PHT 201 Final Study Guide

- temperature - circulatory - moisture - change in location of microorganisms

4 Types of Antemortem Agonal Period Changes

- physical - hypostasis - livor mortis - dehydration - increase in blood viscosity - movement of microorganisms

6 types of postmortem physical changes

sooner; more

A body treated with blood thinners or that has been refrigerated immediately after death may exhibit thinner blood, so livor mortis will establish itself ________ and may be ____ intense. (blood viscosity)

heme and formaldehyde.

A postmortem stain will have tendency to turn grey, which is result of mixing ________________

contact pallor

At points where the body is in contact with a surface (such as a body lying on an embalming table), you may see ______________, or areas where blood movement has been inhibited.

secondary flaccidity

At this point we say that rigor has passed, and this second state of muscle relaxation is aptly called __________________. Once it has passed or is forcibly "broken", rigor mortis does not return.

plasma; cells

Blood is made up of ______ and _____

water is a better conductor of heat

Bodies cool faster in water than in air because

cold stiffening of muscles

Body fats will solidify at 40° f, giving tissues a firmness similar to rigor. At or near freezing, tissues become firm and rigid.

- Temperature - Age - Gender - Cause of death - Condition of muscles

Conditions affecting onset, duration, and termination of rigor:

- cold stiffening of muscles - catalepsy - heat stiffening - cadaveric spasm

Conditions you might mistake for rigor:

without

Decay results in the breakdown of proteins _______ the accompanying foul odors you've heard so much about.

1. Cells 2. Tissues - liquid (blood and lymph) - soft (functional elements of organs) - firm tissues (muscles and stroma) - hard tissues (cartilage and bone) 3. Organs - infantile brain - pregnant uterus - lining of trachea & larynx - stomach - intestines - adult brain - heart - lungs - blood vessels - non-pregnant uterus

Decomposition in Histological Order

thicker; slows down; plug; stops; prevents

Dehydration causes blood to become _______, which __________ the flow of blood, begins to ____ capillaries, _____ circulation and _________ good drainage.

livor mortis

During arterial injection, a __________ discoloration can be cleared, but postmortem stain is left behind as a reddish color.

5 or 6.

During rigor mortis, the pH may be as low as __________.

heme; globin

Hemolysis releases hemoglobin from the red blood cells, which further decomposes into ____ (the part that has the red pigment and has the oxygen-carrying capability) and ______ (protein part).

True

How quickly a body decomposes is variable, depending on intrinsic (within the body) and extrinsic (outside the body) factors. (T/F)

True

If a body is embalmed during the actual stage of rigor mortis, it may be difficult to get good distribution. As proteins of muscles are tightly bound together, there is little reaction with preservative (T/F)

flexing, bending, rotating and massaging

If the body is in rigor when you begin to embalm, you'll want to "break up" the rigor by ______________ joints and muscles. This will make it easier for you to have the body properly positioned during embalming.

reduce

If thickening of blood occurs fast enough, it will ______ the degree of livor mortis (or discoloration) because blood won't move as fast into dependent areas. But generally, blood settles into dependent areas first, then becomes thicker.

rigidity

In general, the sooner ________ appears, the sooner it disappears, and the less intense it will be. The longer it takes to appear, and the longer it lasts, the more pronounced the rigidity.

the surrounding environment; desiccation

In the unprotected dead body, it will continue until the moisture content is equal to that of______________. If the surrounding environment is very dry, either naturally (ie, the desert) or artificially (ie, a mausoleum), ___________ could occur.

• age - stillborn infants, because of the absence of mrganisms in intestinal tract, decompose more slowly than infants that have breathed or been fed. The often dry tissues of the elderly retards decomposition. • gender - the higher moisture content and greater amount of subcutaneous fat in females may be a factor ... • corpulence - the obese will decompose more rapidly because of higher moisture content and greater retention of body heat. • cause/manner of death - • bacteria present in body - since decomposition is caused in part by bacteria, a high bacterial content in the body would accelerate decomposition. Septic conditions would be an example. • degree of hydration of body tissues - bacteria require moisture to grow. If tissues have excess moisture, (as in edematous tissues following congestive heart failure), decomposition is accelerated. If there has been great moisture loss, as from severe vomiting and diarrhea, decomposition will be delayed. • body heat - decomposition-causing bacteria like a warm environment; their optimal temperature for growth is 98 - 100° F. Body temperature in that range over an extended period will accelerate decomposition, while rapid cooling of the body retards it. • drugs

