Medico-legal Autopsy

Forensic pathology

Forensic pathology

Deals with the investigation of sudden, unexpected and/or violent deaths that includes determining the cause of death and the circumstances of how the death occurred.

Autopsy

Refers to the systematic examination of a dead person for medical, legal and/or scientific purposes.

Academic autopsy

Dissection carried by students of anatomy.

Pathological, hospital or clinical autopsy

Done by pathologists to diagnose the cause of death or to confirm a diagnosis.

Medico-legal or forensic autopsy

Type of scientific examination of a dead body carried out under the laws of the State for the protection of rights of citizens in cases of sudden, suspicious, obscure, unnatural, litigious or criminal deaths.

Virtopsy

A bloodless and minimally invasive procedure to examine a body for cause of death.

Psychological autopsy

An investigative procedure of reconstructing a person’s state of mind prior to death.

Toothed forceps

Teeth lend strength in gripping the skin and organs.

Rib shear

Small pruning shears and are used to cut through the ribs prior to lifting off the sternum.

Enterotome

Large scissors used for opening the intestines.

Scissors

used for opening hollow organs and trimming off tissues.

Bone cutter

This is used to cut the ribs and has curved blades.

Councilman rib shear/cutter

Small pruning shears used to cut through the ribs prior to lifting off the sternum.

Vibrating saw (Stryker saw)

Instrument of choice for most autopsy surgeons for removing the skull cap.

Bone saw

The hand saw can be used to saw through the skull, but it’s very slow-going compared to the vibrating saw. Infections from aerosols being thrown up are other disadvantages.

Virchow skull breaker or chisel

After scoring the calvarium with the vibrating saw, the chisel is used to separate the top of the calvarium from the lower skull, thus exposing the brain and the meninges.

Hammer with hook

is used with the chisel to separate the calvarium from the lower skull.

Brain knife

Long knife used to smoothly cut solid organs into slices for examination.

Hagedorn’s needle

is used for sewing up the body after autopsy.

head injury

In suspected ____, the skull is opened first and then the thorax and the abdomen, but some autospy surgeons are of the view that it should be opened after blood has been drained out by opening the heart.

asphyxial deaths

In suspected _____ due to compression of neck, the skull and abdomen is opened first followed by dissection of the neck.

I-shaped incision

extending from the chin straight down to the symphysis pubis and avoiding the umbilicus (because the dense fibrous tissue is difficult to penetrate with a needle, when the body is stitched after autopsy).

Y-shaped incision

Straight line of Y corresponding to the xiphisternum to pubis incision and forks of Y runs down medially to the chest and extending towards the acromion process.

Modified Y-shaped incision

An incision is made in midline from suprasternal notch to symphysis pubis. The incision extends from suprasternal notch over the clavicle to its center on both sides and then passes upwards over the neck behind the ears (1 cm behind external auditory meatus).

T-shaped or ‘bucket handle’ incision

The neck is opened with a transverse incision which runs from acromion to acromion process (bisacromial) along the line of clavicles, creating a trough that is located at the jugular bifurcation.

En masse

This method, described by Letulle, involves removing most of the internal organs in one full swoop.

Virchow’s method

This method of evisceration is simply removal of individual organs one by one with subsequent dissection of that isolated organ.

En bloc removal

It is a compromise between the above two methods and most widely used in the UK.

In situ dissection

This method, developed by Rokitansky, is rarely performed which involves dissecting the organs in situ with little actual evisceration being performed prior to dissection.

Stomach

Two ligatures are applied at the cardiac end of the esophagus and two ligatures below the pyloric end of the stomach.

Intestine

It is cut throughout its full length. Any harm or response caused by poison or the presence of a foreign substance, such as a bullet, is recorded.

Liver

It is removed and its weight, size, color, consistency and presence of any pathology or injury is noted.

Spleen

It is removed by cutting through its pedicle; its size, weight, consistency and condition of capsule, and rupture, injuries or disease is noted.

Pancreas

It is removed along with the stomach and duodenum. It is sliced by multiple sections at right angles to the long axis to expose the ductal system.

Kidneys

They are removed along with adrenal glands after tying the ureters along with the vessels at least 1 inch away from the hilum.

Urinary bladder

It is inspected on the spot. If the bladder contains urine, it is syringed out before opening to eliminate the possibility of contamination by blood or other debris.

