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).

External exam

Is very important in the forensic context.

External exam findings are found in the forensic pathology article.

Internal exam

Is usually where the money is in non-forensic autopsies, i.e. 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;^[2]^[3] triticeous cartilage may be confused with a fragment of hyoid bone.
- Triticeous is pronounced tri-tish´us.^[4]

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.^[5]

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

Methylene blue, used for refractory shock,^[6] turns organs green.^[7]

Leukostasis in acute myelogenous leukemia can lead to congestion of organs and fatal haemorrhages.

Hyperviscosity syndrome - in leukemia.^[8]

Starvation

Serous fat atrophy.
- Gross appearance: brown goo replaces fat.
  - May be associated with blood vessel tortuosity.^[9]

Normal organ mass

Caucasoid population of 684 adults:^[10]

	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

References

↑ URL: http://www.docstoc.com/docs/51609856/CONSENT-FOR-AUTOPSY. Accessed on: 27 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.

External links

[1] URL: http://www.docstoc.com/docs/51609856/CONSENT-FOR-AUTOPSY. Accessed on: 27 September 2010.

[pmid15075682-2] 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.

[3] URL: http://faculty.ksu.edu.sa/Prof.Hamam/curses/Jurnals%20Club/225-Triticeous%20cartilage.pdf. Accessed on: 10 September 2010.

[4] URL: http://medical-dictionary.thefreedictionary.com/triticeous. Accessed on: 15 September 2010.

[pmid9356598-5] Ono, H.; Ono, Y. (Nov 1997). "Nephrosclerosis and hypertension.". Med Clin North Am 81 (6): 1273-88. PMID 9356598.

[pmid17926021-6] 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.

[pmid18703358-7] Tan, CD.; Rodriguez, ER.. "Blue dye, green heart.". Cardiovasc Pathol 19 (2): 125-6. doi:10.1016/j.carpath.2008.06.012. PMID 18703358.

[8] ttp://cat.inist.fr/?aModele=afficheN&cpsidt=18942659

[9] KC. 14 September 2010.

[pmid11376980-10] 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.

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