NUR 587-Case Of Will Smithers: To Exhume Or Not Exhume DQ

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A surprising amount of information can be gleaned about an individual just from one’s tissues. In this case, you have been assigned to shadow histopathologist Dr. Jonas Riehm as he attempts to identify the cause of death of 42-year-old Will Smithers. Mr. Smithers’s body was discovered sitting in his car near an alley several miles from his home. There was no obvious cause of death, necessitating an autopsy to determine if the death was from natural causes or foul play. However, due to a clerical error, the decedent’s body was released and interred before a proper autopsy could be performed, and an official cause of death was not established.

Fortunately, several tissue samples were taken before the interment and remain available for examination. Mr. Smithers’s family does not wish to have his body exhumed, so local law enforcement professionals have asked Dr. Riehm to examine the tissue samples in the hopes of determining his cause of death and whether or not an exhumation is needed. The following sections have been taken from the official report that Dr. Riehm sent to the local coroner’s office. You are to report to Dr. Riehm’s office with your anatomy and physiology textbook. He expects students to answer questions related to the work that he does in his histopathology laboratory.

Dr. Riehm enjoys teaching, and has a collection of microscope slides that he uses to introduce students to the fascinating universe of histology. He starts with the following definition: histology is the study of the normal structure of tissues. Although Dr. Riehm is an expert in the study of the diseases and abnormalities of tissues, histopathology, he is a firm believer that you must be able to recognize normal tissue before you can understand diseased tissue. He has set up four microscope stations for students to get familiar with how the microscopes function and to view slides of normal tissues. Case Of Will Smithers: To Exhume Or Not Exhume DQ

Each station has a microscope with a slide of one of the four primary tissue types. (a) Define tissue and organ, and then describe how each fits into the levels of body organization. (b) Describe what you would expect to observe on the epithelial tissue slide. What are the general functions of this tissue? (c) Describe what you would expect to see on the connective tissue slide. What are the general functions of this tissue? (d) Describe what you would expect to see on the muscle tissue slide. What are the general functions of this tissue? (e) Describe what you would expect to observe on the nervous tissue slide. What are the general functions of this tissue?
Satisfied that you are properly introduced to the concepts of normal tissue, Dr. Riehm begins to fill you in on the details of Mr. Smithers’s case, whose tissue samples have coincidentally arrived just in time for your shadowing visit. The first set of slides included an epithelium sample taken from Mr. Smithers’s forehead. The slide was taken from some oddly colored patches of skin that revealed some abnormal cells, specifically, squamous cell carcinoma. These cancerous cells were in the early stages of the disease and had not spread, or metastasized, to cause disease in other tissues. Dr. Riehm documented that while there was pathology noted in the epithelial slides provided, the squamous cell carcinoma, this was not the cause of Mr. Smithers’s death. Dr. Riehm continued to ask questions about epithelial tissues.

Dr. Riehm has asked you to look at the epithelial tissue slide from the skin of Mr. Smithers’s forehead, and describe how the normal epithelium appeared. (a) Describe the difference between simple and stratified epithelium. Which type would you expect to see in Mr. Smithers’s tissue slide? (b) What are the different shapes that epithelial cells can assume in different epithelial tissues? Which cell shape would you expect to see in Mr. Smithers’s tissue slide; what type of specific epithelium is found in the skin? How would you describe the other two cell shapes? (c) Define what the basement membrane is and discuss the functions of its two components. (d)Which cellular junctions would you expect to find holding these cells to one another? (e) Describe where the apical, basal, and lateral surfaces of an epithelial cell are located.
Dr. Riehm began to review the next set of tissue samples, which included slides prepared from liver tissue and blood smears. He began with the slides taken from the liver and documented the following: the microscopic evaluation of the liver tissue is abnormal. Large deposits of adipose tissue can be seen interspersed throughout the normal structure of the liver tissue that is suggestive of hepatic lipidosis, or fatty liver. The most likely cause of hepatic lipidosis is excessive alcohol consumption, but this would need to be corroborated by further investigation outside the scope of this inquiry. For the record, he documented his findings of hepatic lipidosis. He then explained to you that these findings only indicate that the patient had tissue evidence of an unhealthy behavior, likely alcoholism, which could be a contributing factor in his cause of death but unlikely the cause itself. His family and friends would need to fill in the details about Mr. Smithers’s personal life. This wasn’t enough individually to warrant an exhumation of the body, nor was it enough to establish the cause of death as liver failure. He explained that this is a common histological finding in several long-standing illnesses, but in particular hepatitis, obstructive jaundice, and acute and chronic alcoholism with liver disease. This was still not enough to establish a cause of death but it was more information that would support an exhumation order by the state authorities. A review of Mr. Smithers’s medical history or a report from his personal physician would be helpful in determining the relevance of this finding.

Dr. Riehm moved on to Mr. Smithers’s peripheral blood smear slides. The erythrocytes appeared abnormally large, which provided more evidence that Mr. Smithers had done some significant damage to his body and tissues with alcohol consumption. Dr. Riehm documented his findings from the blood smear as abnormal, having found these large round erythrocytes called macrocytes. This condition called megaloblastic anemia leads to fewer normal cells, which limits the amount of oxygen and metabolic waste products that can be transported. This is a common finding in the peripheral blood smears of alcoholic patients with anemia. Many people suffering from alcohol dependence also have nutritional deficiencies, including poor intake of vitamin B12 and folate, both of which are critical for the normal development of erythrocytes in the bone marrow.

Dr. Riehm asked you to quickly finish your work on the connective tissue slides and take a look at the new set of cardiac muscle samples. Has he finally found something that could have caused Mr. Smithers’s death?

Dr. Riehm has been keeping you busy cataloging the slides that he has finished with while he prepares to review the slides of Mr. Smithers’s cardiac muscle tissue. Dr. Riehm described regions of necrosis, or dead tissue, as he explains, where cardiac muscle cells have died after being separated from the blood supply. This finding indicated that Mr. Smithers had a myocardial infarction or heart attack. Before you are able to even speculate “Was this the cause of Mr. Smithers’s death,” Dr. Riehm poses this question—are heart attacks always fatal, or in other words, can we determine from this slide that this event preceded and therefore caused Mr. Smithers’s death? People survive heart attacks, don’t they?

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Dr. Riehm would need to look at the slides more closely later in the day before he completed this portion of his report. He was not ready to sign off on myocardial infarction as the cause of death just yet. Case Of Will Smithers: To Exhume Or Not Exhume DQ