Autopsy Writing Made Easy!

           Autopsy writing is compulsory question in university exam. It is relatively easy if you have read pathology properly but it is time consuming. we have to recollect all characteristic points of different condition and write in specific format. Here are the characteristic points for frequently asked conditions so revising it become easy and time saving. I hope this helps!!!

Basic Common Theme:

•  Name, age, sex, admitted on, died on 
• Brief clinical history 
• Summary of lab investigation 
• Clinical diagnosis 
• Autopsy findings 
• External appearance 
• Weight of organs

Normal weight

          •    Lungs 450gm(left) 550gm (right)
          •    Spleen 150-200gm
          •    Liver 1200gm
          •    Brain 1200gm
          •    Kidney 200gm
          •    Heart 150gm

• Appearance of organ in-situ 

1.  Thoracic cavity  
2. Abdominal cavity 
3.  Cranial cavity 

• Description of various systemic findings

1. Alimentary 
2. Respiratory 
3. Cardiovascular 
4. Genitourinary 
5. Hemo lymphatic 
6. Endocrine 
7. Nervous 
8. Musculoskeletal
   

• Histopathological findings
• Lab investigations 
• Positive findings 
• C\P correlation 
• Cause of death
  

1)    Myocardial infarction :
•    Chest pain with exercise, sweating, shock, multiple attack
•    Pale, restless, pulse 60, JVP raised, s3 s4 present, pericardial frictional rub, apical systolic murmur
•    ECG ST elevation, t depression, q present
•    X-ray : cardiomegaly
•    External: obese, cyanosis, froth at mouth and nose
•    Lung: voluminous, dark, bilateral congestion, froth in trachea bronchi, cut shows froth
•    Heart: cardiomegaly, patchy opaque pericardium, patchy fibrosis myocardium, transmural infarct.
•    Coronary: multiple partially occluding thrombi, fresh thrombi in AD
•    Aorta: fibrous plaque, aneurism
•    Brain: shrunken brain, gyri narrowed, sulci widened.
•    Organs: cyanotic discoloration, gastric mucosal atrophy, pale scar on convex border of kidney
•    Sgot sgpt lipids increased
 

2)    Rheumatic Heart disease
•    Previous pharyngeal infection, fever, carditis, erythema marginatum, chorea
•    Pallor, edema over feet, JVP raised, pulse 100, murmur, ascites
•    Mitral stenosis(Fish-mouth), biventricular hypertrophy, bread butter pericarditis, fibrous bridging and calcification across commissure, papillary muscle hypertrophy
•    Lung congested edematous
•    Spleen liver enlarged nutmeg(CPC)
•    COD: congestive cardiac failure due to MS of rheumatic etiology
 

3)    Bacterial endocarditis:
•    Due to predisposing factors
•    Fever, purpura, anemia, pallor
•    Bp-90/60, pulse-110/minute, cardiomegaly, murmur
•    Hemorrhagic spots on skin and mucosa
•    Increased WBC, neutrophilia, hematuria
•    Pericardium congested, inflamed, fibrinous exudate
•    Fibrinous pericarditis, vegetations on cusps, chordae tendinea thickened, hemorrhagic endocardium
•    Flea-bitten kidney, shrunken, areas of infarct, internal vessels show thrombosis(embolization)
•    H/P: membranous glomerulonephritis, atrophied tubules, interstitial fibrosis with lymphocytic infiltration
•    Spleen enlarged with areas of infarction, liver slightly enlarged
•    COD: acute renal failure due to bacterial endocarditis secondary to RHD (aschoff’s body)
 

4)    Lobar pneumonia:
•    Cough, fever, breathlessness, cyanosis, clubbing, pallor, prominent neck vein
•    Dull note, air entry diminished, coarse crepitations
•    Increase WBC count
•    X-ray: hazy lobe
•    Adhesion in pleura, firm right lung, consolidation, clear demarcation, dilated bronchi
•    Liver, kidney congested, cloudy degeneration
•    Gram positive pneumococci
•    Cod: septicemia and respiratory failure
 

