PHASES OF DEATH

MLS 013: HISTOPATHOLOGIC AND CYTOLOGIC TECHNIQUES

LESSON TITLE: AUTOPSY A. Somatic death

⇨ irreversible loss of integrating and coordinating functions of the
organism
AUTOPSY B. Molecular death
⇨ the death of individual organs / tissues

○ “To see for oneself”

○ aka NECROPSY (to look at the dead) POSTMORTEM CHANGES
○ aka POSTMORTEM EXAMINATION
○ systematic examination of the dead person for medical, legal and/or
1. Immediate changes
scientific purposes
⇨ occur simultaneously with onset of clinical death; includes
insensibility, loss of reflexes, flat EEG rhythm, cessation of
BENEFITS OF AUTOPSY respiration, cessation of circulation

2. Early changes
1. Identification of diseases with genetic components
⇨ Eye changes (Dilated, fixed pupils)
2. Clinical audit and characterization of poorly understood diseases
⇨ Skin changes
3. Evaluation of new medical therapies and new surgical techniques and
⇨ Primary muscle flaccidity / relaxation
procedures
⇨ Contact flattening with pallor
4. Comparison of objective medical evidence with the apparent
circumstances of death
3. Late changes
5. Provision of an accurate cause of death
⇨ Putrefaction ➝ absolute sign of death; involves autolysis and
6. Contribution to medical and paramedical education and research
bacterial action; greenish discoloration and gas formation
⇨ Teeth Fallout ➝ 7-10 days
TYPES OF AUTOPSY ⇨ Appearance of Maggots
⇨ Attack of the Rodents
⇨ Adipocere formation ➝ aka SAPONIFICATION / GRAVE or
1. Clinical Autopsy MORTUARY WAX; due to C. welchii initiating hydrolysis and
⇨ aka HOSPITAL AUTOPSY hydrogenation of body fats
⇨ Purpose: To determine the cause of death if unknown ⇨ Mummification➝ desiccation of body tissues and viscera after
⇨ done at the request of the family or the MD of the deceased death
⇨ Prosecutor: Pathologist / Forensic pathologists ⇨ Bursting of abdomen
⇨ Changes in external genitalia
2. Forensic Autopsy ⇨ Skin slippage
⇨ aka MEDICOLEGAL AUTOPSY
⇨ performed when COD is not certain, usually in the case of
unexpected, unexplained or unnatural deaths 4 FUNDAMENTAL POSTMORTEM CHANGES
⇨ Purpose:
A. To determine exact cause and manner of death
1. Pallor mortis
B. To establish the identity of the deceased
C. To determine time since death
2. Algor mortis
D. To collect trace evidence
⇨ cooling of the body
E. Reconstruction of the crime scene
⇨ Prosecutor: Medical Examiners, Pathologists,
3. Rigor mortis
Forensic Pathologists
⇨ loss of ATP; stiffness of the body

DEFINITIONS OF DEATH 4. Livor mortis

⇨ aka SUBCUTANEOUS HYPOSTASIS
⇨ postmortem lividity / staing; reliable sign of death
CAUSE OF DEATH ⇨ no blanching when pressed
➔ disease that sets in motion the physiologic train of events culminating in
cerebral and cardiac electrical silence referred to as death by clinicians

1. Underlying Cause - initiates the death / most important entry in death

certificate
2. Immediate Cause - most recent / final condition resulting in death
3. Antecedent Cause - intervening cause of death occurring between
underlying and immediate cause

MANNER OF DEATH
➔ how injury or disease leads to death

A. Natural - caused by disease, Old age

B. Unnatural
⇢ Accidents
⇢ Suicide
⇢ Homicide
⇢ Undetermined
 PRESERVATION OF DEAD BODIES SPECIAL AUTOPSY TECHNIQUES

1. Natural preservation PRIMARY INCISIONS

⇨ Adipocere formation, Mummification 1. I-shaped
2. Y-shaped
2. Artificial preservation 3. Modified Y-shaped
⇨ Embalming - injecting certain fixatives to femoral arteries, neck 4. T-shaped
arteries or aorta
OTHER
● Knee incisions
● Ches-only incision
● Abdomen-only incision

CLASSIC AUTOPSY TECHNIQUES

1. Virchow
⇨ organs are removed one by one

Cranial cavity ⇢ Spinal cord ⇢ Thoracic ⇢ Cervical ⇢ Abdominal

2. Rokitansky
⇨ “In-situ dissection”, in part combined with the removal of organ
blocks

3. Ghon
⇨ “En-bloc removal”
⇨ widely used; removal as organ blocks

4. Letulle
⇨ “En Masse removal”
SAMPLING OF TOXICOLOGICAL MATERIAL IN AUTOPSY
⇨ Thoracic, cervical, abdominal and pelvic organs are removed as one
organ block
1. Urine - NaF Preservative ⇨ recommended for pediatric purposes

2. Blood
■ Central > Cavity THE CONDUCT OF A CLINICAL AUTOPSY
■ Peripheral blood for TCA
■ Consent
3. Vitreous humor - excellent for alcohol & drug analysis
■ The order of nearest kin for consent
4. GIT - establish suicidal intent and to investigate poisoning in intact 1. Surviving legal spouse
2. Adult children
5. CSF - best taken from the cerebral cisterns after the skull has been 3. Adult grandchildren
opened 4. Parent
5. Brother or sister
6. Bile - useful substitute for blood when the analyte of interest is an 6. Nephews and nieces
opiate or alcohol 7. Grandparents
8. Uncles or aunts
7. Solid organs 9. Cousins
■ Liver - most drugs 10. Stepchildren
■ Brain - useful for alcohol determination in the absence of a useful
liquid specimen
■ Lung - accelerant analysis

8. Hair - useful specimen in suspected chronic arsenic poisoning, and

may be useful in the determination of chronic drug abuse

9. Skin - if poisonous substance has been injected, the skin can be

exercised at a radius of 2-4 cm from the injection site