Female genitalia

The uterus and its appendages should be checked in situ before being removed en masse with the vagina by an external incision on the labia up to the symphysis pubis above and the anus below.

uterus

The ____ is examined and its dimensions, weight, whether gravid, parous or nulliparous, or any pathology present is noted.

gravid uterus

In the event of a ____, the state of the whole result of conception should be observed.

abortion or attempted abortion

In situations of _____, the presence of any portion of the product of conception within the cavity, the color of the endometrial surface, erosion, any lesion, ulceration, or perforation of the vaginal canal, or the uterine wall is noticed.

Prostate (in males)

It is examined for enlargement or malignancy. In prostatitis, it is firm and in carcinoma, it is hard and granular.

Antemortem thrombus

firmly adheres to the lining endothelium, with a pale, granular and transversely ridged surface because of alternating layers of platelets and fibrin.

Postmortem thrombus

is weakly adherent to the lining endothelium, dark-red, glistening and friable

Black currant-jelly

When blood clots rapidly, a soft, lumpy, uniformly dark-red, rubbery and moist clot is produced.

Chicken-fat

When red cells sediment before blood coagulates, the red cells produce a clot similar to the first, but above this a pale or bright-yellow layer of serum and fibrin is seen.

Ventricular hypertrophy

An estimate is made by measuring the thickness of the ventricular walls at a point about 1 cm below the atrioventricular valve.

Subendocardial or Sheehan’s Hemorrhages

These flame-shaped, confluent hemorrhages appear in one continuous sheet rather than patches in the left ventricle, on the left side of the interventricular septum, and on the opposing papillary muscles and adjacent columnae carnea.

Consistency

The softness or firmness is appreciated by application of finger pressure.

Cohesion

It is the strength within the tissue that holds an organ together. It is judged by the resistance of the cut surface to tearing, pressure or pulling.

Removal of accumulated fluids

To avoid leaks, remaining fluids, tissues, and bowel contents (blood, ascitic or pleural fluid, serosanguineous fluids, or fecal matter) should be aspirated, removed, and dried after evisceration of organs from the thoracic, abdominal, and pelvic cavities.

Wadding

After the cavities are dry, they are coated with enough wadding or cotton wool to absorb any leftover bodily fluids or fluids that may leak after the repair.

Viscera containment

When histology and toxicological samples have been acquired, all organs and viscera must be returned to the body.

Suturing

might begin above (chin) or below (mons pubis), depending on the patient's desire.

Suturing methods

include continuous sutures, under-stitching, baseball sutures, mattress sutures, individual sutures, and interlocking sutures.

Sutures

must be strong enough to keep tissue in place while yet being flexible enough to be knotted.

Washing

Upon repair, the whole body must be cleansed of any lingering bodily fluids or stains.

ophthalmoscope

An ___ should be used to look for intravascular bubbles in the retina.

Pyrogallol assay

A syringe is loaded with a 2% pyrogallol solution mixed with sodium hydroxide. The gas is then inhaled and shook from the right side of the heart. If there is any air in the mixture, it will become brown.

Blood

After death, the cellular barrier of mucous and serous membranes breaks down, allowing chemicals from the stomach and intestine to travel to organs in the thorax and abdomen, resulting in incorrect findings.

CSF

It can be extracted from the cisterna magna or from the lumbar region by inserting a long needle between the atlanto-occipital membrane.

Vitreous humour

After pulling the eyelid aside, a fine hypodermic needle (20 gauge) attached to a syringe is inserted through the outer canthus into the posterior chamber of the eye, followed by aspiration of 1-2 ml of crystal clear colourless fluid from each eye.

Lungs

In cases of solvent abuse ('glue sniffing') or death from gaseous or volatile substances, these are mobilised and the main bronchus is tightly tied off with a ligature.

Urine

It may be collected through suprapubic puncture or when the bladder is opened in a suitably sterile or non-sterile 'universal container' for microbiological or toxicological investigation.

Bone

About 200 g is collected. It is convenient to remove about 10–15 cm of the shaft of the femur.

Hair

A sufficient sample of head and pubic ____ should be extracted by plucking together with the roots, rather than cutting, and stored in separate Medico-legal Autopsy 113 containers

Maggots

They are immersed in boiling 100% alcohol or 10% hot formalin for a lengthy period of time, which kills them (to disclose the internal structure of the larvae).

