Introduction to autopsy technique. Care and Maintenance of Autopsy Area, Autopsy Instruments, Handling of Dead Bodies, and Various Uses of Autopsy. Unit-III. IMMUNOPATHOLOGY AND CYTOLOGY.

Introduction to autopsy technique

An autopsy is also known as a post-mortem examination. “Autopsy is a medical procedure carried out to investigate the cause of death”. The autopsy technique involves a systematic examination of a deceased person's body to identify any injuries, diseases, or abnormalities that cause death. Here are key aspects of the introduction to the autopsy technique:

Purpose: The primary purpose of an autopsy is to determine the cause of death.

Types of Autopsies:

1. Forensic Autopsy: Conducted when the cause of death is uncertain, suspicious, or related to criminal activity. It involves a detailed examination to gather evidence for legal proceedings.

2. Clinical or Medical Autopsy: Performed in hospitals for research and educational purposes. It aims to enhance medical knowledge and contribute to the understanding of diseases.

Consent and Legal Aspects: Autopsies are performed with the consent of the deceased person's family, legal representative, or by law in specific circumstances.

Procedures:

1. External Examination: Note any visible injuries, marks, or abnormalities with a thorough external examination of the body.

• · Height, weight, condition of the body, and nourishment.

• · Skin color: Pigmentation and jaundice,

• · Lymph nodes

• · Presence of leg edema and cervical emphysema around the chest.

• · Presence of external wounds, burn marks, and signs of violence.

• · Presence of deformity, hernia, etc.

• · Natural orifice conditions of the body such as mouth, ears, nostrils, vagina, anus, etc.

• · Eyes, pupil, tongue, lips, gums. etc, condition.

2. Internal Examination: Dissection and examination of internal organs such as the brain, lungs, heart, liver, and other vital structures.

Dissection (Incision):

a. Y-shaped incision: Incision from the clavicle to the nipple.

b. I shaped: Extend chin and make a vertical incision from chin to pubis.

c. U- shaped: It modified V-shaped incision, Start incision on both sides of the neck and make a vertical incision up to the pubis.

3. Toxicology: Samples are collected for toxicological analysis to identify the presence of drugs, poisons, or other substances.

Documentation: Detailed records of the autopsy process are maintained. This includes photographs, measurements, and descriptions of findings. Autopsy reports document the pathologist's observations and conclusions regarding the cause of death.

Team Involvement: Autopsies are often conducted by a forensic pathologist, a medical professional specializing in the examination of deceased individuals. Other experts, such as forensic scientists, radiologists, and toxicologists, may be involved in specific cases.

Post-Autopsy Care: After completion, the body is usually reconstructed, and efforts are made to restore a natural appearance.

Care and maintenance of the autopsy area

The care and maintenance of an autopsy area are critical to ensure a safe, sanitary, and efficient environment for the examination of deceased individuals. Proper care contributes to the accuracy of forensic investigations. It also helps to maintain the integrity of the facility.

1. Facility Design: Design the autopsy facility with easy-to-clean surfaces. Use materials resistant to corrosion from chemicals used during autopsies. Ensure proper drainage to facilitate cleaning and prevent the accumulation of fluids.

2. Cleaning and Sanitization: Regular and thorough cleaning is essential to prevent the spread of infections and maintain a hygienic environment. Disinfect all surfaces, including autopsy tables, tools, and equipment, using appropriate cleaning agents.

Follow established protocols for the disposal of biological waste.

3. Personal Protective Equipment (PPE): Autopsy personnel should use appropriate PPE, such as gloves, masks, gowns, and eye protection. It minimizes the risk of exposure to biological and chemical hazards. Ensure PPE is properly maintained, replaced it if necessary, and disposed of according to safety regulations.

4. Ventilation and Air Quality: Adequate ventilation is crucial to control odors. Maintain air quality in the autopsy area. Install and maintain ventilation systems to minimize the risk of exposure to potentially harmful fumes or particles.

5. Temperature and Humidity Control: Control the temperature and humidity levels in the autopsy area. It creates a comfortable working environment and preserves the integrity of specimens. Ensure that temperature-controlled storage facilities are available for preserving samples and specimens.

6. Waste Management: Implement a proper waste management system to handle biological and hazardous waste.

Follow local regulations and guidelines for the disposal of human remains and medical waste.

7. Record Keeping: Maintain detailed records of cleaning schedules, equipment maintenance, and any incidents or accidents that occur in the autopsy area.

Regularly review and update standard operating procedures to reflect best practices and compliance with regulations.

