|
Arabic
Bengali
Chinese
English
French
German
Hebrew
Hindi
Italian
Japanese
Korean
Malay
Polish
Portuguese
Spanish
Turkish
Ukrainian
Vietnamese|
Lecture notes, cheat sheets
Obstetrics and gynecology. Inflammatory diseases of the female genital organs (lecture notes)
Directory / Lecture notes, cheat sheets Table of contents (expand) Lecture number 21. Inflammatory diseases of the female genital organs Inflammatory diseases of the female genital organs (VZPO) occupy the first place in the structure of gynecological diseases. About 40% of gynecological patients in the hospital have VZPO. The cause of all inflammatory diseases of the genitals are microbes, which most often enter the body of a woman through sexual contact. The causative agents of infection can also spread by the lymphogenous, hematogenous route, along the intracanalicular route. Factors contributing to the spread of infection are intrauterine interventions: abortion, diagnostic curettage, hysterosalpingography, probing of the uterine cavity, placement and removal of an intrauterine contraceptive. 1. Bacterial vaginosis This disease is caused by a violation of the biocenosis of the normal microflora of the vagina. At the same time, the ratio of aerobic and anaerobic microorganisms changes towards an increase in anaerobes. The main complaint of a woman is an increase in the secretion of whites, sometimes there may be itching (or burning) in the genital area. There are no signs of inflammation in this case. When viewed in the mirrors of hyperemia, there is no swelling of the vagina. The presence of bacterial vaginosis proves a positive aminotest. When a certain component is added to the vaginal discharge, the smell of rotten fish appears. By themselves, the discharge does not smell of anything. Treatment. Since anaerobic flora predominates in the vaginal biocenosis, trichopolum is used. Since the vaginal pH is alkaline, 1-2 douches are performed with solutions of boric acid, citric acid, and potassium permanganate. Frequent douching is not recommended, as this leads to disruption of the biocenosis. Clindomycin has a good positive effect - it is used in the form of a cream and in tablets of 150 mg 3 times a day. A prerequisite for the treatment of all colpitis is the restoration of normal vaginal flora. This is achieved by introducing lactobacilli in the form of tampons with lactobacterin (6-8 tampons - 1 tampon for no more than 4-5 hours). In the presence of hypovitaminosis, vitamin therapy is carried out. 2. Chlamydia infection Chlamydia are gram-negative rods. Currently, it is infection No. 1, it has a lot in common with gonococcus: chlamydia are tropic to the cylindrical epithelium, they are located intracellularly. Chlamydial infection contributes to the massive formation of adhesions in the abdominal cavity and, most importantly, in the ampulla of the fallopian tubes. The main complaint in women will be infertility, often primary infertility. This infection does not have a bright clinical picture - it is erased, oligosymptomatically. For an infection of chlamydial etiology, a symptom of perihepatitis is characteristic, which consists in the formation of hepatic adhesions. This symptom was first noted in gonococcal pelvioperitonitis. Women with chlamydial infection complain of pain in the right hypochondrium, which must be differentiated from exacerbation of chronic cholecystitis, acute cholecystitis, various liver diseases, and in some cases with acute pneumonia. The real cause of these pains is perihepatitis, formed adhesions in the liver, where the pathogen enters the lymphogenous route. Identification of the chlamydia themselves is difficult. If the gonococcus can be seen in Gram smears, then the causative agent of chlamydial infection can only be determined with the help of special studies - by immunofluorescence using immunoclonal antibodies. Due to the fact that chlamydia affects tissues that have a cylindrical epithelium, it is necessary to take discharge from the cervical canal and from the urethra for analysis. Treatment. Chlamydia is sensitive to tetracyclines. Prescribe doxycycline - 0,1 g 2 times a day for 10 days, soluble doxycycline - unidoxolutab; macrolides: erythromycin (0,25 g 4 times a day for at least 7 days), summed (500 mg 1 time a day - 5 days), maropen (400 mg 4 times a day - 7 days), Rulide ( 150 mg 2 times a day - at least 7 days), Klacid (150 mg 3 times a day). To treat infections caused by mycoplasma and ureoplasma, the same medications are used as for chlamydial therapy. The danger of these infections is that they cause infertility, premature termination of pregnancy, postpartum complications - chorioamnionitis, endometritis, metroendometritis. They have a negative effect on the fetus and placenta, causing chlamydial, mycoplasma, and viral pneumonia. 