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1. Autopsy Findings
2. Important premortem finding Blood cultures positive for Escherichia coli
Ascites fluid showed numerous neutrophils
negative for bacterial growth (but culture taken on HD+2, after pt on antibiotics)
Urine cultures positive, but not for E. coli
3. Autopsy Findings Early bronchopneumonia, most prominent in the right upper lobe.
Petechial hemorrhages over the entire visceral surface of the lungs and on the diaphragm
Multiple petechial hemorrhages on the epicardial surface
4. Autopsy Findings 6400 cc of serous fluid in the peritoneal cavity
Liver cirrhosis with marked cholestasis, no significant inflammation and no fatty change
5. Autopsy Findings Multiple diverticula, colon.
Amyloid, islets of Langerhans, pancreas (type 2 diabetes mellitus).
Moderately advanced nodular glomerulosclerosis, kidneys.
Hypertensive vascular disease, kidneys.
6. Cause of Death Part I:
a) Sepsis syndrome
a) Cirrhosis, liver
b) Massive ascites
7. Fatty liver disease Risk factors in history
Poorly controlled diabetes
Despite this, no fat in liver??
8. Cryptogenic Cirrhosis All virological, serological, and histological studies negative for etiology
10-20% of cirrhotics in USA
Most of these (65%) are now felt to be burned-out non-alcoholic fatty liver disease
9. The American Journal of Gastroenterology 101:3, 664-668 Obesity
10. The American Journal of Gastroenterology 101:3, 664-668
11. SBP Spontaneous bacterial peritonitis
25% of hospitalized patients with peritonitis
Mortality 40-70% in adults
75% with aerobic gram-negative organisms
E. coli is most common cause