The Fundamentals of Pathology (Magill’s Medical Guide, Sixth Edition)
Translated literally, pathology is the study (logos) of suffering (pathos). As a science, pathology focuses on the study of the structural and functional consequences of injury on cells, tissues, and organs and ultimately the consequences on the entire organism (that is, the patient). Oftentimes, cells and fragments of tissues are obtained surgically from living patients; this procedure, called biopsy, is for the purpose of evaluating the nature and extent of injury. The results of a biopsy help direct the treatment. Autopsy, by contrast, is performed to examine the dead body and the internal organs systematically, in order to determine why the patient died.
Four aspects of a disease process form the core of pathology and are searched for diligently during autopsy studies. These are etiology, or cause; pathogenesis, the mechanism of development of disease; morphologic changes, the structural alterations induced in cells, tissues, and organs of the body; and clinical significance, the functional consequences of these morphologic changes.
There are two major classes of etiologic causation factors: genetic and acquired. Examples of acquired factors are infections, physical trauma, chemical injury and poisoning, nutritional factors, and radiation and solar injury (sunburn). When an autopsy is performed, this etiology is sought, but it has been acknowledged that the classic concept of one...
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Procedures and Techniques (Magill’s Medical Guide, Sixth Edition)
Autopsies are performed for several generally recognized purposes, which are closely related. Medical autopsies are performed to improve the diagnosis of disease and to help the practicing or treating physician avoid repeating errors in diagnosis and therapy; it has been repeatedly shown that autopsies contribute to improvements in medical care. The College of American Pathologists (CAP) has stressed the importance and necessity of the autopsy as a service to both the medical community and the public, recognizing it as a useful medical procedure performed by a qualified physician to assess the quality of patient care and evaluate clinical diagnostic accuracy. The autopsy is also a valuable tool for determining the effectiveness and impact of treatment modalities, discovering and defining new and/or changing diseases (as in AIDS), increasing the understanding of biological processes of disease (pathogenesis), and augmenting clinical and basic research. Information gathered from autopsies is used to provide accurate public health and vital statistical information and education as it relates to disease. Finally, the autopsy is used for obtaining legal, factual information.
In the United States, permission to perform an autopsy must be granted. A legal action can arise when the autopsy consent has not been obtained or when it has not been obtained from the proper person. The statutes of individual states usually...
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Perspective and Prospects (Magill’s Medical Guide, Sixth Edition)
The field of pathology is, next to therapeutics (the study of medicinal substances), the oldest division of the healing arts because it is the study of disease itself. Its historical development can be broadly sketched in five different periods, each one highlighted by a fundamental change in the concept of the “seat of disease.” An examination of the steps by which pathology has reached its present state provides a useful perspective on the subject.
At the dawn of history, primitive humans believed that there was only a single disease, one that could produce disturbances as varied as headaches, blood vomit, epilepsy, or the death of mother and child during labor. While, in some of those cases, there were apparent causes of death, the real causes were thought to be hidden and supernatural. Thus, the concept of disease was not localized to any specific organ or even to a war wound or broken bone.
The idea of “humors” soon took over. It began in ancient Egypt, was well articulated by the Greeks, and came to dominate medical thought in the Western world up to the Renaissance. The humoral theory of disease proposes that illness is the result of disturbance in the equilibrium between four qualities (hot, cold, wet, and dry) and four elements (air, water, fire, and earth) to affect four body constituents (blood, yellow bile, black bile, and phlegm). This theory was championed by such intellectual giants as...
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For Further Information: (Magill’s Medical Guide, Sixth Edition)
Burton, Julian, and Guy Rutty, eds. The Hospital Autopsy. 2d ed. New York: Arnold, 2001. A comprehensive exploration of the history and techniques of autopsy practice. Includes topics such as external examination, evisceration, dissection of internal organs, the production of the autopsy report, and microbiological, biochemical, toxological and immunological analysis.
Camenson, Blythe. Opportunities in Forensic Science Careers. Rev. ed. New York: McGraw-Hill, 2009. Provides those seeking a career in forensics with information on training, education requirements, and salary statistics. Lists professional and Web resources.
Collins, Kim A., and Grover M. Hutchins, eds. Autopsy: Performance and Reporting. 2d ed. Northfield, Ill.: College of American Pathologists, 2003. A multiauthored, detailed manual that is concisely written and illustrated. The chapters examine techniques, various medicolegal and ethical questions, contemporary issues related to the decline in autopsy rates in the 1980’s, autopsy utilization, quality assurance, and reimbursement.
