acute bacterial endocarditis

7/29/2019 Acute Bacterial Endocarditis

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PEDIATRICS. MEDICINE.OB-GYNE.FAM-MEDLOADIN

G


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UNIVERSITY OF PERPETUALHELPDr. Jose G. Tamayo

Medical Center

June 27,2011

ClinicopathologicConference


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1. 71/Female- Fever-

Dyspnea- hypotension

2. HPI:12 weeks PTA

Syncope Bowel and

bladderincontinence

ECG: oldinferior MI

(-) arrythmia CK: normal CT scan and

MRI: normal

PHYSICALXAMINATION

BMI 17.9(+) JaundicePale PalpebralnjunctivaDistended Abdomen

(+) Splenomegaly

PXCHART

3. HPI:10 weeks PTA

Disoriented Several tonic-

clonic seizure CT : contusion

withsubarachnoidhemorrhage

(-) arrythmia CK: normal CT scan and

MRI: normal

4. HPI

8 weeks PTA Volvulus of

sigmoid colon Central Venous

Catheter

5. HPI4 days PTA

Confused Hyperthermia Leukocytosis Hypotension Tachypnea Tachycarda Gentamicin,

metronidazole,


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PATHOLOG

Y

DAY 1

AUSCULTAT

ION:

Grade 3systolicejection

murmur

Coarsecrackles on

both lungs


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JAUNDICE

INTRAHEPATI

C

POSTHEPATIC

PREHEPATICLOCATION OF

BILIRUBIN METABOLISM

INTRAHEPATIC

CONJUGATION

DERANGEME

NTDISORDERS

INFECTION DEFECT INEXCRETION

Schwartz's Principles of Surgery, Ninth Edition

Viral Hepatitis

Schistosomiasis

GilbertSyndrome

Crigler-NajjarSyndrome

Dubin-JohnsonSyndrome

Unremarkable WhiteCell and DifferentialCount(-) FeverCourse of the Disease

Gilbert Syndrome &cholelithiasis are associatedMale predilection(-) Hepatosplenomegaly(-) Elevation of liverenzymes

Very rare (esp. in Asia)Jaundice in teenage year

POSTHEPATIC

EXTRINSICINTRINSIC

Cholelithiasis

Choledocholithiasis

Compression of theBiliary Tree due to

PeriampullaryDisorders

Age of the patientEarly manifestations ofjaundiceProminent pallor, chronicanemia, & markedsplenomegaly

Cholangiocarcinomaand Pancreatic CA wereunlikely to our patientsage groupUnremarkable imagingfindings

PREHEPATIC

HEMOLYTICANEMIAS

Thalassemias

HereditarySpherocytosis

G6PDDeficiency

ENZYMEDEFECTS

GENETIC

DISORDERS OF THERBC MEMBRANE

DEFECTS INHEMOGLOBINSTRUCTURE

Sickle CellAnemia

Most common inheritedabnormality of the RBCmembraneManifested bysplenomegaly, anemia,jaundice, and gall stones

Pediatric Hematology Oncology 2006 p389-97,

Elevated MCHCJaundiced at birth

Common among SouthEast AsiansJaundiceAnemia

Almost exclusive tomales (X-linked patternof inheritance)

Common in tropical andsubtropical countriesJaundiceHepatosplenomegalyAbdominal pain

CardiovascularmanifestationsEarly splenomegalyElevated MCHC

Thalassemias

Ballas SK. Complications of Sickle Cell anemia inadults: Guidelines for effective Management.


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-

THALASSEMIA

-

THALASSEMIA

Thalassemias

MOST COMMON GENETIC DISORDERS

Harrison's PRINCIPLES OF INTERNAL MEDICINE

PREVALENT IN HUMID COUNTRIES(MEDITERRANEAN, ARABS, & ASIAN)

E. Goljan, Pathology, 2nd ed. Mosby Elsevier,American Family Physician Journal. 2009 Aug 15;

Heterozygous: Noclinical manifestationexcept for Mild AnemiaHomozygous:Incompatible with life

http://www.medicinen

MAJOR

INTERMEDIA

MINOR

First 2 years of lifeSevere AnemiaRBC Transfusion forsurvival

Clinically silent


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Hemolytic Anemia,

probablyBeta-ThalassemiaIntermedia;

Probable transient

Mirizzis Syndrome;Cholecystolithiasis,S/P LaparoscopicCholecystectomy

FINAL

DIAGNOSIS


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acute bacterial endocarditis

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