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Autopsy

Prof. Meng Xiangzhi

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The types of autopsy
 Clinical autopsy

 Medico-legal autopsy. Its main objective is the

investigation of sudden, suspecious, obscure,


unnatural, litigious or criminal deaths.

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The objectives of forensic autopsy
 To identify the body and to assess the size, physique

and nourishment.
 To determine the cause of death.

 To determine the manner of death (suicide,

homicide or accident) and the time of death, where

necessary and possible.


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 To demonstrate all external and internal

abnormalities, malformations and diseases.


 To detect, describe and measure injuries.

 To obtain samples (blood, urine and tissues) for

microbiological, histological and toxicological


analysis.
 To retain relevant organs and tissues as evidence.

 To obtain photographs and video films for

evidential and teaching use . 4


Examination of the scene
 In homicide, suspected homicide, and other
suspicious or obscure cases, the examiner should
visit the scene of the death before the body is
removed. The function of the examiner at the scene
of death is generally to assess the local
circumstance, the position and the condition of the
body; to observe the distribution of blood stains; to
identify the suspected weapon, compared with the
wound; to pick up physical evidence. 5
Examination of clothes

 The clothes should be examined for damages, blood

stains and other evidence. The contents of the


pocket, documents, keys, and other items all assist
in identification. The style, fabric, colour and labels
of clothes all assist in identification of the
individual.
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 In traumatic deaths, the injuries on the body should

be matched up with damages on the clothes. Tears,


slashes, stab wounds and especially bullet hole in
the clothes must be compared with the position of
external lesions on the body. Blood, seminal,
vaginal and other body secretions may be found on
the bedsheet, underwear, wall or floor of the house.

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External examination

 After identification and removal of any clothes, the

race, sex and age are noted.


 The body length is measured from heel to crown.

 The body weight is measured if facility is available;

if not it should be estimated.

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 The general skin color is noted, especially

hypostasis (livor mortis). Congestion or cyanosis of


the face, hands and feet is noted. Congenital
deformities and acquired external marks (surgical
scars) are recorded.
 Vomit, froth or blood may be present at the mouth

and nostrils. Faeces and urine may have been


voided. Ears are examined for leakage of blood or
cerebrospinal fluid.
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 The degree of rigor mortis is assessed by flexing the

arms and legs to test the resistance. Any abnormal


color of livor mortis should be noted.
 Recent injuries are carefully examined, measured,

described in terms and photographed.


 The eyes must be examined carefully, especially to

detect petechial hemorrhage on the conjunctivae and


sclera. The size of the pupils should be recorded.
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 Examination of mouth may reveal foreign bodies,

drugs, damaged teeth, injured gums and lips, and the


bitten tongue of epilepsy or blows on the jaw.
Dentures should be identified and removed before
autopsy.
 The external genitals required careful examination,

especially for the female.

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Skin incision

1. “I”-shaped incision, is an almost straight line from


chin to pubic symphysis, deviating to avoid the
umbilicus.

2. “Y”-shaped incision. An incision is from the back


of each ear to the manubrium of sternum and
continue downwards to the pubic symphysis.
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3. Improved “Y”-shaped incision begins at a point
close to the acromial process. It extends down below
the breast and across to xiphoid process. A similar
incision is then made on the opposite side of the
body. From the xiphoid process, the incision is
carried downwards to the pubic symphysis.

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 The skin, subcutaneous tissues and fat are flayed off

laterally from the main incision. The tissue are taken


back to the lateral edge of the neck and to the outer
third of the clavicles. Over the thorax, the tissues,
including pectoral muscles, are flayed off to the
midaxillary line in the upper part and even further
posteriorly towards the costal margin.

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 A small puncture should be made in the peritoneum

and a finger inserted to lift abdominal wall away


from the intestines. The knife is then used to cut
outwards along the length of the abdomen, to avoid
penetrating the intestine.
The abdomen is inspected for the blood, pus or liquid

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The test of pneumothorax

 If a pneumothorax has been suspected beforehand,

the chest wall can be punctured in the midaxillary


line after filling the reflected skin with water to
observe if there are bubbles escaping.

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Opening the thorax

 In children and young adults, the costal cartilages

can be cut through with a knife. But in old age


persons, the ribs should be severed with a handsaw.
Then the sternoclavicular joints can be disarticulated
by the knife. The sternoclavicular joint can be
identified by moving the shoulder tip with one hand.
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 When the sternum and medial rib segments are free,

the section is lifted and dissected away from the


mediastinum, keeping the knife close to the bone to
avoid cutting the pericardium.
 The pleural cavities are inspected for adhesion,

effusion, pus and blood. If there is any, it should be


measured and recorded.
Sometimes, the liquid should be taken and sent for lab
. 18
Open the pericardial cavity

 The pericardium is opened in a shape of “Y”, and

the pericardial cavity is examined for liquid. The


blood sample can be drawn from inferior vena cava.

