Inflamatory diseases of female sex organs
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Inflammation is the standard pathologic process, which is developed in response to the introduction of infectious agent and accompanied by the development of the standard complex of vascular and tissue reactions.
Three phases of the inflammatory process:
Alteration appears in response to the introduction of infectious agent and is characterized by the predominance of dystrophic and necrotic shifts;
Exudation - the predominance of microcirculatory disorders (in essence of venular division).
Proliferation - productive inflammation - multiplication of cellular elements, micro- and macrophage infiltration.
The main signs of the inflammatory process are:
Tumor (swelling)
rubor (redness)
Callor (heat)
dolor (pain)
functio of lesia (disturbance of function).
Occurrence
Each year in the United States, it is estimated that more than 1 million women experience an episode of acute PID. More than 100,000 women become infertile each year as a result of PID, and a large proportion of the ectopic pregnancies occurring every year are due to the consequences of PID. Annually more than 150 women die from PID or its complications.
Classification
Inflammatory diseases of female sex organs may be classified according to location, aetiology and flow pattern.
Bythe etiological factor:
Specific - unspecific
according to the flow pattern:
Sharp
Chronic
Subacute?
On the localization:
inflammatory diseases of the lower sex organs
·vulvovaginitis
·colpitis
·cervisitis
·Bartholinitis
inflammatorydiseases of upper sex organs
·Endometritis
·Adnexitis
·Pyosalpinx,the tuboovarian abscess
·Pelvic peritonitis
The boundary between which is internal opening.
Factors of the risk of development of inflammation may be
·Genital factors - chronic inflammatory diseases, bacterial [vaginosis],
·Social factors - alcoholism, addiction, avitaminosis.
·Behavioral factors - previously beginning of sexual life, the large number of sexual partners.
·[Extragenital] factors - dysbacteriosis, diabetes mellitus, immunodeficiency.
Aetiology of the inflammatory diseases of the female sex organs
Usually several natural barriers to the ascent of pathogenic organisms exist.Mechanisms of the biological protection include
·Anatomical-physiological special features of the structure of external sex organs; i.e hymen prevents ascending infection
·Multilayer flat epithelium of mucosa of sheath, which bars the penetration of microorganisms into the subjects of tissue;
·Normal microflora of sheath (rod of lactic acid fermentation);
·Acid medium of sheath (pH 3,8-4,5);
·Capability of sheath for self-purification;
·Presence of the mucous plug of the cervical channel (immunoglobulins, lysozyme, mucopolysaccharides), which impedes the ascending infection;
·Cyclic scaling of the functional layer of endometrium;
·Peristaltic reduction of uterine pipes and moving ciliary epithelium of pipes to the side of the opening of the cavity of womb;
·Local and general anti-infection immunity.
This natural mechanisms are usually impaired during menstruation, after abortion, delivery, intra uterine manipulations and IUCDs’.
The causes of inflammatory disease may be viral or bacterial in origin. Most common source of infection is bacterial infection; mainly Neisseriagonorrhoeae - 25-50%and clamydiatrachomatis - 25-30%. Other micro organism include Gardnerella of vaginalis, Bacteroides, Mobiluncus, Streptococcus, Enterobacteriaceae, E. coli, Clostridium, Actinomycetacea, Mycoplasma of hominis, Ureaplasma of urealiticum.
Basic ways of the propagation of the infection
·Intracanalicula (ascending)
·Hematogenic (genital tuberculosis)
·Lymphogenic
·As a result direct contact with the inflammatorily changed organ of abdominal cavity (by appendics, by the bladder or by bowels)
Clinical Picture
Symptoms of PID vary from none to severe. When PID is caused by chlamydial infection, a woman may experience mild symptoms or no symptoms at all, while serious damage is being done to her reproductive organs. Because of vague symptoms, PID goes unrecognized by women and their health care providers about two thirds of the time.
