Basics in autopsy

1. INTRODUCTION
AND
PRINCIPLES OF
AUTOPSY
Dr Sreelekshmi KT

2. MEDICOLEGAL
▪ In cases of violent ,suspicious or sudden deaths
▪ Deaths without medical assistance or during surgical procedure
PATHOLOGICAL
▪ Performed to diagnose a particular disease or for research purpose
▪ Aim to determine clarify or confirm medical diagnosis that remained
unknown or unclear prior to the patients death

3. COURTS OF LAW
▪ CIVIL Court
▪ CRIMINAL Court - Supreme court
High court
Sessions court
Juvenile court

4. ▪ Ultimate medical audit
▪ Five different rulings for manner of death: natural, accident,
homicide, suicide, or undetermined
▪ AUTOPSY (NECROPSY)- Postmortem examination of body

5. HISTORY ….
▪ 460–370 B.C. No autopsies yet. Greek physician
Hippocrates reasoned that diseases had natural rather
than supernatural causes.He establishes the humoral
theory
▪ 44 B.C- first recorded autopsy , when Antistius examines
Julius Caesar’s body after his assassination, determining
which of the 23 stab wounds proved fatal.

6. ▪ GALEN(129-201 AD)-Performed dissections on
animals,primates
▪ FREDERICK II (1194-1250)-Authorised human dissection
▪ Karl rokitanski(1804-1878)-Performed more than 30,000
autopsies

7. TECHNIQUE OF R. VIRCHOW
▪ Organs are removed one
by one
▪ Used most widely, often
with some modifications
▪ First step was to expose
the cranial cavity and, from
the back, the spinal cord,
followed by the thoracic,
cervical, and abdominal
organs

8. ADVANTAGE
▪ Quick
▪ Suitable for beginners
DISADVANTAGE
▪ Difficult to evaluate interrelationship between organs

9. TECHNIQUE OF C.
ROKITANSKY
▪ Characterized by in situ
dissection, in part
combined with the removal
of organ blocks
▪ Connections between
organs disturbed as little as
possible

10. ▪ ADVANTAGES
To limit spread of infections such as hepatitis B,HIV (infected
bodies)
▪ DISADVANTAGE
Organs cannot be studied in detail

11. ZENKERS TECHNIQUE
▪ Connection between physiologically related organs were
maintained
▪ Separation may occur only when a closer view of
pathological changes is otherwise not possible or found
technically too difficult

12. TECHNIQUE OF M. LETULLE
▪ Thoracic, cervical,
abdominal,and pelvic
organs are removed as one
organ block (“en masse”
removal) and subsequently
dissected into organ blocks

13. ADVANTAGE
▪ Preservation of connection between organ and organ
system
DISADVANTAGE
▪ Organ mass is awkward to handle

14. OBJECTIVES OF
AUTOPSY
1.BENEFITS TO PHYSICIAN / HEALTH CARE ORGANISATION
▪ Goldstandard for evaluating treatment outcome and therapy
▪ Alert hospital inspections
▪ Decrease hospital and physician malpractise risk
2.BENEFITS TO FAMILY OF DECEASED
▪ Identify hereditary or contagious diseases
▪ Genetic counselling
▪ Determination of insurance benefits or workers compensation

15. 3. BENEFIT TO PUBLIC HEALTH
▪ Detection of contagious diseases
▪ Identification of environmental hazards
▪ Accurate vital statistics
4.BENEFIT TO MEDICAL EDUCATION
5.BENEFIT TO MEDICAL DISCOVERY AND APPLIED CLINICAL
RESEARCH

16. 6.EVALUATION OF TOXIC EFFECTS OF DRUGS,EFFICACY OF NEW
THERAPIES
7.BENEFITS TO LAW ENFORCEMENT AND JURISDICTION

17. TYPES OF AUTOPSY
▪ Immediate autopsy
▪ Needle autopsy
▪ Endoscopic autopsy
▪ Post operative autopsy
▪ Virtual autopsy

