AUTOPSY PURPOSE OF FORENSIC AUTOPSY

➢ Determining the cause, manner and time of death

To the living, we owe respect, but to the dead, we owe only the truth. ➢ Recovering, identifying and preserving evidentiary material
- Voltaire ➢ Providing interpretation and correlation of facts and
circumstance related to death
AUTOPSY ➢ Providing a factual, objective medical report for law enforcement,
noun au·top·sy \ˈȯ -ˌtäp-sē, ˈȯ -təp-\ prosecution and defense agencies
➢ Greek autopsia act of seeing with one's own eyes, from aut- + opsis ➢ Separating death due to disease from death due to external cause
sight, appearance — more at optic for the protection of the innocent
➢ First known use: 1678
➢ an examination of the body after death usually with such TYPES OF AUTOPSY
dissection as will expose the vital organs for determining the ➢ CLINICAL/
cause of death or the character and extent of changes produced by HOSPITAL/
disease—called also necropsy, postmortem, postmortem NON-OFFICIAL
examination
➢ scientific postmortem examination of a dead body, performed to
reveal the presence of pathologic processes, their relation to PURPOSE OF HOSPITAL AUTOPSY
clinical phenomena and history, and to determine the cause or ➢ Determining the cause of death
causes of the changes encountered ➢ Providing correlation of clinical diagnosis and clinical symptoms
➢ Determining the effectiveness of therapy
MEDICOLEGAL AUTOPSY ➢ Studying the natural course of disease process
➢ a specialized type of autopsy authorized or ordered by proper ➢ Educating students and physicians
legal authorities in cases of accidental, suicidal, homicidal,
unattended, or unexpected deaths for the purpose of determining WHO PERFORMS THE AUTOPSY?
the cause and manner of death in order to protect the society and ➢ Presidential Decree 856, Sec. 95
insure the administration of justice ➢ Persons authorized to perform autopsy:
✓ Health Officers
CATEGORIES OF DEATH ✓ Medical Officers of law enforcement agencies
➢ Natural ✓ Members of the Medical Staff of accredited hospitals
➢ Accident ✓ FORENSIC PATHOLOGIST – EXPERT WITNESS
➢ Homicide ✓ PATHOLOGIST/ RESIDENT – FACT WITNESS
➢ Suicide ✓ MEDICAL EXAMINER
➢ Undetermined ✓ CORONER

TYPES OF AUTOPSY CONSENT

➢ FORENSIC/ CONSENT (OR REFUSAL) - IN ORDER OF LEGAL AUTHORITY
MEDICOLEGAL/ ➢ The surviving SPOUSE not legally separated or whose marriage
OFFICIAL has not been annulled.
➢ The ELDEST SON or DAUGHTER of legal age, unless mentally unfit
or mentally retarded or legally disqualified.
➢ Either PARENT unless legally disqualified by law.
 ➢ BROTHER or SISTER of legal age, unless legally disqualified by ➢ Gloves
law. ➢ Shoe covers
➢ The LEGAL GUARDIAN or CUSTODIAN of the decedent at the time ➢ Goggles or other protective eyewear
of death
➢ For autopsies of newborn infants, the MOTHER signs the consent.
In case wherein the mother is unfit, refer to previous section.
➢ In cases wherein either parent is unfit and/or no legal guardian or
custodian, the provincial or city fiscal signs the consent form for
the autopsy

AUTOPSY PROCEDURE
“ULTIMATE PHYSICAL EXAMINATION”
➢ Complete evaluation of the medical FOUR SIGNS OF DEATH
history and events leading to death ➢ RIGOR MORTIS
➢ Collection and documentation of trace ✓ temporary stiffening of
evidence on and around the body muscles after death
➢ Photographing and cataloging of injuries ✓ muscle proteins (actin and
➢ Detailed external examination from head to toe myosin) lock together
➢ An internal examination, including the dissection of organs and making the muscle stiff
tissues ✓ starts within 30 minutes to 1 hour full rigor mortis 10
➢ Microscopic examination of organs and tissues to 12 hours continues 24 to 36 hours until decomposition
➢ Laboratory and toxicologic examinations of body tissues and starts to loosen the muscles
fluids ➢ ALGOR MORTIS
➢ A written report detailing the pertinent findings, negative findings ✓ cooling of body temperature after death
and conclusions, including the cause and manner of death ➢ LIVOR MORTIS
✓ Gravity-dependent settling in the blood into the blood
GENERAL PRECAUTIONS vessels and soft tissues after death
➢ An internal examination, including the dissection of organs and ✓ When blood is no longer pumped by the heart, it follows
tissues the force of the gravity and pools in the dependent areas
➢ Microscopic examination of organs and tissues of the body
➢ Laboratory and toxicologic examinations of body tissues and
fluids
➢ A written report detailing the pertinent findings, negative findings
and conclusions, including the cause and manner of death