5)    Typhoid fever:
•    Step ladder fever, pulse 90, BP 60/40, dehydrated malnourished
•    Leukopenia with lymphocytosis, Widal positive
•    Peritoneum lost shiny appearance, turbid yellow exudate
•    Ileal perforation, pus pocket in paracolic gutter, hepatosplenomegaly
•    Ulcer long axis parallel, payer patches hypertrophic, edematous, congested
•    Mesentric lymph node enlarged
•    HP: liver spleen typhoid nodule, lymph node shows hypertrophy, ulcer shows loss of continuity, infiltration of plasma cell lymphocytes and erythrophagocytosis
•    Cod: hemorrhagic shock due to perforation
 

6)    Diabetes mellitus:
•    Polyuria, polydipsia, polyphagia, fruity smell, nausea, vomiting
•    Urine sugar increased, blood sugar increased, electrolyte imbalance (ketone-40mg/dl, potassium-5mmol/l, bicarbonate-6mmol/l, ph-6.8)
•    Congested cerebral vessel, microangiopathy, neuronal degeneration with hemorrhagic area
•    Heart enlarged, atherosclerotic change in coronary, flabby
•    Pancreas: reduced in size, beta cell degranulation, glycogen accumulation(PAS), amyloid replacement, lymphocytic infiltrate
•    Diabetic glomerulopathy
•    Retinopathy cataract glaucoma in eye
•    Diabetic foot
•    Death due to diabetes ketoacidosis

7)    AIDS:
•    Malaise, weight loss, night sweats, low grade fever, diarrhoea
•    Generalised lymphadenopathy, pallor
•    Lung: Hazy pleura, fibrocaseous TB, pneumonia due to P. Carinii (Giemsa stain), CMV (intranuclear basophilic inclusions), lungs bulky with areas of consolidation
•    Oral cavity: angular stomatitis, acute erosive gingivitis, aphthous ulcer, hairy leukoplakia
•    GIT: oesophagitis due to candida and cryptosporidiosis
•    Kidney, Liver: non-reactive TB
•    Lymph node: follicular hyperplasia with sinus histiocytosis
•    CNS: meningoencephalitis
•    Leg skin: Kaposi sarcoma
•    COD: respiratory failure due to pneumonia

8)    Falciparum malaria:
•    Fiver with chills, vomiting, abdominal pain, pulse 116, RR 26/min, pallor, koilonychia
•    Drowsy, disoriented, superficial reflex decreased deep increased
•    Smear: trophozoite, target cell, microcytic hypochromic anemia, anisocytosis, poikilocytosis
•    Lungs edematous, bulky, dark brown, congestion, pneumonitis
•    Liver and splenomegaly with parasitization, hemozoin pigment, Kupffer hyperplasia
•    Brain congested, distended capillaries, parasitized RBC, ring hemorrhage
•    COD: respiratory failure due to pneumonitis presented as cerebral malaria
 

9)    Acute myeloid leukemia:
•    Weakness, pallor, malaise, fever, night sweat, back pain, tender bone, dyspnoea, bleeding gums.
•    Blood: Hb-8mg%, tc-3-5lac, myeloblast 60%, promyelocyte 25%, platelet-75000, s. uric acid- 10.5mg%
•    Massive splenomegaly (occupy half of abdomen) with moderate hepatomegaly, increased weights
•    Liver: enlarged with loss of normal lustre, dull grey, firm, cut shows small pale patchy areas
•    Spleen: enlarged, dark red with map like yellow area on cut surface, wedge shaped infarction at periphery, cut was hard and granular with whitish nodules all over section.
•    H/E: BM hypercellular, M: E 6:1, more than 80% myeloblast, numerous megakaryocytes
•    H/E: Spleen architecture lost, lymphoid tissue replaced by myeloid cells, sinusoids contain large no. of granulocytes, patchy infiltration in pulp, perisplenitis
•    Liver, Kidney, Lymph node showed myeloid infiltration
•    COD: disseminated intravascular coagulation, intercurrent infection, malignancy
 

