A 14-year-old girl with history of prolonged fever and abdominal discomfo is observed to have splenomegaly and leucopenia. In the course of the disease she develops acute abdominal event and died. Which of the following is the likely finding on autopsy:
Correct Answer: Longitudinal ulcers
Description: Answer is B (Longitudinal ulcers) Typhoid ulcers (Salmonella/Enteric Fever) occur due to ulceration of Peyer's patches. Since Peyer's patches (aggregation of lymphoid follicles in the wall of gut) are oval in shape and placed longitudinally/veically along the antimesenteric border, the axis of typhoid ulcers is longitudinal. History of prolonged fever and abdominal discomfo together with typical features of splenomegaly and leucopenia suggest a diagnosis of salmonelosis or 'Enteric Fever'. Enteric fever is a potentially fatal systemic illness and death may occur from* life threatening complications of gastrointestinal bleeding and intestinal perforation. This most commonly occurs in the third or fouh week of illness and results from hvperplasia ulceration (longitudinal) and necrosis of the ileocecal Payer's patches at the initial site of salmonella infiltration. Typhoid Ulcers (Enteric Fever) Longitudinal Ulcers (as they occur over lymphoid follicles/Peyer's patches at the antimesenteric border) When they heal, they cause no features of obstruction Tubercular Ulcers Transverse ulcers (due todirection of lymphatics) When they heal they cause stenosis and obstruction due to fibrosis (since they are circular surroundings the lumen of intestine) Enteric Fever Enteric Fever is a potentially life threatening systemic disease characterized by fever and abdominal pain caused by dissemination of Salmonella Typhi or Salmonella Parotyphi. Typical Hallm- ark Features Fever Abdominal Discomfo (Pain, Anorerxia, Diarrhea or Constipation, Anorexia, Nausea, Vomiting) Non specific symptoms Headache Chills/Shivering Cough Sweating Myalgia Ahralgia Fatigue Typical Findings (Signs typical, but not always present) Rose spots Splenomegaly Leucopenia with a distinct left shift Relative Bradycardia dispite high fever Mental state changes (Typhoid Psychosis) (Muttering Delerium/Coma vigil) The lipopolysacharide endotoxin of bacteria is responsible for Leucopenia and splenomegaly Life threatening complications primarily include Gastrointestinal Bleeding and/or Gastrointestinal Perforation which most frequently occur in the third or fouh week of illness from hyperplasia, ulceration and necrosis of the ileocoecal Payer's patches at the initial site of Salmonella infection
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