Thanatology Dr. dr. Annisa Anwar M., SH., M.Kes., SpF Dept of Forensic Pathology & Medicolegal Fac. of Medicine UNTAD PALU

Arti dan Definisi Thanatos = Death Logos = Science Thanatology = Ilmu yang mempelajari tentang penyebab dan perubahan yang terjadi setelah kematian.

Tujuan dari Tanatologi 1. Diagnosis kematian (Scene ) 2. Penentuan waktu kematian (Alibi) 3. Prediksi sebab kematian 4. Prediksi cara kematian

Kematian Definisi : Apakah itu kematian? 1. Mati = Jiwa berpisah dengan jasmani 2. Brain death = Mati batang otak 3. Coma = Tidak Sadar yang dalam 4. Unconscious = Kesadaran turun /Pingsan 5. Wake = Live = Hidup /Sadar

Definisi Kematian Human = 2 dimensions (individual and collection of cells Individual = Mati = roh berpisah dgn jasad Kumpulan sel = kematian di tingkat selular Hidup ditandai : Adanya tanda tanda vital (vital signs) :Bernapas, Jantung berdetak/berdenyut dan otak berfungsi sehat =bicara berfikir.yang ditandai  adanya kebutuhan akan oksigen. Mati = Stop / berhentinya tanda tanda vital yang permanen dan tidak ada lagi kebutuhan oksigen Permanent Stop function of vital organ (lung, heart and brain) do not need Oxygen anymore

Defines Death (cont) 2. Cellular death= lack of Oxygen cells die. In the brain cell only lasting of 7 minutes 3. Brain death = Stop of brain function, even other organ still working due to respirator) 4. Indonesian Doctors Association (IDI,1989), follows death when is brain death

Bagaimana menentukan seseorang itu telah mati? Berhenti tanda tanda vital : jantung dan paru paru  10 menit Adanya alat Respirator (breathing apparatus) kriteria ini jadi tdk cocok lagi Now taken  “Brain death = is death” How to justify Brain death ? Diambil dari bagian otak yang paling akhir hidup (batang otak) yang lain sdh lewat

Bagaimana menentukan MBO (Mati Batang Otak)? No Response on command/ Loss of stimuli Reflexes of pupil, corneal, cough (-) Ice stimuli to inner ear disappear(-) Stopping respirator  no spontaneous response EEG flat (EEG = Rekam otak rata) Diperlukan # 3 doctors (Anesthetist, Neurologist and other)  ICU

Simple Test on Death Scene Tes penentuan kematian 1. Auskultasi (no breath and heart beat)  need time + place on larynx and chest 2. Winslow test: Gelas air diletakkan diatas perut (bila goyang airnya = hidup) 3. Mirror Test : Mirror and spectacle damp / blurred  still alive 4. Feather Test : moving of Chicken feather or cotton on nostril –due to respiration alive

II. Changes after death = Perubahan setelah mati Face Muscle relaxation Eyes Body temp Livor Mortis Rigor Mortis (Stiffness) Putrefaction (Decay/Decomposition)

Kulit Wajah Face = Wajah  Pucat karena tdk ada darah yang mengalir lagi. Kecuali pada kasus keracunan CO = merah sperti buah cherry disebut  Cherry Red

Relaksasi Otot Relaksasi otot dan penurunan tonus otot, shg rahang menjadi turun, mulut terbuka (perlu di ikat). Relaksasi otot – otot wajah  a younger looking than his real age. Pupil (eye)  melebar / dilatasi Relaksasi otot-otot mulai dari :jantung, otot leher, wajah  ektremitas sup dan bagian lain dari badan weak toneless

Perubahan pada mata No shine (damp sight) empty (death fish eye) Light and corneal reflexes (-) Retinal Vein damage in 10 seconds Corneal = Selaput bening mata  dry and blurred Decrease of eyeball tone (softness of eye ball) = bola mata lembek / kempes

Body Temperature = Suhu Badan Decrease of body temp (dingin) Except =Kecuali pada keadaan bacterial infection (sepsis  warm) Depend on vicinity temperature = temp sekitar Location / Medium (di Air > cepat dingin dari di ruangan) Body constituent /bentuk : Kurus > gemuk Clothing /Pakaian : Thin > thick Estimation only = berlaku bila mati dalam < dari 12 jam

