Autopsy

Question 1

Who is the coroner?

Answer 1

An independent judicial officer who investigates the cause of death.

Question 2

What are the 11 cases that must be reported to the coroner?

Answer 2

1) Cause of death is unknown
2) Person not seen by doctor after death or within 14 days before death
3) Violent, unnatural or suspicious
4) Accident 0 related no matter when it occurred
5) May be due to neglect
6) Industrial disease or due to employment
7) Death due to an abortion
8) Death during surgery or before recovering from anaesthetics
9) Suicide
10) Death during/shortly after detention or prison custody
11) Poisoning

Question 3

What is the role of the coroner?

Answer 3

Coroner finds cause of death only and once that is done they must stop with the search.

Question 4

What is a hospital autopsy - when is it done?

Answer 4

Allows thorough examination of disease when there has been a discrepancy between actual COD and the COD stated by coroner.

Question 5

Is consent required for hospital/coroner’s autopsy?

Answer 5

Hospital- yes

Coroner - no

Question 6

Why is a hospital autopsy conducted?

Answer 6

• Thorough examination of the deceased, the extent of their disease, their treatment and its effects
• Useful for audit
• Monitoring effectiveness of new treatments
• Teaching
• Research
• Discrepency between stated and actual COD

Question 7

What is the death certificate data used for?

Answer 7

• Epidemiologu
• Helps divide funds more appropriately
  Hence important to be accurate

Question 8

Compare hospital and coroner’s autopsy

Answer 8

Hospital:

• consent must be obtained from next of kin
• with consent any material can be taken

Coroner’s:

• no consent needed
• material only taken if needed to establish COD

Question 9

How is an autopsy done?

Answer 9

• incision made from neck to top of pelvis

- organs removed and looked at systematically

Question 10

What is a death certificate?

Answer 10

• Filled in for any death
• Taken to Registrar (registers births, marriages and deaths) by the family
• Must be correct before registration of death is possible

Question 11

What is the layout of the death certificate?

Answer 11

1a) immediate cause of death (necessary) e.g. haemopericardium
1b) Predisposing factor e.g. MI
1c) Predisposing factor e.g. Ischaemic heart disease
2) other contributing fcators not directly linked to death e.g. hypertension

Question 12

What are the three main causes of death in young people?

Answer 12

1) Congenital disease - poorly controlled asthma, diabetes, CF
2) Trauma
3) Drugs and alcohol

Question 13

What are the main natural causes of sudden unexpected deaths?

Answer 13

1) Cardiovascular disease - usually cardiac arrhythmia, commonly severe CA atherosclerosis, may find MI scarring or CA thrombosis
2) Hypertensive heart disease - accompanied by CA atherosclerosis, cardiac arrhythmia usual case. Cardiomegaly - left ventricular hypertrophy
3) Other cardiac causes e.g. cardiomyopathy, myocarditis, structural abnormalities, floppy mitral valve, aortic stenosis, conduction abnormalities
4) Vascular system - ruptured aortic aneurysm associated with atherosclerosis and hypertension

5) CNS -
non traumatic subarachnoid haemorrhage e.g. Berry aneurysm (silent till ruptures)

Intracerebral haemorrhage (type of stroke) - causes 10-30% of all strokes. Most common cause is hypertension

Epilepsy

6) Respiratory system - pulmonary embolus, asthma,

7) GI tract e.g. pancreatitis, bleeding ulcers and bleeding esophageal varices
(not usually unexpected)

CHCVCRG

Question 14

Unnatural causes of sudden unexpected deaths

Answer 14

1) Drugs - 1% of coroner reported deaths
2) Alcohol - 1% of coroner reported deaths, associated with GI problems and trauma
3) Trauma

Question 15

What is a bruise/contusion?

Answer 15

An extravasated collection of blood which has leaked from damaged small arteries, venules and veins but not capillaries

Occurs more easily where the skin is lax. Fragility of vessels and coagulation state affect bruising. Caused by a blunt trauma injury. Can bruise after death

Question 16

What is an abrasion?

Answer 16

A graze or scratch. Most superficial of blunt trauma injuries and is confined to the epidermis.
Due to tangential force - may have distal skin tag e.g. friction burn. Can also be due to vertical force - no skin tag e.g. stamp

Question 17

What is a laceration?

Answer 17

A split to the skin caused by blunt force overstretching skin. Passes through the full thickness of the skin. They are deep and bleed. Margins are ragged with crushing and bruising. Bridging fibres arch across skin.

Question 18

Where are lacerations common and rare?

Answer 18

Common where skin can be compressed between the force and underlying bone - e.g. scalp, elbow, shin

Rare over fleshy areas e.g. buttocks or breast

Question 19

What is flaying?

Answer 19

Tangential applied force leading to horizontal laceration

Question 20

What is the difference between a cut and a stab?

Answer 20

stab - depth of wound>width

cut - length of wound> depth

Question 21

What causes cuts and stabs?

Answer 21

• a sharp object e.g. a knife or sharp glass shards

Question 22

What are the features of cuts/stabs?

Answer 22

• edges and margins are clear
• minimal injury to surrounding tissues
• info about weapon type can be deduced

Question 23

What may cause an abrasion?

Answer 23

Friction burn
Car radiator
Flooring
Whip
Stamp