Lesson 3 - Agonal & Postmorem Changes

Question 1

What are postmortem changes?

Answer 1

Normal processes that occur in a deceased human body - starting at the moment of death.

2 types:
- physical PM changes
- chemical PM changes

Question 2

Define physical PM changes

Answer 2

Changes in the physical state or condition of the body / its tissues

• occurs due to natural forces (ex. gravity)
• can rearrange molecules, but DOES NOT generate new chemical substances or change chemical composition in the body

Question 3

Define chemical PM changes

Answer 3

Occur as a result of chemical activities/reactions within the dead body.

• form OR break bonds between atoms
• creates new chemical substances and changes chemical composition of the body

Question 4

What are the 6 types of physical PM changes?

Answer 4

1. Algor morris
2. Hypostasis
3. Livor mortis
4. Dehydration
5. Increased blood viscosity
6. Endogenous invasion of microbes

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Question 5

Define Algor mortis

(physical PM change)

Answer 5

The gradual cooling of the dead body to the temperature of the surrounding environment.

Embalming Implications:
- affects rigid mortis (cold=slower, heat=faster)
- cool temp keeps blood in a liquid state (why bodies are kept in cooler)
- can increase livor morris and postmortem stain

Question 6

Define Hypostasis

(physical PM change)

Answer 6

The movement of blood/body fluids via gravity to dependant area of the body (aka areas closer to floor)

Embalming implications:
- causes livor mortis, leading to postmortem stain
- can result in edema in dependant areas

Question 7

Define Livor mortis

(physical PM change)

Answer 7

The intravascular blood discolouration of dependant areas (due to hypostasis)

Embalming implications:
- can be removed by arterial injection and blood drainage
- can lead to postmortem stain if left too long

Question 8

Define Dehydration

(physical PM change)

Answer 8

Loss of moisture from surface of body due to evaporation.

Embalming implications:
- increases blood viscosity
- discolour/wrinkle/shrivel skin tissue
- can slow down decomposition

Question 9

Define Increased blood viscosity

(physical PM change)

Answer 9

The thickening of blood as moisture is lost due to dehydration.

Embalming implications:
- increased blood coagulation (sludgy)
- causes bad fluid distribution and bad blood drainage

Question 10

Define Endogenous invasion of microbes

(physical PM change)

Answer 10

The relocation of indigenous microbes as metabolic processes stop.

Embalming Implications:
- accelerates decomposition
- unsanitary conditions for embalmer

Question 11

What are the 5 chemical PM changes?

Answer 11

1. Rigor mortis
2. Postmortem stain
3. Postmortem caloricity
4. Shifts in PH
5. Decomposition

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Question 12

Define Rigor mortis

(chemical PM change)

Answer 12

Temporary stiffening of muscles due to buildup of lactic acids

Embalming implications:
- causes extravascular resistance
- makes body positioning harder
- leads to tissue distension

Question 13

Define Postmortem stain

(chemical PM change)

Answer 13

Extravascular blood discolouration due to hemolysis

Embalming implications:
- cannot be fixed by arterial injection
- indicates longer delay between death and embalming

Question 14

Define Postmortem caloricity

(chemical PM change)

Answer 14

Temporary rise in body temp due to continued metabolic processes.

Embalming Implications:
- increases decomposition
- increases rigor mortis cycle

Question 15

Define Shifts in pH

(chemical PM change)

Answer 15

When the normal PH of body becomes more acidic during rigor mortis, then more alkaline with decomposition.

Embalming implications:
- both acidic and alkaline pH create conditions not suitable for preservation

Question 16

Define Decomposition (aka Putrefaction)

(chemical PM change)

Answer 16

When the body tissues are broken down at the molecular level into simpler substances.

Embalming implications:
- 5 cardinal signs of decomp
- poor distribution and drainage
- increases preservative demand

Question 17

What are the 5 cardinal signs of decomposition?

Answer 17

1. Discolouration
2. Odour
3. Gas
4. Purge
5. Skin slip

Question 18

Define somatic death

Answer 18

When the body loses ability to sustain physiological and metronomic activity. (death of the entire body)

Steps:
- Clinical death
- Brain death
- Biological death
- Postmortem cellular death

Question 19

Define clinical death

Answer 19

The cease of respiration and heartbeat.

