Interactive Case Study Companion

iii - Scenario  
Normal Reference Range Table

An 18-year-old female presents to the emergency room 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. Physical examination reveals marked lower abdominal/pelvic tenderness and a purulent vaginal discharge. She is febrile (39 C) at the time of exam. Her CBC is significant for a white blood cell (WBC) count of 15 x 103/µL with 82% polymorphonuclear neutrophils (PMN) and 6% bands and metamyelocytes.

Possible questions for discussion

1. Keeping in mind the history, what is the nature of the pathologic process occurring in this patient's genital tract, and what are likely etiologies of this pathology?

2. What histologic feature suggests that this may not be the first episode of this pathology?

3. What is the significance and pathogenesis of the elevated WBC count? the fever?

4. What alterations in local microvascular physiology would you expect, given this pathology, and what chemical mediators are most likely involved?

5. Given successful medical treatment of this disorder, would you expect complete restitution of normal anatomy and reproductive function? If not, what factors would impede recovery, and what clinical problems might ensue?



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