Autopsy: Natural Deaths

peripheral vascular disease

stasis dermatitis is often indicative of ?

stasis dermatitis

stasis dermatitis

brown-tan hyperpigmented change of lower extremities, often bilateral; circumferential or patchy hair loss

acanthosis nigricans

hyperpigmented, shiny change especially in areas of skin folds

acanthosis nigricans

diabetes mellitus, visceral malignancy

acanthosis nigricans is indicative of ?

drug abuse, age, trauma

dentation is indicative of?

asphyxia (petechiae usually indicate partial suspension vs. hanging)

petechiae in the eyes can be indicative of?

pitting edema

pitting edema vs. anasarca: lymphatic drainage issue due to blockage

pitting edema

pitting edema vs. anasarca: systemic - heart, liver or kidneys

anasarca

pitting edema vs. anasarca: generalized widespread edema

anasarca

pitting edema vs. anasarca: heart, renal, liver failure

anasarca

pitting edema vs. anasarca: cirrhosis and ascites

waterhouse friderichsen syndrome (neisseria meningitidis)

meningeal rash can be indicative of?

epidural hematoma

subdural hematoma

subarachnoid hemorrhage

epidural hematoma

acute brain bleeding usually caused by trauma to the middle meningeal artery; space-occupying and can be life-threatening

subdural hematoma

chronic or peri-acute, space-occupying or diffuse blood on the brain that CAN be wiped off

subarachnoid hemorrhage

typically more chronic brain bleed that CANNOT be wiped away

1. meningeal rash (neisseria meningitidis)

   1. meningitis - purulent CSF, neck stiffness, photophobia

   2. waterhouse friderichsen

2. tuberculosis

3. prion disease (creutzfeldt-jakob disease)

4. COVID (only during the pandemic)

list scenarios (diagnosed history or physical signs) when it would be appropriate to isolate the descendant and take additional protective and preventive measures

subarachnoid hemorrhage

ruptured cerebral aneurysm “thunderclap” headache

MI, PE

facial congestion is often indicative of?

• atherosclerotic CVD = luminal narrowing due to atherosclerotic plaques in the coronary arteries

  • myocardial mottling → infarction (should correspond to impacted arteries)

  • myocardial rupture (3-7 days after MI) and cardiac tamponade

• hypertensive cardiac disease = long-standing systemic hypertension puts bigger load on the heart

  • concentric cardiomyopathy → cardiomegaly = electrically unstable

  • LV concentric hypertrophy

  • nephrosclerosis of the kidneys

differentiate atherosclerotic cardiovascular disease and hypertensive cardiac disease, and what findings you should expect to see at autopsy in a patient who has each/both

• signs of PE because by removing the heart and lungs together it ensures that you won’t miss it - leave the pulmonary intact

• female, fat, forty, facial congestion

• congestion of head, neck, upper chest

recognize when lungs should be removed en bloc and the benefits to this method of evisceration

1. diabetes mellitus (type I or II)

2. chronic kidney disease

3. hx of excessive vomiting and/or diarrhea

4. emaciation (malnutrition, starvation)

5. driver of car (compare to BAC)

6. alcoholic

what are situations when electrolytes should be ordered (6)

• lack of insulin → increased glucose → hyperglycemia

• increased cardiac fibrosis → fatal arrhythmia

• increased blood glucose can damage vessels and increase risk of atherosclerotic plaque build up

• increased risk of athersclerotic CVD

Understand how diabetes affects the cardiovascular system

• cardiac fibrosis, infarct, plaques, hypertrophy

• atherosclerosis, PKD

• peripheral ulcers, non-healing wounds, gangrene

• obesity

• acanthosis nigricans

• blood vessel damage in retina

• shrunken, granular kidneys

how to grossly recognize physical signs of DM

vitreous electrolytes to check for renal failure, ketones, glucose levels

what ancillary testing should be additionally ordered for DM and why