General and special gynecological examination. Inflammation of the appendages in women - symptoms and treatment regimen What does it mean the appendages are not palpable

Inflammatory processes that occur in the female genital organs are dangerous because they can quickly spread to the entire system, causing serious changes in the structure of tissues, disrupting the natural state of the uterus and appendages. In women, inflammation of the uterus, ovaries is often the cause of ectopic pregnancy, infertility and other complications. Early diagnosis and treatment of such pathologies can prevent the transition of the disease into a chronic form. With the appearance of unusual discharge, pain in the lower abdomen, it is necessary to clarify the diagnosis as soon as possible.

The ovaries are endocrine glands that produce female sex hormones, estrogen and progesterone. Hormonal imbalance can be the cause of breast tumors, violations of the cycle and the nature of menstruation, the onset of early menopause. The consequences of hormonal disorders are serious diseases of the uterus.

Inflammation of the ovaries (oophoritis) disrupts the functioning of the entire reproductive system. The process can affect only one organ (unilateral inflammation) or spread to both (bilateral). Often this disease is accompanied by inflammation of the fallopian tubes (salpingitis). In this case, adnexitis occurs, simultaneous inflammation of the ovaries and tubes. At the first stage, the inflammatory process occurs only in the mucous membrane, but then spreads to the tissues.

Causes and types of ovarian inflammation

The cause of inflammation of the ovaries is infection in them. Depending on the nature of the infection that causes the disease, two types of oophoritis are distinguished: nonspecific and specific.

Non-specific. The causative agents of infection are opportunistic microbes. They are always present in the human body and are activated when immunity is weakened, hypothermia, and stress. Such microbes are staphylococci, streptococci, E. coli, Candida fungi.

Specific. Inflammation is caused by sexually transmitted infections (syphilis, chlamydia, trichomoniasis, gonorrhea), as well as tuberculosis pathogens.

Inflammation of the ovaries can occur as a result of the following processes:

• penetration of infection from the external genitalia through the cervix, uterine cavity and fallopian tubes;
• infection from the intestines and urinary organs if the rules of personal hygiene are not observed;
• the spread of infection to the ovaries with inflammation of the intestine or appendicitis;
• infection during an abortion, installation of an intrauterine device, operations on the pelvic organs;
• transmission of infection through the blood or lymph from other organs prone to inflammation (for example, with tonsillitis).

Addition: The occurrence of oophoritis is facilitated by factors such as weakened immunity, hypothermia, uncontrolled intake of certain drugs, overwork, stress, and lack of nutrition.

Video: Causes and prevention of ovarian inflammation

Forms and symptoms of the disease

Inflammation of the ovaries in women can exist in acute, subacute and chronic forms. In this case, the symptoms are similar, but expressed in varying degrees.

Acute inflammation. It has pronounced signs that usually make a woman urgently seek medical attention.

Subacute inflammation. This form occurs in patients with tuberculosis. The signs of the disease are the same as in the acute form, but it is more difficult to recognize them, since they are masked by the symptoms of the underlying disease.

Chronic inflammation. If a woman does not go to the doctor in a timely manner, the treatment is not completed, the disease can become chronic, in which the signs are smoothed out. There are periods of temporary improvement in the condition, followed by an exacerbation of the disease.

Symptoms in the acute form of the disease

Signs of acute inflammation are:

1. Severe pain in the lower abdomen, on one side or both. The pain is felt not only in the ovaries, but also extends to the groin. There are aching pains in the sacrum, lower back. Painful sensations intensify before menstruation, as well as with hypothermia.
2. Increased body temperature, chills. It is not possible to bring down the temperature with the help of conventional antipyretics. There are temperature fluctuations.
3. Headache, aching joints and muscles.
4. Frequent and painful urination.
5. Copious discharge from the genitals. They can be transparent, white, yellow, brown, green, with impurities of blood or pus.
6. Bleeding between periods.
7. Violation of the menstrual cycle.
8. Digestive disorder.
9. Pain during intercourse.
10. Insomnia, irritability, fatigue.

Palpation of the ovaries is difficult because of their swelling and pain.

Features of the chronic form of inflammation

If the inflammation becomes chronic, then it periodically exacerbates. Usually the reason is colds or infectious diseases, physical or mental stress, indigestion, diseases of the genitourinary system. If a woman smokes or drinks alcohol frequently, the risk of exacerbations increases.

In some cases, the disease does not recur, the woman is only concerned about the discharge and the irregular onset of menstruation. This course of inflammation of the ovaries is typical, for example, in gonorrhea. However, gradually there is a thickening of the walls of the fallopian tubes, the formation of adhesions in the ovaries.

With a unilateral process, pain is localized at the site of inflammation. If it occurs on the right side, then the symptoms of oophoritis can be confused with the symptoms of appendicitis. Careful diagnosis of the disease is required.

Often, inflammation that occurs on one side spreads to the second ovary. In women suffering from chronic inflammation of the ovaries, the usual symptom is the presence of persistent scanty discharge (leucorrhoea). Usually, patients go to the doctor for examination and treatment if pregnancy does not occur.

Consequences of inflammation of the ovaries

The greatest danger is bilateral chronic inflammation of the ovaries. Its symptoms are not as pronounced as in the acute form. The woman periodically feels healthy, the treatment is not completed. As a result, ovarian dysfunction (impaired hormone production) can form. This condition is characterized by the absence of ovulation in a woman, the possibility of conception. In this case, there is an irregular onset of menstruation, fluctuations in their intensity and duration.

Ovarian dysfunction, hormonal disorders can cause diseases of the mammary glands, as well as pathological changes in the tissues of the uterus, up to the occurrence of malignant tumors. Inflammation causes complications such as obstruction of the fallopian tubes, miscarriage, ectopic pregnancy, inflammatory diseases of the kidneys and intestines.

Diagnosis of oophoritis

It is not always possible to establish the presence of oophoritis only on the basis of symptoms, since a similar picture is observed in diseases such as appendicitis, ectopic pregnancy, peritonitis, tumor diseases of the uterus and ovaries. To clarify the diagnosis, you need to know about the presence and methods of treating previous diseases, the nature and time of occurrence of ailments, the existence of complications in a woman during childbirth, abortion, intrauterine procedures. The localization of pain, the nature of the discharge, the existence of other signs of inflammation are specified.

During a gynecological examination presence of puffiness and morbidity of ovaries, changes of mobility of appendages comes to light.

Laboratory tests blood, urine and a smear from the vagina allow you to determine the presence of an inflammatory process by an increased content of leukocytes.

ultrasound pelvic organs is done to clarify the nature of the disease.

Bacteriological analysis smear. Allows you to find out the type of opportunistic microorganisms and their sensitivity to various antibiotics.

ELISA(enzymatic immunoassay) - determination of the type of infection by the presence of antibodies corresponding to it in the blood. The method allows you to approximately assess the nature of the infection. It is used to detect chlamydia, mycoplasmosis, trichomoniasis and other latent infections.

PCR(polymerase chain reaction) - a method that allows you to determine with 100% accuracy the type of viruses that caused inflammation by their DNA (including detecting human papillomavirus, herpes, the causative agent of tuberculosis, chlamydia and others).

Hysterosalpingoscopy. The method is used to detect structural changes resulting from inflammation. The organs are filled with a special fluid, and then with the help of ultrasound, they monitor its progress through the pipes, clarify their patency.

Laparoscopy. Allows you to examine the uterus, tubes, ovaries. The most effective diagnostic method. An optical device with a camera is inserted through a small hole in the abdominal wall.

Treatment of oophoritis

The method of treatment depends on the form of the disease and the type of infection that caused it.

In the acute form, treatment is carried out in a hospital. A woman needs to stay in bed. Cold compresses are applied to the lower abdomen. Antibacterial, analgesic, antipyretic drugs, general restorative drugs are used. Antibiotics in the treatment are selected depending on the sensitivity of the infectious agent.

