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path 310 > forensic pathology > Flashcards

forensic pathology Flashcards

1
Q

what is a forensic pathologist?

A

medical doctors that preform autopsies on individuals who have died suddenly/unexpectedly

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2
Q

what are the four types of information that can be gained from a forensic pathologist?

A

(1) identity of the deceased
(2) the medical cause of death
(3) the interpretation of injuries
(4) the manner of death

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3
Q

what is the post-mortum interval? how is it determined?

A
  • the amount of time btwn death and the discovery of a body

- estimated by examining the state of the body

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4
Q

what does post-mortum interval allow forensic pathologists to differentiate?

A

natural changes that occur to the body following death and evidence of homicide

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5
Q

what characteristics do pathologists use to estimate 3 hours post-mortum?

A

body feels warm and is flaccid

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6
Q

what characteristics do pathologists use to estimate 8 hours post-mortum?

A
  • body progressively starts to cool and become stiffened - ultimately the body will cpme to room temp and remain stiff for hours
  • after this point timeline depends on environmental factors
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7
Q

what characteristics do pathologists use to estimate 36 hours post-mortum?

A

usually there’s early putrefactive decomposal changes which leads to progressive flaccidity

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8
Q

what characteristics do pathologists use to estimate >36 hours post-mortum?

A

body feels cold and flaccid

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9
Q

what is the normal range for heart weight and how can this help us during an autopsy?

A
  • normal = 300-350g

- if weighs more or less could be related to the cause of death

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10
Q

what is forward heart failure?

A

inability of the heart to pump blood forward at a sufficient rate to meet metabolic demands of the body

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11
Q

what is backward heart failure?

A
  • occurs when left ventricle does not fill sufficiently with blood, resulting in reduced stroke colume
  • under these condition the heart can only pump enough blood to meet the metabolic demands of the body if cardiac filling pressures are abnormally high
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12
Q

what are the three principle classes of heart failure?

A

(1) reduced ejection fraction
(2) preserved ejection fraction
(3) right heart failure

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13
Q

describe reduced ejection fraction

A
  • the heart isn’t contracting as well as it normally does
  • amount of blood being pumped out of the left ventricle is less than the body needs
  • often occurs bc left ventricle is enlarged and cannot pump normally
  • heart usually appears dilated or baggy
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14
Q

describe preserved ejection fraction

A
  • heart contracts normally
  • but the left ventricle does not relax enough to properly fill with blood
  • amount of blood pumped to the body decreases
  • usually occurs if the heart is stiff or thick
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15
Q

what is an ejection fraction?

A
  • measurement of how much blood is pumped out of the left ventricle with each contraction
  • e.g. 80% ejection fraction = 80% of blood in the left ventricle is pumped out
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16
Q

describe right heart failure

A
  • failure of the right side of the heart to pump deoxygenated blood to lungs
  • often occurs as a result og left-sided heart failure
17
Q

what are primary cardiomyopathies?

A
  • refers to diseases begining in the heart muscle itself
  • most have a clear genetic underlying basis (e.g. ion channel deficiencies), while some are acquired (stress-provoked), or both
  • recall: cardiomyopathy = hard for heart to pump blood to rest of body
18
Q

what are secondary cardiomyopathies?

A
  • refers to systemic disease that leads to heart muscle injury
  • includes many inflammatory and endocrine origins
  • anything that causes damage to the heart can lead to secondary cardiomyopathy if it is severe enough
19
Q

what are the 3 structural forms of cardiomyopathies?

A

(1) dilated cardiomyopathy (reduced ejection fraction)
(2) hypertophic cardiomyopathy (preserved ejection fraction)
(3) restrictive cardiomyopathy (stiff muscle)

20
Q

what is the difference btwn hypertophic cardiomyopathy and myocaridal hypertrophy?

A
  • myocardial hypertrophy = too much heart muscle

- hypertrophic cardiomyopathy = myocardical hypertrophy with a specific underlying genetic cause

21
Q

what represents the end of the line for almost all types of heart disease? why?

A

dilated cardiomyopathy - almost all heart disease comes to this

22
Q

what is a common complicatoin associated with dilated cardiomyopathies? how does this occur?

A
  • mural thrombus - blood clot attached to the wall of a bv or the endocardium, impeeding blood flow
  • occurs when blood is not flowing effectively through the heart
23
Q

can mural thrombi embolize? what is the significance of this?

A

yes - can become logged in smaller vessels

  • kidney = renal failure
  • brain = stroke
24
Q

what are the two levels at which hypertrophic cardiomyopathies are characterized?

A

macroscopic and microscopic levels

25
Q

how are hypertrophic cardiomyopathies characterized at the macroscopic level

A

by unusually thick muscle

26
Q

what macroscopic feature is the most common pattern of hypertrophy? what is another feature commonly seen?

A
  • asymmetrical septal hypertrophy - septum is very thick relative to the walls
  • also see myocardial fibrosis (increased amounts of scar tissue)
27
Q

what are key features at the microscopic level?

A
  • cardiomyocyte enlargement

- myofiber disarray

28
Q

what is apical hypertrophy

A
  • less common pattern

- muscle hypertrophy has occured mostly in the apex of the heart

29
Q

what is concentric hypertrophy?

A
  • less common

- muscle hypertrophy is symmetric either across both ventricles or within one ventrical wall

30
Q

restrictive cardiomyopathies are the ______ form

A

rarest

31
Q

how are restrictive cardiomyopathies characterized?

A
  • stiff heart and in a particular stiff ventricles, caused by infiltration of fibrous tissue into the myocardium
  • heart can’t fill woth blood, & overtime cannot sufficiently pump blood, leading to HF
32
Q

what is the typical cause of restrictive cardiomyopathy?

A

sarcoidosis - inflammatory disease affecting multiple organs that causes the formation of granulomas (consisting of inflammatory cells) throughout the body

33
Q

describe alcohol ablation as treatment for hypertrophic cardiomyopathy resulting in a left ventricular outflow obstruction

A

catheter is inserted into a small branch of the coronary arteries

  • releases alcohol, causing local infarction of the muscle lining the left ventricular outflow tract
  • leads to tissue necrosis and ultimately healing through fibrous tissue deposition
  • leads to tissue retraction, and thus, release of the obstruction caused by hypertrophic cardiomyopathy
34
Q

describe septal myectomy as treatment for hypertrophic cardiomyopathy resulting in a left ventricular outflow obstruction

A
  • ascending aorta is opened surgically

- protruding muscle is shaved away, releiving the obstruction

35
Q

what is a cardiac transplant

A
  • donor heart is sown into patient
  • patient maintains endogenous major vessels
  • for patients that are expected to live less than 6 months
  • do not always work
36
Q

what are heart transplant risks?

A

infection, bleeding, blood clots, kidney failure, breathing problems, cardiac allograft vasculopathy (long-term rejection leading to scarring of the coronary bvs) and accelerated atherosclerosis

37
Q

if do an autopsy on a sudden death patient and nothing is showing what is the likely cause

A
  • ion channel deficiency leading to arrythmia and death
  • likely from a genetic cause
  • could be inherited, must be explained to family

path 310 (14 decks)

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