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AUTOPSY

Reviewer

Joed Ticse, MD

TYPES OF AUTOPSY

COMPLETE / FULL

chest, abdomen, brain, and spinal cord

LIMITED

Limited to 1 organ (liver only, heart only, etc.)

Limited to 1 body cavity (chest only, brain only, etc.)

CONSENT AUTORIZING AUTOPSY

Legal next of kin

Typically in following order

Spouse

Adult daughter or son

Parent

Adult brother or sister

Grandparent

Other relative (cousin, aunt, nephew, etc.)

Friend or person responsible for burial, other affairs

UNIVERSAL

PRECAUTION

Assumes that all autopsies carry a significant risk of transmitting disease, either by aerosols or through the use of sharp instruments.

Mandatory

wear surgical scrubs over which (s)he dons mask

Head protection

Apron

Sleeve covers

Cut-resistant as well as latex (or rubber) gloves.

PEOPLE IN AUTOPSY

PROSECTOR

The one who dissects the cadaver

Pathologist

DIENER

German word which means “servant”

Morgue attendant, autopsy technician

CORONER

One who investigates the cause of death by inquest

EVISCERATION

TECHNIQUES

4 Principal autopsy techniques

1)

R. VIRCHOW

2)

C. ROKITANSKY

3)

A. GHON

4)

M. LETULLE

EVISCERATION

TECHNIQUES

R. VIRCHOW

Most widely used method

Organs are removed one by one

Steps

cranial cavity → the spinal cord → thoracic

organs → cervical organs → abdominal organs

EVISCERATION

TECHNIQUES

C. ROKITANSKY

in situ dissection with little organ block removal

Basic principle: Disturb the connections between organs as little as possible.

If abnormality is found, regions removed intact combination of in situ + en bloc

EVISCERATION

TECHNIQUES

A. GHON / ZENKER

en bloc” (organ block) removal

Organ blocks

thoracic and cervical organs

abdominal organs

urogenital system

Adv:

Preserve impt anatomic relations without unwieldy mass of

organs

Disadv:

Multiple organ system involvement complicates the procedure

Skill necessary to remove each block from the body intact

EVISCERATION

TECHNIQUES

M. LETULLE

en masse” dissection with little organ block removal

thoracic, cervical, abdominal, and pelvic organs are removed as one organ block

Adv:

Complete preservation of relationships among organs

Speed

Organs removed and stored for later dissection

Disadv:

Difficult to handle; require assistant

ADULT AUTOPSY GENERAL SEQUENCE

ADULT AUTOPSY GENERAL SEQUENCE

ESTIMATION OF THE TIME OF DEATH

Livor Mortis (Postmortem Lividity)

After cessation of circulation, the blood drains to the most dependent vessels, and becomes deoxygenated.

3060 min after death

faint pink erythema of the dependent skin

surfaces

1 12 h after death

distinct purple appearance of blood develops on

the dependent surfaces due tovgravity

1224 h after death

livor can be blanched by pressing a finger or

instrument against the skin surface

Usually absent at pressure points, such as the skin over

the scapulae and buttocks in a supine body.

ESTIMATION OF THE TIME OF DEATH

Rigor Mortis (Postmortem Rigidity)

Muscle stiffness secondary to low-energy state (ATP)

Ordinarily makes its first appearance 24 h after death.

Becomes fully developed in roughly 410 h

Hastened by high ambient temperatures

Delayed by cold ambient temperatures.

Rigor begins to fade simultaneously with the onset of putrefaction.

ESTIMATION OF THE TIME OF DEATH

Algor Mortis (Postmortem Cooling)

Rate of cooling

Dependent on

temp gradient bet the body and the environment

body mass in relation to its surface area;

rate at which air or water moves across the body surfaces

Insulation (shelter, clothing, and adipose deposits)

ds

DISSECTION OF CORONARY ARTERIES

Longitudinally

< 30 years old, non-cardiac death

Cross-section at 35 mm intervals

> 30 years old, non-cardiac death

Any age, cardiac death

DISSECTION METHODS OF THE HEART

INFLOW-OUTFLOW METHOD OF CARDIAC DISSECTION

suitable primarily for normal hearts

atrium is opened first

then the ventricle is opened along its inflow and

outflow tracts, following the direction of blood flow

SHORT-AXIS METHOD OF CARDIAC

DISSECTION

method of choice not only for the evaluation of IHD

and virtually any other cardiac condition

slices expose the largest surface area of myocardium

Retention of Records & Materials

Wet stock tissue

3 yrs

Wet tissue of whole organs

3 mos

Paraffin blocks

20 yrs

Reports

indefinitely

Slides

indefinitely

Gross photographs

indefinitely

Retention of Records & Materials

Accession log records

indefinitely

Serum/CSF/urine

2

yrs

Whole blood

6

mos

Dried blood stain orf rozen tissue

 

