Autopsy

Bocoboc, Castillo, Miguel, Nalupta, Roldan

  Comprehensive study of a dead body
• External and
 Performed by a trained physician employing

Autopsy
recognized internal
dissection procedure and
techniques examination
 Includes removal of tissues for further
examination

Post-mortem • External
Examination examination

Autopsy
 Cause of
Cause, death (mode), and time of death
manner
Hospital
Correlation
 Evidentiary of or Non-official
clinical
material Autopsy
diagnosis and clinical
 symptoms
Interpretation and correlation of facts and
Medico-legal
Effectiveness
 circumstances ofrelatedortoOfficial
therapy death Autopsy
 Natural
Factual course of diseasemedical
and objective process report for law
 enforcement,
Education prosecution, and defense agencies
 Separating death due to disease from death due

to external cause for protection of the innocent

Kinds of Autopsies
  Whenever required by special laws
 Upon order of a competent court, a mayor and
a provincial or city fiscal
 Upon written request of police authorities
 Whenever the Solicitor General, Provincial or
city fiscal as authorized by existing laws, shall
deem it necessary to disinter and take
possession of the remains for examination to
determine the cause of death
 Whenever the nearest kin shall request in
writing the authorities concerned in order to
ascertain the cause of death

When shall an autopsy be performed on a

dead body?
 Persons authorized to Perform
Autopsies and Dissections

Health officers

Medical officers of law enforcement agencies

Members of the medical staff of accredited hospitals

 Pathological
Autopsy Medico-legal
Autopsy

MINOR OR NON-PATHOLOGICAL
CONCLUSION
EMPHASIS
PURPOSE
REQUIREMENT
Need not be
Summation
Notation ofofmentioned
allabnormal
all abnormal in If the investigator
Must
Emphasis be specific
laid on thinks
for theofit
effect
Confirmation
Must have the of clinical
consent of Correlation
It iswill
thebe law of tissue
that gives the
findingsthe report
irrespective
findings of its purpose
wrongful useful
of
act in the
determining
on the body.
findings
the next kin changes toconsent.
the criminal act.
correlation with clinical administration
whether
Other it is inmay
findings ofonly
the to
relation be
Consent
justice, of relatives
it criminal
must are
be includednot
findings notedthein act
needed. of the
mitigation
criminal responsibility.
 Clinical history of the deceased in most instances
absent, sketchy or doubtful.
 The identity of the deceased is the responsibility of
the forensic pathologist.
 The time of death and the timing of the tissue

injuries must be answered by the forensic

pathologist.
 The forensic pathologist must alert himself of the
possible inconsistencies between the apparent
cause of death and his actual findings in the crime
scene.
 A careful examination of the external surface for
possible trauma including the clothing to
determine the pattern of injuries in relation to the
injurious agent.
 The autopsy report is written in a style that will
make it easier for laymen to read and more clearly
organized insofar as the mechanism of death is
concerned.
 The professional and environmental climate of a
forensic pathologist is with the courts, attorneys
and police who make scrutiny of the findings and
conclusion.
 Manner of Death
 Death by violence
 Accidental death

 Suicides

 Sudden death of persons who are apparently in

good health.
 Death unattended by physician.

 Death in hospitals or clinics (D.O.A.) wherein a

physician was not able to arrive at a clinical
diagnosis as the cause of death
 Death occurring in an unnatural manner.
 Guidelines
Proper
Guided
identity
by the
of purposes
the deceased
of autopsy
autopsied

AComprehensive
dead body mustand
notmust not leave before
be embalmed some parts of the
the autopsy
body
The body must be autopsied in the same condition
whenCareful examination
found at the crime scene

Show respect to the dead body

 Precautions
Permit
Examination
or authorization
must beto
made
perform
in a well-lit
an examination
place

Detailed history of the

No unauthorized previous
person symptoms
should and
be present
condition of deceased to be used as guide
All external findings must be properly described
True identity of the deceased must be ascertained
All steps and findings must be recorded
 Rules in the Examination

