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Adnexitis
- 3. z Oophorosalpingitis Combination of inflammation of the fallopian tubes (Latin Tuba uterina , Greek salpinx , inflammation salpingitis ) and the ovary (Latin ovary , Greek oophoron , inflammation oophoritis ). The term oophorosalpingitis can also be used as a synonym for adnexitis
- 4. z Etiology Pathogen Chlamydia Mycoplasma E. coli Gonococci Staphylococcus aureus Streptococci
- 5. z Enterococci Klebsiella other anaerobes Clostridium perfringens rarely also tuberculosis pathogens ( Mycobacterium tuberculosis )
- 7. z Pathogenesis As a rule, these are germs that ascend into the fallopian tubes via the vagina and uterus. Often there is also inflammation in the area of the cervix (cervicitis) and the lining of the uterus (endometritis). This inflammation is often found shortly after menstruation or shortly after ovulation (ovulation). At this time, the mucus in the area of the cervix (cervix) is softened and therefore more pervious. The maximum age is between 15 and 20 years.
- 8. z Clinical symptoms The patients usually complain of acute onset, laterally accentuated lower abdominal pain, postmenstrual or periovulatory . If there is accompanying inflammation in the area of the cervix ( cervix uteri ) or the uterus, there is also discharge (fluorine) or spotting . In the case of severe infections, vomiting and ileus symptoms can also occur. It is not uncommon for inflammation caused by chlamydia to be accompanied by perihepatitis ( Fitz- Hugh-Curtis syndrome ). There are pain in the right upper abdomen and a slight increase in liver enzymes . Adnexitis can cause an acute abdomen .
- 9. z Diagnosis Evaluation of history, predisposing factors, complaints Gynecological examination – On palpation , uterine and adnex pressure pain and portio- push pain are found During the speculum examination, inflammation of the cervix can be shown and smears can be taken for microbiological determination of the germs. Blood count – In blood count one can leukocytosis , fibrinogen and CRP increase notice cytological smear to rule out malignancy in the cervical canal or uterus with obstructoneion to drainage and secondary inflammation .
- 10. z Urine analysis Bacteriological and bacterioscopic analysis - During the speculum examination, inflammation of the cervix can be shown and smears can be taken for microbiological determination of the germs In ultrasound , can be provided so as abscesses , swelling and secretions Behave find. In the case of acute illness with an unclear genesis, a laparoscopy or pelviscopy with intraoperative surgery can be used as a last resort
- 11. z Treatment Since most adnexitis today are caused by chlamydia , an uncomplicated and outpatient treatable adnexitis is initially treated with tetracyclines or fluoroquinolones for at least 10 days. If therapy fails, therapy with cephalosporins and metronidazole is initiated. In the event of further therapy failure, an attempt should be made to preserve the triggering germ and a germ-specific antibiotic therapy should be started. Abscesses are usually approached and relieved in the hospital and surgically. Pain is addressed with anti-inflammatory drugs (e.g., diclofenac ).
- 12. z Complications Sterility : The formation of scars and structures due to adhesions can lead to obstructive sterility.Adhesions and accumulation of secretions ( hydrosalpinx , hematosalpinx , pyosalpinx (saktosalpinx), dysmenorrhea ) Tubo- ovarian abscess : encapsulated inflammatory focus with involvement and caking of the fallopian tube and ovary Douglas abscess : encapsulated inflammatory focus in the area between the rectum and uterus ( Douglas space )
- 13. z Peritonitis : life-threatening breakthrough of the purulent inflammation in the free abdominal cavity sepsis Chronic Adnexitis: Symptoms of chronic adnexitis are often bland. Often there are pelvic discomfort and pain during sexual intercourse ( dyspareunia ). There may also be chronic discharge. It is difficult to treat therapeutically, as adhesions are often the cause of the symptoms.