Diverticulitits and Endometriosis

Question 1

A 59-year-old patient with LIF pain & peritonism. She was febrile with HR was 120b/m, BP 90/60. Hartman’s operation done. Histopathology report showed diverticulitis & endometriosis.

Q1. What’s the diagnosis?

Answer 1

Complicated Diverticulitis with sepsis (Septic shock)

Question 2

Q2. Define septic shock and sepsis.

Answer 2

Shock; sepsis + pt is not responding to vasopressors and LDH > 2
*** tell  tissue hypoperfusion from lack of oxygenation of tissue
ABG  Met Acidosis due to anaerobic pathway as in shock pt have hypoperfusion leading to lactate accumulation which will lead to Met. Acidosis
Sepsis; suspected inf. + 2 or more of sofa score

Question 2

Q3. What’s lining of the colon? What’s the layer below the mucosa?

Answer 2

Simple Columnar / (Lamina propria)

Question 3

Q. Speak about SOFA score and survival sepsis bundles?

Answer 3

QSOFA is SBP<100 , RR>22 GCS<15
3 hr / 6 hr bundles

Question 4

Q4. What does submucosa contain?

Answer 4

Muscular layers / Glandular tissue / Lymph and blood vess / Network of nerves

Question 5

Q5. What are the contents of pelvic abscess? How did it occur? Why did occur in pelvis?

Answer 5

. collection of pus /microorganism/ dead neurophils / cell depris and may have fecal material
. By Rapture of Diverticulum by obstruction of diverticula due constipation and stasis & collection microorganism inside the sac.
. Because it’s a dependent area so pus will be collected there and sigmoid lies mainly in pelvis.

Question 5

Q6. Define diverticular disease, diverticulitis, and endometriosis.

Answer 5

Dis; Outpouching of the weak ms layer of colon and comes with constipation, Mild bleeding
Itis; inflammation of the outpouching sac
metroisis; presence of endometrial cell outside the uterus

Question 6

Q. If pt deteriorates with hypotension. Tachycardia and bleeding tendency name 3 pathological justifications.

Answer 6

Septic shock, ARDS, DIC

Question 7

Q7. What’s the pathology of diverticulitis?

Answer 7

With obstruction of Diverticula with the fecal material this will lead to irritation, stasis and bacterial growth leading to inflammation

Question 8

Q8. How does endometriosis cause pain?

Answer 8

Intrapelvic bleeding / Releasing of substance b from pelvic reaction / adhesion of endometrial cells in

Question 9

Q9. How do endometriosis get into the colon?

Answer 9

• Regurgitation Theory: Endometrial tissue implants at ectopic sites via retrograde flow of menstrual endometrium through the fallopian tubes.
• Benign Metastases Theory: Endometrial tissue from the uterus spreads to distant sites (e.g., bone, lung, brain) via blood vessels and lymphatic channels.
• Metaplastic Theory: Endometrial tissue arises directly from coelomic epithelium (mesothelium of pelvis or abdomen), from which the müllerian ducts and endometrium originate during embryonic development.
• Extrauterine Stem/Progenitor Cell Theory: Recent theory proposing that stem/progenitor cells from the bone marrow differentiate into endometrial tissue.

Question 10

Tissue samples from the operation show neutrophils.
Q10. What does this mean?

Answer 10

Inflammation / Infection

Question 11

Q11. What are the contents inside the neurophils? How do neutrophils arrive here? How much is its life span?

Answer 11

• The leukocytes first roll, then become activated and adhere to endothelium, then transmigrate across the endothelium, pierce the
• basement membrane, and migrate toward chemoattractants to from the source of injury.
• blood steam 12-16 hrs

Question 11

Q12. Define abscess.

Answer 11

Local Pathological collection of pus due to seeding of pyogenic microorganism

Question 12

Q10. What are the contents inside the Abcess?
.
Describe the abscess

Answer 12

Central necrotic region
Surrounded by area of preserved neutrophils
and a zone of dilated bld vess and proliferation of fibroblast

Question 13

Q11. How to manage intra-abdominal collection.

Answer 13

According to site and size
Henchy classification
1 & 2 – > Conserve (Triple Abx)
3 & 4 – > in presensce of purulent pus – > Localized or Spread
— Spread —- > Laparotomy
— Localized —> Radio intervention OR Surgical internevtion
——————————-
seek help of interventional radiology to drain it
if not to be drained – > surgical intervention and lavage

Question 14

Q. contents of the Cytoplasm of neurophils?

Answer 14

Mitochondria , Lysosomal enzymes , leucocidin

Question 14

Q. Fate of Abscess?

Answer 14

Resolution
Rapture
Become Chronic

Question 15

Q. Stracture of neutrophils?

Answer 15

Segmented nucleus / Cytoplasm / granules (1ry—toxic mediators and bactericidal agents “Myleoperoxidase” / 2ry—lysosomes )