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ACUTE INFLAMMATORY DISEASES OF FEMALE GENITALS

Inflammatory diseases of the female genitalia are caused by pyogenic flora (staphylococci, streptococci, gonococci), Escherichia coli, anaerobic microorganisms, viruses, clostridia, chlamydia, etc.

The anatomical structure of the female genital organs, the specific functions of the female body, the diagnostic and therapeutic intrauterine procedures used for various diseases of the genitals facilitate the penetration of microorganisms into the genital tract of women and their subsequent development. Important for the development of the disease is the woman’s state of health and the protective mechanisms of her body. Some industrial poisons and air polluting substances, tobacco, coal, chalk and other dust from industrial premises, due to their long-term exposure, contribute to the emergence and development of inflammatory diseases of the genitals.

The pathogenesis and pathoanatomical picture of the acute inflammatory process are well known. Crucial is the infectious agent. In response to its irritating effect, the defense mechanisms of the microorganism are quickly mobilized as a complex unconditioned reflex. The infectious onset is suppressed, the pathological process is limited to a characteristic tissue barrier, and inflammation is eliminated. If this does not happen, then death of part of the tissues (organ) may occur. Therefore, it is so important to make a timely diagnosis, assess the severity of the process, the likelihood of its spread, prognosis for the affected organ and patient, provide emergency assistance in the right amount, and prevent possible serious local and general complications.

With the development of inflammation in the pathological focus, tissue metabolism is disrupted, tissue acidosis occurs, the normal ratio of electrolytes is disturbed, the osmotic pressure decreases and the dispersion of colloids increases, and the ability to retain water increases sharply. At the beginning of the disease, there is a short-term spasm of the vessels, followed by their expansion, blood flow, local hyperemia and fever in the focus of infection. In the future, vascular paralysis is observed, conditions are created for thrombosis and edema, for exudation (the formed elements of the blood pass into the tissue). The pathoanatomical picture is characterized by three signs: tissue damage - alteration, vascular disorders and the multiplication of cellular elements - proliferation.

In the chronic stage of the disease, the microbial pathogen is not significant. Exacerbation is often not associated with infection. The pathogenesis of chronic inflammatory diseases of the female genital organs (especially the most common disease - salpingo-oophoritis) has a number of features. The focus, existing in a chronic inflammatory process, serves as a source of prolonged irritation of the nervous, endocrine and other body systems. There are signs of a violation of them. Manifestations are usually multiple and often prevail over local symptoms. The autonomic nervous system is particularly affected.

The impact on the nervous system can be carried out in a reflex and humoral way in connection with the entry of denatured proteins, toxins and a number of other substances from the focus of inflammation into the blood. There is a violation of blood supply associated with sclerosis and narrowing of the lumen of the vessels of the ovaries and fallopian tubes with partial obliteration of the blood and lymph vessels. Of great importance are fibrosis and cicatricial adhesions that violate the correct anatomical and functional relationships, as well as dystrophic processes in the nerve cells of the solar, hypogastric and aortic plexuses, which are ascending in nature. Changes that occurred in the nerve plexuses of the abdominal cavity, diencephalic region, subcortical and other parts of the central nervous system (CNS) cause changes in more distant peripheral vegetative formations, which become independent, secondary centers of pathological impulse.

A significant role in the spread of the inflammatory process belongs to the sensitization of the body. Various pharmacological preparations used for a long time for therapeutic purposes, as well as decay products and altered metabolism in the focus of inflammation, can be antigens. Long-existing inflammatory diseases of the female genital organs cause menstrual dysfunction, sexual dysfunctions, dysfunctions of the urinary system and intestines, serve as a background for the development of blastomatous processes. A number of inflammatory diseases (especially with suppurative process) require emergency care to prevent possible serious complications.

Acute bartholinitis is an inflammation of the large gland of the vestibule. Ovoid swelling at the border of the middle and lower third of the labia majora, hyperemia, cyanosis are noted. The protrusion of the labia majora extends to the labia minora and closes the entrance to the vagina. Patients complain of sharp pains, worse when walking. Body temperature rises to 38-39 ° C. In the absence of fluctuations, the treatment is conservative, with an abscess - prompt. Short-acting anesthetics are used for pain relief.

