Pelvic inflammatory disease (PID) refers to the inflammation of the female upper reproductive tract and its surrounding tissues, mainly including endometritis, salpingitis, Tubo ovarian abscess (TOA) and pelvic peritonitis. Inflammation can be limited to one part or several parts at the same time. The most common is salpingitis and salpingoovariantis. Pelvic inflammatory disease mostly occurs in sexually active women with menstruation. Pelvic inflammatory disease rarely occurs before menarche, after menopause or unmarried. If pelvic inflammation occurs, it is often the spread of inflammation of adjacent organs. According to its pathogenesis and clinical manifestations, it can be divided into acute and chronic.
Pelvic inflammation refers to the inflammation of female pelvic reproductive organs, connective tissue around the uterus and pelvic peritoneum. Chronic pelvic inflammatory disease often comes from incomplete treatment in the acute stage. Because of its long onset time and stubborn condition, the bacteria in the vulva can retrograde infection and reach the pelvic cavity through the uterus and fallopian tube. But in real life, not all women will suffer from pelvic inflammatory disease, only a few. This is because the female reproductive system has a natural defense function. Under normal circumstances, it can resist the invasion of bacteria. Only when the body’s resistance decreases or the female’s natural defense function is damaged due to other reasons, can pelvic inflammation occur.
Overview of acute pelvic inflammatory disease
Acute pelvic inflammatory disease refers to the acute inflammation of female internal genitalia and its surrounding connective tissue and pelvic peritoneum. It can be limited to one part or several parts at the same time. The common pathogenic bacteria are Staphylococcus, Streptococcus, Escherichia coli, anaerobic bacteria and sexually transmitted pathogens, such as gonococcus, mycoplasma, chlamydia, etc. It is caused by lymphatic, hematogenous or direct spread to the pelvic cavity. Common acute endometritis, myositis, salpingitis, tubal empyema, tubal ovarian abscess, pelvic connective tissue inflammation, pelvic peritonitis, severe cases can cause sepsis and sepsis. If not controlled in time, septic shock or even death may occur. Traditional Chinese medicine calls this disease “women’s abdominal pain”, “hot human blood room”, “postpartum fever”, “bring down disease”, “paralysis” and so on.
(1) Systemic symptoms are not obvious, sometimes low fever and fatigue. For patients with a longer course of disease, some patients may have neurasthenia symptoms, such as depression, general discomfort, insomnia, etc. When the patient’s resistance is poor, it is easy to have acute or subacute attack.
(2) Scar adhesion and pelvic congestion caused by chronic inflammation can cause lower abdominal distension, pain and lumbosacral pain. It is often aggravated after fatigue, sexual intercourse and menstruation.
(3) Due to pelvic blood stasis, patients may have increased menstruation; Menstrual disorders may occur when ovarian function is impaired; Tubal adhesion and obstruction can cause infertility.
Typical symptoms are fever, lower abdominal pain, refusal to press, large amount of leucorrhea, purulent. Can be accompanied by fatigue, low back pain, menstrual disorders. Severe cases include visible high fever, chills, headache and loss of appetite. If there is peritonitis, there will be nausea, vomiting, abdominal distension and other digestive system symptoms. If an abscess is formed, bladder irritation symptoms may appear in the front, such as frequent urination, urgency and pain; Rectal irritation symptoms can occur after being located in the rear, such as irritability, anal distension, diarrhea and difficulty in defecation. Sepsis is often accompanied by abscess lesions in other parts.
Overview of chronic pelvic inflammatory disease
Chronic pelvic inflammatory disease refers to the chronic inflammation of female internal genitalia and its surrounding connective tissue and pelvic peritoneum. The main clinical manifestations are menstrual disorder, increased leucorrhea, waist and abdomen pain and infertility. If chronic adnexitis has been formed, the mass can be touched.
Systemic symptoms are not obvious, sometimes low fever and fatigue. The course of disease is long, and some patients may have neurasthenia symptoms.
Scar adhesion and pelvic congestion caused by chronic inflammation can cause lower abdominal distension, pain and lumbosacral pain, which are often exacerbated before and after fatigue, sexual intercourse and menstruation.
Due to pelvic blood stasis, patients can have increased menstruation, ovarian function damage can have menstrual disorders, and infertility can be caused by tubal adhesion and obstruction. Because the combination of sperm and egg requires a very complex process. The sperm needs to pass the customs and be chopped and screened layer by layer when reaching the uterus. No matter what happens in any link, it will hinder it. If the implantation position is wrong, it will also lead to ectopic pregnancy.
Tuberculous pelvic inflammatory disease
Female genital inflammation caused by Mycobacterium tuberculosis is called genital tuberculosis, also known as tuberculous pelvic inflammation. Most of them are found in women aged 20 ~ 40, and also in postmenopausal elderly women. Tubal tuberculosis is the most common, accounting for 85% ~ 95% of female genital tuberculosis, followed by endometrial tuberculosis, and other types are less common. The majority of genital tuberculosis is secondary infection, often followed by tuberculosis, intestinal tuberculosis, peritoneal tuberculosis, mesenteric lymph node tuberculosis, or secondary to bone tuberculosis or urinary tuberculosis. Primary female genital tuberculosis is rare.
The clinical manifestations of genital tuberculosis are very inconsistent. Many patients can be asymptomatic, while some patients have more severe symptoms.
1,Menstrual disorders, early because of endometrial congestion and ulcer, can have menorrhagia. Most patients have been ill for a long time, the endometrium has been damaged to varying degrees, and the performance is sparse menstruation or amenorrhea.
2,Lower abdominal pain due to pelvic inflammation and adhesion, there can be varying degrees of lower abdominal pain, which is aggravated during menstruation.
3,If the systemic symptoms are active, there may be general symptoms of tuberculosis, such as fever, night sweats, fatigue, loss of appetite, weight loss, and sometimes only fever during menstruation.
4,Infertility often blocks the lumen due to the destruction and adhesion of fallopian tube mucosa; Or because of adhesion around the fallopian tube, sometimes the lumen remains partially unobstructed. However, the mucous membrane cilia are damaged, the fallopian tube is stiff, the peristalsis is limited, the transportation function is lost, and pregnancy cannot be achieved. Therefore, the vast majority of patients are infertile. Genital tuberculosis is often one of the main causes in patients with primary infertility.
5,Systemic and gynecological examinations vary greatly due to the degree and scope of lesions. More patients were found to have endometrial tuberculosis without obvious signs and other conscious symptoms after diagnostic curettage due to infertility. If the more serious patient has peritoneal tuberculosis, there is a sense of flexibility or ascites sign in the abdomen during the examination. When the encapsulated effusion is formed, the cystic mass can be touched, the boundary is unclear and inactive, and the percussion is empty due to intestinal adhesion on the surface. The uterus is generally poorly developed, and its activity is often limited due to adhesion around it. If the accessories are involved, masses of different sizes and irregular shapes can be touched on both sides of the uterus, with hard texture, uneven surface, nodular or papillary processes, or calcified nodules can be touched.
Mode of infection
Genital tuberculosis is a manifestation of systemic tuberculosis, often secondary to tuberculosis in other parts of the body, such as tuberculosis, intestinal tuberculosis, peritoneal tuberculosis, mesenteric lymph node tuberculosis, or secondary to bone tuberculosis or urinary tuberculosis. Hematogenous transmission is the most common, and ascending infection is very rare. Puberty is a time of genital development with rich blood supply. Tuberculosis is easy to spread through blood, which affects the genitals. When most patients find genital tuberculosis in the future, their primary lesions have healed.