Problem
By referring to the below autopsy, I need ti answer the following questions:
A. What would you certify as the cause of death on a death certificate? (Please adopt the format of the death certificate (i.e. Part I, Part II) when presenting your cause of death.);
B. What do you think the manner of death might be?;
C. What additional information do you require before you are confident that you know the cause of death?
D. Has the autopsy assisted in the determination of the cause of death and, if so, how?
Autospy:
Date: 20th July 2003
Autopsy No. 1234
Name of Deceased:
Date of Birth: 24th Oct. 1966
Age at Death: 37
Sex: M
Address: Some House, Edinburgh
Place of Death: Building Site.
Time of Death / Found Dead at: 07.30
INTERNAL EXAMINATION
Cardiovascular System
Heart (370 g): is of normal size and shape.
Pericardial sac: contains less than 5ml of clear straw-coloured fluid.
Atria: normal; contain no thrombus.
Right ventricle: normal in configuration and thickness.
Left ventricle: shows no evidence of old or recent ischaemic changes; normal
in configuration and thickness.
Valves: within normal limits.
Coronary arteries: have a normal distribution. The coronary ostia occupy a
normal anatomical position and are widely patent. The coronary arteries are
widely patent with no significant atheroma. There is no coronary thrombosis.
Aorta: no significant natural disease.
Carotid arteries: widely patent with no significant atheroma.
Venae cavae: normal.
Renal arteries: widely patent with no significant atheroma.
Pulmonary vessels: no thromboemboli.
Other vessels: unremarkable.
Mediastinum: normal.
Respiratory System
Hyoid bone and laryngeal cartilages: intact.
Larynx: normal.
Soft tissues of neck: uninjured and healthy.
Trachea and main bronchi: unobstructed and free from disease.
Pleural cavities: no adhesions or free fluid.
Lungs (right 760 g; left 630 g): both lungs are well inflated and show moderate
agonal congestion and oedema. They are heavier than normal.
Hilar lymph nodes: unremarkable.
Digestive System
Tongue: no trauma. Mouth: unremarkable.
Tonsils: normal. Pharynx: normal.
Oesophagus: normal.
Peritoneal cavity: unremarkable; no excess of fluid and no adhesions.
Stomach: healthy mucosa and wall.
Stomach contents: a little watery brown fluid containing apparent minced
meat and vegetable residues. There are no obvious tablets, capsules or their
remains.
Duodenum: normal.
Small intestine: normal.
Large intestine: normal.
Contents of bowel: normal; no bleeding.
Appendix: present.
Rectum: normal.
Liver (1980 g): unremarkable externally and on section.
Gall bladder: contains clear bile. There are no gallstones.
Bile ducts: healthy and unobstructed.
Pancreas: unremarkable.
Genito-urinary System
Kidneys (right 160g; left 190g): the capsules strip with ease revealing smooth
surfaces. The cortices are of normal width.
Ureters: unremarkable.
Bladder: contains about 50ml of clear amber urine.
Internal genitalia: unremarkable.
Gonads: unremarkable.
External genitalia: unremarkable.
Lymphatic System
Spleen (130g): healthy externally and on section.
Cervical lymph nodes: unremarkable.
Mediastinal lymph nodes: unremarkable.
Mesenteric lymph nodes: unremarkable.
Para-aortic lymph nodes: unremarkable.
Peripheral lymph nodes: unremarkable.
Thymus: not recognisable.
Vertebral bone marrow: not examined.
Endocrine System
Parathyroids: unremarkable.
Thyroid: unremarkable.
Adrenals: unremarkable.
Pituitary: exposed but not removed. No obvious abnormality.
Cranium and Nervous System
Scalp: not injured.
Skull: no fractures identified.
Middle ears: exposed but not opened. No apparent abnormality.
Air sinuses: not opened.
Meninges: no epidural, subdural or subarachnoid haemorrhage.
Cranial vessels: have a normal anatomical distribution with no aneurysmal
dilatation and no significant atheroma.
Brain (1295 g): no contusions. No significant uncal or tonsillar herniation.
Serial coronal sections of the cerebral hemispheres at 1cm intervals reveal no
old or recent pathological changes. The cerebellum and brain stem appear
unremarkable.
Spinal cord: not examined.
Peripheral nerves: where exposed during routine dissection, unremarkable.
Musculo-skeletal System
Spinal column: no visible fractures.
Limb girdles: no visible fractures.
Long limb bones: no fracture evident externally or on palpation.
Hands and feet: no fractures evident externally or on palpation.
Ribs/sternum: no visible fractures.
General condition of skeleton: normal for age.
Muscles: where exposed during routine dissection, unremarkable.
SAMPLES
A range of routine tissue samples have been retained for histology.
No other organs retained.
TOXICOLOGY
Specimens of blood, urine, vitreous, liver, bile and stomach contents
have been retained for estimation of alcohol, common drugs and drugs of
abuse. A sample of head hair has been retained for possible determination of
the pattern of chronic drug abuse.