AUTOPSY

• Somatic death

• Cellular death

2 kinds of death

Somatic death

It is the type of death wherein there is failure in the organs / all organs have stopped functioning.

Cellular Death

It is the type of death that happens after the organs have stopped functioning; the individual dying of cells after organ failure.

• Circulatory failure

• Respiratory failure

• Nervous tissue failure

What are the primary changes in somatic death?

• No pulse

• No heartbeat

How to know if there is circulatory failure?

• Radial

• Wrist

• Back of knee

• Foot

• Groin

Where is pulse palpable?

It becomes stagnant → no flow to organs → organs stop

What will happen to the blood if the heart stopped?

• Failure of chest to rise and fall

• Put mirror on mouth/ nose → no moist

• Check through stethoscope

How to know if there is respiratory failure?

• No eye constriction in light

• Fixedly dilated eyes

• No reflex

• No pain response

How to know if there is nervous tissue failure?

Inflict pain to determine pain response

What is done if there is no pulse?

• Algor mortis

• Rigor mortis

• Livor mortis

• Post mortem clot

• Dessication

• Putrefaction

• Autolysis

What are the secondary changes in somatic death?

Algor Mortis

It is the cooling of the body; the first and prominent sign of death.

The body temperature becomes equal with room temperature

What happens in algor mortis?

7 C per hour

The rate of algor mortis.

Rigor mortis

It refers to the stiffening of the body.

Head → Neck → Abdomen → Legs

The order of rigor mortis.

3-6 hours after death

Rigor mortis happens when?

Livor mortis

The changes of the body color after death.

It is where the blood settled

Why does some parts of the body turn purple after death?

Up to 12 hours

How long will the blood fix on the body (livor mortis)?

Dependent portion of the body (saan siya nakahiga)

Where do blood usually settle after death?

• Livor mortis: put pressure → color will disappear then go back after pressure is removed

• Ecchymoses: color is not removed even with pressure

How to differentiate ecchymoses and livor mortis?

Post Mortem Clot

The blood usually clots after death.

It follows the shape of the blood vessels

Why are post mortem clots elongated?

• Yellow

• Chicken fat / Currant Jelly

• What is the color of post mortem clot?

• What is it called?

Ante mortem clot

The blood clot happened before death.

• Irregular shaped

• Friable (easily destroyed)

• Tightly adhered on the blood vessel walls

The appearance of ante mortem clot.

Dessication

It refers to the drying of the anterior part of the eyes, which will lead to its sinking.

Tache noir de la sclérotique

It is the discoloration of the horizontal orientation of the eyes after death.

Putrefaction

It is the stage wherein the body bloats due to gas.

Bacteria

• Normal flora

• Contamination

What is the source of gas that leads to putrefaction?

• Head

• Neck

• Abdomen

What bloats during putrefaction?

Marbleization

The presence of green, prominent superficial blood vessels / prominent presence of the veins.

Detachment of skin and hair

What happens after marbleization?

• Foul smell

• Contamination of flies and maggots

What are other signs of putrefaction changes?

24 hours after, but best if 48 hours and beyond

When does putrefaction happen?

• Mummification

• Saponification

• Maceration

What are the 3 modified techniques of putrefaction?

Mummification

A type of putrefaction that is also a method of preservation, wherein the body is dried after embalming.

Saponification

A type of putrefaction a result of the hydrolysis and hydrogenation of the fats in the body.

Adipose tissue

What is the chalk-like appearance in saponification?

Maceration

It is usually seen in fetuses that dies in the uterus / submerged in water.

Autolysis

It happens when the death occurred a long time ago; it is the self digestion of the cells in the body.

• Humid weather

• Hot weather

• Death due to drowning

Putrefaction happens more during?

• Females

• More fats

• In drowning, who resurfaces first?

• Why?

The lungs are full of water (due to last breath)

What happens to the lungs if the death is caused by drowning?

Post mortem examination

It is the external examination of the body.

Autopsy

It is the internal examination of the body.

Prosector

It is the head of the team; pathologist. They perform the dissection of the cadaver for anatomic demonstration and pathologic examination.

Diener

It is the assistant of the pathologist in performing autopsies and maintains the morgues.

Coroner

It is an official on duty who investigates the sudden, suspicious or violent death of the patient and its cause.

• Cause of death

• Diagnosis

• Extent of injury

• Preserve tissue for further test

The purpose of autopsy

• Hospital based

• Medico-Legal

What are the types of autopsy according to purpose?

Hospital-based autopsy

It is a type of autopsy wherein a consent is asked from the nearest kin.

Medico-Legal

The cause of death is investigated because it may be due to violence or criminal acts; no consent is needed.

The state

Who owns the body if the autopsy is Medico-Legal?

• Required by special laws

• Order of the court, mayor, provincial, city fiscal

• Request of police authorities

• If it is necessary (solicitor gen, provincial, city fiscal)

• Request of nearest kin

When is autopsy required?

• Consent

• Death certificate

• Medico-legal clearance

What are the requirements for autopsy?

• Scurbs/ gown

• Plastic disposable aprons

• Cap

• N95

• Eye protections

• Shoe cover/ footwear

What is the proper attire in autopsy?

• Head / Resident pathologist

• Histotechnologist

• Interns (assist)

Who performs autopsy?

• Pathologist

• Severely mutilated, burns

• Respect

• Unnecessary dissection

• Identification

• Not be embolized

• Same condition

Guidelines for autopsy

• The___ must be properly guided

• Bodies which are ___, ___ are still suitable for autopsy

• All autopsies must be performed in a manner which show ___ to the dead body.

• ___ must be avoided

• Proper ___ of the deceased autopsied must be established

• A dead body must ___ before the autopsy

• The body must be autopsied in the ___ when found in the crime scene

• Complete

• Partial

• Selective

Types of autopsy according to completeness

• Y-incision

• Modified Y incision

• I incision

Types of autopsy according to manner of incision

Shoulder → Xiphoid process

The Y incision begins from the ___ to the ___

Back of the ear → Sternal notch → Sternum

Modified Y incision begins from the ___ to the ___ (located before the ___), then downwards.

• Skin → separated

• Muscles → deflated

• Ribs and sternum → opened using bone cutter

• Organs

In Comprehensive autopsy, the ___ is separated, the ___ are deflated, then the ___ are retracted open using ___ to have access to the ___.

Skull

The hardest bone in the body.

• Virchow Technique

• Rokitansky Technique

• Ghon Technique

• Letulle Technique

The principal techniques of autopsy

Virchow’s Technique

The organs are removed one by one.

Cranial activity → Spinal cord → Thoracic activity → Cervical activity → Abdominal organs

The order of organ removal in Virchow’s technique

Rokitansky’s Technique

“In Situ” Dissection, in part combined with en-bloc removal​.

In situ dissection

It refers to the removing only of what is needed instead of an entire evisceration.

Ghon technique

It refers to the removal of the cervical, abdominal, and urogenital system organs as organ blocks / en-bloc.

1. Cranial cavity

2. Cervical cavity

3. Thoracic cavity

4. Abdominal cavity

5. Pelvic cavity

What are the 5 cavities of the body?

Ghon technique

It refers to the removal of the organs per cavity.

Letulle Technique

Organs are removed en masse. It is best for routine inspection and preservation of connections between organs and organ systems.​

En Masse

It refers to the removal of all organs before dissecting individually.