External examination at autopsy

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this is a powerpoint presentation on external examination at autopsy, presented during pg program.. useful for both undergraduate and postgraduate students

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External examination at autopsy

  1. 1. EXTERNAL EXAMINATION AUTOPSY
  2. 2. DEFINITIONS    AUTOPSY – seeing for one self i.e. making a personal inspection Pathological sense – dissection of the dead body to determine, through observation, the cause of death and nature of disease. EXTERNAL EXAMINATION – ritual full of meaning and common sense.
  3. 3. On the fabric of the human body
  4. 4. On the Seats and Causes of Diseases
  5. 5. PRELIMINARIES    Consent (hospital administrator (RMO/coroner) and relatives) Identification of body Clinical details
  6. 6. Should have a statement pertaining to retention of body parts/ organs Get specific permission for an unusual examination (removal of eyes/limbs) even if signed as NO RESTRICTIONS Make sure the case is not medicolegal, like delayed accidents, homicides, deaths after abortions, occupational diseases, suspicious cases of poisoning, deaths on table.
  7. 7. Dictate as follows          Autopsy no, date and time Pathologists Name and designation Patient’s age (look for disparity) and sex State of body (built and nourishment) State any restrictions Final clinical diagnosis Clinical summary Height (crown to heel) Weight
  8. 8. Dictate as follows           Rigor mortis Livor mortis Algor mortis Post mortem drying Body built Nourishment Edema Cyanosis Skin Nails
  9. 9. RIGOR MORTIS Rigor is tested by trying to lift eyelids, trying to depress the jaw and bending the neck and various joints of the body
  10. 10. RIGOR MORTIS      Primary flaccidity (till ATP remains) – rigor – secondary flaccidity Secondary flaccidity due to onset of putrefaction Mechanism (4-8 hrs, 24-48hrs) NYSTEN’S rule – doesnot appear in all muscles simultaneously and both voluntary and involuntary muscles affected Contraction of erector pilae – cutis anserina/goose flesh
  11. 11. RIGOR MORTIS         Commences in the heart (LV-RV-atria) , in sytole Diaphragm Skeletal musculature – first jaw, neck, face, arms, lower extremities, last ankle joint Passes off in the same order Contraction of tracheal muscles causes white dots on mucosa Postmortem intususception Iris – dilatation (postmortem) and then contraction (rigor) Handling causes loss of rigor – patchy distribution
  12. 12. Factors affecting rigor       Age – absent in fetus, early and milder in children and old Early onset, short duration – wasting diseases, strychnine poisoning Late onset – asphyxia, hemorrhage, pneumonia, paralytic diseases Increased duration – CO poisoning Less duration – bacterial infection d/t early putrefaction Environment – cold – late onset, more duration, heat – early onset, less duration
  13. 13. CADAVERIC SPASM / INSTANTANEOUS RIGOR / CATALEPTIC RIGIDITY
  14. 14. CADAVERIC SPASM    Muscles that were contracted during life become rigid immediately after death without passing into a stage of primary relaxation Affects single group of voluntary muscles, frequently hands Sudden death, excitement, severe pain, convulsions, strychnine poisoning
  15. 15. LIVOR MORTIS
  16. 16. LIVOR MORTIS Hypostasis       Mechanism Initially intravascular (can blanch), then extravascular Begins 30 to 45 mins after death in dependent parts, max in 6-12 hrs Can enlarge the extent of subcutaneous hemorrhages, can mimick suboccipital hemorrhage Initially cut on the area of livor shows delicate hemorrhagic dots showing transected congested vessels. Not possible to distinguish from antemortem cyanosis
  17. 17. BLANCHING TEST
  18. 18.       Colour is a shade of blue No livor – hemorrhage, anemia, wasting diseases Red in bodies kept in moist refrigeration – higher affininty for O2 Cherry red – cyanide, CO Methemoglobinemia – smoky green, brown Hydrogen sulfide – black
  19. 19. Tardieu spots develop in areas of lividity, such as this individual's shoulder area, as decomposing capillaries rupture.
  20. 20. ALGOR MORTIS Rectal temp falls @ 1 deg/hr  Also inferior surface of liver/EAC/nasal passages  Time of death = n body tem – rect t / rate of cool  Post mortem caloricity – stroke, convulsions, strychnine poisoning, septicemia 
  21. 21. POST MORTEM DRYING develops when the eyelids are not completely shut, the areas of the sclera exposed to the air dry out, which results in a first yellowish, then brownishblackish band like discoloration zone cholera, wasting dis (Tache noire)
  22. 22. DRYING   Skin is wrinkled and leathery Loosening of hair, apparent lengthning of finger nails due to shrinkage of finger tips
  23. 23. Body built and nourishment
  24. 24. BODY BUILT   Gigantism – Hereditary/endocrine proportioned/dys Endocrine –  Pituitry - d/t excess GH acromegaly, gigantism  Hypogonadism – eunuchoid - klienfelter
