Post mortem examination

( autopsy )
• Autopsy :
“ It means the examination of the organs
of the dead body to determine the cause
of death or pathological conditions.”
• Types :
1.clinical
2.medicolegal
• Clinical autopsy:
- cause of death is known
- to confirm the diagnosis, discover the
extent of lesions , for academic interest,
teaching and research purposes.
• Medico-legal autopsy:
-to identify the dead body
-cause of death
-nature and no. of injuries
-time since death
-presence of poison
 Medicolegal autopsies;
• Are taken on :
-victim of unnatural death
-mutilated bodies or fragments
-skeleton or isolated bone
 Pre requisities:
• Mortuary
• Inquest report
• Challan
• Identification
• Day light
• Good ventilation
• Sufficient water supply
• Drainage
• Instruments
• Disinfectants
 Rules :
• Should be conducted in the mortuary
• Undertaken only after receiving inquest report
and challan
• Soon as possible
• Should be identified by police constable
• Conducted in a day light
• MO should 1st read inquest report
• No unauthorised person should be present
• Examination should be external and internal
 Examination proper:
• General description of the body
• Dress and other wearing materials
• Examination of the dead body:
-external :
length, weight, complexion,
scalp hair
beard ,moustache
vermilion mark
tattoo marks, moles scars, deformities
eyes
• Mouth and nostrils
• Tongue
• Cynosis
• Pm staining
• Blood mud
• State and distribution of rigor mortis
• Cadaveric spasm,
• Any foreign body any where in the body
• Maggots
• Cond of prepuce
• Female breast
• Discharge per vagina
• Any injury
• Any suspected stain
• Ligature marks
 Internal examination :
• Opening of the dead body:
 Incisions :
• 1. Head :
incision :
-transverse incision along the head from
ear to ear.
-scalp reflected anteriorly upto the orbits
and posteriorly upto the external occipital
protuberance.
-circular cut around the cranium keeping
close to the reflected cap.
• 2. neck , thorax and abdomen:
3 types :
i. I – shaped
ii. Y – shaped
iii. Modified Y shaped
• i) I shaped incision :
chin straight down to the symphysis pubis,
passing either to the left or right of the umbilicus.
• ii) Y shaped incision :
- two similar incisions begin at a point close to
the acromial process of each clavicle.
- extend down below the breast to the xiphoid
process where they unite.
- from xiphoid process it is carried down to the
symphysis pubis.
• iii) Modified Y shaped incision :
- an incision is made in midline from
suprasternal notch to the symphysis pubis.
- incision extends from the suprasternal
notch over the clavicle to its centre on
both sides and then passed upwards over
the neck behind the ear.
 #neck :
• Examine the superficial and deep t/s
• Knife is passed around inner side of the
lower jaw
• Separate the attachment of tongue, pull
down in to the opening
• It is reflected together with the pharynx,
larynx, trachea and esophagus from the
posterior wall.
 # thorax :
• Cavity of the thorax opened by dividing the
ribs at their cartilages and sternum at
sterno-clavicular junctions,& lifting up the
sternum
• Diaphragm is divided at its attachment to
lower ribs and sternum.
• costotome
 # abdomen :
• Muscles are divided 5 cm above the
symphysis.
• Small cut is made in the peritoneum ,big
enough to admit left index and middle
fingers , w/c are used to shield underlying
structures.
• The peritoneum are cut up to xiphoid.
 To remove the visceras :
• 1. Stomach :
-1st taken out
-2 ligatures at the cardiac end and 2 ligatures at the pyloric end
- cut between the 2 ligatures
- remove the stomach
- open along the lesser curvature
- examine wall of the stomach
- contents
- weight stomach and its contents seperately
- stitch the stomach with the contents inside
- keep for preservation
• Liver :
-remove the liver
-note any injury or pathology
-weight the liver
-part of the liver should be taken out for
preservation
• Kidneys :
- along with adrenal glands
- tie the ureter along with the vessels
- remove the kidney
- adrenal glands seperated
- dissect the kidney transversely
- preserve
• Urinary bladder :
-may be examined in situ
-syringe out the urine
-open the bladder
-examine
• Ureters :
-open along its long axis
-examine
• Spleen :
-take out the spleen
-examine
• Intestines :
-coils of the intestines are pulled forward
-ligature tied round the lower portion of the
rectum.