3. Viral infections The herpes virus of the second serotype and the human papillomavirus cause inflammation of the cervix. Cytomegalovirus infection, as a rule, proceeds in the form of carriage, but has a damaging effect on the fetus, causing, in addition to miscarriages, fetal deformities. All viral infections are latent, difficult to treat, prone to relapses and exacerbations. In case of herpes infection during pregnancy, in order to prevent infection of the fetus, delivery is performed by abdominal caesarean section. Diagnose these infections using immunofluorescence microscopy or special sera. Treatment herpetic infection is carried out with antiviral drugs. The damaging effect of acyclovir (zovirax, virolex) affects the synthesis of viral DNA. The drugs are administered not only locally, but also orally or even intravenously. Acyclovir is prescribed in the form of tablets of 200 mg 5 times a day for 2 weeks. Locally applied viferon in the form of suppositories, it increases nonspecific antiviral activity. Neovir is used as an inducer of endogenous interferon. For the treatment of recurrent, difficult to treat genital herpes, famvir (Famciclovir) is used - 250-500 mg 3 times a day. 4. Candida colpitis Caused by fungi of the genus Candida. Mushrooms of the genus Candida are present in the normal microflora of the vagina. During the reproduction of fungi of the genus Candida, mycelium is found in the smear. For candidal colpitis, the presence of white curdled discharge is characteristic. Candidal colpitis is not sexually transmitted. Most often, the cause of the development of candidal colpitis is the uncontrolled conduct of antibiotic therapy, replacement therapy, the presence of hypovitaminosis, hypoestrogenism. Pregnancy can be a provoking factor, as it creates hypoestrogenism. With the development of candidal colpitis, only local treatment is carried out. Treatment. 1-2 douches with acidic solutions are necessary to normalize the vaginal pH. Clotrimazole is used in the form of cream or vaginal tablets. Representatives of econazole (ginotravalen, ginopivoril) are used in the form of vaginal tablets and suppositories. You can use pimafucin in the form of suppositories, which contain the antimycotic antibiotic katamycin. The course of treatment is 10-14 days. Terzhikan and Polygynax are prescribed in suppositories. They contain neomycin, a topical antibiotic. 5. Papillomavirus infection This infection is only transmitted sexually. The virus causes ectocervix, which is small flat warts - papillomas, which are sometimes not visible during colposcopic examination. Cytoscopies revealed poilocytes with air bubbles in the cytoplasm (Ballon cells). This disease is difficult to diagnose and very difficult to treat, since the papillomavirus is not sensitive to the antiviral drugs acyclovir, famvir. The disease is treated with laser and cryodestruction. 6. Specific infections Gonorrhea A specific infectious disease caused by Neisser's gonococcus. Infection occurs through sexual contact with the patient. The incubation period is from 3 to 20 days. Gonococcus infects mucous membranes covered with cylindrical epithelium, therefore, when infected, the primary foci of infection are the mucous membranes of the cervical canal, the urethra with paraurethral passages and the excretory ducts of the large vestibular glands. The pathological process in the area of primary lesions is usually called gonorrhea of the lower part of the female genital organs. The spread of infection in gonorrhea occurs ascending through the mucous membranes, or intracanalicularly. When the gonococcus penetrates beyond the internal os of the cervix, gonorrhea of the upper genital organs, or ascending gonorrhea, develops. This affects the endometrium, fallopian tubes, ovaries and pelvic peritoneum. Often formed abscesses fallopian tubes (pyosalpinx) and ovaries (pyovarium). Distinctive features of gonorrhea in women are quite often a sluggish course of the process, that is, the disease, regardless of the time of the course, is not felt sick (torpid gonorrhea), inflammation in the genitals is almost absent. The second feature of gonorrhea in women is that it often occurs as a mixed gonorrheal-Trichomonas infection caused by gonococci and Trichomonas vaginalis. The association of gonococcus with Trichomonas vaginalis is found in 96% of patients with acute ascending gonorrhea. With a mixed gonorrheal-Trichomonas infection, phagocytosis of gonococci with Trichomonas vaginalis occurs. Trichomonas and gonococci are in a state of endocytobiosis. Mixed infection changes the clinical course of gonorrhea, makes it difficult to diagnose, lengthens the incubation period, and requires multiple laboratory studies with provocations and cultural diagnostics during treatment. A characteristic feature of gonorrhea in women is the development of multifocal lesions. Recognition of gonorrhea is facilitated by the study of anamnestic data: the appearance of the disease 3-4 days after the onset of sexual activity, casual sexual intercourse, the appearance of discharge from the genitals, pain in the lower abdomen after menstruation, fever, the appearance of acyclic bleeding. A clinical study allows you to recognize gonorrhea with a sufficient degree of probability. Examination of the patient begins with examination and palpation of the abdominal wall, examination of the integument of the vulva and the mucous membrane of the vestibule. Determine the condition of the