The autopsy

Question 1

Name the two types of autopsy

Answer 1

Hospital and Medico-legal

Question 2

Explain why the hospital autopsy is performed

Answer 2

1. to find accurate cause of death
2. audit into accuracy of clinical diagnosis
3. education of students to correlate clinical signs and pathology
4. research into the causes and mechanisms of disease
   resource allocation - to get stats on disease incidence

Question 3

What are the two types of medico-legal autopsy?

Answer 3

coronial

forensic

Question 4

Why is the medico-legal autopsy performed?

Answer 4

1. determine cause of death

2. collect evidence useful in prosecution of those associated with the death

Question 5

Which type of autopsy is more frequently carried out?

Answer 5

medico-legal (>90%)

Question 6

Which deaths are referred to the coroner?

Answer 6

1. presumed natural - where the cause of death is unknown AND they were not seen by a doctor in the past 14 days
2. presumed iatrogenic - peri/postoperative deaths, anaesthetic deaths, abortion, complications of therapy
3. presumed unnatural - accidents, industrial death, suicide, unlawful killing, neglect, custody deaths, people in receipt of war/industrial pensions

Question 7

Who can refer the deceased for an autopsy?

Answer 7

doctors
registrars of BDM
relatives
police
anatomical pathology technicians

Question 8

Who can perform a coronial autopsy?

Answer 8

histopathologists

forensic pathologists

Question 9

Who performs hospital autopsies?

Answer 9

Histopathologists

Question 10

For what reasons can forensic pathologists do a coronial autopsy?

Answer 10

any reason that involves the participation of a third party

Question 11

For what reasons can a histopathologist perform a coronial autopsy?

Answer 11

natural deaths
drowning
suicide
RTDs
accidents
fire deaths
industrial deaths 
peri/postoperative

Question 12

For what reasons can a histopathologist NOT perform an autopsy?

Answer 12

homicide
death in custody
neglect

Question 13

What is the role of the coronial autopsy?

Answer 13

WHO was the deceased
WHEN did they die
WHERE did they die
HOW did they die

Question 14

What is the role of the coroner?

Answer 14

WHO was the deceased
WHEN did they die
WHERE did they die
HOW did they die

Question 15

What are the main steps of an autopsy?

Answer 15

history/scene
external examination
evisceration
internal examination
reconstruction

Question 16

What additional steps can be done in an autopsy?

Answer 16

microbiology
toxicology
genetics
histology
radiology
digital photography

Question 17

What are the key steps of a digital autopsy?

Answer 17

history/scene
internal examination
digital autopsy
reconstruction

Question 18

What does the external examination involve?

Answer 18

identification
disease and treatment
injuries

Question 19

List some methods of identification of the deceased

Answer 19

formal identification
gender
body habits
tattoos and other body modification
clothing
jewellery

Question 20

What are the steps of evisceration?

Answer 20

Y-shaped incision
open all body cavities(remove ribcage)
examine all organs in situ
remove thoracic and abdominal organs
remove brain

Question 21

Give examples of organs examined in the internal examination

Answer 21

heart and great vessels
lungs, trachea, bronchi
liver, pancreas, gallbladder
spleen, thymus, lymph nodes
GU tract
endocrine organs
CNS

Question 22

Is consent from pt’s relatives needed for a hospital autopsy?

Answer 22

Yes

Question 23

Consent from pt’s relatives is needed for a coronial autopsy. T or F?

Answer 23

False - it is a legal requirement

Question 24

What was stated in Coroner’s rules 1984

Answer 24

1. autopsy to be done ASAP
2. autopsy to be done on appropriate premises
3. autopsy to be done by a pathologist with suitable experience
4. findings should be reported promptly and only to the coroner

Question 25

What are the amendment rules 2005?

Answer 25

retention of materials in coronial autopsy:
1. pathologist must tell coroner precisely what materials have been retained
2. coroner authorises retention and sets disposal date
3. coroner informs family of retention
4. the material can either be returned to the family, retained for research/teaching or disposed respectfully
the coroner informs the pathologist of the family’s decision and the pathologist keeps a record. The autopsy report must declare retention and disposal

Question 26

What does the coroners act 1988 allow the coroner to do?

Answer 26

1. the coroner can order an autopsy where the death is likely due to natural causes to avoid the need for an inquest
2. the coroner can order an autopsy where the death is clearly unnatural and an inquest is needed
   so this means an coroner can order natural and unnatural deaths to come for autopsy

Question 27

what did the Coroners and Justice Act 2009 state?

Answer 27

1. system of medical examiners
2. coroner can defer an inquest and launch an investigation
3. inquests have conclusions and not verdicts