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Thanatology

Dr. Cahyono Kaelan


Sp.PA(K), Sp. S., PhD., DFM.

Dept of Forensic Pathology & Medicolegal


Fac. of Medicine Unhas
Makassar
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
(Anesthesiologist, Neurologist and
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.
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
THANK YOU