4: Postmortem Examination (Part 3)

Postmortem Changes

continuum of changes that occur in a dead body following death

Algor Mortis

**Postmortem Changes**

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First demonstrable change after death

* cold death
* cooling of body

**Postmortem Changes**

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AKA Algor Mortis

1\.5°F/hr

**Postmortem Changes:** Algor Mortis

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As a rule the body cools at what temperature in 50% of the cases

false

**Postmortem Changes:** Algor Mortis

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Algor Mortis is a reliable indicator as to the time of death

1st hr: 2 to 2.5 F/hr

next 12: 1.5 to 2 F/hr

next 12-18: 1 F /hr

**Postmortem Changes:** Algor Mortis

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At room temp:

*enumerate the temperature changes as time passes*

different environments → different temperature

**Postmortem Changes:** Algor Mortis

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why is algor mortis unreliable

Rigor Mortis

**Postmortem Changes**

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Rigidity of the body

skeletal

**Postmortem Changes:** Rigor Mortis

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Rigidity of the body due to hardening of the (?) muscles caused by a series of physiochemical events after death

ATP

**Postmortem Changes:** Rigor Mortis

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lacks regeneration of (?)

false

**Postmortem Changes:** Rigor Mortis

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rigor mortis exhibit decreased acidity

lactic acid

**Postmortem Changes:** Rigor Mortis

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acid responsible for increased acidity

formation of locking-chemical bridges between actin & myosin

**Postmortem Changes:** Rigor Mortis

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no ATP regeneration + increased acidity = ?

2 hours, gradually (head and neck)

**Postmortem Changes:** Rigor Mortis

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sets within how many hours after death

small; larger

**Postmortem Changes:** Rigor Mortis

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initially notable in the (?) muscles followed by (?) muscle groups

6 to 12

**Postmortem Changes:** Rigor Mortis

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Complete and fully fixed after approx. how many hours

36 to 48

**Postmortem Changes:** Rigor Mortis

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Dissipates after approximately how many hours

Antigravitational rigor mortis

**Postmortem Changes:** Rigor Mortis

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Fixed rigor mortis of the upper extremities wherein the arms are suspended against gravity

body have been previously held in that position while rigor was fixing, it was moved

**Postmortem Changes:** Rigor Mortis

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what does Antigravitational rigor mortis or rigor mortis in an unusual position indicate

Livor Mortis

**Postmortem Changes**

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* Blood supply gravitates to the skin vessels which becomes toneless
* dilate after circulation ceases
* blanching

Postmortem (Lividity) Hypostasis

**Postmortem Changes:** Liver Mortis

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AKA Livor Mortis

deep purple-red

**Postmortem Changes:** Liver Mortis

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discoloration of skin and internal organs

Blanching

**Postmortem Changes:** Liver Mortis

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occurs in gravity dependent areas of the body that come into contact with firm surfaces

as early as 20 min

**Postmortem Changes:** Liver Mortis

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how many minutes before this is evident after death

4

**Postmortem Changes:** Liver Mortis

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fully evident within how many hours

8 to 12

**Postmortem Changes:** Liver Mortis

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fixed in approx. how many hours

Tardien spots

**Postmortem Changes:** Liver Mortis

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exhibits what type of spots

* Tardieu petechiae
* Tardieu spots
* Tardieu's ecchymoses

**Postmortem Changes:** Liver Mortis

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other terms for Tardien spots

hematoma of the central forehead masked by cutaneous livor mortis

**Postmortem Changes:** Liver Mortis

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Auguste Ambroise Tardieu

**Postmortem Changes:** Liver Mortis

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first person to describe Tardieu spots

purple to black spots on the skin

**Postmortem Changes:** Liver Mortis

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color of tardieu spots

capillaries

**Postmortem Changes:** Liver Mortis

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tardieu spots are caused by the rupture of (?)

