Day 2- Lecture 2- Learning From The Dead

Question 1

History- why did some medical schools conduct autopsies in the winter?

Answer 1

As dissection was challenging experience due to the lack of refrigeration- so in the winter it would reduce the rate of decomposition

Question 2

When do most dissections take place now?

Answer 2

Part of the postmortem or autopsy

Question 3

What are the 3 different autopsies carried out in the 21st century?

Answer 3

Medicolegal

• Performed on behalf of the HM coroner
• No consent is needed

Forensic

• Sub-type of coroner’s post-mortems
• Suspicious deaths

Consent (hospital)

• Consent from next of kin
• May limit examination

Question 4

What is involved in a autopsy?

Answer 4

History
-Often limited in coroner’s cases

External examination

• Natural disease
• Injury
• Medical Intervention
• With or without imaging

Internal examination

• All systems examined in most cases
• BUT limited sometimes especially in consent cases

Question 5

What are the additional tests taken?

Answer 5

Histology (tissue is fixed, stained and looked at under a microscope)

• For making a diagnosis
• For confirming a diagnosis

Toxicology

• Blood, urine, vitreous, bile etc
• Therapeutic drugs (see if overdosed in hospital)
• Recreational drugs

Biochemistry

• Diabetic ketoacidosis
• Alcoholic ketoacidosis
• Renal failure (test urea and creatine)

Microbiology
-Bacteria, viruses and fungi

Genetics
-DNA fingerprinting

Question 6

Name and outline the different types of autopsy?

Answer 6

NEUROPATHOLOGY:
-Specialised branch of cellular pathology
Restricted too... 
-CNS
-Peripheral nerves
-Muscle 
Relevant autopsies
-Trauma 
-Neurodegenerative disease
-Research 

PAEDIATRIC PATHOLOGY: 
-Paediatric pathologists are trained in paediatric surgical pathology and autopsy 
Occur when...
-Deaths in utero
-Perinatal deaths
-Death in infancy (e.g. Sudden infant death)
-Suspicious deaths (in conjunction with forensic pathologists)
Other info...
-Challenging emotionally and technically 
-Vital in providing answers for grieving families and medical staff
-Parents want to know about 'next time' 
-Medicolegal issues
-Safeguarding issues
-Teaching and research 
Examples....
-Macroscopic examination 
-Microscopic examination 
-Toxicology 
-Microbiology
-Genetic studies 

Forensic pathology

• Small speciality
• More than just autopsies

Question 7

What do the autopsies provide? (In general)

Answer 7

• Explanations for families
• Forms part of the legal process
• Confirms or refutes criminality
• Raises or alleviates concerns in health and social are settings

Question 8

What information has examination of dead bodies over centuriesprovided?

Answer 8

• Detailed information of anatomy
• Opportunity to relate structure to function
• Study of effects of disease processes
• Evidence for criminal proceeding
• Ability to assess the impact of therapeutic interventions

Question 9

Is research involving autopsies still continuing?

Answer 9

Yes, particularly with neurodegenerative disorders. There is often discrepancy between ante-mortem and post-mortem (so diagnosed with something however, after post mortem realise it was actually a different diagnosis)

Question 10

Give some examples of when a medicolegal autopsy may be carried out?

Answer 10

• Legal requirement
• Deceased unknown
• Deceased not seen by a doctor within 14 days of death
• Attending doctor not able to give cause of death
• Obviously unnatural death (murder, accident, suicide)
• Death related to occupational disease or accident
• Death related to medical treatment or procedure
• People who are in care of the state prisoners, detained in hospital under mental health act)

Question 11

What are the 4 body parts which can lead sudden death?

Answer 11

• Head
• Heart
• Blood vessels
• Lungs

Question 12

What is the benefits of post-mortem imaging

Answer 12

• Reduces the need for invasive autopsy

- Already used in forensic cases