Histopathology 2: Autopsy

Question 1

What are benefits of autopsy?

Answer 1

1. Final diagnosis and cause of death
2. Provides family of deceased with closure and can inform genetic diseases.
3. Public health: Inform epidemiological statistics
4. Medical education: Provision of teaching materials
5. Medical Research: Discover new diseases.

Question 2

What are the different autopsy types?

Answer 2

1. conventional: hospital/coroner
2. Forensic autopsy
3. Minimally autopsy: CT scan/ Coronary angio/ endoscopic sampling

Question 3

Who issues the death certificate?

Answer 3

A Medical Certificate of Cause of death is needed to register the death of a person.
This may be issued by a doctor who has treated or seen the deceased in the 14 days before death and knows the cause of death
OR
The coroner reviews the case, is satisfied that death was due to a natural cause and instructs a hospital doctor or the GP to issue the certificate.

Question 4

What are the mandatory reasons for referring to coroner or the police?

Answer 4

All deaths of children and young people under 18, even if due to natural causes
Deaths within 24 hours of admission to hospital
Deaths that may be linked to medical treatment, surgery or anaesthetic procedure
Deaths that may be linked to an accident, however long ago it happened
Deaths that may be linked to drugs or medications, whether prescribed or illicit
If there is a possibility that the person took their own life
If there are any suspicious circumstances or history of violence
Deaths that may be linked to the person’s occupation, for example if they have been exposed to asbestos
All deaths of people who are in custody or detained under the Mental Health Act, even if due to natural causes

Question 5

What does an autopsy ascertain ?

Answer 5

Identity of the deceased
			Time of death
			Place of death
			Cause of death (on the balance of probability)
Possibly an inquest?

Question 6

how do we lay out the cause of death on a certificate?

Answer 6

1a: Myocardial infarction
due to
1b: Coronary thrombosis (left anterior descending artery)
due to 
1c: Coronary atherosclerosis

2 Other significant contributing conditions but not related to the direct cause (e.g. diabetes, malignancy, chronic conditions, …)

Question 7

how do you start an autopsy ?

Answer 7

External examination as for a living patient.

Question 8

Describe Letulle’s method of evisceration

Answer 8

all the organs are removed as one large mass and then dissect each organ.

Question 9

Describe Virchow’s method of autopsy

Answer 9

the organs are re- moved one by one and dissected as removed. This approach is good for demonstrating pathological change in individual organs, especially in high- risk autopsies or where permission is limited to one organ.

Question 10

What are the risk factors for atherosclerosis

Answer 10

diabetes 
obesity 
smoking 
poor diet lack of excercise 
hypercholestroleamia 
psychological stress 
HTN 
Age

Question 11

Describe the process of atherposclerosis

Answer 11

1. endothelial damage from HTN/ smoking/ DM/ hyperlipidaemia2. Increased lipid permeability and monocyte adhesion and immigration.
   Monocytes becomes macrohphages in the tissue and phagocytose lipids becoming oxidised and form foam cells. forming an atheroma.
   thrombocyte aggregation also takes place and there is proliferation of the myocytes in the intima.

Question 12

when would atherosclerosis then cause disease?

Answer 12

1. Plaque rupture and thrombus formation
2. anuerysm and rupture
3. critical stenosis

Question 13

what are the changes seen in the tissues post MI

Answer 13

1-2 days = coagulative necrosis,oedema and neutrophils

3-4 days: coagulative ncerosis, extensive inflammation