Forensic Pathology Report

Group Member #1:

Aine Piedad

Group Member #2:
Daniela Rodriguez

Case File (example, HTH-12):
HTH-1

I. Cause of Death

What was the cause of death?

Illicit drug and alcohol abuse. Multiple cysts and tumors within the
kidneys. Kidney infection. Inflamed liver, littered with nodules and
microvesicular steatosis.

What pieces of evidence (from the report or the internet) do you have?

In the decedents toxicology report, multiple unlawful drugs were
detected including cocaine, methamphetamines, heroin and morphine. Opiates
and other substances wreak havoc on the kidneys, increasing chances of kidney
infections and kidney failure.
Her liver also suffered, though mostly because of her frequent
consumption of alcohol. Drinking can have severe effects on the liver including
steatosis or fatty liver, alcoholic hepatitis, fibrosis, and cirrhosis. The autopsy
report showed that she did indeed have steatosis and fibrosis in her liver.

II. Mechanism of Death
What was the mechanism of death?

Kidney failure and liver failure.

What pieces of evidence (from the report or the internet) do you have?

Within the investigative narrative, the decedent had been complaining of
an upset stomach, diarrhea and frequented the bathroom throughout the night.
She was fatigued even after sleeping a good portion of the night. Viewing the
body post mortem, it was discovered that she had vomited. The decedent was
bleeding internally from the distal, (lower), esophagus and stomach as evidence
by the coffee ground emesis that had flowed from her mouth and nose and onto
the floor beneath her. Coffee ground emesis is clotted blood that has been
vomited. Chronic drinkers may have areas of erosion in their esophagus and
stomach which can cause bleeding. This confirms her alcoholism. The Medical
Examiner Investigator also noted that the decedents lower extremities as well
as her abdomen were slightly swollen.
These are key symptoms of a prolonged kidney infection which may have
led to kidney failure as well.
The decedent had already had horribly nourished kidneys from the
superfluous drug and alcohol misuse. The microscopic examination revealed
that the decedent had multiple sclerotic glomeruli, thickened arterioles, areas
of interstitial fibrosis, and focal interstitial lymphocytic infiltrates... The
kidneys were severely infected and deteriorating. Sclerotic glomeruli means
that the kidneys were scarred which accelerated senescence. The toxicology
report additionally shows that she has elevated levels of Creatinine, a waste-
chemical that passes through the kidneys. Normal levels of Creatinine are
around 0.5 mg/dL. The decedents Creatinine levels were at 1.3 mg/dL. This
means that the kidneys are working too hard.
Her symptoms before death were also consistent with liver failure.
Symptoms of liver failure include nausea, fatigue, diarrhea, swelling of the
abdomen, and easy bleeding. Furthermore, in the autopsy, her liver was
reported to be yellow-brown in color, when a healthy liver is closer to a rusty
brown. She had liver fibrosis which is also caused by inflammation, linked to
many diseases, and macro- to microvesicular steatosis which is an accumulation
of fat in the liver, most likely caused by her excessive drinking.
Living without either of these organs is impossible.

III. Manner of Death
What was the manner of death?

This was a natural death.

What pieces of evidence (from the report or the internet) do you have?

A natural death is the death of one that occurs from natural causes.
There is no manner of violence involved and it was not accidental. This case
was a multisystem organ failure. The decedents medical history was significant
for bone marrow cancer and several other life threatening diseases. The tox
screen did not show that she was currently being treated for her cancer with
chemotherapy, or any of her other diseases for that matter. She was not making
an attempt to manage her health care issues, thus her health declined at a
dangerous rate. Without the proper treatment, and due to the fact that the
decedent had numerous health issues, the likelihood of organ failure increased
substantially. Her body shut down.



IV. In 1-2 paragraphs, describe your overall opinion using evidence
about how the individual in your case file died.

We believe that the decedent died from natural causes, for the following
reasons. The decedent showed many symptoms of a kidney infection as well as
symptoms of liver failure. Some examples are the vomiting, nausea, low energy
level, swelling of lower extremities, and changes in urination that the decedent
experienced before death. The decedent was reportedly not an alcoholic and
did not abuse illicit drugs. This was proved false, however in her autopsy and
her toxicology report. Both the kidneys and liver act as filtration devices for the
body and when they are forced to filter these toxic chemicals, strain is put on
them. Through prolonged abuse of substances, the kidney and liver struggle to
function and are left prone to infections, tumors and eventually failure of the
organ itself. The decedent also had a history of a liver condition, already putting
her in a weakened state. Tumors were discovered in her kidneys and her liver
had severe fibrosis caused by the inflammation of the liver, probably from her
constant drinking. Additionally ill with bone marrow cancer, diabetes and an
unidentified heart condition, her body was at its limits.
Her heavy, repeated use of alcohol, drugs, and her terminal illnesses put
strain on her entire body, but moreover the kidney and liver, causing her to have
multisystem organ failure at a relatively young age. Though she passed
prematurely, we found out from researching that fortunately kidney and liver
failure are some of the least painful ways to die.
(This may also be considered an accidental death due to the fact that she was
using drugs, but the the toxicology report shows that there were not enough
drugs in her system to be accidental or suicide).

