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/