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Introduction:The patient that we observed for our Autopsy was a
41 year old Hispanic Male witha height of 625cm and weight of 176
lbs. It was reported by the patients family thatour patient had
been drinking alone at his home for hours before he was
found.Within minutes EMS arrived and rushed him to hospital and he
was declared dead
within the hour. It was also reported that our patient suffered
from hypertension,diabetes, as well as an unspecified seizure
disorder. Socially, it was noted that ourpatient abused alcohol.
When assessed in the emergency room the patients bloodglucose was
elevated at 327. On the report of the patient it was also noted
that alower GI bleed was suspected.
Autopsy Findings:Proceeding with the autopsy, there were no
signs of external trauma to the patientof which trauma to the head
was of particular concern. Opening the chest cavitythere was no
fluid found indicating that there had not been a pleural effusion.
Thepatients heart weighed 400, which was indicated to be at the
upper limit of normal.
Upon further examination of the heart the coronary vessels were
patent and free ofsignificant plaque or calcifications. The right
lung weighed in at 760 and the left at600. Both lungs were slightly
edematous but the main stem bronchi were clear ofobstruction. The
patients liver weighed 2800 which was quite large for his size
andhad a fatty consistency along with a yellow discoloration. The
patients kidneys were220 each and showed no gross pathological
features. The p atients intestinesappeared normal and an external
observation of stool which the patient had passedshowed brown
coloration ,which wasnt consistent with the hospitals
suspectedlower GI bleed. The patients b rain weighed 1280 and
showed no external signs oftrauma, nor did coronal slices through
any notable pathology. It was also noted thatthere was no
indication that the patient suffered an intracranial bleed of any
sort.
Differential Diagnosis:-Alcoholic Steatosis-Alcoholic
Hepatitis-Liver Cirrhosis
Pathophysiologic Correlation:The most evident pathological
finding noted in our patient upon autopsy was hissevere
hepatomegaly and fatty liver change . The patients social history
includedalcohol abuse which aligned with his livers condition. The
pathophysiologic processof chronic alcohol abuse primarily involves
the hepatotoxic characteristics ofethanol and its metabolism. One
of the metabolic products, acetaldehyde, is not onlytoxic but in
its creation via alcohol dehydrogenase the reduced form of
nicotinamideadenine dinucleatide (NADH) is generated. Further NADH
is also produced duringacetaldehydes metabolism to a cetate via
aldehyde dehydrogenase. With excessalcohol consumption there is a
large increase in NADH creation and this sets thestage for
steatosis due to NADHs role in stimulating the synthesis of fatty
acids.
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Although it was evident that the patient was suffering from
alcoholic steatosis, about of alcoholic hepatitis is more in line
with what could have been the cause of hisdeath based on the report
of him heavily consuming alcohol before he was found. Asmentioned
previously, acetaldehyde is an important intermediate in the
metabolismof alcohol. One of its major toxic effects is its ability
to peroxidise lipids. In doing so
it damages not only the plasma membranes of hepatocytes, but
also importantorganelles such as the mitochondria and lysosomes.
Acute damage of this naturedue to heavy alcohol consumption has
been shown to lead to death. With repeatedbouts of such injury
liver cirrhosis is also a potential complication.
Reflection:This autopsy experience was pretty enlightening. The
cadavers used for anatomylab are bodies that are much farther
removed from the actual time of death of theindividual than those
at the autopsy and just knowing that these people were alivenot too
long ago gave the experience a more surreal feeling. I somewhat
felt it was
an honor to be part of a process that, in many ways, gives
families closure on thepassing of their loved ones.
