Question

CASE STUDY: PELVIC PAIN An 18-year-old woman presents to the emergency department with severe abdominal pain, which has been progressive over the last 3 days. Her menstrual period was due about the time her symptoms started. She admits to being sexually active with several partners in the past 2 months with inconsistent use of birth control 1. What are signs of inflammation given in the patient's history? 2. Which cardinal signs of inflammation can you see in the above images? 3. What chemical mediators are responsible for increasing the blood flow to an area of inflammation? 4. Compare the normal and abnormal fallopian tubes below. Physical examination reveals severe tendemess to palpation over the right lower abdomen and pelvic ares Speculum examination reveals a purulent vaginal discharge. She is febrile (39-C) at time of examination. Her CBC is significant for a WBC count of 15,000 L with 82% polymorphonuclear neutrophis (PMN) and 0% bands. Urine b is negative. Normal fallopian tube Inflamed tube Uterus, bilateral fallopian tubes, and ovaries The fallopian tubes are hemorrhagic and edematous. The right fallopian tube and ovary are a single, irregular inflamed mass. The left ovary and fallopian tube are normal. Uterus 5. Does this patient have leukocytosis? Explain your answer 6. Why does this patient have leukocytosis? 7. What steps are involved in the exit of neutrophils from the blood into the tissues? 8. Under high power, the fallopian tubes contain a collection of neutrophils and necrotic debris. What is t this collection called? . Plasma cels, lymphocytes and macrophages are also seen under high power. What does this tell you about the duration of the inflammatory response in this case? 10. What is your diagnosis? What are possible outcomes for this patient? Ovary cervix Fallopian tube abscess To

Answer 1

ANSWERS:-

1. signs of inflammation in patients history: tenderness over palpation, febrile, leukocytosis

2. cardinal signs of inflammation seen in the images :- rubor: redness

                                                                                      tumor : swelling

3. histamine is mainly responsible. other mediators include bradykinin, interleukins

4. leukocytosis is seen in the histological slide of inflamed fallopian tube which is a typical feature of inflammation

5. the patient has wbc count of 15000 /microlitre with predominant neutrophils (84%). normal wbc count is 5000-11000 / microlitre.

explanation:- leukocytosis is a cardinal feature for inflammation. various inflammatory mediators like interleukins recurit neutrophils leading to leukocytosis.

6. neutrophil transmigration

7. granulation tissue

8. this imdicates that the inflammation is chronic

9. probable diagnosis: chronic salpingitis