Intrinsic factors:

more

It is ____ intense in cases of asphyxia, particularly in carbon monoxide poisoning, where blood does not coagulate rapidly. (blood viscosity)

less

It is ____ intense in cases of hemorrhage or anemia due to the reduction of blood and pigment. (blood viscosity)

less

It is ____ intense in cases of lobar pneumonia, febrile diseases, and other conditions where blood coagulates quickly. (blood viscosity)

two

Livor mortis generally appears within _____ hours after death.

that lack an abundance of oil glands; they are areas that will be viewed

Moisture loss occurs most rapidly in areas ______________________, such as the fingertips, and areas, such as the eyelids and lips, that are covered by very thin mucous membranes. These areas are worthy of mention because, obviously, _______________________.

inhibits

Muscles in rigor do not decompose; remember, the pH of the body is acid during rigor mortis, and the acid ________ bacterial activity.

slightly alkaline (7.38-7.4)

Normal ph of blood and tissue fluid is ___________.

does not

Once broken or passed off naturally, rigor mortis ___________ return.

extravascular

Once in the tissue spaces, the discoloration is permanently fixed because it's _______________.

clostridium perfingens

One of the most troublesome microorganisms for embalmers is __________________, a gas-producing, anaerobic bacteria. If present in tissues, it can produce gases which distend tissues to the point where viewing may be impossible.

A. Carbohydrates B. Proteins C. Fats D. Firm protein E. Bones

Order of Decomposition in Body Compounds:

surrounding environment

Over time, the temperature of body will cool to the temperature of the __________________________ which is usually cooler than the body temperature.

physical or chemica

Postmortem pre-embalming changes can be either

slows

Since dehydration causes a loss of moisture, dehydration ____ the decomposition process.

intravascular

Since livor mortis is ____________, it can be removed by arterial injection/venous drainage

• temperature of the water - putrefaction is more rapid in warm water than cold. • nature of the water - it is more rapid in polluted vs. unpolluted, and also more rapid in fresh water vs. salt water (salt will act as a preservative and therefore slow the rate of decomposition) • movement of the water - it is more rapid in stagnant vs. running water. Please note: while the rate of decomposition is slower in water than in air, the rate is accelerated once the body has been removed from the water.

The above applies to bodies in air. How quickly a body decomposes in water depends on:

postmortem stain

The acidic tissues (during rigor mortis) cause cells to rupture. The rupture of red blood cells is called hemolysis, and begins 6-10 hours after death

surface evaporation

The body can easily become dehydrated after death because the tissues lose moisture to surrounding air. The liquid portion of blood can then move through the capillary walls into the tissues, and also eventually leaves by ______________. The remaining blood thickens due to loss of liquid. Also, gravity can draw off the liquid portion (hypostasis).

hydrolysis

The decomposition or breakdown of proteins, carbohydrates and fats is accomplished through a process known as _______

disinfect and preserve human remains; slowing

The embalming process attempts to _______________________, thereby _________ the rate of the chemical change of decomposition

1. algor mortis 2. liver mortis 3. post-mortem stain

The force of gravity will cause blood to pool in low areas of the body. Blood in the superficial capillaries will be seen as a discoloration of the skin, but that blood has not 'stained' the tissues; it can be moved out of the capillaries, thereby removing the discoloration. (Now, without looking back, which three physical changes did I just describe?)

fermentation

The hydrolysis (or decomposition) of carbohydrates under aerobic conditions

lipolysis

The hydrolysis (or decomposition) of fats

decay

The hydrolysis (or decomposition) of proteins by enzymes of aerobic bacteria

putrefaction

The hydrolysis (or decomposition) of proteins by enzymes of anaerobic bacteria

proteolysis

The hydrolysis (or decomposition) of proteins, regardless of the agent that causes it

saccharolysis

The hydrolysis (or decomposition) of sugars, regardless of the agent that causes it

muscular relaxation

The initial state of ____________ is called primary flaccidity. During this time, the pH of the body tissues is still alkaline, and is the best time for the body to be embalmed. If the body is not embalmed during this time, the muscles eventually contract (due, it is believed, to the depletion of another biochemical, ATP, which is a major source of the energy we derive from carbohydrates during life. ATP is necessary in order for muscles to relax). This is the state of rigor mortis.

