Test 4 Lecture Notes Flashcards
Autolysis (physical or chemical change?)
Chemical change
Postmortem caloricity -aka postmortem fever (Physical or chemical change?)
Chemical change
Algormortis (Physical or chemical change?)
Physical change
Postmortem blood changes (physical or chemical changes?)
- hypostasis (physical change)
- increase in viscosity of blood (physical change)
- hemolysis (chemical change)
- coagulation or clotting (physical change)
Change in tissue pH (physical or chemical change?)
Chemical change
Rigor mortis A.k.a. cadaveric rigidity (chemical change or physical change?)
Actually a physiochemical change, but if it is between chemical and physical the answer would be chemical change
Imbibition (Physical or chemical change?)
Physical change
Dehydration or desiccation (physical or chemical change?)
Physical change
General decomposition (physical or chemical change?)
Chemical change (All types of general decomp are chemical changes)
Postmortem physical changes are brought about by three events:
1) stoppage of blood circulation
2) gravitation of blood to the dependent parts of the body
3) environmental surface evaporation
Five postmortem physical changes
1) Algor mortis
2) Hypostasis
3) Livor Mortis
4) dehydration
5) increase in blood viscosity
Postmortem chemical changes are a result of
Definite chemical reactions in which new end products and byproducts are formed in the dead human body
Five postmortem chemical changes
1) change in pH
2) postmortem stain – hemolysis
3) postmortem caloricity
4) rigor mortis
5) General decomposition
10 types of general decomposition
- hydrolysis
- Lipolysis
- proteolysis
- Autolysis
- saccharolysis
- fermentation
- oxidation
- hemolysis
- decay
- putrefaction
Algor mortis
The postmortem cooling of the body to the surrounding temperature
The internal organs cool much ______than the surface tissue of the body
Slower
Intrinsic factors that govern the rate of Algor mortis
1) corpulence- it takes longer for an obese person too cool to surrounding temperature
2) age-The very old and very young will cool faster and go into Algor mortis much faster than healthy young adults
Extrinsic factors that govern the rate of Algor mortis
– Amount of clothing covering the body
– Temperature and humidity of the environment
– Temperature of the patient at death
-cause and manner of death
Hypostasis
Can be antemortem and later postmortem-it is the settling of blood and/or fluids to dependent portions of the body
Generally the thinner the blood flow, the _________ hypostasis occurs
Faster
Medications containing blood thinners _________ hypostasis
Maximize
After death, ______% of blood is in the arteries ,
______% of blood is in the veins, and _____% of blood is in the capillaries
5%, 10%, 85%
Diseases which increase the antemortem metabolic rate tend to ____________ the rate of Algor mortis
Decrease
The rate of cooling will be _______ in cases of sudden death
Slower
Exhausting or emaciating diseases will _________ Algor mortis
Accelerate
Air currents and low humidity __________ the rate of surface evaporation and speed of heat loss
Increase
High humidity and static air _________ surface evaporation And retard heat loss
Decrease
Making a pre-embalming analysis of the deceased individual the embalmer examines the effect of four factors of concerns
– General body condition
– Effects of disease on the body
– Effects of drug therapy on the body
– All postmortem chemical and physical changes
The settling of blood into dependent tissues of the body will cause smaller vessels and capillaries to ___________ thus allowing arterial fluid to enter with greater ease
Expand
The postmortem, intravascular red-blue blood discoloration resulting from hypostasis of blood. Can be removed with arterial injection and venous drainage
Liver mortis-aka cadaveric lividity, aka postmortem lividity
First stage of Livor mortis (postmortem lividity, cadaveric lividity) is _________in color, the last stage is _________.
Blue-pink, purple
Loss of moisture from the body tissues which may occur antemortem and/or postmortem (ex. Antemortem dehydration, agonal dehydration)
Dehydration-desiccation
Postmortem physical change occurring during the:
- postmortem interval (before embalming)
- post embalming (after embalming)
Postmortem dehydration
The _____ the postmortem interval, the better the results
Shorter
A drying of the body or tissue as a result of removal of moisture through the skin and membranes to the surrounding air as a natural process. Will retard decomp because it mitigates bacterial cell metabolism
Postmortem dehydration
Three causes of postmortem dehydration that occur prior to embalming (postmortem interval)
1) surface evaporation
2) imbibition
3) gravitation of serum
When the air is naturally dry, as in a desert or mausoleum crypt, a rapid and complete _____________ will occur.
