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Autopsy (view source)

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[[Image:Rembrandt Harmensz. van Rijn 007.jpg|thumb|300px|An autopsy.]]
'''Autopsy''' was once a mainstay of [[pathology]].  It is now in decline and uncommonly done.  Fetal autopsy is dealt with in a separate article called ''[[fetal autopsy]]''.
'''Autopsy''' was once a mainstay of [[pathology]].  It is now in decline and uncommonly done.  Fetal autopsy is dealt with in a separate article called ''[[fetal autopsy]]''.


==Autopsy checklist==
=Value of autopsy=
===Minimum to proceed===
A significant number of major findings cannot be diagnosed without histology;<ref name=pmid16324191>{{Cite journal  | last1 = Roulson | first1 = J. | last2 = Benbow | first2 = EW. | last3 = Hasleton | first3 = PS. | title = Discrepancies between clinical and autopsy diagnosis and the value of post mortem histology; a meta-analysis and review. | journal = Histopathology | volume = 47 | issue = 6 | pages = 551-9 | month = Dec | year = 2005 | doi = 10.1111/j.1365-2559.2005.02243.x | PMID = 16324191 }}</ref> thus, without a biopsy or an autopsy they cannot be diagnosed.  Autopsies can be regarded as a form of [[quality control]].
 
One large review in ''JAMA'' suggests that approximately:<ref name=pmid12783916>{{cite journal |author=Brian Gallagher, Burton EC, McDonald KM, Goldman L |title=Changes in rates of autopsy-detected diagnostic errors over time: a systematic review |journal=JAMA |volume=289 |issue=21 |pages=2849–56 |year=2003 |pmid=12783916 |doi=10.1001/jama.289.21.2849}}</ref>
* 25% of autopsies reveal a finding that would have changed clinical management.
* 5% of autopsies reveal a missed [[diagnosis]] that probably affected the outcome.
 
=Autopsy checklist=
===Minimum to proceed - hospital autopsy===
*Death certificate complete.
*Death certificate complete.
**Cause of death as per death certificate.
**Cause of death as per death certificate.
*Consent properly done.
*[[Autopsy consent]] properly done.
*Patient identified.
*Patient identified.


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*Date and time of death.
*Date and time of death.
*Clinical status prior to death.
*Clinical status prior to death.
**Unexpected versus unexpected.
**Expected versus unexpected.
 
==Value of autopsy==
A significant number of major findings cannot be diagnosed without histology;<ref name=pmid16324191>{{Cite journal  | last1 = Roulson | first1 = J. | last2 = Benbow | first2 = EW. | last3 = Hasleton | first3 = PS. | title = Discrepancies between clinical and autopsy diagnosis and the value of post mortem histology; a meta-analysis and review. | journal = Histopathology | volume = 47 | issue = 6 | pages = 551-9 | month = Dec | year = 2005 | doi = 10.1111/j.1365-2559.2005.02243.x | PMID = 16324191 }}</ref> thus, without a biopsy or an autopsy they cannot be diagnosed.  Autopsies can be regarded as a form of [[quality control]].
 
One large review in ''JAMA'' suggests that approximately:<ref name=pmid12783916>{{cite journal |author=Brian Gallagher, Burton EC, McDonald KM, Goldman L |title=Changes in rates of autopsy-detected diagnostic errors over time: a systematic review |journal=JAMA |volume=289 |issue=21 |pages=2849–56 |year=2003 |pmid=12783916 |doi=10.1001/jama.289.21.2849}}</ref>
* 25% of autopsies reveal a finding that would have changed clinical management.
* 5% of autopsies reveal a missed [[diagnosis]] that probably affected the outcome.


==Autopsy consent==
=Autopsy consent=
===General===
===General===
In a hospital autopsy the most important thing is: ''proper consent''.
*In a hospital autopsy the ''most important'' thing is: ''proper consent''.
*Generally, corner's cases/medical examiner's cases do not require a consent for autopsy; however, the retention of tissue may require consent.


