ThanatologyThanatologyDr. Cahyono Kaelan Dr. Cahyono Kaelan Sp.PA(K), Sp.S., PhD., DFM.Sp.PA(K), Sp.S., PhD., DFM.

Dept of Forensic Pathology & MedicolegalDept of Forensic Pathology & MedicolegalFac. of Medicine Unhas Fac. of Medicine Unhas

MakassarMakassar

Arti dan DefinisiArti dan Definisi• Thanatos = DeathThanatos = Death• Logos = ScienceLogos = Science

• Thanatology = Ilmu yang Thanatology = Ilmu yang mempelajari tentang penyebab dan mempelajari tentang penyebab dan perubahan yang terjadi setelah perubahan yang terjadi setelah kematian.kematian.

Tujuan dari TanatologiTujuan dari Tanatologi

1. Diagnosis kematian 1. Diagnosis kematian (Scene )(Scene )

2. Penentuan waktu 2. Penentuan waktu kematian kematian (Alibi)(Alibi)

3. Prediksi sebab kematian3. Prediksi sebab kematian

4. Prediksi cara kematian4. Prediksi cara kematian

Kematian Kematian • Definisi : Apakah itu kematian?Definisi : Apakah itu kematian?

1. Mati = Jiwa berpisah dengan 1. Mati = Jiwa berpisah dengan jasmanijasmani

2. Brain death = Mati batang otak2. Brain death = Mati batang otak 3. Coma = Tidak Sadar yang dalam3. Coma = Tidak Sadar yang dalam 4. Unconscious = Kesadaran turun 4. Unconscious = Kesadaran turun /Pingsan/Pingsan 5. Wake = Live = Hidup /Sadar5. Wake = Live = Hidup /Sadar

Definisi KematianDefinisi KematianHumanHuman = 2 dimensions (individual and = 2 dimensions (individual and

collection of cellscollection of cellsIndividual = Mati = roh berpisah dgn jasadIndividual = Mati = roh berpisah dgn jasadKumpulan sel = kematian di tingkat selularKumpulan sel = kematian di tingkat selular

Hidup ditandai : Adanya tanda tanda vital (vital Hidup ditandai : Adanya tanda tanda vital (vital signs) :Bernapas, Jantung berdetak/berdenyut signs) :Bernapas, Jantung berdetak/berdenyut dan otak berfungsi sehat =bicara berfikir.yang dan otak berfungsi sehat =bicara berfikir.yang ditandai ditandai adanya kebutuhan akan oksigen. adanya kebutuhan akan oksigen.

Mati = Stop / berhentinya tanda tanda vital Mati = Stop / berhentinya tanda tanda vital

yang permanen dan tidak ada lagi kebutuhan yang permanen dan tidak ada lagi kebutuhan oksigen Permanent Stop function of vital oksigen Permanent Stop function of vital organ (lung, heart and brain) do not need organ (lung, heart and brain) do not need Oxygen anymore Oxygen anymore

Defines Death Defines Death (cont)(cont)

2. Cellular death= lack of Oxygen cells die. 2. Cellular death= lack of Oxygen cells die. In the brain cell only lasting of 7 minutesIn the brain cell only lasting of 7 minutes

3. Brain death = Stop of brain function, even 3. Brain death = Stop of brain function, even other organ still working due to respirator)other organ still working due to respirator)

4. Indonesian Doctors Association (IDI,1989), 4. Indonesian Doctors Association (IDI,1989), follows death when is brain deathfollows death when is brain death

Bagaimana menentukan Bagaimana menentukan seseorang itu telah mati?seseorang itu telah mati?

Berhenti tanda tanda vital : jantung dan Berhenti tanda tanda vital : jantung dan paru paru paru paru 10 menit 10 menit

Adanya alat Respirator (breathing Adanya alat Respirator (breathing apparatus) kriteria ini jadi tdk cocok lagiapparatus) kriteria ini jadi tdk cocok lagi

Now taken Now taken “Brain death = is death” “Brain death = is death”How to justify Brain death ?How to justify Brain death ?Diambil dari bagian otak yang paling Diambil dari bagian otak yang paling

akhir hidup (batang otak) yang lain sdh akhir hidup (batang otak) yang lain sdh lewatlewat

Bagaimana menentukan MBO Bagaimana menentukan MBO (Mati Batang Otak)? (Mati Batang Otak)?