10)    Chronic Myeloid Leukemia:
•    Weakness, pallor, malaise, fever, night sweat, back pain, tender bone, Abdominal distension, edema feet
•    Blood: Hb-8mg%, tc-3-5lac, myeloblast 1%, promyelocyte 3%, myelocyte-12%, metamyelocyte-13%, band cell-12%, polymorph-47% platelet-75000, s. uric acid- 10.5mg%
•    Massive splenomegaly (occupy half of abdomen) with moderate hepatomegaly, increased weights
•    Ileum perforation
•    Liver: enlarged with loss of normal lustre, dull grey, firm, cut shows small pale patchy areas
•    Spleen: enlarged, dark red with map like yellow area on cut surface, wedge shaped infarction at periphery, cut was hard and granular with whitish nodules all over section.
•    H/E: BM hypercellular, M: E 6:1, numerous megakaryocytes
•    H/E: Spleen architecture lost, lymphoid tissue replaced by myeloid cells, sinusoids contain large no. of granulocytes, patchy infiltration in pulp, perisplenitis
•    Liver, Kidney, Lymph node showed myeloid infiltration
•    COD: disseminated intravascular coagulation, intercurrent infection, malignancy
 

11)    Hodgkin’s Lymphoma:
•    Cervical and lymphatic swelling, abdominal distention, loss of weight, bone pain and tenderness, pruritus and skin eruption, parasthesia
•    Painless lymphadenopathy, hepatosplenomegaly, enlarged vein, anemia, collapse of lung, pleural effusion, dyspnoea, cyanosis
•    Lymph node and BM biopsy: RS cell, blood smear: anemia with eosinophilia
•    Mediastinal gland enlarged trachea shifted to opposite side, pleural fluid, lung collapse
•    Mesentric gland enlarged, liver 2000gm spleen 1800gm
•    Lymph node enlarged homogenous pink with fish flesh (yellow streak) loss of architecture
•    Spleen enlarged firm nodular, lymphoid hyperplasia, malpighian body enlarged
•    Kidney brain intestine BM: patchy yellow infiltrate of hodgkin’s lymphoma
•    COD: Malignancy of RE system causing anemia, jaundice, brain and kidney dissemination
 

12)    Peptic Ulcer:
•    Abdominal pain (below border of rib radiate to back stabbing in character after food worst at night), vomiting (liquid with food particle pain relieved after that), weight loss, belching and flatulence
•    Pallor, bp-90/60, cool and calmly skin(shock)
•    Stomach: normal in size, slight obstruction of pylorus, inner side oval 2-3 cm ulceration with sharply cut edge, bottom clean with thin fibrous tissue Pancrease can be seen, 2mm opening to large branch of gastro duodenal artery
•    PM investigation: normocytic normochromic anemia, hb 5, RBC- 1.2 million
•    H/P: ulcer showed layer of fibrinoid debris with neutrophilic infiltrate and granulation tissue and fibrous scar
•    COD: hypovolemic shock and collapse due to bleeding peptic ulcer
 

13)    Chronic glomerulonephritis:
•    Weakness, fatigue(anemia), loss of appetite and weight, purities, nausea and vomiting, leg cramps(hypocalcemia), edema and HT (fluid retention)
•    Blood: normocytic normochromic anemia, hb-9gm%, HCT-27%
•    Urine: fixed proteinuria, sp. Gravity decreased, dysmorphic hematuria, rbc cast, waxy cast, creatinine-3.5, GFR- 13, BUN-80
•    Na -128, K-5.8, cl-98, ca-7.5, hco3- 19, phosphate- 6
•    USG: kidney small with increased echogenicity
•    H/E: glomeruli reduced in no., small, solid tuft, crescent formation, loss and atrophy of tubules with some infection and dilatation, chronic inflammatory infiltrate and hemorrhage in stroma, arteriolar sclerosis.
•    COD: chronic renal failure due to chronic glomerulonephritis.
 

14)    Chronic renal failure:
•    Same as chronic glomerulonephritis+
•    Increased blood sugar, HBa1c, diabetes retinopathy.
•    Edema and LVH
•    COD: chronic renal failure due to long standing diabetes and HTN.
 