In the subacute form of the disease, quartz irradiation of the site of inflammation is used. In chronic inflammation, drug treatment is used, as well as physiotherapy and therapeutic baths.

The following methods apply:

1. Hirudotherapy- treatment with leeches to remove adhesions, relieve swelling and inflammation.
2. electrophoresis- the introduction of drugs through the skin using a weak direct electric current.
3. Gynecological massage. Allows you to eliminate adhesions, increase the tone of the uterus, restore its normal location.
4. Magnetotherapy– treatment with a low frequency magnetic field. It has anti-inflammatory, analgesic effect.
5. Laser therapy, IR, UV irradiation- optical methods of elimination of microorganisms.

Note: If inflammation of the ovaries resulted from a sexually transmitted infection, then both sexual partners should be treated simultaneously. Sexual contact should be avoided during this time.

In the treatment of advanced chronic diseases, one has to deal with the presence of complications requiring surgical intervention.

Video: Complications of inflammation of the ovaries

To prevent oophoritis, it is necessary to promptly treat any inflammatory processes in the body, strengthen the immune system, lead a healthy lifestyle, use condoms, and regularly undergo gynecological examinations.

Often, many gynecological diseases are asymptomatic. Therefore, a manual examination during a routine examination by a gynecologist can unexpectedly reveal certain pathologies of the pelvic organs. Palpation of the ovaries determines whether the organ is in a normal state, its size corresponds to the norm, including age, whether the examination causes pain.

In premenstrual girls, the ovaries should not be palpable at all. If they are found during a manual examination by touch, some kind of pathology should be assumed. In women of childbearing age, the ovary may not always be palpable, for example, if the abdominal wall is thick or tense. Normally, the glands are 3x2x2 cm in size, they are mobile and sensitive, some increase is found during ovulation and pregnancy.

There is a difference in size - on the right side, the ovaries are always slightly larger than on the left. When the patient takes oral contraceptives, the ovaries are practically not palpable and there is no such obvious asymmetry. In the postmenopausal period, when ovarian function gradually decreases, attention should be paid to their increase, to palpable swelling and irregularities of the glands. This is evidence of a serious pathology or even ovarian cancer.

Clinical symptoms detected by palpation

Most often, diseases of the pelvic organs are detected already in the chronic stage, because their onset is asymptomatic. Therefore, an ordinary examination by a gynecologist is not superfluous even when a woman feels healthy. The patient will not feel a slight increase in the size of the internal genital organs, and this may be an early symptom of the disease. Just palpation, being the simplest research method, can detect the disease at the very beginning and enable prompt treatment.

During the initial manual examination, the doctor may feel an increase in the ovaries. This may indicate such diseases:

• inflammatory process caused by various bacteria and, as a result, the formation of adhesions;
• cysts and neoplasms of the ovaries of various types and nature;
• ovarian cancer.

Simple palpation, until recently, was the only diagnostic method that made it possible to identify a serious pathology that was asymptomatic and even save a woman's life. In the climacteric period in women, an increase in the ovaries and the total mass of the appendages was a priori considered a threatening symptom. When it was not possible to conduct an ultrasound examination, it was recommended to remove these organs. Because such a pathology at an older age is a high risk of developing cancer. Now, to confirm or refute the diagnosis, additional diagnostic studies and analyzes are prescribed. But, nevertheless, cysts and neoplasms are first detected in women most often during a routine gynecological examination.

Palpation of the pelvic organs can reveal, in addition to an increase in the size of the gland:

• irregularities, swelling on the ovaries and cysts, when they are already large enough;
• the presence of fluid in the abdominal cavity;
• uncharacteristic asymmetry of the glands;
• the inability to palpate the ovary separately from the uterus due to the running adhesive process in the appendages and its increase in size.

All symptoms may indicate the presence of certain pathologies or neoplasms in the pelvic organs. For a complete picture, other patient complaints about well-being should be collected. A woman may complain of pain in the lower abdomen, general weakness, menstrual irregularities, a feeling of bloating and an increase in the size of the abdominal cavity, nausea, and so on.

Delusions and fears

Often, the busyness, intense life rhythm of a modern woman does not give her time to take care of herself and her health. Sometimes patients make their own diagnoses and treat themselves. Which leads to the fact that the disease becomes chronic or incurable.

It is impossible to examine yourself and feel for a cyst or some kind of pathology on the ovaries on your own. This can only be done by a qualified gynecologist. If you suspect an ovarian tumor, you should not be afraid of surgery. Some types of cysts are amenable to conservative medical treatment. But if surgery is recommended, you can not hesitate. Because it's about saving lives. Modern surgery allows you to make the operation less traumatic and gentle. Removal of the ovaries in our time does not deprive a woman of reproductive function. It is possible to conceive and bear a child with the help of in vitro fertilization.

Note: The main thing is not to neglect elementary examinations by a gynecologist, lead a healthy lifestyle and follow the recommendations of doctors. Early diagnosis of the disease gives a chance for a complete cure and preservation of all body functions.

On palpation, it is possible to determine a tumor that comes from the ovary or uterus and, when the leg is twisted, proceeds with a picture of an acute abdomen. Then this tumor is painful, especially when trying to displace it. However, the tumor may not be clearly palpable due to severe pain and tension in the abdominal wall. If the tumor originates from the genital organs, then only its upper pole is usually well palpated, while the lower pole is inaccessible to palpation through the abdominal wall.

It is necessary to determine and note in the history of the disease the localization of the tumor, its size, consistency, the nature of its surface, mobility and soreness. If the patient indicates the presence of a tumor or cyst in the anamnesis, and the tumor is not detected on palpation and an acute abdomen has developed, one can think of a rupture of this formation. Sometimes a palpable formation does not have clear contours and is motionless, then they speak of an infiltrate. This happens with inflammatory tubovarial formations or with malignant formations.

5. Other symptoms a. Murphy's sign: severe pain at the height of inspiration with deep

palpation of the right hypochondrium. The symptom is often positive in acute cholecystitis, but is not pathognomonic for this disease.

b. Rovsing's symptom: the appearance of pain in the right iliac region with deep palpation (or percussion) of the left iliac region. A positive symptom is characteristic of appendicitis, but can also be observed in other diseases.

in. Symptom of the lumbar muscle: the patient lies on the left side, with the extension of the right leg pain occurs in the lower back. It is observed in retrocecal appendicitis and other inflammatory diseases affecting the lumbar muscles - paranephritis, psoas abscess, retroperitoneal hematoma, perforation of the posterior wall of the caecum by a malignant tumor. The same symptom observed when the left leg is extended is characteristic of paranephritis, perforation of the diverticulum and cancer of the sigmoid colon.

d. Symptom of the obturator muscle: the patient lies on his back with his legs bent at a right angle; turning the shins in or out causes pain. The occurrence of pain is due to an inflammatory process involving the obturator internus muscle or localized next to it (pelvic abscess, appendicitis, salpingitis).

e. Kehr's symptom: pain in the shoulder on palpation of the lower abdomen, especially in the Trendelenburg position. The symptom was first described with damage to the spleen. Pain caused by the accumulation of fluid in the subdiaphragmatic space radiates to the shoulder and neck.

6. Sometimes there is increased skin sensitivity over the focus of inflammation. This is an interesting biological phenomenon, but it has no diagnostic value.

D. Inspection of the perineum, examination of the genital organs and rectum in case of abdominal pain is mandatory.

Gynecological study.

This study allows not only to determine whether acute pains come from the genital organs, but also to identify the cause of their occurrence.

Examination of the external genitalia. In an acute abdomen, it can provide valuable information if signs of gonorrhea of ​​the lower genital apparatus are detected: vulvitis,

urethritis, gonorrheal spots, purulent discharge, abscess of the excretory duct of the large gland of the vestibule of the vagina.

