PATHOPHYSIOLOGY OF DEATH

YUDHA NURHANTARI, DR, PHD.,SPF

DEPT. OF FORENSIC MEDICINE

FAC. OF MEDICINE, GADJAH MADA UNIVERSITY
Medicolegal investigative system
 Coroner (not physician) investigate the cause and
manner of death
 Not required to consult a physician, may or may not
order an autopsy
 1-2 weeks training
 modified
 Medical examiner (physician)  investigate the
cause and manner of death
 US
 Board certification
 Continental system : the police investigator ask the
doctor to examine the body.
 Indonesia
death
 Respiratory-cardiovascular stop permanently
 Brain stem death
 Criteria: Deep coma with ventilation (inadequate
spontaneous respiration caused by brain damage)
 Dx by 2 doctors 5 years registered and
experienced
Cause, Manner,Mechanism of death
 Cause of death is any injury or disease that
produce a physiological derangement in the body
that results in the death
 Mechanism of death is the physiological
derangement produced by the cause of death
 Manner of death explain how the cause of death
came out: natural, homicide, suicide, accident, undet
Casue mechanism death

cause mechanism
• Stab wound to • hemorrhage
the chest • septicemia
• Adenocarcinoma
death
of the lung
Sudden or unexpected natural death
 Can be instantaneous(ventricular arrhythmia),
sudden but not instantaneous (myocardial infarction)
or cases where the individual was found death
 Unexpected or unexplained naturaldeath
Time of death
 Postmortem changes  determination time of death
 Livor mortis, rigor mortis, body temperature, degree
of decomposition, chemical changes
 Flow-cytometry, stomach contents, insect activity,
and scene markers
Livor mortis
 =postmortem hypostatis=lividity
 Circulation ceases gravity pulls down stagnant

blood to the lowest accessible area sedimentation

of red cells  bluish red discoloration
 Distributed to the lowest area with free compression

 depend on the body position after death

 Begin within 30 minutes- 2 hours, develops
gradually, usually reach its maximum discoloration
at 8-12 hours
 Examination : displacement of livor mortis on thumb
pressure
 Usual bluish red oxygenation at death
 In drowing, may turn to pink  oxyhemoglobin
formation at the expense of the darker reduced hb
 Cherry-pink colour of hypostasis
carboxyhemoglobin  CO poisoning
 Dark blue-pink hue cyanide
 Brownish red methaemoglobinemia chlorate
bruish Livor mortis

 Subcutaneous  Accumulation of red

bleeding cell be gravity
 May be any where  Lowest are free
 Thumb pressure (-) compression
 Slightly raise  Thumb pressure
 flat
Rigor Mortis
 Muscles stiffening after death dissapearence of
ATP actin and myosin filament permanently
complexed and rigor mortis sets in
 Appears 2-4 h, fully develops in 6-12 h. after 24-
36 h disappear.
 Consuming ATP prior to death  speed up
 Drowning fully 2-3 h
 All muscles at the same time and rate  most
evident in small muscles
 Cadaveric spasm: instantaneous appearance
intense physical and or emotional activity
 Heat stiffening denatured and coagulated tissue
protein as in cooking pugilistic
 Cold stiffening freeze
decomposition
 Mixed process : internal autolysis and external process
(bacteria, fungi etc)
 Factor : temperature, body state humidity etc
 First greenish discoloration of lower right abdomen 24-
36 h  other body
  swelling due to gas formation and marbling (
hemolysis of blood vessel
 60-72 h undergoes generalized bloating, followed by
 Vesicle formation, skin slippage, hair slippage the
body is green-black.
 Decomposition fluid will drain from nose and mouth, and
accumulate in body cavity
 Hastened by obesity, heavy clothing, sepsis, high T
 Delayed in the cool environment
 When the decomposition has set in, refrigeration may
not stop decomposition completely
 Internaly, decomposition slower than at surface
 Immersed body slows up putrefaction:
- lower ambient temperature
- protection from insect and small mammal
predator.
 Buried bodies in the earth much slower than in air
or water
Adipocere formation
 Adipocere : a waxy substance derived from body
fat  moisture condition
 Assist by Cl perfringens that produce lecithinase
which facilitates hydrolysis and hydrogenation
 After months (3-12 month)brittle and chalky.
 Adipocere inhibits putrefaction by increasing tissue
acidity, dehydration slows the growth of bacteria
mummification
 A drying of the tissues in place of liquefying
putrefaction
 Only occur in dry environment ,but can occur in
freezing condition
 The skin and underlying tissue are hard
Postmortem damage by predator
 Animal predation is aprt of natural food chain 
returns the protein, fats and carbohydrates.
 Damage from canine nad rodent predators is usually
obvious
 The most active tissue removers are maggots, larval
stage of flies
 The adult insects lay eggs on the fresh body, choosing
wounds or moist areas. The eggs hatch in a day or so,
and several cycles of maggot develop, shedding their
cases at intervals depending on the species
 In water, all aquatic animals can mutilate immersed
body
 Dogs and foxes may leave puncture wound due to
sharp teeth penetration
calliphora
 Adult calliphora lay the eggs on the body 8-14 h
hatch at 6-7 C (will not hatch at t below 4C) first
instar/stage persist another 8-14 h second instar
another 2-3 day third instar stay 3 days pupa 12
days winged fly
 Some maggots, adults, pupae, empty pupa and eggs
should be sent after fixation with alcohol 80%, labeled,
numbered
Post mortem Chemistry
 Humor vitreous PM interval (Sturner)= 7.14x
potassium concentration (mEq/L)-39.1
 Chloroide and sodium  decrease
 Glucose decrease
Body cooling
 After death metabolism stop temperature
decrease  environment temperature
 Time since death = 37 C-rectal temp +3
 Time since death= (98.6F-rectal temp)/1.5
Gastric emptying
 Estimate the interval between eatning and death
 Spitz Small meal (sandwich) is digested in 1 h
Large meal takes 3-5 h
 Adelson  light meal ½-2 h, medium size meal 3-4
h, and heavy meal 4-6 h.
Flow cytometry
 Comparison of the cell degradation degree in tissue
with standard
 DNA degradation degree