• No Response on command/No Response on command/• Loss of stimuliLoss of stimuli• Reflexes of pupil, corneal, cough (-)Reflexes of pupil, corneal, cough (-)• Ice stimuli to inner ear disappear(-)Ice stimuli to inner ear disappear(-)• Stopping respirator Stopping respirator no spontaneous no spontaneous

responseresponse• EEG flat (EEG = Rekam otak rata)EEG flat (EEG = Rekam otak rata)• Diperlukan # 3 doctors (Anesthetist, Diperlukan # 3 doctors (Anesthetist,

Neurologist and other) Neurologist and other) ICU ICU

Simple Test on Death SceneSimple Test on Death SceneTes penentuan kematianTes penentuan kematian

1. 1. Auskultasi Auskultasi (no breath and heart beat) (no breath and heart beat) need time + place on larynx and chest need time + place on larynx and chest

2. 2. Winslow testWinslow test: Gelas air diletakkan diatas : Gelas air diletakkan diatas perut (bila goyang airnya = hidup)perut (bila goyang airnya = hidup)

3. 3. Mirror Test Mirror Test : Mirror and spectacle damp / : Mirror and spectacle damp / blurred blurred still alive still alive

4. 4. Feather Test Feather Test : moving of Chicken feather : moving of Chicken feather or cotton on nostril –due to respiration or cotton on nostril –due to respiration alivealive

II. Changes after death = II. Changes after death = Perubahan setelah matiPerubahan setelah mati•FaceFace•Muscle relaxationMuscle relaxation•EyesEyes•Body tempBody temp•Livor MortisLivor Mortis•Rigor Mortis (Stiffness)Rigor Mortis (Stiffness)•Putrefaction Putrefaction

(Decay/Decomposition)(Decay/Decomposition)

Kulit WajahKulit Wajah• Face = Wajah Face = Wajah Pucat karena tdk Pucat karena tdk

ada darah yang mengalir lagi.ada darah yang mengalir lagi.• Kecuali pada kasus keracunan CO = Kecuali pada kasus keracunan CO =

merah sperti buah cherry disebut merah sperti buah cherry disebut Cherry RedCherry Red

Relaksasi OtotRelaksasi Otot• Relaksasi otot dan penurunan tonus Relaksasi otot dan penurunan tonus

otot, shg rahang menjadi turun, mulut otot, shg rahang menjadi turun, mulut terbuka (perlu di ikat).terbuka (perlu di ikat).

• Relaksasi otot – otot wajah Relaksasi otot – otot wajah a younger a younger looking than his real age.looking than his real age.

• Pupil (eye) Pupil (eye) melebar / dilatasi melebar / dilatasi• Relaksasi otot-otot mulai dari :jantung, Relaksasi otot-otot mulai dari :jantung,

otot leher, wajah otot leher, wajah ektremitas sup dan ektremitas sup dan bagian lain dari badanbagian lain dari badan weak toneless weak toneless

Perubahan pada mataPerubahan pada mata• No shine (damp sight)No shine (damp sight) empty empty

(death fish eye)(death fish eye)• Light and corneal reflexes (-)Light and corneal reflexes (-)• Retinal Vein damage in 10 secondsRetinal Vein damage in 10 seconds• Corneal = Selaput bening mata Corneal = Selaput bening mata

dry and blurreddry and blurred• Decrease of eyeball tone (softness of Decrease of eyeball tone (softness of

eye ball) = bola mata lembek / eye ball) = bola mata lembek / kempeskempes

Body Temperature = Suhu Body Temperature = Suhu BadanBadan

• Decrease of body temp (dingin)Decrease of body temp (dingin)• Except =Kecuali pada keadaan bacterial Except =Kecuali pada keadaan bacterial

infection (sepsis infection (sepsis warm) warm)• Depend on vicinity temperature = temp Depend on vicinity temperature = temp

sekitarsekitar• Location / Medium (di Air > cepat dingin Location / Medium (di Air > cepat dingin

dari di ruangan)dari di ruangan)• Body constituent /bentuk : Kurus > gemukBody constituent /bentuk : Kurus > gemuk• Clothing /Pakaian : Thin > thick Clothing /Pakaian : Thin > thick • Estimation only = berlaku bila mati dalam Estimation only = berlaku bila mati dalam

< dari 12 jam< dari 12 jam

Livor Mortis = Lebam MayatLivor Mortis = Lebam Mayat• Due to gravity force (gaya gravitasi)Due to gravity force (gaya gravitasi)• Blood pool into blood vessel on the lower surfaceBlood pool into blood vessel on the lower surface• Occurred 1- 2hours after deathOccurred 1- 2hours after death• Potision lie on the backPotision lie on the back appear on the back of the appear on the back of the

body, back, buttock, and extremities and vice versabody, back, buttock, and extremities and vice versa• > 4 hrs capillary and blood corpuscle damage > 4 hrs capillary and blood corpuscle damage livor livor

permanently (> 4 jam jadi permanen)permanently (> 4 jam jadi permanen)• >12 hrs livor will not changes anymore (tdk berubah)>12 hrs livor will not changes anymore (tdk berubah) • Color of Livor : Red (Cherry red Color of Livor : Red (Cherry red CO) CO) • Coklat Coklat Chlorate /racun peptiside Chlorate /racun peptiside• Hitam Hitam Asphyxia 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 Kaku Mayat = Rigor Mortis =Postmortem RigidityRigidity