Never Weigh
cut and
Look unless measure
you every-
before
know thing that
you exactly can be
cut what weighed
you are or
measured
cutting
 Stages in the Post-mortem Examination
of the Dead Body

Preliminary Examination
External Examination
Surroundings
Internal Examination
Clothing Body surfaces
Identity of the body Position and
approximate time of
death
Advantages of Starting Autopsy on the Head

 Chest or abdomen  blood content of the brain

and the meninges lose its original pattern
 Prevents liable culturing of microorganisms from

the cranial contents

 Manipulation of other blood vessels, specially at

the neck may result in air bubbles' being

artificially drawn into the cerebral vessels,
impairing fair evaluation of air embolism that
might have occurred during life
 Abdominal Chest Wall
FatPubic symphysis
Amount, color, moisture,
Primary incision: Cut the rectus
passing to the left fibrosis
Suprasternal notch Chest Cavity abdominis muscle
of the umbilicus
Musculature Development,
Amount, color,
color, character,
Fluid
thickness,
consistency,
atrophic
purulent changes
or bloody material.
Adhesions Kind, extent, concomitant
Peritoneal Cavitydisease,
Flap the skin at the
Cut the ribs medial Fluid DisarticulateAmount, character,
the Distribution color,
region of the chest from
to the costo- Pleura sterno-clavicular consistency, disease. incision to
Luster, hemorrhage, the primary
chondral junction joint the lateral aspect of the
Mediastinum purulent or bloody
Enlargement material
of thechest exposing the ribs
lymph
Omentum Amountnodes,
of fat, extent,
tumor.
adhesions,
Thymus Weight,
bloodlobulation,
distribution. fatty
degeneration.
Liver Level of the anterior border,
Remove the breast
and begin adhesions,
examining the blood distribution, color,
following: fatty or atrophic changes.
 Thickness of the ventricle Normal:
Weight Normal:
Left — 1.4 cm
 Right
Men — —300
0.4 grams
cm.
Endocardium Ulceration,
 Women vegetation
— 250 grams and
External sclerosis of the
Size, shape, valves, mural
consistency,
Examine its endocardium,
contents,
contraction thrombi,
Remove
or relaxation of the heart
principally the heart
cordae tendinae, trabecule,
Open the the ventricle. by cutting the root
(Normal pericardial
pericardial sac
Epicardium fluid: 5-6 papillary
Adhesions,
cc, muscles. of of
fat,the blood
amountMottling
yellowish)(Tigroid heart) vessels
luster, petechial
Myocardium Color, consistency,
hemorrhages, milky patches
Cavities resistance
Amount oftoblood,
section
blood
infraction,
clots, emboli,sclerosis, fibrosis
dilatation.
Measurement of the orifices edema.
Normal: Examine the heart
Coronary vessels Special attention
 Tricuspid — 12 cm. must be
on the following
made to the anterior
 pulmonary — 8 cm branch
points:
of
 the left —
mitral coronary
10 cm artery,
sclerosis,
 Aorticatheroma,
— 7 cm
embolism.
 External Examination
 Size External Examination
 o Color
Larger o Emphysema,
o Smaller pneumonia, edema
o Grayish-red Cut Surface
o Variation due to age,
o Compression, atelectasis
Color, occupation,
condition of consolidation, amount ofcontent
