Pelvic adnexitis

　　The pathogens of pelvic adnexitis are usually Streptococcus, Staphylococcus, Escherichia coli, anaerobic bacteria, gonococcus, chlamydia, mycoplasma, and others.

　　1. Streptococcus is a Gram-positive coccus, among which Streptococcus pyogenes has the strongest pathogenicity, capable of producing hemolysins and various enzymes, causing the spread of infection. The pus is thin, pale red, and in large quantities. This bacterium is sensitive to penicillin. Group B hemolytic Streptococcus is common in postpartum uterine infections.

　　2. Staphylococcal infections after childbirth, cesarean section, and gynecological surgery have staphylococci at the wound, which are divided into three types: golden yellow, white, and lemon yellow, with strong pathogenicity. The pus is yellow, thick, and odorless, and is prone to develop resistance to commonly used antibiotics. It is ideal to use medication based on drug sensitivity tests. Staphylococcus aureus resistant to penicillin is sensitive to cephalexin, clindamycin, vancomycin, and chloramphenicol.

　　3. Escherichia coli is a Gram-negative bacterium. This bacterium is generally not pathogenic, but it can cause severe infections in weakened individuals, with trauma, or after surgery, often leading to mixed infections with other bacteria. The pus is thick and has a fecal smell. Aminopenicillin (ampicillin), amoxicillin (amoxicillin), cephalosporins, and aminoglycoside antibiotics are effective, but they are prone to produce drug-resistant strains, and it is best to use medication based on drug sensitivity tests.

　　4. In acute pelvic adnexitis, anaerobic bacteria such as Peptostreptococcus and Bacteroides fragilis can be seen. These bacteria mostly come from the colon, rectum, vaginal mucosa, and oral mucosa, and are prone to form pelvic abscesses and infectious thrombophlebitis. The pus has bubbles and a fecal smell. Reports indicate that 70% to 80% of the pus in abscesses can be cultured to isolate anaerobic bacteria. In terms of medication, antibiotics that cover both anaerobic and aerobic bacteria, such as penicillin, clindamycin, cephalexin, second and third-generation cephalosporins, and metronidazole, should be used.

　　5. Tuberculosis is more common in other organs, and it is rare to occur in pelvic adnexitis.

　　6. The pathogens of sexually transmitted diseases, such as gonococci, chlamydiae, and mycoplasmas, were pathogens that gynecologists and obstetricians paid attention to in the 1980s. Chlamydia is a microorganism that differs from viruses and develops and reproduces within the host cells; Mycoplasma (Mycoplasma) is a microorganism between bacteria and viruses, without a cell wall, highly polymorphic, and is a normal flora, sensitive to tetracycline. This kind of pathogen can sometimes be found in acute pelvic adnexitis.

　　The occurrence of pelvic adnexitis seriously affects the physical health of women, and if not treated in time, it may lead to the following complications:

　　1. Infertility

　　Inflammation of the uterus, fallopian tubes, ovaries, or surrounding tissues, including the peritoneum within the pelvis, can cause infertility in women when any part occurs inflammation. Especially when acute inflammation is not treated thoroughly and turns into chronic, or due to the slow onset and mild condition of chronic pelvic inflammation, which is not noticed, leading to delayed treatment and chronicity, often causing infertility in women.

　　2. Infectious shock

　　If infectious shock is not detected and treated in time, it often causes life-threatening conditions. This situation is usually due to the rapid reproduction of pathogens in the body, these bacteria will secrete a large amount of endotoxins, and the endotoxins will circulate throughout the body with the blood circulation, quickly causing the body's response.

　　3. Tubal pregnancy

　　Chronic salpingitis is the most common factor disturbing the normal operation of the fertilized egg, and is the common and main cause of tubal pregnancy. There are reports from abroad that pelvic inflammatory diseases can increase the risk of ectopic pregnancy by 2.7 times.

　　4. Nephropathy

　　Since the pelvic adnexitis is connected with the retroperitoneal adnexitis, it can reach the periphery of the kidneys, therefore, if acute pelvic adnexitis is not treated, the inflammation can not only spread to the fallopian tubes, pelvic peritoneum, and other tissues and organs, causing pelvic abscess, but can also spread upwards, leading to perinephric abscess.

　　5. Diffuse peritonitis

　　Diffuse pelvic peritonitis is caused by the spread of inflammation to the serous membrane of the uterus, the outermost layer, leading to systemic toxic symptoms in patients, such as high fever, nausea, vomiting, and abdominal distension. Because the inflammatory exudation on the peritoneal surface and the covering of fibrin can cause intestinal adhesion, and can also form abscesses.

　　Pelvic adnexitis is a pelvic inflammatory disease, which can be divided into acute and chronic:

　　1. Acute pelvic adnexitis

　　Acute pelvic adnexitis refers to the initial inflammation of pelvic adnexitis, which is not secondary to the inflammation of fallopian tubes and ovaries, but originates from the adnexitis around the uterus and then spreads to other parts.

　　In the early stage of inflammation, patients may have high fever, lower abdominal pain, with body temperature reaching 39～40℃, and the lower abdominal pain is often similar to acute salpingo-oophoritis. If there is a history of total hysterectomy or unilateral or bilateral wall injury during cesarean section, the diagnosis is more likely to be obtained. If abscess has formed, in addition to fever and lower abdominal pain, common symptoms such as frequent defecation, pain during defecation, nausea, vomiting, pain during urination, and frequent urination may occur.

　　2. Chronic pelvic adhesiitis

　　Chronic pelvic adhesiitis is often due to incomplete treatment of acute pelvic adhesiitis or poor physical condition of the patient, resulting in chronic inflammation due to prolonged inflammation.