Acute endometritis is an inflammation of the uterine mucosa. More often the process captures the muscle layer (metroendometritis). Metroendometritis is especially difficult after criminal intrauterine interventions to terminate pregnancy. A pronounced general reaction of the body to the inflammatory process is characteristic: high body temperature, chills, weakness, sweating, tachycardia, intoxication of the body. Patients complain of abdominal pain, discharge from the genital tract - putrefactive, with an ichorous odor. With a bimanual examination, an enlarged, painful uterus is palpated; inflammatory diseases of other localization are absent.

Typical changes in peripheral blood (leukocytosis, a shift of the leukocyte formula to the left, increased ESR, anemia, toxic granularity of neutrophils) make it possible to diagnose metroendometritis. With metroendometritis, there is always a danger of spreading the infection outside the uterus and involving the appendages of the uterus, peritoneum, perinatal fiber, as well as generalizing the infection with the development of bacterial toxic shock. With this complication, it is always necessary to prescribe intensive conservative therapy. With a complication of the disease, purulent purulent purulent tumors of the uterine appendages, acute

renal or liver failure, generalization of infection, urgent surgical treatment is indicated - hysterectomy with fallopian tubes.

The prognosis depends on the severity of the disease, timely diagnosis and sufficient therapy in the pre- and postoperative periods.

Salpingoophoritis (adnexitis) - inflammation of the uterine appendages (see "Purulent tubo-ovarian formations").

Parametritis is a secondary inflammation of the perinatal fiber (anterior, posterior, and lateral parametritis). The most likely route of infection is lymphogenous. An early symptom symptom is pain. They differ in constancy and gradually increase with irradiation to the sacrum and legs.
Due to severe pain, urination and defecation are difficult. Patients complain of headache, general fatigue, fever up to 39 ° C, rapid pulse. The condition of patients sharply worsens with purulent fusion of parametric fiber (up to 10%). Parametritis is confirmed by the symptom of coincidence of the percussion border of dullness and palpation, the impossibility of palpation of the sacro-uterine ligaments, the density of the infiltrate passing to the pelvic wall, the immobility of the vaginal wall. Purulent fusion should be thought of when the patient's condition worsens, a further increase in body temperature, determination of the areas of softening of the infiltrate during a vaginal rectal examination.

Urgent conservative therapy is required in all cases, and with purulent melting of the infiltrate, surgical treatment is indicated in the amount of posterior colpotomy and drainage of the abscess (if possible, removal of the main source of parametritis).

Pelvioperitonitis is an inflammation of the pelvic peritoneum (gonorrhea or non-specific nature). Patients report severe abdominal pain, sometimes stool retention. Symptom Shchetkina positive. When examining the upper abdomen, pain and tension are absent. The body temperature is elevated, but the general condition of the patient often remains satisfactory. When examining the internal genital organs, the boundaries of the tumor are fuzzy due to the tension of the abdominal wall. In the presence of an abscess in the uterine space, the posterior arch, depending on the amount of pus, becomes flattened or even bulges, fluctuation is determined. The mucous membrane of the vagina under the abscess is mobile, the abscess does not extend to the pelvic bones.

Emergency care for pelvioperitonitis is a comprehensive conservative treatment. Sometimes they perform posterior colpotomy and drainage of the abdominal cavity as a temporary therapeutic measure.

Acute peritonitis. Gynecological peritonitis is usually called those that develop as a result of diseases of the female genital organs (perforation of purulent tumors of the uterine appendages, metroendometritis, perforation of the uterus, etc.). The patient’s severe condition is characteristic: high body temperature, tachycardia, changes in peripheral blood, sharp abdominal pain, bloating and tension of the abdominal wall, vomiting, pronounced Shchetkin’s symptom throughout the abdomen, intestinal atony, flatulence.

As an emergency, urgent surgical treatment is indicated: gluttony, removal of the focus of infection, debridement and drainage of the abdominal cavity (see "Purulent tubo-ovarian formations").

