Editing Autopsy (section)

== Process ==
[[File:Cadaver dissection table - long shot.jpg|thumb|right|200px|[[Cadaver]] dissection tables are similar to those used in medical or forensic autopsies.]]
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. An evidence sheet is a [[sterilization (microbiology)|sterile]] sheet that covers the body when it is moved. If it is believed there may be any significant evidence on the hands, for example, [[gunshot residue]] or skin under the [[Nail (anatomy)|fingernails]], a separate paper sack is put around each hand and taped shut around the wrist.

There are two parts to the physical examination of the body: the external and internal examination. [[Toxicology]], [[Medical test|biochemical tests]] or [[genetic testing]]/[[molecular autopsy]] often supplement these and frequently assist the [[Pathology|pathologist]] in assigning the cause or causes of death.

=== External examination ===
At many institutions, the person responsible for handling, cleaning, and moving the body is called a [[diener]], the [[German language|German]] word for ''servant''. In the UK this role is performed by an Anatomical Pathology Technician (APT), who will also assist the pathologist in eviscerating the body and reconstruction after the autopsy. After the body is received, it is first [[Photography|photographed]]. The examiner then notes the kind of clothes – if any – and their position on the body before they are removed. Next, any evidence such as residue, flakes of paint, or other material is collected from the external surfaces of the body. [[Ultraviolet]] light may also be used to search body surfaces for any evidence not easily visible to the naked eye. Samples of [[hair]], [[Nail (anatomy)|nails]], and the like are taken, and the body may also be [[X-ray|radiographically imaged]]. Once the external evidence is collected, the body is removed from the bag, undressed, and any [[wound]]s present are examined. The body is then cleaned, weighed, and measured in preparation for the internal examination.

A general description of the body as regards [[ethnic group]], [[sex]], age, [[Human hair colour|hair colour]] and length, [[eye colour]], and other distinguishing features ([[birthmark]]s, old [[scar]] [[Tissue (biology)|tissue]], [[Nevus|moles]], [[tattoo]]s, etc.) is then made. A [[Dictation machine|voice recorder]] or a standard examination form is normally used to record this information.

In some countries,<ref>{{Cite web |title=Glossary:Autopsy |url=https://ec.europa.eu/eurostat/statistics-explained/index.php?title=Glossary:Autopsy |access-date=2024-03-02 |website=ec.europa.eu |language=en}}</ref><ref>{{Cite web |title=MEDICO-LEGAL SYSTEMS IN EUROPE {{!}} Office of Justice Programs |url=https://www.ojp.gov/ncjrs/virtual-library/abstracts/medico-legal-systems-europe |access-date=2024-03-02 |website=www.ojp.gov}}</ref> ''e.g.'', Scotland, France, Germany, Russia, and Canada, an autopsy may comprise an external examination only. This concept is sometimes termed a "view and grant". 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.<ref>{{cite web|last1=St Andrew's House|title=Inspectorate of Prosecution in Scotland – Death Cases: A Thematic Report on Liaison in Death Cases with Particular Reference to Organ Retention|url=http://www.gov.scot/Publications/2007/07/16093109/7|website=Scottish Government|language=en|date=18 July 2007}}</ref>

=== Internal examination ===
If not already in place, a plastic or rubber brick called a "head block" is placed under the shoulders of the corpse; hyperflexion of the neck makes the spine arch backward while stretching and pushing the [[Thorax|chest]] upward to make it easier to incise. This gives the APT, or pathologist, maximum exposure to the [[Torso|trunk]]. After this is done, the internal examination begins. The internal examination consists of inspecting the [[Organ (anatomy)|internal organs]] of the body by [[dissection]] for evidence of [[Major trauma|trauma]] or other indications of the cause of death. For the internal examination there are a number of different approaches available:
* a large and deep Y-shaped incision can be made starting at the top of each shoulder and running down the front of the chest, meeting at the lower point of the [[sternum]] (breastbone).
* a curved incision made from the tips of each shoulder, in a semi-circular line across the chest/decolletage, to approximately the level of the second rib, curving back up to the opposite shoulder.
* a single vertical incision is made from the sternal notch at the base of the neck.
* a U-shaped incision is made at the tip of both shoulders, down along the side of the chest to the bottom of the rib cage, following it. This is typically used on women and during chest-only autopsies.
There is no need for any incision to be made, which will be visible after completion of the examination when the deceased is dressed in a shroud.
In all of the above cases, the incision then extends all the way down to the [[Pubis (bone)|pubic bone]] (making a deviation to either side of the navel) and avoiding, where possible, transecting any scars that may be present.

[[Bleeding]] from the cuts is minimal, or non-existent because the pull of [[gravity]] is producing the only [[blood pressure]] at this point, related directly to the complete lack of cardiac functionality. However, in certain cases, there is anecdotal evidence that bleeding can be quite profuse, especially in cases of [[drowning]].

