This time I'm gonna post something which I saw and witness. Doesn't really have much principles in it, but it's just a good experience to see it.
If you find it disgusting or anything in whatever I'm gonna state, you may close and try to read again soon ~ but it's really interesting!
In the Histopathology department, post mortem refers to the medical examination done to a dead body. In this case, it’s a baby.
It's kinda scary when you first see it...cos it's like a formed baby, then it's gonna get cut open and have its organs removed and all, like a nice body being physiologically ruined.
These incisions and cuts have to be done very carefully, and very gently. Stillborn babies can range from those barely formed to those that are already fully formed, near the 5th month of pregnancy etc.
The state at which the pathologist has to adopt to retrieve the organs have to be dependent on the stillborn's age. For example, a not yet fully developed foetus is most likely to have a liquified brain after the skull has been cut open, so the pathologist has to be careful so as to not "spill" the brain contents.
The necessary sharps are needed like surgical scissors, scapel, metal ruler and forceps.
The steps are crucial and the body has to be treated with absolute care.
The body is examined for physical deforms. Actions done are as follows;
- Probing the nose with a probe till the end of the skull (check clearing of nose)
- Checking of the eyes
- Opening of the mouth
- Checking of the ears, with reference to the distance from the eyes
- Measuring the limbs, chest width, abdomen width, spine
- Ensure fingers and toes are separated
- Check the genitals and anus
- Check for a straight spine
Preparation:
Formalin
- To fix the organs that was removed.
Organs (removed in their order from superior to inferior sections of the body)
- The brain is removed first
The scalp is sliced open, followed by an incision of the skull with a surgical needle along the line of the skull.
The skull will then be pried open (like a banana skin) to expose the brain
The linings of the brain is cut, and the brain is removed and then fixed into formalin
- The pituitary gland is removed next
It is located just below the brain and is cut out using a scalpel blade. The gland resembles a rectangle shape. It is located in the middle, behind the posterior cartilage. You can picture the inside of the skull from a bird's eye view...the pituitary gland is right in the "bull's eye" of the cavity.
- The torso is then sliced open. A T-shape cut will be done, as per normal for an adult autopsy. The straight line will be cut across the chest, from shoulder to shoulder, and a vertical line cut down from the neck to the pelvic area. The skin and subcutaneous tissues are to be cut through, as there is no need to remove muscle by muscle.
The attachment under the rib-cages is to be cut, along with soft tissues.
- Remove the thoracic cavity
- Remove the thymus (located below the neck)
- Check the morphology of the organs
E.g. check pulmonary veins, branches from the aorta, isomerism, and pathological findings
* All pathological findings are to be photographed *
- Removal of the intestine
The mesentery is cut between the intestines. It suspends the intestine in the abdominal cavity and stops it being disturbed when a person is physically active.
The intestine is removed as a long strand. Keep in mind to take note to make sure that the intestine has the bile stain
For the small intestine, remove it until it reaches the duodenum, cut it off
For the large intestine, remove it until it reaches the rectum, cut it off.
Measure both intestines and fix formalin into it via needle (the mucosa will not fix easily under external exposure conditions to formalin)
- Removal of stomach, kidney, pancreas, adrenal, and spleen.
All linings of the internal organs are to be cut from the esophagus to the rectum, and the entire digestive system complex is removed by cutting through the urinary tract.
- Removal of salivary glands
- Removal of skeletal muscles (to look out for myopathy etc)
- Removal of ribs for sampling (3 ribs maximum)
- Removal of portion of spinal cord
- Breaking down of digestive system complex
From the posterior
a. Removal of kidneys (for pediatrics, do not remove kidneys from capsules). Keep in mind the removal of renal tubules along with the kidneys
b. Removal of adrenal
c. Removal of pancreas
d. Removal of heart and lungs as a complex. Formalin is injected into the lungs and heart to inflate the organs.
e. Removal of stomach (the stomach is cut open)
f. Liver: Removal of anterior (more effective fixation)
Finishing up
- Disposal of all sharps
- Excess parts are to be returned to the body (the incisions will be patched up by glue, returning the baby's physiological shape to the way it is before the autopsy)
- Fix all organs that were retrieved
Processing in cassettes
- All parts that are taken from the body are to be placed into cassettes for processing in the tissue processor before embedding
- All organs that are to be put into cassettes are to maintain a spare portion in case more samples are needed.
It may be disgusting, especially to imagine it, but after a few looks, it'll seem fine. Hahahaha!
Amazingly too, if you're not very confident about your Human Anatomy, somehow just by looking at an autopsy, where all the organs are removed piece by piece, somehow just by looking you can just memorised the entire basic anatomy of the human body...it's easier somehow just by looking at it in real life.
Well there isn't much to ask also~ it's just steps and procedures. But I'll try to answer questions if you have them. I'll try my best! =D
Happy SIP!
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Hey, Sherman. Indah here. A very unique post. And you actually have the guts to view this. Can I ask what is the purpose of doing a FULL post mortem of the stillborn baby? What kind of pathological findings are you expected to find in a stillborn baby?And lastly is there like a time period to carry out the postmortem on the baby?
ReplyDeleteThanks.
Indah.
0705361D
Hey Sherman,
ReplyDeleteTiong Han here.
Amazing experience you have there. Anyway, are all stillborn babies complusory to go throught this procedure?
Or is it like a random pick for study?
Tiong han
0703762E
Hi Sherman,
ReplyDeleteSounds really interesting! Did you get the chance to see an adult autopsy?
