AUTOPSY

 Post Mortem
SYNONYMS:  Necropsy
 Thanatopsy
 Obduction

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 AUTOPSY
INTRODUCTION

It is a medical procedure that consists of a thorough examination

of a dead body to determine the cause & manner of death & to
evaluate any disease or injury that may be present. It is usually
performed by a specialized medical doctor called a pathologist.
 AUTOPSY
Auto --- Self
Opis --- view / Examination
(self examination)

It may be defined as, The detailed scrutiny of both external

surfaces and internal contents of dead body after opening its
cavities including further examination, such as histology,
biochemistry and toxicology of collected material.

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 POST MORTEM

Post Mortem Post------after

Mortem-death

External examination of dead body With out incisions,

fluids can be collected with the help of needle .

e.g.

Blood, bile, Urine 5

 NECROPSY

NECRO-------Dead
OOSY-----Examination/to see

THANATOPSY:(EXAMINATION OF DEAD)

Thanatopsy:Thantose - means death

6
opsy - view or to see
 OBJECTIVES

 To determine the cause of death.

 To confirm or establish the clinical diagnosis
 To evaluate the effects of treatment given during life.
 Performed by a pathologist with consent of relatives
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 CLASSIFICATION
THERE ARE THREE MAIN TYPES OF AUTOPSY

1)Forensic
2)Clinical/academic
3)Coroner’s

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FORENSIC-

 This is done for medical legal purposes.

 No family permission is required to complete this type of

autopsy.

 This is carried out when the cause of death may be a criminal

matter such as accident or burns.
FORENSIC-

Forensic Autopsy is used to determine the cause of death. Deaths

are placed in following manners:

Natural

Accident

Suicide

Homicide

Undetermined
 CLINICAL/ACADEMIC-

 This is usually performed in hospitals for research and study

purposes.
 For a clinical autopsy to take place, cause of death must have
already been established & a death certificate completed.
 To complete this type of autopsy, permission from the
deceased's legal next of kin is required.
 CORONER’S

 This type of autopsy involves cases where no medical cause

of death is readily available.
 Cause, manner and mechanism of death are in question.
 Eventually, the prospectors will identify whether the cases
deserve comprehensive forensic autopsy or at routine
postmortem.
 CORONER’S

 In some jurisdictions, the undetermined category may

include deaths in absentia, such as deaths at sea & missing
persons declared dead in a court of law, in others, such
deaths are classified under "other"
 THE PROCESS :

 The body is received at a examiner's office or hospital in a body

bag or evidence sheet.
 A brand new body bag is used for each body to ensure that only
evidence from that body is contained within the bag.
 Evidence sheets are an alternate way to transport the body.
 An evidence sheet is a sterile sheet in which the body is covered.
PHYSICAL EXAMINATION INVOLVES TWO
PARTS:

 External examination

 Internal examination
PHYSICAL EXAMINATION INVOLVES TWO
PARTS:
EXTERNAL EXAMINATION

 External Examination After the body is received, it is first

photographed.

 The examiner then notes the kinds of clothes & their

position on the body before they are re moved.

 Next, any evidence such as residue, flakes of paint or other

material is collected from the external surfaces of the body.
PHYSICAL EXAMINATION INVOLVES TWO
PARTS:
EXTERNAL EXAMINATION

 Ultraviolet light may also be used to search body surfaces

for any evidence not easily visible to the naked eye.

 Samples of hair, nails are taken, & the body may also be
radiographically imaged.

 Once the external evidence is collected, the body is

removed from the bag, undressed & any wound present are
examined
 PHYSICAL EXAMINATION INVOLVES TWO
PARTS:
EXTERNAL EXAMINATION

 The body is then cleaned, weighed & measured in preparation

for the internal examination.

 The scale used to weight the body is often designed to

accommodate the cart that body is transported on, its weight is
then deducted from the total weights shown to give the weight
of the body.

 If not already within an autopsy room the body is transported to

the table of autopsy room.
 PHYSICAL EXAMINATION INVOLVES TWO
PARTS:
EXTERNAL EXAMINATION

 A general description of the body such as: race, sex, age, hair
color & length, eye color & other distinguishing features (birth-
marks, old scar tissue, moles etc.) is then made.