===Who has authority?===
===Who has authority?===
*Consent should be given by the ''executer of the estate''.<ref name=olduhnconsent>URL: [http://www.docstoc.com/docs/51609856/CONSENT-FOR-AUTOPSY http://www.docstoc.com/docs/51609856/CONSENT-FOR-AUTOPSY]. Accessed on: 27 September 2010.</ref>
*Consent should be given by the ''executor of the estate''.<ref name=olduhnconsent>URL: [http://www.docstoc.com/docs/51609856/CONSENT-FOR-AUTOPSY http://www.docstoc.com/docs/51609856/CONSENT-FOR-AUTOPSY]. Accessed on: 27 September 2010.</ref>


====Hierarchy====
====Hierarchy====
If the ''executer of the estate'' is not specified the hierarchy is as follows:<ref name=olduhnconsent/>
If the ''executor of the estate'' is not specified the hierarchy is as follows:<ref name=olduhnconsent/>
#Spouse - by marriage (same sex ''or'' opposite sex) ''or'' by common-law ''or'' by together the parents of a child ''or'' by cohabitation agreement (in law).
#Spouse - by marriage (same sex ''or'' opposite sex) ''or'' by common-law ''or'' by together the parents of a child ''or'' by cohabitation agreement (in law).
#If no spouse, any children 16+ years old,
#If no spouse, any children 16+ years old,
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Notes:
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'').
*Exact hierarchy may vary by jurisdiction.
*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"; it is ''not'' acceptable to ask the child of the decedent 'cause they aren't distraught like the spouse of the decedent.  
*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 ''executor 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 (non-corner's) autopsies, '''the hierarchy has to be followed strictly''', as there is no such thing as an "emergency autopsy"; it is ''not'' acceptable to ask the child of the decedent 'cause they aren't distraught like the spouse of the decedent.
*In non-corner's cases/non-medical examiner's cases, a physician ''cannot'' give consent for an autopsy.


===Religious objections===
===Religious objections===
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|}
|}


==External exam==
=External exam=
===General===
===General===
*Very important in the forensic context.
*Very important in the forensic context.
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Body should be examined for ''defensive-type wounds'':
Body should be examined for ''defensive-type wounds'':
*Between the finger, esp. thumb and pointing finger.
*Between the fingers - especially thumb and pointing finger.
*Dorsal aspect of the hand.
*Dorsal aspect of the hand.
*Forearm.
*Forearm.
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*External exam findings are found in the ''[[forensic pathology]]'' article.
*External exam findings are found in the ''[[forensic pathology]]'' article.


==Internal exam==
=Internal exam=
===General===
===General===
*This is usually where the money is in hospital autopsies.
*This is usually where the money is in hospital autopsies.
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===Before the first incision===
===Before the first incision===
If there is suspicion of pneumothorax - one the the three following can be done:<ref name=Ref_HospAuto120-1>{{Ref HospAuto|120-1}}</ref>
If there is suspicion of [[pneumothorax]] - one the the three following can be done:<ref name=Ref_HospAuto120-1>{{Ref HospAuto|120-1}}</ref>
#Create a "pleural window" (between ribs by removing soft tissue... without entering the pleural cavity).
#Create a "pleural window" (between ribs by removing soft tissue... without entering the pleural cavity).
#Open chest underwater and watch for air bubbles.
#Open chest underwater and watch for air bubbles.
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*Y-shaped incision (standard):
*Y-shaped incision (standard):
**Superior "points" of the Y ~ at the deltoid muscle.
**Superior "points" of the Y ~ at the deltoid muscle.
**"Confuence of lines" in the Y ~ inferior to the suprasternal notch.
**"Confluence of lines" in the Y ~ inferior to the suprasternal notch.
*Neck dissection incisions:
*Neck dissection incisions:
**Deltoid to mastoid process.
**Deltoid to mastoid process.
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Notes:
Notes:
*The sterum 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>
*The sternum 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>
*If the decedent has a history of a [[CABG]] removal of the chest plate should be done with care to preserve the grafts.
*If the decedent has a history of a [[CABG]] removal of the chest plate should be done with care to preserve the grafts.


