Inflammatory diseases of the upper genital tract

Endometritis is an inflammation of the uterine mucosa with damage to both the functional and the basal layer. Acute endometritis, as a rule, occurs after various “intrauterine manipulations — abortion, curettage, intrauterine contraceptive insertion (IUD), and also after childbirth. The inflammatory process can quickly spread to the muscle layer (endomyometritis), and in case of severe course it affects the entire wall of the uterus (panmetrit). The disease begins acutely – with an increase in body temperature, the appearance of nballs in the lower abdomen, – knowingly, – purulent or serous-purulent secretions from the genital tract. The acute stage of the disease lasts 8-10 days and ends, as a rule, with recovery. Less commonly, there is generalization of the process with the development of complications (parametritis, peritonitis, pelvic abscesses, thrombophlebitis of the pelvic veins, sepsis) or inflammation becomes subacute and chronic.

A gynecological examination determines a pussy discharge from the cervical canal, an enlarged uterus of a softish texture, painful or sensitive, especially in the region of the ribs (along the large lymphatic vessels). In the clinical analysis of blood, leukocytosis is detected, leukocyte shift to the left, lymphopenia, increased ESR. With ultrasound scanning, the uterus is enlarged, the border between endometrium and myometrium is blurred, the change in echogenicity of the myometrium (alternation of areas of increase and decrease in echo density), expansion of the uterus with hypoechoic contents and fine suspension (pus), and with appropriate anamnesis, BMK. fetal ovum Endoscopic picture with hysteroscopy depends on the causes of endometritis. In the uterine cavity, against the background of a hyperemic edematous mucosa, fragments of the necrotic mucosa, elements of the fetal egg, remnants of placental tissue, foreign bodies (ligatures, IUD, etc.) can be determined.

In case of violation of the outflow and infection of secretions from the uterus due to a narrowing of the cervical canal by a malignant tumor, a polyp, a myomatous node, a pyometra may occur – a secondary purulent lesion of the uterus. There are sharp pains in the lower abdomen, purulent-resorptive fever, chills. During a gynecological examination, the discharge from the cervical canal is absent, an enlarged, rounded, painful body of the uterus is detected, and during an ultrasound scan, an expansion of the uterus cavity with the presence of fluid in it with suspension (according to echo structure corresponds to pus).

Chronic endometritis occurs more often due to inadequate treatment of acute endometritis, which is facilitated by repeated curettage of the uterine mucosa for bleeding, remnants of suture material after cesarean section, IUD. Chronic endometritis is a clinico-anatomical concept; the role of infection in maintaining chronic inflammation is very doubtful, however, there are morphological signs of chronic endometritis: lymphoid infiltrates, stroma fibrosis, sclerotic changes of the spiral arteries, the presence of plasma cells, glandular atrophy or hyperplasia of the mucous membrane with the formation of cysts and synechia (adhesions) . In the endometrium, the number of receptors for sex steroid hormones decreases, resulting in the inferiority of the transformations of the uterine mucosa during the menstrual cycle. The clinical course is latent. The main symptoms of chronic endometritis include menstrual irregularities – menopausal or meteorology due to impaired mucosal regeneration and a decrease in uterine contractility. Patients are worried about the pulling, —hurring pains in the lower abdomen, —serous-purulent discharges from the genital tract. Often in the history there are indications of violations of the generative function – infertility or spontaneous abortions. Chronic endometritis can be suspected on the basis of anamnesis, clinical picture, gynecological examination (a slight increase and compaction of the uterus, sero-purulent discharge from the genital tract). There are ultrasound signs of chronic inflammation of the mucous membrane of the uterus: intrauterine synechia, defined as hyperechoic septa between the walls of the uterus, often with the formation of cavities. In addition, due to the involvement of the basal layer of the endometrium in the pathological process, the thickness of the M-echo does not correspond to the phase of the menstrual cycle. However, for final verification of the diagnosis, a histological examination of the endometrium obtained by diagnostic curettage or a pipeline biopsy of the uterine mucosa is required.

local_offerevent_note February 25, 2019

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