 A hand held voice recorder or a standard examination form is

normally used to record this information.
 PHYSICAL EXAMINATION INVOLVES TWO
PARTS:
INTERNAL EXAMINATION
 It consists of:

1. Incising the body

2. Inspecting the various organs
3. Examining the cavities systematically
4. Weighing and measuring the organs
5. Checking for any pathology
6. Putting all the organs back in and padding
7. Suturing the body
 INTERNAL EXAMINATION
1.‘I’ shaped Incision: It is a straight line incision extending
from the chin to the symphysis pubis.
2.‘Y’ Shaped Incision: This type of incision starts near the
acromion process and progresses downwards towards the
xiphoid process. The incision is then extended till the
symphysis pubis. Also, a similar incision is made on the
opposite side of the body.
3.Modified ‘Y’ Shaped: 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 passes upwards over the neck, behind the
ear.
 REMOVAL OF ORGANS

1. Virchow’s Technique: Head  Thorax  Abdomen

2. Rokitansky’s Technique: in situ dissection in parts combined

with block removal.
3. Letulle’s Technique: Cervical  Thoracic  Abdominal 
Pelvic Organs  Removed masse and dissected as organ
block.
ORDER OF EXAMINATION

VIRCHOW’S TECHNIQUE 

Head

Thoracic (Cervical)

Abdominal Organs
 HEAD

 The neck is extended by placing a wooden block under

the shoulders

 Fix head using a head rest.

 Intermastoidal incision is made i.e. from the mastoid process

behind one ear to the vertex and again to the mastoid

process of the other ear.

 Scalp flap is reflected forward to the superciliary ridge and

backwards to the occipital protuberance.

 HEAD
 With the help of a saw, ‘V’ shaped cut is made so that the
skull fits back correctly after autopsy.
 This ‘V’ shaped cut passes through: the center of the
forehead  base of the mastoid process  occipital
protuberance  the base of the other mastoid process
and back to the center of the forehead.
BRAIN
 Dura is incised along the lines of the incision of the skull
 folded to the midline  falx cerebri is freed from the
cribriform plate  dura is pulled back.
 4 fingers of the left hand are inserted into the frontal
lobe and the nerves and vessels are cut.
 Tentorium is also cut along the posterior part of the
petrous bone.
 BRAIN
• A knife is then inserted into the occipital foramen and the
cervical cord  cervical nerves and the vertebral arteries are
cut as far as possible.
• With the right hand the cerebellum is grasped and examined.
• Any signs of hemorrhage, injury or any other disease should
be carefully seen.
• Vessels, especially the Circle of Willis, should be checked for any
arteriosclerosis or aneurysm etc.
 SPINAL CORD

 Not examined unless there is an indication.

 In prone position, wooden block is placed under the chest and
the head is bent downwards.

 Mid-line incision from the occipital protuberance to the L4

vertebra is made.
 Muscles are dissected all the way.
 Atlas is disarticulated.
 With the help of a double bladed saw, the laminae are sawed
through the entire length and separated by a chisel.
 SPINAL CORD

 Dura is cut open and checked for hemorrhage, inflammation,

tumors, pus etc.
 Nerves are cut from below as they pass though the spinal
foramina.
 And the cord is separated from the

 foramen magnum.

 Cord is then sectioned transversely and serially.

 Lastly, the vertebral column is examined for any fractures or
dislocations.
 THORAX
 Chest muscles are dissected away.

 Chest is opened by cutting the costal cartilages with the help of a

cartilage knife.

 In case of elderly subjects, the costal cartilage may be calcified,

hence, a bone saw or a rib shear is used to cut it out.

 Thereafter, both the sternoclavicular joints are

 disarticulated and the chest is opened.

HEART

 Held at the apex and lifted Upwards so that the pulmonary vessels,
SVC & IVC and the ascending aorta can be examined.
 The pulmonary artery is palpated and then the vessels are cut
open.
 Pericardium is incised and examine for any blood and fluid.
 Heart, opened in the direction of the blood flow i.e. (Inflow-
outflow method).
HEART

 The enterotome is inserted into the:

 RA  Tricuspid valve  RV  Pulmonary Trunk

 Pulmonary vein  LA  Mitral Valve  LV Ascending aorta.

 Both the auricular appendages are examined for thrombi.
 Heart should eventually be weighed and the various measurements
of the circumference of the valves or the thickness of the
ventricles etc. are taken.
 LUNGS

 Anterior surface is faced upwards  PA is identified and cut as far as

possible using small scissors  check for atherosclerosis, thrombi or
emboli.
 Steps are re-traced via PV  check for thrombi.
 At hilum, a long bladed knife is placed with the blunt end facing
upwards  pierced into the hilum and the knife is turned upwards
so that the sharp end now faces upwards  Sawing motion
hilum is cut.
 LUNGS

 Lungs are mounted on a board or held in the left hand incision is

made from the apex to the base.
 Hence, producing an antero-posterior slice.
 Cut sections are then examined for consolidations, edema,
atelectasis, congestion, emphysema, Tardieu spots, emboli etc.
 LUNGS

 Lungs are mounted on a board or held in the left hand incision is

made from the apex to the base.
 Hence, producing an antero-posterior slice.
 Cut sections are then examined for consolidations, edema,
atelectasis, congestion, emphysema, Tardieu spots, emboli etc.
 NECK
• Identify the esophagus incise it from the posterior aspect up
till the cardiac end of the stomach inspected for capsules,
tablets or powders.
• Larynx, trachea and the bronchi are also cut from the
posterior aspect and checked for foreign
bodies, blood, mucous, tumors, inflammation etc.
• Thyroid is removed and examined.

