What was the medical cause of Jesus's death?

medical question about cause of death

• my mother in law recently died from a subphrenic abscess. She was recovering from two operations, the first one a hip replacement followed 7 days later by abdominal surgery due to a perforated duodenal ulcer. The ulcer had an abscess which had burst causing some septicaemia. She then spent three weeks in intensive care and on a ventilator followed by another week in hospital before we were able to bring her home. She was an otherwise healthy 68 year old with no history of any illness apart from some mild hypertension that has been present since two very difficult pregnancies in the 1960's.In the days prior to her death she had never felt better and was doing housework and cooking. On the day she died, she was feeling good, and only seconds before her death she asked for a glass of water as she was feeling sick. There were two nurses present at the time of her death. She was having her dressings changed daily and they were there when she said she felt sick. They immediately performed CPR and an ambulance arrived within a few minutes - but it was all too late. She was dead before the nurses even managed to lay her on the floor. We are not interested in pursuing a case for negligence against anyone, but we are unable to get a clear answer from anyone in the medical profession. We know she did not suffer, but we were prepared for a different cause of death - i.e. clot or major heart attack. However this answer from the post mortem has only raised more questions. What we are struggling to come to terms with is this - how could this abscess recur following the surgical repair of her ulcer? What exactly happens internally for this abscess to kill so quickly?

• Answer:

  Hello doasuwouldbedoneby, I want to tell you and your spouse,again, that I am sorry for your loss, and I understand your concern. Before you continue reading, please keep in mind that my answer contains only *possible* causes of death, or circumstances that may have contributed to the cause of death, and can in no way be construed as a definitive cause. First, let?s define a subphrenic abscess. This is a broad term for an abscess below the diaphragm, and usually indicates a break or rupture of the peritoneum. A perforation, either from bacterial infection or scalpel, of the appendix, gall bladder, duodenum, or bowel can lead to an abscess. (An abscess is a collection of pus and decayed tissue, results of invading bacteria.). Subphrenic abscesses can appear 2-21 days following surgery. http://www.gpnotebook.co.uk/simplepage.cfm?ID=-13303782&linkID=32069&cook=yes ?Commonly these abscesses only show up two or more weeks after the infection.? http://www.surgerydoor.co.uk/so/detail2.asp?level2=Abscess%20-%20Subphrenic ?Subphrenic abscesses are the commonest intra-abdominal abscess.? http://www.gpnotebook.com/cache/-315293670.htm ?Although multiple causes of intra-abdominal abscesses exist, the following are the most common: (1) perforation of a diseased viscus, which includes peptic ulcer perforation, (2) perforated appendicitis and diverticulitis, (3) gangrenous cholecystitis, (4) mesenteric ischemia with bowel infarction, and (5) pancreatitis or pancreatic necrosis progressing to pancreatic abscess.? The causative organisms of an abdominal abscess are generally e.coli and B.fragilis, although nosocomial bacteria can cause abdominal abscess as well. (Nosocomial indicates something that was acquired while in the hospital - a staph infection is the most well know form of a nosocomial infection). Patients who have been on antibiotic therapy for other infections, such as your mother-in-law?s septicemia and H. pylori infection, may develop a yeast abcsess, specifically candida species. ?If a deeply seated abscess is present, many of these classic features may be absent. The only initial clues may be persistent fever, mild liver dysfunction, persistent GI dysfunction, or nonlocalizing debilitating illness. The diagnosis of an intra-abdominal abscess in the postoperative period may be difficult because postoperative analgesics and incisional pain frequently mask abdominal findings. In addition, antibiotic administration may mask abdominal tenderness, fever, and leukocytosis.? This statement presents us with an interesting possibility; your mother-in-law probably was taking some form of pain reliever and some form of antibiotic at the time of her passing. These medications could have cloaked any presenting symptoms. It is possible that the causative organism was an overgrowth of a resistant strain of her septicemia, or a separate organism, that was not susceptible to the antibiotics she was taking. Your mother-in-law was already in a weakened state and may not have been able to effectively fight off a new infection. ?In patients with subphrenic abscesses, irritation of contiguous structures may produce shoulder pain, hiccup, or unexplained pulmonary manifestations such as pleural effusion, basal atelectasis, or pneumonia. Many patients have a significant septic response, volume