Hi - Post-Mortem Flashcards
describe the practical steps of a post mortem
- external examination
- incision from adams apple to pelvis
- remove ribs
- dissect out lungs and heart together
- dissect out bowel
- dissect out liver, stomach, pancreas, spleen
- dissect out kidneys, internal genitalia, ureters
- inspect bones for fractures, tumours
- assess each organ one by one
how can the length of time from death to post mortem affect the body
decomposition, decolouration, rigor mortis, temp/humidity changes, maggots, liquifactor necrosis of brain
why do previous heart surgeries make post mortem difficult
adhesions / fibrosis
how would pericarditis be seen in post mortem
adhesions
what is being observed in the heart at PM
muscle damage
valves
artery grafts
patent vessels inc coronaries
ventricles / lumen
size - hypertrophy
what % of body weight should the heart be in M and Fs
0.4% M
0.35% F
describe the processes that occur to the heart due to HF
hypertrophy
dilatation and thinning
baggy heart
end stage
what does a pale heart represent
ischaemia
what does a nutmeg liver indicated
back pressure on liver due to RHF
major cause of RHF
LHF
describe the steps in post MI rupture
MI –> fibrosis –> digestion of myocardium –> rupture
when would a post MI rupture happen
5 days post MI
causes of valve vegetations
infective endocarditis –> IVDU / dental
GI polyps
rheumatic fever
what is rheumatic fever
cross reactivity with strep sore throat
what valve is affected in rheumatic fever
mitral
how does a post mortem blood clot differ from an ante mortem blood clot at PM
PM = gelatinous
AM = vessel shape, solid, red to grey stripey colour change, valve impressions
what is the cause of black pigment commonly seen in the lungs
soot from industrialisation
what does frothy / bubbly fluid in lungs represent
pulmonary oedema
what is being observed in the lungs
parenchyma - tumours, pus, fluid
hilar - size
pleura - smooth/inflammed
airways
BVs - clots
thick, white, fibrotic outer covering of the lung. dx?
mesothelioma
what is the lag period of exposure in mesothelioma
20 years
what is mesothelioma
malignancy of pleura due to asbestos
what does a tumour look like at PM
white / creamy and invasive. like stilton
where does lung cancer met to
liver, brain, bone
what colour is a normal lung at PM
grey
what does a white lung at PM indicate
pneumonia
what do lung mets look like at PM
large white/brown circles
MANY of them
lumps of consolidation seen in lung at PM. Dx?
bronchopneumonia
little white dots all over lung at PM. Dx?
miliary TB
who gets miliary TB
homeless / IVDU
pre TB Tx
what does miliary TB look like
disseminated carcinoma
where is the appendix
end of the caecum
what does foecal peritonitis indicate on PM
perforation of bowel
what are outpouchings of the bowel mucosa called
diverticuli
what pathology can happen at stomach sphincter
H pylori
peptic ulcers
what 2 common pancreatic pathologies can and can’t be visualised at PM
cancer CAN
DM CAN’T - microscopic
what does a cut spleen look like
meaty
what does white dots on spleen indicate
infarction
what causes an enlarged spleen
malaria
leukaemia
what causes a small spleen & why
sickle cell - autoinfarcts
what is looked at in the gall bladder
stones ?
bright green bile present ?
blockages ?
white balls all through liver. Dx?
mets
what would primary cancer look like in the liver
cirrhotic liver
single nodule
florid fluffy area in colon. dx?
adenocarcinoma
where does bowel Ca metastasise to
liver / lung
what can cause a hole in the stomach
H Pylori
ulcer - if in peptic area
malignant - if elsewhere
where do cancers met to commonly
liver
lung
brain
bone
which 2 cancers commonly met to bone
breast
prostate
what is the consequence of a diverticuli rupture
peritonitis
fistulae
perforation
very bloody omental fat. Dx?
AAA rupture
why do you slice through the omental fat on PM?
look for bleeds / cancer
name the cancer of kidney collecting system
transitional cell
SCC
name the cancer of kidney parenchyma
renal cell carcinoma
which kidney stones are found in collecting ducts
staghorn calculi
how easy should it be to remove capsule off kidney in healthy PM?
VERY easy
nodular, pock marked kidney with capsule hard to remove from kidney. Dx?
HTN
contrast kidney cyst from PCKD
PCKD is whole kidney replaced by cysts
benign cysts filled with turbid fluid is not uncommon
bubbly looking kidney removed to make way for transplant. Dx?
PCKD
where do emboli come from that block renal artery
AF / infection that is throwing off clots
name a common gynae cancer
adenocarcinoma
does gynae cancer present late / early / single site / multi site
late presentation
multi areas affected
when would an ectopic burst the fallopian tube (wks)
8-11 weeks
consequence of a fallopian ectopic
burst fallopian tube –> haemorrhage –> high fatality
what type of cancer is in the testes
NOT carcinoma
yolk sac, semianoma, germ cell
PC of testicular cancer
20-30 year old man
large testes
prognosis of testicular cancer
good as caught early - massive testicle is hard to ignore
apperance of testicular cancer on PM
looks like cheese ball
why is it not always possible to do PM on brain
decomposes very quickly after death - liquid factor necrosis so liquefies
PC of extradural haemorrhage
whack on the side of the head
temporal bleed causes brief LOC
lucid interval
then rapid decline & death
what is a risk of extradural haemorrhage
coning due to raised ICP
2 main causes of SAH
ruptured berry aneurysm !!!
trauma
PC of SAH
sudden worst headache of their life - hit round the head with a baseball bat
can be small bleed (subclinical) –> fine –> HUGE bleed
age peak of SAH
40
what does haemorrhage look like PM
black
pale, irregular, discoloured “cream cheese” area of brain on PM. Dx?
tumour
what key definition is lost in brain tumour on PM
loss of white / grey matter definition
most common brain ca
mets
most aggressive brain ca
GBM
very black area on brain PM. Dx? & why is it so dark
melanoma mets - makes melanin so is dark
how do you write a death certificate
1a immediate cause of death
1b condition leading to 1a
1c condition leading to 1b
2 other present conditions not related to death
what is a very classic old people death certificate after stroke
1a LRTI
1b stroke
why would a death be referred to the coroner
suspicious circumstances around death or murder
sudden death
unknown cause of death
Dr not seen pt 28 days before they died
if person had their liberties removed
what group of conditions are not liked on death certificates
“failures” eg heart failure - need underlying cause
suitable alternative to cardiac failure on death certificates
MI / sepsis / aortic disease
is old age acceptable as a 1a cause of death
YES
is AKI / pulmonary oedema as 1a causes of death ok
NO - they are failures
list common causes of sudden unexpected death in the community
main 2:
illicit drug use
trauma related to alcohol
other common ones:
stroke
MI
rupture AAA
do you need consent for PMs?
hopsital PMs - YES
coroner PMs - NO
what is looked at in the gall bladder
stones ?
bright green bile present ?
blockages ?