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==Neck organ pluck==
==Neck organ pluck==
===Non-suspicious cases===
#Trim tissue posterior to horns of the thyroid.
#Trim tissue posterior to horns of the thyroid.
#Cut between thyroid horns & hyoid.
#Cut between thyroid horns & hyoid.
#Cut off base of tongue.
#Cut off base of tongue.
===Suspicious cases===
*In Canada, it is convention to do ''layered neck dissection''.
**The strap muscles of the neck are lifted of in layers to look for injuries (mostly contusions).
**Strap muscle hematomas may arise in a number of contexts, e.g. they are reported in drowning.<ref>{{Cite journal  | last1 = Püschel | first1 = K. | last2 = Schulz | first2 = F. | last3 = Darrmann | first3 = I. | last4 = Tsokos | first4 = M. | title = Macromorphology and histology of intramuscular hemorrhages in cases of drowning. | journal = Int J Legal Med | volume = 112 | issue = 2 | pages = 101-6 | month =  | year = 1999 | doi =  | PMID = 10048667 }}</ref>


====Hyoid bone====
====Hyoid bone====
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#*Check renal veins.
#*Check renal veins.
#Separate IVC.
#Separate IVC.
#Transect esophagus (~2 cm) distal to inferior margin of the cricoid cartilage.
#Transect [[esophagus]] (~2 cm) distal to inferior margin of the cricoid cartilage.
#Take down esophagus using blunt dissection (to separate from thorax).
#Take down esophagus using blunt dissection (to separate from thorax).
#Separate thorax and abdomen - by dissecting through the pericardium.
#Separate thorax and abdomen - by dissecting through the [[pericardium]].


===Common finding(s)===
===Common finding(s)===
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===Respiratory system===
===Respiratory system===
#Open trachea + bronchus (see ''Note'').
#Open [[trachea]] + bronchus (see ''Note'').
#Examine proximal airway.
#Examine proximal airway.
#Examine proximal pulmonary arteries.  
#Examine proximal pulmonary arteries.  
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{{main|Adrenal gland}}
{{main|Adrenal gland}}
*[[Adrenal cortical adenoma|Cortical adenoma]]s - seen in ~ 2% of autopsies.<ref name=pmid14514341>{{cite journal |author=Barzon L, Sonino N, Fallo F, Palu G, Boscaro M |title=Prevalence and natural history of adrenal incidentalomas |journal=Eur. J. Endocrinol. |volume=149 |issue=4 |pages=273–85 |year=2003 |month=October |pmid=14514341 |doi= |url=}}</ref>
*[[Adrenal cortical adenoma|Cortical adenoma]]s - seen in ~ 2% of autopsies.<ref name=pmid14514341>{{cite journal |author=Barzon L, Sonino N, Fallo F, Palu G, Boscaro M |title=Prevalence and natural history of adrenal incidentalomas |journal=Eur. J. Endocrinol. |volume=149 |issue=4 |pages=273–85 |year=2003 |month=October |pmid=14514341 |doi= |url=}}</ref>
*Metastatic cancer, esp. in the context of lung cancer.
 
=====Others=====
=====Others=====
*Atrophy - typically iatrogenic, may be [[Addison's disease]].
*Atrophy - typically iatrogenic, may be [[Addison's disease]].
*[[Adrenal cortical hyperplasia|Hyperplasia]] (bilateral).
*[[Adrenal cortical hyperplasia|Hyperplasia]] (bilateral).
*Hemorrhage ([[Waterhouse-Friderichsen syndrome]]).
*Hemorrhage ([[Waterhouse-Friderichsen syndrome]]).
*[[Metastatic]] cancer, esp. in the context of lung cancer.
*[[Adrenal myelolipoma]].


