Skeletal changes in adults occur with deficiency of vitamin C.
B
Defective mineralization is the central cause of bone changes
C
Bowing of legs
D
Cartilaginous overgrowth results in widening of the metaphyseal plate.
Q. 1
True about scurvy is:
A
Skeletal changes in adults occur with deficiency of vitamin C.
B
Defective mineralization is the central cause of bone changes
C
Bowing of legs
D
Cartilaginous overgrowth results in widening of the metaphyseal plate.
Ans.
C
Explanation:
Bowing of legs [Ref: Robbins 7/e p458; Nelson 18/c p251; Grainger Radiology 4/e p1942/
Scurvy results from a long-term deficiency of vitamin C.
Humans are unable to synthesize vitamin C, due to lack of the enzyme gulonolactone oxidase and therefore depend on dietary sources.
Vitamin C is not stored in the body, but is taken up by all tissues; the highest levels are found in the pituitary and adrenal glands.
This disorder occurs more frequently in children (particularly infants) than in adults, and for the most part, results from a diet of pasteurized or boiled milk. (This type of milk is deficient in vitamin C because the vitamin is inactivated by heat).
For scurvy to develop, the deficiency must be present for a long time of approx. 4 to 6 months. Therefore it is unlikely that the disorder will be seen before the age of 4-6 months.
The occurrence of scurvy in adults is rare, being seen mostly in patients suffering from chronic severe malnutrition.
Vitamin C is essential for the hydroxylation of lysine and proline in collagen formation.
The defect in collagen synthesis results in inadequate support of the walls of capillaries and venules leading to bleeding in the skin and in the gingival mucosa, haemarthroses, and subperiosteal hemorrhages. The gums are swollen and bleed easily. Bleeding in the skin causes petechiae, eccyhmoses, perifollicular hemorrhages.
Skeletal changes may also develop in infants and children. The pritnaly disturbance is in the formation of osteoid matrix, rather than in mineralization or calcification. (Rickets is characterized by the presence of excess osteoid and lack of calcification; whereas scurvy is associated with deficient osteoid and much calcified cartilage). The potential for skeletal lesions diminish with increasing age.
The skeletal changes are most pronounced in regions of active endochondral bone growth and therefore are best seen in the distal end of the long bones particularly of the lower extremity. Changes at the sternal ends of the ribs cause scorbutic rosary formation.
Key imaging features of scurvy or Vit. “C” Def
Osteoporosis
White line of Frank! (irregular but thickened white line at the growth plate, it represents the zone of well-calcified cartilage).
Pelkan’s spur (the zone of calcification extends beyond the margins of the metaphyses, resulting in periosteal elevation and inetaphyseal spurs)
Trummerfield zone or scurvy line (a transverse band of radioluscency subjacent to the white line of Frank!)
Winiberger’s sign (thin ring of increased density surrounding epiphyses)
Periosteal elevation (due to subperiosteal hemorrhage)
The weakened bones yield to the stresses of weight bearing and muscle tension, with bowing of the long bones of the lower legs and abnormal depression of the sternum.
Wound and fracture healing is impaired due to derangement of collagen synthesis.
Laboratory diagnosis of vitamin C deficiency is made on the basis of low plasma or leukocyte levels.
Q. 2
Primary metabolic bone disorder in scurvy is:
A
Decreased mineralization
B
Decreased osteoid matrix formation
C
Increased bone resorption
D
Decreased bone mass with normal mineralization and osteoid formation
Q. 2
Primary metabolic bone disorder in scurvy is:
A
Decreased mineralization
B
Decreased osteoid matrix formation
C
Increased bone resorption
D
Decreased bone mass with normal mineralization and osteoid formation
Ans.
B
Explanation:
There is disturbance in osteoid formation in scurvy. Decreased mineralization or calcification is characteristic of rickets. Reduced bone formation and increased bone resorption is seen in Ostoprorosis and diseases associated with increased PTH.
James Lind was a Scottish physician. In 1753 he published a treatise of the scurvy was published by James Lind.
Scurvy is a disease now known to be caused by a Vitamin C deficiency, but in Lind’s day, the concept of vitamins was unknown.
Ref: Diseases: Finding the Cure By Robert Mulcah.
Q. 4
In vitamin C deficiency, post translational modification of which amino acid is defective:
A
Lysine
B
Alanine
C
Glycine
D
Arginine
Q. 4
In vitamin C deficiency, post translational modification of which amino acid is defective:
A
Lysine
B
Alanine
C
Glycine
D
Arginine
Ans.
A
Explanation:
A i.e. Lysine
– Both vitamin C and vitamin K are required for post translational modificationQ.
– Vitamin C is required for post translational modification of proline & lysine in collagen synthesisQ.
– Vit K is required for post translational modification of glutamate residue for generation of clotting factorsQ.
Q. 5
Definitive sign of scurvy in X-ray –
A
Ringed epiphysis
B
Ground glass appearance
C
White line in metaphysis
D
Thin cortex
Q. 5
Definitive sign of scurvy in X-ray –
A
Ringed epiphysis
B
Ground glass appearance
C
White line in metaphysis
D
Thin cortex
Ans.