Examination of the vagina and cervix using mirrors allows you to identify cyanosis, as a sign of pregnancy, the nature of the discharge (dark blood in tubal pregnancy, purulent in the inflammatory process, light in other diseases). Cervical hyperemia and purulent discharge can be with endocervicitis, which was the source of ascending gonorrhea. A sample of secretions from the uterine os is taken for bacteriological examination (bacterioscopy of a Gram-stained smear and culture).

Bimanual study: can be vaginal-abdominal and rectal-abdominal. In a bimanual study, the shape and consistency of the cervix, the state of the uterine os, a feeling of pain when the cervix is ​​​​displaced are determined. Soreness with displacement of the cervix during a two-handed examination is characteristic of tubal pregnancy, inflammation of the uterine appendages, pelvic peritonitis. In surgical pathology, this symptom is usually absent. Next, you should determine the condition of the vaginal vaults. Usually, the filling of the rectal-uterine recess with blood or inflammatory effusion is manifested by flattening of the posterior and sometimes lateral arches. However, the lower pole of the tumor or infiltrate can also be determined through the vaults; in these cases, in the picture of an acute abdomen, one can think either of a tubo-ovarian inflammatory formation with microperforation, or of an ovarian tumor. In some cases, the posterior fornix is ​​protruded by a uterine hematoma in an "old" tubal pregnancy.

Then determine the location, size, shape, consistency and degree of mobility of the uterus. During tubal pregnancy, the uterus is softened, somewhat enlarged, very mobile (syndrome of the “floating” uterus). In case of inflammation of the appendages, pelvioperitonitis, the uterus is not enlarged, but painful, since it can be involved in the inflammatory process. Soreness on palpation of the knotty uterus, especially against the background of infertility, indicates endometriosis.

With ovarian apoplexy, torsion of the pedicle of the ovarian tumor, with surgical pathology, the uterus does not have any pathological features. An enlarged, tuberous uterus is detected with myoma, while some of its nodes can be sharply painful on palpation, which indicates impaired blood supply and necrosis. Appendages in the normal state are most often not palpated, especially with obesity of the abdominal wall.

In tubal pregnancy, the appendages are thickened, painful and pasty on the one hand, without clear contours, which is explained by the presence of a fetal egg and peritubal hematoma. With inflammation, the appendages are most often thickened and painful on both sides, but they cannot be clearly palpated. A dense, bumpy, motionless and painful formation on one or both sides of the uterus is determined either with tubo-ovarian abscesses or with true ovarian tumors, which, in combination with the clinic of an acute abdomen, may indicate microperforation of these formations. Sometimes a painful band is palpated in the area of ​​the appendages, which may be a twisted leg of a cyst or ovarian tumor. An attempt to displace the tumor in this case causes severe pain. With ovarian apoplexy with hemorrhage, it is palpated as a sharply painful tumor-like formation of an elastic consistency with clear contours. In surgical pathology, the area of ​​​​the appendages is usually painless.

Sometimes the uterus and appendages cannot be palpated due to severe pain and tension of the abdominal wall. This most often happens with gonorrheal pelvioperitonitis, with diffuse peritonitis, sometimes with a rupture of the tube.

Recto-abdominal examination is resorted to if the patient does not live sexually or in the case when the main pathological formations are palpated through the anus. Such a study will provide more accurate data.

A rectal examination can reveal a symptom of Promptov, which consists in pain on palpation of the recto-uterine cavity and pain when the uterus is displaced to the womb. This symptom is characteristic of acute appendicitis. A rectovaginal examination can be of great help, in which the examiner's fingers are more intimately closer to the uterine appendages and the broad ligament, which makes it possible to identify a pelvic abscess and retrograde metastases to pararectal lymph nodes (often with asymptomatic malignant tumors of the abdominal organs).

Additional research methods.

1. Laboratory research

Laboratory studies can provide significant assistance in the differential diagnosis of an acute abdomen. However, the results of blood and urine tests, as well as the data of radiological studies, by themselves do not allow either to make or exclude any of the options for the diagnosis, and without a detailed history and physical examination, they are meaningless. “The patient should be treated, not his blood test or X-ray.” Laboratory studies that provide valuable information include:

a. Urinalysis is an affordable and inexpensive method for detecting diseases of the kidneys and urinary tract. Hematuria confirms the diagnosis of urolithiasis. Leukocyturia and bacteriuria are indicative of a urinary tract infection. Proteinuria is a nonspecific symptom. The specific gravity of urine allows you to assess the water balance. All these studies can be quickly carried out using test strips. Urinalysis for chorionic gonadotropin (hCG) allows you to differentiate pregnancy from other pathological conditions.

b. General blood analysis. The white blood cell count helps to establish whether abdominal pain is associated with an inflammatory process. Inflammation is characterized by leukocytosis, although there are many exceptions. So, with appendicitis, the number of leukocytes in the blood may be normal. Therefore, the leukocyte formula should be determined, especially in cases where the total number of leukocytes is normal or slightly increased. The shift of the leukocyte formula to the left is a more important diagnostic sign than leukocytosis. With gynecological pathology, an increase in ESR is more pronounced, with surgical pathology - leukocytosis, which rapidly increases in dynamics. A general blood test allows not only to detect anemia (by reducing the absolute level of hemoglobin and hematocrit), which indicates acute blood loss, but also to establish its type (by the morphology of red blood cells).

in. Serum amylase and lipase activity. The diagnosis of acute pancreatitis is always clinical. An increase in amylase and lipase activity confirms the diagnosis. However, it should be remembered that an increase in amylase activity is a non-specific sign that is observed in many other diseases (mechanical intestinal obstruction, intestinal infarction, perforated ulcer, ectopic pregnancy). Since amylase is excreted by the kidneys, its activity in serum also increases in renal failure. In acute pancreatitis, amylase activity usually reaches a maximum in a day and normalizes by the end of 2-3 days. Therefore, to confirm the diagnosis, it is advisable to also determine the activity of lipase. Note that the increase in the activity of both enzymes does not correlate with the severity of pancreatitis. Moreover, in chronic pancreatitis accompanied by pancreatic necrosis, the activity of amylase and lipase may not change. If blood amylase activity exceeds 2000 U/L, calculous pancreatitis should be suspected.

d. Bacterioscopy Analysis of vaginal discharge reveals the presence of an increased content of leukocytes and pathogenic flora, which almost always happens with inflammation of the internal genital organs. However, it should be remembered that these signs can also be detected in other pathologies, including extragenital, if it is combined, for example, with inflammation of the uterus or vagina.

2. Instrumental Research Women X-ray and isotope studies are carried out only after

exclusion of pregnancy.

a. X-ray studies Plain radiography. Referring the patient for X-ray examination

the doctor must be sure that his result will affect the tactics of treatment. For example, a patient with typical appendicitis complaints, right iliac tenderness, abdominal muscle tension at McBurney's point, and mild leukocytosis needs surgery rather than x-ray. In some diseases, the information content of the survey radiography is so small that its implementation is not justified. An x-ray of the abdominal cavity in the supine position allows you to see the distribution of gas in the intestine, determine the cause of bloating (accumulation of gas or fluid), detect fluid-filled bowel loops, soft tissue thickening and calculi. X-rays show 90% of urinary stones (because they contain enough calcium) and only 10% of gallstones. You can see the calcification of the pancreas - a sign of chronic pancreatitis. The focus of calcification in the right iliac region, together with the corresponding complaints and physical examination data, indicates acute appendicitis. The presence of gas in the bile ducts is a sign of vesico-intestinal fistula, which can occur with gallstone intestinal obstruction. The absence of a shadow of the lumbar muscle indicates a pathological process in the retroperitoneal space - bleeding (in case of injury) or inflammation (retrocecal appendicitis, pancreatitis, diverticulitis of the sigmoid colon). And finally, the picture allows you to detect the pathology of the spine and pelvis.

A standing abdominal x-ray is used primarily to detect horizontal levels of fluid and gas in loops of the small intestine. With mechanical intestinal obstruction, the fluid levels in adjacent knees of the intestinal loop have different heights.

