MLS 117: HISTOPATHOLOGY 5.

Educating students and physicians

AUTOPSY
WHO PEFORMS THE AUTOPSY?
AUTOPSY
 Presidential Decree 856, Sec. 95
Definition:
 Persons authorized to perform autopsy:
 Greek autopsia act of seeing with one's own eyes, from
1. Health Officers
aut- + opsis sight, appearance — more at optic
2. Medical Officers of law enforcement agencies
 First known use: 1678
3. Members of the Medical Staff of accredited hospitals
 an examination of the body after death usually with such
4. Forensic Pathologist – Expert witness
dissection as will expose the vital organs for determining
5. Pathologist resident – Fact Witness
the cause of death or the character and extent of changes
6. Medical examiner
produced by disease
7. Coroner
 also called necropsy, postmortem, postmortem
examination
 scientific postmortem examination of a dead body, CONSENT
performed to reveal the presence of pathologic processes,
CONSENT (OR REFUSAL) - in order of legal authority
their relation to clinical phenomena and history, and to
1. The surviving SPOUSE not legally separated or whose
determine the cause or causes of the changes encountered
marriage has not been annulled.
2. The ELDEST SON or DAUGHTER of legal age, unless
MEDICOLEGAL AUTOPSY mentally unfit or mentally retarded or legally disqualified.
3. Either PARENT unless legally disqualified by law.
 a specialized type of autopsy authorized or ordered by
4. BROTHER or SISTER of legal age, unless legally
proper legal authorities in cases of accidental, suicidal,
disqualified by law.
homicidal, unattended, or unexpected deaths
5. The LEGAL GUARDIAN or CUSTODIAN of the
 purpose: determining the cause and manner of death in
decedent at the time of death.
order to protect the society and insure the administration
of justice
 For autopsies of newborn infants, the MOTHER signs
the consent. In case wherein the mother is unfit, refer to
CATEGORIES OF DEATH previous section.
1. Natural  In cases wherein either parent is unfit and/or no legal
2. Accident guardian or custodian, the PROVINCIAL OR CITY
3. Homicide FISCAL signs the consent form for the autopsy
4. Suicide
5. Undetermined
AUTOPSY PROCEDURE
TYPES OF AUTOPSY  ULTIMATE PHYSICAL EXAMINATION
1. Complete evaluation of the medical history and events
1. Forensic/ Medicolegal / Official leading to death
2. Hospital/ Clinical/ Non-official 2. Collection and documentation of trace evidence on
and around the body
3. Photographing and cataloging of injuries
FORENSIC AUTOPSY 4. Detailed external examination from head to toe
PURPOSE: 5. An internal examination, including the dissection of
1. Determining the cause, manner and time of death organs and tissues
2. Recovering, identifying and preserving evidentiary material 6. Microscopic examination of organs and tissues
3. Providing interpretation and correlation of facts and 7. Laboratory and toxicologic examinations of body
circumstance related to death tissues and fluids
4. Providing a factual, objective medical report for law 8. A written report detailing the pertinent findings,
enforcement, prosecution and defense agencies negative findings and conclusions, including the cause
5. Separating death due to disease from death due to external and manner of death
cause for the protection of the innocent.
GENERAL PRECAUTIONS
1. Universal precautions should be observed in all cases.
HOSPITAL AUTOPSY
2. Use disposable cap, mask, goggles, apron, shoe covers, and
gloves.
PURPOSE:
3. Do not dispose of items contaminated with blood, body
1. Determining the cause of death fluids, etc., outside the autopsy room.
2. Providing correlation of clinical diagnosis and clinical 4. Observe safety precautions.
symptoms 5. Avoid contaminating clean areas with dirty gloves.
3. Determining the effectiveness of therapy 6. Observe gloves frequently for tears, change when
4. Studying the natural course of disease process necessary.