inguinal lymph nodes, their painlessness. When examining the urethra, its swelling, hyperemia of the sponges are noted. Infiltration of the urethra is determined by its palpation. After the massage, discharge appears. Smears are taken after rubbing the sponges of the urethra with sterile cotton wool with a blunt ear spoon or loop inserted to a depth of 0,5-1 cm. The discharge is applied with a thin smear in parallel on two glass slides in the form of the letter "U". The vestibular glands are palpated with the index finger. It is placed behind the hymen, and the thumb of the same hand is placed over the excretory duct. Selections are taken for analysis. The swab is done in the shape of a "B" next to the urethral swab. Pay attention also to the hyperemia of the mouths of the duct of the gland, its compaction, soreness. The vagina is examined in the mirrors. Note the hyperemia of the mucous membranes, the presence or absence of erosion, discharge. Discharge from the region of the posterior fornix is taken with a spoon, and to take material for fungi of the genus Candida, a light scraping is made from the walls of the vagina. Then they examine the cervix, determine the presence of erosion, their location, the nature of the discharge. The cervix is treated with a sterile cotton ball using long gynecological tweezers inserted into the cervical canal to a depth of 0,5-1 cm, parietal mucus is taken and applied to the same glasses in the form of the letter "C". Bimanual examination determines the state of the body of the uterus, its position, size, texture, pain. Next, the uterine appendages are palpated, their size, shape, consistency, soreness and the presence of adhesions are determined. Then, on palpation of the parametrium, the presence of infiltrates and their location are noted. When examining the rectum, attention is paid to the presence of swelling of the folds of the external sphincter, hyperemia, and the nature of the discharge. Wash water is taken with a double current catheter. Lumps of pus and mucus are taken from the resulting liquid with tweezers. They are rubbed between slides or applied to the slides in the form of the letter "R". In view of the difficulty of detecting gonococci during bacterioscopic examination of secretions, sowing is done, and then various types of provocations are carried out in order to detect infection in hidden foci. Several types of provocations are used. Chemical provocation - lubrication of the urethra and the lower segment of the rectum with a 1-2% solution of silver nitrate or Lugol's solution on glycerin, and the cervical canal with a 5% solution of silver nitrate. When carrying out a biological challenge, gonovaccine is administered intramuscularly in a dose of 500 million microbial bodies or pyrogenal (200 MTD) is administered simultaneously with gonovaccine. If before provocation the gonovaccine was used for therapeutic purposes, then a double therapeutic dose is administered, but not more than 2 billion microbial bodies. In a hospital setting, regional administration of gonovaccine is performed under the mucous membrane of the cervical canal and urethra (100 million microbial bodies in total). Thermal provocation involves performing inductothermy for 3 days. The duration of the procedure is 15-20 minutes, while the discharge is taken daily 1 hour after warming up. A physiological provocation is menstruation (smears are taken on the days of heaviest bleeding). The best indicators are observed after a combined provocation: a combination of chemical, biological and thermal. The discharge is collected 24, 48, 72 hours after provocation. The diagnosis of gonorrheal infection is made after the detection of gonococci. Treatment of gonorrhea of the lower genital organs is carried out on an outpatient basis; patients with ascending gonorrhea, as a rule, are treated in a gynecological hospital. The principles of treatment of patients with gonorrhea do not differ from the treatment of patients with inflammatory processes of septic etiology. General therapy (antibacterial, desensitizing, detoxification, etc.) in the subacute and chronic stages is combined with local treatment of lesions. Trichomoniasis (trichomoniasis) A specific infectious disease of the genitourinary organs caused by Trichomonas vaginalis, which are the simplest unicellular organisms from the flagellate class. They only parasitize humans. In the external environment, they are not stable, they quickly die at temperatures above 40 ° C, drying, exposure to disinfectants. The disease is transmitted sexually, very rarely - household. In women, the urethra, the glands of the vestibule of the vagina, and the cervical canal are affected. Often trichomoniasis is combined with gonococcal infection, chlamydia and bacterial urethritis of other etiologies. The duration of the incubation period is from 7 to 14 days or more. The clinic is due to the virulent properties of the microbe, the reactivity of the organism. The disease can have an acute, subacute and asymptomatic course. The diagnosis of chronic trichomoniasis is made after 2 months of illness. There is also asymptomatic