Autopsy
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:
- Spouse - by marriage (same sex or opposite sex) or common-law or together the parents of a child or cohabitation agreement in law.
- if no spouse, any children 16+ years old,
- if no children, either parent,
- if no parent, any brother or sister 16+ years old,
- if no sibling, any next-of-kin 16+ years old,
- 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.
Extremities
- Fingers should be identified by name (e.g. ring finger), as some people number the digits 1-4 and consider the thumb separately, while others number 'em 1-5.[5]
Body should be examined for defensive-type wounds:
- Between the finger, esp. thumb and pointing finger.
- Dorsal aspect of the hand.
- Forearm.
Findings
- External exam findings are found in the forensic pathology article.
Internal exam
General
- This is usually where the money is in 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;[6][7] triticeous cartilage may be confused with a fragment of hyoid bone.
- Triticeous is pronounced tri-tish´us.[8]
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.[9]
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
- Leukostasis in acute myelogenous leukemia can lead to congestion of organs and fatal haemorrhages.
- Hyperviscosity syndrome - in leukemia.[12]
Starvation
- Serous fat atrophy.
- Gross appearance: brown goo replaces fat.
- May be associated with blood vessel tortuosity.[13]
- Gross appearance: brown goo replaces fat.
Normal organ mass
Caucasoid population of 684 adults:[14]
| 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
- ↑ URL: http://www.docstoc.com/docs/51609856/CONSENT-FOR-AUTOPSY. Accessed on: 27 September 2010.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ TR. 28 September 2010.
- ↑ 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.
- ↑ URL: http://faculty.ksu.edu.sa/Prof.Hamam/curses/Jurnals%20Club/225-Triticeous%20cartilage.pdf. Accessed on: 10 September 2010.
- ↑ URL: http://medical-dictionary.thefreedictionary.com/triticeous. Accessed on: 15 September 2010.
- ↑ Ono, H.; Ono, Y. (Nov 1997). "Nephrosclerosis and hypertension.". Med Clin North Am 81 (6): 1273-88. PMID 9356598.
- ↑ 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.
- ↑ Tan, CD.; Rodriguez, ER.. "Blue dye, green heart.". Cardiovasc Pathol 19 (2): 125-6. doi:10.1016/j.carpath.2008.06.012. PMID 18703358.
- ↑ http://cat.inist.fr/?aModele=afficheN&cpsidt=18942659
- ↑ KC. 14 September 2010.
- ↑ 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.