07 post mortem examination (autopsy)

Post mortem examination Post mortem examination ( autopsy )( autopsy )

• Autopsy :

“ It means the examination of the organs of the dead body to determine the cause of death or pathological conditions.”

• Types :

1.clinical

2.medicolegal

• Clinical autopsy:

- cause of death is known

- to confirm the diagnosis, discover the extent of lesions , for academic interest, teaching and research purposes.

• Medico-legal autopsy:

-to identify the dead body

-cause of death

-nature and no. of injuries

-time since death

-presence of poison

Medicolegal autopsies; Medicolegal autopsies;

• Are taken on :

-victim of unnatural death

-mutilated bodies or fragments

-skeleton or isolated bone

Pre requisities:Pre requisities:

• Mortuary• Inquest report• Challan• Identification• Day light• Good ventilation• Sufficient water supply• Drainage• Instruments• Disinfectants

Rules :Rules :

• Should be conducted in the mortuary• Undertaken only after receiving inquest report

and challan• Soon as possible• Should be identified by police constable • Conducted in a day light• MO should 1st read inquest report• No unauthorised person should be present• Examination should be external and internal

Examination proper:Examination proper:

• General description of the body• Dress and other wearing materials• Examination of the dead body: -external : length, weight, complexion, scalp hair beard ,moustache vermilion mark tattoo marks, moles scars, deformities eyes

• Mouth and nostrils• Tongue• Cynosis• Pm staining• Blood mud • State and distribution of rigor mortis• Cadaveric spasm, • Any foreign body any where in the body • Maggots• Cond of prepuce• Female breast• Discharge per vagina• Any injury• Any suspected stain• Ligature marks

Internal examination :Internal examination :

• Opening of the dead body:

Incisions :Incisions :

• 1. Head : incision : -transverse incision along the head from

ear to ear. -scalp reflected anteriorly upto the orbits

and posteriorly upto the external occipital protuberance.

-circular cut around the cranium keeping close to the reflected cap.

• 2. neck , thorax and abdomen:

3 types :

i. I – shaped

ii. Y – shaped

iii. Modified Y shaped

• i) I shaped incision : chin straight down to the symphysis pubis,

passing either to the left or right of the umbilicus.• ii) Y shaped incision : - two similar incisions begin at a point close to

the acromial process of each clavicle. - extend down below the breast to the xiphoid

process where they unite. - from xiphoid process it is carried down to the

symphysis pubis.

• iii) Modified Y shaped incision :

- an incision is made in midline from suprasternal notch to the symphysis pubis.

- incision extends from the suprasternal notch over the clavicle to its centre on both sides and then passed upwards over the neck behind the ear.

#neck :#neck :

• Examine the superficial and deep t/s

• Knife is passed around inner side of the lower jaw

• Separate the attachment of tongue, pull down in to the opening

• It is reflected together with the pharynx, larynx, trachea and esophagus from the posterior wall.

# thorax :# thorax :

• Cavity of the thorax opened by dividing the ribs at their cartilages and sternum at sterno-clavicular junctions,& lifting up the sternum

• Diaphragm is divided at its attachment to lower ribs and sternum.

• costotome

# abdomen :# abdomen :

• Muscles are divided 5 cm above the symphysis.

• Small cut is made in the peritoneum ,big enough to admit left index and middle fingers , w/c are used to shield underlying structures.

• The peritoneum are cut up to xiphoid.

To remove the visceras :To remove the visceras :

• 1. Stomach : -1st taken out -2 ligatures at the cardiac end and 2 ligatures at the pyloric end - cut between the 2 ligatures - remove the stomach - open along the lesser curvature - examine wall of the stomach - contents - weight stomach and its contents seperately - stitch the stomach with the contents inside - keep for preservation

• Liver :

-remove the liver

-note any injury or pathology

-weight the liver

-part of the liver should be taken out for preservation

• Kidneys :

- along with adrenal glands

- tie the ureter along with the vessels

- remove the kidney

- adrenal glands seperated

- dissect the kidney transversely

- preserve

• Urinary bladder : -may be examined in situ -syringe out the urine -open the bladder -examine• Ureters : -open along its long axis -examine

• Spleen :

-take out the spleen

-examine

• Intestines :

-coils of the intestines are pulled forward

-ligature tied round the lower portion of the rectum.