depletion, and catabolic state. This syndrome may include high cardiac output, tachycardia, low urine output, and low peripheral oxygen extraction. Initially, respiratory alkalosis due to hyperventilation may occur. If left untreated, this progresses to metabolic acidosis. Sequential multiple organ failure is highly suggestive of intra-abdominal sepsis.? Your mother-in-law could have had a sudden septic response, whose symptoms may have been masked by her medications, leading to metabolic acidosis. Once septic shock sets in, and acidosis begins, and is not medically interrupted, the organs begin to shut down. A seemingly healthy body, can be rendered non-functional in a matter of moments by a septic response. The body can not function without the proper acid-base balance. Septic response/shock can disrupt the normal blood flow to organ systems, whereby the core organs may not receive an adequate oxygen supply. ?Microcirculation is the key target organ for injury in sepsis syndrome. A decrease in the number of functional capillaries causes an inability to extract oxygen maximally, which is caused by intrinsic and extrinsic compression of capillaries and plugging of the capillary lumen by blood cells. Increased endothelial permeability leads to widespread tissue edema of protein-rich fluid. Redistribution of intravascular fluid volume resulting from reduced arterial vascular tone, diminished venous return from venous dilation, and release of myocardial depressant substances causes hypotension.? http://www.emedicine.com/med/topic2702.htm http://classes.kumc.edu/son/nurs420/unit6/signs_MODS.htm ?However, in patients who have undergone previous surgery, the diagnosis is more difficult. The most consistent finding is fever associated with tachycardia. Abdominal pain and tenderness are difficult to evaluate because of the recent surgical incision and post-operative ileus. An exception is pelvic abscess where tenderness may be elicited on rectal or vaginal examination. Understandably, the surgeon is reluctant to undertake a second operation without definite evidence of the presence of an abscess.? http://www.pchrd.dost.gov.ph/pcs_publications/number_03/pc970381.html ?The subphrenic space is arbitrarily defined as lying below the diaphragm and above the transverse colon. About 55% of subphrenic abscesses are right-sided, 25% are left-sided, and 20% are multiple. Most subphrenic abscesses arise from direct contamination after surgery, local disease, or injury. They develop from peritonitis secondary to another cause, such as a perforated viscus; extension from an abscess in an adjacent organ; or, most commonly, as a postoperative complication of abdominal surgery, especially on the biliary tract, duodenum, or stomach. The peritoneum may be contaminated during or after surgery? ?Clinical manifestations usually begin subtly within 3 to 6 wk after surgery but occasionally do not appear for several months. Fever, nearly always present, may be the only evidence, although anorexia and weight loss are common. Nonproductive cough, chest pain, dyspnea, and shoulder pain may result from the effects of the infection on the adjacent diaphragm, and rales, rhonchi, or a friction rub may be audible. Dullness to percussion and decreased breath sounds are present when basilar atelectasis, pneumonia, or pleural effusion occurs.? http://www.medilligence.com/knowbase/infecti12.htm http://www.merck.com/mrkshared/mmanual/section13/chapter155/155b.jsp Blood Clots =========== Some medicines, as well as the effects of septicemia can trigger blood clots. IV tubing can also occasionally form blood clots, some can even occlude an entire vein. This News in Education site about blood clotting, gives a colorful description: ?Living conditions in the bloodstream are great -- there's plenty to eat, central heating and air conditioning, waste removal, water quality control facilities, and convenient means of transportation. It's worth the trouble to get in and exploit the system. Living creatures take advantage of an opportunity that provides the things they require. They adapt themselves, step by step, to the environmental conditions found in or upon a host organism. Microorganisms have devised every means possible to gain entry and evade the body's protection systems. But the host fights back by developing counter-measures just as sophisticated. This biological warfare has had an enormous impact on the course of humanity.? http://www.goerie.com/nie/itsaboutlife/clotting_and_disease.html ?The complications are those of any major abdominal operation: infections of the chest, wound or urine and thrombosis (blood clots) in the veins of the leg.? http://www.surgerydoor.co.uk/medical_conditions/Indices/P/peptic_ulcer_surgery.htm ?If a portion of the forming blood clot breaks free inside the veins of the leg, it may travel through the veins to the lung where it can lodge itself in the tiny vessels of the lung. This cuts off the blood supply to the portion of the lung that is blocked. The portion of the lung that is blocked cannot survive and may collapse, which is called