THE POSTMORTEM EXAMINATION (Autopsy) Flashcards
Who said “We must turn to nature itself, to the observations of the body in health and disease, to learn the truth”
Hippocrates
Considered the ultimate medical audit
Autopsy
What are the five different rulings for manner of death?
SHAUN
- Suicide
- Homicide
- Accident
- Undetermined
- Natural
T/F: in a case where suspicious circumstances surround the death, a medical examiner or coroner can order an autopsy without consent from next of kin
True
T/F: Everyone receives an autopsy upon death
False
In the 44 B.C. The first recorded autopsy occurs when ______ examines ________’s body
after his assassination.
Antistius; Julius Caesar
Which among the 23 stab wounds of Julius Caesar was proven fatal?
one wound to the chest that ruptured Caesar’s aorta
Who wrote “Hsi Yüan Lu, or The Washing Away of Wrongs”
Song Ci
an instruction manual on how to conduct medico-legal investigations, examine corpses, and determine the time and cause of death. Other forward-thinking forensic issues were illustrated, such as poisoning, decomposition, wounds from various weapons, strangulation, and fake wounds.
Hsi YĂĽan Lu, or The Washing Away of Wrongs by Song Ci
Conducted the first-known legal autopsy in 1302 where the death was investigated explicitly to determine if there was fault (what is referred to as a medico-legal autopsy)
Bartolomeo de Varignana
Bartolomeo da Varignana was influenced by what book?
The Washing Away of Wrongs
T/F: Bartolomeo da Varignana utilized his observations through a microscope
False; his observations were limited by the power of the human eye and his tools
Throughout the renaissance, anatomy teachers and students in medical school would congregate in an operating theater and watch a cadaver be opened by a ______
Lay dissector
T/F: Throughout the Renaissance, anatomy teachers and students in medical schools did not perform dissections themselves.
True
performed a number of “autopsies,” dissecting corpses and observing the anatomy unseen by the naked eye.
Leonardo da Vinci and Michelangelo
realized the importance of the microscope when conducting pathological research to uncover minute details.
Rudolf Virchow
Through his examinations, he characterized a case of leukemia, and his resulting report is one of the earliest formal reports on this cancer.
Rudolf Virchow
T/F: Wherever Scientific medicine of high quality is practiced, postmortem examinations are performed
True
Also known as “Autopsy”
Postmortem examination
Autopsies are helpful for physicians who challenge their ______
Diagnosis
Considered as the first pathologist
Rudolf Virchow
Most popular field where autopsies are done
Criminal law
What are the 3 steps in preparation before the postmortem examination
Step 1 - Administrative preparations
Step 2 - Preparation of the autopsy room
Step 3 - Confirmation of decedent identity
This is where we obtain and confirm consent for autopsy, review clinical records, and contact clinical team and staff pathologist
Step 1- Administrative preparations
This is when we set up of dissection instruments and tools, Lay out swabs, media, etc. for any ancillary studies to be performed, prepare photographic equipment, assemble personal protective equipment
Step 2 - Preparation of the autopsy room
This is the most important step in the autopsy procedure, where identifiers on the body must be confirmed and matched with the autopsy consent form, and also confirm any limitations or restrictions to the autopsy at this time
Step 3 - Confirmation of decedent identity
Has jurisdiction in medicolegal cases, and may authorize the pathologist to proceed with an autopsy.
Medicolegal examiner or the coroner
What are the 2 types of autopsies
Medical Autopsy
Non-medical autopsy
This type of autopsy is largely medicolegal and mainly used for forensics
Non-medical autopsy
It is the death of an organism, cessation of circulation and respiration (1960s), and criteria for the pronouncement of death
Somatic Death
If there in any medicolegal angle of death, the jurisdiction lies with which government agencies?
PNP and NBI
What are the criteria for brain death? (4)
- Coma and Cerebral unresponsiveness
- Apnea
- Absent cephalic (brainstem) reflexes
- Electrocerebral silence
Criteria for brain death should be present for how long after onset of coma and apnea?
30 minutes to at least 6 hours
Order of consent for autopsy
- Spouse
- Adult children
- Adult grandchildren
- Parents
- Brother/Sister
- Nephew
- Grandparents
- Uncle/Aunt
- Cousin
- Stepchildren
T/F: If autopsy is not required by law, it can be done even without the next of kin giving permission
False; CANNOT be done until the next of kin gives permission
T/F: Consent form must be signed in the presence of a witness
True
Autopsy in which all body cavities are examined (including the head / brain)
Complete
Type of autopsy which may exclude the head / brain.
Limited (Partial)
Type of autopsy where specific organs only are examined.
Selective
An autopsy is usually carried out within how long after the death of a person?
48 hours
T/F: Coronial autopsies are ordered by the state coroner, whereas hospital based autopsies may be performed at the request of the family of the deceased.
True
This part of an autopsy indicates the gross findings
Death certificate
Irreversible cessation of circulatory and respiratory functions or Irreversible cessation of all functions of the entire brain, including the brainstem
Death
RA as amended by Republic Act No. 7885, organ and tissue donations from donors who have been declared brain dead has been allowed.
REPUBLIC ACT 7170 OR ORGAN DONATION ACT OF 1991
How many copies of medical certifications of death are given and to whom.
3
1- Relatives
1 - City health office
1 - Funeral home
is the final disease, injury, or complication directly causing death.
Immediate cause of death
It precedes death as a consequence of an underlying cause or causes.