Regular inspection, routine maintenance, and adherence to safety protocols are essential components of caring for and maintaining an autopsy area. These practices contribute to the overall functionality of the facility. It ensures the well-being of the staff involved in forensic investigations

Autopsy instruments

Autopsy instruments cover a wide range of tools used during post-mortem examinations. The following are some commonly used autopsy instruments:

• 1. Scalpel: A small, sharp knife used for making incisions.

• 2. Autopsy Needle: Used for suturing incisions during the autopsy.

• 3. Scissors: Various types, including dissecting scissors for cutting tissue.

• 4. Y-shaped Autopsy Scissors: Specifically designed for opening the cranial cavity.

• 5. Forceps: Grasping and holding instruments; e.g., tissue forceps or dissecting forceps.

• 6. Bone Forceps: For handling and grasping bones.

• 7. Surgical Blades: Used in conjunction with a handle (scalpel) for cutting.

• 8. Bone Saw: Used for cutting through bone during autopsies.

• 9. Rib Shears: Specifically designed for cutting through ribs.

• 10. Post-Mortem Hammer: Used for disarticulating joints and breaking bones.

• 11. Y-shaped Autopsy Scissors: Specifically designed for opening the cranial cavity.

• 12. Raspatories and Elevators: Tools for lifting tissues or bones during dissection.

• 13. Trocar and Cannula: Used for aspirating fluids from body cavities.

• 14. Tissue Sampling Tools: Such as biopsy punches or needles for collecting samples.

• 15. Mallet: Used for delicate bone work or dislodging organs.

• 16. Organ Bags: Used to contain and transport organs during the examination.

• 17. Specimen Containers: Containers for preserving and transporting tissue samples.

• 18. Ruler/Calipers: Used for measuring dimensions of organs or injuries.

• 19. Dissecting Table: The surface on which the autopsy is performed.

• 20. Gloves: Protective gear worn by autopsy personnel.

• 21. Autopsy Apron/Gown: Protective clothing worn during autopsies.

Care and maintenance of autopsy instruments

Proper care and maintenance of autopsy instruments are essential to ensure accurate and reliable results during post-mortem examinations. The following are some general guidelines for maintaining autopsy instruments:

1. Immediate Cleaning: Instruments should be cleaned immediately after each use to prevent the drying of tissues and fluids.

Use of Enzymatic Cleaners: Autopsy instruments are soaked in enzymatic cleaners to break down organic materials. Follow the manufacturer's instructions for proper dilution and soaking time.

Ultrasonic Cleaning: Some instruments can be cleaned using ultrasonic cleaners to remove debris from hard-to-reach areas.

2. Chemical Disinfection: Autopsy instruments are disinfected after cleaning. Use appropriate disinfectants recommended for medical instruments, and follow the manufacturer's instructions.

Sterilization: Some instruments may require sterilization. Autoclaving is a common method. However, all instruments cannot bear high temperatures and pressure. For these check manufacturer guidelines.

3. Drying: Ensure instruments are thoroughly dried after cleaning and disinfection. It prevents corrosion. Use a clean, dry cloth or air-dry the instruments.

4. Storage: Store instruments in a dry, clean environment to prevent corrosion. Use instrument trays or containers specifically designed for storage.

Avoiding Contact: Store instruments in a way that avoids contact with other metallic objects to prevent scratches and damage.

5. Regular Inspection:

6. Visual Inspection: Regularly inspect instruments for signs of wear, damage, or corrosion. Replace or repair any instruments that show signs of deterioration.

7. Sharpening: Sharp instruments like scalpels and scissors should be regularly inspected and sharpened as needed.

8. Instrument-Specific Care: Follow Manufacturer Guidelines: Adhere to the manufacturer's guidelines for care and maintenance specific to each type of instrument.

9. Documentation: Record Keeping: Maintain a log of instrument usage, cleaning, disinfection, and any maintenance or repairs performed. This documentation can be useful for quality control and audit purposes.

Training and Education: Staff Training: Ensure that staff members are properly trained on the care and maintenance of autopsy instruments. Follow established protocols and guidelines.

Handling of Dead Bodies and Various Uses of Autopsy

Handling dead bodies and performing autopsies are important aspects of forensic pathology and medical examination. The handling of dead bodies involves various steps to ensure proper identification, documentation, and examination, while autopsies serve multiple purposes, including determining the cause of death and providing valuable information for medical research.

Handling of Dead Bodies

1. Identification:

• Initial Identification: The first step is to establish the identity of the deceased. It is done through identification tags or information from family members.

• Official Identification: Authorities may use official documents, fingerprints, dental records, or DNA testing for positive identification.

