Patient's question:
What are the symptoms of pelvic inflammatory disease and endometritis respectively?Doctor's answer:
Disease Analysis: Endometritis is a type of pelvic inflammatory disease (PID). Pelvic Inflammatory Disease (PID): Acute Pelvic Inflammatory Disease (PID) refers to acute inflammation of the female internal reproductive organs and surrounding connective tissues, as well as the pelvic peritoneum. It can be localized to one area or affect multiple areas simultaneously. The common pathogens include Staphylococcus, Streptococcus, Escherichia coli, anaerobic bacteria, and sexually transmitted pathogens such as Neisseria gonorrhoeae, Mycoplasma, and Chlamydia. It spreads to the pelvic area through lymphatic channels, bloodstream, or direct extension. Common conditions include acute endometritis, myometritis, salpingitis, tubo-ovarian abscess, pelvic connective tissue inflammation, and pelvic peritonitis. Severe cases may lead to sepsis and bacteremia. If not promptly controlled, it can result in septic shock or even death. In Traditional Chinese Medicine (TCM), this condition is referred to as "women's abdominal pain," "heat entering the blood chamber," "postpartum fever," "leukorrhea," or "tumor and hardening."Clinical Manifestations: The typical symptoms are fever, lower abdominal pain that is resistant to pressure, excessive purulent leukorrhea. It may be accompanied by fatigue, lower back pain, and menstrual disorders. In severe cases, high fever, chills, headache, and anorexia may occur. If peritonitis is present, symptoms such as nausea, vomiting, and abdominal distension may appear. If an abscess forms, it may cause urinary symptoms (e.g., frequent urination, urgency, dysuria) if located anteriorly, or rectal symptoms (e.g., tenesmus, rectal fullness, diarrhea, and difficulty defecating) if located posteriorly. When sepsis occurs, it is often accompanied by abscesses in other parts of the body.
Chronic Pelvic Inflammatory Disease: Systemic symptoms are often mild, with occasional low-grade fever and increased fatigue. The course of the disease is prolonged, and some patients may experience neurotic symptoms.
[Physical Examination] Scarring and adhesions caused by chronic inflammation, along with pelvic congestion, can lead to lower abdominal heaviness, pain, and lower back soreness, often worsening during exertion, sexual intercourse, or around menstruation.
Advice: Endometritis: Clinical Presentation: The onset is relatively acute, with chills or even rigors, fever (38–40°C), rapid pulse, general weakness, sweating, severe lower abdominal pain, and a sense of heaviness. There is a large amount of bloody, purulent, or watery leukorrhea with a foul odor. Postpartum infection may result in lochia with a muddy appearance.
Physical Examination: The lower abdomen is tender upon palpation. Speculum examination reveals copious purulent or foul-smelling, bloody discharge from the cervical os. Bimanual examination shows cervical motion tenderness. The uterus is enlarged due to congestion and edema, feels soft, and is tender to touch. Laboratory tests show an elevated total white blood cell count and neutrophilia.
Symptoms:
(1) The patient may have mild fever, lower abdominal heaviness, and persistent pain.
(2) Leukorrhea significantly increases, may be purulent with a foul odor, or may appear bloody. Acute endometritis during the postpartum period often has prolonged lochia with a foul odor, usually due to Escherichia coli or anaerobic bacterial infection. If caused by hemolytic Streptococcus or Staphylococcus aureus, the lochia is typically less abundant and has no obvious odor but can easily spread through the lymphatic system.
(3) Gynecological examination reveals purulent leukorrhea at the cervical os, cervical motion tenderness, and mild tenderness of the uterus. Laboratory tests show elevated white blood cell count and neutrophilia.