　　Since the lymphatic vessels of the cervix directly communicate with the pelvic connective tissue, it can also develop into pelvic adhesiitis due to the development of chronic cervicitis.

　　The pathological changes of this disease are mostly the transformation of pelvic connective tissue from congestion and edema to fibrous tissue, thickening, and hard scar tissue, connected with the pelvic wall, with the uterus fixed and unable to move, or the mobility is restricted, and the uterus is often biased to the affected pelvic connective tissue.

　　Mild chronic pelvic adhesiitis usually has no symptoms; occasionally, there may be low back pain and lower abdominal坠痛 during physical fatigue. In severe cases, there may be severe lower abdominal坠痛, lumbar pain, and dyspareunia. Mild chronic pelvic adhesiitis may have no symptoms. Dyspareunia is a common symptom of this disease, which is due to the lower position of the pelvic connective tissue, which is prone to be stimulated.

　　Reasonable prevention is the key to reducing the incidence of the disease. Below, I will introduce the methods of prevention for pelvic adhesiitis to everyone:

　　1. Pelvic adhesiitis can come from postpartum, cesarean section, abortion, and gynecological surgical operations, so it is necessary to do a good job of publicity and education, pay attention to the physical condition during pregnancy to reduce local injury during delivery, operate gently on the injured area, pay attention to local disinfection, and follow sterile operation procedures.

　　1. The reproductive organs have a weaker resistance during the menstrual period, and the open cervix is prone to ascending infection. Women should be educated to pay attention to menstrual hygiene, avoid sexual behavior and bathing in the bath, and also try to avoid surgery as much as possible.

　　2. Eat more fruits and vegetables rich in vitamins, eggs and poultry rich in protein, exercise more, rest more, and pay attention to strengthening the body to avoid infection.

　　3. If surgical treatment is to be performed, the following preoperative preparations should be made: Before surgery, the patient's physical condition should be carefully examined for anemia and other organ infections, and treatment should be given if found.

　　Pelvic adhesiitis is often induced by surgical reasons, and usually the following examinations are required for this disease:

　　1. Routine blood test and urine test

　　The total white blood cell count and the number of neutrophils in patients with this disease are both elevated, and the erythrocyte sedimentation rate may increase. Blood cultures and drug sensitivity tests should be performed for those with body temperature above 39℃.

　　2. Cultures and drug sensitivity tests of cervical canal secretions

　　Cultures and drug sensitivity tests of cervical canal secretions should be performed to check for gonococcal infection.

　　3. Ultrasound diagnosis

　　The diagnosis of pelvic inflammatory disease usually presents as a solid, heterogeneous mass, with chaotic distribution of light points and light bands.

　　4. Laparoscopic exploration

　　Firstly, it is necessary to determine the most severe lesion to judge the condition. The exudate or pus from the pelvic cavity should be sent for bacterial culture and drug sensitivity test, which is helpful for selecting antibiotics after surgery. If there is a suspicion of pelvic abscess, posterior fornix puncture should be performed, and the presence of pus can confirm the diagnosis.

　　To help patients with pelvic adhesion peritonitis recover better, it is recommended that the following dietary principles should be paid attention to:

　　1. Foods that are light and easy to digest should be eaten. Such as red beans, coix seed, mung bean, winter melon, lentil, pachysandra, cabbage, asparagus, celery, spinach, cucumber, winter melon, mushrooms, tofu, kelp, seaweed, fruit, etc.

　　2. Foods with the effect of promoting blood circulation, regulating qi, and dissipating masses should be eaten. Such as hawthorn, peach kernel, fruit peel, tangerine kernel, tangerine peel, rose, etc.

　　3. Appropriate protein supplementation, such as lean pork, duck, goose, quail, eggs, crucian carp, and turtle.

　　4. You can eat more papayas and yogurt. Yogurt helps digestion and can effectively prevent intestinal infections and improve the body's immune function.

　　5. Sweet potatoes are rich in fiber, potassium, iron, and vitamin B6, which can not only prevent aging and prevent atherosclerosis, but also effectively prevent tumors.

　　Pelvic adhesion peritonitis can be divided into acute and chronic types, and their treatment methods are also different. The specific introduction is as follows:

　　Firstly, the treatment of acute pelvic adhesion peritonitis

　　Active and thorough treatment is required to prevent pathogens from潜伏 in the body. The use of antibiotics for treatment may also achieve certain effects, and it is better when combined with physical therapy, but antibiotics cannot be used for a long time.

　　1. Antibiotic treatment: Broad-spectrum antibiotics can be used, and sensitive antibiotics can be changed after the antibacterial sensitivity test is obtained.

　　2. Surgical treatment: For mild cases of acute pelvic adhesion peritonitis, surgical treatment is generally not performed to avoid the spread of inflammation or bleeding, but some situations need to be determined according to specific circumstances.

　　Secondly, the treatment of chronic pelvic adhesion peritonitis

　　If there is concurrent chronic cervicitis, it should also be treated accordingly.

　　1. Treatment of chronic cervicitis: Including physical therapy such as ultra-short wave, laser, microwave, medium wave direct current iontophoresis, ultraviolet light, etc.

　　2. Treatment of chronic pelvic adhesion peritonitis: Physical therapy can also be used to alleviate pain. After treatment, the symptoms of chronic pelvic adhesion peritonitis can be alleviated, but it is also prone to recurrence, such as after menstruation, after sexual intercourse, and after excessive physical labor, so it is necessary to do a good job of propaganda and explanation for patients, so that patients can accept treatment calmly and peacefully.