A
Explanation:
Ans. is ‘a’ i.e., White line in metaphysis
o Ringed epiphysis (Wimburger sign): It is white ring surrounding the epiphyseal centres of ossicification. It is relatively specific for scurvy.
White line in metaphysis (Freaenkel) can be seen in scurvy, healing rickets, Plumbism, severe PEM, congenital syphilis and acute leukemia
o Option b & d are not specific for scurvy.
Q. 6
Radiological findings of scurvy are A/E:
A
Epiphyseal widening
B
Metaphyseal porosis
C
Metapyseal infarction
D
Pelkan spur
Q. 6
Radiological findings of scurvy are A/E:
A
Epiphyseal widening
B
Metaphyseal porosis
C
Metapyseal infarction
D
Pelkan spur
Ans.
A
Explanation:
A i.e. Epiphyseal widening
Q. 7
About scurvy, all are true EXCEPT:
September 2012
A
Subperiosteal hematomas with tenderness
B
Separation of epiphysis
C
Raised serum alkaline phosphatase
D
Gingival bleeding
Q. 7
About scurvy, all are true EXCEPT:
September 2012
A
Subperiosteal hematomas with tenderness
B
Separation of epiphysis
C
Raised serum alkaline phosphatase
D
Gingival bleeding
Ans.
C
Explanation:
Ans. C i.e. Raised serum alkaline phosphatase
Scurvy
Bleeding into skin & joints,
Wimberger sign,
Pseudoparalysis etc.
Q. 8
All of the following are the features of scurvy except:
September 2009
A
Hyperkeratosis
B
Ecchymosis of lower limbs
C
Hypoglycemia
D
Bleeding gums
Q. 8
All of the following are the features of scurvy except:
September 2009
A
Hyperkeratosis
B
Ecchymosis of lower limbs
C
Hypoglycemia
D
Bleeding gums
Ans.
C
Explanation:
Ans. C: Hypoglycemia
One of the first signs of scurvy is the development of perifollicular hyperkeratotic papules, often on the shins. These appear as reddish/bluish bruise-like spots surrounding hair follicles. The central hairs are twisted like corkscrews that may break easily. The papules may join together to form large areas of palpable purpura or ecchymoses (bruises).
Gums may swell and become red, soft and spongy. Any slight friction may cause the gums to bleed. Often this results in poor oral hygiene and dental diseases.
Bleeding in the joints causes extreme discomfort and pain. Joints may be swollen and tender and the pain can be so severe that patients cannot walk.
Patients may complain of dryness, irritation, light intolerance, transient visual blurring and stickiness. Haemorrhaging (bleeding) beneath the conjunctiva and within the optic nerve sheath may also occur.
Anemia develops in 75% of patients as a result of blood loss into tissue, altered absorptions and metabolism of iron and folate, gastrointestinal bleeding and intravascular haemolysis.
Shortness of breath, low blood pressure, and chest pain leading to shock and death.
Q. 9
In scurvy all of the following radiological signs are seen except:
A
Pelican spur
B
Soap bubble appearance
C
Zone of demarcation near epiphysis
D
Frenkel’s line
Q. 9
In scurvy all of the following radiological signs are seen except:
A
Pelican spur
B
Soap bubble appearance
C
Zone of demarcation near epiphysis
D
Frenkel’s line
Ans.
B
Explanation:
Ans. Soap bubble appearance
Q. 10
Deficiency of which vitamin causes excretion of xantheurenic acid in urine ‑
A
Folic acid
B
Pyridoxin
C
Niacin
D
Vitamin B12
Q. 10
Deficiency of which vitamin causes excretion of xantheurenic acid in urine ‑
A
Folic acid
B
Pyridoxin
C
Niacin
D
Vitamin B12
Ans.
B
Explanation:
Ans. is ‘b’ i.e., Pyridoxin
Q. 11
Vitamin C deficiency causes ‑
A
Rickets
B
Scurvy
C
Beri-Ben
D
Megaloblastic anemia
Q. 11
Vitamin C deficiency causes ‑
A
Rickets
B
Scurvy
C
Beri-Ben
D
Megaloblastic anemia
Ans.
B
Explanation:
Ans. is ‘b’ i.e., Scurvy
Vitamin C deficiency causes scurvy.
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It is a modification of putrefaction, which occurs in the absence of moisture.
That is when there is excess air and warmth but no moisture (humidity), i.e. hot dry and windy climate, mummification takes place in place of normal putrefaction.
Thus mummification occurs in deserts, especially in summer and also in bodies buried in shallow grave in sandy soil.
Characteristics
Mummification is characterized by desiccation or drying of the dead body.
There is drying, dehydration and shrivelling of dead body.
Sites involved
It proceeds from exterior to interior.
Therefore first to be involved is skin, especially of exposed body parts like lips, nose tip, hands (fingers) and feet (toes).
The skin is shrunken, contracted, dry, brittle, leathery, stretched across bony prominences and rusty brown to black in color.
Internally
Internal viscera also dry up, darken in color and blend with each other to form a single mass.
Body emits smell like rotten cheese.
Facial features and injuries are well preserved, thus identification of body and cause of death can be determined (like adipocere formation).