===Stomach===
===Stomach===
*Opened along greater curvature.
*Opened along greater curvature.
**Large carcinomas preferentially involve the lesser curvature.<ref name=pmid2550682>{{Cite journal  | last1 = Yamagawa | first1 = H. | last2 = Onishi | first2 = T. | title = [A clinicopathological study of early gastric cancers with a diameter larger than five centimeters]. | journal = Gan No Rinsho | volume = 35 | issue = 10 | pages = 1114-8 | month = Sep | year = 1989 | doi =  | PMID = 2550682 }}</ref>
**Large carcinomas preferentially involve the lesser curvature.<ref name=pmid2550682>{{Cite journal  | last1 = Yamagawa | first1 = H. | last2 = Onishi | first2 = T. | title = [A clinicopathological study of early gastric cancers with a diameter larger than five centimeters]. | journal = Gan No Rinsho | volume = 35 | issue = 10 | pages = 1114-8 | month = Sep | year = 1989 | doi =  | PMID = 2550682 }}</ref>
*GE junction should not be opened if portal hypertension is suspected (see: ''esophagus'').
*GE junction should not be opened if [[portal hypertension]] is suspected (see: ''esophagus'').


====Findings====
====Findings====
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===Esophagus===
===Esophagus===
*Should be everted, if portal hypertension is suspected, as varices are thus more readily demonstrated.<ref name=Ref_HospAuto140>{{Ref HospAuto|140}}</ref>
{{Main|Esophagus}}
*Should be everted, if [[portal hypertension]] is suspected, as [[esophageal varices]] are thus more readily demonstrated.<ref name=Ref_HospAuto140>{{Ref HospAuto|140}}</ref>
*#Stomach opened (''without opening GE junction'').
*#Stomach opened (''without opening GE junction'').
*#String tied to proximal esophagus.
*#String tied to proximal esophagus.
*#Forceps inserted from stomach to grasp tied end and invert esophagus.
*#Forceps inserted from stomach to grasp tied end and invert [[esophagus]].


===Omentum===
===Omentum===
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**Capsule of the spleen is white - resembles sugar-coating.
**Capsule of the spleen is white - resembles sugar-coating.
**Importance: ''none'' - benign.
**Importance: ''none'' - benign.
*Splenomegaly secondary to portal hypertension.
*[[Splenomegaly]] secondary to [[portal hypertension]].


===Kidney===
===Kidney===
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**''Flea-bitten appearance'' - seen in [[hypertension]].<ref name=pmid9356598>{{Cite journal  | last1 = Ono | first1 = H. | last2 = Ono | first2 = Y. | title = Nephrosclerosis and hypertension. | journal = Med Clin North Am | volume = 81 | issue = 6 | pages = 1273-88 | month = Nov | year = 1997 | doi =  | PMID = 9356598 }}</ref>
**''Flea-bitten appearance'' - seen in [[hypertension]].<ref name=pmid9356598>{{Cite journal  | last1 = Ono | first1 = H. | last2 = Ono | first2 = Y. | title = Nephrosclerosis and hypertension. | journal = Med Clin North Am | volume = 81 | issue = 6 | pages = 1273-88 | month = Nov | year = 1997 | doi =  | PMID = 9356598 }}</ref>
*[[Acute tubular necrosis]] (ATN).
*[[Acute tubular necrosis]] (ATN).
**ATN is difficult (or impossible) to prove on autopsy material.
**ATN is difficult to prove on autopsy material.
**Look for:
**On microscopy, look for:<ref name=pmid19207286>{{Cite journal  | last1 = Kocovski | first1 = L. | last2 = Duflou | first2 = J. | title = Can renal acute tubular necrosis be differentiated from autolysis at autopsy? | journal = J Forensic Sci | volume = 54 | issue = 2 | pages = 439-42 | month = Mar | year = 2009 | doi = 10.1111/j.1556-4029.2008.00956.x | PMID = 19207286 }}</ref>
***Heme-granular casts in the lumen.
***Tubular epithelial whorls.
***Regenerative activity (mitoses).
***Tubulorrhexis.
***Interstitial edema.