for DNA

indefinitely

Frozen tissue for tox

6

mos

PRELIMENARY AUTOPSY REPORT

First autopsy report to

be sent to the clinician

Comprises the gross autopsy diagnoses arranged in two lists

Major Diagnoses

Additional Diagnoses.

It should be issued

within 24 hours of the initial dissection

The following should head the report:

Name, age, medical

record number and

autopsy number

Date of admission (if

admitted).

Date and time of death.

Date and time of

autopsy.

Name of clinician(s) to

which the report will be

sent.

Restrictions (if any).

FINAL AUTOPSY REPORT

CLINICAL SUMMARY

GROSS AND MICROSCOPIC DESCRIPTION

LIST OF FINAL DIAGNOSES CASE DISCUSSION

DEATH CERTIFICATE

Civil Registry Law-Act No. 3753

approved on November 26, 1930 and took effect on February 27, 1931.

mandates the registration of all facts and acts concerning

the civil status of persons from birth to death

The Philippine Statistical Act - Republic Act No.

10625

Article 6 (e) of RA 10625 mandates the Philippine Statistics Authority (PSA) to carry out, enforce, and administer civil registration functions in the country

DEATH CERTIFICATE

Who is Responsible in Reporting the Event and Preparing the Certificate of Death/Certificate of Fetal Death (COD/COFD)?

For Death that Occurred in the Hospital

Physician who last attended the deceased or the

administrator of the hospital or clinic where the person died. Certificate is forwarded, within 48 hours after death, to the local health officer

DEATH CERTIFICATE

Who is Responsible in Reporting the Event and Preparing the Certificate of Death/Certificate of Fetal Death (COD/COFD)?

For Death in Hospital Emergency Room (ER)

Deaths of patients occurring in the ER regardless

of the time of stay in ER, including patients who were revived by initial but eventually died there

COD shall be accomplished by the ER Officer if he can provide a definite diagnosis.

Otherwise, the death should be referred to the

medico-legal officer of the hospital or the local

health officer

DEATH CERTIFICATE

Who is Responsible in Reporting the Event and Preparing the Certificate of Death/Certificate of Fetal Death (COD/COFD)?

For Death that Occurred in the Ambulance attending physician during the transport of the

patient shall accomplish the Certificate of Death.

DEATH CERTIFICATE

Who is Responsible in Reporting the Event and Preparing the Certificate of Death/Certificate of Fetal Death (COD/COFD)?

For Death that Occurred Outside the Hospital

The local health officer is the one who will prepare

and certify the COD/COFD

In the absence of the local health officer the death should be reported to the mayor, or to any member of the Sangguniang Bayan, or to the

municipal secretary who shall issue the

Certificate of Death for burial purposes.

DEATH CERTIFICATE

Underlying cause of death

disease or injury which initiated the train of morbid events

leading to death, or the circumstances of the accident or violence which produced the fatal injury.

most important entry in the certificate since mortality

statistics is based on this underlying cause.

All certification of death must include an underlying cause.

Immediate cause

The most recent condition written on top line of the certificate that directly leads to death is the.

Antecedent cause

Other intervening cause (or causes) of death occurring

between the underlying and immediate causes.

there can be one, or more than one reported antecedent cause of death.

It is even possible not to have intervening cause at all if only

one line (immediate cause) or two lines (immediate and underlying cause) are filled out.

ACUTE MYOCARDIAL INFARCTION

ACUTE MYOCARDIAL INFARCTION

PULMONARY

THROMBOEMBOLISM

PULMONARY THROMBOEMBOLISM

AORTIC DISSECTION

AORTIC DISSECTION

ABDOMINAL AORTIC ANEURYSM

ABDOMINAL AORTIC ANEURYSM

HEPATIC HEMORRHAGE

HEPATIC HEMORRHAGE

HEMORRHAGIC

PANCREATITIS

HEMORRHAGIC PANCREATITIS

STROKE

STROKE