AUTOPSY, POST MORTEM CHANGES AND ESTIMATION OF DEATH

AUTOPSY
 Gold standard for confirmation of a medical disease
 Wherever scientific medicine of high quality is practiced, postmortem exams are
performed
 Whenever a conscientious physician knows why he lost his patient, a postmortem
exam has been performed
 Whenever criminal law is enforced
 Whenever a death certificate shows accurately the causes of death & confirmed
medical diagnosis for the assembling of vital statistics, a postmortem has been
performed Whenever there is medical research on the causes & nature of diseases
such as cancer, heart diseases & stroke, the investigative method is the
postmortem exam
 An informed society requires a postmortem exam in human death for the good of
medical science, for the public’s health & for the future care of the living patient
Types of autopsy
1. Complete autopsy - Requires consent - Complete examination of all organs,
including the brain

2. Partial autopsy - Part of the anatomy

3. Selective autopsy - Restricted to at least a single organ (Ex. MI – heart)

Preliminaries for PME

1. Written consent from the next kin-abide by the extent or restrictions allowed -
Relative: oriented by the attending physician, not the pathologist
2. Death certificate (Old: Blue form | New: Blue border/frame)
Signed by:
a. Physician
b. b. Pathologist (back): will sign when PME has been performed
3. Medical abstract or clinical data
4. Medico-legal clearance -
Suspicious evidence of foul play - Ex. physical injury

Other Uses of Death Certificate

Certificate
Burial & cremation purposes
Transport of body from hospital funeral cemetery
Medical insurance claiming - If suicide: (-) insurance - Acts of God (lightning, flood):
(-) insurance - Civil war: (-) insurance

PRINCIPAL TECHNIQUES: Vary in the order in which the organs are removed, in
the planes and lines of sectioning, and in the method of removal of organs from the
body.

4 Techniques of Autopsy
1. Technique of Virchow
Organs removed & dissected individually in the body
Most widely used metohd
2. Technique of Rokitansky
In-situ dissection in part combined w/ en bloc technique
♫ En bloc:
-By cavity
- Interrelated to each other
- Systemic dissection
- Ex. thoracic cavity (lungs, heart, diaphragm), respiratory system

3. Technique of Ghon
En bloc technique

4. Technique of Letulle
En masse technique
♫ En masse:
- All organs of thoracic, abdominal, & pelvic are removed at the same time
- Sweeping of all organs

VALUE OF AUTOPSY
Provides opportunity of studying the nature of disease process
To see the results of particular treatment
Reveal acquired and congenital anomalies
Opportunity of visualizing the normal and abnormal appearance of body structure
Recognition of hereditary disorders
Aids in the study of epidemic diseases

AUTHORIZATION FOR AUTOPSY

By next kin and 2 witnesses in duplicate form
NEXT OF KIN:
Spouse of the dead
Children of the deceased, if only at legal age
Father of the deceased
Mother of the deceased
Next nearest relatives

ESTIMATION OF TIME OF DEATH

 Somatic death
 Death of an organism
 Cessation of circulation & respiration (1960’s)

 1’ changes During somatic death “CRC”: circulatory, respiratory, CNS failure

 2’ changes After somatic death “ARLP DPA”: Algor mortis, Rigor mortis,
Livor mortis, Postmortem clotting, Dessication, Putrefaction, Autolysis

Criteria for the pronouncement of death

1. Advanced resuscitation techniques that are capable of reviving effectively cases of
clinical death
*Clinical death: cessation of heartbeat & respiration but the brain is still alive but
injured
2. Advance life-sustaining equipment capable of maintaining cardiovascular &
respiratory functions despite severe brain injury
3. Redefinition from cessation to irreversible cessation of cardiorespiratory functions
after resuscitation attempts
4. Brain death: cannot be revived anymore [National institute of neurological diseases
& stroke in the US (1977)] - Clinically dead & dead are the same

Criteria for brain death

Brain death: perpetual state of deep sleed
a. Coma (patient will not respond) & cerebral unresponsiveness
b. Apnea
c. Absent cephalic (brainstem) reflexes
d. Electrocerebral silence criteria should be present for 30 mins at least 6 hrs after
onset of coma & apnea

American bar association & national conference of commission of uniform state

laws legislative definition of death (1980)
1. irreversible cessation of circulation & respiratory functions
2. Irreversible cessation of all functions of the entire brain, including the brainstem is
dead
American academy of neurology
Death:
1. Coma
2. Absence of the following:
- Motor response
- Pupillary response to light & pupils at mid-position
- Corneal reflexes
- Caloric responses
- Gag reflexes
- Coughing in response to tracheal suctioning
- Sucking & rooting reflexes

POST MORTEM CHANGES

1. Algor mortis
- 1st demonstrable change after death is cooling of the body
- At room temp: 2’-2.5’F/hr (1st hr)
- 1.5-2’F/hr (next 12 hrs) - 1’F/hr (next 12-18 hrs)
- As a rule, the body cools at 1.5’F/hr (50% of cases)
- Not a reliable indicator as to the time of death

2. Rigor mortis - Rigidity of the body due to hardening of the skeletal muscles
caused by a series of physiochemical events after death
- This interlocking is fixed & produces rigor mortis w/o shortening of the muscles
- Sets w/in 2 hrs after death (head & neck)
- Complete w/ 12 hrs
- Persists about 3-4 days

3. Livor mortis (postmortem lividity/hypostasis)

- Blood supply gravitates to the skin vessels w/c becomes toneless & dilate after
circulation ceases
- Becomes evident as early as 20 mins after death
- Fully evident w/in 4-8 hrs
- Tardien spots: petechiae

4. Postmortem clotting of blood

5. Discoloration of tissue
- Abdomen: green
- Formation of sulfur gases (bacteria)
6. Putrefaction
7. Dessication (mummification)
8. Autolysis