===Liver===
===Liver===
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**DDx:  
**DDx:  
**#Shock liver.
**#Shock liver.
**#Steatosis ''or'' [[steatohepatitis]].
**#[[Liver steatosis|Steatosis]] ''or'' [[steatohepatitis]].
*Congested (blood red/yellow) "nutmeg liver".
*Congested (blood red/yellow) "nutmeg liver".
**Image: [http://www.pathology-india.com/nutmegliv1.JPG Nutmeg liver (pathology-india.com)].
**Image: [http://www.pathology-india.com/nutmegliv1.JPG Nutmeg liver (pathology-india.com)].
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***May be associated with blood vessel tortuosity.<ref>KC. 14 September 2010.</ref>
***May be associated with blood vessel tortuosity.<ref>KC. 14 September 2010.</ref>


==Normal size parameters==
=Histology=
===Normal organ masses (adult)===
Caucasoid population of 684 adults:<ref name=pmid11376980>{{cite journal |author=de la Grandmaison GL, Clairand I, Durigon M |title=Organ weight in 684 adult autopsies: new tables for a Caucasoid population |journal=Forensic Sci. Int. |volume=119 |issue=2 |pages=149–54 |year=2001 |month=June |pmid=11376980 |doi= |url=}}</ref>
{| class="wikitable"
|
|'''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
|}
 
===Pediatrics===
{{Main|Growth charts}}
 
==Histology==
===General===
===General===
It's the at the pathologists discretion.  In ''decomp'' cases it is reasonable to submit nothing.
It's the at the pathologists discretion.  In ''[[decomp]]'' cases it is reasonable to submit nothing.


===Forensic context===
===Forensic context===
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*Muscle.
*Muscle.
*[[Lymph nodes]].
*[[Lymph nodes]].
=Autopsy report=
==Normal size parameters==
===Normal organ masses (adult)===
Caucasoid population of 684 adults:<ref name=pmid11376980>{{cite journal |author=de la Grandmaison GL, Clairand I, Durigon M |title=Organ weight in 684 adult autopsies: new tables for a Caucasoid population |journal=Forensic Sci. Int. |volume=119 |issue=2 |pages=149–54 |year=2001 |month=June |pmid=11376980 |doi= |url=}}</ref>
{| class="wikitable"
|
|'''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
|}
===Pediatrics===
{{Main|Growth charts}}


==Negative autopsy==
==Negative autopsy==
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*[[Sudden infant death syndrome]].
*[[Sudden infant death syndrome]].


==See also==
==Histology checklist==
{| class="wikitable sortable"
! Section/organ
! Expected finding(s)/common finding(s)
! Findings to consider
|-
| [[Bone marrow]]
|
*trilineage hematopoiesis
|
*infection
*tumour
|-
| [[Coronary arteries]]
|
*[[atherosclerosis]] - should give percent stenosis for major arteries (LMCA, LAD, LCx, RCA)
|
*atherosclerotic plaque rupture
*thrombi
*inflammation
|-
| [[Heart]] muscle
|
*fibrosis - esp. post. LV (old [[myocardial infarction|MI]])
*nuclear enlargement, arteriolosclerosis, periarteriolar fibrosis ([[hypertensive heart disease]])
|
*hemorrhage
*wavy fibres (early ischemic change)
*[[necrosis]] - coagulative/contraction band (recent MI)
*inflammatory infiltrate - not associated with necrosis
*hyaline material ([[cardiac amyloidosis]])
*fibre disarray ([[hypertrophic cardiomyopathy]])
*fatty replacement ([[ARVC]])
|-
| [[Adrenal gland]]
|
*no pathology
|
*tumour
**primary (cortex, medulla)
**metastatic
*hemorrhage
*fat
|-
| [[Kidney]]
|
*vessels (atherosclerosis, [[arterial hyaline|arteriolar hyalinization]])
|
*tumour
*glomeruli (enlargement, crescents, [[mesangial expansion]], inflammation - esp. [[PMN]]s)
*vessels - thrombi ([[thrombotic microangiopathy]])
*interstitial (fibrosis, inflammation, edema)
*tubules (inflammation, tubular epithelial whorls, tubulorrhexis)
|-
| [[Liver]]
|
*steatosis - should give severity (mild, mederate, severe), location & type (macrovesicular vs. microvesicular)
|
*fibrosis (septa, rounded contours, [[cirrhosis]]), inflammation (cell type, location (portal, interface, lobular))
*tumour - esp. metastatic
*bile ducts
*[[ballooning degeneration]] ([[steatohepatitis]])/feathery degeneration ([[cholestasis]])
*necrosis (location important)
|-
| [[Spleen]]
|
*normal white pulp/red pulp
|
*tumour
*surface abnormalities
|-
| Gastrointestinal tract
|
*autolytic changes
|
*tumour
*vessels
*inflammation - esp. [[PMN]]s
*fibrosis
|-
| [[Thyroid gland]]
|
*no pathology
|
*tumour - papillary thyroid carcinoma, goitre
*inflammation
|-
| [[Lung pathology|Lung]]
|
*pulmonary edema
*[[emphysema]]
|
*infectious pneumonia
*[[pulmonary hypertension]] (may be focal)
*interstitial fibrosis
*tumour
*[[granuloma]]s
*hemorrhage
*hyaline membranes ([[diffuse alveolar damage]])
|}
 
