Difference between revisions of "Forensic pathology"

'''Forensic pathology''' is figuring-out why, when, where and how people died, if the manner of death is ''not'' obviously natural.

'''Forensic pathology''' is figuring-out why, when, where and how people died, if the manner of death is ''not'' obviously natural.

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MANNER OF DEATH

MANNER OF DEATH

*#Undetermined.

*#Undetermined.

===General===

===General===

*The cause of death should be what started the sequence of events that lead to death.

*The cause of death should be what started the sequence of events that lead to death.

*All ''A cases'' are done at regional centers by certified forensic pathologists.

*All ''A cases'' are done at regional centers by certified forensic pathologists.

Most general differential diagnosis:

Most general differential diagnosis:

*Natural:

*Natural:

*If he was a lone and depressed... he might have been trying to kill himself, ergo ''suicide''.

*If he was a lone and depressed... he might have been trying to kill himself, ergo ''suicide''.

===Rigor mortis===

===Rigor mortis===

Definition:  

Definition:  

*Intussusception of small bowel - often multiple.

*Intussusception of small bowel - often multiple.

===Classification (gross pathology)===

===Classification (gross pathology)===

Mnemonic ''CALI'':

Mnemonic ''CALI'':

**PMNs replaced monocytes in 24-48 hours.

**PMNs replaced monocytes in 24-48 hours.

===Artefactual===

===Artefactual===

*"Undertaker's fracture" - cervical fracture due to rough handling.<ref>URL: [http://www.the-crankshaft.info/2010/07/postmortem-changes_29.html http://www.the-crankshaft.info/2010/07/postmortem-changes_29.html]. Accessed on: 29 September 2010.</ref>

*"Undertaker's fracture" - cervical fracture due to rough handling.<ref>URL: [http://www.the-crankshaft.info/2010/07/postmortem-changes_29.html http://www.the-crankshaft.info/2010/07/postmortem-changes_29.html]. Accessed on: 29 September 2010.</ref>

</ref> the wedge points in the direction of the (impact) force.

</ref> the wedge points in the direction of the (impact) force.

{{Main|Autopsy}}

{{Main|Autopsy}}

The ''autopsy'' article covers procedural things.  Heart dissection is covered in the ''[[heart]]'' article.

The ''autopsy'' article covers procedural things.  Heart dissection is covered in the ''[[heart]]'' article.

#*Bones cooked for 1+ hours... with frequent checks to avoid that they become mushy.

#*Bones cooked for 1+ hours... with frequent checks to avoid that they become mushy.

==Environmental==

==Environmental==

*Palisading of basal cells (like cautery artefact).

*Palisading of basal cells (like cautery artefact).

{{main|Gunshot wounds}}

{{main|Gunshot wounds}}

Gunshot wounds (GSWs) are a relatively uncommon finding in Canada.  They are dealt within a separate article.

Gunshot wounds (GSWs) are a relatively uncommon finding in Canada.  They are dealt within a separate article.

{{main|Asphyxial deaths}}

{{main|Asphyxial deaths}}

*Aortic dissection with subsequent rupture.

*Aortic dissection with subsequent rupture.

===Characteristics<ref name=Ref_HospAuto111-2>{{Ref HospAuto|111-2}}</ref>===

===Characteristics<ref name=Ref_HospAuto111-2>{{Ref HospAuto|111-2}}</ref>===

*Incised wound (see: ''[[Forensic_pathology#Classification_of_wounds|Classification of wounds]]'').

*Incised wound (see: ''[[Forensic_pathology#Classification_of_wounds|Classification of wounds]]'').

*Glass.

*Glass.

==Aortic trauma==

==Aortic trauma==

*Aortic dissection due to trauma is often catastrophic.

*Aortic dissection due to trauma is often catastrophic.

*Type B - distal to (left) subclavian artery.

*Type B - distal to (left) subclavian artery.

===Accidental vs. intentional===

===Accidental vs. intentional===

Features of non-accidental injuries:<ref name=pmid20141554>{{cite journal |author=Guyomarc'h P, Campagna-Vaillancourt M, Kremer C, Sauvageau A |title=Discrimination of falls and blows in blunt head trauma: a multi-criteria approach |journal=J. Forensic Sci. |volume=55 |issue=2 |pages=423–7 |year=2010 |month=March |pmid=20141554 |doi=10.1111/j.1556-4029.2009.01310.x |url=}}</ref>

Features of non-accidental injuries:<ref name=pmid20141554>{{cite journal |author=Guyomarc'h P, Campagna-Vaillancourt M, Kremer C, Sauvageau A |title=Discrimination of falls and blows in blunt head trauma: a multi-criteria approach |journal=J. Forensic Sci. |volume=55 |issue=2 |pages=423–7 |year=2010 |month=March |pmid=20141554 |doi=10.1111/j.1556-4029.2009.01310.x |url=}}</ref>

Note: The paper doesn't give odds ratios for the the different features -- like in the rational clinical exam series... it is a shame.

Note: The paper doesn't give odds ratios for the the different features -- like in the rational clinical exam series... it is a shame.

Clinical:

Clinical:

*Vegetative state.  

*Vegetative state.  