15)    Portal cirrhosis:
•    Chronic alcoholic, cachectic, malnourished, feminine look, gynecomastia, jaundice, distention of abdomen, spider nevi, splenomegaly, hepatomegaly, ascites
•    Total, conjugated bilirubin, SGOT increased
•    Hematemesis
•    Transudate in cavities, yellow fluid in abdomen, dilated veins (splenic, portal, mesentric)
•    Oesophageal varices, anal piles, gi bleeding
•    Shrunken, Macronodular, non-fatty, hob-nail liver
•    Pancreas show chalky white calcification
•    Brain extremely pale, edema
•    Pericardial, pleural effusion
•    Wasting of muscle
•    H/P: liver cell necrosis, architecture lost, neutrophil infiltrate, fibrous septa, Mallory hyaline bodies
•    COD: hematemeses and encephalopathy due to cirrhosis
 

16)    Hepatic failure:
•    Fever, nausea, vomiting, loss of appetite, pain in RH, dark yellow urine, light coloured stool, yellow sclera
•    Urine: bile pigment, bile salt positive
•    Blood: s.bilirubin increased, SGPT 1240, SGOT-350, albumin reduced, ALP- increased, HbsAg positive, Thrombocytopenia
•    Liver small in size, soft, wrinkled capsule, 600gm
•    Brain edema with increased ICT, pale
•    H/E: liver cell necrosis, architecture lost, neutrophil infiltrate, hepatocyte bile stained, extensive hemorrhage, sinusoid congested. Brain cortical astrocyte swelling, focal area of necrosis and edema
•    COD: massive liver necrosis leading to acute liver failure and encephalopathy
 

17)    Pyogenic meningitis:
•    Secondary to pre-existing lesion in skin, lung, middle ear, bacterial endocarditis, head injury
•    Fever with chills, headache, vomiting, neck stiffness, Kernig Brudzinski sign, localising signs, increased ICT, papilledema
•    Increased TLC, neutrophilia, purulent CSF, less sugar increased protein, organisms
•    External features of antecedent condition
•    Dura tensely covering swollen brain, narrow sulci, widened gyri, purulent exudate in sulci, lesion in base of skull(mastoid)
•    Other detectable lesion of etiology
•    Intramedullary coning as prominent tonsillar groove on cerebellum
•    Congestion of vessels
•    SOL like abscess, purulent exudate
•    Healing by gliosis around it
•    If complicated by thrombosis of dural sinus, then peripheral hemorrhagic infarcts
•    COD: raised ICT leads to conning then cardiorespi failure and death
 

18)    Fibrocaseous TB:
•    Productive cough, low grade fever, hemoptysis, breathlessness
•    Retraction of infraclavicular region, decreased chest movement, hb-8, P-53 L-63, AFB detected
•    Pale, clubbing, pedal edema
•    Pleural adhesion to wall, apex and middle lobe multiple cavitary and fibrocaseous lesion, walls of bronchi thickened and filled with caseous material
•    Peritoneum studded with miliary TB, ileum show transverse ulcer, mesentric lymph node enlarged with caseous necrosis
•    Kidney, liver: miliary TB Heart: Brown atrophy
 

19)    Tuberculous Meningitis:
•    Headache, vomiting, High fever, confusion, irrational behaviour
•    Brain biopsy showed h/P changes of tuberculous granuloma, Culture showed colony
•    Csf changes and gelatinous exudate at basal surface
 

20)    Bronchogenic carcinoma:
•    Cough with blood tinged expectoration, fever, breathlessness, hemoptysis
•    Chronic smoker, cachexic, right SCL enlarged, pulse 100, clubbing, pallor
•    Dull note, decreased air entry, abdominothoracic breathing, tachypnea, rhonchi, decreased sounds, opacity on x-ray
•    Hemorrhagic pleural effusion, mediastinal shift, adhesion to diaphragm, tumor mass (cut shows white soft necrosed)
•    COD: respiratory failure due to pleural effusion