Cell Pathology 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 is the criteria for reporting deaths to the coroner
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
Describe the coroner’s autopsy
Conducted to establish the cause of death
Once Coroner has the cause of death his remit is over
What are the rules of the role of the coroner based on
Laws in the 1950s
Coroners in different legal systems will have different roles and responsibilities.
What is an exception of a deprivation of liberty
When the patient dies in their own home
Describe the difficulties in establishing the exact cause of death after surgery
May have had multiple surgeries (endoscopies, ventilation, anaesthetic) difficult to know exactly what caused the patient’s death
List the reasons for a hospital autopsy
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.
Describe the differences in the regulations for consent in hospital and coroner autopsies
Hospital
Consent must be obtained from next of kin
Coroners
No consent of next of kin needed (but their wishes should be considered)
Describe the differences in the material that can be taken in each of the autopsies
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)
What is a death certificate
Filled in for any death
Taken to Registrar by family
Scrutinised and must be correct before registration of death possible
Describe the structure of a death certificate
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
Describe the statistics associated with cardiovascular disease
75% (approximately) of deaths handled by medical examiners in USA
50% die suddenly
25% die without any preceding history or warning
What is the usual mode of death for patients with cardiovascular disease
Cardiac Arrhythmia is usual mode of death
What is the most common finding in patients with CVD
Severe coronary artery atherosclerosis is most common anatomical finding
Usually in 2 or more major vessels
Usually 75% or greater stenosis to cause death
What other findings may be evident in autopsies of patients who have died from CVD
Myocardial scarring
Coronary artery thrombosis
Acute or subacute MI
What happens if arrhythmia is the major cause of death
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
Describe hypertensive heart disease
Usually accompanied by coronary artery atherosclerosis
Cardiomegaly with symmetrical left ventricular hypertrophy
Acute cardiac arrhythmia is usual cause of death
Describe the other cardiac causes of sudden unexpected death
Cardiomyopathy Myocarditis Structural anomalies (eg bridging) Floppy mitral valve Aortic stenosis (usually calcific) Conduction abnormalities (eg long QT syndrome)
Describe sudden unexpected deaths associated with the vascular system
Ruptured Aortic Aneurism Associated with: Atherosclerosis & Hypertension
Describe sudden unexpected deaths associated with the nervous system
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
What are the difficulties with epilepsy
Poorly controlled, lack of compliance, unwillingness to seek medical help
Describe sudden unexpected deaths associated with the respiratory system
Pulmonary embolus
Asthma
Describe sudden unexpected deaths associated with the gastrointestinal tract
Not usually unexpected or sudden
Unusual cause of Sudden Death
Bleeding Oesophageal Varices
Bleeding Ulcers
Pancreatitis
Describe the un-natural sudden unexpected deaths associated with alcohol
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
