Autopsy

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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:

  1. Spouse - by marriage (same sex or opposite sex) or common-law or together the parents of a child or cohabitation agreement in law.
  2. if no spouse, any children 16+ years old,
  3. if no children, either parent,
  4. if no parent, any brother or sister 16+ years old,
  5. if no sibling, any next-of-kin 16+ years old,
  6. 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).

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.

Findings

Internal exam

Is usually where the money is in non-forensic autopsies, i.e. hospital autopsies.

Hyoid bone

  • Important in forensic pathology.
  • Fracture is seen in manual strangulation.
  • May appear fractured if triticeous cartilage (or triticeal cartilage) is present;[5][6] triticeous cartilage may be confused with a fragment of hyoid bone.
    • Triticeous is pronounced tri-tish´us.[7]

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.[8]

ATN

  • ATN is difficult to prove on autopsy material.
  • Look for:
    • Heme-granular casts in the lumen.
    • Regenerative activity (mitoses).

Brain

  • 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.

Weird stuff

  • Methylene blue, used for refractory shock,[9] turns organs green.[10]
  • Hyperviscosity syndrome - in leukemia.[11]

Starvation

  • Serous fat atrophy.
    • Gross appearance: brown goo replaces fat.
      • May be associated with blood vessel tortuosity.[12]

Normal organ mass

Caucasoid population of 684 adults:[13]

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

See also

References

  1. ↑ URL: http://www.docstoc.com/docs/51609856/CONSENT-FOR-AUTOPSY. Accessed on: 27 September 2010.
  2. ↑ 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.
  3. ↑ 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.
  4. ↑ 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.
  5. ↑ 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.
  6. ↑ URL: http://faculty.ksu.edu.sa/Prof.Hamam/curses/Jurnals%20Club/225-Triticeous%20cartilage.pdf. Accessed on: 10 September 2010.
  7. ↑ URL: http://medical-dictionary.thefreedictionary.com/triticeous. Accessed on: 15 September 2010.
  8. ↑ Ono, H.; Ono, Y. (Nov 1997). "Nephrosclerosis and hypertension.". Med Clin North Am 81 (6): 1273-88. PMID 9356598.
  9. ↑ 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.
  10. ↑ Tan, CD.; Rodriguez, ER.. "Blue dye, green heart.". Cardiovasc Pathol 19 (2): 125-6. doi:10.1016/j.carpath.2008.06.012. PMID 18703358.
  11. ↑ http://cat.inist.fr/?aModele=afficheN&cpsidt=18942659
  12. ↑ KC. 14 September 2010.
  13. ↑ 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.

External links

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