Livor mortis

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Livor mortis

  1. 1. Literature Review on LIVOR MORTIS Presented by: Astari Mayang A, MD
  2. 2. Introduction <ul><li>Post mortem changes </li></ul><ul><li>Livor mortis </li></ul><ul><li>Signs of death </li></ul><ul><li>Determination time of death </li></ul><ul><li>Extra clues from livor mortis </li></ul>
  3. 3. Definitions 1 <ul><li>Livor mortis = lividity = postmortem hypostasis </li></ul><ul><li>Reddish purple to purple coloration </li></ul><ul><li>In dependent areas </li></ul><ul><li>Accumulation of blood in small vessels </li></ul><ul><li>Secondary to gravity </li></ul>
  4. 4. Subject <ul><li>Corpse </li></ul><ul><li>Rarely happens to living human 6 </li></ul>
  5. 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
  7. 8. Diameter of erythrocytes 6-8 µm
  8. 10. Trapped erythrocytes in capillary and venules
  9. 11. Fixed lividity packed of erythrocytes trapped in capillaries
  10. 12. Timing <ul><li>Actual onset  when heart stop working </li></ul><ul><li>Visibel onset  20-30 minutes 3,6 </li></ul><ul><li> 2-4 to 6 hours 1,2,7 </li></ul><ul><li>Depends on: 7 </li></ul><ul><li>Quantity of blood intravascular </li></ul><ul><li>Blood fluidity after death </li></ul>
  11. 13. <ul><li>Quantity of 7 </li></ul><ul><li>whole blood (e.g. bleeding) </li></ul><ul><li>Red blood cells (e.g. anemia) </li></ul><ul><li>Blood fluidity 7 </li></ul><ul><li>Fibrinolysin  liquefied small clots  blood will fluid enough so gravity can act to pooled them down in small vessels of dependent area </li></ul>
  12. 14. Location 1,3,6,7 <ul><li>Most dependent area </li></ul><ul><li>Except the part with local pressure </li></ul>
  13. 15. Location 1,3,6,7 <ul><li>Primary and secondary hypostasis </li></ul><ul><li>Hypostasis in internal organs </li></ul>
  14. 16. Location 1,3,6,7 : fixed lividity Primary hypostasis Position changes <ul><li>Lividity remain fixed </li></ul><ul><li>Moved completely </li></ul><ul><li>Partially relocated </li></ul>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
  15. 17. Colors <ul><li>Reddish purple, purplish blue, bluish red 1,2,6 </li></ul><ul><li>Engorgement of small vessels  rupture  punctate purple-black hemorrhages </li></ul>
  16. 18. Influencing factors <ul><li>External temperature </li></ul><ul><li>Cold (hypothermia, refrigerator)  </li></ul><ul><li>Brighter pink color </li></ul><ul><li>General condition before death </li></ul><ul><li>Affecting quantity of whole blood & red blood cells ( bleeding, anemia ) </li></ul><ul><li>Interfering the action of fibrinolysin ( infection, malnutrition ) </li></ul>
  17. 19. Influencing factors <ul><li>P oison 2,3,7 </li></ul><ul><li>CN  specific PINK colour </li></ul><ul><li>CO  CHERRY RED colour </li></ul><ul><li>Aniline or nitrites  REDDISH BROWN colour </li></ul><ul><li>Potassium Chlorate  CHOCCOLATE BROWN colour </li></ul><ul><li>Decomposition </li></ul><ul><li>autolysis + putrefaction  hemolytic  leaked to extra vascular </li></ul>
  18. 20. Microscopic appearance
  19. 21. Importance: Sign of death Death Multiple organ failure Cardiovascular system stagnation gravity Blood pool Lividity appears
  20. 22. LIVOR MORTIS (+) = DEATH
  21. 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
  22. 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
  23. 25. Importance: position <ul><li>Lividity ~ corpse last position </li></ul><ul><li>Certain period of time  position changes  don’t match </li></ul><ul><li>: clue that the body had been moved </li></ul>
  24. 26. Practically <ul><li>Pressure to observe shifting  Thumb pressure </li></ul><ul><li>how long?? </li></ul><ul><li>The difference with bruising/hematomes and congestion </li></ul>
  25. 27. TERIMA KASIH

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