- blood volume - blood viscosity

The intensity of livor mortis depends on

proteins

The muscles will remain in this contracted state until they soften and once again appear relaxed due to the breakdown of ____________, the second biochemical compounds to decompose in the dead human body.

- intrinsic factors - extrinsic factors

The rate at which a body cools is dependent on several variables:

8-20 hours after death (but may occur in a matter of minutes); 10-72 hours (but may remain for several days)

The time of appearance and disappearance of rigor is extremely variable, but in general, rigidity usually appears in from ________________, and usually lasts ___________________

Anabolism; Catabolism

The two phases of metabolism are:

postmortem interval

There are physical and chemical changes that take place in the body during the time that elapses between death and embalming that is also known as the

a. Heat b. Medication c. Disease Processes

Thicker blood, due to factors such as ________________ settle more slowly

True

Thinner, less viscous blood flows with less resistance and gravitates more readily. (T/F)

alkaline; acidic

This acid buildup causes the pH in the body to shift from slightly ________ which is what it is during life, to ________.

postmortem stain

This condition is not caused by the presence of blood in tissues after death; it is the pigment portion of the hemoglobin molecule in tissues.

alkaline; acidic; alkaline

When proteins break down (into alkaline end-products), the pH will shift back to ___________, and will not return to an _______ pH. During advanced decomposition, therefore, pH is ________.

stronger-than-average

With a postmortem stain, you will probably need to inject a __________ arterial solution, which will help to bleach the stained tissue.

do not; livor mortis

You ________ remove hypostasis by your arterial injection and venous drainage, it is ___________, or the discoloration, that is removed.

Heme

____ passes through the walls and pores of capillaries, moves into tissue spaces, and stains the tissues.

Age of the individual (intrinsic)

a child cools faster than an adult

postmortem stain

an extravascular blood discoloration caused by the hemolysis of blood

simple test to determine if discoloration is livor mortis and intravascular

apply pressure by pinching or pushing on a body area. If area pinched returns to normal color, discoloration is intravascular and can be removed during the embalming process.

cadaveric spasm

(ex. muscles in badly burned bodies) - they shorten, causing flexing of joints

more rapidly

bodies cool __________ in cold water than warm water

slower

bodies cool __________ in running water than in stagnant fluids.

Body coverings (extrinsic)

clothing and other coverings protect skin from direct exposure to environment, adds insulation, retards or prevents heat loss.

Agonal period

during which a body may be moribund

Body weight (intrinsic)

fat tissue helps insulate a body and slows cooling

Age

feeble rigidity in infants and elderly - onset rapid, duration brief, rigidity less intense ♣ In previously healthy adolescents and young adults - onset slow, duration lengthy, rigidity intense.

gender

generally, a male with greater degree of muscular build develops rigor more slowly, with longer duration and more intense rigidity than a female.

process; manifestation

hypostasis is a _______, livor mortis is the physical result or ________________ of that process.

Cause of death (intrinsic)

i. Diseases which cause fever elevate temperature and slows onset of algor mortis. ii. It will be slower in someone who had a much-higher-than-normal temperature prior to death from conditions such as sepsis, heat stroke, drugs such as cocaine or amphetamines; iii. Wasting diseases speed its onset

Blood Viscosity

if blood is thick and not readily subject to gravitation, this reduces intensity of livor mortis. Think of the blood as being too thick to enter the tiny, superficial capillaries, thus reducing the intensity of the discoloration.

