Semey state medical university Chair of Obstetrics and

Semey state medical university Chair of Obstetrics and Gyneaco logy Inflammatory disease of upper department of female sexual organs Lecturer : Antonova G.A

Women of 23 years old was admitted to hospital with complains on temperature of body rising till 39-40ºC pain in low part of abdomen , vomiting, purulent discharges from vagina.

How many days she is sick? What is her opinion about reason of disease? When was her last menstrual period? Is her menstrual function has some abnormalities? Did she used any treatment before hospitalization?

What is necessary to know from anamnesis of patient for you?

She is not completely well during 5 days already. She is connect her disease with medical abortion. It was done 7th days ago. On the 4th day after abortion she had rising of a body temperature. She used aspirin and small doses of ampicillinum. 2 day ago pain became more worst and localized to the left. Sometimes she has painful urination.

What are the data of common examination of a patient?

Her condition is rather heavy. Temperature is 40ºC. tong is wet. Palpation of abdomen is painful in lower part, particular to the left. Shetkin-blumberg symptom is positive to the left.

Common blood analysis Urine analysis Take smear on microscopy Bacterial examination Take blood on C- reactive protein contents USI of small pelvis

What are particularities of blood analysis in this case?

She never had problems due to disturbance of menstrual cycle and bloody discharges b/w menstruation.

Date of gyneacological examination: In speculum fluid purulent discharges from cervix are P.V. Uterus is displaced to the left, a little bigger of norm, rather soft. To the left at a region of adnexa there is infiltration of tissue, sever pain on palpation. Left fornix is flattened.

What is a picture of laparoscopy in such cases?

Peritonium is hyperemic and purulent discharges may go from ampula of tube. what is an additional method of examination, that help us to receive a pus from abdominal cavity?

Which type of additional examination I should prescribe for her?

Puncture of fornex posterior.

Why in our case tube is palpable during examination. It is normal. When tube is not palpable and very thin.

Inflammator exuded is collected in tube and is a reason of adherence process in place of fimbias and a tube occlusion. It call hydrosalpinx.

How do you think, from which disease o process was started?

In the beginning endometritis was. Due to absence of treatment we see speading of process.

Describe, please, data of USI in cases of acute salpingitis.

Inflammatory changed ovary with pus inside.

What is call as pyosalpinx?

What calls pyovarum?

Tube is rather wide and liquor may be in small pelvis.

From which factors a clinical picture depending on?

From virulent’ s of microorganisms and reactivity of patient.

What is differential diagnosis in this disease? From the acute endometritis?

General condition is the same serious, but during examination it is found that all low part of abdomen is painful. It is not possible to palpate. Uterus, adnexa due to sever pain. Exuded will be definitely at the fornex posterior and posterior fornex will be flattened.

General condition may be very serious, but uterus, in the beginning is not painful. But slight enlarged, no pain in lower part of abdomen and to the left as in our case.

What is differential diagnosis in this disease? From the acute pelvioperitonitis?

Leucocytosis very expressed, misplaced of a blood leucocytes formula to the lef, reaction of leucocytes pecipitation is very fast. Reaction od C- reacted protein is positive.

In the beginning of endometritis was. Due to absence of treatment we see spreading of process.

What is the modern method of diagnostic in this cases?

Laparoscopy