Learning from the dead Flashcards
Examination of dead bodies over centuries has provided
- Information about anatomy
- Opportunity to relate structure to function
- Ability to study the effects of disease processes and allow clinicopathological correlation/cause of death
- Evidence for criminal proceedings
- Ability to assess the impact of therapeutic interventions
Do we still learn from the dead?
- Modern imaging techniques, biochemistry, biopsies etc provide valuable information in life but do not explain everything
- Discrepancy between ante-mortem and post-mortem diagnosis
- Neurodegenerative disorders
- Research studies involving autopsies are continuing e.g. (in Leicester) chronic renal disease, lung cancer
History of dissection
- Frowned upon by religious authorities
- Used to be a secret activity
- Detailed drawings and wax models produced
- Used in medical education
- Body snatching e.g. Burke and Hare
autopsy means
to see for oneself (same as a post-mortem)
autopsy is the same as a
post-mortem
types of autopsy
medicolegal
forensic
consent
medicolegal autopsy
- Performed on behalf of the HM coroner
- No consent needed
Foresenic autopsy
- Sub-type of coroners post-mortems
- Suspicious deaths
consent autopsy
- Consent from next of kin
- May limit examination (relatives wishes)
when are coroners autopsies carried out
- 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
What’s involved in an autopsy?
history
external examination
internal examination
history during a coroners autopsies
often limited
external examiantion in coroners autopsies
- Natural disease
- Injury
- Medical intervention
internal examination during a coroners autopsy
- All systems usually
- Limited sometimes- especially in consent cases
additional tests in a coroners autopsy
histology
toxicology
biochemistry
microbiology
molecular
histology
- For making a diagnosis
- For confirming a diagnosis
Toxicology
- Blood, urine, vitreous, bile etc
- Therapeutic drugs
- Recreational drugs
Biochemistry
- Diabetes quite hard to diagnose because cells use glucose after death (BG may be normal level at time of autopsy)
- Diabetic ketoacidosis
- Alcoholic ketoacidosis
- Renal failure
Microbiology
Bacteria
Viruses
Fungi
Molecular
- Identification/ elimination of suspect
- Test for genetic diseases e.g. cardiomyopathy
genetic fingerpritning
- First described in Leicester by Prof. Sir Alec Jeffreys
- First murder case solved by genetic fingerprinting also in Leicester
- Colin Pitchfork- Murdered two young girls
Common causes of sudden death: Head
- Extradural haemorrhage
- Subdural haemorrhage
- Sub-arachnoid haemorrhage
- Stroke
- Ischaemic
- Haemorrhagic
Common causes of sudden death: Heart
- Coronary thrombosis
- Valvular disease
- Cardiomyopathy
- Non-ischaemic
- Non-inflammatory disease of heart muscle
- Hypertrophic
- Arrhythmogenic right ventricular cardiomyopathy
- Obstructive
- Dilated
Common causes of sudden death: blood vessels
- Rupture abdominal aortic aneurysm
- Deep vein thrombosis and pulmonary embolism (where thrombus has travelled from sit of origin to new tissue)
- Peritonitis
Common causes of sudden death: lungs
bronchopneumonia
Post-mortem imaging
- Reduces the need for invasive autopsy
- Used in forensic cases as an adjunct to autopsy
- Research in Leicester
in neuropathology cellular pathology restricted to
- CNS
- Peripheral nerves
- Muscle
relevant autopsies for neuropathology
trama and neurodegenerative disease
padiatric pathology
Trained in paediatric surgical pathology and autopsy
- Deaths in utero
- Perinatal deaths
- Deaths in infancy
- Suspicious deaths (in conjunction with forensic pathologists)
why do padiatric pathology
- Vital in providing answers for grieving families and medical staff
- Parents want to know about ‘next time’
- Medicolegal issues
- Safeguarding issues
- Teaching and research
investigations done in paediatric pathology
- Macroscopic examinations
- Microscopic examination
- Toxicology
- Microbiology
- In utero infections
- Sudden infant death
- Genetic studies
- Karyotyping
forensic pathology
- Forensic pathology
- Small speciality
- Best known to public
- More than just autopsies
- Not like TV