-rectum is divided below the ligature

-whole of the intestines are removed from the abdominal cavity.

-examine

• Pancreas and adrenal glands :

examine

• Uterus :

- 1st examination in situ

- remove along with vagina

- examine

• Heart : -apply double ligature at the base of the

heart over each large vessels - divide in between them - note size , weight of the heart - condition of valves -coronary vessels -preserve for suspected pathology

• Lungs :

-separate both lungs after tying the vessels and the bronchioles

-note conditions of pleura

-examine lungs

-preserve t/s

• Head : -note any injury to the dura & extra dural haemorrhage -criss cross incision over the dura and remove - examine - dissect out the brain - keep it in a tray -examine the circle of willis before dissecting the

substances of brain. -dissect the cerebrum then cerebellum – 1st longitudinally

then transversely. -examine

• Others :

spinal cord

scrotal sac

limbs

Preservation of viscera:Preservation of viscera:

• In case of suspected poisoning: (dead )

-stomach and its contents

-upper part of small intestine ( 30 cms ) and its contents

-a part of liver ( < than 1 lb)

-half of each kidney

• Preserve in : rectified spirit • In case of : carbolic acid alcohol phosphorus paraldehyde acetic acid # preserve in saturated solution of common

salt

• Living :

-vomite(300ml)

-stomach wash

-urine(> than 100 ml)

-faeces

-blood

-saliva

Preservation of other parts :Preservation of other parts :

• Heart : nux vomica strychnine digitalis• Brain : strychnine OP • Spinal cord: strychnine• Lungs : CO,coal,gas,alcohol• End of long bones : cocaine,barbiturates

• Scalp hair

chronic poisoning by minerals

• Bile :

cocaine

barbiturates

neurotics

Instructions during preservation :Instructions during preservation :

• Cut visceras into small pieces• Should reach 2/3rd height of the bottle• Well fitted covers,• Label name, PM date, no, etc• Sample of preservatives in another small bottle• Hand it over to the police, or personally deliver it

to the office of the chemical examiner• DON’T FORGET TO TAKE RECEIPT!!

PM examination of the mutilated PM examination of the mutilated bodies:bodies:

• Mutilated bodies:

“ Mutilated bodies are those which are extensively disfigured or are deprived of a limb or a part ,but the muscles , t/s and skin are attached to the bones.”

eg. Head, trunk, limbs etc.

??? See for:??? See for:

• Source :

human or animal

-easy if head,trunk or limbs are available

-pieces of muscles are available then??

-precipitin test

-antiglobulin inhibition test

• Part belongs to same individual ?

-fitting together of all the parts

-color of the skin

• Age :

general development

skull

teeth

ossification of bones

• Sex:

characters of pelvis, sacrum ,femur

prostate,uterus

• Stature :

measure long bones

• Identity :

finger prints, tattoo marks, scars, hair, teeth .

• Time since death :

condition of the part

• Cause of death :

# bones

burning

PM examination of decomposed PM examination of decomposed body :body :

• Look for :-Identification : remnants of genitals bones tattoo marks ornaments-time since death progressive changes in the body-cause of death abortion bullets

Reconstruction of the body after Reconstruction of the body after PM examination :PM examination :

• Sympathy/ skill/ practice!!!

• Sponge out the body cavities• Plugged the pelvis with cotton wool or

paper• Wash the organ in water dry it and replace

them in body cavities• Place thin layers of paper or cotton wool

over it• Dry the cranial cavity replace the brain in

the cranial cavity wrapped in a dry cloth

• Fit the skull , ant. And post. Flaps of the scalp are brought together and sutured

• All other autopsy incisions were stitched together

• After the stitching is complete:

wash the body with running water,dry it

keep it in trolley, ctothed, hair dried and combed, dentures cleaned,

• Face is made to look as natural as possible.

• ???