trichomoniasis (trichomonas carriers). Trichomoniasis is acute. The vagina is most commonly affected (Trichomonas vaginitis). Usually patients complain of the appearance of yellow foamy liquid discharge, often with an unpleasant odor, itching and burning in the vulva, perineum, inner thighs. When the urethra is affected, patients experience pain and burning during urination. Sexual intercourse is often painful. Without treatment, the intensity of the inflammatory process gradually subsides, the process takes on a chronic course, and may be asymptomatic. With the transition of inflammation to the neck of the bladder, there are frequent urges to urinate and pain at the end of it. Chronic trichomonas urethritis is most often asymptomatic. When the glands of the vestibule of the vagina are affected, they swell, the lumen of the excretory duct closes, and a false abscess is formed. When the cervix is affected, the mucosa is hyperemic, edematous, muco-purulent discharge flows from the cervical canal, which often leads to the development of cervical erosion, especially on the back lip. Due to the ascending inflammatory process, the menstrual cycle may be disturbed, uterine bleeding is possible. Diagnosis of trichomoniasis is made by microscopic examination of discharge from the vagina, cervix and urethra. Treatment. Trichopolum - 5 g (total dose) per course of treatment. Trichopolum has a hepatotoxic effect, so it is recommended to use Flagyl (USA) or Atrican - 250 mg 2 times a day for 5 days. A prerequisite is treatment of the sexual partner, as reinfection is possible. For recurrent or difficult to treat trichomoniasis, the SolkoTrichovak and SolkoU-rovak vaccines are administered - 2 ml every 2 weeks, course - 3 injections. They normalize the vaginal microflora, damage Trichomonas and increase the body's resistance. Tuberculosis of the genital organs Genital tuberculosis is caused by Mycobacterium tuberculosis that enters the genitals from other sources. Most often, the infection comes from the lungs, less often from the intestines, mainly by the hematogenous route. Infection of the genital organs with Mycobacterium tuberculosis, as a rule, occurs in adolescence, but the clinical manifestations of the disease occur during puberty, with the onset of sexual activity or later. Most often, tuberculosis affects the fallopian tubes, uterus, less often the ovaries. Forms of tuberculosis of the genital organs: 1) exudative form, characterized by damage to the tubes and peritoneum with the formation of serous effusion, caseous-serous accumulations; 2) productive-proliferative form. Exudation is weakly expressed, the process of formation of tuberculous tubercles predominates; 3) fibrous-sclerotic form. The late stage of the process, which is characterized by sclerosis of the affected tissues, the formation of adhesions, scars, intrauterine synechia. Clinical manifestations of genital tuberculosis are extremely diverse. Tuberculosis of the appendages and uterus is characterized by a violation of menstrual and generative functions. Violation of the generative function is most often manifested by primary (rarely secondary) infertility. The resulting pregnancy is often ectopic or ends in spontaneous miscarriage. Hypofunction of the ovaries is often observed (insufficiency of both phases of the menstrual cycle, the predominance of violations of the second phase, anovulation), sometimes there is a violation of the function of the adrenal cortex with symptoms of hirsutism. The disease often begins imperceptibly, its symptoms are not very pronounced. Most patients go to the doctor with the only complaint of infertility or menstrual dysfunction. The diagnosis is established as a result of a careful study of the anamnesis, on the basis of clinical data and the use of special research methods. Treatment of genital tuberculosis is complex with the use of specific anti-tuberculosis drugs. Author: Ilyin A.A. << Back: Ectopic pregnancy >> Forward: Inflammatory diseases of the uterus and periuterine tissue (Endometritis. Pelvioperitonitis. Parametritis)
▪ International economic relations. Crib ▪ Operative surgery. Lecture notes ▪ The budget system of the Russian Federation. Lecture notes
The existence of an entropy rule for quantum entanglement has been proven
09.05.2024 Mini air conditioner Sony Reon Pocket 5
09.05.2024 Energy from space for Starship
08.05.2024
▪ New exotic state of matter discovered ▪ Portable drive Samsung T5 EVO 8 TB ▪ Amorphous graphene synthesis technology for wearable electronics ▪ Compact computer MINISFORUM GK50
▪ site section Parameters of radio components. Article selection ▪ article Rubber model of a paddle steamer. Tips for a modeller ▪ article When did the first police emerge? Detailed answer ▪ article Packaging of medicines. Standard instruction on labor protection ▪ Time relay article. Encyclopedia of radio electronics and electrical engineering
Home page | Library | Articles | Website map | Site Reviews
www.diagram.com.ua |
We recommend interesting articles Section 
See other articles Section 
Latest news of science and technology, new electronics:
All languages of this page