Difference between revisions of "Autopsy"
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*Usually of no interest. | *Usually of no interest. | ||
*May have cleft or foramen - as an anatomical variant.<ref name=pmid10803333>{{cite journal |author=Fokin AA |title=Cleft sternum and sternal foramen |journal=Chest Surg. Clin. N. Am. |volume=10 |issue=2 |pages=261–76 |year=2000 |month=May |pmid=10803333 |doi= |url=}}</ref> | *May have cleft or foramen - as an anatomical variant.<ref name=pmid10803333>{{cite journal |author=Fokin AA |title=Cleft sternum and sternal foramen |journal=Chest Surg. Clin. N. Am. |volume=10 |issue=2 |pages=261–76 |year=2000 |month=May |pmid=10803333 |doi= |url=}}</ref> | ||
===Blood clots - ''pre- and post-mortem''=== | |||
{| class="wikitable" | |||
|'''Feature/time''' | |||
|'''Pre-mortem''' | |||
|'''Post-mortem''' | |||
|- | |||
|Shininess | |||
| dull | |||
| shiny | |||
|- | |||
|Adherent to wall | |||
| yes | |||
| no | |||
|- | |||
|Colour | |||
| grey; may have zebraic <br>appearance (lines of Zahn) - <br>red alt. with grey/yellow | |||
| dark purple ''or''<br> bilayered red/yellow | |||
|- | |||
|Pressurized | |||
| yes; "ejects itself" from lumen | |||
| no; needs to be pulled-out | |||
|- | |||
|Consistency <br>-elastic modulus (E)<br>-fracture toughness (K) | |||
| firm (high E)<br> brittle (low K) | |||
| jello (low E)<br> elastic (high K) | |||
|- | |||
|Image - gross | |||
| [http://www.pathguy.com/lectures/waut033.jpg thrombus (pathguy.com)], <br>[http://www.thrombosisadviser.com/en/image.php?image=thrombus-right-atrial-appendage-pathology&category=atherothrombosis thrombus (thrombosisadviser.com)] | |||
| [http://www.meddean.luc.edu/lumen/meded/MEDICINE/PULMONAR/IMAGES/leischne/L3.JPG coronary thrombus (luc.edu)]<ref>URL: [http://www.meddean.luc.edu/lumen/meded/mech/cases/case1/list.htm http://www.meddean.luc.edu/lumen/meded/mech/cases/case1/list.htm]. Accessed on 8 October 2010.</ref> | |||
|- | |||
|Image - micro. | |||
| [http://www.elsevier.es/ficheros/images/255/255v62n10/origen/255v62n10-13142654fig1.jpg pre- & post-mortem (elsevier.es)]<ref>URL: [http://www.elsevier.es/cardio_eng/ctl_servlet?_f=40&ident=13142654 http://www.elsevier.es/cardio_eng/ctl_servlet?_f=40&ident=13142654]. Accessed on: 8 October 2010.</ref> | |||
| [http://eurheartj.oxfordjournals.org/content/early/2010/01/12/eurheartj.ehp557/F3.expansion.html thrombus (oxfordjournals.org)], <br>[http://pathhsw5m54.ucsf.edu/cts/unknown16/thrombi.html thrombi (ucsf.edu)] | |||
|} | |||
==Spleen== | ==Spleen== | ||
Revision as of 01:49, 10 October 2010
Autopsy is a part of pathology.
In a hospital autopsy the most important thing is: proper consent.
Consent
- Consent should be given by the executer of the estate.[1]
If the executer of the estate is not specified the hierarchy is as follows:
- Spouse - by marriage (same sex or opposite sex) or common-law or together the parents of a child or cohabitation agreement in law.
- if no spouse, any children 16+ years old,
- if no children, either parent,
- if no parent, any brother or sister 16+ years old,
- if no sibling, any next-of-kin 16+ years old,
- if no next-of-kin, the person lawfully in possession of the body (not the hospital).
Notes:
- The power a person that is designated as power of attorney for health care decisions does not have the authority to consent for an autopsy; their power ends with death (unless they are also the executer of the estate).
