female cycle.
In the inflammatory process, sometimes the hormonal background is also disturbed, which is characterized by the malfunctioning of the ovaries (the absence of follicles in them, the appearance of cysts, and so on). The visualized fallopian tubes may indicate an inflammatory process.
Neoplasms
You already know how and when cysts, fibroids and polyps are found. These pathologies are clearly visible throughout the cycle (with the exception of menstrual bleeding). They are indicated by unusual inclusions located in different places, which may differ in their echogenicity from the general background.
Signs of fibroids in the picture: increased size of the main female organ, the appearance of a round-shaped clot in the uterine cavity. If the image shows that the uterus has changed its shape, it means that the myomatous nodes have reached large sizes
Adhesion process
During the diagnosis, it is often assumed in women that the causes are inflammatory diseases and surgical interventions. The presence of adhesions can be suspected due to the displacement of organs from their usual places, deformation of the body of the uterus, and the appearance of fluid in the posterior pocket.
The main complications arising from such a disease include: intestinal obstruction, chronic pelvic pain syndrome, impaired gestation, infertility
Ectopic pregnancy
Easily determined by ultrasound. In most cases, the embryo is found inside the fallopian tubes, which gives them a clear visualization, as with inflammation.
This examination allows you to determine a tubal pregnancy at those stages when the disease does not threaten dangerous consequences. Such a pregnancy is characterized by the location of the ovum in the fallopian tube.
Less commonly, the fertilized egg can be seen on the outer wall of the uterus, in the ovary, cervical canal, or abdominal cavity.
Congenital and acquired anomalies
During ultrasound, such deviations as bending of the genital organ or its prolapse, a two-horned uterus, and oncological diseases are reliably established.
Conclusion with decoding
After the diagnosis, the sonologist issues a conclusion to his patient. It prescribes the features seen, indicates the size of the pelvic organs, and provides preliminary conclusions.
You should not take the information received as a diagnosis, since women do not always interpret it correctly.
For example, a specialist has discovered that you are pregnant and is recording it. " A woman can interpret this conclusion in the most unexpected way: myoma, cyst, malignant tumor, and so on.
Therefore, it is so important to contact a gynecologist who will collect anamnesis, listen to complaints and, based on the results obtained, make the correct diagnosis. With the help of ultrasound diagnostics, many pathologies can be identified or refuted.
This study allows you to detect pregnancy in the early stages, to examine the organ cavity after the installation of the intrauterine device. in women, it is carried out in combination with other manipulations, for example, with metrosalpingography (). It is used for puncture, hysteroscopy. Modern gynecology is simply impossible to imagine without this examination.