* induced (has a pattern)
* natural (no pattern)

**Postmortem Changes:** Liver Mortis

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2 types of tardieu spots

1. postmortem clotting of blood
2. discoloration of tissues
3. autolysis and putrefication
4. dessication
5. postmortem drying

**Postmortem Changes**

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enumerate 5 other postmortem changes

20

**Postmortem Changes**

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postmortem clotting of blood settles within how many minutes

tache noir

**Postmortem Changes**

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other term for dessication

noir

**Postmortem Changes**

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it means *black*

skin and mucosal membranes

**Postmortem Changes**

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After death, the (?) may desiccate

Tache noir de la sclerotique

**Postmortem Changes**

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* horizontal linear scleral blackening along the equator of the globe of the eye
* sclera is exposed to drying when the eyelids are incompletely shut

red to black

**Postmortem Changes**

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color change of tache noir

* lips
* tip of tongue
* scrotum

**Postmortem Changes**

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body parts affected by tache noir

died eyes closed

**Postmortem Changes**

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died eyes partially open

**Postmortem Changes**

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1. scalp
2. trunk

**Autopsy Techniques**

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2 primary autopsy incisions on SKIN

Mastoid-to-Mastoid incision

**Autopsy Techniques**

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incision/s for scalp

* I shaped
* Y shaped
* modified Y shaped

**Autopsy Techniques**

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incision/s for trunk

1. sawing of skull
2. cutting of sternal plate

**Autopsy Techniques**

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2 secondary autopsy incisions

I shaped

**Autopsy Techniques**

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Y shaped

**Autopsy Techniques**

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Modified Y shaped

**Autopsy Techniques**

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I shaped

**Autopsy Techniques**

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* straight line
* chin to symphisis pubis

Y shaped

**Autopsy Techniques**

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* acromian process to xiphoid process to symphisis pubis
* similar incision on opposite side of body

Modified Y shaped

**Autopsy Techniques**

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* suprasternal notch to symphisis pubis

1. expose heart chambers
2. expose inner lungs
3. expose inner liver
4. open urinary bladder cavity
5. expose GIT lumen

4 purposes of autopsy

Virchow

**Conventional Techniques of Autopsy**

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organs removed and dissected individually

head → thoracic (cervical) → abdominal organs

**Conventional Techniques of Autopsy**

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describe Virchow’s technique

Rokitansky

**Conventional Techniques of Autopsy**

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in-situ (onsite) dissection in part combined with en bloc (portions) technique

Ghon

**Conventional Techniques of Autopsy**

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en bloc Technique (portions)

Letulle

**Conventional Techniques of Autopsy**

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en masse Technique (complete removal)

1. needle autopsy
2. aspiration
3. blind biopsies
4. laparoscopic, thorascopic
5. mini-autopsy
6. imaging

**Autopsy Techniques**

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enumerate the 6 minimally invasive types of autopsy techniques

needle autopsy

**Autopsy Techniques:** Minimally Invasive

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* histological and microbiological analyses
* biopsy needles

aspiration

**Autopsy Techniques:** Minimally Invasive

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* blood, urine, cytology, etc., for analysis

blind biopsies

**Autopsy Techniques:** Minimally Invasive

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* Multiple percutaneous needle biopsies

laparoscopic, thorascopic

**Autopsy Techniques:** Minimally Invasive

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* abdominal and chest investigation with tissue sampling

mini-autopsy

**Autopsy Techniques:** Minimally Invasive

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* extensive organ sampling or removal via a limited incision

imaging

**Autopsy Techniques:** Minimally Invasive

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* identification of ruptured blood vessels, clots
* use of ct & mri scans

3 months after final report

**Suggested autopsy material retention**

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Non-forensic: wet tissue

10 years

**Suggested autopsy material retention**

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Non-forensic: paraffin blocks

10 years

**Suggested autopsy material retention**

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Non-forensic: slides

10 years

**Suggested autopsy material retention**

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Non-forensic: reports

3 years

**Suggested autopsy material retention**

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Forensic reports: wet tissue

Indefinitely

**Suggested autopsy material retention**

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Forensic reports: paraffin blocks

Indefinitely

**Suggested autopsy material retention**

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Forensic reports: slides

Indefinitely

**Suggested autopsy material retention**

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Forensic reports: reports

Indefinitely

**Suggested autopsy material retention**

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Forensic reports: gross photog/negatives

1 year

**Suggested autopsy material retention**

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Forensic reports: body fluids and tissues for toxicology

Indefinitely

**Suggested autopsy material retention**

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Forensic reports: body fluids and tissues for toxicology

liver - 1500 to 1800 gm

heaviest human organ

ovary each - 5 to 7 gm

lightest human organ