this is a powerpoint presentation on external examination at autopsy, presented during pg program.. useful for both undergraduate and postgraduate students

1. EXTERNAL EXAMINATION AUTOPSY

2. DEFINITIONS
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AUTOPSY – seeing for one self i.e.
making a personal inspection
Pathological sense – dissection of
the dead body to determine,
through observation, the cause of
death and nature of disease.
EXTERNAL EXAMINATION – ritual
full of meaning and common sense.

6. On the fabric of the human body

8. On the Seats and Causes of Diseases

14. PRELIMINARIES
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Consent (hospital administrator
(RMO/coroner) and relatives)
Identification of body
Clinical details

15. Should have a statement pertaining to retention
of body parts/ organs
Get specific permission for an unusual
examination (removal of eyes/limbs) even if
signed as NO RESTRICTIONS
Make sure the case is not medicolegal, like
delayed accidents, homicides, deaths after
abortions, occupational diseases, suspicious
cases of poisoning, deaths on table.

18. Dictate as follows
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Autopsy no, date and time
Pathologists Name and designation
Patient’s age (look for disparity) and sex
State of body (built and nourishment)
State any restrictions
Final clinical diagnosis
Clinical summary
Height (crown to heel)
Weight

19. Dictate as follows
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Rigor mortis
Livor mortis
Algor mortis
Post mortem drying
Body built
Nourishment
Edema
Cyanosis
Skin
Nails

20. RIGOR MORTIS
Rigor is tested by trying to lift eyelids, trying to depress
the jaw and bending the neck and various joints of the
body

21. RIGOR MORTIS
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Primary flaccidity (till ATP remains) – rigor
– secondary flaccidity
Secondary flaccidity due to onset of
putrefaction
Mechanism (4-8 hrs, 24-48hrs)
NYSTEN’S rule – doesnot appear in all
muscles simultaneously and both voluntary
and involuntary muscles affected
Contraction of erector pilae – cutis
anserina/goose flesh

22. RIGOR MORTIS
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Commences in the heart (LV-RV-atria) , in
sytole
Diaphragm
Skeletal musculature – first jaw, neck, face,
arms, lower extremities, last ankle joint
Passes off in the same order
Contraction of tracheal muscles causes white
dots on mucosa
Postmortem intususception
Iris – dilatation (postmortem) and then
contraction (rigor)
Handling causes loss of rigor – patchy
distribution

23. Factors affecting rigor
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Age – absent in fetus, early and milder in
children and old
Early onset, short duration – wasting
diseases, strychnine poisoning
Late onset – asphyxia, hemorrhage,
pneumonia, paralytic diseases
Increased duration – CO poisoning
Less duration – bacterial infection d/t
early putrefaction
Environment – cold – late onset, more
duration, heat – early onset, less
duration

24. CADAVERIC SPASM / INSTANTANEOUS
RIGOR / CATALEPTIC RIGIDITY

25. CADAVERIC SPASM
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Muscles that were contracted during
life become rigid immediately after
death without passing into a stage
of primary relaxation
Affects single group of voluntary
muscles, frequently hands
Sudden death, excitement, severe
pain, convulsions, strychnine
poisoning

26. LIVOR MORTIS

27. LIVOR MORTIS
Hypostasis
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Mechanism
Initially intravascular (can blanch), then
extravascular
Begins 30 to 45 mins after death in
dependent parts, max in 6-12 hrs
Can enlarge the extent of subcutaneous
hemorrhages, can mimick suboccipital
hemorrhage
Initially cut on the area of livor shows
delicate hemorrhagic dots showing
transected congested vessels.
Not possible to distinguish from
antemortem cyanosis

28. BLANCHING TEST

29. 
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Colour is a shade of blue
No livor – hemorrhage, anemia,
wasting diseases
Red in bodies kept in moist
refrigeration – higher affininty for
O2
Cherry red – cyanide, CO
Methemoglobinemia – smoky green,
brown
Hydrogen sulfide – black

30. Tardieu spots
develop in areas of lividity, such as this
individual's shoulder area, as decomposing capillaries
rupture.

31. ALGOR MORTIS
Rectal temp falls @ 1 deg/hr
 Also inferior surface of
liver/EAC/nasal passages
 Time of death =
n body tem – rect t / rate of cool
 Post mortem caloricity – stroke,
convulsions, strychnine poisoning,
septicemia


32. POST MORTEM DRYING
develops when the eyelids are not completely shut, the areas of the sclera
exposed to the air dry out, which results in a first yellowish, then brownishblackish band like discoloration zone
cholera, wasting dis
(Tache noire)

33. DRYING
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Skin is wrinkled and leathery
Loosening of hair, apparent
lengthning of finger nails due to
shrinkage of finger tips

34. Body built and nourishment

35. BODY BUILT
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Gigantism – Hereditary/endocrine
proportioned/dys
Endocrine –
 Pituitry
- d/t excess GH acromegaly,
gigantism
 Hypogonadism – eunuchoid - klienfelter

39. BODY BUILT
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DWARFISM – hereditary / endocrine
perfect/imperfect
Hereditary – pygmies (primordial)
sporadic (mutation)
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achondroplasia
Endocrine –
 Hypothyroidism
– cretinism
 Pituitary dwarfism – GH deficiency
 Gonadal dwarfism – Turner’s syndrome

