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 Part II: a) Cirrhosis, liver b) Massive ascites

7. Fatty liver disease Risk factors in history –Poorly controlled diabetes –Obesity –Elevated triglycerides –Hypertension 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