Dix, Jay, and Robert Calaluce. Guide to Forensic Pathology. Boca Raton, Fla.: CRC Press, 1998. Provides a concise overview of forensic pathology. Discusses how to determine the time and manner of death, the roles of experts in death investigation, how effective testimony is presented in court, and the importance of forensic...
(The entire section is 310 words.)
Autopsy (Encyclopedia of Medicine)
An autopsy is a postmortem assessment or examination of a body to determine the cause of death. An autopsy is performed by a physician trained in pathology.
Most autopsies advance medical knowledge and provide evidence for legal action. Medically, autopsies determine the exact cause and circumstances of death, discover the pathway of a disease, and provide valuable information to be used in the care of the living. When foul play is suspected, a government coroner or medical examiner performs autopsies for legal use. This branch of medical study is called forensic medicine. Forensic specialists investigate deaths resulting from violence or occurring under suspicious circumstances.
Benefits of research from autopsies include the production of new medical information on diseases such as toxic shock syndrome, acquired immunodeficiency syndrome (AIDS). Organ donation, which can potentially save the lives of other patients, is also another benefit of autopsies.
When performed for medical reasons, autopsies require formal permission from family members or the legal guardian. (Autopsies required for legal reasons when foul play is suspected do not need the consent of next of kin.) During the autopsy, very...
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Autopsy (West's Encyclopedia of American Law)
The dissection of a dead body by a medical examiner or physician authorized by law to do so in order to determine the cause and time of a death that appears to have resulted from other than natural causes.
This postmortem examination, required by law, is ordered by the local CORONER when a person is suspected to have died by violent or unnatural means. The consent of the decedent's next of kin is not necessary for an authorized autopsy to be held. The medical findings must be presented at an inquest and might be used as evidence in a police investigation and a subsequent criminal prosecution.
- Forensic Science.
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Autopsy (Encyclopedia of Nursing & Allied Health)
An autopsy is a postmortem assessment or examination of a body to determine the cause of death. An autopsy is performed by a physician educated in pathology. Often this physician also has forensic training.
Most autopsies advance medical knowledge or provide evidence for legal action. Medically, autopsies may determine the exact cause and circumstances of death, discover the pathway of a disease, and/or provide valuable information to be used in the care of the living. When foul play is suspected, a government coroner or medical examiner performs an autopsy to collect data for legal investigation. This branch of medical study is called forensic medicine. Forensic specialists investigate deaths resulting from violence or occurring under suspicious circumstances.
Benefits of research from autopsies include the discovery of new medical information on diseases such as toxic shock syndrome, acquired immunodeficiency syndrome (AIDS), and Alzheimer's disease.
When performed for medical reasons, autopsies require formal permission (written consent), from family members or a legal guardian. Autopsies required for legal reasons when foul play is suspected require authorization from a coroner or medical examiner. Such autopsies do not need the consent of next of kin. During the autopsy, very concise notes and documentation must be made for both medical and legal reasons. Some religious groups prohibit autopsies, although special waivers apply where suspicious death occurs.
An autopsy is the examination of a deceased human body with a detailed investigation of the person's remains. This procedure dates back to the Roman era when few human dissections were performed. Autopsies were utilized, however, to determine the cause of death in criminal cases.
At the beginning of the procedure, the exterior body is examined and the internal organs are removed and studied. Some pathologists argue that more autopsies are performed than necessary. However, recent studies show that autopsies can detect major findings about a person's condition which were not suspected when the person was alive. The growing awareness of the influence of genetic factors in disease has also emphasized the importance of autopsies.
Despite the usefulness of autopsies, fewer autopsies have been performed in the United States during the past 10 to 20 years. A possible reason for this decline is concern about malpractice suits on the part of the attending physician, although there are other reasons. Hospitals are performing fewer autopsies because of the expense. Modern technology, such as CT scans and magnetic resonance imaging (MRI), can often provide sufficient diagnostic information. Nonetheless, federal regulators and pathology groups have begun to establish new guidelines designed to increase the number and quality of autopsies being performed.