Mummification
5 examples of Postmortem Dehydration
1) Lips- become hard, crusty, leathery, dark, reddish-brown in color
2) eyelids- hard, brownish in color (leathery)
3) eyeball- cupping, sclera turns tan in color
4) finger tips- hard brownish-red and shriveled
5) skin- loss of luster and elasticity
Absorption of fluid portion of blood by the tissues after death resluting in postmortem edema. As surface tissues dehydrate, deeper organs go into edema and swell
Imbibition
dehydration of the surface of the body.
Gravitation of Serum
Imbibition will co-exist most often in _________ cases where currents of dry air rapidly dehydrate the surface and low temperatures retard blood coagulation and permit gravitation of blood serum and plasma into more dependent areas of the body.
refrigerated
Dehydration will bring about surface discoloration ranging from a ________into_______ and finally _____.
yellow, brown, black
Dehydrated tissue discoloration cannot be __________
bleached
Causes of postmortem dehydration that occur AFTER embalming
1) Chemical dehydration
2) Drainage dehydration
3) environmental surface evaporation
4) Increase in blood viscosity
Arterial solution is too strong.
- Use of concentrated arterial/cavity fluid in direct contact with membranes to induce dehydration.
- Regurgitation of cavity fluid up through respiratory tract or cervical vessels
Chemical dehydration
Drainage Dehydration
the removal of tissue moisture may occur as a result of too rapid injection and drainage
most common cause; concerns with temperature, flow of air and humidity around casketed remains in the viewing room.
Environmental surface evaporation
5 results of post embalming dehydration
1) tissue will take on a gray cast; in severe cases, dark gray.
2) Eyes will open
3) lips will part
4) back of hands will shrivel
5) Desiccation marks, red-brown is most noticeable.
Three causes of increased viscosity of the blood
1) Imbibition
2) Gravitation
3) Agglutination of formed elements
Heat causes
coagulation
cause of agglutination of formed elements
pathological agglutination-(result of disease prior to death)- febrile diseases prior to death cause sludge substance (sticky grape jelly) in blood which coat red blood cells, making them stick together in clumps.
exceptions of pathological agglutination are:
1) Septicemia
2) Liver Disorders
Most ______ cases drain well
jaundice
Any condition causing ___________ will also cause agglutination of the blood, thus increasing viscosity
bodily dehydration
Left and right common carotid arteries bifurcate into
left and right internal and external carotid arteries
The descending abdominal aorta bifurcates into
Left and right common iliac arteries
The left and right popliteal arteries bifurcate into
left and right anterior and posterior tibial arteries
Left and right brachial arteries bifurcate into
left and right ulnar and radial arteries
right brachiocephalic artery bifurcates into
right subclavian and right common carotid arteries
diminished coagulability of the blood
Hypinosis
Rapidly forming clots
- currant
- sludge
- jelly clot
- cruor
clot containing all of the blood elements but having red and white cell separated into distinct layers. classified according to location.
slow forming clot
Two types of slow forming clots
- vascular chicken fat clot
- cardiac chicken fat clot
The all white fibrin heart clot
few if any red blood cells, look like flesh color rubber bands.
Difference between antemortem clots and postmortem clots
- soft consistency, especially the cruor
- elastic and do not completely fill the blood vessel
- never attached to vessel wall
- homogenous as described
- when removed unbroken, they appear as a cast of the vessel in which they were formed
self-destruction of cells; decomp of all tissues by enzymes of their own formation without microbial assistance
Autolysis
Chemical catalysts which are employed by the tissue cells for the digestion and metabolism of food substances during life.
Enzymes
Accelerator substances which increase the activity of enzymes
co-enzymes
similar to antibodies. They have a marked inhibitory action on certain enzymes and serve to protect the living tissues against their own digestive agents.
Anti-enzymes
membrane bound body within the cell containing a microscopic droplet of acid hydrolase. Organelles within a cell containing digestive enzymes.
