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Autopsy

Belongs to subject Post-mortem examination

Autopsies are usually performed by a specialized medical doctor called a pathologist. In most cases, a medical examiner or coroner can determine cause of death and only a small portion of deaths require an autopsy.

Autopsies are performed for either legal or medical purposes. Autopsies can be performed when any of the following information is desired:

Determine if death was natural or unnatural Injury source and extent on the corpse Manner of death must be determined Time since death Establish identity of deceased Retain relevant organs For example, a forensic autopsy is carried out when the cause of death may be a criminal matter, while a clinical or academic autopsy is performed to find the medical cause of death and is used in cases of unknown or uncertain death, or for research purposes. Autopsies can be further classified into cases where external examination suffices, and those where the body is dissected and internal examination is conducted. Permission from next of kin may be required for internal autopsy in some cases. Once an internal autopsy is complete the body is reconstituted by sewing it back together.

The word “autopsy” has been used since around the 17th century, it refers to the examination of inside the dead human body to discover diseases and cause of death.

The principal aims of an autopsy is to determine the cause of death, mode of death, manner of death the state of health of the person before he or she died, and whether any medical diagnosis and treatment before death was appropriate. In most Western countries the number of autopsies performed in hospitals has been decreasing every year since 1955. When a person has given permission in advance of their death, autopsies may also be carried out for the purposes of teaching or medical research. An autopsy is frequently performed in cases of sudden death, where a doctor is not able to write a death certificate, or when death is believed to result from an unnatural cause. Some religions including Judaism and Islam usually discourage the performing of autopsies on their adherents. A systematic review of studies of the autopsy calculated that in about 25% of autopsies a major diagnostic error will be revealed. A large meta-analysis suggested that approximately one-third of death certificates are incorrect and that half of the autopsies performed produced findings that were not suspected before the person died. There are four main types of autopsies:

Medico-Legal Autopsy or Forensic or coroner's autopsies seek to find the cause and manner of death and to identify the decedent. They are generally performed, as prescribed by applicable law, in cases of violent, suspicious or sudden deaths, deaths without medical assistance or during surgical procedures. Clinical or Pathological autopsies are performed to diagnose a particular disease or for research purposes. Anatomical or academic autopsies are performed by students of anatomy for study purpose only. A forensic autopsy is used to determine the cause, mode and manner of death. Medical examiners attempt to determine the time of death, the exact cause of death, and what, if anything, preceded the death, such as a struggle. A forensic autopsy may include obtaining biological specimens from the deceased for toxicological testing, including stomach contents. Clinical autopsies serve two major purposes. They are performed to gain more insight into pathological processes and determine what factors contributed to a patient's death. Autopsies are also performed to ensure the standard of care at hospitals. Autopsies can yield insight into how patient deaths can be prevented in the future. In the UK in 2013 only 0.7% of inpatient adult deaths were followed by consented autopsy. The body is received at a medical examiner's office, municipal mortuary, or hospital in a body bag or evidence sheet. A new body bag is used for each body to ensure that only evidence from that body is contained within the bag. Evidence sheets are an alternative way to transport the body. There are two parts to the physical examination of the body: the external and internal examination. /molecular autopsy often supplement these and frequently assist the pathologist in assigning the cause or causes of death.

The body is then cleaned, weighed, and measured in preparation for the internal examination. The principle behind this is that the medical records, history of the deceased and circumstances of death have all indicated as to the cause and manner of death without the need for an internal examination.

The internal examination consists of inspecting the internal organs of the body by dissection for evidence of trauma or other indications of the cause of death. This is typically used on women and during chest-only autopsies. During autopsies of infants, this method is used almost all of the time. By around 150 BC, ancient Roman legal practice had established clear parameters for autopsies.The 18th-century medical researcher Rudolf Virchow, in response to a lack of standardization of autopsy procedures, established and published specific autopsy protocols (one such protocol still bears his name). A necropsy is mostly used like an autopsy to determine cause of death.

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