Time
The time required for mummification varies between 3 months – 2 years. If properly preserved, a mummified body can remain for years.
Chronic arsenic or antimony poisoning favor mummification.
Medicolegal importance :
Identification of body (facial features are preserved)
Cause of death (injury marks are preserved)
Time since death can be estimated.
Exam Important
Mummification is characterized by desiccation or drying of the dead body.
Occurs when there is excess air and warmth but no moisture (humidity), i.e. hot dry and windy climate, mummification takes place in place of normal putrefaction.
Thus mummification occurs in deserts, especially in summer and also in bodies buried in shallow grave in sandy soil.
Body features and appearances are preserved but face is greatly distorted
Time since death can be estimated.
Don’t Forget to Solve all the previous Year Question asked on Late Postmortem changes – Mummification
Mummification is dessication/ dehydration or drying & shriveling of body tissue & viscera after death.Q Mummification is drying or dehydrationQ of cadaver & is modification of putrefactionQ. In which body features and appearances are preservedQ but face is greatly distortedQ
High temperature, dry (devoid of moisture) environment with free circulation of airQ are ideal conditions for mummification.
Q. 4
Mummification is seen in :
A
I.U.D. (Intrauterine death) fresh
B
I.U.D. late
C
Both
D
None
Q. 4
Mummification is seen in :
A
I.U.D. (Intrauterine death) fresh
B
I.U.D. late
C
Both
D
None
Ans.
B
Explanation:
B i.e. IUD late
Q. 5
Mummification is enhanced by ‑
A
Moist and hot air
B
Moist and cool air
C
Dry and hot air
D
Dry and cool air
Q. 5
Mummification is enhanced by ‑
A
Moist and hot air
B
Moist and cool air
C
Dry and hot air
D
Dry and cool air
Ans.
C
Explanation:
Ans. is ‘c’ i.e., Dry and hot air
Mummification
It is a modification of putrefaction, which occurs in the absence of moisture. That is when there is excess air and warmth but no moisture (humidity), i.e. hot dry and windy climate, mummification takes place in place of normal putrefaction. Thus mummification occurs in deserts, especially in summer and also in bodies buried in shallow grave in sandy soil.
Mummification is characterized by dessication or drying of the dead body. There is drying, dehydration and shriveling of dead body. It proceeds from exterior to interior. Therefore first to be involved is skin, especially of exposed body parts like lips, nose tip, hands (fingers) and feet (toes). The skin is shrunken, contracted, dry, brittle, leathery, streched across bony prominences and rusty brown to black in color. Internal viscera also dry up, darken in color and blend with each other to form a single mass. Body emits smell like rotten cheese. Facial features and injuries are well preserved, thus identification of body and cause of death can be determined (like adipocere formation).
Time required for mummification varies between 3 months – 2 years. If properly preserved, a mummified body can remain for years. Chronic arsenic or antimony poisoning favor mummification.
Medicolegal importance : (i) Identification of body (facial features are preserved), (ii) cause of death (injury marks are preserved), (iii) time since death can be estimated.
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Modification of the process of putrefaction in the dead body is (checked and is replaced) adipocere formation.
It is also called saponification
Process
Hydrolisation of fatty tissue into fatty acids.
Bacterial fat splitting enzymes and moisture are essential – Lecithinase.
Composed of saturated fatty acids by palmitic, stearic, hydroxystearic, olic acids
Yellowish white, greasy wax .
Body has an offensive sweet smell(Rancid smelling wax like substance)
Site
It forms at any site where fatty tissue is present.
It is usually formed first in the subcutaneous tissues of cheeks, breasts, buttocks, and abdomen.
The limbs, chest wall, or other parts of the body may also be affected.
Sometimes in infants and obese individuals, the whole body is converted in adipocere formation.
Time required
In summer-3 wks, in tropics-5 to 15 days.
Most common in
Bodies immersed in water or in damp, warm environment with relative lack of air.
Factors Affecting
Water is essential for the bacterial and enzymatic process of adipocere formation.
A warm moist anaerobic conditions favour adipocere formation.
Adipocere formation is more frequent in females, well-nourished mature newborns, and obese persons. Fetuses under seven months do not show adipocere formation.
Medicolegal Importance
Identification
When adipocere develops in the face, the facial features are preserved, helping in the identification.
Cause of death can be determined as injuries can be recognized.
Time since death can be estimated.
Exam Important
Adipocere is most commonly seen in the body immersed in water or in damp, warm environment with lack of air.
It is also called saponification
Modification of putrefaction
Body has an offensive sweet smell
Hydrolisation of fatty tissue into fatty acids.
Bacterial fat splitting enzymes and moisture are essential – Lecithinase.
Cl. welchii bacteria helpful in adipocere formation
It is usually formed first in the subcutaneous tissues of cheeks, breasts, buttocks, and abdomen.
Don’t Forget to Solve all the previous Year Question asked on Late Postmortem changes – Adipocere
Q. 1 Which of the following is a feature of adipocere?
A
Rancid smelling wax like substance
B
Foul smelling oily liquid
C
Has no particular smell
D
None of the above
Q. 1 Which of the following is a feature of adipocere?
A
Rancid smelling wax like substance
B
Foul smelling oily liquid
C
Has no particular smell
D
None of the above
Ans.