3. Special methods.

In acute abdominal pain, invasive and non-invasive examinations of the abdominal organs are often necessary.

a. Ultrasound Women with complaints of pain in the lower abdomen are shown transabdominal and transvaginal ultrasound of the small pelvis.

b. Puncture of the abdominal cavity through the posterior fornix of the vagina. It allows you to identify the nature of the liquid contents in the abdominal cavity (pus, serous effusion, blood). Indications for puncture are signs of the presence of free fluid (overhanging arches, dullness of percussion sound, pain when the neck is displaced). If the clinic of internal bleeding or rupture of the pyosalpinx is clear, and the patient's condition requires urgent surgical treatment, then puncture of the posterior fornix is ​​inappropriate, because its result cannot change the patient's management plan. A contraindication to puncture of the posterior fornix is ​​the filling of the recto-uterine cavity with a tumor. If no contents are obtained during the puncture, it is not considered diagnostically significant, since sometimes blood or effusion does not enter the uterus due to the adhesive process.

in. CT (computed tomography) - one of the best methods for diagnosing diseases of the abdominal cavity, retroperitoneal space and small pelvis. With all their

The advantages of the method are not without some disadvantages (high cost, high radiation exposure, allergic reactions to intravenous administration of contrast agents). CT should not replace physical examination or exploratory surgery.

d. Laparoscopy. It is resorted to with questionable results of physical and additional research methods. The study can be performed on a patient under local anesthesia, this is its main advantage over diagnostic laparotomy performed in the operating room. Diagnostic laparoscopy is indispensable in the examination of women with pain in the right iliac region. In this category of patients, up to 30% of appendectomies are erroneous. Laparoscopy can reduce the number of unnecessary surgical interventions and get the most complete picture of the state of the abdominal organs, in addition, laparoscopy can be the method of final surgical treatment.

d .Trial treatment. In some obscure cases of acute abdomen, a trial treatment with dynamic monitoring of the patient is justified. With gonorrheal pelvioperitonitis, acute salpingitis, usually within a few hours, the patient's condition progressively improves, which confirms the correctness of the diagnosis and the chosen method of treatment.

Thus, a methodical and consistent study of the anamnesis and an objective examination of the patient makes it possible to identify all the symptoms of the disease and choose the optimal method of therapy at all stages of observation.

Lead tactics.

If an acute gynecological disease of the abdominal organs is accompanied by collapse, the patient undergoes the following drug therapy: intramuscular injection of 1 ml of a 5% solution of ephedrine or 1 ml of a 1% solution of mezaton, intravenous reopoliglyukin, polyglucin, gelatinol, 5% glucose solution ( 400800 ml), cardiac agents are added to the infusion medium (1 ml of a 0.06% solution of korglucon or 0.3 ml of a 0.05% solution of strophanthin).

The use of painkillers in cases of "acute abdomen" at the prehospital stage is unacceptable! Before the operation, the surgeon should be able to assess the clinical picture, not distorted by the action of narcotic analgesics. But in some cases (for example, when the patient does not allow himself to be examined due to severe pain), the appointment of small doses of analgesics is acceptable in a hospital setting - to alleviate suffering, increase confidence in the doctor and, as a result, to conduct a more complete and sparing examination.

At the prehospital stage

1. Carefully collect anamnestic data and complaints.

2. By examination, palpation, percussion, auscultation of the abdomen and changing the position of the patient, identify symptoms characteristic of an "acute abdomen".

3. Perform a recto-vaginal-abdominal examination.

4. Exclude a somatic disease that simulates an acute pathology in the abdominal cavity (diabetes, renal failure, cirrhosis, hepatitis, intercostal neuralgia, pleurisy, pneumonia, etc.), as well as infectious diseases.

5. Explore respiratory and cardiovascular system.

In the hospital 1. To study and evaluate complaints, anamnesis, objective data.

2. Make a blood and urine test (laboratory tests in dynamics: blood count and leukocytosis, bilirubin, blood clotting, transaminase and alkaline phosphatase, urine diastase, etc.), analyze the smear for the flora and the degree of frequency of the vagina ..

3. Examine the state of the respiratory system, and if necessary, perform a chest x-ray.

4. Explore Function cardiovascular system (pulse, blood pressure, if necessary - ECG).

5. If a urological disease is suspected, it is necessary to make an overview picture of the kidneys, urography, chromocystoscopy, urine examination, bladder catheterization (if there is no damage to the urethra).

6. Measure rectal and axillary temperatures (an increase in this difference over 1 "indicates an inflammatory process in the abdominal cavity).

7. According to the indications, perform: laparoscopy, laparocentesis (abdominal puncture), separate diagnostic curettage, ultrasound, fluoroscopy and radiography of the abdominal cavity.

In doubtful cases or in the absence of the effect of conservative therapy, indications should be given for diagnostic laparotomy or laparoscopy, which may also be therapeutic.

Acute abdomen in gynecology (main causes and symptoms).

This is a syndrome that develops as a result of an acute pathology in the abdominal cavity and is manifested by sudden pain in any part of the abdomen, peritoneal symptoms and pronounced changes in the patient's condition.

Acute pain in the lower abdomen in women with severe peritoneal symptoms is possible with intra-abdominal bleeding (ectopic pregnancy, ovarian apoplexy; torsion of the ovarian cyst (cystoma); perforation of purulent tubo-ovarian formations; pelvioperitonitis).

Ectopic pregnancy- implantation and development of a fertilized egg outside the uterine cavity. Inflammatory diseases of the uterine appendages, violation of the functional state of the fallopian tubes and ovaries, sexual infantilism, increased activity of the trophoblast, etc. lead to this pathology.

Its most frequent type is pipe (98.5%). Other types of ectopic pregnancy are extremely rare - abdominal (0.4%), ovarian (0.2%). Ectopic pregnancy predominantly occurs at the age of 20-35 years, somewhat more often in the right tube. Termination of an ectopic tubal pregnancy, accompanied by bleeding, occurs at 4-6 weeks due to a violation of the integrity of the fetus.

The main task of the general practitioner is to suspect an ectopic pregnancy in a timely manner and urgently refer the patient to the gynecological or surgical department.

It is practically important to remember that sudden abdominal pain in a young woman, accompanied by signs of acute vascular insufficiency and signs of acute blood loss, are sufficient to diagnose an ectopic pregnancy.

The doctor providing emergency care should not administer painkillers, so as not to distort the clinical picture of the disease, should not prescribe cold or heat on the abdomen and a cleansing enema, so as not to cause increased bleeding.

I. Prehospital stage

The clinical picture of ectopic pregnancy is very complex and diverse. The emergency doctor most often has to deal with its acutely developing forms: internal and external rupture of the tube and tubal abortion.

A well-collected gynecological history is essential for making a correct diagnosis. When questioning, it is necessary to pay attention to the delay in menstruation, infantilism (late onset of menstruation - at 16-17 years old, their soreness and atypicality), past inflammatory diseases of the genital organs, abortions in the past, long intervals between pregnancies. Most often, a woman considers herself pregnant, but in some cases she denies pregnancy. Often a woman is disturbed by slight pains and bloody, dirty, foul-smelling discharge. The clinic of ectopic pregnancy most often develops among full health. There is a sharp paroxysmal cramping pain in the lower abdomen, radiating to the anus, lower back, lower limbs, sometimes the pain radiates to the corresponding shoulder girdle (phrenicus symptom). Often there is a short-term loss of consciousness, dizziness, fainting, nausea, vomiting, hiccups. Urination is usually delayed, but may be frequent. There are urges to defecate, sometimes there is diarrhea. Signs of internal bleeding come to the fore: a sharp pallor of the skin and visible mucous membranes, a pale face, a semi-conscious state, cold sweat, sunken facial features, an expression of fear in the eyes. Body temperature is usually normal, subfebrile or even low.

