PATH2220 Study Guide - Final Guide: Radiography, Vasculitis, Muscle Hypertrophy
Forensic Pathology
Introduction to Forensic Pathology:
• Generally deals with medico-legal investigation of death
• Primary role → suggest a cause of death
• Perform coronal autopsies
• Investigate circumstances of death and determine matter
• Autopsies
o Post mortem examination
o 2 types
▪ Coronal → part of legally mandated process
▪ Consent/hospital → natural death, usually in hospital,
cause of death unknown
o Examination of a body after death → not specific for extent of
examination → external only, full, partial/limited
o Full autopsies
▪ External examination
▪ Internal examination
• Open all body cavities, remove organs
• Weigh, examine and sample all major organs
• Ancillary testing
o Histology
o Toxicology
o Microbiology
o Neuropathology
o Trace elements
o Dental examination/DNA/fingerprints
o Genetic testing
o External only examination
▪ 10% follows an objection to autopsy by next of kin
▪ Always send toxicology
▪ Often cant give cause of death
▪ 10% pathologists recommend external → clear cut COD
without full PM, usually in-hospital death, often palliated
• Cases
o Sudden deaths → 65-70% of cases
▪ Most are sudden expected natural deaths → most are
cardiac
▪ Other common COD
• Ruptured aneurysms
• Blood clots in lungs/other major vessels
• Pneumonia → complication of other problems
• Stroke
▪ Also include some ODs, hospital deaths
o Traffic fatalities
▪ Quite common
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▪ Involve criminal charges
▪ Toxicology testing very important
▪ X-rays useful
▪ Pre-existing natural disease
o Suicides
▪ Hanging
▪ CO poisoning
o Homicides
▪ Few in number
▪ Mostly stabbings/blunt force
▪ Autopsies → longer, police present
o Suspicious deaths → still treated as homicides → include deaths in
custody
o Industrial
▪ Many are just sudden natural deaths that happen to be in
the workplace
▪ Some are real industrial injuries → crush injuries, burns,
explosions
• Manner of death → circumstances that lead to death →
natural/accident/suicide
• Mechanism of death → physiological derangement that results in death
• Cause of death → disease or injury which results in the physiological
derangement that leads to death
• Why are PMs necessary
o COD → 20-45% of death certificates without PM are inaccurate
o Hidden homicide
o IDs
o Other tests
o Circumstances
o Clinical audit
o Public safety
Natural Disease and Forensic Pathology:
• Cardiac causes
o Coronary
▪ Atherosclerosis
• Most common cause of death → usually arrhythmia
• Especially in men 20-65
• Causes → smoking, high cholesterol, hypertension,
diabetes
• Chest/referred pain → often mistaken for
indigestion
• Common in early morning, exercise/exertion, sex
• Port mortem
o Significant luminal stenosis
o Often myocardial scarring
o May have thrombosis, may seen an infarct
▪ Dissection
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• Blood outside lumen
• Uncommon
• Eosinophils at site of dissection
▪ Vasculitis
• Inflammation of blood vessels
• Uncommon
• Multitude of potential causes
▪ Aneurysms/congenital abnormalities
• Form secondary to Kawasaki disease
• Some congenital anomalies
▪ Bridging/tunneling
• Controversial
• Ischaemic changes due to moving arteries →
surrounded by myocardium
▪ Spasm
• Impossible to prove at autopsy
• Seen at angiography
• May occur with drug use → e.g. cocaine
o Non-coronary causes
▪ Hypertensive heart disease
• Cardiomelagy
• Concentric LV hypertrophy
• Myocardial fibrosis
• Myocyte hypertrophy
• Usually changes in kidneys as well
▪ Valve disease
• Floppy mitral valve/MV prolapse
o Recognised cause of sudden death
o Mechanism not understood
o Might be related to long QT interval
• Aortic stenosis → usually sudden death due to
massive cardiomegaly
• Infective → uncommon cause of sudden death
▪ Cardiomyopathies
• Hypertrophic
o Most common cause of sudden death in the
young
o Diastolic dysfunction
o Genetically heterogenous, usually sarcomeric
proteins
o Fibrous plaques on septum
o Myofibre disarray on histology
• Dilated
o 4 chamber dilation
o Cardiomegaly, interstitial fibrosis
o Systolic dysfunction
o Many antecedent causes → genetic, alcohol
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