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General Pathology > postmortem > Flashcards

postmortem Flashcards

1
Q

Examination of a body after death to discover the cause of death is called?

A

autopsy

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2
Q

list the types of autopsies

A

1) Hospital
2) Corner’s
3) Forensic

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3
Q

describe the types of autopsies

A

1) Hospital autopsies (requested by treating surgeon or next of kin) – not legal aspect 5%
2) Corner’s autopsy (officer appointed by the department of justice- lawyer/dr)- most common – next of kin consent not required 90%
3) Forensic autopsies - criminal cases (dr appointed by DOJ- nothing to do with the hospital) 1%

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4
Q

why an autopsy is important?

A

1) 20% of cases have diagnoses that were not known when they were alive
2) If next of kin are unhappy with the management of the patient, the autopsy provides objective evidence of how well or badly the patient was managed
3) good audit of hospital service

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5
Q

what indicates thinning, a fibrotic wall at the tip of the heart found during the autopsy?

A

indicates old, healed myocardial infarction.

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6
Q

what is the significance of myocardial wall aneurysm developed after Myocardial infarction?

A

predispose to thrombus formation and systemic embolization

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7
Q

during autopsy blood seeping from the retroperitoneum probably indicates?

A

ruptured abdominal aortic aneurysm

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8
Q

what is splinter hemorrhage?

A

A thin, linear collection of blood that accumulates under the nail plate due to rupture of nail bed capillaries. Etiologies include trauma, nail psoriasis, infective endocarditis.

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9
Q

vegetations on heart valves are seen with?

A

infective endocarditis

are composed of thrombosis and bacteria

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10
Q

autopsy of a patient dies due to ascending cholangitis will show?

A

of suppurative pus seeping from ductules

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11
Q

what is the classic mode of death seen in hypertensive scleropathy?

A

intracerebral hemorrhage

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12
Q

pale lung on autopsy indicates

A

pulmonary embolism that has blocked pulmonary artery

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13
Q

a subdural hematoma is usually of venous or arterial origin?

A

venous, so develops slowly over days

vs epidural hematoma

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14
Q

what is the most common cause of subarachnoid hemorrhage?

A

due to rupture of a pre-existing berry aneurysm (which is usually due to long-standing hypertension, can be congenital, associated with ADPKD)

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15
Q

a hospital autopsy is done at the request of?

A

a clinician or the next of kin, and requires the written consent of the next of kin

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16
Q

by whom consent is taken?

A

senior physician

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17
Q

do retain of organs/tissues for research/teaching/diagnosis require written consent?

A

yes

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18
Q

do we need to explain the next of kin what is an autopsy?

A

yes

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19
Q

describe Coroner’sautopsy

A

Ordered by Coroner

Are all legal cases

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20
Q

when Coroner’s autopsy is required?

A

Required when a death cert cannot be signed because the cause of death is not known

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21
Q

which death cases will go for Coroner’s autopsy?

A
  • All drownings
  • All poisonings
  • All suicides
  • All road traffic accidents
  • All deaths in institutions (prison, long-stay nursing homes, hospitals, etc.)
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22
Q

what medical conditions resulting in death require coroner’s autopsy?

A
  • All deaths within 24hours of admission to hospital
  • All deaths within 24 hours of an invasive procedure
  • All deaths where MRSA, Clostridium Difficile are implicated
  • All deaths due to notifiable diseases
  • Other cases to be reported to the Coroner are “online” on Beaumont Hospital computer system
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23
Q

what is the role of Coroner’s autopsy?

A
  • Cause of Death

* Place of Death

24
Q

does Coroner’s autopsy require the permission of the next of kin?

A

Do not require permission from the next of kin

25
Q

does Coroner’s autopsy need to be asked

A

no

26
Q

does permission to retain organs for diagnosis/research is necessary from next of kin

A

no

27
Q

what is a limited autopsy?

A

Where next of kin agree only to a partial autopsy (hospital autopsy- only applies to hospital death)

28
Q

Coroner’s autopsy can be limited or partial. True/False

A

False

29
Q

when a forensic autopsy is carried?

A
  • Where a criminal cause of death is suspected

* Carried out by Forensic Pathologist

30
Q

do you need to leave drains, IV lines, catheters, endotracheal tubes in situ in a forensic autopsy?

A

yes

31
Q

what is rigor mortis

A

A stiffening of the muscles after death. Caused by persistent attachment of actin and myosin due to lack of ATP. It begins (depending on temperature, humidity, and atmosphere) within 1-4 hours after death and begins to resolve ~ 24 hours after death (due to decomposition).