Many experts are concerned that if the number of autopsies increases, hospitals may be forced to charge families a fee for the procedure as autopsies are not normally covered by insurance companies or Medicare. However, according to several pathologists, the benefits of the procedure for families and doctors justify the cost. In medical autopsies, physicians remain cautious, examining only as much of the body as necessary, taking into account the wishes of the family. It is important to note that in certain circumstances, autopsies can provide peace of mind for a bereaved family.
If a medical autopsy is being performed, written permission is secured from the family member of record of the deceased.
After an autopsy has been completed, the body is prepared for final arrangements according to the family's wishes, or the funeral director's instructions.
There is some risk of disease transmission from the deceased. In fact, some physicians may refuse to do autopsies on specific persons because of a fear of contracting diseases such as AIDS, hepatitis, or Creutzfeld-Jakob disease.
In most situations, the cause of death is determined from the autopsy without any transmission of disease. Results of tests performed on samples of tissue and bodily fluids provide information about the cause and mechanism of death.
Abnormal results include inconclusive results from the autopsy and transmission of infectious disease during the autopsy. By following proper procedures, these are both highly unusual.
Health care team roles
Bodies of persons dying in a hospital are taken to the morgue by hospital attendants. Bodies of persons from any other location are transported by funeral home personnel, coroners, or their assistants. An autopsy is conducted by a physician, usually by one trained in pathology or forensic science. In some states, a coroner can legally carry out an autopsy. Laboratory personnel process any specimens or samples obtained during an autopsy. Once completed, funeral home personnel transport the remains to another location for burial preparation.
Acquired immunodeficiency syndrome (AIDS) group of diseases resulting from infection with the human immunodeficiency virus (HIV). A person infected with HIV gradually loses immune function, becoming less able to resist immune-related diseases and cancers, resulting in death.
Computed tomography scan (CT scan)he technique used in diagnostic studies of internal bodily structures in the detection of tumors or dysfunction. This diagnostic test consists of a computer analysis of a series of cross-sectional scans made along a single axis of a bodily structure or tissue that is used to construct a three-dimensional digital image of that structure.
Creutzfeld-Jakob disease rare, often fatal disease of the brain, characterized by gradual dementia and loss of muscle control that occurs most often in middle age and is caused by a slow-acting virus.
Hepatitisnflammation of the liver, caused by infectious or toxic agents and characterized by jaundice, fever, liver enlargement, and abdominal pain, with abnormal blood chemistry readings.
Magnetic resonance imaging (MRI) diagnostic tool that utilizes nuclear magnetic energy in the production of digital images of specific atoms and molecular structures in solids, especially human cells, tissues, and organs.
Burgess, Samuel B. Understanding Autopsy. Burnsville, NC: Celo Valley Books, 1993.
Dix, Jay. Forensic Pathology: A Color Atlas. Boca Raton, FL: CRC Press, 1999.
Finkbeiner, J. Autopsy: A Manual & Atlas. Philadelphia: W.B. Saunders, 2001.
Iserson, Kenneth B. Death to Dust: What Happens to Dead Bodies? Tucson, AZ: Galen Press Ltd, 2001.
Sheaff, Michael T., and Deborah J. Hopster. Post Mortem Technique Handbook. New York: Springer Verlag, 2001.
Burnett, B.R. "A Shot Through the Window." Journal of Forensic Science 46(2001): 379-385.
Houston, K., K. Hawton, and R. Sheppherd. "Suicide in Young People Aged 15-24: A Psychological Autopsy Study." Journal of Affective Disorders 63(2001): 159-170.
Roger, V.L., et al. "Time Trends in the Prevalence of Atherosclerosis: A Population-based Autopsy Study." American Journal of Medicine 110(2001): 267-273.
Targonski, P., et al. "Referral to Autopsy: Effect of Antemortem Cardiovascular Disease. A Population-based Study in Olmsted County, Minnesota." Annals of Epidemiology 11(2001):264-270.
American Academy of Family Physicians, 11400 Tomahawk Creek Parkway, Leawood, KS 66211-2672. (913) 906-6000. <<a href="http://www.aafp.org">www.aafp.org>.
American Medical Association, 515 N. State Street, Chicago, IL 60610. (312) 464-5000. <<a href="http://www.ama-assn.org">www.ama-assn.org>.
American Society of Clinical Pathologists, 2100 West Harrison Street, Chicago IL 60612. (312) 738-1336. <<a href="http://www.ascp.org/index.asp">www.ascp.org/index.asp>.