Immediate cause of death
The condition(s) that led to or precipitated the immediate cause of death, as recorded on a death certificate.
Antecedent cause of death
Other intervening cause (or causes) of death occurring between the underlying and immediate causes
Antecedent cause of death
Defined for public health and legal purposes as “the disease or injury that initiated the train of events leading to death.”
Underlying (Proximate) cause of death
The circumstances of the accident or violence which produced the fatal injury.
Underlying (Proximate) cause of death
It is the most important entry in the certificate since mortality statistics is based on this.
Underlying (Proximate) Cause of Death
Immediate/Antecedent/Underlying: Congestive Heart Failure
Immediate
Immediate/Antecedent/Underlying: Myocardial Ischemia caused by coronary artery
Antecedent
Immediate/Antecedent/Underlying: Coronary arterial atherosclerosis
Underlying
Immediate/Antecedent/Underlying: Hypovolemic shock
Immediate
Immediate/Antecedent/Underlying: Multiple fractures
Antecedent
Immediate/Antecedent/Underlying: Pedestrian hit by a truck
Underlying
Immediate/Antecedent/Underlying: Lobar pneumonia
Immediate
Immediate/Antecedent/Underlying: High output cardiac failure due to anemia
Antecedent
Immediate/Antecedent/Underlying: Thalassemia
Underlying
Death resulting from disease
Natural
Death as a result of environmental influence
Accidental
Death intentionally self-inflicted
Suicide
Death resulting from the deliberate action of another person
Homicide
Unknown cause of death
Intermediate or undetermined
Death without the intention to kill
Homicide
Refers to a continuum of changes that occur in a dead body following death; these changes include livor mortis, rigor mortis, decomposition, and taphonomy.
Post-mortem changes
First demonstrable change after death is cooling of the body.
Algor Mortis
the body cools at ___ in 50% of cases
1.5°F/hr
At room temp, the body cools to which temperature at the 1st hour?
2 to 2.5 deg F/hr
At room temp, the body cools to which temperature at the next 12 hours?
1.5 to 2 degrees F/hr
At room temp, the body cools to which temperature at the next 12-18 hrs?
1 deg F/hr
Rigidity of the body due to hardening of the skeletal muscles caused by a series of physiochemical events after death
Rigor mortis
Rigor mortis is the lack of ATP regeneration and increased acidity result in the formation of locking-chemical bridges between ____ and ____
Actin and myosin
Rigor mortis sets within how many hours after death?
2 hours
Rigor mortis is complete and fully fixed after approx. how many hours?
6-12 hours
Rigor mortis dissipates after approximately how many hours?
36-48 hours
Fixed rigor mortis of the upper extremities wherein the arms are suspended against gravity, indicating they were previously held in that position while rigor was fixing.
Antigravitational rigor mortis
Blood supply gravitates to the skin vessels, which becomes toneless and dilate after circulation ceases.
Livor mortis
Evident as deep purple-red discoloration in the skin and internal organs.
Livor mortis
Other term for livor mortis
Postmortem (lividity) hypostasis
Livor mortis can be mistaken for?
Hematoma
Occurs in gravity-dependent areas of the body that come into contact with firm surfaces
Blanching
Livor mortis is spared in these areas due to localized pressure preventing blood from entering the skin
Gravity-dependent areas (i.e. floor, tight clothing)
Livor mortis becomes evident as early as how many minutes/hours after death?
20 minutes
Livor mortis is fully evident within how many hours?
4 hours
Livor mortis is fixed in aporox. how many hours?
8-12 hours
What is observed during livor mortis?
Tardien spots aka: Tardieu petechiae, Tardieu spots
2 Techniques of Autopsy
Cutting of bones to expose the cavities
1. Sawing of the skull
2. Cutting of the sternal plate
It is a straight line incision extending from the chin to the symphysis pubis
I shaped incision
This type of incision starts near the acromian process and progresses downwards towards the xiphoid process. The incision is then extended til the symphysis pubis. Also, a similar incision is made on the opposite side of the body.
Y shaped incision
A Y shaped incision is made from the suprasternal notch to symphysis pubis. It extends from the suprasternal notch over the clavicle to its center on both sides and lasses upwards over the neck, behind the ear
Modified Y shaped
T/F: For a woman, the Y-incision is curved around the bottom of the breasts before meeting at the breast bone.
True
What is the order of examination according to Virchow’s technique?
Head > Thoracic (Cervical) > Abdominal Organs
Material/Record (Non-Forensic autopsy records)
Wet tissue
3 months after final report
Material/Record (Non-Forensic autopsy records)
Paraffin blocks
10 years
Material/Record (Non-Forensic autopsy records)
Slides
10 years
Material/Record (Non-Forensic autopsy records)
Reports
10 years
subpleural spots of ecchymosis that follow the death of a newborn child by strangulation or su ffocation
Tardieu’s ecchymoses
is pink to purple discoloration of the skin from blood pooling in dependent areas of the body.
Lividity
are purple to black spots on the skin that can develop along with lividity, from the rupture of capillaries.
Tardieu spots
horizontal linear scleral blackening along the equator of the globe of the eye
Tache noir de la sclerotique
T/F: tache noir is often initially black in appearance and over time becomes red
False; initially red —> black
Multiple percutaneous needle biopsies after death
Blind biopsies
extensive organ sampling or
removal via a limited incision
Mini-autopsy
