L5: Learning From The Dead

Question 1

What has examination of dead bodies over the centuries provided?

Answer 1

Information about anatomy
Opportunity to relate structure to function
Study effect of disease processes
Allow clinicopathological correlation/ cause of death
Evidence of criminal proceeding
Ability to assess the impact of therapeutic interventions

Question 2

Are we still learning from the dead?

Answer 2

Yes

• Modern imaging technique, biochemistry, biopsies—> provide valuable information in life but do not explain everything
• Continued discrepancy between ante-mortem (before death) and post-mortem (after death)
• Research into neurodegenerative disorders
• Research studies involving autopsies are continuing

Question 3

How did they use early human dissection? What was the problem with it?

Answer 3

Created detailed drawings and wax models

Frowned upon by religious authorities
Clandestine (secretive) activity

Question 4

How is cadaveric dissection seen nowadays? What is it used for?

Answer 4

Rite of passage
Privilege
Used in medical education

Question 5

What was the problems with cadavers dissection in medical education in the past?

Answer 5

Body snatching—> resurrection men—> dug up graves

Burke and Hare—> murders —> kill people and sell their bodies to medical schools

Question 6

Define autopsy?

Answer 6

To see for oneself

Question 7

What are the different types of autopsy?

Answer 7

Medicolegal—> no consent needed (often family kill patient and may try to hide it by not allowing autopsy)—> requested by HM coroner —> legal requirement
- CT scanner commonly used to prevent body being opened up

Forensic—> Suspicious deaths
- Sub-type of Coroner’s post-mortems e.g. potential murder

Consent (hospital) —> consent needed
- Limit examination—> say what they want and don’t want

Question 8

Why are coroner’s autopsies carried out?

Answer 8

• Legal requirement
• Deceased unknown—> often in larger cities e.g. London
• Decreased not seen by Doctor within 14days before death —> unless long term chronic patient whose cause of death was obvious
• Attending Dr unable to give cause
• Unnatural death (murder, suicide, accident)
• Death related to occupational disease or accident
• Death related to medical treatment or procedure
• All people attained by the state (prison, mental hospital)—> protection—> ensures deaths not unnatural

Question 9

How is an autopsy carried out?

Answer 9

Patient history looked at (limited in Coroner’s cases)
External examination (natural disease, injury, medical intervention)
Internal examination (all systems, limited (consent cases))

Question 10

What additional tests are often requested?

Answer 10

Histology —> tissue sample microscope
-make or confirm diagnosis
Toxicology —> blood, urine, bile, vitreous (fluid in eye
-look for therapeutic and recreational drugs, some
Biochemistry —> determine if pt died from diabetic ketoacidosis, alcoholic ketoacidosis, renal failure etc…
Microbiology—> Bacteria, viruses, and fungi—> swabs identify particular organisms
- problem—> translocation of organisms—> barriers break down releasing them
Molecular—> genetic testing
- identify suspect, eliminate suspect, genetic disease testing, identification of pt

Question 11

What are the most common causes of sudden death?

Answer 11

Head (haemorrhage, stroke)
Heart (MI, thrombosis, valvular disease)
Blood Vessel (aneurysm, thrombosis (blood clot develops in vessel), embolisms (bit of clot or something from elsewhere gets stuck)
Lungs (bronchopneumonia)

Question 12

What can happen in the head to cause sudden death?

Answer 12

Extradural haemorrhage—> outside the dura—> temporal region trauma—> bleeding slowly—> increased in pressure

Subdural haemorrhage—> under the dura—> raised intracranial pressure

Subarachnoid haemorrhage—> blood in subarachnoid space

Stroke—> ischaemic (no blood or O2–> necrosis), Haemorrhagic (ruptured artery)

Question 13

What can happen in the heart to cause sudden death?

Answer 13

MI—> tissue death—> no blood supply
Coronary thrombosis—> blocking of vessel
Ruptured vessel or part of heart—> hemopercardium (blood in pericardial sac)
Valvular disease—> bacteria on valves, infected endocarditis/ stenosis etc—> backflow of blood —> systemic effect of infection too

Question 14

What is cardiomyopathy?

Answer 14

Non ischaemic, non inflammatory disease of heart muscle (stretched, thickened or stiff)
Types:
-Hypertrophic
-Arrhythmogenic right ventricular cardiomyopathy
-Obstructive
-Dilated

Young people affected

Question 15

What defects in the vascular system can lead to sudden death?

Answer 15

Ruptured abdominal aortic aneurysm

Deep vein thrombosis and pulmonary embolism

Question 16

What is peritonitis?

Answer 16

Inflammation of the peritoneum

E.g. ruptured intestine—> bacteria on peritoneum

Question 17

What is the advantages of post-mortem imaging?

Answer 17

Non invasie
CT, MRI
Coronary angiogram—> possible in deceased

Question 18

What is neuropathology?

Answer 18

Branch of cellular pathology of CNS, PNS, muscles
Type of autopsy after head injury (trauma) or neurodegenerative disease
Used for AD, Lewy body dementia etc…

Question 19

When would paediatric autopsy be carried out?

Answer 19

After deaths

• In Utero
• Perinatal
• Sudden infant death
• Suspicious deaths

Question 20

Why are paediatric autopsies important?

Answer 20

• Answer for grieving families and medial staff
• Parents want to know about ‘next time’ —> was there a genetic abnormality meaning it’ll happen again etc
• Medicolegal issues—> has child suffered injuries—> prosecution or safeguarding issues for other children
• Teaching and research - more about congenital disease

Question 21

How are paediatric autopsies carried out?

Answer 21

Similar to normal
-macroscopic examination 
-microscopic examination 
-Toxicology
-Microbiology 
—> in utero infections 
—> sudden infant death 
-Genetic studies- perinatal or intrauterine death 
—> karyotyping

Question 22

Why are autopsy important?

Answer 22

Learning 
Health statistics
Support research 
Forms part of legal process (civil and criminal) 
Helps relatives
—> explains what happened
—> alleviates concerns 
—> genetic disease
—> likelihood of recurrence