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In this chapter we will review the traumatic injuries to the organs of the abdominal cavity, which will include the esophagus, stomach, duodenum, jejunum, ileum, mesentery, appendix, colon, liver, gallbladder, and spleen. Although, much of the esophagus is within the thorax, for the sake of continutiy, it will be discussed with the gastrointestinal tract, most of which is located within the abdomenal cavity. There will also be a discussion, in a general sense, of the mechanisms of injury to the abdominal organs when the abdomen is subjected to blunt force trauma. We will first review the surface anatomy, as well as the anatomy of the abdominal cavity. The foundation of thought behind reviewing the anatomy is based on the fact that an understanding of the surface anatomy will give you some insight into what you can anticipate internally during your external examination. It will also give you a grasp of the dynamics involved which produced the external and internal traumatic injuries. Since this educational blog may also be used by medicolegal investigators, police officers and attorneys, who for the most part have little knowledge of anatomy, such a review may help them in having a better understanding of the relationship between the blunt force trauma applied to the victim and their injuries.
Traumatic Injuries of the Organs of the Abdominal Cavity- Adult and Pediatric
In this chapter we will discuss traumatic injuries to the chest wall and the thoracic viscera. Chest wall injuries include the skin, subcutaneous tissue, intercostal musculature, ribs, sternum, and parietal pleura. Thoracic visceral injuries include two main categories: (1) mechanical injuries of the respiratory system, which will include diaphragmatic rupture. The inclusion of diaphragmatic rupture is due to the fact clinically it presents with symptoms analagous to pneumothorax. (2) mechanical injuries of the cardiovascular system, which will include the mediastinum. This is primarily due to the fact the most common cause of a widen mediastinum is aortic rupture. We will also discuss the mechanisms of chest injury. Prior to a discussion of the blunt force traumatic injuries of the chest and mechanisms of chest injury, we will review the anatomy of the thorax.
In this article we will discuss those injuries produced by sharp-edged instruments, incised wounds, and pointed instruments with a sharp-edge or edges, stab wounds. This will be followed by a review of those injuries produced by instruments, which do not have a sharp-edge, but have a blunt point, such as found in barbecue forks, dinner forks, screwdrivers and scissors. Chop wounds and impaled injuries will be discussed. Mechanism and manner of death will then be reviewed. Fundamental concepts such as cardiac tamponade will be explained, as well as the function of various cellular structures, such as neutrophils, monocytes and lymphocytes, in the inflammatory reaction to trauma. There is a detailed review of the chronological histologic features of dating of incised and stab wounds, the purpose of which is to show there is sound scientific basis for the histologic dating of these injuries.
In this article we will review the gross and microscopic appearance of Blunt Force Traumatic Injuries and the mechanisms, which causes them. We will discuss abrasions, contusions, lacerations, fractures, compression and hemorrhage.
Now that we have reviewed the fundamentals of human anatomy, as well as various measurements and indices applied to skeletal remains we can apply this knowledge to the identification of skeletal remains.
This article is devoted to the utilization of the anthropologic landmarks of the skull in the determination of the various measurements and indices, which are then used as a foundation for identification. It also includes important anatomic landmarks of the upper and lower extremities, clavicle, scapula, sternum and pelvis, which are also utilized to determine the measurements and indices to aid in identification of skeletal remains.
When skeletalized remains are found, whether complete or incomplete, their examination should proceed in a scientific stepwise fashion, the purpose of which is to address a number of key points: Are the remains human? What are the sex, race, stature, and the age at the time of death? Are there any distinguishing characteristics either of an anatomic anomaly or pathology. Is there evidence of a cause of death? In this first article we will first review the fundamentals of human skeletal anatomy.
The process of postmortem decomposition can be divided into five stages: Fresh (autolysis), putrefaction, black putrefaction, butyric fermentation and dry decay. The first stage begins within minutes of death and last typically up to 36 to 72 hours before the beginning of putrefaction. The length of the first stage, as is true of the entire decomposition process, is primarily determined by environmental temperature. The first stage was discussed in the previous article entitled “Early Postmortem Decomposition.” In this article we will discuss putrefaction, black putrefaction, butyric fermentation and dry decay.
Subarachnoid hemorrhage (SAH) affects approximately 30,000 individuals per year in the United States, with an annual incidence of 1 per 10,000. In most populations primary non-traumatic SAH accounts for 5 to 9% of all strokes. SAH as the result of aneurysms is about 10 to 11 per 100,000 populations in Western Countries, with somewhat higher frequencies in the United States and Finland and among the Asian countries, Japan. It is lower in New Zealand and the other Scandinavian countries.
In this article we will discuss the changes, which occur following death and how they relate to time of death. We will address changes to the body in the early postmortem period, which include rigor mortis, livor mortis, algor mortis, external appearance of the eyes, stomach contents, chemical changes within the vitreous humor, evidence of insect activity and scene investigation.
EARLY POSTMORTEM CHANGES
