Kronik Karaciğer Hastalığı Olan Olguda Cilt altı Enfekte Hematom ve Pnömomediastinum

Öz

Giriş: Sirotik hastalarda bakteriyel enfeksiyon, morbidite ve mortalitenin en önemli nedenlerindendir. Kronik karaciğer hastalarında immünsistem mekanizmaları bozulmuştur. Sirotik hastalarda mortalite nedenlerinin %25’i bakteriyel enfeksiyon olduğu kabul edilir. Kronik karaciğer hastalığında diğer bir sorun hemostaz bozukluklarıdır. Ağır koagülopati akut karaciğer yetmezliğinde sık olarak görülse de, karaciğer sirozu ve kronik karaciğer yetmezliğinin en ciddi komplikasyonudur. Olgu Sunumu: Banyoda düşme sonrası sol skapula üzerinde hematom gelişen ve sonrasında spontan enfekte hematoma ilerleyen, 61 yaşındaki erkek, kronik karaciğer hastası anlatılacaktır. Sonuç: Küçük travmalar, kanama parametreleri anormal olan hastada kanamalara neden olabilir. Altta yatan hastalık varlığında vücut sıvıları enfekte hale gelebilir. Cilt enfeksiyonlarında, özellikle apse ve koleksiyonlarda drenaj gereklidir. Bu koleksiyonlardan örnekleme yapılmalı ve en erken zamanda uygun antibiyotik tedavisi başlanmalıdır.

Anahtar Kelimeler

• Kronik karaciğer hastalığı, enfekte hematom, pnömomediastinum, acil

Infected Subcutaneous Hematoma and Pneumomediastinum in a Patient with Chronic Liver Disease

Öz

Introduction: Morbidity and mortality are significantly associated with bacterial infection in cirrhotic patients. Immune system mechanisms tend to be abnormal in patients with chronic liver disease. The causes of mortality in cirrhotic patients are associated with bacterial infections by 25%. Also, another problem with chronic liver disease is disorders in hemostasis. Although coagulopathy is mostly seen in acute liver failure, the most serious complication of liver cirrhosis and chronic liver failure is coagulopathy disorders.Case Report: A 61-year-old man with chronic liver disease was admitted to the emergency department with swelling in his left shoulder. In his history, after falling in the bathroom, a hematoma in the left scapular region developed; then, the hematoma became spontaneously infected.Conclusion: Even minor trauma can cause bleeding in patients with abnormal hemostasis parameters. These body fluids can become infected in the presence of underlying disease. Skin infections, particularly abscesses and collections, require drainage; sampling should be made; and appropriate antibiotic therapy must be initiated as soon as possible

Anahtar Kelimeler

• Chronic liver disease, infected hematoma, pneumomediastinum, emergency

Kaynakça

1. Wyke RJ. Problems of bacterial infection in patients with liver disease. Gut 1987; 28: 623-41. [CrossRef]
2. Pluta A, Gutkowski K, Hartleb M. Coagulopathy in liver diseases. Adv Med Sci 2010; 55: 16-21. [CrossRef]
3. Christou L, Pappas G, Falagas ME. Bacterial infection-related morbidity and mortality in cirrhosis. Am J Gastroenterol 2007; 102: 1510-7. [CrossRef]
4. Bernard B, Cadranel JF, Valla D, Escolano S, Jarlier V, Opolon P. Prognostic significance of bacterial infection in bleeding cirrhotic patients: a prospective study. Gastroenterology 1995; 108: 1828-34. [CrossRef]
5. Taneja SK, Dhiman RK. Prevention and management of bacterial infections in cirrhosis. Int J Hepatol 2011; 2011: 784540.
6. Borzio M, Salerno F, Piantoni L, Cazzaniga M, Angeli P, Bissoli F ve ark. Bacterial infection in patients with advanced cirrhosis: a multicentre prospective study. Digestive and Liver Disease. vol. 33, no. 1, pp. 41-48, 2001. [CrossRef]
7. Wong F, Bernardi M, Balk R, Christman B, Moreau R, Garcia-Tsao G ve ark. Sepsis in cirrhosis: report on the 7th meeting of the International Ascites Club, Gut, vol. 54, no. 5, pp. 718-725, 2005. [CrossRef]
8. Runyon BA. Bacterial infections in patients with cirrhosis. J Hepatol 1993; 18: 271-2. [CrossRef]

9. Fernandez J, Navasa M, Gomez J, Colmenero J, Vila J, Arroyo V ve ark. Bacterial infections in cirrhosis: epidemiological changes with invasive procedures and norfloxacin prophylaxis. Hepatology 2002; 35: 140-8. [CrossRef]
10. Mohan P, Ramu B, Bhaskar E, Venkataraman J. Prevalence and risk factors for bacterial skin infection and mortality in cirrhosis. Ann Hepatol 2011; 10: 15-20.