• The carotid arteries are examined for thrombi, esophagus at

their bifurcation.
• Later, the hyoid bone, cricoid and the thyroid cartilages
are examined.
ABDOMEN
 ABDOMEN

 5 cm above the symphysis pubis the rectus muscles are divided

and a small cut is made.
 Middle and the index fingers are then inserted and spread in a ‘V’
shape.
 Sharp braded knife is inserted between them and the peritoneum is
cut up to the xiphoid process.
 Firstly, inspection is done and if any damage, free fluid, perforations
etc. are seen then these are noted.
 Also, note should be made about the abnormalities, positions,
abdominal organs, adhesions, pathology (if any), injuries etc.
ABDOMEN
 STOMACH
After applying double ligatures, the stomach is opened along the
greater curvature  from the cardiac to the pyloric end size of the
pyloric ring is noted.
Contents are examined for any nature of food which might be
present & its state of digestion, smell, colour, character, the
presence of foreign bodies or any other suspicious matter etc.
Mucous membrane is examined for

congestion, hemorrhage, ulcerations or any other abnormality.

 INTESTINE

• Note the colour, consistency, adhesions, hernia, haem orrhage, serosal

surface etc.
• Small intestine is opened along its line of mesenteric attachments.
• Large intestine is opened along the anterior taenia coli.
• Examined for inflammation, congestion, erosions, perforatio
LIVER
 Either liver is removed by itself or attached to the stomach and
the duodenum.
 It is examined for its weight, size, consistency and for the
presence of any other pathology / injury.
 It is cut along the long axis into 2 cm thick slices.
SPLEEN

 It is removed by itself.

 Size, weight, consistency, capsule condition, rupture injuries or

any pathology is noted.
 This is also sectioned along its long axis and the character
of the septa and the parenchyma are noted.
PANCREASE

 Along the long axis cuts are made at right angles.

 Examined for fat necrosis.
 KIDNEY

 Size and weight are noted.

 Capsules are excised and examined carefully.
 Kidney is sectioned longitudinally the convex border of the
hilum so that it splits into half and opens the pelvis.

 Checked for calculi, inflammation etc.

 Ureter is cut into and examined.
BLADDER

 Incision is made from the fundus and carried to the urethra.

 Wall condition, amount and character of urine is noted.
PROSTATE & TESTES
 Examined for enlargement and malignancies.

 Vertical cross-sections are made through the lateral and

median lobes and the prostate is split open for examination.

 Inguinal canal is incised from the peritoneal aspect and the

loop of the vas deference is pulled to free it from the internal

inguinal ring.
PROSTATE & TESTES
 The testes is pushed with one hand and pulled out of the

scrotum easily by the other.

 These are cut longitudinally and checked for any clotted

blood inside the scrotum and in the testis.

 FEMALE GENITAL ORGAN

 Vagina and the uterus are cut either anteriorly or posteriorly upto the
fundus.
 Two short incisions are made at the fundus from the main incision
towards each cornu so as to expose the endometrium.
 Ovaries are sectioned longitudinally and the fallopian tubes are cut
longitudinally.
 If the uterus contains a fetus, its age should be determined.
STORAGE OF DEAD BODIES

There are two types of storage..

⚫ Long term at -20 0C [for preservation]

⚫ Short term +4 0C [for autopsy purpose]

INSTRUMENTS COMMONLY USED IN AUTOPSY

  Bone forceps
Surgical blade/knife
 Scissors  Skull elevator

 Probe  Brain knife

 Dissecting forceps  Scalpel

 Cartilage knife  Knife

 Rib shears  Measuring jug

 Chisel  Weighing machine

 Hammer  Magnifying lens

 Saw  Trays (steel)

 INSTRUMENTS COMMONLY USED IN AUTOPSY

 Surgical hand gloves

 Sewing material

 Preservatives

 Labeling / sealing material

 RECONSTITUTION OF THE BODY

 After the examination, the body has an open and empty chest
cavity with chest flaps open on both sides, the top of the skull
is missing & the skull flaps are pulled over the face and neck.

 It is unusual to examine the face, arms, hands or legs

internally. All the organs & tissue must be returned to the
body unless permission is given by family to retain any tissue
for further investigation.
 RECONSTITUTION OF THE BODY

 Normally, the internal body cavity is lined with cotton wood

or an appropriate material, the organs are then placed into a
plastic bag to prevent leakage & returned to the body cavity.

 The chest flaps are then closed and sewn back together and
the skull cap is sewed back in place.

 Then the body may be wrapped in a sheet and it is common

for relatives of the deceased not be able to tell the procedure
has been done when the deceased is viewed in a funeral
place after embalming.