A
Explanation:
Adipocere = Saponification- hydrolysis and hydrogenation of fat (Olein and higher fatty acid) by lipases + lecithinase (Cl. Perfringens) hydrolysis, hydrogenation → with Ca+, NH3 → insoluble soap (whole fat to palmitic, oleic, stearic and hydroxy stearic acid). After death – fat contain – ½ % FA. In adipocere – FA ↑ 20% (1 month), 70% (3 months). Conditions for adipocere formation: Immersion in water, damp and warm climate + Enzyme lecithinase + fatty tissue. Sites: Buttocks, breast, face, and abdomen. Adipocere has offensive or sweetish smell earlier, later ammoniacal odour; Fresh adipocere– soft, moist, whitish, translucent and float on water, dissolved in alcohol and ether and gives yellow flame on burning, old adipocere hard and cracked appearance. Time required- 3 weeks to upto 3-6 months in summer. It may last for years or decades. Foetus < 7 mths – no adipocere.
Q. 2
Which among the following is NOT a feature of adipocere formation?
A
Develops in moist clay soil
B
Due to hydrolysis and hydrogenation of fat
C
Cheesy odour
D
First seen in subcutaneous fat deposit of cheek, buttocks etc
Q. 2
Which among the following is NOT a feature of adipocere formation?
A
Develops in moist clay soil
B
Due to hydrolysis and hydrogenation of fat
C
Cheesy odour
D
First seen in subcutaneous fat deposit of cheek, buttocks etc
Ans.
C
Explanation:
Adipocere has a offensive rancid or an unpleasant sweetish smell.
It occurs as a result of hydrolysis and hydrogenation of preexisting fats into higher fatty acids which later combines with calcium and ammonium ions to form soluble soap which resists putrefaction.
Ref: Textbook of Forensic Medicine and Toxicology by Narayan Reddy, Edition 23, Page – 137, 138.
Q. 3
Adipocere formation is characterized by all except:
A
Hydrolysis and hydrogenation of fat
B
Foulsmell
C
Cheesy odour
D
Develops in dampy clay soil in whole body
Q. 3
Adipocere formation is characterized by all except:
A
Hydrolysis and hydrogenation of fat
B
Foulsmell
C
Cheesy odour
D
Develops in dampy clay soil in whole body
Ans.
C
Explanation:
C i.e. Cheesy odour
Adipocere has a distinct offensive (rancid) odour or penetrating ammonical odour or sweetish smellQ
Q. 4
True about adipocere :
A
True about adipocere :
B
Also called saponification
C
Sweetish smell
D
b and c
Q. 4
True about adipocere :
A
True about adipocere :
B
Also called saponification
C
Sweetish smell
D
b and c
Ans.
D
Explanation:
B i.e. Also called Saponification; C i.e. Sweetish smell
Q. 5
Bacteria helpful in adipocere formation:
March 2004
A
Staphyococcus
B
E. coli
C
B. proteus
D
Cl. welchii
Q. 5
Bacteria helpful in adipocere formation:
March 2004
A
Staphyococcus
B
E. coli
C
B. proteus
D
Cl. welchii
Ans.
D
Explanation:
Ans. D i.e. Cl. welchii
Q. 6
All are features of adipocere, except:
MAHE 11; PGI 13
A
It consists of fatty acids
B
Takes place in bodies buried in dry sandy soil
C
Takes about 3 weeks to form
D
Bacterial enzymes are necessary for its formation
Q. 6
All are features of adipocere, except:
MAHE 11; PGI 13
A
It consists of fatty acids
B
Takes place in bodies buried in dry sandy soil
C
Takes about 3 weeks to form
D
Bacterial enzymes are necessary for its formation
Ans.
B
Explanation:
Ans. Takes place in bodies buried in dry sandy soil
Q. 7
Following is not true about adipocere formation ‑
A
It is a modification of putrefaction
B
It is developed in presence of air
C
It occurs in dead bodies lying in water
D
Body has an offensive sweet smell
Q. 7
Following is not true about adipocere formation ‑
A
It is a modification of putrefaction
B
It is developed in presence of air
C
It occurs in dead bodies lying in water
D
Body has an offensive sweet smell
Ans.
B
Explanation:
Ans. is ‘b’ i.e., It is developed in presence of air
Adipocere formation (saponification).
Adipocere is a modification of putrefaction, which occurs in the absence of air. That is when there is excessive moisture (humidity) and warnth (warm temperature), but absence of air i.e. warm humid climate, normal putrefaction does not occur, rather saponification occurs.
Thus adipocese formation occurs in dead bodies which are lying in water (immered in water) or burned in damp lay soil.
Saponification (adipocer formation) is the conversion of dead body into soft, fatty waxy substance due to conversion of unsaturated liquid fats to saturated solid fats under the influence of intrinsic lipase and lecithinase produced by Cl. perfringens. The process involves gradual hydrolysis and hydrogenation of body fats into higher fatty acids which combine with calcium and ammonium ions to form insoluble soaps. Ultimately, palmitic, oleic, stearic and hydroxystearic acids are formed, mixture of these is known as adipocere.