- In clinical medicine, it is allowable to skip down the hierarchy if the consent giver is not reachable, e.g. if a child of the patient is present they can consent in emergency circumstances, if the spouse is not reachable. In the context of autopsies, the hierarchy has to be followed strictly, as there is no such thing as an "emergency autopsy", e.g. it is not acceptable to ask the child of the decedent 'cause they aren't distraught like the spouse of the decedent.
Religious objections
There are religious objections to autopsy among Jews and Muslims.[2][3]
External exam
General
- Very important in the forensic context.
- Medical devices, tubes and lines should be left in situ to allow placement within the body;[4] it is very difficult to determine what the location of a line was once it is removed.
Extremities
- Fingers should be identified by name (e.g. ring finger), as some people number the digits 1-4 and consider the thumb separately, while others number 'em 1-5.[5]
Body should be examined for defensive-type wounds:
- Between the finger, esp. thumb and pointing finger.
- Dorsal aspect of the hand.
- Forearm.
Findings
- External exam findings are found in the forensic pathology article.
Internal exam
General
- This is usually where the money is in hospital autopsies.
Neck
- Trim tissue posterior to horns of the thyroid.
- Cut between thyroid horns & hyoid.
- Cut off base of tongue.
Hyoid bone
- Important in forensic pathology.
- Fracture is seen in manual strangulation.
- May appear fractured if triticeous cartilage (or triticeal cartilage) is present;[6][7] triticeous cartilage may be confused with a fragment of hyoid bone.
- Triticeous is pronounced tri-tish´us.[8]
Sternum
- Usually of no interest.
- May have cleft or foramen - as an anatomical variant.[9]
Blood clots - pre- and post-mortem
| Feature/time | Pre-mortem | Post-mortem |
| Shininess | dull | shiny |
| Adherent to wall | yes | no |
| Colour | grey; may have zebraic appearance (lines of Zahn) - red alt. with grey/yellow |
dark purple or bilayered red/yellow |
| Pressurized | yes; "ejects itself" from lumen | no; needs to be pulled-out |
| Consistency -elastic modulus (E) -fracture toughness (K) |
firm (high E) brittle (low K) |
jello (low E) elastic (high K) |
| Image - gross | thrombus (pathguy.com), thrombus (thrombosisadviser.com) |
coronary thrombus (luc.edu)[10] |
| Image - micro. | pre- & post-mortem (elsevier.es)[11] | thrombus (oxfordjournals.org), thrombi (ucsf.edu) |
Spleen
Main article: Spleen
Sugar-coated spleen
- Properly referred to as hyaloserositis of the spleen.
- Capsule of the spleen is white - resembles sugar-coating.
- Importance: none - benign.
Liver
- Portal vein patency.
Kidney
Size of the kidney - small kidneys are seen in chronic renal failure.
Nephrosclerosis
- Flea-bitten appearance - seen in hypertension.[12]
ATN
- ATN is difficult to prove on autopsy material.
- Look for:
- Heme-granular casts in the lumen.
- Regenerative activity (mitoses).
Skull
- One should saw through the skull completely, i.e. one should not "crack" the skull open with a chisel.
- Cracking open the skull may result in artefactual fractures that are impossible to differentiate from antemortem fractures.
- Cuts into the brain (from opening the skull) are not difficult to distinguish from antemortem injuries.
Scalp hematoma:
- May result from intracranial pressure.
Anatomic variants
- Metopic suture - midline in frontal bone.[13]
- Wormian bones = "extra" bone at the sutures in the skull.
Anatomy
- Lambdoidal suture - occipital bone/parietal bones.
- Coronal suture - frontal bone/parietal bone.
Weird stuff
- Leukostasis in acute myelogenous leukemia can lead to congestion of organs and fatal haemorrhages.
- Hyperviscosity syndrome - in leukemia.[16]
Starvation
- Serous fat atrophy.
- Gross appearance: brown goo replaces fat.
- May be associated with blood vessel tortuosity.[17]
- Gross appearance: brown goo replaces fat.
