Cell pathology 5 Flashcards
What are the cases that must be reported to a coroner?
- Unknown cause of death
- Deceased has not been seen by doctor after death or 14 days before death
- Death was violent/unnatural/suspicious
- Death due to accident
- Death due to neglect
- Death due to industrial disease / deceased persons employment.
- Death due to abortion
- Death during operation or whilst recovering from anaesthetic
- Death due to suicide
- Death during prison sentence or shortly after police custody
- Death related to poisoning
What does the coroners autopsy aims to do?
Establish the cause of death
What is a hospital autopsy?
Allows thorough examination of disease, extent of disease, treatment and effects
What are some reasons for conducting a hospital autopsy?
- Allows thorough examination of disease, extent/treatment/effects
- Useful for audit
- Monitoring effectiveness of new treatments
- Teaching
- Research
Benefit of death certificate?
Used for epidemiology, so mortality and morbidity data can be used to divide funds.
Consent in hospital autopsy vs coroners autopsy.
Hospital:
- consent must be obtained from next of kin
- ANY material can be taken with consent
Coroners:
- no consent needed
- only material pertaining to cause of death can be taken
3 most common causes of death in young people.
- Congenital disease
- Trauma
- Drugs and alcohol
What are the 9 natural causes of sudden unexpected death?
- Coronary Artery Disease
- Hypertensive heart disease
- Other cardiac causes
- Vascular system
- CNS
- Respiratory system
- Drugs
- Alcohol
- Trauma
Describe coronary artery disease.
75% deaths handled by medical examiners in USA
50% die suddenly, 25% without warning
- CARDIAC ARRHYTHMIA IS USUAL MODE OF DEATH
- Severe coronary artery atherosclerosis is most common anatomical finding (usually in 1/2 major vessels)/
- over 75% stenosis to cause death
What are some other findings of coronary artery disease?
Myocardial scarring
Coronary artery thrombosis
Acute/subacute MI
Describe hypertensive heart disease.
- Usually accompanied by coronary artery atherosclerosis.
- Cardiomegaly with symmetrical left ventricular hypertrophy.
- Acute cardiac arrhythmia = usual cause of death
List other cardiac causes of sudden unexpected death.
- Cardiomyopathy
- Myocarditis
- Structural anomalies
- Floppy mitral valve
- Aortic stenosis
- Conduction abnormalities
Describe vascular system sudden death.
- Ruptured aortic aneurism.
Associated with atherosclerosis and hypertension
Describe CNS sudden death.
- Non-traumatic subarachnoid haemorrhage.
2/3 symptomatic between 40-65 years
90% silent until rupture
- Intracerebral haemorrhage.
10-30% of all strokes
MOST COMMON CAUSE = hypertension
- Epilepsy
Describe respiratory system sudden death.
- Pulmonary embolus
2. Asthma
Describe GI tract sudden death.
- Bleeding oesophageal varices
- Bleeding ulcers
- Pancreatitis
Describe other causes of sudden unexpected death.
Drugs - 1% reported deaths
Alcohol - 1% reported deaths
- often associated with GI problems
What are the types of trauma
- Bruise
- Abrasion
- Laceration
- Cut
- Stab
Describe bruises.
- Contusion (blunt trauma)
- Occurs alone/conjunction with other injuries
BRUISE = extravasated collection of blood which has leaked from damaged small arteries, venues and veins, but not capillaries.
- Vessel fragility and coagulation affect bruising. They occur more easily where skin is lax
- You can bruise after death
Describe abrasions.
- Graze or scratch
- Most superficial blunt trauma injuries
- STRICTLY CONFINED TO EPIDERMIS
- May have a distal skin tag due to tangential force
- May not have distal skin tag if vertical force
Describe lacerations.
- Split to skin due to blunt force trauma, which overstretched the skin
- Usually pass through full thickness of the skin - deep and will bleed
- Margins ragged with crushing and bruising
- “Bridging fibres” arch across skin defect
- Common in areas where skin can be compressed between force and underlying bone.
- RARELY OVER SOFT FLESHY AREAS (e.g. arse/tits)
- “Flaying” = tangentially applied force which leads to a horizontal laceration
Difference between cut and stab?
Cut = length > depth
Stab = depth > width
Describe cut and stab wounds.
- Clean, well demarcated edges
- Minimal injury to surrounding tissue
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