a pulmonary embolism. If a pulmonary embolism is large enough and the portion of the lung that collapses is large enough it may cause death.? http://www.jointreplacement.com/xq/ASP.default/pg.content/content_id.87/mn./newFont.2/joint_id./joint_nm./tp.search/qx/default.htm DIC (Disseminated Intravascular Coagulation) ============================================= DIC is a strange cycle of coagulation, often caused by sepsis, which the body tries to combat by producing anti-coagulants in excessively large amounts. Internal hemorrhage occurs, followed by shock, organ shutdown, and death. ??an important primary cause of DIC in all patients. The clinical condition is worsened by secondary fibrinolysis, which results in the formation of FDP's (fibrinogen / fibrin degradation products or "D - dimers) that interfere with normal fibrin formation and platelet function. Fibrin deposition in DIC may lead to further organ dysfunction. DIC is a major cause of acute renal failure and it also contributes to multiple system organ failure. The converse is also true with damaged organs contributing to DIC.? http://rnbob.tripod.com/dic.htm http://www.hosppract.com/issues/2000/08/celevi.htm Delayed Hemolytic Transfusion Reaction ====================================== Some patients have a delayed transfusion reaction. While rare, alloantibodies to blood cell antigens can occur up to a month post transfusion. This is a virtually unpreventable reaction, that happens with little frequency, but it does happen. I have seen perhaps two dozen reactions of this type in my 25 years in the health care field. http://www.blood.co.uk/hospitals/library/shot/SHOT0001/shot01n.htm ?In some circumstances, the magnitude of a risk can be estimated from characteristics of the donated units and the recipient population. For example, we may know the frequency of certain rare antigens and antibodies in the population and can estimate the likelihood that a recipient will receive a unit that will cause an antigen-antibody reaction, which in turn may or may not produce clinical symptoms? http://www2.us.elsevierhealth.com/scripts/om.dll/serve?action=searchDB&searchDBfor=art&artType=full&id=atmrv50009 ?In truth, in most cases, we can't do anything to prevent a delayed hemolytic reaction. Since the majority of DHTRs result from the reappearance of an antibody that by definition, we could not detect, you could say that we are all operating with the possibility that a transfusion reaction could occur with any transfusion? http://www.bbguy.org/Rxns/dhtrprev.htm Here is a simple illustration of a ?coated? red blood cell. The body develops antibodies in response to the foreign substance. http://www.umm.edu/imagepages/9985.htm As you can see, there are many possible contributing factors. Your mother-in-law had recently had two surgeries, fairly close together, both of which have their own risks. The fact that she had been treated for H.pylori and had duodenal surgery greatly increases the possibility of a subphrenic abscess. She had had two transfusions, was probably taking medications that could have masked septic shock and it?s symptoms, and was in a state of recovery from two surgeries. I am not surprised that the medical staff is giving vague answers. You are not pursuing litigation, but many people do. I certainly don?t want to sound cavalier, as I know you are in mourning, but sometimes there *are* irreproachable complications following surgery. Delayed transfusion reactions, even when all protocols have been followed, do occur. On the other hand, errors areoccasionally made, and a small nick of a scalpel has been implicated more than once in post-surgical septicemia and death. Anecdotally, I have seen cases very similar to your mother-in-law?s case. Septic shock particularly can strike very quickly. I have seen patients sitting up, feeling good, playing cards, and laughing, when they were struck with septic shock, and quickly succumbed to the bacterial infection. Additional Reading: You may be interested in reading two other answers of mine that cover H.pylori: http://answers.google.com/answers/threadview?id=275889 http://answers.google.com/answers/threadview?id=356017 http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Abstract&list_uids=81034069 A strange cause of subphrenic abscess is swallowing toothpicks! (You can read the abstract without signing up for free membership) http://www.highbeam.com/library/doc1.asp?docid=1P1:29236746 Bacterial Toxins http://www.uni-wuerzburg.de/infektionsbiologie/hauck/overview.htm Sudden Death http://www.mywhatever.com/cifwriter/library/mortals/mort2467.html I hope this has helped you understand what could have occurred to you mother-in-law. Perhaps the Post Mortem will reveal pertinent information! If any part of my answer is unclear, or if I have duplicated information you already had, please request an Answer Clarification, before rating, and I will be glad to assist you further. Sincerely, crabcakes Search Terms abdominal subphrenic abscess DIC post septicemia DIC abscess Sequela subphrenic abcess Post surgical complications