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Washington University Experience | VASCULAR | Hemorrhage, hypertensive | 49A Liver Cirrhosis (A20-76)
Case 49 History ---- The decedent was a 37yo female with a past medical history of alcoholic cirrhosis, hypertension and chronic kidney disease. She presented with abdominal pain, jaundice and altered mental status on May 4. Diagnostic paracentesis ruled out spontaneous bacterial peritonitis, while treatment with empiric antibiotics continued. On May 7 she developed decreasing responsiveness and hypoxia with agonal respiration resulting in ICU admission with multifocal pneumonia. A COVID-19 test was negative. Her hospital course was subsequently complicated by acute respiratory distress syndrome and acute tubular necrosis requiring continuous renal replacement therapies. The patient became severely coagulopathic (INR >9.0) during her hospital stay. A head CT scan on May 16 showed a large frontoparietal intraparenchymal hemorrhage with significant mass effect and 1.9 cm of right to left midline shift, entrapment of the left lateral ventricle, and subarachnoid and subdural hemorrhage tracking. She received comfort measures and died on May 16. ---- 49A The liver is small, yellowish-green and firm with a nodular surface. Microscopic examination showed macrovesicular steatosis, ballooning degeneration of hepatocytes, pericellular neutrophilic inflammation and fibrosis with cholestasis consistent with the patient’s history of alcoholic cirrhosis.
