PRIS > Post mortem examination > Flashcards

Post mortem examination Flashcards

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1
Q

What is a post mortem/ necropsy/autopsy?

A
  • the examination of a body after death
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2
Q

We perform PME to confirm or refute a clinical diagnosis - what would this include?

A
  • if the diagnosis was correct
  • can you reined the differential diagnosis
  • was there other concurrent disease
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3
Q

We perform PME to work out if there was failure in treatment - why do we do this?

A
  • to work out why did treatment of clinical diagnosis fail
  • clinical audit
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4
Q

What is sudden death?

A
  • death without any knowledge of disease, injury or intoxication, or death within minutes or hours of onset of clinical signs
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5
Q

Why do we perform a PME for sudden death?

A
  • aims to provide a diagnosis when there is no clinical diagnosis
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6
Q

What is apparent sudden death?

A
  • the clinical signs had not been noticed by owner
  • e.g., prey animal masking evidence or suffering
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7
Q

Why do we PME in herd, group or population health?

A
  • for rapid diagnosis of disease in a herd, group or population
  • provides additional opportunity to implement treatment, nutrition or management changes to prevent further losses of individuals or production
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8
Q

Why do we use PME in surveillance?

A
  • monitor endemic disease
  • detect exotic / notifiable disease
  • monitoring effects of husbandry / management changes
  • public health
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9
Q

Forensic post mortem examinations can be used in cases of crime involving animals - what do these look into?

A
  • cause of death
  • disease / health status
  • degree of suffering
  • obtaining trace evidence
  • identification
  • insurance
  • malpractice inquests
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10
Q

Zoo animals have PME following death or euthanasia - why may these be performed?

A
  • population health
  • research
  • husbandry / management changes
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11
Q

What can obtained samples be used in?

A
  • histopathology
  • microbiology
  • bacteriology
  • virology
  • mycology
  • parasitology
  • trace element analysis
  • toxicology
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12
Q

PME can be used in research such as toxicological pathology - what can tissues/other samples for further study be used in?

A
  • pathology research
  • clinical research
  • basic science research
  • achieved samples allow retrospective studies
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13
Q

There is no one correct way to perform a PME - however what should you make sure you do?

A
  • examine every organ
  • follow a standard procedure
  • take samples from each tissue into formalin (1:10)
  • take any additional samples which may require for further testing
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14
Q

What prerequisites are required before a PME?

A
  • permission to perform
  • reason to perform
  • signalment (species, breed, sex, age)
  • clinical history
  • time of death
  • mode of death
  • found death
  • type of euthanasia
  • cadaver storage
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15
Q

What should be checked before PME?

A
  • check identification details compared to paperwork
  • packaging and any other items
  • microchip number
  • body weight
  • crown to rump length/height
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16
Q

During an external examination pre PME why do you not give a BCS?

A
  • dehydration and post mortem changes of the cadaver, and lack of muscle tone can give a misleading score
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17
Q

What should be described in a post mortem examination?

A
  • subcutaneous adipose tissue
  • adipose tissue: around organs, behind eyes, in marrow cavities
  • muscle and organ size/atrophy
  • bony prominences
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18
Q

What descriptors can be used to describe each point in a PME?

A
  • excellent, adequate through to emaciated
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19
Q

What would you like for on the external examination?

A
  • wounds or other superficial lesions
  • hair coat condition, ectoparasites
  • discharges from orifices
  • colour of skin, sclera and mucous membranes
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20
Q

How would you perform the initial dissection?

A
  • disarticulate the limbs to ensure cadaver is stable
  • midline skin incision (through skin only) from mandibular symphysis to pubis
  • reflect the skin way from the midline to expose subcutaneous tissue to muscle
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21
Q

What would you look for in skin and subcutaneous tissues?

A
  • colour changes
  • masses
  • fluid
  • gas
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22
Q

What would yellowed skin or tissues indicate?

A
  • icterus
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23
Q

What would pallor skin or tissues indicate?

A
  • loss of blood / anaemia
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24
Q

What would red-purple skin or tissues indicate?