V. References - share your vocabulary list with appropriate links with
me

Incontinent- not having control of your bladder/bowels.
Coffee Ground Emesis- instance of vomiting old, clotted blood.
Edematous- abnormal excess accumulation of serous fluid in connective tissue,
(swelling).
Tache Noire- small dark-centered ulcer or a post mortem change in the eye.
Petechiae- small reddish or purplish spot containing blood that appears in skin
as a result of hemorrhage.
Hemorrhages- copious discharge of blood from the blood vessels.
Opaque- not transparent or not clear.
Sclerotic- pathological condition in which a tissue becomes hard, (scarring).
Glomeruli- filtration structures in the kidneys.
Sclerotic Glomeruli- fibrosis and scarring in the kidneys.
Interstitial- situated between organs and/or tissues.
Fibrosis- development of excess fibrous tissues in an organ.
Focal- focus point.
Lymphocytic- white blood cells.
Infiltrates- to permeate something by penetrating its pores.
Proliferation- rapid production of new parts/cells.
Benign- not harmful in effect or not malignant.
Spindle Cells- cell shaped like a stick with narrow ends characteristic of some
tumors.
Atrophic- decreased in size or shrunk from wasting, (a tissue or body part).
Tubules- a small tube, can pertain to anatomy.
Ecchymosis- bruising.
Creatinine- a chemical waste product in the blood that is to be filtered through
the kidneys.
Natural Death-death that occurs from natural causes, not violent or
accidental.

Citations
1. Acute liver failure. (n.d.). Symptoms. Retrieved September 19, 2014,
from http://www.mayoclinic.org/diseases-conditions/liver-
failure/basics/symptoms/con-20030966

2. Alcohol's Effects on the Body. (n.d.).National Institute on Alcohol Abuse
and Alcoholism (NIAAA). Retrieved September 19, 2014, from
http://www.niaaa.nih.gov/alcohol-health/alcohols-effects-body

3. Bowen, R. (n.d.). Hepatic Histology: Hepatocytes. Hepatic Histology:
Hepatocytes. Retrieved September 19, 2014, from
http://www.rivendell.colostate.edu/hbooks/pathphys/digestion/liver/histo_
hcytes.html

4. Burt. (n.d.). Bile duct proliferationits true significance?. Bile Duct
Proliferation. Retrieved September 19, 2014, from
http://onlinelibrary.wiley.com/doi/10.1111/j.1365-
2559.1993.tb01258.x/abstract

5. Crowe, A. (n.d.). QJM: An International Journal of Medicine. Substance
abuse and the kidney. Retrieved September 19, 2014, from
http://qjmed.oxfordjournals.org/content/93/3/147.full

6. Cystic fibrosis and liver disease. (n.d.).Cystic fibrosis and liver disease.
Retrieved September 19, 2014, from
http://www.cfmedicine.com/htmldocs/cftext/liv

7. Harding, M. (n.d.). Steatohepatitis and Steatosis (Fatty Liver) | Doctor |
Patient.co.uk. Patient.co.uk. Retrieved September 19, 2014, from
http://www.patient.co.uk/doctor/steatohepatitis-and-steatosis-fatty-liver#


9. Kidney Infection (Pyelonephritis) Kidney Infection Treatment | Health |
Patient.co.uk. (n.d.). Patient.co.uk. Retrieved September 19, 2014, from
http://www.patient.co.uk/health/kidney-infection-pyelonephritis

10. Peptic Ulcer. (n.d.). : Causes, Treatment, & Prevention. Retrieved
September 19, 2014, from http://www.healthline.com/health/peptic-
ulcer#Overview1

11. The Liver (Human Anatomy): Liver Picture, Definition, Function,
Conditions, Tests, and Treatments. (n.d.). WebMD. Retrieved September 19,
2014, from http://www.webmd.com/digestive-disorders/picture-of-the-liver

12. What is Creatinine?. (n.d.). DaVita. Retrieved September 18, 2014, from
http://www.davita.com/kidney-disease/overview/symptoms-and-
diagnosis/what-is-creatinine?/e/ 4726

13. What to Expect When Dying of Kidney Failure. (n.d.). About. Retrieved
September 19, 2014, from http://dying.about.com/od/thedyingprocess/f/