Autopsy Findings Important premortem finding Blood cultures positive

Autopsy Findings

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

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

Autopsy Findings • 6400 cc of serous fluid in the peritoneal cavity • Liver cirrhosis with marked cholestasis, no significant inflammation and no fatty change

Autopsy Findings • Multiple diverticula, colon. • Amyloid, islets of Langerhans, pancreas (type 2 diabetes mellitus). • Moderately advanced nodular glomerulosclerosis, kidneys. • Hypertensive vascular disease, kidneys.

Cause of Death Part I: a) Sepsis syndrome Part II: a) Cirrhosis, liver b) Massive ascites

Fatty liver disease • Risk factors in history – Poorly controlled diabetes – Obesity – Elevated triglycerides – Hypertension • Despite this, no fat in liver? ?

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

Obesity The American Journal of Gastroenterology 101: 3, 664 -668

The American Journal of Gastroenterology 101: 3, 664 -668

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