Clinical picture for inflammation of upper sex organs
·Puss
·Pain syndrome
·Increase in temperature
·Dyspeptic disorders
·Dysuric disorders
·Disturbances of the Menstrual cycle
Clinical picture of inflammation to lower sex organs
·Pus (mucopurulent, putriform);
·Painful syndrome;
·Itch, burning;
·post-coital bloody discharges;
·Disparenia
Complications
Prompt and appropriate treatment can help prevent complications of PID. Without treatment, PID can cause permanent damage to the female reproductive organs. Infection-causing bacteria can silently invade the fallopian tubes, causing normal tissue to turn into scar tissue. This scar tissue blocks or interrupts the normal movement of eggs into the uterus. If the fallopian tubes are totally blocked by scar tissue, sperm cannot fertilize an egg, and the woman becomes infertile. Infertility also can occur if the fallopian tubes are partially blocked or even slightly damaged. About one in eight women with PID becomes infertile, and if a woman has multiple episodes of PID, her chances of becoming infertile increase.
In addition, a partially blocked or slightly damaged fallopian tube may cause a fertilized egg to remain in the fallopian tube. If this fertilized egg begins to grow in the tube as if it were in the uterus, an ectopic pregnancy occurs. As it grows, an ectopic pregnancy rupture the fallopian tube causing severe pain, internal bleeding and even death.
Scarring in the fallopian tubes and other pelvic structures can also cause chronic pelvic pain (pain that lasts for months or even years). Women with repeated episodes of PID are more likely to suffer infertility, ectopic pregnancy, or chronic pelvic pain.
Diagnostics
PID is difficult to diagnose because the symptoms are often subtle and mild. Many episodes of PID go undetected because the woman or her health care provider fails to recognize the implications of mild or nonspecific symptoms. Because there are no precise tests for PID, a diagnosis is usually based on clinical findings
·Gynaecological inspection.
·Criteria of diagnostics:
·Purulent separable from the cervical channel (swab test);
·Hemophilia (vulnerability), edema and hyperemia of mucosa, erythema in the region of external opening;
·bacterioscopy;
·Microbiological studies (from the indications).
Diagnostic criteria
Minimum criteria:
- pain during the palpation in the lower divisions of stomach;
- pain in the region of appendages;
- the unhealthy tractions of the neck of womb.
Additional criteria:
- the temperature of the body > of 38 degrees;
- leukocytosis of >10 000 in [mm]3, increase coe and of c-reactive protein;
- pathologic isolations from sheath or neck of womb;
- laboratory (microbiological) confirmation of cervical infection.
The characteristic criteria:
- the sonographic and bi-manual confirmation of inflammatory tubo-ovary formations;
- laparoscopic picture
Differential diagnosis
·Extra-uterine
·Pregnancy
·the cysts of ovary
Treatment
Aim: restoration of normal anatomical function
Antibiotics are the mainstay of PID treatment. If the infection fails to respond to the medications or has become walled off in an abscess, surgery may be needed. Depending on the cause and severity of the problem, the antibiotics may be given by mouth, injection, or intravenously. Since PID is often sexually acquired, sexual partners may need to be examined and treated to prevent a reinfection. Diet may also be recommended i.e yogurt.
Some drugs that may be administered include
phytoestrogens (soya, [tsimitsifuga], red clover)[Dyufalak] (SOLVAY PHARMA)[Eubiotiki][Dalatsin] (PFIZER)[Betadin] (EGIS)[Mikosist] (GEDEON RICHTER) [Diflyukan] (PFIZER)[Regulon], [Novinet], It [lindinet] (GEDEON RICHTER)[Dyufaston], [Femoston] (SOLVAY PHARMA)
Propylaxis
You can reduce your risk of getting PID by reducing your risk of acquiring a sexually transmitted infection in the first place. Short of refraining from sex altogether, the best way to do that is by remaining in a monogamous relationship or using a latex condom and a spermicide for every sexual encounter. Using a diaphragm and spermicide also reduces the risk, though not to the same degree as using a condom. Having regular gynecologic checkups and screenings is also important, because cervical infections can be identified and treated before they have time to spread. Experts estimate that regular chlamydia screenings could reduce the number of PID cases by half.