In the study of such patients, engorgement of the mammary glands is observed, with pressure, drops of colostrum are released from the nipples. Shortness of breath is noted. The pulse is frequent - 100 beats / min or more, small, weak filling, sometimes barely palpable or completely imperceptible. Arterial pressure (maximum and minimum) is reduced and progressively falls.

Palpation of the abdomen and vaginal examination in acute ectopic pregnancy should be carried out with extreme caution. Patients are often in a forced semi-sitting position. The abdomen is moderately swollen. The patient spares him when breathing. Percussion and palpation of the abdomen are sharply painful, especially on the side of the ruptured tube. There is a dullness of percussion sound in sloping areas of the abdomen, which is due to the presence of free blood in the abdominal cavity.

With a two-handed vaginal examination, a sharp soreness is determined at the entrance to the vagina and in the posterior fornix, which is supple and soft. In one of the arches, resistance is usually noted. The uterus is slightly enlarged. Vaginal discharge - spotting, bloody, dark in color.

If an ectopic pregnancy is detected or suspected, the patient should be urgently taken on a stretcher to the gynecological department of the hospital for surgical treatment. It is especially important to create conditions of complete rest during the transportation of the patient. Due to the variety of clinical forms (atypical and obliterated forms), the recognition of ectopic pregnancy is often a difficult task, so most patients are admitted to surgical departments with a diagnosis of "acute abdomen".

II. hospital

Great difficulties in recognizing an ectopic pregnancy occur when peritoneal phenomena predominate in the clinical picture. In the blood taken in the first hours after the attack, anemia is noted, on the part of white blood -

transient leukopenia and thrombocytopenia. ESR is increased with a large blood loss.

Gynecological examination helps to clarify the diagnosis. With an indistinct clinical picture, a puncture of the abdominal cavity through the posterior fornix of the vagina is indicated to establish the presence of free blood in the abdominal cavity.

AT In the diagnosis of ectopic pregnancy, laparoscopy is widely used, which allows you to detect blood in the abdominal cavity, hematosalpinx, hemorrhage in the ovary, as well as to provide the necessary amount of surgical care.

To clarify the diagnosis, it is also possible to use laparocentesis (abdominal puncture) to determine the blood in the abdominal cavity.

With a clear clinical picture and a threatening condition, the patient must be operated on an emergency basis, regardless of the severity of the condition (operative access, either laparoscopy or laparotomy). The fight against shock, blood loss should not delay the operation, but be carried out during the surgical intervention. Anesthesia is general.

After revision of the pelvic organs, the affected tube is found and most often a salpingectomy is performed. In the absence of contraindications, autotransfusion of blood from the abdominal cavity is required.

Discharge from the hospital with a favorable course of the postoperative period on the 7-8th day after the operation.

AT Depending on the place of implantation of the fetal egg, an ectopic pregnancy can be disrupted by the type of tubal abortion and rupture of the fallopian tube.

With a tubal abortion, the fetal egg, not having the appropriate conditions for development, exfoliates from the walls of the fallopian tube and is expelled into the abdominal cavity. Due to the rhythmic contraction of the fallopian tube, blood enters the abdominal cavity periodically.

When the fallopian tube ruptures as a result of an ectopic pregnancy, the villi of the fetal egg completely destroy the thin wall of the fallopian tube, and blood from the damaged vessels flows into the abdominal cavity. Bleeding is usually massive, so signs of intra-abdominal bleeding predominate in the clinical picture of fallopian tube rupture. Rupture of the fallopian tube, as a rule, occurs suddenly against the background of absolute health, with a delay in menstruation by an average of three to four weeks.

Sudden and severe pain in the lower abdomen radiates to the rectum and is accompanied by dizziness, weakness, pallor, fainting. The abdomen participates in the act of breathing to a limited extent, is painful on palpation and percussion, the symptoms of peritoneal irritation are positive, with percussion in sloping places there is dullness. With continued bleeding, signs of hemorrhagic shock and posthemorrhagic anemia come to the fore.

Differential diagnosis is carried out with acute pancreatitis, perforated gastric and duodenal ulcer, acute appendicitis, torsion of the ovarian cyst, etc. Diagnostically important is an indication of delayed menstruation, subjective signs of pregnancy, bloody discharge from the genital tract.

Patients with an ectopic pregnancy need emergency care in a gynecological hospital; in case of diagnostic doubt, hospitalization in a multidisciplinary hospital is indicated. . Signs of intra-abdominal

bleeding requires immediate replenishment of the BCC with any available blood-substituting solution, preferably dextrans, starch preparations. The infusion is continued until the patient is admitted to the hospital.

Ovarian apoplexy(rupture of the ovary, ovarian infarction, ovarian hematoma) - an acute violation of the integrity of the ovary with hemorrhage in its stroma and subsequent bleeding into the abdominal cavity. Ovarian apoplexy occurs more often in women of reproductive age, but also occurs in adolescents. Rupture of the ovary occurs due to congestive hyperemia, varicose, dilated veins or sclerotic vessels, as well as sclerotic changes in the stroma. Bleeding from the ovary is preceded by the formation of a hematoma, which causes severe pain due to an increase in intra-ovarian pressure, followed by rupture of the ovarian tissue.

An important role belongs to dysfunctions of the autonomic and endocrine systems, which leads to an increase in the secretion of luteinizing hormone from the pituitary gland. Apoplexy often occurs during the period of ovulation, as well as in the stage of vascularization and flowering of the corpus luteum.

Ovarian apoplexy is accompanied by intra-abdominal bleeding and pain. According to the predominance of one of them, anemic and painful forms of the disease are conditionally distinguished. It begins acutely, with sudden pain in the lower abdomen, mainly on the side of the lesion. In the painful form, on examination, pain in the lower abdomen is determined, symptoms of peritoneal irritation are mild. In this situation, differential diagnosis with acute appendicitis is necessary. With an anemic form, all signs of intra-abdominal bleeding come to the fore.

Unlike an ectopic pregnancy, with a rupture of the ovary, there are no indications of a delay in menstruation, signs of pregnancy, or spotting from the genital tract. With ovarian apoplexy, hospitalization in a multidisciplinary hospital is necessary. With signs of intra-abdominal bleeding, immediate administration of blood-substituting solutions is required.

Torsion of the legs of a cyst (cystoma) of the ovary- complication of an existing cyst or ovarian cystoma. The onset of the disease is often associated with a sharp change in body position, an increase in intra-abdominal pressure as a result of strong straining, prolonged coughing, hard physical work, as well as a violation of the blood supply to the cyst. Torsion can occur acutely or develop gradually, with a violation of the blood supply with swelling of the cyst, hemorrhage and necrosis of the parenchyma. There are partial (gradual) and complete (sudden) torsion.

With partial torsion, the pedicle changes its position by 90-180°, arterial blood flow is preserved, but venous outflow is difficult due to vascular compression, resulting in venous plethora and swelling of the cyst wall. With complete torsion (up to 360°), arterial blood flow stops, which causes necrobiotic processes in the ovarian cyst and the appearance of peritoneal symptoms, and when the cyst becomes infected, peritonitis. Pain in the lower abdomen from the side of education can be gradually increasing or acute. Nausea, vomiting, flatulence, intestinal paresis, tension of the anterior abdominal wall, symptoms of peritoneal irritation are possible. Differential diagnosis is carried out with acute appendicitis and disturbed ectopic pregnancy. Urgent

hospitalization. At the prehospital stage, treatment is not carried out.

Perforation of purulent formations of the uterine appendages

Inflammatory diseases of the female genital organs occupy a leading place in gynecological practice and remain the most common cause of hospitalization in women of reproductive age. Inflammatory diseases go through several stages, from acute inflammation to complex destructive tissue changes. The main mechanism for the development of inflammation is microbial invasion. At the same time, in the etiology of the purulent process, provocative factors occupy a significant, and sometimes leading place. This is a physiological (menstruation, childbirth) or iatrogenic (abortion, intrauterine contraceptives, surgery, hysteroscopy, in vitro fertilization) weakening or change in the barrier properties of the uterus and genital tract, contributing to the formation of an entrance gate for pathogenic microflora and its further spread. Infection occurs by intracanalicular, ascending, hematogenous and lymphogenous routes.

