5 - The Autopsy Flashcards
What is a coroner?
An independent judicial officer of the crown who has a statutory duty to investigate the circumstance of certain categories of death for the protection of the public.
What are the cases that must be reported to the Coroner?
- Cause of death is unknown
- The deceased has not been seen by the certifying doctor either after death or within the 14 days before death
- Death was violent, unnatural or suspicious
- Death may be due to an accident (whenever it occurred)
- Death may be due to neglect by self or others
- Death may be due to an industrial disease or due to the deceased persons employment
- Death may be due to an abortion
- Death occurred during an operation or before recovery from the effects of an anaesthetic
- Death may be a suicide
- Death occurred during or shortly after detention in police or prison custody
- Death may be related to poisoning
If in any doubt the case must be discussed with the Coroner’s office.
What does a Coroners autopsy do?
Conducted to establish the cause of death
Once Coroner has the cause of death his remit is over
What are the reasons for a hospital autopsy?
Allows a very thorough examination of the deceased, the extent of their disease, their treatment and its effects
Pros for doing a hospital autopsy
Audit – Major discrepancies between stated cause of death and actual cause of death
Monitoring effectiveness of new treatments e.g. complex congenital heart disease.
Teaching e.g. unrivalled clinic pathological correlation.
Research e.g. knowledge of variant CJD relies heavily on study of post mortem brain tissue.
What can death certificate data be used for?
Death certificate data used for epidemiology
i.e. Accurate morbidity and mortality data is needed to monitor the nations health, to direct the allocation of scanty resources and to detect environmental risks.
What are the 2 types of autopsy?
- Hospital
Consent must be obtained from the relatives. With the relevant consent, any material can be taken.
- Coroners
No consent of family needed (but their wishes should be considered)
Material can only be taken if it bears upon the cause of death (with Coroner’s permission)
Death certificates. 3 important facts
- Filled in for any death
- Taken to Registrar (of Births, Deaths & Marriages) by family
- Scrutinised and must be correct before registration of death possible
What are the parts of a death certificate that must be filled in?
1a Immediate cause of death (must be filled in) 1b Predisposing factor 1c Predisposing factor 2 Other factors contributing to but not directly leading to death E.G. – 1a Gun shot wound to head or 1a Haemopericardium 1b Myocardial infarction 1c Ischaemic heart disease 2 Hypertension
What are the natural causes of sudden unexpected death (in the community)?
Cardiovascular Disease
- Coronary artery disease
- Hypertensive heart disease
Central nervous system
Respiratory system
Gastrointestinal Tract
Natural causes of sudden unexpected death
CORONARY ARTERY DISEASE
Cardiac Arrhythmia is usual mode of death (irregular heartbeat)
Severe coronary artery atherosclerosis is most common anatomical finding
Usually in 2 or more major vessels
Other possible findings…
- Myocardial scarring
- Coronary artery thrombosis
- Acute or subacute MI (myocardial infarction)
If arrhythmia is the mechanism of death the diagnosis is one of exclusion, full autopsy must be conducted and severe coronary atherosclerosis must be the major finding. (In such cases cause of death usually stated as1a Ischaemic heart disease)
Natural causes of sudden unexpected death
HYPERTENSIVE HEART DISEASE
Usually accompanied by coronary artery atherosclerosis
Cardiomegaly with symmetrical left ventricular hypertrophy
Acute cardiac arrhythmia is usual cause of death
Other Cardiac Causes of Sudden Unexpected Death?
- Cardiomyopathy
- Myocarditis
- Structural anomalies (e.g. bridging)
- Floppy mitral valve
- Aortic stenosis (usually calcific)
- Conduction abnormalities (e.g. long QT syndrome)
Vascular System
-Ruptured aortic aneurysm associated with atherosclerosis & hypertension
Natural causes of sudden unexpected death
CENTRAL NERVOUS SYSTEM
Non traumatic subarachnoid haemorrhage:
(Usually due to Berry aneurisms, 2-4% adults, 90% silent until rupture 2/3 symptomatic between 40 & 65 years old)
Intracerebral haemorrhage:
10-30% of all strokes most common cause is hypertension.
Epilepsy
Natural causes of sudden unexpected death
RESPIRATORY SYSTEM
Pulmonary embolus
Asthma
Natural causes of sudden unexpected death
GASTRO INTESTINAL TRACT
(Not usually unexpected or sudden)
Bleeding Oesophageal Varices
Bleeding Ulcers
Pancreatitis
What are the causes of Sudden Unexpected Death (in the community)? NOT NATURAL
Drugs (alcohol)
Trauma
Causes of Sudden Unexpected Death (in the community)- (Not Natural)
ALCOHOL
Not usually a cause of sudden unexpected death (but can be in alcoholics).
Often associated with GI problems.
Often alcohol related damage goes with drug use so think of drugs when you see it.
Causes of Sudden Unexpected Death (in the community)- (Not Natural)
TRAUMA
Self induced
Caused by others
What is a bruise? (Contusion)
A blunt trauma injury. Occurs alone (skin intact) or is associated with other injuries.
You can bruise after death (but usually small and lie on dependant parts).
Not everything is a bruise: e.g. Pink areas may be due to hypothermia.
How are bruises formed?
An extraversated collection of blood which has leaked from damaged small arteries, venules and veins but not capillaries.
Occur more easily where skin is lax. Fragility of vessels, coagulation state etc all effect bruising.
May take hours or days to form. May get patterned bruises (can see better with special light sources). Deep bruising may never be seen on the surface.
What is an abrasion?
A graze or scratch. The most superficial of blunt trauma injuries.
Confined to the epidermis (strict definition) but may actually extend into the superficial dermis due to skin anatomy).
Can occur before and after death
Due tangential force – may have a distal skin tag eg. Friction burn, or Vertical force eg Stamp – no distal skin tag.
Abrasion examples – Friction burn, Car radiator, Flooring, Whip, Stamp.
What is a laceration?
A split to the skin. The result of blunt force overstretching the skin. Usually pass through the full thickness of the skin. They are deep and will bleed.
Margins ragged with crushing and bruising. “Bridging fibres” arch across the skin defect.
Common where skin can be compressed between the force and underlying bone e.g. Scalp, elbow, shin.
Rare over soft fleshy areas e.g. Buttocks, breasts. A laceration shows poor reproduction of the object causing it.
“Flaying” – tangentially applied force leading to a horizontal laceration.
examples – Fall, Punch, Stick, Hammer, Bomb, Wheel of car (flaying).
What are Cut and Stab wounds?
CUT (or slash)
The length of the injury is longer than its depth.
STAB (or penetrating injury)
The depth of the wound is greater than the width.
BOTH
- Caused by an object with a sharp or cutting edge
- Usually a knife but can be anything eg a broken glass or bottle or a piece of metal.
- Edges are clean and well demarcated. Minimal injury to surrounding tissue.
Information about weapon type can be gained from the wound but beware of over interpretation.
