Special gynecology

General aspects of inflammatory diseases

Inflammatory diseases of the female genital organs require a comprehensive approach to study. First of all, it is necessary to determine the etiological factor—the main pathogens triggering the pathological process. The classification of these diseases is based on two key criteria: the localization of the lesion and the features of the clinical course.

Special attention is paid to pathogenesis. The physician must clearly understand the pathways of infection spread in the patient's body, as well as know the factors that contribute to the generalization of the process in the genital tract. It is equally important to consider natural defense mechanisms—barriers that prevent the entry and further progression of pathogens.

Nosological forms of infections

For successful clinical practice, it is necessary to analyze in detail the etiology, pathogenesis, symptoms, diagnostic methods, and principles of therapy for each specific pathology. Infectious lesions are traditionally divided into several levels:

• Lower genital tract infections: include bacterial vaginosis, vulvovaginal candidiasis, and trichomonal vaginitis.
• Inflammation of internal organs (pelvic inflammatory disease): requires a comprehensive study of inflammatory processes affecting the uterus and its appendages.
• Specific infections (STIs): primarily gonorrhea and genital chlamydia.

Acute abdomen syndrome and differential diagnosis

Acute abdomen syndrome is a collective term requiring emergency medical tactics. Gynecological pathologies causing this condition include ectopic pregnancy, ovarian apoplexy, ovarian cyst torsion or rupture, as well as acute pelvic inflammatory disease (PID).

To make an accurate diagnosis, the gynecologist must perform a differential diagnosis with other groups of causes according to the general surgical classification:

1. Acute abdominal inflammation: appendicitis, diverticulitis, cholecystitis (may be complicated by cholangitis, gallbladder empyema, and peritonitis with increasing fever and intoxication), pancreatitis (characterized by girdle pain, signs of peritoneal irritation, and weakened bowel sounds).
2. Hollow organ perforation: perforation of a gastric or duodenal ulcer, diverticulum, or bowel tumor.
3. Intestinal obstruction: mechanical (obstructive, strangulated) and dynamic (paralytic, spastic).
4. Intra-abdominal hemorrhage: ruptures of the liver or spleen in trauma, ruptured aortic aneurysm.
5. Impaired mesenteric circulation: thrombosis, mesenteric vessel embolism, acute ischemia.
6. Urological pathology: renal colic, acute urinary retention with bladder overdistension, testicular torsion in males.
7. Pseudo-abdominal syndrome (extra-abdominal causes): gastralgic myocardial infarction, basal pneumonia, pleurisy, diabetic ketoacidosis, porphyria, acute adrenal insufficiency.

Rubella in obstetrician-gynecologist practice

Rubella is a widespread viral infection transmitted via airborne droplets. Although it is most typical for children and young adults, it is of critical importance in obstetrics and gynecology. The main threat to women of childbearing age is the high risk of vertical transmission of the infection, which inevitably leads to severe congenital fetal pathology.

There are two main forms of the disease: acquired and congenital. The epidemiological pattern is currently changing thanks to preventive vaccination. However, the clinical presentation of acquired rubella is diverse, and about 50% of cases in adult patients occur in mild (atypical) forms. This tremendously complicates timely diagnosis and the identification of specific complications, such as central nervous system lesions.

Practical physician skills

When managing patients with infectious and urgent pathologies, a specialist must master a number of practical skills. These include targeted collection of complaints, medical history, and epidemiological history, as well as a thorough physical and objective examination.

The physician must be able to identify leading syndromes (for example, in rubella these are lymphadenopathy, exanthema, oropharyngeal catarrhal changes, scleritis, and intoxication syndrome), assess the severity of the condition, and perform a differential diagnosis with other exanthematous infections. A crucial stage is justifying the appointment of laboratory tests (with special attention to examining pregnant women), making a diagnosis based on a clinical algorithm, prescribing adequate therapy, and determining indications for hospitalization or discharge.

Class and exam questions

What else to study on this topic

• Etiology and pathogenesis of inflammatory diseases of the internal genital organs (pelvic inflammatory disease).
• Clinical presentation and diagnostic methods for gonorrhea and genital chlamydia.
• Factors preventing and promoting the spread of infection in the genital tract.
• Differential diagnosis of rubella with other exanthematous infections.
• Laboratory diagnosis of viral infections in pregnant women.

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Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.