Forensic Pathology Flashcards
When should a forensic autopsy be performed?
- when we cannot exclude the possibility of crime
- when there is a possibility of malpractice
- to identify a body
Name the four aims of a forensic autopsy
- to examine unnatural and suspected unnatural death cases
- to detect, confirm or rule out criminal deaths
- to determine the cause of death
- to document and interprete other medical findings relevant to the police investigation
Define “cause of death”
The disease or injury that produces the physiological disruption inside the body resulting in death
Define “mechanism of death”
The physiological derangement that results in death
Define “manner of death”
How the death came about
Name the five types of manners of death
- natural
- accident
- suicide
- homicide
- undetermined
Name some characteristics of sudden death
- deaths from natural causes which can be sudden, unexpected, clinically unexplained or otherwise obscure
- it can be also defined as a death case within 1 hour or the onset of symptoms
- there is no unnatural element in their causation
- approx 50% of cases are caused by sudden, natural death
How can sudden deaths be subdivided?
- according to the mechanism of death
- according to age
- according to organs involved
Name some mechanisms of death
- hemorrhage, hypovolemic shock
- infection/sepsis
- ischaemia/hypoxia
- acidosis
- alkalosis
- arrythmia (asystole, ventricular fibrillation)
- respiratory depression and paralysis
- cardiac tamponade
Which organ system is most often involved in natural sudden death?
cardiovascular (56%)
followed by respiratory (16%), CNS and malignancies (both 8%)
What is coronary atherosclerosis?
The major cause of sudden cardiac death
- basic mechanisms:
- stenosis
- occlusion
- complications
- ulcerated plaques
- haemorrhage in the plaque
- coronary thrombosis
Acute myocardial infarction (AMI)
- mostly caused by atherosclerosis or its complications
- mostly located in the left ventricle
- types
- laminar infarct
- regional or focal infarct
Macroscopic changes after acute myocardial infarction AMi
- under the first day - nothing
- days 1-3 - demarcated and turns yellow; tigroid appearance (red streaks from breakdown of myocytes and hemorrhages)
- few days till few weeks - area becomes fragile and softer (myomalacia)
- from ca 3 weeks - the center becomes gelatinous and grey
- after circa 3 months - widespread fibrosis
Early microscopic changes of AMI
contraction bands
late (18-24 hours) microscopic changes after AMI
- Eosinophilia
- oedema
- variable cellular infiltration
- after 1 weeks - new capillaries and fibroblasts are appearing
Causes for hypertrophy of the heart
- hypertonia
- valvular heart disease (aortic stenosis)
- cardiomyopathy
- (obesity)
Name five cardiovascular causes of sudden death
- myocarditis, endocarditis
- rupture of aneurysm
- aortic
- cerebral
- pulmonary thrombo-embolism
- anatomic anomalies
- functional disorders
Name six functional disorders that may be cardiovascular causes of sudden death
- low-output state due to sepsis
- surgically repaired congenital heart defects
- coronary artery spasm
- vagal inhibition
- spontaneous ventricular fibrillation
- hereditary or acquired predisposition to arrythmia
Respiratory causes of sudden death
- asthma
- pneumonia
- pneumothorax
- tumour
- epiglottitis
- respirator hemorrhages
- functional disorders
Abdominal causes of sudden death
- bleeding in the alimentary tract
- esophageal varices
- mallory weiss syndrome
- gastric and duodenal ulcers
- carcinoma of the stomach
- mesenteric thrombosis and infarction
- acute pancreatitis
- strangulated intestines, hernia
- peritonitis (perforations)
- tumour
- vascular malformation
- cirrhosis
spelic rupture
Genitourinary causes of sudden death
- pyelonephritis
- ruptured ectopic pregnancy
- induced abortions
- amniotic embolism
Endocrine causes of sudden death
- adrenal hemorrhage
- pheochromocytoma
- hyper- and hypothyroidism
- pituitary inufficiency
- diabetic ketoacidosis
CNS causes of sudden death
- cererovascular accident
- ecephalomyelitis, meningitis, brain abscess
- tumour
- functional disorder (exclusion diagnosis)
Which organs/organ systems are the most common primary sources of infections resulting in sepsis?
lungs, abdomen, urnary tract
Name changes in three organs that are specific for chronic alcoholism
- liver
- fatty changes, cirrhosis
- heart
- alcoholic cardiomyopathy
- brain
- alcoholic cerebral degeneration
Name risk factors for SIDS
(sudden infant death syndrome)
- maternal smoking
- stomach sleeping
- co-sleeping
- overheating
- prematourity and low birth weight
- poor prenatal care
- mothers younger than 20 years of age