College of American Pathologists, 325 Waukegan Road, Northfield, IL 60093. (800) 323-4040. <<a href="http://www.cap.org">www.cap.org>.
American Academy of Forensic Sciences website. <<a href="http://www.aafs.org/">www.aafs.org/>.
International Association of Forensic Nursing website. <<a href="http://www.forensicnurse.org">www.forensicnurse.org>.
Johns Hopkins Autopsy Resource. <<a href="http://www.med.jhu.edu/pathology/iad.html">www.med.jhu.edu/pathology/iad.html>.
Leicester University Virtual Autopsy. <<a href="http://www.le.ac.uk/pathology/teach/VA/">www.le.ac.uk/pathology/teach/VA/>.
L. Fleming Fallon, Jr., MD, DrPH
Autopsy (World of Forensic Science)
Autopsy means "see for yourself." It is a special surgical operation, performed by specially trained physicians, on a dead body. Its purpose is to learn the truth about the person's health during life, and how the person died.
There are many advantages to getting an autopsy. Even when the law does not require it, there is always something interesting for the family to knowomething worth knowing that wasn't known during life is often found. Even at major hospitals, in approximately one case in four, a major disease is found that was unknown in life. Giving families the explanations they want is often stated as one of the most satisfying things that a pathologist does. A pathologist is a physician with a specialty in the scientific study of body parts. This specialty always includes a year or more learning to do autopsies.
Under the laws of most states, an autopsy can be ordered by the government. The job of coroner is a political position, while a medical examiner is a physician, usually a pathologist. Exactly who makes the decisions, and who just gives advice, depends on the jurisdiction. Autopsies can be ordered in every state when there is suspicion of foul play. In most states, an autopsy can be ordered when there is some public health concern, for example a mysterious disease or a worry about the quality of health care. In most states, an autopsy may be ordered if someone dies unattended by a physician (or attended for less than 24 hours), or if the attending physician is uncomfortable signing the death certificate. If autopsy is not required by law, the legal next-of-kin must sign an autopsy permit.
When a loved one dies, a family can ask the hospital to perform an autopsy. If the family prefers, a private pathologist can do the autopsy in the funeral home. It does not matter much whether the body has been embalmed first. Whoever does the autopsy, there should not be a problem with an open-casket funeral afterwards. This is true even if the brain has been removed and the dead person is bald. The pillow will conceal the marks.
Most religions allow autopsy. If the body is that of an Orthodox Jew, pathologists are happy to have a rabbi present to offer suggestions. Many Muslims prefer not to autopsy.
Here's how an autopsy is done. In this example, there are three pathologists working together.
The body has already been identified and lawful consent obtained.
The procedure is done with respect and seriousness. The prevailing mood in the autopsy room is curiosity, scientific interest, and pleasure at being able to find the truth and share it. Most pathologists choose their specialty, at least in part, because they like finding the real answers. Many autopsy services have a sign, "This is the place where death rejoices to teach those who live." Usually it is written in Latin: Hic locus est ubi mors gaudet succurrere vitae. Autopsy practice was largely developed in Germany, and an autopsy assistant is traditionally called a "diener," which is German for "servant."
The pathologist first examines the outside of the body. A great deal can be learned in this way. Many pathologists use scalpels with rulers marked on their blades. The body is opened using a Y-shaped incision from shoulders to mid-chest and down to the pubic region. There is almost no bleeding, since a dead body has no blood pressure except that produced by gravity. If the head is to be opened, the pathologist makes a second incision across the head, joining the bony prominences just below and behind the ears. When this is sewn back up, it will be concealed by the pillow on which the dead person's head rests.
The incisions are carried down to the skull, the rib cage and breastbone, and the cavity that contains the organs of the abdomen. The scalp and the soft tissues in front of the chest are then folded back. Again, the pathologist looks around for any abnormalities.
One pathologist prepares to open the skull using a special vibrating saw that cuts bone but not soft tissue. This is an important safety feature. Another pathologist cuts the cartilages that join the ribs to the breastbone, in order to be able to enter the chest cavity. This can be done using a scalpel, a saw, or a special knife, depending on the pathologist's preferences and whether the cartilages have begun to turn into bone, as they often do in older people. The third pathologist explores the abdominal cavity. The first dissection in the abdomen usually frees up the large intestine. Some pathologists do this with a scalpel, while others use scissors.
