 Autopsy (Post Mortem Examination, Obduction)
Autopsy (Post Mortem Examination, Obduction) Quote: Quote: What is an autopsy?
An autopsy (also known as a post-mortem examination or obduction) is the examination of the body of a dead person and is performed primarily to determine the cause of death, to identify or characterize the extent of disease states that the person may have had, or to determine whether a particular medical or surgical treatment has been effective. In academic institutions, autopsies sometimes are also requested for teaching and research purposes. Forensic autopsies are autopsies with legal implications and are performed to determine if death was an accident, homicide, suicide, or a natural event. The word autopsy is derived from the Greek word autopsia: "to see with one's own eyes."
Autopsies are performed by pathologists; medical doctors who have received specialty training in the diagnosis of diseases by the examination of body fluids and tissues.
| Quote: Who determines whether an autopsy is performed?
A physician cannot order an autopsy on a patient without the consent of the next-of-kin. A medical examiner can order an autopsy without the consent of the next-of-kin. Deaths that are investigated by the medical examiner or coroner include all suspicious deaths, and, depending upon the jurisdiction, may include deaths of persons not being treated by a physician for a known medical condition, deaths of those who have been under medical care for less than 24 hours, or deaths that occurred during operations or other medical procedures.
In all other cases, consent must be obtained from the next-of-kin before an autopsy is performed, even at academic institutions or hospitals. The next-of-kin also has the right to limit the scope of the autopsy (for example, excluding the brain from evaluation or limiting the procedure to examination of the abdomen) if he/she wishes.
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Quote: How is an autopsy performed?
The extent of an autopsy can vary from the examination of a single organ such as the heart or brain, to a very extensive examination. Examination of the chest, abdomen, and brain is probably considered by most pathologists as the standard autopsy, and one technique is briefly described below.
The autopsy begins with a complete external examination. The weight and height of the body are recorded, and identifying marks such as scars and tattoos also are recorded.
The internal examination begins with the creation of a Y or U- shaped incision from both shoulders joining over the sternum and continuing down to the pubic bone. The skin and underlying tissues are then separated to expose the rib cage and abdominal cavity. The front of the rib cage is removed to expose the neck and chest organs. This opening allows the trachea (windpipe), thyroid gland, parathyroid glands, esophagus, heart, thoracic aorta and lungs to be removed. Following removal of the neck and chest organs, the abdominal organs are cut (dissected) free. These include the intestines, liver, gallbladder and bile duct system, pancreas, spleen, adrenal glands, kidneys, ureters, urinary bladder, abdominal aorta, and reproductive organs.
To remove the brain, an incision is made in the back of the skull from one ear to the other. The scalp is cut and separated from the underlying skull and pulled forward. The top of the skull is removed using a vibrating saw. The entire brain is then gently lifted out of the cranial vault. The spinal cord may also be taken by removing the anterior or posterior portion of the spinal column.
The organs are first examined by the pathologist to note any changes visible with the naked eye. Examples of diseases that may produce changes readily recognizable in the organs include atherosclerosis, cirrhosis of the liver , and coronary artery disease in the heart.
After the organs are removed from the body, they usually are separated from each other and further dissected to reveal any abnormalities, such as tumors, on the inside. Small samples are typically taken from all organs to be made into slide preparations for examination under a microscope. At the end of an autopsy, the incisions made in the body are sewn closed. The organs may be returned to the body or may be retained for teaching, research, and diagnostic purposes. Performance of an autopsy does not interfere with an open casket funeral service, as none of the incisions made in order to accomplish the autopsy are apparent after embalming and dressing of the body by the mortician.
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Quote: What other special studies may be done as part of the autopsy?
Pictures of findings may be taken for future reference. Special studies may include cultures to identify infectious agents, chemical analysis for the measurement of drug levels or metabolic abnormalities, or genetic studies. Tissue may be frozen for future diagnostic or research purposes. Organs may be preserved and stored in formalin for later examination, sampling for microscopy, presentation at conferences, or archiving for the training of medical students.
| Quote: What is the autopsy report?
After all studies are completed, a detailed report is prepared that describes the autopsy procedure and microscopic findings, gives a list of medical diagnoses, and a summary of the case. The report emphasizes the relationship or correlation between clinical findings (the doctor's examination, laboratory tests, radiology findings, etc.) and pathologic findings (those made from the autopsy).
| Quote: Why is the autopsy rate declining?
Beginning in the 1950s, hospital autopsy rates started falling from an average of around 50% of all deaths to 10% in the late 1990s. Currently, the rates are even lower at non-academic hospitals. In 1970, the Joint Commission for Accreditation of Hospitals dropped the requirement that a hospital needed an autopsy rate of 20% to be accredited. To some, this decline represents a crisis in medical education, research, and practice, and deprives decedents' families, physicians, and society of the many benefits of an autopsy.