Adipocere formation starts in subcutaneous fat and is marked in areas having excessive fat, eg. cheeks, female breast, buttocks and abdomen. Slowly the whole body including muscles and internal viscera change into adipocere. Adipocere has offensive or sweetish smell, however in early stages, smell is ammonical.
Body is converted into soft, waxy and brittle substance, it floats on water, it can be cut easily, it dissolves in alcohol and ethers, and it melts on heating. Facial features and injuries on body are well preserved, thus identfication of body and determination cause of death (in case of injury) are possible.
Normally adipocere formation requires 3 weeks to upto 3 to 6 months. However shortest recorded period in india is 3 days 22 hours. In india, it has been observed to begin within 4-5 days. Adipocere may persist for years or decades. Adipocere does not occur in foetus less than 7 month’s.
Medicolegal importance : (i) Identification of body (facial features are preserved), (ii) cause of death (injury marks are preserved), (iii) time since death can be estimated.
Q. 8
Condition suitable for adipocere formation ‑
A
Cold and dry environment
B
Warm and dry environment
C
Warm and damp environment
D
Cold and damp environment
Q. 8
Condition suitable for adipocere formation ‑
A
Cold and dry environment
B
Warm and dry environment
C
Warm and damp environment
D
Cold and damp environment
Ans.
C
Explanation:
Ans. is ‘c’ i.e., Warm and damp environment
Adipocere
It is also called saponification
It is a modification of putrefaction
In this, the fatty tissues of the body change into substance known as adipocere.
It is most commonly seen in the body immersed in water or in damp, warm environment.
Moisture present, warmth present, air present → Putrefaction.
Moisture present, warmth present, air absent, i.e. warm humid climate → Adipocere formation (saponification).
Moisture absent, warmth present, air present, i.e. hot dry climate → Mummification.
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Amongst the soft tissues uterus in female and prostate in males are last to undergo putrefaction, as uterus and prostate resist putrefaction. Otherwise bones are last to undergo putrefaction, overall
STOMACH
Dark red patches over the walls
Perforation due to autolysis
LIVER
Softens and flabby
Becomes spongy ‘Foamy liver’
Honeycombing
Early putrefaction 24-48hrs
Larynx, trachea, brain of infants, stomach, intestines, spleen, omentum and mesentery, liver and adult brain.
Late putrefaction 2-3 weeks
Heart, lungs, kidneys, bladder, oesophagus, pancreas, diaphragm, blood vessels, prostate, testis and non gravid uterus, ovaries.
Factors causing delay of putrefaction
Temperature 48° C (very high temperature).
Dry weather and/or decreased air velocity.
More than 2 meter deep grave.
Tight clothing.
Body in dry soil, and body packed in coffin.
Infant not fed.
Wasting diseases like anemia.
Poisoning: Carbolic acid, ZnC12, strychnine (nux vomica), and heavy metals (arsenic, antimony).
In water slower than in air (casper’s dictum)
Caspers dictum.
Rate of decomposition in soil water and air- 1:2:8.
“According to an old rule of thumb (Casper’s dictum) one week of. putrefaction in air is equivalent to two weeks in water, which is equivalent to eight. weeks buried in soil, given the same environmental temperature”
Factors facilitating putrefaction
Free access of air
Moisture
Optimum warmth (10°C – 45° C).
Thus decomposition is fast in shallow damp, marshy shallow graves, in bodies without clothes and coffin.
Exam Important
Late Changes
Decomposition /
Putrefaction.
BACTERIAL ACTION
Action of bacterial enzymes on tissue components(lecithinase —Cl. welchii)
CHARACTERISTIC FEATURES
COLOUR CHANGES
First external sign of putrefaction in a dead body
Greenish discolouration of skin over caecum and flanks after death appears 18-24 hrs.
Greenish to black discolouration- ‘Sulphmethahaemoglobin’ formed by H2S due to microorganisms in the large intestine.
PRESSURE EFFECTS OF PUTREFACTIVE GASES
Displaces the diaphragm upwards
Discoloured fluid and liquefied tissue mixes with gases producing froth.
Shifting of the area of hypostasis.
Extrusion of fluid from the mouth and nose.(Post-mortem purge)
APPEARANCE OF MAGGOTS
Maggots are seen
on the dead body after 2-3 days
2-4 days in rainy season
INTERNALLY
Order of appearance of putrefaction from earliest to last is
Larynx, trachea > stomach, intestine > spleen, liver> brain, lungs >heart > kidney, bladder > uterus/prostate > bone Amongst the softtissues uterus in female and prostate in males are last to undergo putrefaction, as uterus and prostate resist putrefaction. Otherwise bones are last to undergo putrefaction, overall
LIVER
Softens and
flabby
Becomes spongy
‘Foamy liver’
Honeycombing
Factors
causing delay of putrefaction
Temperature 48°C (very high temperature).
Dry weather and/or decreased air velocity.
More than 2 meter deep grave.
Tight clothing.
Body in dry soil, and body packed in coffin.