===List form===
====Bone marrow====
*Trilineage hematopoiesis present.
 
*Negative for infection and negative for tumour.
 
====Cardiovascular system====
[[Coronary arteries]]:
*[[Atherosclerosis]] -
**Left main coronary artery 30%.
**Left anterior descending coronary artery 75%.
**Left circumflex coronary artery 30%.
**Right coronary artery 85%.
 
*No identified atherosclerotic plaque rupture.
*No thrombosis.
*No vasculitis.
 
[[Heart]] muscle:
*Fibrosis - posterior left ventricle.
*Nuclear enlargement, arteriolosclerosis and periarteriolar fibrosis.
 
*No hemorrhage.
*No wavy fibres.
*No [[necrosis]].
*No inflammatory infiltrate.
*No hyaline material.
 
====Endocrine organs====
[[Adrenal gland]]:
 
*No pathology apparent.
*No tumour.
*No hemorrhage.
*No fatty replacement.
 
 
Thyroid gland:
*Normal thyroid gland.
 
*No tumour.
*No inflammation.
 
====Genitourinary system====
[[Kidney]]:
*Atherosclerosis, mild.
*Arteriolar hyalinization.
 
*No tumour.
*Normal glomeruli (no enlargement, no crescents, no [[mesangial expansion]], no inflammation).
*No thrombi.
*No interstitial fibrosis, no inflammation, and no edema.
*No tubular inflammation, no whorls, and no fragmentation.
*No apparently pathologic renal casts.
 
====Gastrointestinal system====
[[Liver]]
*Steatosis - mild, centrilobular, macrovesicular.
 
*No fibrosis.
*No inflammation.
*No tumour.
*Normal bile ducts.
*No [[ballooning degeneration]] and no feathery degeneration.
*No necrosis.
 
Luminal GI tract:
*Autolytic changes.
 
*No tumour
*No vasculitis.
*No siginificant atherosclerosis.
*No inflammation.
*No fibrosis.
 
====Spleen====
*Normal white pulp/red pulp.
 
*No tumour.
*No surface abnormalities.
 
====Lung====
*Pulmonary edema.
*Infectious pneumonia, mild.
*Emphysema, mild.
 
*No pulmonary hypertension.
*No interstitial fibrosis.
*No tumour,
*No granulomas,
*No significant hemorrhage.
*No hyaline membranes.
 
==Sign out==
===Sample clinical history===
<pre>
A 63 year old male with a history of alcohol abuse was admitted on December 13, 2018 for
recurrent alcohol related pancreatitis. On December 21, he was found unresponsive at 0:15.
Approximately fifteen minutes earlier, he was on oxygen and in no apparent distress. A code
blue was called; however, the attempted resuscitation was unsuccessful.  Death was declared
at 1:00 on December 21, 2018.
</pre>
 
=See also=
*[[Fetal autopsy]].
*[[Fetal autopsy]].
*[[Forensic pathology]].
*[[Forensic pathology]].


==References==
=References=
{{reflist|2}}
{{reflist|2}}


==External links==
=External links=


[[Category:Autopsy]]
[[Category:Autopsy]]
Michael
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