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Quote: Multiple factors are believed to contribute to the declining autopsy rate.
Quote: Family factors:
Certainly the relationship between patients and their doctors has changed dramatically over the past 50 years due to factors such as specialization, managed care, and the disappearance of the "house call." Physicians no longer are "family doctors" and do not have the same rapport with patients and their families as in past years. This change in the basic doctor-patient relationship would seem to make it increasingly difficult to obtain consent for an autopsy, as issues of trust are most certainly involved.
Concerns over disfigurement of the remains or delays in funeral arrangements may prevent a vast majority of families from consenting to an autopsy. In reality, however, the visual examination of the body and the removal of tissues and/or organs for microscopic examination can be completed in a few hours. Furthermore, there are no visible external changes that would preclude an open-casket funeral service.
In the majority of cases and certainly at academic medical centers, there is currently no charge to the family. More recently, though, some institutions have started to charge and private autopsies at the request of family members that are performed outside of the hospital may cost several thousand dollars.
| Quote: Clinician factors:
The perceived and experienced hostility of patients' families towards medical providers may also have an impact on the physician's practice regarding the autopsy. Most physicians are generally uncomfortable requesting an autopsy because it is not an easy or pleasant task. If, in addition, a physician feels that a given family questions the care that their relative was given, the physician may be further dissuaded from requesting an autopsy that might prove that the care that was given was indeed incorrect. During the first half of the century, physicians requested autopsies with the hope of uncovering errors or missed diagnoses that would serve to improve future patient care. This practice may still occur, but sometimes at the price of a lawsuit.
Many individuals in medicine feel that modern technology has made the autopsy outdated or obsolete. With modern imaging studies and laboratory tests, it is thought that the autopsy is unlikely to reveal any conditions that were not detected clinically. The accuracy of the clinical diagnosis has been the subject of numerous research studies. These studies have consistently shown that in 20% to 40% of autopsied patients, there were important, treatable conditions that were detected at autopsy that were not diagnosed clinically. This consistent and significant discrepancy between clinical and pathologic diagnoses is probably the most compelling argument for continued efforts to revive the autopsy as the "gold standard" in evaluating the quality of medical care.
| Quote: Pathologist factors: Some doctors express dissatisfaction with the quality of an autopsy if the pathologist does not provide answers regarding the case. Unfortunately, an autopsy does not guarantee that the cause of death, for example a heart arrhythmia, will be identified.
Autopsy pathology is a vanishing subspecialty, which, for the most part, has been relegated to a secondary position. At the turn of the century, most of the pathologist's activities revolved around the autopsy. Since that time, laboratory medicine and surgical pathology (examining tissue biopsies from living patients) have become the major activities of practicing pathologists.
In addition, the autopsy is not one of the favorite activities among the majority of pathologists. For many pathologists, an autopsy is an extra burden with no compensation during a busy day.
| | Quote: What are the benefits of autopsies?
Quote: Benefits for families:
For families, the autopsy has both tangible and psychological benefits. Uncertainty regarding the cause of an individual's death can delay payment of insurance benefits. The autopsy can also uncover genetic or environmental (for example, a bacterium or fungus) causes of disease that could affect other family members. Psychologically, the autopsy provides closure by identifying or confirming the cause of death. The autopsy can demonstrate to the family that the care provided was appropriate, thereby alleviating guilt among family members and offering reassurance regarding the quality of medical care. Lastly, the autopsy is a mechanism that enables the family to participate in medical education and research.
| Quote: Benefits for the clinician and hospital:
The procedure can confirm the accuracy of the clinical diagnoses and the appropriateness of medical care. The autopsy findings can be utilized to educate physicians, nurses, residents, and students, thereby contributing to an improved quality of care.
| Quote: Benefits to society:
Many of the benefits of the autopsy are experienced by society as a whole. The autopsy aids in the evaluation of new diagnostic tests, the assessment of new therapeutic interventions (drugs, devices, surgical techniques), and the investigation of environmental and occupational diseases. Autopsy data are useful in establishing valid mortality statistics. Data derived from death certificates in the absence of autopsy data have repeatedly been shown to be inaccurate. New medical knowledge on existing diseases that is derived from autopsy-based research is clearly important for everyone. Remarkably, new diseases continue to emerge which can only be fully investigated by autopsy.
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Last edited by trimurtulu; 02-22-2009 at 12:56 PM.
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02-22-2009, 12:53 PM
Virtual Autopsy: Inside the Skull of a Suicide Victim 
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