Learning from the dead

Question 1

Examination of dead bodies over centuries has provided

Answer 1

• Information about anatomy
• Opportunity to relate structure to function
• Ability to study the effects of disease processes and allow clinicopathological correlation/cause of death
• Evidence for criminal proceedings
• Ability to assess the impact of therapeutic interventions

Question 2

Do we still learn from the dead?

Answer 2

• Modern imaging techniques, biochemistry, biopsies etc provide valuable information in life but do not explain everything
• Discrepancy between ante-mortem and post-mortem diagnosis
• Neurodegenerative disorders
• Research studies involving autopsies are continuing e.g. (in Leicester) chronic renal disease, lung cancer

Question 3

History of dissection

Answer 3

• Frowned upon by religious authorities
• Used to be a secret activity
• Detailed drawings and wax models produced
• Used in medical education
  
  • Body snatching e.g. Burke and Hare

Question 4

autopsy means

Answer 4

to see for oneself (same as a post-mortem)

Question 5

autopsy is the same as a

Answer 5

post-mortem

Question 6

types of autopsy

Answer 6

medicolegal

forensic

consent

Question 7

medicolegal autopsy

Answer 7

• Performed on behalf of the HM coroner
• No consent needed

Question 8

Foresenic autopsy

Answer 8

• Sub-type of coroners post-mortems
• Suspicious deaths

Question 9

consent autopsy

Answer 9

• Consent from next of kin
• May limit examination (relatives wishes)

Question 10

when are coroners autopsies carried out

Answer 10

1. Legal requirement
2. Deceased unknown
3. Deceased not seen by a doctor within 14 days of death
4. Attending doctor not able to give cause of death
5. Obviously unnatural death (murder, accident, suicide)
6. Death related to occupational disease or accident
7. Death related to medical treatment or procedure

Question 11

What’s involved in an autopsy?

Answer 11

history

external examination

internal examination

Question 12

history during a coroners autopsies

Answer 12

often limited

Question 13

external examiantion in coroners autopsies

Answer 13

• Natural disease
• Injury
• Medical intervention

Question 14

internal examination during a coroners autopsy

Answer 14

• All systems usually
• Limited sometimes- especially in consent cases

Question 15

additional tests in a coroners autopsy

Answer 15

histology

toxicology

biochemistry

microbiology

molecular

Question 16

histology

Answer 16

• For making a diagnosis
• For confirming a diagnosis

Question 17

Toxicology

Answer 17

• Blood, urine, vitreous, bile etc
• Therapeutic drugs
• Recreational drugs

Question 18

Biochemistry

Answer 18

• Diabetes quite hard to diagnose because cells use glucose after death (BG may be normal level at time of autopsy)
• Diabetic ketoacidosis
• Alcoholic ketoacidosis
• Renal failure

Question 19

Microbiology

Answer 19

Bacteria

Viruses

Fungi

Question 20

Molecular

Answer 20

• Identification/ elimination of suspect
• Test for genetic diseases e.g. cardiomyopathy

Question 21

genetic fingerpritning

Answer 21

• First described in Leicester by Prof. Sir Alec Jeffreys
• First murder case solved by genetic fingerprinting also in Leicester
  
  • Colin Pitchfork- Murdered two young girls

Question 22

Common causes of sudden death: Head

Answer 22

• Extradural haemorrhage
• Subdural haemorrhage
• Sub-arachnoid haemorrhage
• Stroke
• Ischaemic
• Haemorrhagic

Question 23

Common causes of sudden death: Heart

Answer 23

• Coronary thrombosis
• Valvular disease
• Cardiomyopathy
  
  • Non-ischaemic
  • Non-inflammatory disease of heart muscle
    
    • Hypertrophic
    • Arrhythmogenic right ventricular cardiomyopathy
    • Obstructive
    • Dilated

Question 25

Common causes of sudden death: blood vessels

Answer 25

* Rupture abdominal aortic aneurysm * Deep vein thrombosis and pulmonary embolism (where thrombus has travelled from sit of origin to new tissue) * Peritonitis

Question 26

Common causes of sudden death: lungs

Answer 26

bronchopneumonia

Question 27

Post-mortem imaging

Answer 27

* Reduces the need for invasive autopsy * Used in forensic cases as an adjunct to autopsy * Research in Leicester

Question 28

in neuropathology cellular pathology restricted to

Answer 28

* CNS * Peripheral nerves * Muscle

Question 29

relevant autopsies for neuropathology

Answer 29

trama and neurodegenerative disease

Question 30

padiatric pathology

Answer 30

Trained in paediatric surgical pathology and autopsy * Deaths in utero * Perinatal deaths * Deaths in infancy * Suspicious deaths (in conjunction with forensic pathologists)

Question 31

why do padiatric pathology

Answer 31

* Vital in providing answers for grieving families and medical staff * Parents want to know about ‘next time’ * Medicolegal issues * Safeguarding issues * Teaching and research

Question 32

investigations done in paediatric pathology

Answer 32

* Macroscopic examinations * Microscopic examination * Toxicology * Microbiology * In utero infections * Sudden infant death * Genetic studies * Karyotyping

Question 33

forensic pathology

Answer 33

* Forensic pathology * Small speciality * Best known to public * More than just autopsies * Not like TV