Bilateral lower abdominal pain

Introduction The pain can be caused by blood or pus in the uterine cavity. Paroxysmal colic can be caused by contraction of uterine organs such as the uterus or fallopian tubes. Acute tearing pain can be caused by rupture of the ovarian tumor. Unbearable pain in refractory pain may be caused by a neurological invasion of advanced cancer. Patients should have improvement in clinical conditions within 3 days of starting treatment, such as fever, abdominal tenderness or rebound tenderness reduction, reduction of uterine and accessory tenderness, and reduction of cervical pain.

Cause

Causes: The main causes of pelvic inflammatory disease are:

1. Postpartum or post-abortion infection: maternal physique is weak after delivery, the cervix is out due to residual blood turbidity, not closed in time, there is a placenta peeling surface in the uterine cavity, or birth canal damage, or placenta, fetal membrane residue Etc., or premature sexual life after childbirth, pathogens invade the uterine cavity, easily cause infection; spontaneous abortion, medical abortion, vaginal bleeding for too long, or tissue remains in the uterine cavity, or artificial abortion surgery aseptic Post-abortion infections can occur if the operation is not strict.

2, intrauterine surgery after infection: such as placement or removal of intrauterine birth control ring, curettage, tubal fluid, hysterosalpingography, hysteroscopy, submucosal uterine myomectomy, etc., due to preoperative Sexual life or surgical disinfection is not strict or inappropriate preoperative indications, chronic inflammation of the genital tract, acute exacerbation and spread by surgical intervention; some patients do not pay attention to personal hygiene after surgery, or do not follow the doctor's advice after surgery, the same Can cause bacterial infection, causing pelvic inflammatory disease.

3, poor health during menstruation: if you do not pay attention to menstrual hygiene, use unclean sanitary napkins and pads, menstrual bath, menstrual sexual intercourse, etc. can cause pathogens to invade and cause inflammation.

4, the direct spread of inflammation of adjacent organs: the most common is appendicitis, peritonitis, because they are adjacent to the female internal reproductive organs, inflammation can be directly spread, causing pelvic inflammatory disease; when suffering from chronic cervicitis, inflammation can also pass the lymphatic circulation, Causes pelvic connective tissue inflammation.

5, the acute onset of chronic pelvic inflammatory disease.

an examination

Related inspection

Abdominal MRI examination of abdominal plain film

Diagnosis: Minimum standard: cervical pain or uterine tenderness or attachment tenderness.

Additional criteria: body temperature over 38.3 ° C, a mucus purulent discharge in the cervix or vagina; vaginal secretions 0.9% nacl solution picture see a large number of white blood cells; erythrocyte sedimentation rate increased; blood c-reactive protein increased, laboratory confirmed Cervical gonorrhea is positive for Neisseria or Chlamydia.

Specific criteria

Patients with a history of acute pelvic inflammatory disease and symptoms and signs have no difficulty in diagnosis, but sometimes patients have more symptoms without significant history of pelvic inflammatory disease and positive signs. At this time, the diagnosis of chronic pelvic inflammatory disease should be cautious, so as not to make a diagnosis. Ideological burden. Sometimes pelvic congestion or wide ligament varicose veins can also produce symptoms similar to chronic inflammation. Chronic pelvic inflammatory disease and endometriosis are sometimes difficult to identify, endometriosis dysmenorrhea is more significant, if you can touch the typical nodules, it is helpful for diagnosis. Laparoscopy is feasible when it is difficult to identify. Oviductal hydrops or tubal ovarian cysts need to be differentiated from ovarian cysts. In addition to the history of pelvic inflammatory disease, the mass is a sausage-like type, the wall of the capsule is thin, and there are adhesions around it; while the ovarian cysts are generally round or oval, with no surrounding Adhesive, free to move. The pelvic inflammatory accessory mass adheres to the surrounding area, is inactive, and sometimes is confused with ovarian cancer. The inflammatory mass is cystic and the ovarian cancer is solid. B-mode ultrasound is helpful for identification.

Acute chronic pelvic inflammatory disease can be diagnosed based on history, symptoms and signs. But be sure to make a differential diagnosis. The main differential diagnosis of acute pelvic inflammatory disease is: acute appendicitis, ectopic pregnancy, ovarian cyst pedicle torsion and so on.

The main differential diagnosis of chronic pelvic inflammatory disease is: endometriosis and ovarian cancer.

Acute pelvic inflammatory disease has a history of acute infection, lower abdominal pain, muscle tension, tenderness and rebound tenderness, accompanied by rapid heart rate, fever, and a large amount of purulent secretions in the vagina. When the condition is serious, there may be high fever, headache, chills, loss of appetite, a lot of yellow and white smell, small abdominal pain, tenderness, waist pain, etc.; there are nausea, bloating, vomiting, diarrhea, etc. in peritonitis; when there is puff formation, There may be lower abdominal mass and local compression stimulation symptoms. The mass may be in front of the dysuria, frequent urination, dysuria, etc., and the mass may cause diarrhea at the rear.

The systemic symptoms of chronic pelvic inflammatory disease are sometimes low fever and susceptibility to fatigue. Some patients have symptoms of neurasthenia due to long course of disease, such as insomnia, lack of energy, and general discomfort. Lower abdomen bulge, pain and soreness in the lumbosacral region, often worsened after exertion, after sexual intercourse, before and after menstruation.

Differential diagnosis

Differential diagnosis:

First, vaginitis

Trichomonas vaginitis: more secretions, foamy, burning, tingling.

Fungal vaginitis: genital itching, local erosion, ulceration with burning pain, dysuria, frequent urination. Increased secretions.

Bacterial vaginitis: more odor, increased vaginal discharge. Common complications occur simultaneously with cervicitis and pelvic inflammatory disease.

Second, cervicitis

In acute inflammation, the cervix is congested, red and swollen, abdominal pain, and sometimes body temperature rises. After switching to chronic inflammation, vaginal secretions increase. With backache, pain, falling feeling, every time before and after menstruation, there are dysmenorrhea and menstrual disorders.

Third, pelvic inflammatory disease

Lower abdomen pain, pain and lumbosacral pain, increased menstrual flow, menstrual disorders and so on. Chronic pelvic inflammatory disease can easily cause inflammation of the fallopian tubes, ovaries, uterus and other parts, which can lead to infertility and various complications.

Fourth, attachment inflammation

The most common symptoms of acute attachment inflammation are fever and abdominal pain. The fever can reach above 38 °C, accompanied by chills. The abdominal pain is mostly caused by severe pain in the lower abdomen. The compression pain is intensified, and sometimes the lower abdomen is more painful than the other side. . Chronic attachment inflammation has no obvious fever and pain, only feeling soreness or discomfort in the waist, or swelling of the lower abdomen.

Five, urinary tract infection

Frequent urination, urgency, dysuria, itching, redness and other symptoms, if not treated in time, will destroy the adjacent normal tissue structure, causing vaginitis, pelvic inflammatory disease, etc. If the treatment is not easy to relapse, severe cases can also lead to chronic renal failure.

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