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Livor mortis

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  • 1. Literature Review on LIVOR MORTIS Presented by: Astari Mayang A, MD
  • 2. Introduction
    • Post mortem changes
    • Livor mortis
    • Signs of death
    • Determination time of death
    • Extra clues from livor mortis
  • 3. Definitions 1
    • Livor mortis = lividity = postmortem hypostasis
    • Reddish purple to purple coloration
    • In dependent areas
    • Accumulation of blood in small vessels
    • Secondary to gravity
  • 4. Subject
    • Corpse
    • Rarely happens to living human 6
  • 5. Heart stop pumping blood, no pressure differences between vessels, blood fails to move through capillary bed Stagnation GRAVITY Trapped at capillary bed Death P A T H O P H Y S I O L O G Y Blood pooled down Sedimentation of erythrocytes Red purplish coloration + Rigor mortis “ fixed” lividity
  • 6.  
  • 7. Vein supposed to deliver blood back to the heart
  • 8. Diameter of erythrocytes 6-8 µm
  • 9.  
  • 10. Trapped erythrocytes in capillary and venules
  • 11. Fixed lividity packed of erythrocytes trapped in capillaries
  • 12. Timing
    • Actual onset  when heart stop working
    • Visibel onset  20-30 minutes 3,6
    •  2-4 to 6 hours 1,2,7
    • Depends on: 7
    • Quantity of blood intravascular
    • Blood fluidity after death
  • 13.
    • Quantity of 7
    • whole blood (e.g. bleeding)
    • Red blood cells (e.g. anemia)
    • Blood fluidity 7
    • Fibrinolysin  liquefied small clots  blood will fluid enough so gravity can act to pooled them down in small vessels of dependent area
  • 14. Location 1,3,6,7
    • Most dependent area
    • Except the part with local pressure
  • 15. Location 1,3,6,7
    • Primary and secondary hypostasis
    • Hypostasis in internal organs
  • 16. Location 1,3,6,7 : fixed lividity Primary hypostasis Position changes
    • Lividity remain fixed
    • Moved completely
    • Partially relocated
    Secondary hypostasis Western authors: hypostasis shift marked in 12h up to 48h. on 72h had become fixed Asian (India) authors: hypostasis marked in 6-8h and become permanently fixed in 7-13h
  • 17. Colors
    • Reddish purple, purplish blue, bluish red 1,2,6
    • Engorgement of small vessels  rupture  punctate purple-black hemorrhages
  • 18. Influencing factors
    • External temperature
    • Cold (hypothermia, refrigerator) 
    • Brighter pink color
    • General condition before death
    • Affecting quantity of whole blood & red blood cells ( bleeding, anemia )
    • Interfering the action of fibrinolysin ( infection, malnutrition )
  • 19. Influencing factors
    • P oison 2,3,7
    • CN  specific PINK colour
    • CO  CHERRY RED colour
    • Aniline or nitrites  REDDISH BROWN colour
    • Potassium Chlorate  CHOCCOLATE BROWN colour
    • Decomposition
    • autolysis + putrefaction  hemolytic  leaked to extra vascular
  • 20. Microscopic appearance
  • 21. Importance: Sign of death Death Multiple organ failure Cardiovascular system stagnation gravity Blood pool Lividity appears
  • 22. LIVOR MORTIS (+) = DEATH
  • 23. Importance: time of death Reference Onset Maximum Adelson 30 minutes – 4 hours 8-12 hours Polson and Gee 30 minutes – 2 hours 6-12 hours Spitz and Fisher 2-4 hours 8-12 hours Taylor (ed. Simpson) 0 hours 12 hours Taylor (ed. Mant) 1 hours 12 hours Gradwohl (ed. Camps) 20-30 minutes 6-12 hours Glaister - 8-12 hours DiMaio 30 minutes – 2 hours 8-12 hours Sydney Smith 0 hours 12 hours Mant 0 hours 12 hours Gordon and Saphiro Few hours 12 hours Coe and Curran (ed. Curran) 5 Less than an hour 6-12 hours Guharaj and Chandran 7 2-6 hours 6-8 hours
  • 24. Importance: time of death When signs of decomposition occurs 7-13 hours to 3 days 6-12 hours 20 minutes – 6 hours Unable to analize Time range to fixed Time range to maximum Time range start to visibel
  • 25. Importance: position
    • Lividity ~ corpse last position
    • Certain period of time  position changes  don’t match
    • : clue that the body had been moved
  • 26. Practically
    • Pressure to observe shifting  Thumb pressure
    • how long??
    • The difference with bruising/hematomes and congestion
  • 27. TERIMA KASIH