THE POSTMORTEM EXAMINATION (Autopsy) Why Postmortem Examination (PME)? 1.

Wherever Scientific medicine of high quality is practiced, postmortem examinations are performed. 2.Whenever a conscientious physician knows why he lost his patient, a post mortem examination has been performed. 3.Whenever criminal law is enforced. 4.Whenever a death certificate shows accurately the causes of death and confirmed medical diagnosis for the assembling of vital statistics a postmortem has been performed 5.Whenever there is medical research on the causes and nature of diseases such as cancer, heart disease and stroke, the investigative method is the postmortem examination. 6.An informed society requires a postmortem examination in human death for the good of medical science, for the publics health and for the future care of the living patient. Preliminaries for PME 1.Written consent from the next of kin-abide by the extent or restrictions allowed 2.Death certificate (blue form) 3.Medical abstract / Clinical data 4.Medicolegal clearance PME is permitted w/o consent in the following circumstances: 1.When it is ordered by the police or coroner 2.When it is necessary to complete the death certificate 3.When the deceased himself has given consent before he died (advanced directive) 4. Deceased military personnel who dies in active/training duty or military service The medicolegal examiner or the coroner has jurisdiction in medicolegal cases, and may authorize the pathologist to proceed with an autopsy. The coroner has authority in the following cases: 1.All natural deaths occurring in the hospital within 24 hrs of admission, unless the case was attended by a private physician within 36 hours of death 2.Newborns in the first 24 hrs of life 3.All injury cases, old or recent 4.All deaths due to unknown cases 5.All deaths due to suspicious cases 6.All abortion cases, whether self induced or otherwise 7.All violent deaths 8.All accidental deaths

9.All sudden deaths 10.All cases without medical attendance within 36 hours prior to the hour of death 11.All deaths due to drowning, hanging or strangulation 12.All deaths due to shooting, stab wounds, burns, electricity, lightning, tetanus, etc. 13.All homicides 14.All suicides 15.All cases in which there is suspicion of poisoning 16.Stillborns 17.Prematures Postmortem changes: 1.Algor Mortis First demonstrable change after death is cooling of the body At room temp.: 2-2.5F/hr 1st hour 1.5-2F/hr - next 12hrs 1F / hr - next 12-18hrs As a rule the body cools at 1.5F/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 Lack of ATP regeneration and increased acidity result in the formation of locking-chemical bridges between actin & myosin This interlocking is fixed and produces rigor mortis without shortening of the muscle Sets within 2 hrs after death (head & neck) Complete with 12 hrs Persists for about 3-4 days 3.Livor Mortis or Postmortem (Lividity)Hypostasis Blood supply gravitates to the skin vessels which becomes toneless and dilate after circulation ceases Becomes evident as early as 20 min after death Fully evident within 4-8 hrs Tardien spots 4.Postmortem clotting of blood 5. Discoloration of tissues 6.Putrefaction

7. Dessication Techniques of Autopsy 1. Technique of Virchow (organs removed and dissected individually) a. Organs removed one by one and dissected as removed b. Good for: i. Demonstrating pathologic change in individual organs 1. High risk autopsies 2. Limited autpsies c. Simple to perform d. Systematic examination of organs e. Destroys anatomic relationships 2. Technique of Rokitansky (in- situ dissection in part combined with en bloc- technique) a. In situ dissection combined with en bloc removal b. Principle: i. Disturb connections as little as possible 1. Little actual evisceration 2. In case a pathologic organ is found, the region is removed intact c. Practical for single examiner d. Good preservation of anatomic structures e. Good preservation of pathologic anatomic relationships f. Subsequent autopsies can be easily performed on the same body g. Requires a certain degree of expertise and skill h. Thorough examination may not be possible i. If cause of death is determined, less attention is paid to other pathologies 3. Technique of Ghon (en bloc Technique) a. Maintains all connections between physiologically related organs (organ systems) b. Preserves anatomical relationships and simpler to execute c. Anatomic relationships are preserved without a bulky mass of organs d. Systems examined within their structural integrity e. Good observation of pathologic lesions f. Not ideal for multiple organ involvement g. Requires skill and time 4. Technique of Letulle (en masse Technique) a. All organs removed en masse and subsequently dissected b. Best for preserving vascular supply and relationship of different organs c. Fast and Easy

d. e. f. g. h. i.

i. Organs can be removed and stored for later dissection ii. Body can be released Complete preservation of relationships among organs is possible All organs examined thoroughly Bulky and difficult to handle for a single prosector Organs dissected rarely returned to their respective sites Artifactual postmortem injuries may occur Subsequent autopsies not possible

Suggested autopsy material retention* Material / Record (Non- Forensic autopsy records) Wet Tissue: Paraffin blocks: Slides: Reports: 3 months after final report 10 years 10 years 10 years

*Commission on Laboratory Accreditation. 2004 Inspection Checklist section VIII: Anatomic Pathology and Cytopathology. Northfield, Illinois: College of American Pathologists; 2004 Suggested autopsy material retention* Material / Record (Forensic autopsy records) Wet Tissue: Paraffin blocks: Slides: Reports: Gross Photographs / Negatives: Body Fluids and Tissues for Toxicology: Dried Blood stain or frozen tissue for DNA: 3 years Indefinitely Indefinitely Indefinitely Indefinitely 1 year indefinitely

*Commission on Laboratory Accreditation. 2004 Inspection Checklist section VIII: Anatomic Pathology and Cytopathology. Northfield, Illinois: College of American Pathologists; 2004