Blood Volume

if excessive bleeding has taken place, there is less blood available to pool, and reduces the intensity of livor mortis

physical change

if the temperature of an area is lower than the temperature of the dead body, the body will cool to that temperature - the change from high temperature to lower temperature is a ____________

catalysts

in the presence of moisture, [substances known as] _________ begin chemical changes which split the proteins, carbohydrates, and fats, which are the main constituents of the human body, into amino acids, monosaccharides, and fatty acids and glycerin, respectively. The water molecule is broken apart, and new products are formed. Remember, the water reacts with these substances chemically, not physically; if you pour water on a piece of meat, a cup of sugar, or a cup of oil, you do not initiate their decomposition!

size of body (intrinsic)

larger persons cool more slowly, thin persons cool faster

duration

length of time it lasts once it develops

Extrinsic factors

outside the body

cause of death

people who die of exhausting diseases or during strenuous exercises rapidly develop rigor (and it remains for a short time) because the oxygen in tissues is already greatly reduced. Poisons which cause violent muscular contractions also tend to accelerate rigor.

body's chemical composition

physical changes are brought about by forces of nature, and while they may cause changes in the state of the body or its tissues, they do not change the ________________________.

Algor Mortis

post mortem cooling of the body

rigor mortis

postmortem stiffening of body muscles by natural body processes.

Mummification

process of [sometimes] embalming, then drying out the body. Like desiccation, it refers to extreme dehydration.

desiccation

process of drying out. Refers to extreme dehydration.

onset

refers to time required for rigidity to appear

Hypostasis

settling of blood to the dependent, or lowest, parts of the body (parts closest to the ground). Obviously this would change depending on position of body. Settling of blood also affected by constriction, ligatures, and any other factors that would impede free movement of blood in vessels.

Condition of muscles

since the amount or degree of rigidity depends to a large extent on the tissues affected, well-muscled bodies will present a marked degree of rigidity. ♣ The greater the muscular development at time of death, the slower the onset of rigor mortis, the greater the degree of rigidity, and the longer the duration.

Agonal edema

the accumulation of fluid in the tissues and body cavities prior to death

Catabolism

the breakdown phase, which releases energy. In this phase, chemical reactions break down complex organic compounds into simpler ones. Some of the released energy is used by the body for cellular functions, while the rest is converted to heat, some of which helps maintain normal body temperature, with excess heat lost to the environment.

Anabolism

the building phase - in living cells, chemical reactions that combine simple substances into more complex molecules. This requires energy. Example: (1) formation of bonds between amino acids, building them up into protein portions of enzymes, hormones, and antibodies. (2) The storage of fat as adipose tissue.

Agonal algor

the cooling of the body before death

Livor mortis

the discoloration that occurs as a result of hypostasis. The discoloration may first appear as dull, reddish patches, then take on deep reddish-blue appearance

Agonal fever

the increase in temperature of the body prior to death

Agonal dehydration

the loss of fluids or moisture in tissues prior to death

Agonal capillary expansion

the opening of the pores in the walls of the capillaries

decomposition

the separation or breakdown of biochemical compounds into simpler substances or smaller types of matter by the action of microbial and/or autolytic enzymes.

Agonal hypostasis

the settling of blood into dependent tissues of the body

Postmortem calorici

the slight rise in body temperature after death; most noticeable when a body was functioning in healthy manner prior to death, especially where there was vigorous physical activity prior to death.

catalepsy

vital signs feebly maintained and there's a pronounced rigidity over body which occurs during life a result of some nervous disorder. Not only can this not be relieved by force, but in this condition, the person is not dead!!

Agonal coagulation

when formed elements begin to clot and congeal

intrinsic factors

within the body

- agonal edema - agonal dehydration

2 types of Antemortem moisture changes

- agonal algor - agonal fever

2 types of Antemortem temperature changes

- agonal hypostasis - agonal coagulation - agonal capillary expansion

3 types of Antemortem circulatory changes

3 hours

After death, with the buildup of acid, there is a drop in ph of blood and tissue into the acid range - begins about ________ after death.

dehydration

As long as there is moisture in the tissues available to be evaporated, _________ occurs, both in living and dead bodies.