The following protective clothing should be worn when

performing an autopsy:
➢ Cover-all
➢ Apron
➢ Cap
➢ Mask
 ✓ X-rays
✓ Physical Features
✓ Circumstances surrounding death

FOCUS ON WHAT IS NOT OBVIOUS

➢ Traumatic injuries, both old and new
➢ Natural disease processes (e.g. tumors/atherosclerosis/etc.)
➢ Congenital defects or deformities
➢ Toxicologic, thermal (burns) and chemical injuries
➢ Trace evidence
➢ Infectious disease process
➢ DECOMPOSITION ➢ Anything abnormal, unusual or unexpected
✓ late advancement of postmortem tissue breakdown
✓ enzymes from the dying cells begin the autolysis process EXTERNAL EXAMINATION
✓ bacteria mu

ARTIFACTS OF MEDICAL INTERVENTION

➢ IV lines
➢ skin becomes discolored purplish-green, might blister and slip ➢ Electrocardiogram (ECG) pads
➢ venous marbling🡺 blood in vessels staining the soft tissue ➢ Cricothyroidotomy
➢ hair begins to slip ➢ Surgery
➢ odor from formation of gas is putrid and unmistakable ➢ Bandages
➢ gas bloating remarkable when a body in water is removed ➢ Sutures
➢ insects, carnivore and other invaders ➢ Arterial and large venous lines
➢ Defibrillators
IDENTIFICATION
➢ POSITIVE IDENTIFICATION BLUNT FORCE INJURIES
✓ Visual ➢ Laceration
✓ Fingerprints ➢ Abrasion
✓ Dental ➢ Contusion
✓ X-rays ➢ Avulsion
✓ DNA Fingerprinting
➢ PRESUMPTIVE IDENTIFICATION
✓ Skeletal Remains
✓ Clothing
SHARP FORCE INJURIES ➢ Prostate
➢ Stab wounds ➢ Uterus and ovaries
➢ Incised wounds ➢ Neck organs (thyroid gland/ larynx)
➢ Defense wounds ➢ Vertebral column
➢ Puncture wounds ➢ Skull
➢ Chopping wounds ➢ Brain and meninges
➢ Gunshot wounds
Y-INCISION
SPECIFIC BODY AREAS
➢ OVERALL “GESTALT”
➢ SKIN
➢ HAIR
➢ SCALP
➢ FACE
➢ EYES
➢ NOSE
➢ MOUTH
➢ NECK ORGAN AND TISSUE REMOVAL
➢ CHEST ➢ VIRCHOW AUTOPSY METHOD
➢ BREAST ✓ The organs are removed one after another in an organized
➢ ABDOMEN and logical fashion
➢ EXTREMITIES, HANDS, FINGERS, NAILS ➢ GOHN/ LETULLE/MODIFIED ROKITANSKY METHOD
➢ BACK ✓ The organs are removed en bloc
➢ GENITALIA ✓ Allows the internal viscera to be examined while they are
➢ RECTUM/ ANUS still connected together
✓ Useful when examining infants with multiple cardiac and
INTERNAL EXAMINATION other birth defects
➢ Heart
➢ Chest cavity and mediastinum SURVEY OF CHEST TISSUES AND ORGANS
➢ Lungs and lung hilum
➢ Liver and gallbladder
➢ Spleen
➢ Stomach and esophagus
➢ Small and large intestines
➢ Bowel mesentery
➢ Peritoneal cavity
➢ Body walls
➢ Aorta and its branches
➢ Kidneys and adrenals
➢ Bladder
Hyperinflated Lungs (Status asthmaticus) Pleural Scar

Metastatic Carcinoma Opening the Pericardium

Adhesions Hemopericardium
Palpation and Examination of the Heart in Situ

Inflammation of the Bowel and Abdomen

Survey of Abdominal Organs

Measurement of
abdominal panniculus

Upper Abdominal Organs ORGAN AND TISSUE REMOVAL: Heart

LUNG EXCISION SPLEEN EXCISION

SMALL AND LARGE BOWEL EXCISION

REMOVAL OF THE ESOPHAGUS AND STOMACH

LIVER EXCISION
 EXAMINATION OF SKULL, BRAIN AND SPINAL CORD

EXAMINATION OF SKULL, BRAIN AND SPINAL CORD

EXAMINATION OF THE DURA SPINAL CORD EXAMINATION

REMOVING THE BRAIN 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 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).

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).