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 7. Do not leave the autopsy room with disposables. 1. Traumatic injuries, both old and new
2. Natural disease processes (e.g. tumors / atherosclerosis /
 The following protective clothing should be worn when etc.)
performing an autopsy: 3. Congenital defects or deformities
1. Cover-all 4. Toxicologic, thermal (burns) and chemical injuries
2. Apron 5. Trace evidence
3. Cap 6. Infectious disease process
4. Mask 7. Anything abnormal, unusual or unexpected
5. Gloves
6. Shoe covers EXTERNAL EXAMINATION
7. Goggles or other protective eyewear
1. Artifacts of medical intervention
FOUR SIGNS OF DEATH 2. Blunt force injuries
3. Sharp force injuries
1. RIGOR MORTIS 4. Specific Body areas
→ temporary stiffening of muscles
after death ARTIFACTS OF MEDICAL INTERVENTION
→ muscle proteins (actin and
myosin) lock together making the 1. IV lines
muscles stiff 2. Electrocardiogram (ECG) pads
→ starts within 30 minutes to 1 hour  3. Cricothyroidotomy
full rigor mortis 10 to 12 hours  continues 24 to 36 4. Surgery
hours until decomposition starts to loosen 5. Bandages
the muscles 6. Sutures
2. ALGOR MORTIS 7. Arterial and large venous lines
→ cooling of body temperature after 8. Defibrillators
death BLUNT FORCE INJURIES
3. LIVOR MORTIS
→ gravity-dependent settling of blood 1. Laceration
into the blood vessels and soft 2. Abrasion
tissues after death 3. Contusion
→ when blood is no longer pumped 4. Avulsion
by theSHARP
heart, it follows
FORCE the INJURIES
force
of gravity and pools in the
dependent areas of the body 1. Stab wounds
2. Incised wounds
4.DECOMPOSITION 3. Defense wounds
→ Late advancement of postmortem tissue breakdown 4. Puncture wounds
→ enzymes from the dying cells begin the autolysis process 5. Chopping wounds
→ bacteria mu 6. Gunshot wounds
→ skin becomes
SPECIFIC discolored
BODYpurplish-green,
AREAS might blister and
slip
→ venous marbling - blood in vessels staining the soft tissue • overall “gestalt” • chest
• skin • breast
→ hair begins to slip
• hair • abdomen
→ odor from formation of gas is putrid and unmistakable
• scalp • extremities, hands,
→ gas bloating - remarkable when a body in water is removed • face fingers, nails
→ insects, carnivore and other invaders • eyes • back
• nose • genitalia
\ • mouth • rectum/ anus
IDENTIFICATION
• neck
POSITIVE PRESUMPTIVE
IDENTIFICATION IDENTIFICATION
1. Visual 1. Skeletal Remains INTERNAL EXAMINATION
2. Fingerprints 2. Clothing • Heart • Body walls
3. Dental 3. X-rays • Chest cavity and • Aorta and its
4. X-rays 4. Physical Features mediastinum branches
5. DNA Fingerprinting 5. Circumstances • Lungs and lung • Kidneys and adrenals
hilum • Bladder
surrounding death
• Liver and gallbladder • Prostate
• Spleen • Uterus and ovaries
• Stomach and • Neck organs (thyroid
esophagus gland/ larynx)
• Small and large • Vertebral column
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 intestines • Skull
• Bowel mesentery • Brain and meninges
• Peritoneal cavity

Opening the Pericardium

ORGAN AND TISSUE REMOVAL
VIRCHOW AUTOPSY
METHOD
 The organs are removed
one after another in an
organized and logical
fashion
GOHN/ LETULLE/
MODIFIED ROKITANSKY
METHOD
 Organs are removed en
bloc
 Allows internal viscera
to be examined while they
are still connected together
 Useful when examining
infants with multiple cardiac
and other birth defects

Survey of Chest Tissues and Organs

Hyperinflated lungs (status

asthmaticus)

Metastatic Carcinoma

HEMOPERICARDIUM

Adhesion

Pleural Scar

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INDIVIDUAL ORGAN EXAMINATION
 Examine and observe the diseases or injuries of each
organ or tissue in a systematic, complete fashion.
 Make diagnosis and form opinions about the etiologies of
the diseases or injuries. This is done be examining the gross
organ on the day of the autopsy and then looking at
microscopic sections of the organ or tissue at a later date
 Describe the diseases, disorders, or injuries, and make a
record of these observations. This allows other experts to
review the report and to draw independent conclusion about
the data provided
 Document pertinent diseases or injuries using photography
or other media.
 Preserve pertinent tissues either in a fixative or paraffin,
so that additional studies can be performed later.
FETAL / NEWBORN AUTOPSY
AUTOPSY REPORT
 Paragraph 1. Brief clinical history up to the time of the
patient's last admission (includes the reason that the patient
was admitted).
 Paragraph 2. Hospital course on the patient's last admission.
This paragraph should include findings that relate to his cause
of death and to the autopsy findings. Special attention should
be focused on the clinical events occurring in the last few
days before death (excluding details of resuscitative
efforts). This paragraph should contain the clinician's
working diagnoses for the patient's chief medical problems.
 Paragraph 3. Autopsy findings, combining gross and clinical
observations. Include only findings that relate to the patient's
death or that have some intrinsic interest (i.e., exclude
incidental cholelithiasis, diverticula, atherosclerosis, etc.,
unless they are clinically relevant).
 Paragraph 4. Clinicopathologic correlations. Describe where
the autopsy findings and clinical diagnoses converge or
diverge. Give particular attention to findings not diagnosed
clinically.
 Paragraph 5. Summarize findings and state, if possible, the
primary and final cause of death (e.g., lung cancer is primary
cause; respiratory insufficiency is the final cause of death).

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