S2 Learning from the Dead Flashcards
What has examination of dead bodies over the centuries provided?
- detailed info about the human 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
Why do we still need to learn from the dead?
- studies have shown that there are continuous discrepancies between ante-mortem and post-mortem diagnosis
- allows research into specific clinical areas like neurodegenerative disorders, chronic renal disease and lung cancer
What is an autopsy?
“To see for oneself”
The same as a post-mortem
Examining dead people
What are the 3 types of autopsy?
- Medicolegal
- Forensic
- Consent (hospital)
What is a medicolegal autopsy?
- performed on behalf of HM coroner
* no consent needed - to avoid any possibly interference by e.g. family members (who possibly killed them?)
What is a forensic autopsy?
- a subtype of coroner’s post-mortems
* looks into suspicious deaths
What is a consent (hospital) autopsy?
- consent from the next of kin which may limit the examination
- to determine exactly why they died and for research?
When is a coroner’s autopsy carried out?
- if the deceased is unknown
- if the deceased wasn’t seen by a doctor within the last 14 days of death (extended if someone has a chronic condition)
- the attending doctor can’t give a cause of death
- obviously unnatural (murder, accident, suicide)
- death related to occupation disease or accident e.g. asbestos exposure or injury from machinery
- death related to a medical treatment or procedure
- those in prison, etc
What 3 stages do you carry out in an autopsy?
- History
- External examination
- Internal examination
What additional tests do you carry out in an autopsy?
- histology (to make/confirm a diagnosis)
- toxicology (any drugs in system?)
- biochemistry (e.g ketoacidosis, renal failure)
- microbiology (bacteria, viruses, fungi) - interpret with caution as body could be invaded by these after death
- molecular (identification/elimination of a suspect, testing for genetic diseases)
What are 4 causes of common death?
Injury to:
- head
- heart
- blood vessels
- lungs
Give some examples of head/brain damage leading to death.
- extradural haemorrhage
- subdural haemorrhage
- sub-arachnoid haemorrhage
- stroke
Give some examples of heart damage leading to death.
- coronary thrombosis
- valvular disease
- cardiomyopathy (hypertrophy, obstructive, dilated, arrhythmogenic right ventricular cardiomyopathy)
Give some examples of blood vessel damage leading to death.
- ruptured (abdominal) aortic aneurysm
* deep vein thrombosis and pulmonary embolism
Give an example of lung damage leading to death.
- bronchopneumonia
* pneumothorax
What is the benefit of post-mortem imaging?
It reduces the need for invasive autopsy (it is already used alongside autopsy)
Can use CT, MRI and coronary angiography (inject with contrast after death)
What is neuropathology? When are autopsies for this sort carried out?
Cellular pathology restricted to the CNS, peripheral nerves, muscle
After trauma (to any of these areas) or neurodegenerative diseases
What are three examples of neuropathological diseases?
- Alzheimer’s disease
- Lewy body dementia
- bovine spongiform encephalopathy
When are paediatric autopsies carried out?
- death in utero
- perinatal deaths
- death in infancy (e.g. sudden infant death)
- suspicious death
Why are paediatric autopsies important?
Parent’s want to know if the same will happen to their next child
Important for medicolegal and safeguarding issues
But also teaching and research
What examinations/tests do you carry out in paediatric autopsies?
- macroscopic examination
- microscopic examination
- toxicology
- microbiology
- genetic studies (will it happen with the parents next child ( esp. if death is in-utero/perinatal)
What were issues with learning from the dead in the past?
- was forbidden by Christianity so used apes
- no way of keeping bodies cool e.g. refrigerators
- bodies were stolen from graves as there was a shortage of cadavers for teaching (Burke and Hare even murdered people that they then sold to Edinburgh medical school)
