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3/19/2015

THE POSTMORTEM
EXAMINATION
(AUTOPSY)

WE MUST TURN TO NATURE ITSELF, TO


THE OBSERVATIONS OF THE BODY IN
HEALTH AND DISEASE, TO LEARN THE
TRUTH

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.

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.

- Hippocrates

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

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PRELIMINARIES FOR PME:


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.

1.

2.
3.
4.

Written consent from the next of kin-abide by


the extent or restrictions allowed
Death certificate (blue form)
Medical abstract / Clinical data
Medicolegal clearance

PME IS PERMITTED W/O CONSENT IN


THE FOLLOWING CIRCUMSTANCES:
When it is ordered by the police or coroner
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
1.

The medicolegal examiner or the coroner has


jurisdiction in medicolegal cases, and may
authorize the pathologist to proceed with an
autopsy.

2.

THE CORONER HAS AUTHORITY IN THE


FOLLOWING CASES:
1.

2.
3.
4.

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
Newborns in the first 24 hrs of life
All injury cases, old or recent
All deaths due to unknown cases

THE CORONER HAS AUTHORITY IN THE


FOLLOWING CASES:
5.
6.

7.
8.
9.

All deaths due to suspicious cases


All abortion cases, whether self induced or
otherwise
All violent deaths
All accidental deaths
All sudden deaths

3/19/2015

THE CORONER HAS AUTHORITY IN THE


FOLLOWING CASES:
All cases without medical attendance within
36 hours prior to the hour of death
All deaths due to drowning, hanging or
strangulation
All deaths due to shooting, stab wounds,
burns, electricity, lightning, tetanus, etc.
All homicides

10.
11.
12.
13.

THE CORONER HAS AUTHORITY IN THE


FOLLOWING CASES:
15.

16.
17.

POSTMORTEM CHANGES:
Algor Mortis

1.

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

All suicides
All cases in which there is suspicion of
poisoning
Stillborns
Prematures

14.

POSTMORTEM CHANGES:
Rigor Mortis

2.

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

POSTMORTEM CHANGES:
2.

Rigor Mortis

Sets within 2 hrs after death


(head & neck)

Complete with 12 hrs

Persists for about 3-4 days

3/19/2015

POSTMORTEM CHANGES:
Livor Mortis or Postmortem
(Lividity)Hypostasis

3.

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

POSTMORTEM CHANGES:
Postmortem clotting of blood

4.

TECHNIQUES OF AUTOPSY
1. Technique of Virchow (organs removed
and dissected individually)

5. Discoloration of tissues
Putrefaction

6.

7. Dessication

2. Technique of Rokitansky (in- situ


dissection in part combined with en bloctechnique)
3. Technique of Ghon (en bloc Technique)
4. Technique of Letulle (en masse
Technique)

VIRCHOW TECHNIQUE

ADVANTAGE:

Organs removed one by one and dissected as


removed
Good for:

Demonstrating pathologic change in individual


organs

Simple to perform
Systematic examination of organs

High risk autopsies


Limited autpsies

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DISADVANTAGE:

ROKITANSKY TECHNIQUE

Destroys anatomic relationships

In situ dissection combined with en bloc removal


Principle:

Disturb connections as little as possible

Little actual evisceration


In case a pathologic organ is found, the region is removed
intact

ADVANTAGE:

DISADVANTAGE:

Practical for single examiner


Good preservation of anatomic structures
Good preservation of pathologic anatomic
relationships
Subsequent autopsies can be easily performed on
the same body

LETULLE TECHNIQUE

ADVANTAGES:

All organs removed en masse and subsequently


dissected
Best for preserving vascular supply and
relationship of different organs

Requires a certain degree of expertise and skill


Thorough examination may not be possible
If cause of death is determined, less attention is
paid to other pathologies

Fast and Easy

Organs can be removed and stored for later dissection


Body can be released

Complete preservation of relationships among


organs is possible
All organs examined thoroughly

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DISADVANTAGE:

GHON TECHNIQUE

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

Maintains all connections between


physiologically related organs (organ systems)
Preserves anatomical relationships and simpler
to execute

ADVANTAGES:

DISADVANTAGE:

Anatomic relationships are preserved without a


bulky mass of organs
Systems examined within their structural
integrity
Good observation of pathologic lesions

SUGGESTED AUTOPSY MATERIAL


RETENTION*

Not ideal for multiple organ involvement


Requires skill and time

SUGGESTED AUTOPSY MATERIAL


RETENTION*

Material / Record (Non- Forensic autopsy records)

Material / Record (Forensic autopsy records)

Wet Tissue:

Wet Tissue:
3 years
Paraffin blocks:
Indefinitely
Slides:
Indefinitely
Reports:
Indefinitely
Gross Photographs / Negatives:
Indefinitely
Body Fluids and Tissues for Toxicology:
1 year
Dried Blood stain or frozen tissue for DNA: indefinitely

Paraffin blocks:

3 months after final report


10 years

Slides:

10 years

Reports:

10 years

*Commission on Laboratory Accreditation. 2004


Inspection Checklist section VIII: Anatomic Pathology
and Cytopathology. Northfield, Illinois: College of
American Pathologists; 2004

*Commission on Laboratory Accreditation. 2004 Inspection Checklist


section VIII: Anatomic Pathology and Cytopathology. Northfield,
Illinois: College of American Pathologists; 2004