  25. 25. BODY BUILT   DWARFISM – hereditary / endocrine perfect/imperfect Hereditary – pygmies (primordial) sporadic (mutation)   achondroplasia Endocrine –  Hypothyroidism – cretinism  Pituitary dwarfism – GH deficiency  Gonadal dwarfism – Turner’s syndrome
  26. 26. Achondroplasia Upper arms and thigh shorter Trident hand Face disproportionately large Spinal stenosis, kyphosis
  27. 27. TURNER SYNDROME
  28. 28. Spinal deformities Old age Chronic emphysema Rickets Osteomalacia Acromegaly Tuberculosis
  29. 29. Spinal deformities Dislocation of hips Ascites Pregnancy Postural weakness
  30. 30. Spinal deformities Weakness/paralysis of muscles on one side – poliomyelitis, shortening of one lower limb
  31. 31. NOURISHMENT   OBESITY Exogenous – food intake   Double chin and abdominal Endogenous - glandular   Cushing’s – truncal – moon face, buffalo hump, protuberant abdomen, thin extremities Hypothyroidism – non pitting myxedema – eyelids, hands and tibia – hyaluronic acid infiltrn
  32. 32. Complications of obesity
  33. 33. NOURISHMENT  CACHEXIA  Cancer  TB  Thyrotoxicosis  Addison’s disease  Anorexia nervosa  Starvation
  34. 34. EDEMA   Generalized and localized Pitting and non pitting (lymphedema/myxedema)
  35. 35. GENERALISED/ LOCALISED  GENERALISED      Congestive heart failure Nephrotic syndrome Hypoproteinemia Cirrhosis LOCALISED     Filariasis Post operative Insect bites Vena caval syndromes
  36. 36. CYANOSIS
  37. 37. CYANOSIS  CENTRAL  Conjunctive, mouth, nose, lips  Pneumonia, chronic bronchitis, fallot’s, shunts as in cirrhosis  Associated with clubbing  PERIPHERAL  Extremities, not associated with clubbing  Localised obstruction to blood flow like raynaud’s, arterial obstruction, varicose veins
  38. 38. Raynaud’s
  39. 39. NAILS
  40. 40. KOILONYCHIA
  41. 41. FINGERS – MARFAN’S DUE TO MUTATION IN FIBRILLIN I GENE
  42. 42. SKIN PIGMENT DISTURBANCES  Hyperpigmentation  Generalised  Jaundice, Addison’s, Hemochromatosis, chronic malaria  Localised   Chloasma, Acanthosis nigricans Hypopigmentation  Albinism, vitiligo  Fungal disease (tinea vericolor, pityriasis alba), leprosy
  43. 43. Signs of liver cell failure
  44. 44. Hemochromatosis
  45. 45. SKIN   Petechiae, ecchymoses Striae
  46. 46. HAIR AND FACE
  47. 47. HAIR     Loss – debilitating illness, malignancy, typhoid, male pattern baldness, alopecia, ringworms, thallium poisoning Female distribution in male – portal cirrhosis, after castration Hirsuitism – Male pattern hair in female – Cushing’s, ovarian tumors Thinning and drying of scalp hair – myxedema
  48. 48. Cicatrical alopecia male pattern baldness
  49. 49. FACE      Hippocratic facies - A pinched expression of the face, with sunken eyes, hollow cheeks and temples, and relaxed lips, observed in one dying after an exhausting illness Moon face – cushing’s Potter facies - oligohydramnios Mask like facies - parkinsonism Leonine facies - lepromatous leprosy
  50. 50. •Potter's facies. •Parrot-beaked nose. Recessed chin. Epicanthic folds. micrognathia •Low set ears (helices often folded). •Hypertelorism.
  51. 51. EYES
  52. 52. EYES – POST MORTEM CHANGES       Loss of corneal reflex – not reliable Opacity of cornea – cholera, wasting diseases Flaccidity of eyeball – sunken Pupils – dilatation then constriction Retina – Kevorkian sign – shunting/tracking of blood due to fall in bp Steady rise in K+ values of vitreous upto 100 hrs
  53. 53. EYES  Exophthalmos   Enophthalmos   Cachexia, Horner’s syndrome Cornea –   Hyperthyroidism, myopia Ulceration, opacity, Arcus senilis, KayserFleischer ring Sclera –   Icterus Blue sclera (osteogenesis imperfecta, marfan’s)
  54. 54.  Horner’s syndrome – due to compression of ipsilateral thoracic /cervical sympathetic chain – miosis, enophthalmos, ptosis and loss of sweating on same side with loss of ciliospinal reflex
  55. 55.  Arcus senilis wilson’s disease
  56. 56. ORIFICES
  57. 57. Tongue   Geographic tongue – Vitamin B12 deficiency Protuberant tongue – cushing’s
  58. 58. THYROID
  59. 59. LYMPH NODES – NECK, AXILLA AND INGUINAL
  60. 60. NECK   Look for neck veins Prominence indicates RVF
  61. 61. BREAST
  62. 62. CHEST  Pectus carinatum aka alar chest   Pigeon Chest   Emphysema, chronic bronchitis Pectus excavatum   Nasopharyngeal obstruction, respiratory disease Barrel Chest   Prominence of vertebral border of sternum Occupational deformity, cobblers Rachitic Chest  Pigeon breast, keel breast, Harrison’s sulci, Verical grooves, Rickety rosary
  63. 63. RIBS
  64. 64. LIVER AND SPLEEN
  65. 65. UMBILICUS
  66. 66. Perinatal autopsy       Weights lung:heart=3:1 Brain : liver = 3:1 Liver:heart = 6:1 Adrenal:thymus:spleen = 1:1:1 OFC=CR Lanugo hair, poorly formed ear cartilage, absent breast buds, undescended testis, rugose scrotum, palmar and plantar creases

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