The clinical picture of inflammatory diseases of the female genital organs, in particular the uterine appendages, is now often erased, oligosymptomatic. Pyosalpinx, tubo-ovarian abscess cause constant pain in the lower abdomen, mainly from inflammation, chills, high fever, weakness, malaise. Pain radiates to the lower extremities, lumbar region. The abdomen is soft, may be moderately swollen. Patients have tachycardia. There are no symptoms of peritoneal irritation, nausea, stool retention, gases are possible.

A purulent discharge sometimes appears from the genital tract.

With perforation of purulent formations, already in the first hours, mild symptoms of peritonitis appear, which are superimposed on the clinic of a severe inflammatory process. Pain is intense, sometimes aching, indistinct localization. Chills, fever, tachycardia accompany this stage of the disease. Painful urination, loose stools, and bloating are often noted.

At the prehospital stage, the introduction of analgesics is strictly unacceptable.

Broad-spectrum and long-acting antibiotics are used. Antibiotics should have cross-effectiveness in gynecological, urological, general surgical and other diseases). For example, ceftriaxone 1-2 g IV or IM in combination with metronidazole 100 ml IV drip and amoxicillin 2.4 g IV in combination with metronidazole 100 ml IV are eligible. . required hospitalization and

the main treatment is carried out in a hospital.

Pelvic peritonitis (pelvioperitonitis).

There are primary and secondary pelvioperitonitis. Primary occurs as a result of damage to the peritoneum by microbes that have penetrated hematogenous, lymphogenous or through the fallopian tubes. Secondary peritonitis is much more common and is the result of the spread of the inflammatory process from the organs, as a result of their perforation or inflammation.

Gynecological diseases are most often characterized by local limited pelvic peritonitis. However, with insufficient defense mechanisms, with high virulence of the microflora, with inadequate treatment, inflammation of the peritoneum progresses and diffuse peritonitis occurs. With pelvic peritonitis, against the background of predisposing moments, there are constant increasing pain, malaise, fever, chills, tachycardia, nausea, shortness of breath, dry and

Bimanual gynecological examination occupies a central place in the assessment of the condition of the ovaries. Symptoms arising from physiological or pathological processes in the ovaries usually correspond to the findings of a physical examination. Some ovarian diseases are asymptomatic, so physical examination data may be the only information at the first stage of the examination.

For the correct interpretations results of the study, it is necessary to know the palpation characteristics of the ovaries at different periods of life.

AT premenstrual age ovaries should not be palpable. If they can be felt, their pathology should be assumed and further in-depth examination should be carried out.

AT reproductive age normal ovaries are palpable in about half of women. The most important characteristics are: size, shape, consistency (solid or cystic) and mobility. In women of reproductive age taking oral contraceptives, the ovaries are less frequently palpated, smaller and more symmetrical than in women not using these means.

In female patients in postmenopausal age, the ovaries are functionally inactive except for the production of a small amount of androgens. The ovaries no longer respond to gonadotropic stimulation and therefore their superficial follicular activity gradually decreases, ending in most cases within three years of the onset of natural menopause. Women close to the onset of natural menopause are more likely to have residual functional cysts. In general, palpable ovarian enlargement in the postmenopausal period requires more critical evaluation than in younger women, since this age group has a higher incidence of ovarian malignancies.

Approximately 1/4 of all ovarian tumors in the postmenopausal period are malignant, while in reproductive age only 10% of tumors are malignant. In the past, the risk was considered so great that the detection of any enlargement of the ovary in the postmenopausal period (the so-called palpable postmenopausal ovary syndrome) served as an indication for surgical intervention. The advent of more sensitive diagnostic pelvic imaging modalities has changed routine tactics. Mandatory removal of minimally enlarged postmenopausal ovaries is no longer recommended.

If the patient has a natural menopause lasts 3 to years and transvaginal ultrasound reveals the presence of a simple single-chamber cyst less than 5 cm in diameter, further management of such a patient may consist of repeated ultrasound examinations (including transvaginal) to monitor the condition of the cyst. Masses that are larger or have a complex ultrasound structure are best treated surgically.

Functional ovarian cysts- These are not tumors, but rather normal anatomical variants resulting from the normal activity of the ovaries. They may occur as asymptomatic adnexal masses or be accompanied by symptoms that require further investigation and possibly specific treatment.

When ovarian follicle does not rupture at the end of its maturation, ovulation does not occur and a follicular cyst may occur. The consequence of this will be the lengthening of the follicular phase of the cycle and, as a result, secondary amenorrhea. Follicular cysts are lined internally with normal granulosa cells and contain estrogen-rich fluid.

Follicular cyst becomes clinically significant when it is large enough to cause pain, or when it persists for more than one menstrual period. It is not entirely clear why the granulosa cells lining the follicular cysts persist beyond the time when ovulation is due and continue to function during the second half of the cycle. The cyst may enlarge, reaching a diameter of 5 cm or more, and continues to fill with estrogen-rich follicular fluid coming from the thickened layer of phanular cells. Symptoms caused by a follicular cyst may present with mild to moderate unilateral pain in the lower abdomen and changes in the pattern of the menstrual cycle.

The latter may be the result of both a failed follow-up ovulation. and an excess amount of estradiol produced inside the follicle. Excessive estrogen saturation of the body in the absence of ovulation hyperstimulates the endometrium and causes irregular bleeding. A bimanual gynecological examination may reveal a unilateral painful mobile cystic adnexal mass.

Having received such data during the primary survey. the doctor must decide whether to undertake further in-depth examination and decide on treatment. Ultrasound of the pelvic organs is recommended for patients of reproductive age with a cyst size of more than 5 cm in diameter. This study reveals a single-chambered simple cyst with no signs of blood or soft tissue elements inside and no signs of growths outside. Most patients do not require ultrasound confirmation. Instead, the woman should be reassured and reassessed in 6 to 8 weeks.

Pain in the abdomen on palpation.

Good afternoon. Age 30 years old, weight 52 kg. Approximately 4 months of pain in the lower abdomen, as if inflammation of the ovaries, and sometimes on the right under the navel. She was checked in gynecology, did an ultrasound of all the internal organs, no pathologies were found. I began to suspect the intestines, as during palpation in certain places (to the right of the navel and a little higher along the intestinal line) severe pain, though, if you do not touch, there is no pain in those places, only when pressed, I checked with the gynecologist again, the doctor On a manual examination, she said that the intestines give such pains, as she felt the painful areas of the intestine. The therapist referred me to a proctologist. did a colonoscopy

The colon was examined up to the splenic angle, the tone was normal. The rectum is hyperemic, the vascular pattern is clear. External and internal hemorrhoids are noted, in the anal canal a polyp 0.4 cm in diameter. Conclusion — moderately pronounced proctosigmoiditis. Chronic hemorrhoids. They prescribed omez, flax to drink and a diet for a month. Nothing helped.

I passed the analysis of feces: leukocytes 0-1-2vp.z, undigested fiber - in large quantities, muscle fibers 1-2-3 in p.z. everything else is normal.

For dysbacteriosis:

Everything is normal, except for lactobacilli 0 v10^5 and fungi of the genus Candida 10^4.

Blood test in the app. The doctor did not prescribe anything except lactobacilli. I would be very grateful at least for a hint on what else to check, who to contact. Thanks in advance.

P.S. Periodically, pains in the lower abdomen began to be observed three months after the birth (child 1.4 years old), but periodically. and now almost always. Thank you.

Pain and its causes in alphabetical order:

pain in the ovaries

The ovary is a steamy female gonad, the site of the formation of maturation of eggs and the production of hormones that regulate the sex life of women. The anatomical structure, reactions to hormonal stimulation and secretory activity of the ovaries in different periods of life are not the same. In this chapter, the normal physiology of the ovaries is considered as the basis for understanding the pathology of both the ovaries themselves and other organs of the female reproductive system.

