Role of the Pathologist Flashcards
What are the roles of the general pathologist?
Diagnostician, MDT meeting, research, teaching, management and leadership, post mortem
What are the roles of the forensic pathologist?
Post mortem = full, part, CT scan, view and grant Determine cause of death Non-suspicious and suspicious deaths Court Fatal accident inquiries
What additional testing can be done as part of a post mortem?
Histology, microbiology, radiology, toxicology, genetic studies, neuropathology
What are the types of post mortem?
Hospital and Legally required
What are some features of hospital post mortems?
Less common, family or clinician requested, consented and not a legal requirement
Why might a patient request a hospital post mortem?
Donation of brain for neurodegenerative research
What are some features of legally required post mortems?
Procurator fiscal requested and legally required, no consent needed
When may a post mortem be legally required?
Sudden and unexpected death Responsible clinician unable to certify death Death due to negligence Suspected suicide or homicide Death at work or in custody Death of a child
What is sudden death?
Death within 24hrs of symptom onset
Some only accept death within 1hr from onset
What are the reversible causes of cardiac arrest?
Hypoxia, hypovolaemia, hyperkalaemia (metabolic), hypothermia, thrombosis, tamponade, toxins, tension pneumothorax
What are some causes of hypoxia?
Non-suspicious = asthma, pneumothorax, respiratory obstruction or depression, aspiration Suspicious = respiratory obstruction, drug related, drowning
What are some features of an autopsy of a hanging?
May have respiratory obstruction
Usually a space in the ligature mark
What are some indications of strangulation?
Petechial haemorrhages behind the eyes
Damage to the hyoid bone
What is the most common cause of hypovolaemia?
Aneurysms
What are some causes of hypovolaemia?
Non-suspicious = upper or lower GI bleed, haemoperitoneum, trauma Suspicious = trauma, stabbings, shootings
What are some causes of hyperkalaemia and other metabolic disturbances?
Non-suspicious = diabetic and alcoholic ketoacidosis, toxins Suspicious = toxins (e.g poisoning)
What is an internal sign of hypothermia?
Wischnewski ulcers = look like black spots
What are some causes of hypothermia?
Non-suspicious = exposure to cold, alcoholic, drugs, underlying medical disease Suspicious = exposure to cold, neglect, forced outside
What are some external signs of atherosclerosis due to coronary artery disease?
Fold in ear lobe
Corneal arcus
What are some non-suspicious causes of thrombosis?
Coronary artery thrombosis (usually on atherosclerosis), pulmonary venous thromboembolism, embolism from DVT, paradoxical emboli
What are some suspicious causes of thrombosis?
Contribution, deaths in custody, one punch or “scared to death” due to increased physiological stress
What are some causes of tamponade?
Non-suspicious = after MI, pericarditis, TB, iatrogenic, aortic dissection, trauma, neoplasm Suspicious = secondary to blunt or sharp force trauma
What are some causes of toxins?
Non-suspicious = overdose, negligence, accidental Suspicious = third party involvement (poisoning), negligence
What are some causes of a tension pneumothorax?
Non-suspicious = chronic lung disease, spontaneous, trauma Suspicious = secondary to trauma
Why is a tension pneumothorax difficult to diagnose in an autopsy?
Any disturbance after death will cause release of pleural fluids
What may be a sign that a patient has had CPR before death?
Target lesion on chest from CPR thumper, especially if elderly
