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7/29/2019 Acute Bacterial Endocarditis
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PEDIATRICS. MEDICINE.OB-GYNE.FAM-MEDLOADIN
G
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Click to edit Master subtitle style
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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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Thank You forListening!!!