Lysosomes
All bodies in the refrigerator have two things in common
1) all of them will have I.D. tags
2) they will all be covered
Self-digestion begins with
The digestion of enzymes
The end products of Autolysis
1) amino acids
2) sugars
3) fatty acids
4) glycerol
Fermentation
Bacterial decomposition of carbohydrates.
Fermentation occurs simultaneously with ___________ and constitutes a major embalming problem
Putrefaction
Fermentation is the reduction of carbohydrates into simpler substances, usually ___________ and ____________.
Carbon dioxide and water
Bacteria, yeasts, and autolytic enzymes play a key role in
Fermentation and saccharolysis
Oxidative bacterial fermentation will always ____________ the fermentation process
Dominate
Saccharolysis is similar to
Fermentation
Putrefaction is the most unequivocal sign of
Death
Foul odors are much less with __________ than with putrefaction
Decay
Lipolysis will occur concurrently with other types of
Decomposition
One of the earliest postmortem chemical changes is the destructive influence encountered from _____________ which begins to form shortly after death, reaching its peak during rigor mortis
Tissue acidity
The source of the acid from tissue acidity (in post mortem changes) is __________________accumulated in the tissues as a result of cell metabolism and the absence of blood circulation to carry the waste material away from the tissue
Carbon dioxide
Carbon dioxide + water ——>___________
Carbonic acid (H2CO3)
A pH of ____ is where bacteria thrive
8
As bodily tissue reaches a pH of 8, ____________ will directly react with __________ causing it to break down into amino acids
Carbonic acid, protein
Hydrolysis of protein will begin __________
Putrefaction
Cardinal signs of decomposition (COPSA)
- Color
- Odor
- Purge
- Skin (Desquamation)
- Accumulation of gas
First external sign of decomposition appears as a small circle over the right Inguinal or iliac region. What color is it?
Yellow green to green
First external sign of decomp is the activity of __________ causing visceral gas with a combination of hydrogen sulfide and hemoglobin—results in spreading of green discoloration eventually covering the body
E. Coli
Pink-red-purple discoloration of decomp is due to
Hemolysis resulting in extravascular postmortem stain.
Dark brown discoloration of decomp accompanied by
Leatherized condition due to postmortem dehydration – example: freezer burn
Putrefaction is characterized by a nauseating odor resulting from three things:
- simple amines
- complex amines (ptomines)
- the end products of putrefaction
Odor is much less noticeable in _________
Decay
Four examples of odor causing gas
1) hydrogen sulfide
2) hydrogen phosphate
3) ammonia
4) mercaptans
Formaldehyde is completely neutralized by
Ammonia
The postmortem evacuation of any substance from any external orifice of the body. Specifically, the evacuation of the contents of the respiratory and gastrointestinal tracts.
Purge
Purge may occur through the
Mouth, nose, and/or anus as a result of visceral gas pressure
Separation of the epidermis from the dermis as a result of putrefactive softening in the rete mucosum.
Skin slip (Desquamation)
The jelly like substance that binds the dermis to the epidermis; has a lot of capillaries
Rete mucosum
Two kinds of skin slip
- postmortem: a result of putrefaction
- antemortem: or agonal Desquamation due to conditions existing prior to death
Conditions existing prior to death that cause skin slip
- edema: most common, most likely to cause skin slip
- I.V. Needle: infiltration
- old and emaciated w/ unhealthy or degenerative epidermal tissue (diabetes)
- bandages carelessly pulled off by embalmer
Gas formed in the intestinal tract due to the activity of intestinal flora. An example is E.Coli, a facultative anaerobe.
Visceral gas
Compressed air is introduced to raise the atmospheric pressure to several times normal.
Hyperbaric chamber
Exposure to oxygen under conditions of greatly increased pressure usually in a hyperbaric chamber
H.P.O. (High oxygenated pressure)
Dr. William Henry Welch
Discovered clostridium perfringen while a researcher at Johns Hopkins University and later became Dean of the Medical School
Abdominal edema, fluid build up
Ascites
Visceral gas
Gas in the abdomen
Both ________ and ___________ are common intestinal flora
E.coli and clostridium perfringen
Tissue gas is the same thing as
Postmortem emphysema
Formation of gas in the intercellular spaces of the body caused by clostridium perfringen (clostridium welshii)
Tissue gas
Tissue gas in its antemortem stage is called
Gas gangrene
Embalmer’s worst nightmare
Gas gangrene/ tissue gas
True/false:
It is impossible to stop the spread of tissue gas in advanced stages
True
True/false:
Tissue gas can be carried from one body to another by contaminated instruments .
