The Autopsy Flashcards
Two different types of autopsies?
Hospital Autopsies- 10%
- useful for audit, teaching, governance, research
Medico-legal autopsies- 90% = done on request of coroners
- coronal autopsies = standard
- forensic autopsies = death involving crime
Types of deaths referred to coroners?
Presumed natural
- not sure what natural cause of death is as not seen by doctor with recent illness (last 14 days)
Presumed iatrogenic - due to the care a person received
- pre/postoperative death
- anaesthetic deaths
- abortion
- complications of therapy
Presumed unnatural
- accidents
- industrial death
- suicide
- unlawful death (murder)
- neglect
- custody deaths
Types of referrals?
- Doctors = do not have a statuary duty to refer but do have common law duty and GMC guidance
- A register of BDM = statuary duty to refer
- Relatives
- Police
- Pathological technicians
- Property interested parties
What is the Coroners Act 1988
Allows coroner to order an autopsy where death is likely due to natural causes to obviate need for inquest
Allows coroner to order an autopsy where death is clearly unnatural and inquest will be needed
What is the Coroner Rules 1984?
Autopsy as soon as possible
By a pathologist of suitable qualifications and experiences
Report findings promptly only to coroner
Autopsy only on appropriate premises
Amendment Rules 2005
Pathologist must tell coroner precisely what materials have been retained
Coroner authorising retention and sets disposal date
Coroner informs family of retention
Family had choices:
- Return material to family
- Retain for research/teaching
- Respectful disposal
Coroner informs pathologist of families decision
Pathologist to keep record
Autopsy report must declare retention and disposal
Coroners and Justice Act 2009
Coroner can now defer opening the inquest and instead launch an investigation
Enshrines a system of medical examiners
Little practical practical changed to the pathologist
Inquest now have conclusions not verdicts
Human Tissue Act 2004
Autopsies only to be performed on licensed premises
License holder
Consent from relatives for any use of tissue retained autopsy if not subject to coronial legislation or retained for criminal justice purposes
Public display requires consent from the deceased
Penalties displayed requires consent from the deceased
Penalties include up to 3 years of imprisonment and/or a fine for not following the human active human tissue act
What is the role of the coronal autopsy?
To answer 4 questions:
Who is the deceased?
When did they die?
Where did they die?
How did the death come about?
Essentially the same role as the coroner
Who performs which autopsies?
Histopathologist
- Hospital autopsies
- Coronial autopsies
= Natural deaths, Drowning, Suicide, Accidents, Road traffic deaths, Fire deaths, Industrial deaths, Peri/postoperative deaths
Forensic pathologist
- Coronial autopsies
= Homicide, Death of custody, Neglect, Any from list above that may be due to the action of a third party
What is an autopsy?
- Identification:
= Formal identification
= Gender
= Age - External
= Body habitus (build)
= Jewellery
= Body modification
= Clothing - Disease and Treatment
- Injuries
- Evisceration
= Y- shaped (from behind ears down to clavicle then down to midline), open all body cavities, examine all organs in situ, remove thoracic and abdominal organs, remove brain - Internal examination
= heart and great vessels
= lungs, trachea, bronchi
= liver, gallbladder, pancreas
= avoid the lower GI tract if possible - presents infection risk
= spleen, thymus, and lymph nodes
= genitourinary tract (common place for cancer)
= endocrine organs
= central nervous system
Role of the coronal autopsy
Who was the deceased
When did they die
Where did they die
How did they come about their death (not why)
Iatrogenic meaning
Relating to illness caused by medical examination / treatment