-rectum is divided below the ligature
-whole of the intestines are removed from
the abdominal cavity.
-examine
• Pancreas and adrenal glands :
examine
• Uterus :
- 1st examination in situ
- remove along with vagina
- examine
• Heart :
-apply double ligature at the base of the
heart over each large vessels
- divide in between them
- note size , weight of the heart
- condition of valves
-coronary vessels
-preserve for suspected pathology
• Lungs :
-separate both lungs after tying the vessels
and the bronchioles
-note conditions of pleura
-examine lungs
-preserve t/s
• Head :
-note any injury to the dura & extra dural haemorrhage
-criss cross incision over the dura and remove
- examine
- dissect out the brain
- keep it in a tray
-examine the circle of willis before dissecting the
substances of brain.
-dissect the cerebrum then cerebellum – 1st longitudinally
then transversely.
-examine
• Others :
spinal cord
scrotal sac
limbs
 Preservation of viscera:
• In case of suspected poisoning: (dead )
-stomach and its contents
-upper part of small intestine ( 30 cms )
and its contents
-a part of liver ( < than 1 lb)
-half of each kidney
• Preserve in :
rectified spirit
• In case of :
carbolic acid
alcohol
phosphorus
paraldehyde
acetic acid
# preserve in saturated solution of common
salt
• Living :
-vomite(300ml)
-stomach wash
-urine(> than 100 ml)
-faeces
-blood
-saliva
 Preservation of other parts :
• Heart :
nux vomica
strychnine
digitalis
• Brain :
strychnine
OP
• Spinal cord:
strychnine
• Lungs :
CO,coal,gas,alcohol
• End of long bones :
cocaine,barbiturates
• Scalp hair
chronic poisoning by minerals
• Bile :
cocaine
barbiturates
neurotics
 Instructions during preservation :
• Cut visceras into small pieces
• Should reach 2/3rd height of the bottle
• Well fitted covers,
• Label name, PM date, no, etc
• Sample of preservatives in another small bottle
• Hand it over to the police, or personally deliver it
to the office of the chemical examiner
• DON’T FORGET TO TAKE RECEIPT!!
 PM examination of the mutilated
bodies:
• Mutilated bodies:
“ Mutilated bodies are those which are
extensively disfigured or are deprived of a
limb or a part ,but the muscles , t/s and
skin are attached to the bones.”
eg. Head, trunk, limbs etc.
 ??? See for:
• Source :
human or animal
-easy if head,trunk or limbs are
available
-pieces of muscles are available then??
-precipitin test
-antiglobulin inhibition test
• Part belongs to same individual ?
-fitting together of all the parts
-color of the skin
• Age :
general development
skull
teeth
ossification of bones
• Sex:
characters of pelvis, sacrum ,femur
prostate,uterus
• Stature :
measure long bones
• Identity :
finger prints, tattoo marks, scars, hair,
teeth .
• Time since death :
condition of the part
• Cause of death :
# bones
burning
 PM examination of decomposed
body :
• Look for :
-Identification :
remnants of genitals
bones
tattoo marks
ornaments
-time since death
progressive changes in the body
-cause of death
abortion
bullets
 Reconstruction of the body after
PM examination :
• Sympathy/ skill/ practice!!!
• Sponge out the body cavities
• Plugged the pelvis with cotton wool or
paper
• Wash the organ in water dry it and replace
them in body cavities
• Place thin layers of paper or cotton wool
over it
• Dry the cranial cavity replace the brain in
the cranial cavity wrapped in a dry cloth
• Fit the skull , ant. And post. Flaps of the scalp
are brought together and sutured
• All other autopsy incisions were stitched
together
• After the stitching is complete:
wash the body with running water,dry it
keep it in trolley, ctothed, hair dried and combed,
dentures cleaned,
• Face is made to look as natural as possible.
• ???