Infant not fed.
Wasting diseases like anemia.
Poisoning:
Carbolic acid, ZnC12, strychnine (nux vomica), and heavy metals (arsenic, antimony).
In water slower than in air (casper’s dictum)
.Caspers dictum.
Rate of decomposition in soil water and air- 1:2:8.
“According to an old rule of thumb (Casper’sdictum) one week of. putrefaction in air is equivalent to two weeks in water, which is equivalent to eight. weeks buried in soil, given the same environmental temperature”
Factors facilitating putrefaction
Free
access of air
Moisture
Optimum warmth
(10°C – 45° C).
Thus decomposition is fast in shallow damp, marshy shallow graves, in bodies without clothes and coffin.
Don’t Forget to Solve all the previous Year Question asked on Late Postmortem changes – Putrefaction
Post-mortem purge is associated with the following:
A
Hypostasis
B
Rigor mortis
C
Post mortem lividity
D
Putrefaction
Q. 1
Post-mortem purge is associated with the following:
A
Hypostasis
B
Rigor mortis
C
Post mortem lividity
D
Putrefaction
Ans.
D
Explanation:
During putrefaction, discoloured natural fluids and liquified tissues are made frothy by gas.
Due to the presence of gas in the abdomen, the diaphragm is forced upwards compressing the lungs and heart, and blood stained froth exudes from the mouth and nostrils which is known as post-partum purge.
Ref: The Essentials of Forensic Medicine and Toxicology by K S Narayan Reddy, 27th edition, Page 146.
Q. 2
Honeycombing is seen in liver in case of :
A
Cirrhosis
B
Rupture
C
Putrefaction
D
Hydatid disease
Q. 2
Honeycombing is seen in liver in case of :
A
Cirrhosis
B
Rupture
C
Putrefaction
D
Hydatid disease
Ans.
C
Explanation:
C i.e. Putrefaction
Q. 3
Putrefaction is a :
A
Perimortem sign of death
B
Immediate sign of death
C
Early sign of death
D
Late sign of death
Q. 3
Putrefaction is a :
A
Perimortem sign of death
B
Immediate sign of death
C
Early sign of death
D
Late sign of death
Ans.
D
Explanation:
D i.e. Late sign of death
Q. 4
Putrefaction is facilitated by following except:
A
Very high temp
B
Free air
C
Damp environment
D
Shallow grave
Q. 4
Putrefaction is facilitated by following except:
A
Very high temp
B
Free air
C
Damp environment
D
Shallow grave
Ans.
A
Explanation:
A i.e. Very high temperature
– In females ovaries & non gravid uterusQ; and in males prostate & testisQ putrify very late only preceeded by skin, muscle, tendon & bone which are last organ to putrify. (in the same order)
– Due to involution of gases, the liver becomes spongy in W. putrefaction and it is k/a Foamy or Swiss cheese or Honey combed liverQ
– Greenish discolouration of flank over cecum i.e. right iliac fossaQ, which appears in about 12-24 hoursQ (6 hours in summer & > 24 hours in winter) is first external sign of putrefaction (decomposition).
– In females ovaries & non gravid uterusQ; and in males prostate & testisQ putrify very late only preceeded by skin, niuscle, tendon & bone which are last organ to putrify. (in the same order)
Casper’s dictum relates to the rate of putrefaction of a dead body and helps in estimation of time since death.
Putrefaction is arrested below 0°C & above 48°CQ as the activity of microorganism stops.
Putrefaction is facilitated by free access of air, moisture & optimum temperature (10°C-450C), so decomposition is fast in shallow damp, marshy gravesQ in bodies without clothes & coffin.
Q. 5
Maggots in rainy day are seen within
A
6 hours
B
1-2 days
C
2-4 days
D
5-6 days
Q. 5
Maggots in rainy day are seen within
A
6 hours
B
1-2 days
C
2-4 days
D
5-6 days
Ans.
C
Explanation:
C i.e. 2 – 4 days
Q. 6
Maggots are seen on the dead body after :
A
One day
B
2-3 days
C
3-4 days
D
One week
Q. 6
Maggots are seen on the dead body after :
A
One day
B
2-3 days
C
3-4 days
D
One week
Ans.
B
Explanation:
B i.e. 2-3 days
Q. 7
Foamy liver is seen in:
TN 08; UP 08; NIMS 11; NEET 13
A
Arsenic poisoning
B
Electrocution
C
Hanging
D
Putrefaction
Q. 7
Foamy liver is seen in:
TN 08; UP 08; NIMS 11; NEET 13
A
Arsenic poisoning
B
Electrocution
C
Hanging
D
Putrefaction
Ans.
D
Explanation:
Ans. Putrefaction
Q. 8
Last organ to putrefy in females is:
BHU 12
A
Kidney
B
Uterus
C
Brain
D
Spleen
Q. 8
Last organ to putrefy in females is:
BHU 12
A
Kidney
B
Uterus
C
Brain
D
Spleen
Ans.
