The Medicolegal Autopsy
Sub-topics:
1)Introduction
2)Natural and unnatural death
3)Cause , manner and mechanism of death
4)The Pre-autopsy Requirements
5)The External Examination
6)The Internal Examination: Abdominal organs
7) The Internal Examination: Chest Organs
8) The Internal Examination: Head and Neck
9)The Possible Ancillary Investigations
10)The Autopsy Report
Introduction
An autopsy is a surgical procedure that consists of a examination of a corpse by dissection to determine the cause, mode, and manner of death or to evaluate any disease or injury that may be present for research or educational purposes. The term is derived from Greek meaning “looking for one’s self”.
A medicolegal autopsy is a special type of autopsy or postmortem examination, ordered by the government/legal authorities in all mysterious unnatural deaths, such as homicide, suicide, accident, etc. The purpose of autopsy is to find out the cause of the death by putting all the findings in a logical sequence of events that could have occurred.
Natural and Unnatural Deaths
The death resulting from an illness or an internal malfunction of the body not directly caused by external forces, other than infectious disease is known as natural deaths. This also refers to death due to old age opposed to accident or violence.
The deaths resulting from an external causes like homicides, suicides, accidents, medical errors, drug overdoses ,murders, etc are unnatural deaths.
Cause, Manner and Mechanism of Death
Mechanism of death: This is the proximate cause of death (physiological derangement in the body that is incompatible to life). The mechanism of death is the process by which an organ or organ system fails when there is fatal disease, injury, chemical insult. For eg. Brain ischemia is the mechanism of death due to brain tumors.
Cause of death: Cause of death initiates the mechanism of death. Eg: Shock is the cause of death that will lead to brain ischemia (mechanism of death).
Manner of death: It is the way which the cause of death arises. It may be documented as natural ,homicidal, suicidal, accidental or undetermined.
The Pre-autopsy Requirements
Avoid unnecessary delay in performing.
Do not allow unauthorised person into the mortuary.
Autopsy should be done in daylight.
Authorization for conducting medico legal autopsy
A inquest letter from the police asking the medical officer to carry out the autopsy and authorizing him to collect any material from the body for further investigations
Authorized mortuary
The External Examination
Hair color and length, eye color and pupillary diameter and presence or absence of ocular abnormlies, particularly bulbar or conjuctival petechiae, must be noted. The measured body_ length and the body weight ,should also be noted. If clothing is present, 1t should be described as that may serve as an evidence. This also includes examination of kind of clothes , position of body before they were removed. Any evidence such as residue, flakes of paint or other material is collected from the external surfaces of the body. Further examination of stains of mud, blood, urine, stool, etc; identity; body orifices; finger/toe-nails; injuries/surgical intervention; rigor mortis ; postmortem staining; decomposition/other changes are taken into account.
The Internal Examination: Abdominal organs
The internal examination consists of inspecting the internal organs of the body by dissection for evidence of trauma or other indications of the cause of death.
Several types of incisions are there: I-shaped incision ,Y-shaped incision , Modified Y-shaped incision , Elongated X-shaped incision
Stomach content , the gastric mucosa ,the duodenal mucosa are looked into. Vermiform appendix and the intestines and its contents are examined. The liver and its consistency , the gallbladder and its content( any stones) are examined. The pancreas and its architecture is examined as well.The spleen architecture should be examined and any lymphadenopathy should be noted .
The Internal Examination: Chest Organs
First it is examined whether the heart appears of normal size, weight, and configuration and has smooth, glistening epicardium or not. Then coronary arteries are examined (number and distribution) and if atherosclerosis is present or absent. Cardiac chambers are looked into whether the myocardium is free from focal lesions or not and the valves and chordae tendineae intact and normally formed or not. Consistency of lungs are examined too. Anthracosis or other pneumoconiosis are examined if so. Pleural spaces are examined whether they are whiste glistening or not. Tracheobronchial tree are examined as well.
The Internal Examination: Head and Neck
It is examined whether brain has clear, glistening leptomeninges, and is there edema, hemorrhage, or herniation. Any gross anomalies after sectioning if so are examined. Arteries of the circle of Willis and its major branches may have aneurysms or other significant anomaly. Those are looked for too.
Structures of the neck are examined carefully . Skin is examined for any injuries . Subcutaneous tissues for features of compression. Vessels of the neck are examined for any tears. Thyroid gland and tracheal rings are examined for any fractures .Hyoid bone ,thyroid cartilage and cricothyroid cartilage examined for any fractures. Esophagus and its mucosa are examined.
The Possible Ancillary Investigations:
Those investigations include collection of trace evidence, and sample for DNA analyses, for microbial analyses and forensic evidence analyses. Also commonly considered ancillary investigations include chemical or toxicological analysis of body viscera and fluids and histopathological or microscopical examination of various organs. Other possible ancillary tests include vitreous analysis, post-mortem growth of organisms , previous antibiotic treatment, etc.
The Autopsy Report:
The report of autopsy may become widely distributed and read by many different people, depending upon the case involved . It is essentially a "word picture or painting" that should allow the reader of the report to "see" exactly what the findings were, and it should clearly show the bases for the findings and the designated cause of death. One should be mindful of the language and grammar in writing the report of the autopsy. Sentences should be constructed so as to contain maximum information with minimum verbiage. A disorganized and incomplete report may cause the reader to believe the pathologist is unreliable and failed to perform the autopsy in a professional, systematic fashion.
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