procedure of autopsy

the assistants going to make the first incision in any autopsy the classical way of beginning it is by making a y-shaped incision starting on the chest and then extending downwards to the pubic area this allows full exposure of the various body cavities while still maintaining a procedure which allows for an open casket female if that's what the family desires well he's cutting through his subcutaneous fat and muscle the first flap that he's reflecting will is being done so that you can expose the neck organs which also will be dissected out and examined as part of the autopsy [Music] the individual is being examined in this case we suspect that the cause of death is a drug intoxication with a meat rippling which is a antidepressant medication but in order to prove that we need huh what they're noticing is that this individual has had a resting point has had breast implants placed they hadn't noticed the scarring earlier so it's a little bit of a surprise and that's a silicone implant okay what he's doing now is reflecting back cutting the dye for the diaphragm or the breathing muscle attaches to the side of the body and exposing the peritoneal cavity or the abdominal cavity the doctors examining the loops about trying to find the appendix and she's found it and so she'll remove that we keep that as basically as a way of helping us identify people in place it's an identifying feature now the ribs are being cut and so that the chest cavity can be exposed he's cool now he's also cutting the next portion of the diaphragm and reflecting back the chest plate in order to expose the heart and lungs and now you see the heart and lungs in place what he's doing now is cutting the pulmonary artery and checking to make sure there are no blood clots in there pulmonary embolus which is when somebody throws a clot to the lung is when a large clot formed is formed somewhere else in the body and then travels to the lung what he pulled out was not a clot that formed while the person was alive that was a post-mortem blood clot now the hardest in the move next step will be to remove the lungs he's taking the right along out first he's hmm he's cut the bronchus the main airway to the lung and noticed that there was some mucoid material in that bronchus he's now removing the pericardial sac and reflecting the diaphragm in order to free up the liver for removal pardon me spleen is coming out now that sits in the left upper quadrant of the abdomen that's about normal shape and size what he's doing now is he's putting a clamp on the proximal end of the small intestine the duodenum and then he'll free up all of the intestine so that it can be removed in a block and there we go that's an adrenal gland when she's dissected off the top one of the kidneys set the left dead right now he's in sizing the renal capsule which is a thin membrane that surrounds the surrounds the kidneys and he'll strip that back to expose the kidney itself and then remove the kidney he's gonna free up all of the tissues through to the base of the tongue and then dissect down along either side so that the neck organs can be removed along with the tongue now that he's down in the upper chest he can transect them because that leaves enough room for them to infuse embalming fluid through those vessels down low okay he's now reflecting the scalp the front has been done now he'll reflect the posterior portion now that the all the incisions have been made he'll use the key in order to free it up and peel it off from the dura as you can see now the brain has been exposed first thing he'll do is reach down in and cut the optic nerves there the first thing that we'll hold holding the brain in place once those have been cut he'll cut some of the other nerves and then he'll need to make an incision through the tentorium which is a tough membrane that holds the cerebellum in the posterior fossa of the skull once that's done he can put his knife down into the frame and the item and transect the spinal tome and essentially deliver the brain the skull on the inside is lined by a tough membrane the dura mater in order for us to be able to visualize if there's any fractures that membrane needs to be peeled away from the underlying bone so that's what the assistance is doing dr. chrissy is now examining the heart the first thing she'll be doing is looking at the coronary arteries to make sure that they're intact and that there's no signs of thrombosis or atherosclerosis the artery she's dissecting right now is called the left anterior descending artery which is the vessel that supplies the anterior portion of the left side of the heart or the main pumping chamber of the heart representative samples the various tissues that we examined will be saved in formaldehyde and so that's what you're seeing her do right now the outflow tract to the pulmonary artery is normal and the three leaflets of the pulmonary valve are intact and normal this is the aorta she's opened the aortic valve and you can see the two coronary Ostia where the coronary arteries come off from the aorta just above the valve cusps this is the right lung you can tell that it's the right lung because it has three lobes one two and three the left lung normally will have two sometimes you can find multiple lobes in both lungs sometimes up to five separate lobes may be seen dr. phreak is now opening the main bronchus of the right lung and following it out through its primary and secondary divisions again the purpose of this is to see if there's any evidence of disease or other