Forensic Pathology for Police - Brainshare Public Online Library

Multisystem and Other Disorders 245
hypertension and diabetes mellitus. In hypertension, gross kidney changes include
a granular surface (Disc Image 10.49), and microscopic changes are common in
the blood vessels within the kidneys. Clinical renal (kidney) failure is a common
occurrence in severely ill patients who are hospitalized. Kidney infections
(“pyelonephritis”) can lead to sepsis and death. Kidney malignancies (Wilms tumor
in children; renal cell carcinoma in adults) can cause death.
The sexual organs and structures of both men (especially the testes and prostate
gland) and women (especially the uterus, including cervix, and ovaries) may develop
malignant tumors that can lead to death. In addition, the prostate gland frequently
becomes enlarged via hyperplasia in older men. As the gland enlarges, the veins
around it can become dilated. In rare circumstances, venous thrombosis can develop,
with subsequent pulmonary thromboembolism.
Pregnancy is a normal biological process that carries with it an increased risk
of death, related to a variety of factors. Pregnancy-related maternal deaths are
discussed in further detail in Chapter 21.
Bones, Joints, and Soft Tissues
There are numerous bone, joint, and soft tissue diseases. Many of these are diagnosed
during life, with only rare cases being diagnosed after death. Some are
potentially life-threatening; cancers are one of the most serious. Primary bone
cancers tend to affect children and young adults. Infection of a bone, which is particularly
difficult to treat, is referred to as “osteomyelitis.” Osteoporosis (loss of bone
mass related to aging) is quite debilitating and frequently plays a role in deaths
in the elderly, when death is preceded by an accidental fall with associated hip
fracture.
Inflammatory joint disorders (arthritis) are quite common and can be terribly
disabling. Examples include osteoarthritis (a wear and tear disorder), rheumatoid
arthritis (an autoimmune disorder), and gout (related to uric acid crystal
deposition).
Primary soft tissue cancers are referred to as “sarcomas.” A variety of genetic
muscular dystrophies can occur, the most common and debilitating of which is
Duchenne muscular dystrophy, in which skeletal muscles are abnormal, eventually
resulting in atrophy and death.
Multisystem and Other Disorders
Many disorders that can cause or contribute to death are not isolated to a single organ
system. Some have been presented previously within specific organ system sections
above. Others are presented here. Others, specifically nutrition-related disorders,
will be described in Chapter 21.