Anyway, you said that the organs are removed from superior to inferior sections of the body, why is the intestine removed first before the removal of stomach? And will they take the body for regrossing if specimen is insufficient?
Thanks:)
Lok Pui
HEY ALL! HAHAHAHAHAH! This is so cool! 3 comments all in 1 day! XDDD
ReplyDeleteAll your questions look so difficult to answer =x but i'll try ~ otherwise I'll enquire for you all
To Indah:
Hahaha! The first experience wasn't that impressive...had to close my eyes from time to time when they perform the incision, like so disgusting! But after seeing 3 or 4 post mortems, it's fine already.
K erm the reason to perform a post mortem is because technically the baby is a stillborn ~ so there has to be a reason why it died this way yes...something that occurred to the baby that caused this to happen, so this the pathologist have to find out. Therefore a full post-mortem has to be conducted on every organ possible to find out the underlying cause.
What kind of pathological findings you can find...erm I'm not entirely sure. But I can give you 3 things I've seen so far.
#1
The first one I saw, the baby has this disorder where her right lung is bigger than her left lung...and somehow this disorder came about which brought further complications along the way, and unfortunately through this, the baby died
#2 and #3
This ones I asked very briefly at that time only, so as not to disturb the pathologist at work. The baby was at a stage of which its organs are already developed, but not fully (approx 4mths to 5mths of pregnancy)...however for both babies, their brains were liquified. So logically, no brain means no life...thus resulting in their deaths.
All these 3 babies are around 4-5mths old, roughly around the size of your average pencil-case, about the height of 20cm+ only (well they were the biggest I've seen so far)
Time period for post mortem hmmm if you're saying for the TIME OF THE DAY to peform the post-mortem, it can be done anytime during laboratory hours as long as the pathologist in charge is available. Each post mortem takes at least approximately 2 hours to conduct, and about 30mins to assemble and regain the baby's physical state before autopsy through surgical glue.
That's about all I can help to answer for your question. Any more feel free to ask k =DDD
Good Luck for your SIP! =DD
Sherman (0703326I)
To Tiong Han:
ReplyDeleteLike I mentioned to Indah, it's a stillborn, therefore there has to be a reason for this to happen. So it has to go through this procedure.
Postmortem has to be done for stillborn, usually for the benefit for the parents to know why their child died...postmortem I believe is done upon request if this is the case. Logically it's not considered a random study TO THE LABORATORY, because a postmortem request is sent to the histopathology, so in the first place the department won't even know if there's gonna be a postmortem to begin with unless told. In addition it's the pathologist duty to report and diagnose the problem, therefore can't be considered a random study. (Sounds complicating...)
Postmortems CAN be used for studies. For example if pathological findings are found, it'll be photographed. And if there are pathological findings in the organs, it'll be blocked in the cassette and sectioned onto a microscope slide for the pathologist diagnosis yes? So all of these can be used for training of new pathologists, where they can view past archived slides and compare it with the pathologist diagnosis...and from there they'll learn.
Well there's all I can help for your question. Anything feel free to ask again
Good Luck for your SIP!!! =DDD
Sherman (0703326I)
To Lok Pui:
ReplyDeleteNo I didn't see, didn't get the chance to see, nor would I want to see HAHAHAHA! The first time I see baby post-mortem I had to close my eyes during incisions...the bigger the baby the more difficult is it to stomach =xx I think if I were to see an adult post-mortem I'll faint XDDD HAHAHAH!
The corpse is in an anatomical lying position, therefore it's a common practice to remove whatever is exposed first, therefore intestines because it's in the posterior.
Another reason is for organisation. In the procedure, all organs taken out are to be fixed as soon as possible. In addition, organisation is needed, especially for foetal organs (to prevent any organs lost that are taken out)
Ok this question is really interesting and the answer lies in the anatomy of the human body.
At the gastrointestinal section (from diaphram onwards towards the rectum), the intestines are located in the posterior section of the body, below the liver. Remember in the post I mentioned, after removing the intestines, the entire digestive system (from esophagus to rectum) will be removed as an entire complex. If you do not remove the intestines first, it'll be EXTREMELY difficult to remove the entirely digestive complex neatly without the intestines "spilling" out, and not to mention the complexicity to cut through the smooth muscles and fats of the organs in the anterior with the intestines in the way.
Sounds really chim...you have to picture the anatomy to fully understand it HAHAHAHAHA! Basically is because in the gastrointestinal system, the kidneys, adrenals etc are in the anterior and intestines are in the posterior.
The intestines are quite long also...so it's best to remove it first too (it'll be very messy. With small organs lying around and long intestines lying everywhere...it might cause complicatiions and probably a few organs missing if possible along the way =x).
It's all organisation and understanding on an anatomical basis =xx
Hopefully it helps =x otherwise I'll be more than happy to answer your questions again =))
Good Luck with your SIP! =DD
Sherman (0703326I)
Hello.
ReplyDeletefor those body tissues that are being processed, is it processed immediately just like routine processing, or must it be fixed overnight in formalin because the tissue is still quite fresh since it was from a post mortem?
thanks,
Ang Yu Hui
0702632A
To Yu Hui:
ReplyDeleteHi! They'll be fixed in formalin, however for these they'll be fixed for at least 2 days. As long as it's fixed it's fine. The brain is a large component and takes at least 2 day to fix. Then from there, all the organs fixed will be trimmed and processed into cassettes for routine processing.
Good Luck with your SIP =)