Autopsy

Question 1

Implicit questions asked from autopsy

Answer 1

• were we right

- did we miss something

Question 2

Giovanni Battista Morgagni - Padua

Answer 2

• out with Galen’s evil humours, in with structure/function
• 60 years careful correlation of clinical symptoms & anatomic findings
• 1700s

Question 3

Karl Rokitansky - Vienna

Answer 3

• one of the first PATHOLOGISTS: gross tissue morphology became basis of medicine
• pathologic anatomy to clinical abnormalities
• 70,000 autopsies!!!!!
• 1800s

Question 4

Rudolph Virchow - Berlin

Answer 4

• narrowed gross tissue morphology to separate organs
• cellular pathology as the basis of medicine
• late 1800s

Question 5

William Osler

Answer 5

• wished he could see his autopsy
• what to why
• 1849-1919

Question 6

Richard Cabot

Answer 6

• landmark JAMA paper 1912

- couple quotes

Question 7

1912 Cabot listed common diseases inaccessible to diagnosis

Answer 7

Diabetes Mellitus - 95%
Typhoid - 92%
Aortic Regurgitation - 84%
Cancer of Colon - 74%
Lobar Pneumonia - 74%

Question 8

Diseases discovered or clarified via autopsies in 20th century

Answer 8

• coronary artery atherosclerosis & thrombosis, angina pectoris, MIs
• congenital heart malfomations
• cystic fibrosis

Question 9

Diseases discovered or clarified via autopsies late 20th century

Answer 9

AIDs, hantavirus pulmonary syndrome, dementias, inhalation diseases of lungs, creutzfeldt-jakob disease, infectious complications of drug therapies, hospital-acquired infections

Question 10

Why autopsies

Answer 10

• medical education (now rare)
• quality assessment of diagnosis and treatment
• risk management
• public health
• family

Question 11

UIHC QA program from autopsies

Answer 11

• list major validated/refined diagnoses
• list major clinicopathologic discrepancies
• list major unexpected findings

Question 12

why decline of autopsy

Answer 12

• payment: hospitals & pathologists unpaid under fee for service model
• public perception
• clinical medicine: overconfidence & litigation
• medical education

Question 13

autopsy decline statistics

Answer 13

1950s:>50%
UIHC: 25%
US:

Question 14

when can autopsies be performed

Answer 14

• after obtaining informed consent from family, process is aprt of physician family communication
• ME cases don’t need consent

Question 15

define autopsy

Answer 15

autopsy - to see for oneself

postmortem - after death