• temperature of environment o minimum=32° F - decomposition is inhibited at temperatures below this o optimum = 98° -100° F - rate of putrefaction is most rapid in this range o maximum = 120° F - temperatures consistently over this inhibits decomposition • moisture - putrefaction accelerated with free access of warm and humid air. Air that is dry and in motion accelerates dehydration and mummification • access of air - free access of air accelerates decomposition because, in addition to the microorganisms in and on the body, this air carries additional organisms to the body. Remember, aerobic organisms cause decay. o Casper's Law - the ratio of the rate of decomposition in air, water, and under pressure of the earth - the actual ratio is 1:2:8. This means that a body decomposes two times faster in air than if immersed in water, and eight times faster than if buried in the earth. o Make sure you understand this ratio. Many students are confused because they came to this class with the assumption that a body decomposes faster in water than it does in air. Casper's law is the opposite of that belief! See if this makes it clearer: you will see the same amount of decomposition in a body exposed to the air for one week as in a body floating in water for two weeks or buried in the earth for eight weeks. Did that help? • bacteria present in environment - remember, you read earlier that putrefaction is partly due to bacterial action. If the environment is heavily populated with bacteria, putrefaction will be accelerated. • pressure due to clothing or earth - as you saw above when I mentioned Casper's Law, pressure on the body from the earth or clothing provides protection from rapid decomposition. • vermin, including maggots, lice, rats - these little beauties do not cause decomposition, but they contribute to it as they eat away at a dead body.

Extrinsic factors:

a. Refrigeration b. Medication c. Disease Processes

Factors which affect viscosity of blood such as _________________ will influence speed at which postmortem hypostasis takes place.

• amino acids, which are reduced to amines, which could be solids, liquids or gases • amines • ptomaines, which are a special class of amines, and which are toxic by-products. These include cadaverine (said to be in the odor of urine and also present in bad breath), putrescine (the smell of rotting flesh), indoles and skatoles (both contribute to the characteristic odor of feces). Does that help give you an idea of what you will smell, hmmm, or do you need to hear more? OK - • end products such as ammonia and ammonia compounds, gaseous hydrogen sulfide (smell of rotten eggs), gaseous hydrogen phosphide (garlic-like odor), mercaptans (volatile liquids with an intolerable smell), methane gas, hydrogen, nitrogen, carbon dioxide and water. Now can you imagine the smell?

Putrefaction, on the other hand, reduces proteins to by-products that cause foul-smelling gases, color changes, and other problems for the embalmer. Those by-products include:

muscles

Rigor mortis affects only _________, and usually all muscles of body are affected - they all contract, which is why it's so much stronger than normal muscle contraction, where some muscles contract will others will be relaxed.

True (memorize)

Rigor mortis appears to begin in the involuntary muscles of eye, then the face, neck, upper extremities, trunk, lower extremities, and appears to pass from the body in the same order as onset. (T/F)

- it retards decomposition temporarily, because the acidity of the tissues retards bacterial activity - it restricts arterial fluid distribution, because of the shrinking of vascular paths by the contraction of (involuntary) muscles of arterial walls. - it gives a false impression of preservation because the rigidity of muscles may lead you to believe tissue firming has been achieved. - it reduces the coagulability of proteins and alters fluid chemical reactions, because the acidity of tissues in rigor reduces normal tissue protein to simpler substances which do not coagulate well in the presence of embalming chemicals. (and that's how embalming process achieves preservation, by the fixation or coagulation of tissue cell protein, where the protein is altered in such a way that it's no longer a suitable medium or food for bacterial growth.) - it can distort features and extremities, and may be difficult to create the appearance of complete relaxation.

Rigor mortis is of concern to embalmers for the following reasons:

Temperature

accelerated by heat, retarded by cold ♣ Elevation of temp of body itself at time of death usually hastens appearance ♣ minimum = 32°F ♣ optimum = 98°-100°F ♣ maximum = 120°F

Surrounding environment (extrinsic)

after a period of time, temperature of the body will match that of the environment. Refrigerating a body speeds algor mortis.

Dehydration

loss of moisture from body tissues by surface evaporation.

Moisture loss

obvious in areas where tissues are naturally thin and dry. Fingertips often become dry and shrunken long before other parts of the body shows signs of decomposition. Hands and fingers do not have numerous oil glands like the face.