Autopsy (Postmortem Examination) Flashcards
-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
Autopsy
Types of autopsy
- Complete autopsy
- Partial autopsy
- Selective autopsy
Type of autopsy
- Requires consent
- Complete examination of all organs, including the brain
Complete autopsy
Type of autopsy
- Part of the anatomy
Partial autopsy
Type of autopsy
- Restricted to at least a single organ (Ex. MI – heart)
Selective autopsy
- Written consent from the next kin-abide by the extent or restrictions allowed
- Relative: oriented by the attending physician, not the pathologist - Death certificate (Old: Blue form | New: Blue border/frame)
- Signed by:
a. Physician
b. Pathologist (back): will sign when PME has been performed - Medical abstract or clinical data
- Medico-legal clearance
- Suspicious evidence of foul play
- Ex. physical injury
Preliminaries for PME
Other Uses of Death 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
PME is permitted w/o consent in the following circumstances
- When it is ordered by the police or coroner (NBI)
- When it is necessary to complete the death certificate
- When the deceased himself has given consent before he died (advanced directive)
- Stipulate that in the event you will die, you will be giving out a consent for autopsy
- Donate your organs for medical purposes or for transplantations - Deceased military personnel who dies in active services/training duty or military services
If pathologist is not available
The medico-legal examiner or the coroner has jurisdiction in medico-legal cases & may authorize the pathologist to proceed w/ an autopsy
The coroner has authority in the following cases: (Give atleast 3)
- All natural deaths occurring in the hospital w/in 24 hrs of admission, unless the case was attended by a private physician w/in 36 hrs of death
- Newborns in the 1st 24 hrs of life
- All injury cases, old or recent
- All deaths due to unknown cases
- All deaths due to suspicious cases
- All abortion, whether self-induced or otherwise
- All violent deaths
- All accidental deaths
- All sudden deaths
- All cases w/o medical attendance w/in 36 hrs prior to the hour of death
- All deaths due to drowning, hanging or strangulation (asphyxia)
- All deaths due to shooting, stab wounds, burns, electricity, lightning, tetanus, etc.
- Homicides
- All suicides
- All poisoning
- Stillborn = omission
- Premature death
Death of an organism
Cessation of circulation & respiration (1960’s)
Somatic death
T/F:
Clinically dead & dead are the same.
T
cessation of heartbeat & respiration but the brain is still alive but injured
Clinical death
Criteria for the pronouncement of death
- Advanced resuscitation techniques that are capable of reviving effectively cases of clinical death
- Advance life-sustaining equipment capable of maintaining cardiovascular & respiratory functions despite severe brain injury
- Redefinition from cessation to irreversible cessation of cardiorespiratory functions after resuscitation attempts
- Brain death: cannot be revived anymore [National institute of neurological diseases & stroke in the US (1977)]
perpetual state of deep sleep
Brain death
Criteria for brain death
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)
- irreversible cessation of circulation & respiratory functions
- Irreversible cessation of all functions of the entire brain, including the brainstem is dead
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
Death according to American academy of Neurology
- 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
Algor mortis
- Rigidity of the body due to hardening of the skeletal muscles caused by a series of physiochemical events after death
- (–chemical bodies between actin & myosin
- 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
Rigor mortis
- 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
Livor mortis (postmortem lividity/hypostasis)
- Abdomen: green
- Formation of sulfur gases (bacteria)
Discoloration of tissue
Enumerate the postmortem changes.
- Algor mortis
- Rigor mortis
- Livor mortis (postmortem lividity/hypostasis)
- Postmortem clotting of blood
- Discoloration of tissue
- Putrefaction
- Dessication (mummification)
Organs removed & dissected individually in the body
Most widely used metohd
Technique of Rokitansky
En bloc technique
Technique of Ghon
En masse technique
♫ En masse:
- All organs of thoracic, abdominal, & pelvic are removed at the same time
- Sweeping of all organs
Technique of Letulle
Very popular, easy to do, convenient
Part of consent: organs should be retained completely or partially
Organs set aside later
Body undertaker of the body
Autopsy: Larynx Rectum
Tissue specimen Watchglass (isotonic solution)
BF/PC microscope
Teasing/Dissociation
Tissue (<1mm)
Sandwich bet. 2 slides/coverslip
Vital stain
Crushing/squash preparation
Spread lightly over a slide (wireloop/applicator)
Smear preparation
Fresh Tissue Examination preparation (3)
Teasing/Dissociation
Crushing/squash preparation
Smear preparation
(-) Fixative
Frozen section
Best frozen section
Freezing of unfixed tissue
To localize hydrolytic enzymes & other antigens
Freezing of fixed tissue
Derivative of formaldehyde
Fix at 4’C for 18 hrs
Formal (formol) calcium
most rapid
Isopentane cooled by liquid nitrogen
Liquid nitrogen
Commonly used methods of freezing
Liquid nitrogen
CO2 gas
Aerosol sprays
Staining methods
(frozen sections)
1) “PATH”
2) Polychrome methylene blue
3) Alcoholic pinacyanol
4) Thionine
5) H & E = progressive, no decolorizer
- w/o decolorizer
- for frozen sections
Progressive H&E
- w/ decolorizer (acid-alcohol)
- for routine histology staining
Regressive H&E
1) w/o use of any chemical fixative
2) __________: rapid freezing (-160’C)
3) __________: removal of H2O in the form of ice (-40’C) – vacuum
1) Freeze drying:
w/o use of any chemical fixative
2) Quenching: rapid freezing (-160’C)
3) Sublimation: removal of H2O in the form of ice (-40’C) – vacuum
Similar to freeze drying but:
Frozen tissue Rossman’s formula/1% acetone
Dehydrated in absolute alcohol
Freeze-substitution
Any microtome
Uses CO2
Knife: -40 to -60’C
Tissue: 5 to -10’C
Environment: 0 to -10’C
Cold knife procedure
Temperature: -18 to -20’C
_________: refrigerated cabinet w/ rotary microtome
Cryostat procedure
(Cold microtome);
blank= cryostat
Temperature: -18 to -20’C
_________: refrigerated cabinet w/ rotary microtome
Cryostat procedure
(Cold microtome);
blank= cryostat
Best mounting media for cryostat sections
O.C.T. (Optimal Cutting Temperature)