abnormalities such as obstruction by foreign bodies she's examining the liver this is the inferior or under surface of the liver the gallbladder has already been opened and that's what she's looking at there the top surface of the liver seen here with the larger portion being the right lobe the smaller portion the left lobe the color and appearance of the liver are normal it's a little darker than expected which is probably due again to congestion or the backup of blood in the organ these are the kidneys remember that the left kidney was the one who which had all of the scarring and is markedly shrunken in with it right pardon me it was markedly shrunken in comparison to the right side and that's weird looks like a brain which is seeing is that there is marked thinning of the cortical tissues and even in portions of the medula see how much more full and thick the tissues are in the uninvolved kidney this is the spleen outer surface and then the inner surface with hilum which is where the blood vessels enter the spleen the is intact in essentially normal the parenchyma or internal part of the organ it appears a little congested or filled with blood but otherwise normal this is the organ blob containing the uterus fallopian tubes and ovaries along with the vaginal stump and the urinary bladder the bladder is anterior to the uterus the this is opened through the urethral urethra our original meatus doesn't look that bad for somebody dr. Ricky is now dissecting off the bladder and opening the vagina so that you can see the cervix this is a cervix that has a slit like opening which would indicate that the true this person has probably had at least one child the uterus is normal shape and size and no evidence of tumors in muscular wall of the uterus the endometrial cavity appears a little hemorrhagic could be an early menstrual phase a little leiomyoma this is a benign muscle tumor of the uterine wall the fallopian tubes are intact and the ovaries appear again normal shape and size there may be some small yeah you can see if degenerative corpus luteum which is that yellow red structure now we're doing the neck block with the attached tongue this is the epiglottis here the vocal cords can be seen down in that opening this is the anesthesiologist and paramedics view this is what they see when they're trying to intubate somebody first you open the esophagus you can just a normal looking mucosa no foreign bodies next she will open the larynx and trachea again a very normal looking appearance and those are the vocal cords there and they're finally shall open the aorta and you can see the openings for the very branches of the costal arteries the ones that run into the lid coming off of the thoracic aorta next you'll dissect down to expose the thyroid gland which essentially sits like a butterfly raft with its wings wrapped around either side of the tricking gland again looking like it has normal shape color and consistency these are the adrenal glands that sit on top of the kidneys as you can see they have two layers one is that outer sort of yellow layer the inner is a darker red Brown the outer layer is where you produce various hormones such as steroids steroid hormones other things that control fluid balance in the in the body things like that the inner layer the red one is the adrenal medulla and that's where you produce epinephrine or adrenaline but gives you that surge in a flight or fight or flight situation finally the brain nice symmetry no evidence of some nerve process involving one side of the brain over the other the inferior surface the top of and now shows the various cranial nerves the olfactory nerves are the two long ones across the front of the brain that's what she's touching now is where the optic chiasm is where the optic nerves across various cranial nerves extend off the either side of the brainstem that's like the trigeminal the vessels are intact do not have atherosclerosis first thing she'll do is remove the cerebellum those two black stripes yeah the same thing those two black stripes are the substantia nigra this is the guy who had the fetal brain transplant she's now dissecting off the brain stem from the cerebellum cutting the cerebral peadler cerebellar peduncles waiting for the guests of honor waiting for the guests of honor now dissecting through this brain stem again making sure that there's no signs of any abnormality substantial then you get into the ponds which has lots and lots of crossing fibers and then the medulla where the fibers straighten out of our rundown what you're seeing is the white or light colored portions of the brain are essentially wiring and then the gray or darker parts are where cell bodies reside this central lobe right here is the thermos particles very malnourished alcoholic this is the dentate nucleus which is one of the places we look for scientific interruption of oxygen supply is very sensitive the Coordination Center [Music] I sure hope you finds a man of truth yeah these are the very the various lobes of the brain the frontal lobes these are the temporal lobes this would be pariah ttle and occipital towards the back now there's two small dots are called the mammillary bodies now what you'll do is just serially section through the brain that division between white and grey is more apparent here in the cerebral cortex you can see fluid leaking from the ventricular system the right band crossing from the right and left side says the corpus callosum essentially that's how your bridge the two halves of your brain communicate with each other