2. Documentation:

• Scene Documentation: If the death occurred outside a controlled environment (e.g., at a crime scene), documenting the surroundings, position of the body, and any potential evidence is crucial.

• Photography: Photographs of the external condition of the body, injuries, and any relevant evidence are taken to document.

3. Transportation:

4. Body Bags: Bodies are usually placed in body bags to facilitate transportation and to minimize the risk of contamination.

5. Preservation: In certain cases, bodies may be refrigerated or stored in a mortuary to preserve them until further examination.

6. Forensic Examination:

7. External Examination: A preliminary external examination may be conducted to observe any visible injuries, marks, or signs of trauma.

8. Toxicology Samples: Depending on the circumstances, samples for toxicology testing may be collected.

Uses of Autopsy

1. Clinical (Hospital) Autopsy:

• Medical Diagnosis: It is conducted to determine the cause of death for medical and educational purposes.

• Disease Identification: It helps to identify diseases, abnormalities, or conditions that may not have been diagnosed during the person's life.

2. Forensic (Medicolegal) Autopsy:

• Legal Investigation: Primarily performed to investigate deaths that may be sudden, unexpected, suspicious, or due to trauma.

• Establishing Cause and Manner of Death: Determines the cause of death (e.g., disease, injury, poisoning) and the manner of death (e.g., natural, accidental, homicide, suicide).

3. Post-Mortem Examinations for Research:

• Scientific Studies: Autopsies are crucial for medical research, helping to understand the progression of diseases, identify genetic factors, and contribute to advancements in medical science.

4. Mass Disaster Autopsies:

• Identification: In cases of mass casualties, autopsies play a vital role in identifying victims and determining the cause of the disaster.

• Legal and Humanitarian Reasons: Autopsies may be conducted for legal investigations and to provide closure to families.

5. Anatomical Autopsy:

• Medical Education: Autopsies performed for educational purposes, allowing medical students to study human anatomy and pathology.

• Research and Training: Pathologists use these autopsies to enhance their skills and knowledge.

6. Virtual Autopsy: Advanced Imaging: Virtual autopsies using advanced imaging techniques like CT scans may be conducted in some cases. It provides a non-invasive alternative for examination.

Legal and Ethical Considerations

• 1. Consent: Autopsies typically require the consent of the deceased person's next of kin unless mandated by law.

• 2. Cultural and Religious Considerations: Respect for cultural and religious beliefs regarding the handling and examination of the deceased is essential.

• 3. Chain of Custody: Proper documentation and maintenance of the chain of custody are crucial in forensic investigations to preserve the integrity of evidence.

POSTMORTEM-RECORD PROFORMA

• P. M. No………. Serial No……

• Date……………… Time…………..

• Name……………………. Age…………….. Religion………… Sex……………

• Clinical Diagnosis…………………..

• Anatomical Diagnosis………………..

• Histological Diagnosis……………….

• Signature of Prosector

• 1. External Examination;

  • · Peritoneal cavity

  • · Pleural cavity

  • · Pericardial cavity

  • · Heart: Weight

  • Valves: Tricuspid valve (TV), Mitral valve (MV) Atrioventricular valve (AV) Pulmonary valve (PV).

  • Measurement: Left ventricle, Right ventricle, Left atrium, Right atrium.

• 2. Muscles (Myocardium)

• 3. Blood vessels

• 4. Aorta

• 5. Portal veins

• 6. Lungs: Right lung weight and left lung weight.

• 7. Spleen: Weight…….. Size……… Cut surface.

• 8. Organs of Neck: Tongue,,,,, Larynx……… Tonsils…. Trachea…. Salivary gland….. Thyroid

• 9. Lymph Node

• 10. Alimentary canal: Oesophagus, Stomach, Small intestine, Appendix, Large intestine, Rectum.

• 11. Pancreas

• 12. Liver: Weight in gm, Size, and cut surface.

• 13. Gall bladder Bile duct

• 14. Kidney: Weight of right kidney and left kidney.

• 15. Adrenal glands: Weight of right adrenal and left adrenal.

• 16. Pelvic organs: Urinary bladder.

  • Male: prostate, testes, and Spermatic cord

  • Female: Ovaries, uterus, vagina, and fallopian tube

• 17. Bones: Ribs, Vertebrate, sternum, pelvis, femora.

• 18. Brain: Brain weight, pituitary, middle ear, and air sinuses of the skull

• 19. Spinal cord: Pathological summary, Chemical and bacteriological examination, clinicalpathological correlation.

Pramila Singh