32
Q

what is livor mortis ( postmortem lividity)

A

1) Definition: postmortem discoloration of the skin, resulting from blood pooling into the interstitial tissues under the force of gravity
2) Occurrence
- At least 30 minutes to 2 hours after onset of death
- Maximum observed at 6–12 hours
3) Location
- Blood pools in areas of dependency under the force of gravity
- The person died lying face-up: the back of the corpse
- Hanging death: feet, fingertips and ear lobes
- Drowning: face, upper chest, hands, lower arms, feet, and calves
- Lividity is evident on the ear lobes and the nail beds
- Also occurs in visceral organs (e.g., lungs)
4) Features
- Redistribution: lividity can be altered up to 6 hours after onset of death
- Blanching: skin will turn white when applying pressure within the first ∼ 12 hours
5) Color:
- the intensity of color depends on the amount of hemoglobin in the blood
- Bluish-purple: normal lividity
- Greenish-red: hydrogen sulfide (produced in decaying organic matter)
- Dark brown: phosphorus poisoning
- Brownish-red: poisoning with methemoglobin-forming substances (such as nitrite or aniline)
- Pale pink (barely pronounced): blood loss, severe anemia, severe hemorrhage
- Cherry red: carbon monoxide poisoning
- Bright red: cyanide poisoning

33
Q

describe the actions on the chest during an autopsy

A

• Sternum and ribs removed
• Check for pulmonary embolus whilst organs in situ
• Check for pneumothorax whilst organs are in situ
• Remove the heart and lungs together after separating off the lower esophagus
• Check for broken ribs
• Check for asbestos in the chest wall
• Check for pleural effusions
• Weigh each lung and the heart separately
- Lungs abnormal – 300+ grams each
- Heart abnormal >500g i.e. enlarged

34
Q

what is the weight of a single lung that is abnormal

A

300g

35
Q

what is the weight of the heart that is abnormal?

A

> 500g

36
Q

what do you need to check in chest while organs are in situ?

A

check for pulmonary embolus, pneumothorax

37
Q

what you should look on the heart during an autopsy

A
  • Look for left ventricular hypertrophy
  • Examine coronary arteries for atheroma and thrombus
  • Look for left ventricular wall infarct
  • Look for interventricular septum thickening
38
Q

what you should look on the lungs during an autopsy

A
  • Pulmonary embolus
  • Pneumonia
  • Pleural effusion
  • Emphysema
  • Tumour
  • Signs of Status Asthmaticus - Solid viscid mucin secretions in the bronchi and expanded hyperinflated lungs
39
Q

how to look for status asthmaticus?

A

Solid viscid mucin secretions in the bronchi and expanded hyperinflated lungs

40
Q

what you should look in the stomach during an autopsy

A
  • How much food? What food? Any tablets?
  • Any ulcer/bleeding?
  • Any esophageal varices?
  • Contents for toxicology if appropriate
41
Q

what you should look in the liver during an autopsy

A
  • Weight <2kg
  • Any cirrhosis?
  • Any malignancy?
  • Bile for toxicology if appropriate
42
Q

what you should look in the kidneys during an autopsy

A
  • Weight of each <200g
  • Cortical/medullary ratio
  • Pelvis- any obstruction?
  • Ureters- Any obstruction?
  • Bladder- how much urine and toxicology (if appropriate)?
  • Prostate – Enlarged?
43
Q

what is the normal weight of a single kidney?

A

<200 g

44
Q

what you should look in the brain during an autopsy

A
  • Weight
  • Any hemorrhage?
  • Any atrophy – dementia?
  • Any meningitis/abscess?
  • Any tumor?
  • Any herniation?
45
Q

do you need to take samples from all organs for microscopy?

A

yes

46
Q

which samples should be taken for the toxicology screen if the cause of death is unknown?

A
  • Blood
  • Urine
  • Bile
  • Aqueous Humour – K+ and Na+
47
Q

when sterile techniques are used to take samples?

A

In case of possible sepsis, sterile techniques must be used for taking samples of blood, urine, pulmonary secretions.

48
Q

role of autopsy for post-operative death

A

Sometimes no obvious cause found and pathologist is only able to confirm the absence of bleeding, slipping of sutures, etc.

49
Q

sudden infant death autopsies are done by forensic pathologists. True/False.

A

False

By pediatric pathologist.

50
Q

what is important in road traffic accidents?

A
  • Important to photograph injuries as this may help identify the vehicle involved
  • Important to exclude/confirm any natural cause of death for an accident
51
Q

How are retained organs disposed of?

A
  1. Incinerated
  2. Returned to relatives for burial
  3. Buried in coffins by the hospital in special plots in a cemetery
52
Q

an inquest of a report after autopsy can be held if

A
  • The cause of death is not clear after the autopsy
  • If there are any unanswered questions from next of kin
  • All Road Traffic Accidents and suicides
53
Q

what can go wrong in autopsy work?

A

• The body is sent incorrectly for burial despite the next of kin have requested an autopsy
• Cause - poor communication
• Clinicians have not informed the Coroner of a death and a body has been incorrectly sent for burial
• A major problem for all concerned
In a Coroner’s case, the Clinician has asked for permission for an autopsy from next of kin but next of kin refuse. Very upsetting for next of kin to be told even though they were asked for permission and they refused permission, an autopsy will be performed anyway

54
Q

what verdicts give Coroners?

A
  • Natural Causes
  • Accidental death
  • Suicide
  • Death by misadventure
55
Q

in Coroner’s case if next of kin refuses the autopsy, can pathologist proceed with the autopsy?

A

yes

General Pathology (9 decks)

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