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Inflammation of The Ovaries

Inflammation of the ovaries (oophoritis) is one form of pelvic inflammatory disease (pelvic inflammatory disease – PID). Infection occurs by climbing microorganisms from the lower parts of the female reproductive system and is one of the major causes of ectopic pregnancy, infertility and chronic pelvic pain. Inflammation of the ovaries should be distinguished from other forms of abdominal pain.

Definition 

Inflammation of the ovaries (oophoritis) is one form of pelvic inflammatory disease (pelvic inflammatory disease – PID). Infection occurs by climbing microorganisms from the lower parts of the female reproductive system and is one of the major causes of ectopic pregnancy, infertility and chronic pelvic pain. Inflammation of the ovaries should be distinguished from other forms of abdominal pain. 

Emergence 

Infection ascends after bacteria colonize the cervix and spread to the uterus, fallopian tubes and ovaries. The bacteria Neisseria gonorrhoeae (the cause of gonorrhea) and Chlamydia trachomatis typically cause pelvic inflammatory disease. These agents are rarely isolated from ovarian tissue, often encourage other bacterial infection. If the inflammation of the ovaries is not treated, about the fallopian tubes and ovaries can create a limited purulent accumulations called tubo-ovarian abscess. 

Age 
Inflammation of the ovary is most common in women under the age of 25 years 

Symptoms 

  1. abdominal pain 
  2. pelvic pain 
  3. vaginal discharge 
  4. painful vaginal intercourse 
  5. fever 
  6. chills 
  7. nausea 
  8. vomit 

Doctor finds: 

  1. body temperature higher than 38 ° C 
  2. lower quadrant abdominal tenderness when you touch 
  3. purulent discharge 
  4. painful sensitivity of the cervix to move 
  5. ovarian pain 
  6. mass of the ovary 8ako originated tuboovarijski abscess) 

Causes 

The main causes of pelvic inflammatory disease caused by sexually transmitted diseases are most common in young, sexually active population, with more sexual partners. Sexually transmitted diseases are, unfortunately, often without symptoms or symptoms so mild that they are not given the importance of people and it’s difficult to detect. 

Risk factors can be summarized as follows: 

  1. Unprotected sexual intercourse 
  2. multiple sexual partners 
  3. high-risk sexual behavior 
  4. immunosuppression (immune system disorder) 
  5. Instrumental views of genital tract (endometrial biopsy) 
  6. intrauterine contraceptive insert (spiral) 

Differential Diagnosis 

The occurrence of these symptoms, but inflammation of the ovary should be no doubt on some of the following diseases: 

  1. ovarian tumors 
  2. inflammation of the appendix (appendectomy) 
  3. nebakterijska inflammation of the bladder 
  4. diverticulitis 
  5. ectopic pregnancy 
  6. inflammatory diseases of the digestive system – gastroenteritis 
  7. inflammation of the lymph vessels cancer – mesenteric lymphadenitis 

Diagnosis 

The diagnosis of inflammation of the ovary is set based on interviews with patients, examination, laboratory techniques, histology tests and various imaging technique and imaging of the ovaries and abdominal cavity. Laboratory findings that are required: a complete blood count, differential blood count, urine analysis (to the exclusion bladder inflammation), a pregnancy test (exclusion of ectopic pregnancy), wet preparation of vaginal discharge, bacterial culture of the cervix at the gonococcus (Neisseria gonorrhoeae) and chlamydia (Chlamydia trachomatis) could be excluded or confirmed infection with these bacteria. Since recording the cheapest and widely available is ultrasound, which will exclude the presence of tuboovarijskog abscess. 

Other methods include diagnostic laparoscopy, which is usually done only when the diagnosis is unclear. Serological tests for hepatitis B virus, hepatitis C virus, syphilis and HIV are needed because these pathogens can be found skewers those involved in high-risk sexual activity. Microscopic evaluation is performed in cases when the cases are assessed surgically 

Treatment 

Hospitalization is required if the patient: 

1st hemodynamically stable (no bleeding) 
2nd responsible enough to endure the treatment and come to control 
3rd immunocompetent (properly functioning immune system) 
4th not pregnant 
5th No tuboovarijski abscess 

Hospital treatment is needed if the patient: 

1st already been treated with outpatient, but the treatment was not successful 
2nd pregnant 
3rd infected with HIV 
4th If the abscess developed tuboovarijski 
5th If you can not cure pills that are taken by mouth because of severe nausea and vomiting 

Drug treatment aims to reduce morbidity, prevent complications, and eradicate the infection. For the treatment using antibiotics. Antimicrobial therapy should cover all likely pathogens. For gonococcal infection of the best acting third-generation cephalosporins such as ceftriaxone, and cefuroxime cefiksim and medications such as ciprofloxacin and ofloxacin. For chlamydia infection  azithromycin, doxycycline, ofloxacin and erythromycin. On the mycoplasma positive effect of tetracyclines. Anaerobic bacteria are treated with clindamycin, metronidazole, imipenem, some cephalosporines third generation, and amoxicillin plus clavulanic acid. 

For ambulatory patients treatment can start with the combination of ofloxacin and metronidazole for the withdrawal of the main symptoms continue treatment for another two weeks. Particular importance is well treated chlamydia infection because of lack of symptoms and beliefs that are cured patients are often not implemented by the end of therapy. Then the infection was suppressed and continues to destroy the female reproductive system which can lead to infertility and ectopic pregnancy. 

Surgical treatment can be done if other treatments have not reduced symptoms after 48-72 h. Surgical intervention may include laparoscopy with drainage of abscess, removal of the ovaries or removal of the uterus with bilateral removal of the ovaries. Factors that determine the scope of the project were the size of abscess, the degree of disorder of immunity and the preservation of fertility for the birth of children in the future.Interventional radiology is sometimes used in patients who for some reason are not candidates for surgical treatment. 

Complications 

Infertility occurs in 12-15% of women after an episode of pelvic inflammatory disease 
ectopic pregnancy is more frequent after this illness. If a woman get pregnant shortly after the inflammation of the ovary, one should consult your doctor as soon as possible. 
Long-term pelvic pain is a possible consequence recovered after pelvic inflammatory disease 
Forecast 
90% of patients will respond well to antibiotic therapy. 

Special care 

Increased concern is necessary if inflammation develops in the ovary: 

Pregnancy – although rare, is possible and should immediately consult a doctor gynecologist 
childhood – children rarely have inflammation of the ovaries, and if it is suspected in the adolescent to think about sexual abuse 
old age – in this age of ovarian inflammation is often associated with malignant changes, such as ovarian or endometrial cancer. 

Prevention 

In addition to educating women, an unusually important and early diagnosis and treatment of inflammation of the lower parts of the female reproductive system in order not to spread. Women who have recovered from an inflammation of the ovary is to educate and advise on the use of condoms to prevent future infections. Sexual partners should also be tested for sexually transmitted diseases and treatable. 




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