air and of
fluid
 Shape
exudingchanges Weight
on pressure, air and
bronchi, blood
blood vessels
o Congenital o Abnormal furrows,
o Slaty-black
Remove both o Anthracosis
After examining the
o Acquired changes Normal: increased number of
lungs
o Bluish-red byBronchial
cutting Lymph Nodes
fluid or adhesions
o Atelectasis
the region of the lobes
 Left — 350 gramswithin the chest
Enlargement,
o Light brownish anthracosis, tuberculosis brown
hilus  Right —o400 o Hemosiderin
gramswall,
Pleuritis deformans,
the following points
induration
retractions due to
must be considered
 Air content and fibrosis
in in the lung itself,
the examination
consistency o Formation of cavity or
furrows corresponding
o Marked softness postmortem
to the first rib, partial
decomposition
enlargement
Examine the mediastinum for due to
o Firm consistency o lymph
enlargement of the Consolidation
glands,
localized emphysema,
o Compressibility hemorrhage, Emphysema
inflammatory
change due to adhesions
 Weight conditions and other pathology.
o Increased o Edema, inflammation,
o Decreased congestion, induration
o Emphysema
Kidneys Weight - 120 to 150 grams (left is heavier
than the right)
Liver Weight
Spleen Weight — Very variable, approximately 150
Male
Small Intestine
Pelvis grams. — 1,400
Length,
Pelvic grams;inflammatory
fat,external
stones, appearance, changes.contents,
External
mucosa,Examination
lymphoid - follicles
Perirenaland tissue, size,
Peyer's
Ureter Obstruction,
Female:1,200
External grams dilatation,
(Filipino). inflammatory
shape andExamination
patches, consistency, — thickness
color,
obstruction, Size, Merkel's
color,
and
changes.
consistency, thickness
adherence
External
diverticulum, capsule,ofexternal
ofExamination-
the parasites. the surface
Size, capsule,of
color,
Bladder smoothnessDistention and contents, condition of the
the
Large Intestine cortex,orgranulation,
consistency,
Length, wrinkling
external
sharpness ofcyst,
the the
appearance,
of capsule.
fetal lobulation,
edges,
contents,
rib
mucosa and trigonum, opening of the
condition
markings,
mesocolicof the veins.
Cut ureter. —scars,
Surface glands,
thickness
Resistance epiploicof the
to cutting, appendages,
capsule,
bulging of
cutlobulation,
thickness
surface,granulation.
of the walls,
color, conditionofof the
prominence the
mucosa, corpuscles,
Malphigian inflammation, and ulcerations,
trabeculae,
Cut
Cut Surface-
surface: Resistance to cutting, amount of
condition
consistency of
of the the appendix,
pulp by of parasites
scraping
blood vessels, condition the bilewithduct.sharp
Rectum New growth, hemorrhoid, dysenteric
Gallbladderedge of knife.
Condition
Adhesions, ofdistention,
the cut edgescolor(everted or not).
and consistency
ulcers,
Stomach Distention, fistulae.
shape, contents,
of the bile, condition andcondition
staining of of the
the
Proportionate
mucosa, post-mortem thickness of the cortex and the
mucosa, thickness changes.
and adhesions of the
medulla
walls, concretion, obstruction of the cystic,
hepatic and
(normal — 1.3),
the common
cortical striation,
bile duct. pyramidal
striation.