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Removal of the thoracic contents
 The neck structures are then freed by passing a knife

under the skin of the upper neck until it enters the


floor of the mouth. The knife is then run around the
inside of the mandible to free the tongue. The tissue
at the back and sides of the pharynx are cut.

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 Fingers are then inserted from the floor of mouth to

grasp the tongue, which is then drawn down, the


remaining tissues behind the larynx being cut to
release the neck structures.
 The subclavian bundles of vessels and nerves are

severed at the medial ends of the clavicles and first


ribs to release the trachea and oesophagus.

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 With gentle traction, the neck structures are held up

and pulled, whilst carefully cutting all attachments


to the thoracic spine with the knife. The oesophagus,
thoracic aorta and inferior vena cava are severed just
above the diaphragm, so that the neck organs and
thoracic organs can be freed.

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Removal of the heart

 The heart is held up so that its attachment is tensed

against the other organs. A knife is then introduced


at the reflection of the pericardium, cutting through
the root of the aorta and other great vessels just
above the atria.

23
Examining the tongue

 The tongue is cut to examine if there is bleeding or

bitten wound, which is usually present in the


epilepsy patient.

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Examining the esophagus and trachea

 The esophagus is opened from the lower end to the

larynx, looking for tablet, bleeding spot etc. The


trachea and main bronchi are opened to inspect
obstruction or any abnormality.

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Examining the heart
 The heart is washed and then the general size, shape

should be noted. The heart is opened along the


bloodstream. The right atrium is opened by
introducing the scissors into the inferior vena cava
and cutting to the superior vena cava. Then the right
ventricle is opened by cutting along the right edge
of heart, so the tricuspid can be inspected. 26
 The pulmonary artery is opened by cutting from the

cardiac apex to the trunk of pulmonary artery, and


the pulmonary valve can be inspected. The
pulmonary vein is opened to expose the left atrium.
Fingers are introduced down through the mitral
valve to estimate its size and detect any stenosis. A
cut is along the left edge of heart. From the cardiac
apex, along the outflow tract, the scissors are passed
up at the side of the mitral valve, and the aortic
valve opened. 27
 The blood in the heart is washed and the weight of

heart is measured. After weighting, the endocardium


and valves are examined.
 The perimeter of valves and the thick of left

ventricle wall are measured. The interatrial septum


and interventricular septum are inspected against
light for defect.

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 The ostium of left and right coronary artery are

examined for variation and obstruction. Then the


anterior descending branch, right coronary artery
and left circumflex are cut across at frequent
intervals not more than 3mm to observe there is any
thrombus or atheromatous plaque. The cut should be
started as close to the ostium as possible, as
occlusion and serious stenosis can occur very near
the origin.
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Removal of the intestine

 The rectum is identified and cut. Then the colon and

small intestines are stripped out by cutting along the


mesentery near the attachment until the uppermost
part of jejunum is reached.
The intestine is opened along the opposite side of mes

30
Examining the spleen
 The spleen is removed by cutting through its

pedicle. After weighting, it is sliced in its long axis.

31
Examining the stomach, liver, gall bladd

 The liver, stomach, duodenum and pancreas are


removed together. The stomach is opened from the
greater curvature, and the contents in stomach is
measured and collected for toxicological
examination. The biliary tract is examined by
squeezing the gall bladder to see if there is any bile
effusing from the bulb of duodenum. Then the gall
bladder is opened to see if there is gallstone. 32
Examining the kidney

 The kidneys are freed from their hilums and the

perirenal fat is stripped. Then hold the kidney in left


hand and cut it from the cortex border to the hilum,
so as to split in half and open renal pelvis. The renal
pelvis is exmined for stone.

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Drawn the urine

 The urine can be drawn from urinary bladder with

syringe. If it is difficult, open the urinary bladder.

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Removal of the brain

 The scalp is incised from a point behind the ear,

through the posterior vertex, to the corresponding


place on the other side. The scalp and subcutaneous
tissue are reflected respectively forwards to the
lower forehead and back to the occiput. The deep
scalp tissues can be peeled off by traction. If it is
difficult, the knife is needed to free them. 35
 The skull is sawn through, using either hand or

power saw. The calvarium is then removed to


expose the dura. The dura is removed after
inspection. Two fingers slipped beneath each frontal
lobe. With gentle traction, the frontal lobes are lifted
back to expose the optic chiasma and anterior
cranial nerves. Then a scalpel is introduced to cut
the cranial nerves until the free edges of the
tentorium are accessible. 36
 A cut is made along each side of the tentorium.

Pulling brain back, then the remaining posterior


cranial nerves are cut. Finally, the scalpel is inserted
down into the foramen magnum to transect the
spinal cord as far down as it can be reached. The
right hand of examiner is now slid under the base of
the brain, pulling the whole brain out, any attached
dura being severed where necessary.

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The fixation of brain

 The brain is suspended by a thread passed under the

basilar artery and tied to a support across the mouth


of the container, which contains 10 percent buffered
formalin, so that the vertex does not touch the
bottom of container. Because the surface of brain
may be distorted when it touches the bottom.
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