Livor Mortis = Lebam Mayat Due to gravity force (gaya gravitasi) Blood pool into blood vessel on the lower surface Occurred 1- 2hours after death Potision lie on the back appear on the back of the body, back, buttock, and extremities and vice versa > 4 hrs capillary and blood corpuscle damage  livor permanently (> 4 jam jadi permanen) >12 hrs livor will not changes anymore (tdk berubah) Color of Livor : Red (Cherry red  CO) Coklat  Chlorate /racun peptiside Hitam  Asphyxia

DEFINISI Nama lain livor mortis ini antara lain lebam mayat, post mortem lividity, post mortem hypostatic, post mortem sugillation, dan vibices. Livor mortis adalah suatu bercak besar berwarna merah kebiruan atau merah ungu (livide) pada lokasi terendah tubuh mayat akibat penumpukan eritrosit atau stagnasi darah karena terhentinya kerja pembuluh darah dan dipengaruhi gaya gravitasi bumi, bukan bagian tubuh mayat yang tertekan oleh alas keras. Lecture Notes in Forensic Medicine © Derrick Pounder, University of Dundee.

Dix J. Color Atlas of Forensic Pathology. USA: CRC Press. 2000.

Kaku Mayat = Rigor Mortis =Postmortem Rigidity ATP ADP + LA Small muscle first ( Face, palpebrae, Jaw) due to less of Glycogen Heart, neck, face, extremity and upper part of body and other seperti waktu relaksasi otot. Occur / Terjadi : 6 hours after death 12 hrs all part of the body stiff 12- 36 hrs persistent stiff (rigorous)u >48 hrs return of relaxation (Secondary)

Gambar 3. Rigor mortis Dix, J. Time of Death and Decomposition in : Color Atlas of Forensic Pathology. New York: CRC Press: 2000. p. 10-27.

Gambar 4. Cadaveric Spasme Shkrum, MJ., Ramsay, DA. Postmortem Changes The Great Pretenders in : Forensic Pathology of Trauma Common Problems for The Pathologist. New Jersey: Humana Press: 2002. p. 23-47.

Decay = Putrefaction = Decomposition Pembusukan Autolysis=Mikrobacteria Coecum region Gas putrefection 48 hrs = > 48 jam Change in color on right bottom region belly  Greenish Gas H2S + Hb  Sulf-Met-Hb

Putrefaction signs = Tanda Pembusukan.1 Greenish in color (Coecum region) Superficial vein dilatation Swelling of face Abdominal distended (gases) Scrotum / vulva Swelling Skin blister

Putrefaction signs = Tanda Pembusukan.2 Fluid come up through mouth and nose Tongue and eye ball protruded out Belly and chest blast due to gas pressure Hair and nail easy to pull or discharges Internal organ decays and porridge like uterus, brain, spleen , lung, kidneys. But a little lasting are prostate for male and uterus on female

Putrefaction Mulai timbul >24 jam post mortem Warna kehijauan diperut kanan bawah (dini) Pelebaran p.darah superficial Muka membengkak Perut menggelembung (gas) Skrotum / vulva membengkak Kulit Melepuh Keluar cairan darah dari mulut / hidung Lidah dan bola mata menonjol keluar

Special Circumstances = Keadaan khusus 1.Mummification: Mummy Dry of air , cool, low humidity no bacterial contamination after a few months Corpus smaller / shrinkage Dry Blackish in color Skin covered bones Odorless Anatomical composition intact 2. Adipocere (Saponifikation): occurred when

Mumifikasi Mumifikasi terjadi pada lingkungan yang panas dan kering dimana tubuh mengalami dehidrasi dan proliferasi bakteri yang terjadi minimal. Kulit berubah menjadi gelap, kering dan keras Mumifikasi dapat terjadi partial di mana bagian tubuh lain sudah mengalami dekomposisi, adiposera ataupun skeletonisasi

Saponification = Penyabunan Fat or fatty acid (asam lemak). Dari unsaturated fatty acid  saturated fatty acid (asam) Reaction with alkaline /alkali dari tanah forms  Salt (asam)+ alkali (base)  Garam (Salt not dissolve in water) Occurred in part of the body contains fat (check, omentum) White in color, Smell sting /tengik like decay of Coconut oil = minyak kelapa FAT + alkali  SALT (Soap)

Summary = Ringkasan 1. Thanatology and Purposes of Thanatology 2. Vital signs and death 3. Brain death 4. Changes after death 5. Postmortem changes (Early to late)

Reference. 1. Forensic Medicine 2. Forensic Pathology

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