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PLIC CONSULTANTS

Autopsy

Postmortem Examination
It is the complete external or internal examination of a dead body along with further examination.
Types
1- Forensic or Medicolegal Autopsy.
2- Medical or Hospital Autopsy.
3- Mini Autopsy.
4- Psychological Autopsy.

1- Forensic or Medicolegal Autopsy.
An authorized medical man carries it out under the law of state for the protection of society with permission from state.
Objectives:
It is done for the determination of: -
a-  Identity of deceased.
b- To find the cause of death.
c- Manner of death.
d- Circumstances of death.
e- Any association of the crime in the occurrence.
f-  Time since death.
g- Viability in birth. (live or still birth)

2- Medical or Hospital Autopsy.
It is done by hospital pathologist to determine cause of death, course of disease and affective ness of drug therapy during life. It is not routinely done in Pakistan.

3- Mini Autopsy.
It is the examination of viscera removed from body, both gross and microscopic during hospital or medico-legal autopsy.

4- Psychological Autopsy.
It is the investigation of suicidal deaths, for obtaining sufficient information to justify the inference of suicide.
Importance of Psychological Autopsy:
a- Police reports are not sufficient and do not provide all relative information.
b- Opinion drawn to the basis of wound complex is not proper.
Sources of Information:
Persons known to victim, friends, relatives, family, teachers, medical attendants etc.
Information:
a. General life style
b. Social relations.
c. Personality make up.
d. Special habits.
e. Mental deviations.

Principles of Autopsy:
a- Examination must be careful and thorough.
b- Medical man should be precise and neat.
c- Decorum of Autopsy room reflect a deep respect for the dead human body.
d- Procedure should be carried out with efficiency and dignity.
e- Body, instruments and table should be kept clean and orderly all the time.
f-  Every case should receive the same degree of care and skill.
g- Record should be available to public.

Rules and Precautions of Autopsy:

1- Permission or Authorization:
Written request from the Investigative Officer of Police is required to start Autopsy. It is a legal compulsion.

2- Careful Study of Poilce Papers:
Doctor should not rely upon the papers but should read them to know the circumstances of death and to know what is required by Police.For this purpose, following is read,
a- Inquest report (Death Report) .
b- Statement of injuries by police.
c- Statements of witnesses.
d- Medico-legal certificate (MLC) if examined during life.
e- Treatment / operation notes if treated or operated.

3- Inspection of Scene of Crime:
It is obligatory in Pakistan but sometimes it helps to understand the circumstances of death and manner of death.
a- Note the position of body and situation of surroundings.
b- Collect the trace for example articles, weapon, blood etc. on or around the body.
c- Take the photographs.
d- Rely on your own observation.
e- Keep the thresh hold of suspicion low

3- Examination of Clothes:
It is done for,
a- Blood., semen or other stains.
b- Any cut, hole or tears.
c- Cloths should be marked signed nad handed over to police.

4- Examination of the dead body:
1- Preferably done in day light ------ in emergency in colorless light e.g tube light.
2- Note the POSTMORTEM CHANGES.
3- Carefully examine the natural orifices of the body.
4. Verify the injuries noted by the police any missing or misinterpretation should be noted.
5. Open all the three cavities i.e. cranial, chest and abdominal.

5- Collection of Specimens for further examination:
A. FOR CHEMICAL EXAMINER.

a- If poisoning is suspected.
b- To exclude poisoning if case is uncertain.
Specimen taken are stomach with contents, liver, spleen, kidney, piece of small intestine, specimen of blood and urine. Preservative is Saturated saline.

B.
FOR BACTERIOLOGIST/ PATHOLOGIST.
a- If role of disease is suspected in death.
b- To exclude disease in case of death is uncertain.
Specimen taken are lung, heart and brain. Preservative is Formalin.

6- Examination of Clothes:
a- Articles, jewellery or weapon etc. found with body.
b- Bullets, pellets etc recovered from the wound.

6- Reconstruction of dead body after Autopsy:
a- Stitch the body properly.
b-Wash and clean after examination.

7- Handing over the body and Report:
a- Dead body is handed over to police.
b- Report should be prepared as early as possible and should be handed over to police and signatures are taken.

Fundamental Procedures in Medicolegal Autopsy:
1- INITIAL STEPS IN POSTMORTEM THEATRE..
2- AUTOPSY PROPER.
3- DOCUMENTATION.

1- Initial Steps in Postmortem theatre:
a- Identification of the dead body.
b- Photographs of the body in the condition received.
c- Collection of trace evidence.
d- Xray examination of the body.

2- Autopsy Proper:

A- Examination of Clothes:
a- On the body.
b- Removal procedure.
c- Special comments.
d- Packing and preservation.

A- External examination of the body:
a- Information about general health e.g. weight, height, age, sex, color of the skin, body build etc.
b- Information about visible changes after death e.g. rigor mortis, post-mortem staining.
c- External evidence of injuries.
d- External evidence of therapy e.g. needle puncture marks, surgical stitches

B- Opening of the body cavities:
Autopsy Incisions:
Scalp: Divide down to bone across vertex from ear to ear at the level just behind the ears.
Chest & Abdomen: Usual straight incision which extend from thyroid cartilage in the mid line to the pubis avoiding umbilicus.
Neck: V-incision two lines extending from behind the ears (mastoid process) on both sides in the center of manubrium sterni.
Shoulder Incision: Two curved lines on both sides from shoulder tip crossing the nipple and meeting the straight incision in mid line and then to the pubis.

C- Internal examination of the body:
a- Internal evidence of the injuries
b- Internal evidence of the therapy.
c- System review ( color, shape, consistency of organs.)
d- Specimen collection. (organs, body fluids and recoveries e.g. bullets, pallets, splinters)

3- Documentation:
a- Recording of findings on examination.
b- Provisional opinion on the basis of above findings.
c- Reports from further examination.
d- Final opinion.

Negative Autopsy:
An autopsy is considered to be negative when all the efforts including gross and microscopic studies and toxicological studies and analysis fail to reveal the cause of death.

Factors Resulting in Negative Autopsy:
a- Commencement of autopsy without adequate history.
b- Faulty technique and procedure.
c- Inadequate external or internal examination.
d- Insufficient histological or toxicological examination.
e- Lack of pathologist’s training.

What to do when Autopsy is Negative:
Cause of death should be given as UNDETERMINED.
Manner of death should be listed as UNKNOWN.

Exhumation
It is lawful digging out of the dead body from the grave for postmortem examination or re-examination.

Objectives of Exhumation:
a- When suspicion of foul play has been raised after burial.
b- When cause of death is disputed and further medical evidence is required.
c- When identity of the dead body is to be established.

Authorization:
In Pakistan............... By Session Judge.
Time Limit:
In Pakistan............... No time limit.

Procedure of Exhumation:
a- Necessary preparations with the help of graveyard authorities
b- Identification of the grave by:
        Care taker of graveyard
        Grave digger.
        Relatives or friends present at the time of burial.
c- Removal of the dead body from the grave.
d- Collection of the samples of the earth in cases of suspected poisoning from :
        Above the dead body
        Below the dead body
        On the sides of the body
        Control sample from distant place

Autopsy Examination:
No difference in the procedure of Autopsy between a fresh body and body burried in a grave.
a- Identification
b- External examination
c- Internal examination: Special attention to any bony injury.
d- Collection of viscera for chemical examination,
        If not available------- shapeless, homogenous mass of different organs in abdomainal & thoracic cavities.
        Hair, nail, teeth, skin if present.

 

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