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Cell Pathology > Cell Pathology 5- The Autopsy > Flashcards

Cell Pathology 5- The Autopsy Flashcards

1
Q

What is a coroner

A

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

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2
Q

What is the criteria for reporting deaths to the coroner

A

The 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
The death was violent, unnatural or suspicious
The death may be due to an accident (whenever it occurred)- accident may have happened a long time ago

The death may be due to neglect by self or others
/ The death may be due to an industrial disease or due to the deceased persons employment- asbestos- mesothelioma
The death may be due to an abortion

The death occurred during an operation or before recovery from the effects of an anaesthetic
The death may be a suicide
The death occurred during or shortly after detention in police or prison custody
The death may be related to poisoning
If any doubt the case must be discussed with the coroner’s office

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3
Q

Describe the coroner’s autopsy

A

Conducted to establish the cause of death

Once Coroner has the cause of death his remit is over

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4
Q

What are the rules of the role of the coroner based on

A

Laws in the 1950s

Coroners in different legal systems will have different roles and responsibilities.

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5
Q

What is an exception of a deprivation of liberty

A

When the patient dies in their own home

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6
Q

Describe the difficulties in establishing the exact cause of death after surgery

A

May have had multiple surgeries (endoscopies, ventilation, anaesthetic) difficult to know exactly what caused the patient’s death

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7
Q

List the reasons for a hospital autopsy

A

Allows a very thorough examination of the deceased, the extent of their disease, their treatment and its effects
Audit – Major discrepancies between stated cause of death and actual cause of death
Monitoring effectiveness of new treatments
Eg complex congenital heart disease

Teaching
Eg unrivalled clinic pathological correlation
Research
Eg knowledge of variant CJD relies heavily on study of post mortem brain tissue
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.

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8
Q

Describe the differences in the regulations for consent in hospital and coroner autopsies

A

Hospital

Consent must be obtained from next of kin

Coroners

No consent of next of kin needed (but their wishes should be considered)

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9
Q

Describe the differences in the material that can be taken in each of the autopsies

A

Hospital

With consent any material can be taken

Coroners

Material can only be taken if it bears upon the cause of death (with Coroners permission)

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10
Q

What is a death certificate

A

Filled in for any death

Taken to Registrar by family

Scrutinised and must be correct before registration of death possible

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11
Q

Describe the structure of a death certificate

A

1a- Immediate cause of death (must be filled in)
1b-Predisposing factor
1c- Predisposing factor
2- Other factors contributing to death, but not directly related to death
1b leads to 1a

1b leads to 1c

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12
Q

Describe the statistics associated with cardiovascular disease

A

75% (approximately) of deaths handled by medical examiners in USA

50% die suddenly

25% die without any preceding history or warning

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13
Q

What is the usual mode of death for patients with cardiovascular disease

A

Cardiac Arrhythmia is usual mode of death

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14
Q

What is the most common finding in patients with CVD

A

Severe coronary artery atherosclerosis is most common anatomical finding

Usually in 2 or more major vessels

Usually 75% or greater stenosis to cause death

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15
Q

What other findings may be evident in autopsies of patients who have died from CVD

A

Myocardial scarring
Coronary artery thrombosis
Acute or subacute MI

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16
Q

What happens if arrhythmia is the major cause of death

A

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 is usually stated as 1a- Ischaemic heart disease

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17
Q

Describe hypertensive heart disease

A

Usually accompanied by coronary artery atherosclerosis

Cardiomegaly with symmetrical left ventricular hypertrophy

Acute cardiac arrhythmia is usual cause of death

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18
Q

Describe the other cardiac causes of sudden unexpected death

A 
Cardiomyopathy
Myocarditis
Structural anomalies (eg bridging)
Floppy mitral valve
Aortic stenosis (usually calcific)
Conduction abnormalities (eg long QT syndrome)
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19
Q

Describe sudden unexpected deaths associated with the vascular system

A 
Ruptured Aortic Aneurism 
Associated with:
Atherosclerosis
&
Hypertension
20
Q

Describe sudden unexpected deaths associated with the nervous system

A 
Non traumatic subarachnoid haemorrhage: 
Berry aneurism
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 Hypertension

Epilepsy

21
Q

What are the difficulties with epilepsy

A

Poorly controlled, lack of compliance, unwillingness to seek medical help

22
Q

Describe sudden unexpected deaths associated with the respiratory system

A

Pulmonary embolus

Asthma

23
Q

Describe sudden unexpected deaths associated with the gastrointestinal tract

A

Not usually unexpected or sudden
Unusual cause of Sudden Death

Bleeding Oesophageal Varices

Bleeding Ulcers

Pancreatitis

24
Q

Describe the un-natural sudden unexpected deaths associated with alcohol

A

Associated with 1% of deaths reported to the Coroner 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

25
Q

Describe the un-natural sudden unexpected deaths associated with drugs

A

Associated with 1% of deaths reported to the Coroner

26
Q

Describe the 2 different types of trauma

A

Self-induced

Caused by others

27
Q

What is a bruise or contusion

A

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

28
Q

How do bruises occur

A

A blunt trauma injury

Occurs alone (skin intact)
or
is associated with other injuries

29
Q

What facilitates bruising

A

Occur more easily where skin is lax

Fragility of vessels, coagulation state etc all effect bruising

30
Q

Describe the characteristics of bruises

A

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

31
Q

Can you bruise after death

A

You can bruise after death (but usually small and lie on dependant parts)

32
Q

What may be confused with bruises

A

Not everything is a bruise:

Eg Pink areas may be due to hypothermia

33
Q

Should you attempt to age a bruise

A

no

34
Q

What is meant by an abrasion

A

A graze or scratch

The most superficial of blunt trauma injuries

35
Q

Where are abrasions confined to

A

Confined to the epidermis (strict definition) but may actually extend into the superficial dermis due to skin anatomy)

Can occur before and after death

36
Q

What are abrasions caused by

A

Due tangential force – may have a distal skin tag Eg Friction burn

Or vertical force Eg Stamp – no distal skin tag

37
Q

List some examples of abrasions

A 
Friction burn
Car radiator
Flooring
Whip
Stamp
38
Q

What is meant by a laceration

A

A split to the skin

The result of blunt force overstretching the skin

Usually pass through the full thickness of the skin

39
Q

How do lacerations appear

A

They are deep and will bleed

Margins ragged with crushing and bruising

“Bridging fibres” arch across the skin defect

40
Q

Where are lacerations common

A

Common where skin can be compressed between the force and underlying bone
Eg Scalp, elbow, shin

Rare over soft fleshy areas
Eg Buttocks, breasts

41
Q

What causes a laceration

A

“Flaying” – tangentially applied force leading to a horizontal laceration

Poor reproduction of the object causing it

42
Q

Describe a cut

A

The length of the injury is longer than its depth

43
Q

Describe a stab

A

The depth of the wound is greater than the width

44
Q

What are cut and stab wounds caused by

A

Causes 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

45
Q

How do cut and stab wounds appear

A

Edges are clean and well demarcated

Minimal injury to surrounding tissue

46
Q

What are the procedures with cut and stab wounds

A

Information about weapon type can be gained from the wound
But
Beware of over interpretation

47
Q

Describe the discrepancy associated with incised wounds

A

“Incised Wounds”
Some discrepancy in terms used (Knight)

To some (eg Rutty/Burton) includes cuts & stabs

To others (eg Shepherd) is synonymous just with cuts.

Cell Pathology (6 decks)

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