A
  • congestion, sepsis, bruising
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25
What would green skin or tissues indicate?
- bile imbibition, pseudomelanosis
26
What would gelatinous skin or tissues indicate?
- oedema, serous atrophy of fat
27
How would you open the adnominal cavity during an PME?
- incise along linear alba (avoid viscera, top right image) - collect any fluid within the abdominal cavity - cut from Linea alba laterally along the last rib on each side to open the cavity - check for negative pressure in the thoracic cavity (small incision in diaphragm) - check topography
28
How would you open the thoracic cavity in a PME?
- cut along the costochondral junctions on one sider of the thorax - reflect the rib cage (dethatching the mediastinum) - cut along the bend in the costochondral junctions on the other side to expose the thoracic contents
29
What is the pluck?
= tongue, larynx, thyroid and parathyroid glands, trachea, oesophagus, heart and lungs
30
How would you remove the pluck?
- cut along the medial aspect of the body of the mandible, from the ramus to the symphysis, bilaterally - reflect the tongue, ventrally, through incision - hold the tongue and move ventrally and caudally - examine the hyoid apparatus before cutting through the cartilaginous joints - continue reflecting ventrally and caudally the tongue, larynx, trachea and oesophagus by cutting the fascia dorsal to these structures - continue this technique to remove the heart and lungs still attached to the pluck - cut oesophagus, vena cava and aorta at the level of the diaphragm to remove the pluck from the cadaver
31
How would you check patency of the bile duct?
- make a small incision into the duodenum, near the bile duct - squeeze the gall bladder - bile should ooze from the incision
32
What would you then remove from the abdomen (after removing viscera)?
- remove the adrenal glands - remove the liver and spleen - remove the GIT - remove the urinary tract - remove ovaries and uterus/testes
33
What extra things would you check after dissecting from the abdomen?
- check lymph nodes - check bones and joints
34
How would you examine the oesophagus in the pluck?
- remove the thyroid and parathyroid glands - open the oesophagus - examine content - are there strictures (narrower bits) - are there lesions
35
How would you examine the larynx, trachea and bronchi of the pluck?
- with clean scissors open the larynx, trachea and bronchi - check content - check for froth - check for lesions
36
When examining the heart what should you make sure to do?
- examine every chamber - examine every valve
37
What should heart weight be in cats and dogs?
- dogs = <1% of body weight - cats = <18-20g
38
The thickness of left ventricular free wall, interventricular septum and right ventricular free wall should be a ratio of what?
- ratio of 3:3:1
39
What components of the heart should you examine?
- pericardium - epicardium - myocardium - endocardium - valves
40
How would you examine the parenchymatous (liver, spleen, lungs) organs?
- make a partial thickness incisions through parenchymatous organs
41
When removing the capsule from the kidneys what would you look for?
- adhesions - lesions - exudate
42
You would then bisect the kidneys to examine what?
- cortex - medulla - pelvis - urethra
43
What would you collect from the urogenital tract?
- urine if possible
44
Apart form the kidneys what other aspects of the urogenital tract would you open and examine?
- bladder - genital tract - reproductive organs
45
What would you do when examining the entire GIT?
- collect and describe stomach and intestinal contents - examine the serosa and mucosal surfaces
46
How would you examine the central nervous system?
1. remove head - check foramen magnum 2. open cranial vault - check meninges 3. remove brain and eyes ( +/- spinal cord) - fix whole before dissection ( around 1 week)
47
When would you need to describe lesions?
- PME - biopsy submissions - clinical consultation notes - surgery reports - referral letters - seeking advice from pathologist/other vets
48
What descriptors would you use to describe a lesion?
- organ/tissue - position - number - weight - distribution - contour - size - colour - shape - consistency - smell
49
When taking about the weight of a lesion what do you need to include?
- percentage of body weight
50
What does distribution of a lesion refer to?
- the spatial arrangement of lesions within the tissue
51
You can describe a lesion as random distribution - what does this mean?
- without relationship to the architecture of the organ or tissue - e.g., abscess or tumours in the lungs or liver
52
What does symmetrical distribution mean?
- highlights or outlines an anatomical or physiological subunit - e.g., metabolic disorder affecting a group of related cells in a paired organ
53
What does focal distribution mean?
- a single defined lesion on a normal background or background exhibiting a different process - e.g., an abscess in a consolidated lung
54
What does multifocal distribution mean?
- more than one discrete lesion on a background
55
What is multifocal to coalescing distribution?
- many lesions which appear to be growing together or fusing suggesting an active process which is expanding or not contained
56
What is miliary distribution?
- numerous tiny foci which are too numerous to count
57
What is a segmental distribution?
- well defined portion of the tissue is abnormal - often defines a vascular bed
58
What is a diffuse lesion?
- the whole tissue is affected
59
What is a raised contour and give examples?
- where something is added - fluids = blood, transudate, exudate, effusion, oedema - cells = hyperplasia, neoplasia, inflammation - tissues = fat, cartilage, bone
60
What is a depressed contour and give examples?
- something has been removed - necrosis - atrophy
61
How would you describe a flat contour?
- not raised or depressed - has not had time to progress or does not cause expansion or necrosis
62
How do we measure lesions?
- in 3D
63
What would a uniform size lesion be like?
- lesions occurring at the same time, or over a short period, and are progressing at the same rate
64
What would a non-uniform lesion be like?
- lesions are separated in time or rate of progression
65
Organs could be larger than normal due to what?
- hyperplasia - hypertrophy - oedema - neoplasia - congestion - inflammation
66
Organs could be smaller than normal due to what?
- hypoplasia - atrophy - necrosis
67
What does dynamic organs mean?
- size due to physiological status
68
What organs would be rapidly (sec-mins) dynamic?
- lungs, urinary bladder
69
What organs would be moderately dynamic (min to hrs)?
- spleen, GIT, brain
70
What organs are slowly dynamic (days to months)?
- heart - liver - lymph nodes - endocrine glands
71
What would a red to red black colour suggest?
- congestion - haemorrhage
72
What would a white/grey/yellow colour suggest?
- lack of blood, necrosis, icterus, fibrosis
73
What would a black colour suggest?
- melanin - melanosis - flat - melanoma - raised
74
What would a green-black colour suggest?
- pseudomelanosis - H2S pigments
75
What would a green colour suggest?
- bile - some fungi
76
What do you need to think of when describing lesion shape?
- what does it most resemble - 2D or 3D terms - symmetrical shapes and pattern may reflect the underlying architecture
77
What would a gas consistency be like?
- trapped in tissue = emphysema = autolysis
78
What would a fluid consistency be like?
- looks or feels wet = oedema = blood = transudates = fluid rich exudate = effusions = urine
79
What would a soft consistency be like?
- fluid rich - cell/stroma poor
80
What would a firm consistency be like?
- fluid poor - cell/stroma rich
81
What would a hard/gritty consistency be like?
- mineralised stroma/matrix - cartilage - bone - calcified tissue
82
If a lesion has a distinct smell what could theses be?
- Foul = rotting smell, putrefactive necrosis, saprophytic bacteria - Ammonia = uraemia - No odour = aseptic process?
83
If a lesion has a distinctive sound what could these be and what could they mean?
* Crepitant – emphysema, gas producing bacteria, normal lung (absence = atelectasis) * Sloshing – fluid filled structure – ascites, effusions, diarrhoea
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