What diseases cause pain in the ovarian region:

Causes of pain in the ovarian region:

- Pain in the ovarian region may indicate the presence of an inflammatory process in the ovarian appendages (oophoritis). It is the most characteristic sign of this disease, is localized in the lower abdomen and often radiates to the lumbosacral spine. As a rule, pain in the ovarian region occurs paroxysmal, but may be present and permanent. Hypothermia, physical and mental overwork, decreased immunity against the background of other internal diseases contribute to their emergence and intensification. Such pains are often accompanied by disturbances in the functioning of the nervous system - increased irritability, weakness, problems with sleep, and decreased ability to work.

- Adnexitis, or inflammation of the ovaries. The most common causative agents of inflammatory processes of the internal genital organs, which lead to inflammation of the ovaries (adnexitis) are chlamydia, mycoplasma, ureaplasma, candida. The clinic of chlamydial infection has no characteristic manifestations. Without adequate therapy, the inflammatory process in inflammation of the ovaries (adnexitis) takes a protracted course and leads to infertility. The main symptom of inflammation of the ovaries (adnexitis) is pain in the ovaries and lower abdomen. The pain can radiate to the lower back, and periodic pains almost always predominate. Treatment of inflammation of the ovaries is carried out within 5 days.

- In some cases, pain in the ovarian region occurs when a cyst forms. Until the cystic capsule is small and does not undergo negative changes, this pathology is asymptomatic.

- The cause of constant pain in the ovarian region is a cyst or tumor of the ovary, which has reached a large size. It compresses neighboring internal organs and nerve endings. Not only neoplasms can twist, but also the ovaries themselves. This leads to impaired blood supply and tissue necrosis, inflammation and pain develop.

- Pain in the ovarian region occurs when the pedicle of the cyst is twisted or as a result of a violation of its integrity, which is accompanied by the outflow of liquid contents into the abdominal cavity and causes tissue irritation. In addition to nausea, vomiting and pain, rupture of an ovarian cyst or necrosis of its tissue due to torsion of the leg can provoke inflammation of the peritoneum - peritonitis, which requires immediate surgical intervention. A similar situation can be observed in the presence of a benign or malignant tumor of the ovary.

- Pathological changes in the position of the ovarian appendages are facilitated by their relative mobility in the pelvic cavity, as well as increased physical activity. That is why this pathology is observed, as a rule, in childhood. Among the factors contributing to ovarian torsion, it should be noted drug stimulation of ovulation, pregnancy, as well as any conditions accompanied by an increase in the size of the ovaries. Sharp pain in the ovaries and abdomen may be accompanied by vomiting, palpation reveals a painful swelling. If the tissue of the appendages has undergone irreversible pathological changes, surgical removal of the ovary is performed.

“Sometimes during ovulation, an ovary ruptures, causing bleeding. The ingress of blood into the abdominal cavity provokes pain and threatens with the development of peritonitis, therefore, surgical intervention is indicated, during which sutures are applied and the integrity of the organ is restored. In some women, ovulation itself is quite painful, as indicated by the appearance of pain in the ovarian region on certain days of the menstrual cycle. In addition, acute and chronic inflammatory processes contribute to the formation of adhesions in the ovaries, which in turn often cause pain in the ovarian region.

- Ovarian apoplexy is a sudden hemorrhage in the ovary, which is accompanied by its rupture and bleeding into the abdominal cavity.

Ovarian apoplexy occurs, as a rule, in women under the age of 40, more often in the right ovary, while bleeding and pain in the ovarian region always occur. According to the predominance of one of these signs, anemic and painful forms of the disease are conventionally distinguished. With the same severity of these signs, they speak of a mixed form of apoplexy.

The disease begins acutely with sudden, sometimes very severe pain in the ovaries and lower abdomen, with a predominance on the side of the affected ovary. Pain is often given to the rectum, thigh and lower back. Often the attack is accompanied by nausea and vomiting, as well as fainting.

Body temperature remains normal. With heavy bleeding, a sharp decrease in blood pressure and collapse occurs (a serious condition with severe cardiac weakness, a drop in vascular tone, frequent pulse, and cold sweat). The ovary, when palpated, has a spherical shape and sharp pain.

- Ovulatory pain in the ovarian region occurs in the lower abdomen during the periovulatory period as a result of irritation of the peritoneum with follicular fluid; last from 12 to 36 hours with separate attacks for several hours.

- Ovarian hyperstimulation syndrome can develop in women with infertility when treated with hormones (clomiphene, gonadotropins). The ovaries are enlarged, with multiple follicular cysts, a large cystic corpus luteum, and stromal edema. With a mild form, there are pains in the ovarian region, bloating; weight gain. In severe form, shortness of breath, ascites, pleural effusion, electrolyte imbalance, hypovolemia, oliguria appear.

- Psychogenic factors: with the exclusion of organic causes of pain in the ovaries, it is necessary to examine the woman by a psychotherapist (borderline conditions: hypochondria, depression, hysteria).

- To establish the presence of a large neoplasm of the ovary, palpation of the abdomen and gynecological examination helps. Important information about the condition of the uterine appendages is provided by ultrasound of the pelvic organs and magnetic resonance imaging. Especially valuable is the diagnostic laparoscopy, which allows to identify the adhesive process and foci of endometriosis, localized in the ovaries. Through this technique, you can not only detect, but also eliminate many pathologies of the pelvic organs. Proper diagnosis is the key to effective treatment, which will permanently get rid of pain in the ovaries.

Which doctor should I contact if there is pain in the ovarian region:

Ovarian cancer symptoms and signs | How to identify ovarian cancer

One of the most common female cancers in the world is this disease. In the countries of the former CIS, ovarian cancer does not predominate among oncological diseases, but still remains a common problem. The main problem of the disease is the difficulty of diagnosing even with the help of medical means.

Symptoms of ovarian cancer

This disease, like other female oncologies, rarely causes vivid symptoms. Most often, signs of ovarian cancer and the main manifestations of the disease do not appear until the development of a dangerous stage of the disease. Most often, the symptoms of the disease appear six months or even a year after the onset of the development of the pathogenic process.

Most often, all manifestations of cancer are not caused by tissue destruction, but by the pressure of the tumor on the ovary from the inside or from the side - it all depends on the place of its deployment. However, if the symptoms have already begun, then they will go on increasing. The following signs of the disease in women of different ages are possible.

First, spasmodic pains in the abdomen begin to appear. The pains are not strong, but the sensations are atypical and new. Painful signs of ovarian cancer are not like menstrual pain.

Then pain in the lower abdomen, in the pelvis, in the lower back may begin. They are provoked by the inflammatory process. These pains can be akin to pain during menstruation, but they will only haunt the patient for the whole month. Note that women who suffer from this problem are at a potential risk group for ovarian cancer. So, physical atypical sensations may appear at an early stage, they may not appear until the development of the third stage of cancer.

In parallel with the physical manifestations, there may be a violation of menstruation, weight loss may begin, or vice versa, its growth for no reason, such a reaction can be caused by a hormonal imbalance, which is highly dependent on the ovaries. The presence of spotting bleeding, especially in women after menopause, is always a sign of problems in the reproductive system. This manifestation of the disease should be paid attention first of all.

Bleeding and pain during sports or during sexual intercourse, this is another indication of a malfunction of the ovaries. Physical activity, heaviness, sexual contact - all this can provoke such a symptom of ovarian cancer as bleeding.

Almost always, ovarian cancer provokes the formation of mucous and / or purulent discharge. This is due to the destruction of the lymphatic vessels. Allocations will be uncharacteristic, do not ignore them. Mucous discharge with an unpleasant odor, odorless, with blood, and no color at all. All this can be a sign of cancer and a reaction to inflammatory and destructive processes.