(brain activity may still be present)

Question 20

Define brain death

Answer 20

Loss of all brain function, including brain stem.

Sequence of brain death:
1. (first) Cerebral cortex
2. Midbrain
3. (last) Brain stem

Question 21

Define biological death

Answer 21

The irreversable ceasing of function to simple body processes. The organs in the body no longer function.

Question 22

Define postmortem cellular death

Answer 22

The gradual process of individual cells dying following somatic death

Question 23

Describe the agonal period and how it effects the postmortem condition of the body

Answer 23

The agonal period occurs prior to death and is the final stages of dying.

If the agonal period is longer:
- disease processes have progressed
- secondary infections are present
- drug therapies have altered tissue conditions and chemical balances

Question 24

What are the 4 types of agonal changes that occur in the body prior to death?

Answer 24

1. Temperature changes (involves Agonal algor, Agonal fever)
2. Circulatory changes (involves Agonal hypostasis, Agonal coagulation, Agonal capillary expansion)
3. Moisture changes (involves Agonal edema, Agonal dehydration)
4. Translocation of microbes

Question 25

Define Agonal algor (agonal changes)

Answer 25

The decrease in body temperature prior to death.

Question 26

Define Agonal fever (Agonal change)

Answer 26

An increase in body temperate just prior to death. Common with infection and certain types of poisoning.

Question 27

Define Agonal hypostasis (Agonal change)

Answer 27

The settling of blood into the dependant areas of the body prior to death. Slows circulation down, and gravity becomes the overpowering force)

Question 28

Define Agonal coagulation (Agonal change)

Answer 28

Occurs as the circulation of blood slows and begins to clot and congeal prior to death

Question 29

Define Agonal capillary expansion (Agonal change)

Answer 29

The dilation of the pores within capillaries prior to death, in attempt to send more oxygen to the tissues and cells.

Question 30

Define Agonal edema (Agonal change)

Answer 30

An increase in the amount of moisture or fluids in the tissues and body cavities prior to death. Can result from disease processes, or from agonal capillary expansion.

Question 31

Define Agonal dehydration (Agonal change)

Answer 31

The decrease in the amount of moisture, or fluids, in the tissues and body cavities prior to death.

Question 32

Define the Transloaction of microbes (Agonal change)

Answer 32

The movement of microbes from one area to another prior to death.

Question 33

What is contact pallor

Answer 33

Areas of the dead body where blood movement has been stopped. (part of hypostasis) Appears bright red, and typically in places where the body is pressed against a surface. ex. someone who died lying on their stomach may have bright red marks all along the front of their body from blood pooling in those areas

Question 34

Do lower or elevated parts of the dead body dehydrate quicker?

Answer 34

More elevated parts of the body dehydrate quick due to lack of fluids in those areas. Lowers areas of the body contain the most fluids due to gravitational force.

Question 35

What is postmortem edema?

Answer 35

A swelling condition that may occur as a result of hypostasis (body fluids flowing towards lower parts of the body)

Question 36

Which has the greatest impact on decomposition: Lipids, Carbohydrates, or Proteins?

Answer 36

Proteins During decomposition, protein chains (peptide bonds) break down.

Question 37

Define autolysis

Answer 37

The self-decomposition of cells caused by enzymes (saprophytic bacteria and lysosomes)

Question 38

Which organ system is one of the last to decompose?

Answer 38

The vascular system

Question 39

Where does the first colour change occur in an unembalmed body? What is it caused by?

Answer 39

The right lower abdomen area turns greenish. Caused by hydrogen sulfide mixed with hemoglobin

Question 40

What is the basic cause of purge?

Answer 40

The buildup of gas in the abdomen or other parts of the body.

Question 41

What are the stages of rigor mortis?

Answer 41

1. **Primary flaccidity** - immediately after death, muscles still relaxed. (ideal for embalming) 2. **Active rigor** - muscles have stiffened and pH has shifted towards acidic. (not ideal for embalming) 3. **Secondary flaccidity** - rigor has subsided overtime, muscles have loosened, pH shifts towards alkaline (needs increased preservative since decomp is starting)