IHC: beta-amyloid precursor protein (beta-APP ''or'' APP).<ref name=pmid10050789>{{cite journal |author=Gleckman AM, Bell MD, Evans RJ, Smith TW |title=Diffuse axonal injury in infants with nonaccidental craniocerebral trauma: enhanced detection by beta-amyloid precursor protein immunohistochemical staining |journal=Arch. Pathol. Lab. Med. |volume=123 |issue=2 |pages=146–51 |year=1999 |month=February |pmid=10050789 |doi= |url=}}</ref>

IHC: beta-amyloid precursor protein (beta-APP ''or'' APP).<ref name=pmid10050789>{{cite journal |author=Gleckman AM, Bell MD, Evans RJ, Smith TW |title=Diffuse axonal injury in infants with nonaccidental craniocerebral trauma: enhanced detection by beta-amyloid precursor protein immunohistochemical staining |journal=Arch. Pathol. Lab. Med. |volume=123 |issue=2 |pages=146–51 |year=1999 |month=February |pmid=10050789 |doi= |url=}}</ref>

{{main|Intracranial hematoma}}

{{main|Intracranial hematoma}}

*Subarachnoid hematoma.

*Subarachnoid hematoma.

{{main|Traumatic brain injury in infants}}

{{main|Traumatic brain injury in infants}}

*Shaken baby syndrome.

*Shaken baby syndrome.

Features:<ref name=Ref_Shkrum613>{{Ref Shkrum|613}}</ref>

Features:<ref name=Ref_Shkrum613>{{Ref Shkrum|613}}</ref>

*Sudden death after head trauma that is insufficient to explain death.

*Sudden death after head trauma that is insufficient to explain death.

*Analogous to ''commotio cordis'' (see ''blunt force trauma'').

*Analogous to ''commotio cordis'' (see ''blunt force trauma'').

General:

General:

*Also known as "agitated delirium".<ref name=pmid8768172>{{cite journal |author=Wetli CV, Mash D, Karch SB |title=Cocaine-associated agitated delirium and the neuroleptic malignant syndrome |journal=Am J Emerg Med |volume=14 |issue=4 |pages=425–8 |year=1996 |month=July |pmid=8768172 |doi= |url=}}</ref>

*Also known as "agitated delirium".<ref name=pmid8768172>{{cite journal |author=Wetli CV, Mash D, Karch SB |title=Cocaine-associated agitated delirium and the neuroleptic malignant syndrome |journal=Am J Emerg Med |volume=14 |issue=4 |pages=425–8 |year=1996 |month=July |pmid=8768172 |doi= |url=}}</ref>

*Thought to result from alteration of dopamine receptor density.  The D2 receptor in particular, which is thought to be important in temperature regulation, is decreased in psychotic cocaine abusers.<ref name=pmid8768172/>

*Thought to result from alteration of dopamine receptor density.  The D2 receptor in particular, which is thought to be important in temperature regulation, is decreased in psychotic cocaine abusers.<ref name=pmid8768172/>

===General===

===General===

Things usually collected at autopsy:

Things usually collected at autopsy:

*Tryptase.

*Tryptase.

{{main|Natural death}}

{{main|Natural death}}

There is a lot that can kill ya... but only a few of those are quickly, i.e. within a hour or so.

There is a lot that can kill ya... but only a few of those are quickly, i.e. within a hour or so.

***Thrombotic (more common than haemorrhagic).

***Thrombotic (more common than haemorrhagic).

{{main|Forensic entomology}}

{{main|Forensic entomology}}

*Study of the bugs that eat corpses.

*Study of the bugs that eat corpses.

*Bugs may hide a wound... it is important to know where they like to be.

*Bugs may hide a wound... it is important to know where they like to be.

{{main|Forensic anthropology}}

{{main|Forensic anthropology}}

Forensic anthropology is looking at skeletal remains.  It may be useful of [[decendent identification|identification]] and, rarely, the cause of death.  Important in skeletonized remains and decomp cases.

Forensic anthropology is looking at skeletal remains.  It may be useful of [[decendent identification|identification]] and, rarely, the cause of death.  Important in skeletonized remains and decomp cases.

*The study of post-mortem decay to assist in a medicolegal investigation.

*The study of post-mortem decay to assist in a medicolegal investigation.

**''Taphonomy'' = postmortem fate of biological remains; derived from the Greek word ''taphos'' (grave).<ref>{{cite journal |author=Milroy CM |title=Forensic taphonomy: the postmortem fate of human remains |journal=BMJ |volume=319 |issue=7207 |pages=458 |year=1999 |month=August |pmid=10445946 |pmc=1127062 |doi= |url=}}</ref>

**''Taphonomy'' = postmortem fate of biological remains; derived from the Greek word ''taphos'' (grave).<ref>{{cite journal |author=Milroy CM |title=Forensic taphonomy: the postmortem fate of human remains |journal=BMJ |volume=319 |issue=7207 |pages=458 |year=1999 |month=August |pmid=10445946 |pmc=1127062 |doi= |url=}}</ref>

*[[Forensic entomology]].

*[[Forensic entomology]].

*[[Autopsy]].

*[[Autopsy]].

*[[Heart]].

*[[Heart]].

{{reflist|2}}

{{reflist|2}}

*[http://cap-acp.org/forensic.cfm Forensic pathology (cap-acp.org)].

*[http://cap-acp.org/forensic.cfm Forensic pathology (cap-acp.org)].

*[http://neurobio.drexelmed.edu/goldmanweb/forensicanthro/trauma.pdf Fractures (drexelmed.edu)].

*[http://neurobio.drexelmed.edu/goldmanweb/forensicanthro/trauma.pdf Fractures (drexelmed.edu)].

*[http://emedicine.medscape.com/article/1680032-overview Post-mortem changes (emedicine.medscape.com)].

*[http://emedicine.medscape.com/article/1680032-overview Post-mortem changes (emedicine.medscape.com)].

*[http://www.the-crankshaft.info/2010/07/postmortem-changes_29.html Post-mortem changes (the-crankshaft.info)].

*[http://www.the-crankshaft.info/2010/07/postmortem-changes_29.html Post-mortem changes (the-crankshaft.info)].