There may be loss of appetite, nausea, a feeling of rejection of food and drink. Due to the refusal of food, weakness and loss of strength appear. In this case, the forces will decrease exponentially.

With the development of the disease, spasmodic pains in the lower abdomen, in the lower back, in the peritoneum will appear.

Ascites as a sign of ovarian cancer

By its nature, ascites is the release of fluid into the peritoneal cavity, which causes inflammation, abscess, necrotic processes and death. What causes ascites in ovarian cancer, and what are the methods of primary diagnosis of the problem?

Ascites causes an increase in tumor formations due to fluid. Fluid occurs due to the destruction of the lymphatic vessels. Partly it remains inside the ovary and the tumor, which threatens to rupture the ovary, partly it simply enters the abdominal cavity.

In the abdominal cavity, the presence of fluid up to 140 ml is not diagnosed by external methods of observation. In large volumes, the doctor finds liquid during palpation and examination. Ascites can be indicated by asymmetrically protruding parts of the peritoneum. A sharp increase in the volume of the patient's abdomen.

Ascites in ovarian cancer can cause severe swelling of the lower abdomen, legs, and genitals. As a rule, edema cannot be ignored and doctors begin prompt action.

Ascites in ovarian cancer can be painless, or it can cause severe pain. In this case, the patient can be pulled into the “embryo” position, as with appendicitis. The pain syndrome is strong, and it is often relieved by the use of drugs to remove fluid from the peritoneum.

The fluid obtained from the peritoneum with ascites is analyzed for composition and the presence of pathogenic flora. Depending on the results, the direction for the treatment of the problem is chosen. Given the fact that this problem can cause the death of the patient, it is treated with great attention.

Specific manifestations of ovarian cancer

Also, ovarian problems can affect the excretory system. Signs of cancer may include diarrhea, constipation, frequent urination, or problems with normal urination.

Flatulence and bloating can also be caused by a problem in the ovaries.

In addition, atypical enlargement of the abdomen, asymmetrical enlargement of the abdomen, bad signs. If a swelling appears on the abdomen that you feel with your hands, then this also clearly indicates the development of a problem in the peritoneal cavity.

As you can see, there are quite a few signs of the disease. The problem is that many do not connect these manifestations with each other, while others attribute them to endometriosis or other chronic diseases.

Why are the symptoms of the disease subtle? The reason is due to the location of the cancerous tumor. In most cases, it is located inside the ovary, which makes it simply invisible in the first, and sometimes in the second stage of the problem. However, if a woman is attentive and knows how to monitor her body, then she will be able to determine ovarian cancer. The tumor will provoke some reactions that only the carrier can notice.

How to identify ovarian cancer yourself?

The most terrible thing in female oncology is diagnostic problems. The fact is that these problems do not have external manifestations in the early stages of development. Because of this circumstance, women are strongly recommended to be diagnosed with ovarian cancer by a doctor and do tests for cellular changes every six months. In this case, the cancer will be detected at a stage accessible for effective treatment.

Unfortunately, the Pap test does not detect ovarian cancer. In order to determine ovarian cancer, a deeper diagnosis is needed. It is worth knowing about the features of the diagnosis in advance. This will help the woman avoid problems in the future. Moreover, it will not be superfluous, after reading the article, to talk with your doctor so that he can suggest options for those methods for diagnosing ovarian cancer that are available to him. Perhaps you will be more comfortable using them.

The most correct thing is to do a CA-125 blood test. This test detects tumors on the ovaries. Unfortunately, even he cannot say about the good quality of the tumor. In addition, there are a number of physiological factors that can bring down the accuracy of the analysis. Therefore, it is proposed to use it in case of suspicion and in combination with other studies.

As an addition to the blood test, a transvaginal ultrasound can be used. This diagnostic method allows you to diagnose changes in the size of the ovaries and identify the problem, in the case of atypical bulges, the formation of growths on the outside of the ovary, and so on.

Rectovaginal examination can also be used in the diagnosis of ovarian cancer. However, the doctor must have the skills of this procedure in order to be able to identify the beginnings of the problem.

Diagnosis at an early stage makes it possible to save a woman's life, health and appendages. And this is extremely important, because the treatment of the disease is difficult and complex.

Diagnosis of an ovarian tumor

Manifestations of the disease are characterized by the appearance of pain in the lower abdomen, disorders in the gastrointestinal tract and urinary system. Diagnostic signs of the disease are as follows.

Ovarian apoplexy is one of the gynecological diseases that cause the appearance of a clinical picture of an acute abdomen. This dangerous pathology in the absence of timely medical care can lead to very serious complications. However, the occurrence of pain in the lower abdomen is not a rare symptom. Almost all women from time to time experience pain in this area associated with certain phases of the menstrual cycle. But ovarian apoplexy is exactly the disease in which it is worth paying attention to pain and seeking qualified medical help as early as possible. Knowing the symptoms of ovarian apoplexy helps to diagnose this pathology in a timely manner.

Diagnostic methods and symptoms of ovarian apoplexy

The main clinical symptom of ovarian apoplexy, as well as other gynecological diseases that cause the clinical picture of an acute abdomen, is sudden pain in the lower abdomen. The occurrence of pain in this case is explained by irritation of the receptor field of the ovarian tissue, the effect of the outflow of blood on the peritoneum, as well as spasm in the basin of the ovarian artery. In addition to the pain syndrome with apoplexy, a woman is worried about weakness, nausea and vomiting, dizziness and fainting. But depending on the form of pathology, the clinical picture of ovarian apoplexy may differ somewhat.

Symptoms of ovarian apoplexy:

• symptoms of ovarian apoplexy in pain form;
• symptoms of ovarian apoplexy in hemorrhagic form;
• main methods for diagnosing ovarian apoplexy.

Symptoms of ovarian apoplexy in pain form

The painful form of ovarian apoplexy is observed when a hemorrhage occurs directly into the tissue of the follicle or corpus luteum. There is no bleeding into the abdominal cavity. With this form of the disease, the main symptom of ovarian apoplexy is pain in the lower abdomen, which does not radiate, and may be accompanied by nausea and vomiting. There are no signs of bleeding into the abdominal cavity. When examining the patient, the color of the skin and mucous membranes remains normal, the pulse and blood pressure do not change. Palpation marked pain in the iliac region on the right. On gynecological examination, the uterus is of normal size, the affected ovary may be slightly enlarged and painful on palpation.

Symptoms of ovarian apoplexy in hemorrhagic form

The mild hemorrhagic form of ovarian tissue rupture is clinically very similar to the pain form, but in moderate and severe forms, the symptoms of ovarian apoplexy are somewhat different, since they are associated with intra-abdominal bleeding. The pain syndrome occurs acutely, often appears during physical exertion or sexual intercourse, radiates to the rectum, leg, lower back and external genitalia. The patient is also concerned about weakness, dizziness, nausea and vomiting. The patient's skin and mucous membranes are pale, and cold clammy sweat may occur. Blood pressure is reduced, tachycardia occurs, which is explained by blood loss. Palpation is determined by a sharp pain in the iliac region, with a bimanual gynecological examination on the side of apoplexy, a painful, somewhat enlarged ovary is palpated.

The main methods for diagnosing ovarian apoplexy

For the diagnosis of ovarian apoplexy, the following laboratory and instrumental research methods are used:

• general blood test: moderate leukocytosis in pain form, decrease in hemoglobin level, leukocytosis in hemorrhagic form;
• ultrasound examination: a small amount of hypoechoic fluid with a fine suspension in the Douglas space in case of pain, a significant amount of finely and medium-dispersed fluid in the abdominal cavity, with irregularly shaped hyperechoic structures in hemorrhagic form of ovarian apoplexy;
• laparoscopic examination: ovulation stigma is observed - a small spot raised above the surface of the ovary with signs of bleeding, in the form of a cyst of the corpus luteum or the corpus luteum itself with a rupture or defect.