40. Achondroplasia
Upper arms and thigh shorter
Trident hand
Face disproportionately large
Spinal stenosis, kyphosis

41. TURNER SYNDROME

42. Spinal deformities
Old age
Chronic
emphysema
Rickets
Osteomalacia
Acromegaly
Tuberculosis

43. Spinal deformities
Dislocation
of hips
Ascites
Pregnancy
Postural
weakness

44. Spinal deformities
Weakness/paralysis
of muscles on one
side – poliomyelitis,
shortening of one
lower limb

45. NOURISHMENT
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OBESITY
Exogenous – food intake
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Double chin and abdominal
Endogenous - glandular
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Cushing’s – truncal – moon face, buffalo hump,
protuberant abdomen, thin extremities
Hypothyroidism – non pitting myxedema –
eyelids, hands and tibia – hyaluronic acid
infiltrn

46. Complications of obesity

48. NOURISHMENT
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CACHEXIA
 Cancer
 TB
 Thyrotoxicosis
 Addison’s
disease
 Anorexia nervosa
 Starvation

49. EDEMA
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Generalized and localized
Pitting and non pitting
(lymphedema/myxedema)

50. GENERALISED/ LOCALISED
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GENERALISED
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Congestive heart failure
Nephrotic syndrome
Hypoproteinemia
Cirrhosis
LOCALISED
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Filariasis
Post operative
Insect bites
Vena caval syndromes

52. CYANOSIS

53. CYANOSIS
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CENTRAL
 Conjunctive,
mouth, nose, lips
 Pneumonia, chronic bronchitis, fallot’s,
shunts as in cirrhosis
 Associated with clubbing
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PERIPHERAL
 Extremities,
not associated with
clubbing
 Localised obstruction to blood flow like
raynaud’s, arterial obstruction, varicose
veins

55. Raynaud’s

56. NAILS

57. KOILONYCHIA

58. FINGERS – MARFAN’S
DUE TO MUTATION IN FIBRILLIN I GENE

59. SKIN
PIGMENT DISTURBANCES
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Hyperpigmentation
 Generalised
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Jaundice, Addison’s, Hemochromatosis,
chronic malaria
 Localised
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Chloasma, Acanthosis nigricans
Hypopigmentation
 Albinism,
vitiligo
 Fungal disease (tinea vericolor,
pityriasis alba), leprosy

61. Signs of liver cell failure

63. Hemochromatosis

64. SKIN
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Petechiae, ecchymoses
Striae

65. HAIR AND FACE

66. HAIR
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Loss – debilitating illness, malignancy,
typhoid, male pattern baldness, alopecia,
ringworms, thallium poisoning
Female distribution in male – portal
cirrhosis, after castration
Hirsuitism – Male pattern hair in female –
Cushing’s, ovarian tumors
Thinning and drying of scalp hair –
myxedema

67. Cicatrical alopecia
male pattern baldness

68. FACE
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Hippocratic facies - A pinched expression of
the face, with sunken eyes, hollow cheeks
and temples, and relaxed lips, observed in
one dying after an exhausting illness
Moon face – cushing’s
Potter facies - oligohydramnios
Mask like facies - parkinsonism
Leonine facies - lepromatous leprosy

69. •Potter's facies.
•Parrot-beaked nose. Recessed chin. Epicanthic folds. micrognathia
•Low set ears (helices often folded).
•Hypertelorism.

70. EYES

71. EYES – POST MORTEM
CHANGES
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Loss of corneal reflex – not reliable
Opacity of cornea – cholera, wasting
diseases
Flaccidity of eyeball – sunken
Pupils – dilatation then constriction
Retina – Kevorkian sign – shunting/tracking
of blood due to fall in bp
Steady rise in K+ values of vitreous upto
100 hrs

72. EYES
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Exophthalmos
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Enophthalmos
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Cachexia, Horner’s syndrome
Cornea –
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Hyperthyroidism, myopia
Ulceration, opacity, Arcus senilis, KayserFleischer ring
Sclera –
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Icterus
Blue sclera (osteogenesis imperfecta,
marfan’s)

74. 
Horner’s syndrome – due to compression of ipsilateral thoracic /cervical
sympathetic chain – miosis, enophthalmos, ptosis and loss of sweating
on same side with loss of ciliospinal reflex

75. 
Arcus senilis
wilson’s disease

76. ORIFICES

77. Tongue
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Geographic tongue – Vitamin B12
deficiency
Protuberant tongue – cushing’s

78. THYROID

79. LYMPH NODES – NECK,
AXILLA AND INGUINAL

80. NECK
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Look for neck veins
Prominence indicates RVF

81. BREAST

82. CHEST
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Pectus carinatum aka alar chest
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Pigeon Chest
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Emphysema, chronic bronchitis
Pectus excavatum
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Nasopharyngeal obstruction, respiratory
disease
Barrel Chest
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Prominence of vertebral border of sternum
Occupational deformity, cobblers
Rachitic Chest
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Pigeon breast, keel breast, Harrison’s sulci,
Verical grooves, Rickety rosary

83. RIBS

84. LIVER AND SPLEEN

85. UMBILICUS

86. Perinatal autopsy
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Weights lung:heart=3:1
Brain : liver = 3:1
Liver:heart = 6:1
Adrenal:thymus:spleen = 1:1:1
OFC=CR
Lanugo hair, poorly formed ear
cartilage, absent breast buds,
undescended testis, rugose scrotum,
palmar and plantar creases