The skull vault is opened using two saw cuts, one in front, and one in back. These will not show through the scalp when it is sewn back together. The top of the skull is removed, and the brain is very carefully cut free of its attachments from inside the skull.
When the breastbone and attached rib cartilages are removed, they are examined. Often they are fractured during cardiopulmonary resuscitation. Freeing up the intestine takes some time. The pathologist carefully cuts along the attachment using a scalpel.
The chest organs, including the heart and lungs, are inspected. Sometimes the pathologist takes blood from the heart to check for bacteria in the blood. For this, he or she uses a very large hypodermic needle and syringe. The team may also find something else that will need to be sent to the microbiology lab to search for infection. Sometimes the pathologist will send blood, urine, bile, or even the fluid of the eye for chemical study and to look for medicine, street drugs, alcohols, and/or poisons.
Then the pathologist must decide in what order to perform the rest of the autopsy. The choice will be based on a variety of considerations. One method is the method of Virchow, which is removing organs individually. After the intestines are mobilized, they are opened using special scissors. Inspecting the brain often reveals surprises. A good pathologist takes some time to do this. The pathologist examines the heart, and generally the first step following its removal is sectioning the coronary arteries that supply the heart with blood. There is often disease here, even in people who assumed their hearts were normal.
After any organ is removed, the pathologist will save a section in preservative solution. Of course, if something looks abnormal, the pathologist will probably save more. The rest of the organ goes into a biohazard bag, which is supported by a large plastic container.
The pathologist weighs the major solid organs (heart, lung, brain, kidney, liver, spleen, sometimes others) on a grocer's scale. The smaller organs (thyroid, adrenals) get weighed on a chemist's triple-beam balance. The next step in this abdominal dissection will be exploring the bile ducts and then freeing up the liver, usually using a scalpel. After weighing the heart, the pathologist completes the dissection. There are a variety of ways of doing this, and the choice will depend on the case. If the pathologist suspects a heart attack, a long knife may be the best choice.
The liver has been removed. In our example of a fictitious autopsy, the pathologist finds something important. It appears that this man had a fatty liver. It is too light, too orange, and a bit too big. It is possible that this man had been drinking alcohol heavily for a while. The liver in this case weighs much more than the normal 49.4 ounces (1400 gm).
The pathologist decides to remove the neck organs, large airways, and lungs in one piece. This requires careful dissection. The pathologist always examines the neck very carefully. The lungs are almost never completely normal at autopsy. These lungs are pink, because the dead man was a nonsmoker. The pathologist will inspect and feel them for areas of pneumonia and other abnormalities. The pathologist weighs both lungs together, then each one separately. Afterwards, the lungs may get inflated with fixative. Dissecting the lungs can be done in any of several ways. All methods reveal the surfaces of the large airways, and the great arteries of the lungs. Most pathologists use the long knife again while studying the lungs. The air spaces of the lungs will be evaluated based on their texture and appearance.
The liver is cut at intervals of about a centimeter, using a long knife. This enables the pathologist to examine its inner structure.
The rest of the team continues with the removal of the other organs. They have decided to take the
Before the autopsy is over, the brain is usually suspended in fixative for a week so that the later dissection will be clean, neat, and accurate. If no disease of the brain is suspected, the pathologist may cut it fresh.
The kidneys are weighed before they are dissected.
When the internal organs have been examined, the pathologist may return all but the portions they have saved to the body cavity. Or the organs may be cremated without being returned. The appropriate laws and the wishes of the family are obeyed.
The breastbone and ribs are usually replaced in the body. A pathologist prepares a large needle and thread used to sew up the body. The skull and trunk incisions are sewed shut ("baseball stitch"). The body is washed and is then ready to go to the funeral director.
The pathologists will submit the tissue they saved to the histology lab, to be made into microscopic slides. When the slides are ready, the pathologists will examine the sections, look at the results of any lab work, and draw their final conclusions.
The only finding in this imaginary autopsy was fatty liver. There are several ways in which heavy drinking, without any other disease, can kill a person. The pathologists will rule each of these in or out, and will probably be able to give a single answer to the police or family.
A final report is ready in a month or so. The glass slides and a few bits of tissue are kept forever, so that other pathologists can review the work.
SEE ALSO Anatomical nomenclature; Body Farm; Coroner; Death, cause of; Death, mechanism of; Decomposition; Identification; Medical examiner; Pathology; Pathology careers; Rigor mortis; Time of death; Toxicological analysis.