True
Tissue gas prior to the bubble stage. When the gas-filled area is pressed upon, it has a spongy feeling and emits crackling sensation
Crepitation
Tissue gas will appear first in the poorly supported tissues like
- scrotum
- neck
- shoulders
- eyelids
- area around sternum
Some embalmers have had success containing tissue gas by injecting hypodermically into gas pockets the following chemicals:
- gasonline, kerosene
- high index cavity fluid-50
- San veno (liquid)
Hospital life support systems can create
Subcutaneous emphysema
Non-pathological condition that has no relation to putrefaction. Looks and feels like tissue gas.
Subcutaneous emphysema
The signs of tissue gas and subcutaneous emphysema are similar except for two:
- subcutaneous emphysema won’t bubble or blister
- subcutaneous emphysema has no odor of putrefaction
Cause of subcutaneous emphysema
The influx of massive amounts of oxygen and/or carbon dioxide into the tissues causing gas formations in intercellular spaces.
Two possible events that can lead to subcutaneous emphysema
- punctured lungs as a result of trauma
- massive antemortem dosage of oxygen just prior to death
Effects of subcutaneous emphysema on embalming
- remains may turn dark or even black during injection
- severe swelling as in tissue gas
- no danger of early decomp; do not increase strength of fluid
- air may be pressed out or squeezed from tissue by working gas toward an open incision or by aspiration and reaspiration
The only positive sign of death
General decomposition
Difference between subcutaneous emphysema and postmortem emphysema
Putrefactive odor which is present in the latter
The factors that regulate rigor mortis are the same factors that regulate
Decomposition
Fatty acids are products of
Lipolysis
The break down of lipids and proteins result from the action of
Bacterial enzymes and autolytic enzymes
Embalmable with good results
Protein
Poor results that accompany embalming amino acids
- swelling
- no firmness
- distortion of features
Unembalmable
Amines
Simple amines (H.H.A.M.M)
- hydrogen sulfide
- hydrogen phosphide
- ammonia compounds
- mercaptans
- methane
Complex amines (ptomines-body poisons) (P.I.N.S.C)
- Putrescine
- Indole
- Neurine
- Skatole
- Cadaverine
End products of decomposition (S.H.A.W.N.P.C)
- Sulfuric Acid
- Hydrogen
- Ammonia
- Water
- Nitrogen
- Phosphoric acid
- Carbon dioxide
Intrinsic factors governing decomposition
1) age
2) sex
3) corpulence
4) cause and manner of death
5) bacterial and parasitic activity
6) pharmaceutical agents
Extrinsic factors governing decomposition
1) air
2) moisture
3) temperature
4) bacterial and parasitic activity
5) pressure due to earth or clothing
6) vermin including maggots, lace, and rats
Stillborn infants decompose very slowly because of the absence of
Intestinal flora
Infants which have lived long enough to be fed or have breathed will decompose rapidly because of
An abundance of intestinal flora
An aged person, because of a lack of______________ and dehydration, will generally decompose at a much slower rate
Moisture
A middle aged, so called healthy person with A high moisture content and a high quality of bacteria in the gastrointestinal tract will usually decompose
Rapidly
Certain diseases and conditions common to one sex or the other may have a marked influence on the rate of
Putrefaction
A higher moisture content and greater amount of ____________ in the female usually brings on putrefaction at a much greater rate.
Subcutaneous fat
Postpartum Hemorrhage, or______________ May also cause a rapid onset of putrefaction
Death in childbirth
Obese people decompose more__________ than thin ones, largely because of the higher moisture content and the greater retention of body heat
Rapidly
After death, ___________________ encouraged putrefaction
Postmortem caloricity
Moisture is essential for
Bacterial growth
Putrefaction is delayed when the tissues are
Dehydrated
Optimum temperature for the growth of bacteria causing decomposition is
98.6
A rapid onset of______________Will slow down the putrefactive process
Algor mortis
If the amount of organisms accumulated with in the body at the time of death is high it will_________ The putrefactive process
Hasten
A free access of air accelerates decomposition get for two reasons
1) additional airborne bacteria are carried to the body and could enter through various openings, wounds, etc.