B
Explanation:
Ans. Uterus
Q. 9
Sequence of putrefaction:
WB 07
A
Heart-brain-uterus-spleen
B
Spleen-brain-heart-uterus
C
Heart-spleen-brain-uterus
D
Heart-brain-spleen-uterus
Q. 9
Sequence of putrefaction:
WB 07
A
Heart-brain-uterus-spleen
B
Spleen-brain-heart-uterus
C
Heart-spleen-brain-uterus
D
Heart-brain-spleen-uterus
Ans.
B
Explanation:
Ans. Spleen-brain-heart-uterus
Q. 10
Following poisoning retards putrefaction:
NEET 13
A
Aluminium phosphide
B
Lead
C
Arsenic
D
Copper
Q. 10
Following poisoning retards putrefaction:
NEET 13
A
Aluminium phosphide
B
Lead
C
Arsenic
D
Copper
Ans.
C
Explanation:
Ans. Arsenic
Q. 11
Casper’s dictum is related to:
AI 09; MP 11
A
Identification of dead body
B
Calculation of time since death
C
Floatation of a dead body
D
Rate of putrefaction
Q. 11
Casper’s dictum is related to:
AI 09; MP 11
A
Identification of dead body
B
Calculation of time since death
C
Floatation of a dead body
D
Rate of putrefaction
Ans.
D
Explanation:
Ans. Rate of putrefaction
Q. 12
Putrefaction of body in air compared to earth is:
AP 07
A
Same
B
Two times
C
Four times
D
Eight times
Q. 12
Putrefaction of body in air compared to earth is:
AP 07
A
Same
B
Two times
C
Four times
D
Eight times
Ans.
D
Explanation:
Ans. Eight times
Q. 13
In which organ putrefaction is late ‑
A
Pancreas
B
Brain
C
Prostate
D
Intestines
Q. 13
In which organ putrefaction is late ‑
A
Pancreas
B
Brain
C
Prostate
D
Intestines
Ans.
C
Explanation:
Ans. is ‘c’ i.e., Prostate
Order of putrefaction
Order of appearance of putrefaction from earliest to last is :larynx, trachea > stomach, intestine > spleen, liver> brain, lungs > heart > kidney, bladder > uterus/prostate > bone.
Amongst the soft tissues uterus in femaleand prostate in males are last to undergo putrefaction, as uterus and prostate resist putrefaction. Otherwise bones are last to undergo putrefaction, overall
Q. 14
Last to undergo of putrefaction –
A
Lung
B
Spleen
C
Prostate
D
Heart
Q. 14
Last to undergo of putrefaction –
A
Lung
B
Spleen
C
Prostate
D
Heart
Ans.
C
Explanation:
Ans. is ‘c’ i.e., Prostate
Q. 15
Greenish discolouration at putrefaction is due to‑
A
MetHb
B
Sulph-meth Hb
C
Deoxy Hb
D
Carboxy Hb
Q. 15
Greenish discolouration at putrefaction is due to‑
A
MetHb
B
Sulph-meth Hb
C
Deoxy Hb
D
Carboxy Hb
Ans.
B
Explanation:
Ans. is ‘b’ i.e., Sulph-meth Hb
Q. 16
First external sign of putrefaction in a dead body as shown in the photograph below is ?
A
Purple coloration spread over the entire abdomen
B
Greenish discoloration over Right iliac fossa.
C
Greenish discolouration of dependent parts.
D
Blood stained froth from mouth.
Q. 16
First external sign of putrefaction in a dead body as shown in the photograph below is ?
A
Purple coloration spread over the entire abdomen
B
Greenish discoloration over Right iliac fossa.
C
Greenish discolouration of dependent parts.
D
Blood stained froth from mouth.
Ans.
B
Explanation:
Ans:B.)Greenish discoloration over Right iliac fossa.
Greenish dislocation of skin over right iliac fossa is the first sign seen in a decomposed body.
Stages of Decomposition A.)Fresh (1-2 days) Autolysis
This is the part of decomposition that happens almost instanly after death, when the human body starts loosing heat. The body goes through a process called Autolysis/Self-digestion, due to the actions of its own enzymes.
B.)Bloated (2-6 days) Putrefaction
Destruction of the soft tissues of the body is caused mainly by the action of bacterial enzymes, mostly anaerobic organisms derived from the intestines.
The characteristic features of putrefaction are:
(i) changes in the color of the tissues
The first external sign of putrefaction in a body lying in air is usually a greenish discoloration of the skin over the region of the cecum, which lies fairly superficially, and where the contents of the bowel are more fluid and full of bacteria.
Internally, this is seen on the under surface of the liver, where that organ is in contact with the transverse colon.
The color results from the conversion of hemoglobin of blood into sulphmet hemoglobin by the hydrogen sulphide formed in the large intestine and escaping into the surrounding tissues.
The green coloration then spreads over the entire abdomen, external genitals and then patches appear successively on the chest, neck, face, arms and legs.
The patches become dark-green and later purple and dark-blue.
They are at first scattered, but later on join together and the whole skin of the body appears discolored.
As a general rule, the organs show putrefactive changes in the following order.
(1) Larynx and trachea.
(2) Stomach, intestines and spleen.
(3) Liver, lungs.
(4) Brain.
(5) Heart.
(6) Kidneys, bladder.
(7) Prostate, uterus.