At this point, shears are used to open the chest cavity. The examiner uses the tool to cut through the ribs on the costal cartilage, to allow the sternum to be removed; this is done so that the heart and lungs can be seen [[in situ]] and that the heart{{snd}}in particular, the [[Pericardium|pericardial sac]]{{snd}}is not damaged or disturbed from opening. A PM 40 knife is used to remove the sternum from the soft tissue that attaches it to the mediastinum. Now the [[lung]]s and the heart are exposed. The sternum is set aside and will eventually be replaced at the end of the autopsy.

At this stage, the [[organ (anatomy)|organs]] are exposed. Usually, the organs are removed in a systematic fashion.  Making a decision as to what order the organs are to be removed will depend highly on the case in question. Organs can be removed in several ways: The first is the ''[[List of French expressions in English#En masse|en masse]]'' technique of Letulle whereby all the organs are removed as one large mass. The second is the en bloc method of Ghon.<ref>{{cite book
 | editor-last = Waters
 | editor-first = B. L.
 | year = 2009
 | title = Handbook of autopsy practice
 | volume = 420
 | publisher = Humana Press
 | location = Totowa, NJ
 | language = en
}}</ref> The most popular in the UK is a modified version of this method, which is divided into four groups of organs. Although these are the two predominant evisceration techniques, in the UK variations on these are widespread.

One method is described here: The pericardial sac is opened to view the heart. Blood for chemical analysis may be removed from the [[inferior vena cava]] or the pulmonary veins.  Before removing the heart, the [[pulmonary artery]] is opened in order to search for a blood clot. The heart can then be removed by cutting the inferior vena cava, the pulmonary veins, the [[aorta]] and pulmonary artery, and the [[superior vena cava]].  This method leaves the aortic arch intact, which will make things easier for the embalmer. The left lung is then easily accessible and can be removed by cutting the [[bronchus]], artery, and vein at the [[Root of the lung|hilum]]. The right lung can then be similarly removed. The abdominal organs can be removed one by one after first examining their relationships and vessels.

Most pathologists, however, prefer the organs to be removed all in one "block". Using dissection of the fascia, blunt dissection; using the fingers or hands and traction; the organs are dissected out in one piece for further inspection and sampling. During autopsies of infants, this method is used almost all of the time. The various organs are examined, weighed and tissue samples in the form of slices are taken. Even major [[blood vessel]]s are cut open and inspected at this stage. Next, the [[stomach]] and intestinal contents are examined and weighed. This could be useful to find the cause and time of death, due to the natural passage of food through the bowel during digestion. The more area empty, the longer the deceased had gone without a meal before death.

[[File:Streptococcus pneumoniae meningitis, gross pathology 33 lores.jpg|right|175px|thumb|A brain autopsy demonstrating signs of [[meningitis]]. The [[forceps]] (center) are retracting the [[dura mater]] (white).  Underneath the dura mater are the [[Meninges#Leptomeninges|leptomeninges]], which appear to be [[edema]]tous and have multiple small hemorrhagic foci.]]
[[File:Standard sections of brain.jpg|thumb|Autopsy of a brain after sectioning, showing a normal brain with the cerebrum cut in coronal sections, and the cerebellum, pons and medulla cut in horizontal sections. Standard sections for microscopic examination are annotated.]]
The body block that was used earlier to elevate the chest cavity is now used to elevate the head. To examine the [[brain]], an incision is made from behind one ear, over the crown of the head, to a point behind the other ear. When the autopsy is completed, the incision can be neatly sewn up and is not noticed when the head is resting on a pillow in an open casket [[funeral]]. The [[scalp]] is pulled away from the [[skull]] in two flaps with the front flap going over the face and the rear flap over the back of the neck. The skull is then cut with a circular (or semicircular) bladed reciprocating saw to create a "cap" that can be pulled off, exposing the brain. The brain is then observed in situ. Then the brain's connections to the cranial nerves and [[spinal cord]] are severed, and the brain is lifted out of the skull for further examination. If the brain needs to be preserved before being inspected, it is contained in a large container of formalin (15 percent solution of [[formaldehyde]] gas in buffered [[water]]) for at least two, but preferably four weeks. This not only preserves the brain, but also makes it firmer, allowing easier handling without corrupting the tissue.

=== Reconstitution of the body ===
An important component of the autopsy is the reconstitution of the body such that it can be viewed, if desired, by relatives of the deceased following the procedure. After the examination, the body has an open and empty [[thoracic cavity]] with chest flaps open on both sides; the top of the skull is missing, and the skull flaps are pulled over the face and neck. It is unusual to examine the face, arms, hands or legs internally.

In the UK, following the [[Human Tissue Act 2004]] all organs and tissue must be returned to the body unless permission is given by the family to retain any tissue for further investigation. Normally the internal body cavity is lined with cotton, wool, or a similar material, and the organs are then placed into a plastic bag to prevent leakage and are returned to the body cavity. The chest flaps are then closed and sewn back together and the skull cap is sewed back in place. Then the body may be wrapped in a [[shroud]], and it is common for relatives to not be able to tell the procedure has been done when the body is viewed in a [[funeral home|funeral parlor]] after [[embalming]].