2) Decay would be rapid because the organisms would be aerobic
Caspers dictum
All things being equal, a body will decompose as much in one week lying on the ground as it would into weeks submerged in water, and as much as in eight weeks buried in the ground.
Decay is accelerated when there is a free access to warm humid air or a high___________environment
Moisture
One of the most important factors affecting bacterial growth
Temperature
Temperatures for bacterial growth
Optimum: 98°F to 100°F or body temperature
Minimum: 32°F
Maximum: 120°F (which stops most decomposition)
Order of decomposition of body compounds
- carbohydrates
- proteins
- fats
- firm protein – connective tissue
- hard protein – cartilage
- bone
Order of decomposition of the organs
- infantile brain
- lining of the larynx and trachea
- stomach
- intestines
- spleen
- mesentery and omentum
- liver
- adult brain
- Heart
- lungs
- kidneys
- urinary bladder
- esophagus
- pancreas
- diaphragm
- blood vessels – (mostly large)
- non-pregnant uterus
Containing all of the blood elements in a homogenous mass. Bright red in color, similar to one taken from a living person
Rapidly forming clot
Containing all of the blood elements but having red and white cells separated into distinct layers. Classified according to location
Slow forming clot
Types of slow forming clots
- vascular chicken fat clot
- cardiac chicken fat clot
Synonymous with mummification; one of the basic necessities for bacterial growth, water, has been eliminated from the body.
Permanent preservation
Environment for permanent preservation to take place
Hot dry desert or cold, mountainous regions with perma frost
Characteristics of a wet or dry floater
- adipose tissue formation
- facial features swollen beyond recognition
- intense odor of putrefaction
- protruding eyes and tongue
- massive skin slip (Desquamation)
- blue-black streaked with red in color (marbleized)
- purge from all orifices
- hair, fingernails, and toe nails have dropped off or are loose
- intense odor of ammonia
Terms associated with decomposition
- maceration
- mummification
- deamination
- oxidative decarboxylation
- saponification
Moistening or softening of any tissue decomposing in a liquid medium. Ex: a fetus dies in the uterus and remains enclosed in the amniotic sac
Maceration
Extreme or complete dehydration of body so as to form a dry, brown, hard structure which is light in weight and resistant to decomposition
Mummification
Two-step reaction involving the removal of the amino groups from amino acids
Deamination
With the help of oxygen, atoms of carbon and oxygen are pulled off the molecular structure. Reaction is associated with decay
Oxidative decarboxylation
Any substance altering the velocity of a chemical change.
Catalyst
The enzymes secreted by the tissue cells are called
Autolytic enzymes
Chronological order of putrefaction at 70 degrees F in air
- 1-3 days: cupping of the eyeball, greenish discoloration over the abdominal area, postmortem stain, dehydrated lips and eyelids
- 3-5 days: purge, green discoloration spreading over whole body, visceral gas and some tissue gas, odor
- 8-10 days: tissue gas present in all parts of the body, massive skin slip, body swollen, starting to turn dark
- 14-20 days: bubbles and blisters over the body, mottled red, green and brown. Intense odor of putrefaction, nails and hair loose, eyes and tongue bulging, recognition of features difficult.
- 1-6 months: thoracic and abdominal cavities may burst open, body liquification and gases escaping; feature recognition is impossible,bones separating from joints.
Change in body pH
- 4-7.0–> 1st stage flaccidity
- 0-6.0 & 6.0-7.0–> stage of rigor
- 0-7.4—> 2nd stage flaccidity
Most embalming fluids have a slightly _________pH
Alkaline
A group of chemicals called ________ are used to control embalming fluid pH and tissue pH
Buffers
The agent that results in coagulation of muscle joints in rigor mortis
Sarcolactic acid
Formula for rigor mortis
In death, absence of oxygen will cause glycogen to form and release pyruvic acid, which will break down to form sarcolactic acid. Sarcolactic acid will combine with muscle juices causing rigor mortis
Two definite and somewhat separate actions of sarcolactic acid in the muscle tissue
- coagulates soluble muscle juices to form insoluble myosin
- causes a swelling of the muscle cell colloid which may be so great as to destroy the structure of the muscle cells.
