Diagnosis of pelvic inflammatory disease

In today's society, the status of women is getting higher and higher. However, the emergence of a large number of gynecological diseases such as pelvic inflammatory disease not only brings physical distress to women, but also affects the relationship between husband and wife and the harmony of the family to a certain extent, thus causing psychological distress. How can we diagnose pelvic inflammatory disease? Let's learn about the examination and diagnosis of pelvic inflammatory disease.

Experts remind: Friends who suffer from pelvic inflammatory disease must pay more attention to changes in their bodies and seek medical advice in a timely manner. Here are our experts' answers to the common causes of acute and chronic pelvic inflammatory disease. The specific contents are as follows:

1. Diagnostic criteria

Diagnosis can usually be made based on medical history, symptoms and physical signs. In addition, some necessary tests are required, such as routine blood and urine tests, erythrocyte sedimentation rate, cervical secretion culture and drug sensitivity tests. When the body temperature is as high as 39°C or above, blood culture and drug sensitivity tests are performed, combined with B-ultrasound and CT examinations, and posterior fornix puncture is performed when necessary. If pus is drawn out, the diagnosis can be confirmed.

Minimum criteria: cervical motion tenderness or uterine tenderness or adnexal tenderness

Additional criteria: body temperature over 38.3℃; abnormal mucopurulent discharge from the cervix or vagina; large number of white blood cells in the image of 0.9% NaCl solution of vaginal discharge; increased erythrocyte sedimentation rate; increased blood C-reactive protein; laboratory confirmed positive cervical gonorrhea Neisseria or Chlamydia

Specific criteria: Patients with a history of acute pelvic inflammatory disease and symptoms and signs usually have no difficulty in diagnosis. However, sometimes patients have more symptoms but no obvious history of pelvic inflammatory disease and positive signs. At this time, the diagnosis of chronic pelvic inflammatory disease must be cautious to avoid making a rash diagnosis and causing mental burden on patients. Sometimes pelvic congestion or varicose veins in the broad ligament can also produce symptoms similar to chronic inflammation. Chronic pelvic inflammatory disease and endometriosis are sometimes difficult to distinguish. Endometriosis dysmenorrhea is more obvious. If typical nodules can be felt, it will help with diagnosis. Laparoscopy can be performed when differentiation is difficult. Hydrosalpinx or tubo-ovarian cysts need to be differentiated from ovarian cysts. In addition to a history of pelvic inflammatory disease, the former has a sausage-shaped mass, a thin cyst wall, and adhesions around it; while ovarian cysts are generally more round or oval, with no adhesions around them and free movement. Pelvic inflammatory adnexal masses are adhered to the surrounding area and are immobile, which can sometimes be confused with ovarian cancer. Inflammatory masses are cystic while ovarian cancer is solid. B-mode ultrasound examination can help to differentiate them.

Acute and chronic pelvic inflammatory disease can be diagnosed based on medical history, symptoms and signs. However, differential diagnosis must be done well. The main differential diagnosis of acute pelvic inflammatory disease includes: acute appendicitis, ectopic pregnancy, ovarian cyst pedicle torsion, etc.; the main differential diagnosis of chronic pelvic inflammatory disease includes: endometriosis and ovarian cancer.

Acute pelvic inflammatory disease is characterized by a history of acute infection, dull pain in the lower abdomen, muscle tension, tenderness and rebound pain, accompanied by rapid heart rate, fever, and a large amount of purulent vaginal secretions. In severe cases, there may be high fever, headache, chills, loss of appetite, a large amount of yellow leucorrhea with odor, lower abdominal distension and tenderness, and lower back pain. When there is peritonitis, there may be nausea, bloating, vomiting, diarrhea, etc. When pus is formed, there may be a lower abdominal mass and local compression and irritation symptoms. If the mass is located in the front, there may be difficulty urinating, frequent urination, and painful urination. If the mass is located in the back, it may cause diarrhea.

The systemic symptoms of chronic pelvic inflammatory disease are sometimes low fever and fatigue. Some patients develop neurasthenia symptoms due to the long course of the disease, such as insomnia, lack of energy, and general discomfort. The lower abdomen is distended and painful, and the lumbar and sacral pain is often aggravated after fatigue, sexual intercourse, and before and after menstruation. Chronic inflammation can lead to pelvic congestion, menorrhagia, menstrual disorders when ovarian function is damaged, and infertility when the fallopian tubes are blocked by adhesions.

(II) Differential diagnosis

1. Pelvic connective tissue inflammation: It needs to be differentiated from pyosalpinx and tubo-ovarian abscess; broad ligament tumors, advanced cervical cancer, etc.

2. Pelvic peritonitis: It needs to be differentiated from acute appendicitis perforation or intestinal perforation, ovarian tumor pedicle torsion or rupture, ectopic pregnancy rupture, tuberculous peritonitis, ovarian malignant tumor, etc.

3. Pelvic abscess: needs to be differentiated from pelvic hemorrhage, appendiceal abscess, etc.

(III) Inspection items

1. Pathogen culture. Now the new relatively rapid chlamydia enzyme assay has replaced the traditional chlamydia detection method. Chlamydia antigen detection can also be performed using mammalian cell culture. This method is an enzyme-linked immunosorbent assay. The average sensitivity is 89.5% and the specificity is 98.4%.

2. Direct smear of secretions. The samples can be vaginal, cervical secretions, urethral secretions, or peritoneal fluid for direct thin-layer smear. After drying, it is stained with methylene blue or Gram. If Gram-negative diplococci are seen in polymorphonuclear leukocytes, it is gonorrhea infection. Because the detection rate of cervical gonorrhea is only 67%, a negative smear cannot exclude the presence of gonorrhea, while a positive smear is very specific.

3. Ultrasonic examination, mainly B-type or grayscale ultrasound scanning and filming. This technology has an 85% accuracy in identifying masses or abscesses formed by adhesions of the fallopian tubes, ovaries and intestinal tract, but mild or moderate pelvic inflammatory disease is difficult to show characteristics in B-type ultrasound images.

4. Laparoscopy. If it is not diffuse peritonitis and the patient is in general good condition, laparoscopy can be performed on patients with pelvic inflammatory disease, suspected pelvic inflammatory disease, and other acute abdominal diseases. Laparoscopy can not only make a clear diagnosis and differential diagnosis, but also make a preliminary judgment on the severity of pelvic inflammatory disease.

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