18. IMMEDIATE AUTOPSY
▪ For the preservation of cytological detail or growth in tissue
culture
▪ Postmortem interval is very short
▪ FIRST PHASE -modified “Y” incision
mini-incisions

19. NEEDLE AUTOPSIES
▪ Used to obtain tissue samples when , more invasive procedures, as
described under “immediate autopsies,”are not possible.
▪ May be the case in tropical countries if proper infection precautions
cannot be taken
▪ All efforts to obtain permission for a regular autopsy fail but the next of
kin agree to multiple sampling by needle.
▪ Inferior to conventional autopsies

20. ENDOSCOPIC AUTOPSIES
Indications may be the same as those for needle autopsies

21. POSTOPERATIVE
AUTOPSIES▪ Pathologist is rarely familiar with all operative techniques that may have
been used, the complications that were encountered
Following general guidelines should be observed:
1. Most experienced autopsy pathologist should do postoperative cases
1. Surgeon or one surgical assistant who participated in the operation
should attend the autopsy
1. Autopsy technique should be changed as required by the specific
situation

22. VIRTUAL
AUTOPSY(VIRTOPSY)
▪ Employs imaging methods that are also used in clinical medicine such
as
computed tomography (CT), magnetic resonance imaging (MRI), etc
1. Alternative to standard autopsies for broad and systemic
examination of the whole body as it is less time consuming,
2. Aids better diagnosis,
3. Renders respect to religious sentiments

23. THE AUTOPSY ROOM..
▪ Should have at least two mortuary tables preferably of stainless steel
with arrangements for free drainage of a constant flow of water from top
to bottom
▪ A proper vent and duct system needs to be installed for exit of foul
smelling gases and entry of fresh air.
▪ There should be large charts depicting weights and measurements of
viscera, bones etc. for quick reference for autopsy surgeon

24. ▪ The floors should be constructed of materials like granite and walls with
epoxy which facilitate easy cleaning with a slope to a main drain
▪ There should be X-ray view boxes in these rooms for seeing x-ray film
▪ Portable x-ray machine should be available.

26. INSTRUMENTS

28. OTHER MATERIALS
▪ Glass slides
▪ Coplin jar with fixatives for cytology
▪ Spirit lamp/spatula
▪ Culture broth
▪ Swabs
▪ Weighing scales

29. PRELIMINARY EXAMINATION
▪ Identification
▪ Signs of death – Cessation of respiration,heart beat and functional
activity of nervous system
▪ ALGOR MORTIS
▪ LIVOR MORTIS
▪ RIGOR MORTIS

30. ALGOR MORTIS
▪ Progressive chilling of the body
▪ Body becomes cold within 8-17 hours
▪ This may be noted in the uncovered parts of body within 4-5
hours
▪ Immediate surroundings of body and outside temperature
influences

31. LIVOR MORTIS
▪ Postmortem accumulation of blood in the dependant parts
▪ 20-30 minutes after death
▪ Not permanent at first,shifts with change in position of body
▪ After 3-4 hours livor spots become stationary
▪ Pressure points- shoulder girdle,buttocks and heels do not
show livor mortis (supine body)
▪ Lead blue in color
▪ Light red in CO poisoning and cyanide poisoning

32. RIGOR MORTIS
▪ Rigidity or stiffness of muscles
▪ 2-4 hours after death
▪ Head,face ,neck>Thoracic and abdominal muscles>upper
extremity>lower extremity
▪ Completed in 6-8 hours
▪ Disappears after 12-48 hours (jaw and neck>lower extremity)
▪ Early appearance-fever,strychnine/pilocarpine/atropine
poisoning, deaths due to lightning or severe haemorrhage

33. INSPECTION OF BODY
▪ Height /Weight
▪ Chest circumference
▪ Abdominal circumference
▪ Leave indwelling central lines/endotracheal tubes/feeding
tubes/urine catheters to confirm their location
▪ Signs of external injury /laceration/gunshot/strangulation