Nails

All the ____ (fingers and/or toes) should be removed in their entirety and collected in separate envelopes.

Skin

If there is a needle puncture, the whole needle track and surrounding tissue should be removed.

Fibroblasts for tissue culture

Karyotyping, metabolic assays, enzyme assays and diagnostic ultrastructural studies can be performed on cultured fibroblasts

Tissue for metabolic studies and nucleic acid analysis

Liver, kidney, cardiac and skeletal muscle, and peripheral nerve obtained at autopsy may be used for biochemical studies in the diagnosis of inborn errors of metabolism.

Blood

It is the most useful sample because toxins present in it can be best linked to a physiological effect and can be used to assess the likelihood of recent poison/drug exposure.

Urine

It is the second most important specimen collected.

Vitreous humor

As vitreous does not generate ethanol postmortem, it is the best specimen for alcohol intake confirmation in decaying corpses.

Stomach content

It is invaluable in cases of suspected poisoning—establish actual content of poison, determination of route of administration, high concentration of toxins, and analysis is uncomplicated by metabolism.

Liver

While spleen and kidneys are regularly maintained, ____ is most essential due to its huge tissue supply, simplicity of sample collection, high toxin concentration, and extensive hepatic drug concentration database.

Bile

It may be show the presence of number of drugs including morphine/heroin, benzodiazepine, cocaine, methadone, glutathione, many antibiotics and tranquillizers and heavy metals.

Brain, kidney and spleen

are used to determine and interpret the concentration of toxins.

Spleen

It is useful as a specimen for toxins, such as carbon monoxide (CO) and cyanide that binds to hemoglobin.

The viscera should be refrigerated at about ____, if not sent to the laboratory.

Saturated solution of common salt

The most commonly used preservative for viscera. It is easily available, cheap and effective preservative

Rectified spirit

It is used in cases of suspected alkali or acid poisoning (except carbolic acid), only is used.

sodium or potassium fluoride

For toxicological analysis, blood is preserved in ____ at the concentration of 10 mg/ml of blood and anticoagulant potassium oxalate, 30 mg/10 ml of blood.

liquid paraffin

In the event of suspected CO poisoning, a coating of 1-2 cm of _____ is applied immediately over the blood sample to prevent exposure to ambient oxygen.

foil-lined

If solvent misuse and anesthetic death are suspected, the glass container should have a ___ cover (gas may infiltrate rubber) and be entirely filled to prevent gas from escaping in "dead" air space.

Hematological examinations

especially glycosylated hemoglobin in diabetics, need clean glass containers containing anticoagulant.

Formalin

is not employed as a preservative for chemical analysis because toxins, particularly non-volatile organic chemicals, are difficult to remove.

sodium fluoride

It inhibits bacteria and enolase.

Histopathological examination

Sections of various internal organs (1.5 × 1.0 × 1.0 cm) in case of suspected abnormality are preserved in 10% formalin or 95% alcohol.

Bacteriological/serological examination

Blood should be kept in sterile container using sterile syringe from the right ventricle of the heart or from some large vessel, such as femoral vein or artery. It may also be used for biochemical examination.

Virological examination

A piece of tissue is collected and preserved in 50% sterile glycerin.

Enzymatic studies

Small pieces of tissues are collected into a thermos containing liquid nitrogen.

Smears

Vaginal/anal ___ are needed in cases of alleged sexual assault.

Obscure autopsy

In about 20% of all postmortem examination cases, the cause of death may not be clear at the time of dissection of the body, and there are minimal or indeterminate findings or even no positive findings at all.

Negative autopsy

In about 2–5% of all postmortem examination cases, the cause of death remains unknown, even after all laboratory examinations including biochemical, microbiological, virological, microscopic and toxicological examination.

Second autopsy or re-postmortem examination

It is the autopsy conducted on an already autopsied body.

Forensic anthropology

It is that branch of physical anthropology which for forensic purposes deals with identification of skeletonized remains known to be or suspected to be being human.

Mass disaster

Death of more than 12 victims in a single event, like fire, air crashes or floods.

Decomposed bodies

These show putrefactive changes in varying degree depending upon the time elapsed since death.

Mutilated bodies

These are extensively disfigured, deprived of a limb or a part of the body, but the soft tissues, muscles and skin are still attached to the bones.

Fragmentary remains

These include only fragments of the body such as head, trunk or limb.