Doctor Tactics

1. The diagnosis. Diagnosis of acute inflammatory diseases of the female genitalia requiring emergency care should include:

- timely topical diagnosis of the disease;

- assessment of the severity of the pathological process, the degree of damage to the organ and surrounding tissues;

- identification of prognostic criteria (clinical and laboratory) for a particular patient;

- drawing up a plan for examination and treatment of the patient in emergency order.

2. The sequence of therapeutic measures. Infection with pathogens is the main principle of antibiotic therapy.

Antibiotics. Antibiotic therapy should be multicomponent, taking into account the impact on the likely flora (gram-positive and gram-negative, aerobic and anaerobic). To provide for the need for the use of broad-spectrum antibiotics, to choose the most rational and effective combination and route of administration (including parenteral).

Currently, the most active in action is the combination of cephalosporins, penems with aminoglycosides and metragil, as well as semisynthetic penicillins and their combinations.

Sulfanilamide preparations. They have a bacteriostatic, antipyretic, anti-allergic and antitoxic effect. In severe cases, used in combination with antibiotics. Polysulfanilamides and long-acting sulfonamides possess the weakest toxicity and good tolerance: sulfonomethoxin, sulfadimethoxin, sulfalene, biseptol.

Nitrofuran drugs (furagin, furazolidone, furadonin, furazolin, etc.) are close to broad-spectrum antibiotics. They are low toxic, rarely cause dysbiosis and candidiasis. They have a pronounced synergistic property in combination with antibiotics, have a bactericidal effect, enhance phagocytosis.

Derivatives of metronidazole (flagyl, clion, nidazole, vaginil) are especially effective for anaerobic infections and resistant strains of staphylococci (possibly intravenous administration).

3. Correction of hemodynamic disturbances. It is based on multicomponent infusion therapy aimed at eliminating hypovolemia, disorders of cardiovascular activity, disturbances in peripheral hemodynamics and transcapillary metabolism, under the control of central venous pressure (CVP), circulating blood volume (BCC), hourly urine output. In severe diseases, treatment should begin with intravenous administration of Ringer-Locke solution, glucose (2.5%, 5% or 10%) with the addition of insulin (based on 1 unit per 4 g of glucose), albumin, polyglucin, reopoliglukin, 5-10 % solution of calcium chloride. It is advisable to introduce cardiac glycosides (digoxin, isolanide), and after stabilization of blood pressure - a solution of aminophylline. Curantyl (persantine, dipyridamole) is administered to protect the myocardium from hypoxia. In some cases, drugs with? -Adrenergic blocking action, drugs for neuroleptoanalgesia (droperidol, fentanyl) are indicated.

Along with the therapy, a detoxifying effect is also achieved, which is enhanced by the use of hemodesis, polydesis, reopoliglyukin, saline and protein solutions, antioxidants (unitiol with ascorbic acid, vitamin E).

4. Desensitizing therapy. It includes the appointment of diphenhydramine, diprazine, suprastin.

5. General strengthening and immunostimulating therapy. There is no doubt the need for appropriate nutrition and patient care. With an exacerbation of the chronic process, immunostimulating therapy is required. Passive immunization is carried out using hyperimmune antistaphylococcal plasma, antistaphylococcal immunoglobulin and bacteriophage. Passive immunotherapy should be supported by stimulation of the activation processes of the T-lymphocyte system (staphylococcal toxoid, decaris). Nonspecific reactivity of the body is enhanced by pyrogenal, prodigiosan. Directionally alter the body's immune responses using hyperbaric oxygenation (HBO), ultraviolet irradiation (UV) of blood, laser irradiation of blood (see "Purulent tubo-ovarian formations").

6. Symptomatic treatment. The following drugs are used: non-narcotic analgesics (aspirin, antipyrine, amidopyrine, analgin, butadion), sedatives (valerian, motherwort tincture), tranquilizers (trioxazine, etc.), stimulants (lemongrass tincture, ginseng preparations, pantocrine, eleutherococcus).
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ACUTE INFLAMMATORY DISEASES OF FEMALE GENITALS

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