Normal organ mass
Caucasoid population of 684 adults:[18]
| Men | Women | |
| Heart | 365 +/- 71 g | 312 +/- 78 g |
| Right lung | 663 +/- 239 g | 546 +/- 207 g |
| Left lung | 583 +/- 216 g | 467 +/- 174 g |
| Liver | 1677 +/- 396 g | 1475 +/- 362 g |
| Spleen | 156 +/- 87 g | 140 +/- 78 g |
| Right kidney | 162 +/- 39 g | 135 +/- 39 g |
| Left kidney | 160 +/- 41 g | 136 +/- 37 g |
Negative autopsy
Definition:
- A negative autopsy is a post-mortem exam that has no anatomical or toxicological cause of death.
- This does not preclude the presence of pathology (that is not sufficient to cause death).
Cause of death (in a negative autopsy):
- Unascertained.
Considerations/Causes
- Channelopathy (unrecognized).
- Electrocution (unrecognized).
- Decomposition.
- SUDEP (missing history).
See also
References
- ↑ URL: http://www.docstoc.com/docs/51609856/CONSENT-FOR-AUTOPSY. Accessed on: 27 September 2010.
- ↑ Burton, Julian L.; Rutty, Guy N. (2010). The Hospital Autopsy A Manual of Fundamental Autopsy Practice (3rd ed.). Oxford University Press. pp. 43. ISBN 978-0340965146.
- ↑ Burton, Julian L.; Rutty, Guy N. (2010). The Hospital Autopsy A Manual of Fundamental Autopsy Practice (3rd ed.). Oxford University Press. pp. 47. ISBN 978-0340965146.
- ↑ Burton, Julian L.; Rutty, Guy N. (2010). The Hospital Autopsy A Manual of Fundamental Autopsy Practice (3rd ed.). Oxford University Press. pp. 101. ISBN 978-0340965146.
- ↑ TR. 28 September 2010.
- ↑ Di Nunno N, Lombardo S, Costantinides F, Di Nunno C (March 2004). "Anomalies and alterations of the hyoid-larynx complex in forensic radiographic studies". Am J Forensic Med Pathol 25 (1): 14–9. PMID 15075682.
- ↑ URL: http://faculty.ksu.edu.sa/Prof.Hamam/curses/Jurnals%20Club/225-Triticeous%20cartilage.pdf. Accessed on: 10 September 2010.
- ↑ URL: http://medical-dictionary.thefreedictionary.com/triticeous. Accessed on: 15 September 2010.
- ↑ Fokin AA (May 2000). "Cleft sternum and sternal foramen". Chest Surg. Clin. N. Am. 10 (2): 261–76. PMID 10803333.
- ↑ URL: http://www.meddean.luc.edu/lumen/meded/mech/cases/case1/list.htm. Accessed on 8 October 2010.
- ↑ URL: http://www.elsevier.es/cardio_eng/ctl_servlet?_f=40&ident=13142654. Accessed on: 8 October 2010.
- ↑ Ono, H.; Ono, Y. (Nov 1997). "Nephrosclerosis and hypertension.". Med Clin North Am 81 (6): 1273-88. PMID 9356598.
- ↑ Ramos GA, Ylagan MV, Romine LE, D'Agostini DA, Pretorius DH (December 2008). "Diagnostic evaluation of the fetal face using 3-dimensional ultrasound". Ultrasound Q 24 (4): 215–23. doi:10.1097/RUQ.0b013e31819073c2. PMID 19060688.
- ↑ Heemskerk, S.; van Haren, FM.; Foudraine, NA.; Peters, WH.; van der Hoeven, JG.; Russel, FG.; Masereeuw, R.; Pickkers, P. (Feb 2008). "Short-term beneficial effects of methylene blue on kidney damage in septic shock patients.". Intensive Care Med 34 (2): 350-4. doi:10.1007/s00134-007-0867-9. PMID 17926021.
- ↑ Tan, CD.; Rodriguez, ER.. "Blue dye, green heart.". Cardiovasc Pathol 19 (2): 125-6. doi:10.1016/j.carpath.2008.06.012. PMID 18703358.
- ↑ http://cat.inist.fr/?aModele=afficheN&cpsidt=18942659
- ↑ KC. 14 September 2010.
- ↑ de la Grandmaison GL, Clairand I, Durigon M (June 2001). "Organ weight in 684 adult autopsies: new tables for a Caucasoid population". Forensic Sci. Int. 119 (2): 149–54. PMID 11376980.