At autopsy of an adult who died of prolonged total starvation, extreme emaciation is confirmed. Which additional gross visceral finding is classically described as characteristic of death from inanition?
- A Dilated cardiomyopathy with biventricular enlargement
- B Grossly enlarged, pale, greasy liver
- C Distended gallbladder filled with dark, viscid bile ✓
- D Marked splenomegaly with a thickened capsule
Correct answer: C. Distended gallbladder filled with dark, viscid bile
Explanation
In chronic starvation, standard forensic texts describe a distended, thin-walled gallbladder containing dark, viscid, inspissated bile, reflecting prolonged absence of food and absent enteral stimulation of bile flow. The best distractor, the pale greasy liver, belongs to kwashiorkor-type protein deficiency rather than total starvation, where the liver is small and brown. Similarly, the heart is shrunken and atrophic, never dilated, and splenomegaly is not a feature of inanition.
Reference: Knight's Forensic Pathology, 4th ed.
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