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External examination at autopsy
The document outlines detailed procedures and definitions related to autopsies, focusing on external examinations, consent requirements, and various postmortem changes such as rigor mortis, livor mortis, and algor mortis. It discusses the importance of clinical details and specific observations relevant to identifying the cause of death. Additionally, it examines various anatomical and physiological conditions observed during an autopsy, including body built, nourishment, and pathological signs.
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External examination at autopsy
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- 2. DEFINITIONS AUTOPSY – seeingfor 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.
- 6. On the fabricof the human body
- 8. On the Seatsand Causes of Diseases
- 14. PRELIMINARIES Consent (hospital administrator (RMO/coroner)and relatives) Identification of body Clinical details
- 15. Should have astatement 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.
- 18. Dictate as follows Autopsyno, 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
- 19. Dictate as follows Rigormortis Livor mortis Algor mortis Post mortem drying Body built Nourishment Edema Cyanosis Skin Nails
- 20. RIGOR MORTIS Rigor istested by trying to lift eyelids, trying to depress the jaw and bending the neck and various joints of the body
- 21. 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
- 22. RIGOR MORTIS Commences inthe 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
- 23. 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
- 24. CADAVERIC SPASM /INSTANTANEOUS RIGOR / CATALEPTIC RIGIDITY
- 25. CADAVERIC SPASM Muscles thatwere 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
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- 27. 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
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- 29. Colour is ashade 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
- 30. Tardieu spots develop inareas of lividity, such as this individual's shoulder area, as decomposing capillaries rupture.
- 31. ALGOR MORTIS Rectal tempfalls @ 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
- 32. POST MORTEM DRYING developswhen 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)
- 33. DRYING Skin is wrinkledand leathery Loosening of hair, apparent lengthning of finger nails due to shrinkage of finger tips
- 34. Body built andnourishment
- 35. BODY BUILT Gigantism –Hereditary/endocrine proportioned/dys Endocrine – Pituitry - d/t excess GH acromegaly, gigantism Hypogonadism – eunuchoid - klienfelter
- 39. 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
- 40. Achondroplasia Upper arms andthigh shorter Trident hand Face disproportionately large Spinal stenosis, kyphosis
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- 44. Spinal deformities Weakness/paralysis of muscleson one side – poliomyelitis, shortening of one lower limb
- 45. NOURISHMENT OBESITY Exogenous – foodintake 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
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- 48. NOURISHMENT CACHEXIA Cancer TB Thyrotoxicosis Addison’s disease Anorexia nervosa Starvation
- 49. EDEMA Generalized and localized Pittingand non pitting (lymphedema/myxedema)
- 50. GENERALISED/ LOCALISED GENERALISED Congestive heartfailure Nephrotic syndrome Hypoproteinemia Cirrhosis LOCALISED Filariasis Post operative Insect bites Vena caval syndromes
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- 53. 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
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- 58. FINGERS – MARFAN’S DUETO MUTATION IN FIBRILLIN I GENE
- 59. 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
- 61. Signs of livercell failure
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- 66. HAIR Loss – debilitatingillness, 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
- 67. Cicatrical alopecia male patternbaldness
- 68. 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
- 69. •Potter's facies. •Parrot-beaked nose.Recessed chin. Epicanthic folds. micrognathia •Low set ears (helices often folded). •Hypertelorism.
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- 71. EYES – POSTMORTEM 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
- 72. EYES Exophthalmos Enophthalmos Cachexia, Horner’s syndrome Cornea– Hyperthyroidism, myopia Ulceration, opacity, Arcus senilis, KayserFleischer ring Sclera – Icterus Blue sclera (osteogenesis imperfecta, marfan’s)
- 74. 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
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- 77. Tongue Geographic tongue –Vitamin B12 deficiency Protuberant tongue – cushing’s
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- 79. LYMPH NODES –NECK, AXILLA AND INGUINAL
- 80. NECK Look for neckveins Prominence indicates RVF
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- 82. CHEST Pectus carinatum akaalar 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
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- 86. 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