34. ▪ Edema
▪ Jaundice
▪ Petichae-Blood dyscrasia,asphyxia or septicemia

35. SKIN DISEASES
▪ Sections to be taken from skin lesions and put in 10%
formalin
▪ Bullae in palms and soles in newborns – congenital syphilis
▪ Acute dermatitis,boil around nails may be source of
septicaemia or pyaemia
▪ Chancroid/granuloma inguinale present as ulcers in inguinal
region and genitals
▪ Psoriasis-dry papules covered by fine silvery scales
▪ Lichen planus – shiny violaceous papules

36. ▪ Tattoo marks
▪ Lipomas/angiomas
▪ Keloids
▪ Skin tumors

37. ▪ Lower limb deformities
▪ Clubbing
▪ Eye-artificial eye/petechial haemorrhages/cataract/pupils
▪ Teeth-artificial dentures
▪ Neck- position of trachea,size and consistency of thyroid
gland
▪ Lymph nodes-neck,axilla,inguinal
▪ Caput medusae

38. ODOR
▪ Foul odor-gangrene and putrefaction
▪ Urine odour in lungs-uraemia
▪ Diabetes-Sweet odor
▪ Cyanide and nitrobenzol poisoning- bitter almond smell
▪ Phosphorous poisoning – onion smell

39. OPENING THE BODY
▪ Before opening- A wooden block should be placed under the
lower portion of spinal column
▪ INCISION- Y shaped incision
▪ This incision makes the axillary region and neck organs
easily accessible

42. ▪ Breasts-should be cut from within
ABNORMALITIES OF BREAST
▪ Malformations
▪ Lactating breast
▪ Abscess
▪ Acute mastitis/cysts
▪ Haematoma/fat necrosis
▪ Lipoma/papilloma/carcinoma/sarcoma
▪ Tuberculosis
▪ Fibroadenoma

43. PERITONEAL CAVITY
▪ Inspect peritoneal cavity and omentum
▪ Peritoneal surface – smooth glistening and transparent
▪ Smooth – absence of acute inflammatory exudate
▪ Glistening – normal continuity of lining cells
▪ Transparency – absence of foreign tissue between lining cells and
underlying tissue

44. ▪ Measure and charecterise ascitic fluid
ABNORMALITIES OF PERITONEUM
▪ Ascites
▪ Hemoperitoneum
▪ Inflammation of peritoneum
▪ Foreign bodies /fat necrosis
▪ Congenital anomalies – meckels diverticulum/adhesions/fibrous
strands/mesentry length
▪ Pseudomelanosis

45. CHECKING FOR
PNEUMOTHORAAX
▪ Fill the space between ribs
and thoracic skin flap with
water
▪ Cut through first intercostal
space

46. ▪ Cut cartilaginous portion of the ribs with a rib knife,cut should be
somewhat parallel to the costochondral junctions

47. OPENING
STERNOCLAVICULAR
JOINT

48. PLEURAL CAVITY
▪ Adhesions – torn with ease or difficulty
▪ Inspect thoracic duct
▪ Hydrothorax
▪ Haemorrhage
▪ Pneumothorax
▪ Acute pleuritis
▪ Healed pleuritis
▪ Empyema/TB
▪ Tumors

49. PERICARDIAL CAVITY
▪ Note position of heart and relation to lungs
▪ Open pericardial sac with scissors by cutting a triangular flap
starting from the apex of the heart
▪ Blood culture can be taken
▪ Normally 20-50 cc of fluid present in the pericardial cavity
▪ Dissect thoracic duct by lifting up the right lung and placing it
over the heart

50. ▪ The brachiocephalic,left common carotid and left subclavian
arteries are ligated close to their points of origin and a long
segment of ligature to be exposed

51. REMOVAL OF
ORGANS
FREEING OF RECTUM

52. CUTTING THROUGH
THE LEFT PORTION OF
DIAPHGRAM

53. CUTTING THROUGH
LEFT PORTION OF
DIAPHRAGM

54. REFERENCES
▪ Handbook of autopsy practise , Jurgen Ludwig, 3rd edition
▪ Autopsy diagnosis and techniques ,Otto Saphir ,4th edition
▪ Synopsis of forensic medicine and toxicology, KSN Reddy,29th edition

55. THANK YOU