Autopsy

Question 1

Benefits of autopsy

• Medical
• Public health
• Family

Answer 1

Medical

• Final diagnosis, cause of death
• Education
• Research: discover disease, course of disease, tissue samples

Public health

• Epidemiology stats
• Surveillance of communicable diseases

Family of deceased
- Informs them, grieving process, hereditary disease.

Question 2

Different type of autopsy [4]

Answer 2

Conventional autopsy/ post-mortem examination

• Hospital autopsy
• Coroner’s autopsy

Forensic autopsy

Minimally invasive autopsy

Question 3

Examples of minimally invasive autopsy [5]

Answer 3

• CT full body scan
• CT CA
• Endoscopic sampling
• Limited dissection
• Full autopsy

Question 4

Who can issue death certificate. [2]

Answer 4

• Doctor who has seen or treated deceased in 14 days before death + knows cause of death.
• Coroner who reviews and advices GP or doctor to issue certificate.

Question 5

Reasons to refer to coroner. [9]

Answer 5

Deaths that are:

• Of people <18.
• Within 24 hrs admission in hospital.
• Linked to medical treatment/ anaesthetics.
• Accidental
• Linked to drugs or medications.
• Suicidal possibility.
• Linked to suspicious circumstances/ history of violence.
• Linked to person’s occupation.
• Of people in custody under MHA.

Question 6

What is a post-mortem examination

Answer 6

Undertaken by coroner in deaths that are

• Unnatural
• Of unknown cause
• Those in custody

Ascertains

• Identify of deceased
• Time and place of death
• Cause of death

Question 7

Letulle method of evisceration

Answer 7

Method where the Thoracic, cervical, abdominal and pelvic organs are removed altogether, then dissection individually and inspected in detail.

Allows relationship between organ systems to be studied.

Question 8

Virchow’s method of evisceration

Answer 8

Organs are removed one by one, starting from the CNS–> Thoracic–> cervical–> Abdominal

Cannot observe the relationships between organ systems.

Question 9

Risk factors for atherosclerosis [9]

Answer 9

• Diabetes
• Hypercholesterolaemia
• Diet (fats, cholesterol)
• Smoking
• Overweight
• Sedentary lifestyle
• Psychological stress
• Hypertension
• Age

Question 10

Vascular wall features in atherosclerosis

• Fatty streaks
• Fibrous plaque

Answer 10

1. Fatty streaks
   - Foam cells in intima
   - Endothelial damage and dysfunction
2. Fibrous plaque
   - Fibrous cover plate (CT, muscle cells)
   - Necrotic nucleus (foam cells, cell debris, cholesterol crystals)

Question 11

Process of atherosclerosis

Answer 11

1. Endothelial damage due to atherosclerosis risk factors increases the wall’s:
   - lipid permeability
   - monocyte immigration
   - thrombocyte migration
2. Cholesterol, monocytes and platelets undergo changes in intima.
   - LDL enters the intima and is oxidised.
   - Platelets aggregate release growth and chemotactic factors
   - Monocytes differentiate into macrophages releases free oxygen radicals, growth and chemotactic factors
   - Myocytes migrate from media and proliferate
3. • Macrophages binds to oxidised LDL via scavenger receptor, phagocytose oxidised LDL=foam cells=forms plaque

Question 12

Day 1-2 post MI pathology

Answer 12

Coagulative necrosis
- Death of myocytes, loss of nuclei

Oedema
- In between myocytes, filled with neutrophils

Increase in contraction bands

Question 13

Day 3-4 post MI pathology

Answer 13

Coagulative necrosis
- More death of myocytes, lots of myocyte nuclei gone

Extensive inflammation

Question 14

Day 7-10 MI pathology

Answer 14

Granulation tissue formation

• Blood vessels
• fibroblasts

Susceptible to rupture