(8) Skin, muscle, tendon.
(9) Bones.
(ii) the evolution of gases in the tissues:
Gas bubbles accumulate in the tissues, causing crepitant, sponge-like feeling which soon begins to distend the body.
Discolored natural fluids and liquefied tissues are made frothy by gas.
Due to the presence of gas in the abdomen, the diaphragm is forced upwards compressing the lungs and heart, and bloodstained froth exudes from the mouth and nostrils (postmortem purge), which can be mistaken for the bleeding following antemortem injury.
(iii) the liquefaction of tissues.
Colliquative putrefaction begins from 5 to 10 days or more after death. The abdomen bursts and the stomach and intestines protrude.
C.)Decay (5-11 days)
Active decay- this part of decay is reconizeable by a great loss in mass(weight), this weight loss is caused by the ravinous feeding by maggots, and the leaking of the body’s decomposition fluids into the the environment around it
D.)Post-Decay (10-24 days)
Advanced Decay- this decay is marked by change in the soil surrounding the body that is, by now, leaking fluids. insect activity will start to lessen, and the surrounding plant life will start to die.
E.)Dry Stage (24+ days)
The final stage of decomposition results in the remains consisting primarily of bones, some dried skin and cartilage. There is typically no odour of decay at this point.
Skeletonisation- this the final act of human decomposition in a temperate climate it can take two years, in a hot climate it can happen as fast as two weeks, and in a cold temperature it can take longer. all moisture in the body is lost, and the bones are exposed and easily visible.
Q. 17
Major bacterial enzyme responsible for putrefaction‑
A
Hyaluronidase
B
Lecithinase
C
Metalloproteinase
D
Collagenase
Q. 17
Major bacterial enzyme responsible for putrefaction‑
A
Hyaluronidase
B
Lecithinase
C
Metalloproteinase
D
Collagenase
Ans.
B
Explanation:
Ans. is ‘b’ i.e., Lecithinase
Putrefaction
Produced mainly by the action of bacterial enzymes (lecithinase — Cl. welchii)
Anaerobic organism (from bowels)
Causing marked hemolysis and liquefaction in blood vessels and tissue spaces, thus producing following effects
Color changes : greenish discoloration in right iliac fossa abdomen —> genitalia -4 chest —> neck —> face – arms -4 legs. Superficial veins over the root of the limbs, thighs, sides of abdomen, shoulder, chest and neck are stained greenish-brown or purplish-red, marbled appearance in 36 to 48 hours (marbling).
Foul-smelling and breakdown of proteins and carbohydrates. Gases produced : CO2 + NH3 + CH4 mercaptans + mercaptans (noninflammable) + H2S (inflammable). Gas bubbles cause crepitation and give spongelike feeling. Blood-stained froth from mouth and nostrils is called postmortem purge.
Distension of body 36 to 48 hours
Anus and uterus prolapse : 2 to 3 days
PM blisters, face distroted : more than 3 days
Nail, skull sutures, and hair loss : more than 5 days
Skin shows slippage, comes off in glove and stocking fashion.
Postmortem luminescence due to : Photobacterium fischeri bacteria and Armillaria mellea fungi.
3.Liquefaction of tissues (colliquative putrefaction) : 5 to 10 days.
Putrefactive effusion : pleural cavity 60 to 100 ml.
Skeletonization of an uncoffined buried body occurs in about 1 year.
Order of appearance of putrefaction (earliest to last) : larynx, trachea —> Stomach, intestine —> Liver, spleen —> Brain, lungs —> Heart, kidney -4 Bladder, uterus/prostrate —> Skin, muscles, tendon -4 lastly, bones.
Uterus and prostate resist putrefaction (last to putrefy).
Entomology of the cadaver
Eggs of houseflies are deposited in 6 to 12 hours in nostrils, mouth, etc.
In 8 to 12 hours, maggots/larvae are produced from the eggs.
Maggots become pupae in 4 to 5 days.
Total time from egg laying to development into adult flies = 8 to 10 days.
Q. 18
Putrefaction is delayed in all except ‑
A
Warm moist atmosphere
B
Carbolic acid poisoning
C
Anemia
D
Heavy metals poisoning
Q. 18
Putrefaction is delayed in all except ‑
A
Warm moist atmosphere
B
Carbolic acid poisoning
C
Anemia
D
Heavy metals poisoning
Ans.
A
Explanation:
Ans. is ‘a’ i.e., Warm moist atmosphere
Factors causing delay of putrefaction
Temperature <0°C or > 48° C (very high temperature).
Dry weather and/or decreased air velocity.
More than 2 meter deep grave.
Tight clothing.
Body in dry soil, and body packed in coffin.
Infant not fed.
Wasting diseases like anemia.
Poisoning : Carbolic acid, ZnC12, strychnine (nux vomica), and heavy metals (arsenic, antimony).
In water slower than in air (casper’s dictum).
Factors facilitating putrefaction
Putrefaction is facilitated by (i) free access of air (ii) moisture and (iii) optimum warnth (10°C – 45° C). Thus decomposition is fast in shallow damp, marshy shallow graves, in bodies without clothes and coffin.
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