Abdominal Cavity Examination

 Female
Male
Ovary
Remove the prostate and theCorpus luteum,
seminal vesicle withhydatid
the
cyst, tumor
urinary bladder.
Fallopian
glandstube Distention,
and opening the internal hydrosalpinx,
inguinal ring.
pyosalpinx, hematosalpinx
The testicle and the epididymis is removed by pushing
adhesions
through the inguinal.
Uterus Resting, menstruating,
Note the condition of the testicle, epididymis,
gravid, seminal
involuting, atrophic,
vesicle and tumor
prostate.

Genital Organs
Aorta Sclerosis, atheroma,
syphilis, aneurysm
Veins Thrombosis, phlebitis

Cardiovascular System
Neck Organs
 Remove the larynx, pharynx and tongue including
the tonsils.
 The condition of the lymph glands, obstruction

and edema of the glottis, foreign body and

materials in the larynx and trachea, condition of
the thyroid gland, and condition of the tongue and
tonsils should be noted.
Head
 Note the presence of hemorrhage, bruise,
hematoma and fracture of the skull.
 Note the condition of the meninges.

 Examine the brain for pathological condition,

hemorrhage, laceration, softening, and the base
and side of the cranial box for hemorrhage and
fracture.
 Make several incisions on the brain and study the

injury or disease.
Extremities
 There is no technical incision for the extremities.
 Just open what is deemed necessary and
appropriate for the occasion.
 Mistakes in Autopsy
 Failure to open the thorax under water if one wishes to

 Failure
Opening
Failure
Failure
Error toto
ofuse
on omission tothe an
reportskull
make
collect
in X-Ray before
the for
frontal,
rectal
specimens locating
blood is permitted
a blood
bulletfor
temperature.
oblique
of or to
and
an fragments
drain from
profile
brain of
for
obtain evidence ofthe collection
pneumothorax. of evidence identification
determination
bullet
the superior
if there vena
photographs of
isofany contents
cava.
thedoubt
face. of alcohol
If with
the regardisor
head barbiturates
toopened
their process
before andthe
 Failure to observe changes that
 Failure to tie the great vessels between sites of transection
location.
blood drained from it, blood will ofalmostmay occur
invariably in the
Failure
 Errors or to determine
omission in the the blood
collection group
evidence of the escape
required dead
for
 intensity
Failure
and the
person to
heart and
have
when
ifsubdural
death distribution
byfingerprints
air embolism
violence of
made.
is rigor mortis
suspected.
is associated space,with – before,
external
 into the to
Failure protect and
establishing
the subarachnoidal
bulletthe from
time of death
defacement, and such
such as an
is
 bleeding.
during
Failure and
to after theautopsy.
 observation
Failure
likely
Errors toopen
ortoomission
occur may
have then
if they
the
right
becomplete
aare ventricle
interpreted
handled
collection with of
as
dental
of evidence an
metaltheevidence
heart and
examination
instruments.
required
the
forofother
ante
pulmonary
 Failure
mortem artery in
tocollect
collect situ scrapings
nails if pulmonary and thrombo-embolism
samples of hair is
if
 Failure tohemorrhage.
 Failure
performed. to observeseparate
medico-legalthe ingredients
specimens of blood
examination of the
fromlastthe Rmeal
and
there
 The useis of
suspected. reasonable
hammer chance
and chisel thatfor death
opening resulted
thebody from
skull. A
L
andsides
Errorsits
assault. of the
orlocation
omission inheart in
the
result instances
inalimentary in
the production which
tract. the
of undesirable was
 Failure
hammer toandremove
chiselthe uterus,
should never vagina,
be usedandfor vulva
the en masseI ifa
purpose
recovered in
artifacts water.
or in thefor destruction of fluid
valid evidence
 Failure
rape to search
or abortion is suspected. seminal if thethere isarea
medico
 Failure
legal
to strip autopsy.
the dura Fractures
mater produced by chisel
reasonable chance that thefrom the calvaria
fatal injuriesand base of
occurred
frequently
the skull.toconfused
incident a sexual
Many with
crime.
fractures ante-mortem.
of the skull have been missed
 because
Failure to theexamine
pathologist did not
clothing, skinexpose
and the the superficial
surface of
portion
fracturedof the bullet tract for residue of powder and
bone.
the failure to collect samples of any residue for the
purpose of chemical identification.
Negative Autopsies
 If after all efforts, including gross and microscopic
studies and toxicological analyses, fail to reveal a
cause of death.
 An autopsy where in after a meticulous
examination with the aid of other examinations
does not yield any definite cause of death.
 2 to 10% of the total autopsy cases in medico-legal

centers yield a negative result although

theoretically there must be a cause of death.
Negligent Autopsy
 An autopsy wherein no cause of death is found on
account of imprudence, negligence, lack of skill or
lack of foresight of the examiner
Negligent Autopsy
Failure to have an adequate history or facts and circumstances
surrounding the death

Failure to make a thorough external examination

Inadequate or improper internal examination

Improper histological examination

Lack of toxicological or other laboratory aids

Pathologist Incompetence
Religious Objections to Autopsies
 No place in the Bible, Talmudic or Post-Talmudic
writings where it was said that post-mortem
examination is prohibited.
 According to traditional interpretation, autopsies
and transplantation of organs are permitted for as
long as the descendants gave consent
 No definite statement from the Catholic Church
about prohibition of autopsies
 Autopsies have been encouraged when it appeared that
benefit would accrue from it.
 Nothing in the writings of the Protestant Clergy
that point to prohibition of autopsy