Minimum temperature for rigor mortis
32 degrees F
Optimum temperature for rigor mortis
98-100 degrees F
Maximum temperature for rigor mortis
120 degrees F
The extent of physical activity before death will affect the production of
Sarcolactic acid
Rigor mortis is ________ by heat and _______ by cold
Accelerated, retarded
Will cause early onset of post mortem caloricity
Febrile disease
Females go into rigor mortis _________ than males
Faster
Conditions affecting onset, duration and temperature of rigor mortis
1) age
2) gender
3) cause and manner of death
4) condition of the muscles
Characteristics of rigor mortis
1) shortened
2) stiffened
3) acid in reaction
4) loss of sensitivity to stimuli
Detailed outline of influence of rigor mortis on embalming
A) the acidity of the tissue during rigor mortis retards bacterial growth
B) limits arterial fluid distribution because of the force of contraction exerted on vessel walls.
C) by giving a false impression of fluid reaction, the embalmer becomes confused as to whether the tissues are really firming or not
D) destroys the ability of tissue to coagulate on contact with HCHO. Also weakens fluid strength when acid unites with HCHO
E) distortion of facial features, hands and arms if rigor mortis is not relieved immediately. ( remains will swell during injection)
Between death and putrefaction, the muscle tissue of the body will pass through three distinct stages of rigor mortis:
1) primary flaccidity
2) the stage of rigidity
3) secondary flaccidity
Primary flaccidity
- muscles are soft and relaxed and will still react to stimuli
- as cellular death increases, muscles will become rigid
- pH goes from alkaline to neutral to slightly acidic
The stage of rigidity ( rigor mortis)
- cells are all dead
- muscles no longer react to stimuli
- muscles and joints are firmly contracted and rigid
- pH goes from mildly acid to strongly acid to mildly acid
Secondary flaccidity
- after a variable period of time, rigidity disappears
- muscles are again in a state of relaxation
- all power of contraction is lost forever
- pH goes from mildly acid, to neutral, to alkaline, to strongly alkaline
Maximum rigidity
6.5 pH
Bacterial decomposition will be retarded in _____________ because bacteria will not grow in an acid medium.
Stage 2 (rigor mortis)
The best embalming results will occur during
The early stage of primary flaccidity
Arterial fluid mixed with water in the embalming machine
Primary dilution
Arterial fluid solution uniting with bodily fluids and tissues in the body
Secondary dilution
Conditions often mistaken for rigor mortis
- catalepsy
- cold stiffening
- heat stiffening
When exposed to temperatures near or below freezing, the body tissues become firm and rigid. Extreme coldness of the body indicates the cause of rigidity
Cold stiffening
There is a more or less permanent coagulation and stiffening as a result of exposure to very high temperatures, as in burning or scalding. Will persist until the muscles undergo softening during putrefaction.
Heat stiffening
Prolongation of the last violent contraction of the muscles into the rigidity of death. It will disappear naturally as does rigor mortis over a period of time.
Cadaveric spasm aka instantaneous rigor mortis
Examples of cadaveric spasm
- soldier killed in combat–grasping rifle
- automobile accident–clutching steering wheel
- suicide– clutching pistol
- murder– victim aware-fear
- drowning–clutching grass, weeds
- falling off cliff–clutching for branches
- sports
- downhill skiing accident–clutching poles
Associated with cadaveric spasm, over production of sarcolactic acid under duress.
Death grip
Order of what happens to the blood after death
1) hypostasis
2) Livor mortis
3) hemolysis
4) postmortem stain
__________will always occur before hemolysis
Hypostasis
Will occur when formalin solutions contact trapped heme in surface tissues during postmortem stain.
Formaldehyde grey
Carbon monoxide poisoning is both __________ and _________
Antemortem and postmortem
Will cause hemolysis to occur at a much faster rate, resulting in cherry red color to surface tissue
Carbon monoxide poisoning
Postmortem caloricity will always occur before ____________
Algor mortis
Putrefaction is more rapid in _________than in salt water
Fresh water
Putrefaction is more rapid in ___________water than in running water
Stagnant
Factors governing the rate of putrefaction in water
1) temperature
2) nature of the medium
3) movement of fluid