• ATPATP ADP + LAADP + LA• Small muscle first ( Face, palpebrae, Jaw) due to Small muscle first ( Face, palpebrae, Jaw) due to

less of less of GlycogenGlycogen• Heart, neck, face, extremity and upper part of Heart, neck, face, extremity and upper part of

body and other seperti waktu relaksasi otot.body and other seperti waktu relaksasi otot.• Occur / Terjadi :Occur / Terjadi : 6 hours after death6 hours after death 12 hrs all part of the body stiff12 hrs all part of the body stiff 12- 36 hrs persistent stiff (rigorous)u12- 36 hrs persistent stiff (rigorous)u>48 hrs return of relaxation >48 hrs return of relaxation

(Secondary)(Secondary)

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

Gambar 3. Rigor mortis

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

Gambar 4. Cadaveric Spasme

Decay = Putrefaction = Decay = Putrefaction = DecompositionDecomposition Pembusukan Pembusukan

• Autolysis=MikrobacteriaAutolysis=Mikrobacteria• Coecum regionCoecum region• Gas putrefectionGas putrefection• 48 hrs = > 48 jam48 hrs = > 48 jam• Change in color on right bottom Change in color on right bottom

region belly region belly Greenish Greenish • Gas H2S + Hb Gas H2S + Hb Sulf-Met-Hb Sulf-Met-Hb

Putrefaction signs = Tanda Putrefaction signs = Tanda Pembusukan.1Pembusukan.1

•Greenish in color (Coecum region)Greenish in color (Coecum region)•Superficial vein dilatationSuperficial vein dilatation•Swelling of faceSwelling of face•Abdominal distended (gases)Abdominal distended (gases)•Scrotum / vulva SwellingScrotum / vulva Swelling•Skin blisterSkin blister

Putrefaction signs = Tanda Putrefaction signs = Tanda Pembusukan.2Pembusukan.2

•Fluid come up through mouth and noseFluid come up through mouth and nose•Tongue and eye ball protruded outTongue and eye ball protruded out•Belly and chest blast due to gas pressureBelly and chest blast due to gas pressure•Hair and nail easy to pull or dischargesHair and nail easy to pull or discharges• Internal organ decays and porridge like Internal organ decays and porridge like

uterus, brain, spleen , lung, kidneys. uterus, brain, spleen , lung, kidneys. •But a little lasting are prostate for male But a little lasting are prostate for male

and uterus on femaleand uterus on female

PutrefactionPutrefaction• Mulai tMulai timbul >24 jam post mortemimbul >24 jam post mortem• Warna kehijauan diperut Warna kehijauan diperut kanan bawah (dini)kanan bawah (dini)• Pelebaran p.darah superficialPelebaran p.darah superficial• Muka membengkakMuka membengkak• Perut menggelembung (gas)Perut menggelembung (gas)• Skrotum / vulva membengkakSkrotum / vulva membengkak• Kulit MelepuhKulit Melepuh• Keluar cairan darah dari mulut / hidungKeluar cairan darah dari mulut / hidung• Lidah dan bola mata menonjol keluarLidah dan bola mata menonjol keluar

Special Circumstances = Keadaan Special Circumstances = Keadaan khususkhusus

1.Mummification:1.Mummification: Mummy MummyDry of air , cool, low humidity no bacterial Dry of air , cool, low humidity no bacterial

contamination after a few monthscontamination after a few months• Corpus smaller / shrinkageCorpus smaller / shrinkage• DryDry• Blackish in colorBlackish in color• Skin covered bonesSkin covered bones• OdorlessOdorless• Anatomical composition intactAnatomical composition intact

2. Adipocere (Saponifikation): occurred when2. Adipocere (Saponifikation): occurred when

MumifikasiMumifikasi• Mumifikasi terjadi pada lingkungan yang Mumifikasi terjadi pada lingkungan yang

panas dan kering dimana tubuh mengalami panas dan kering dimana tubuh mengalami dehidrasi dan proliferasi bakteri yang terjadi dehidrasi dan proliferasi bakteri yang terjadi minimal.minimal.

• Kulit berubah menjadi gelap, Kulit berubah menjadi gelap, kering dan keraskering dan keras

• Mumifikasi dapat terjadi partial di mana Mumifikasi dapat terjadi partial di mana bagian tubuh lain sudah mengalami bagian tubuh lain sudah mengalami dekomposisi, adiposera ataupun skeletonisasidekomposisi, adiposera ataupun skeletonisasi

Saponification = PenyabunanSaponification = Penyabunan• Fat or fatty acidFat or fatty acid (asam lemak). Dari (asam lemak). Dari

unsaturated fatty acid unsaturated fatty acid saturated fatty saturated fatty acid acid (asam)(asam)

• Reaction with alkaline /alkali dari tanah Reaction with alkaline /alkali dari tanah forms forms Salt Salt

• (asam)+ alkali (base) (asam)+ alkali (base) Garam Garam (Salt not dissolve in water)(Salt not dissolve in water)• Occurred in part of the body contains fat Occurred in part of the body contains fat

(check, omentum)(check, omentum)• White in color, Smell sting /tengik like decay White in color, Smell sting /tengik like decay

of Coconut oil = minyak kelapaof Coconut oil = minyak kelapa

• FAT + alkali FAT + alkali SALT (Soap) SALT (Soap)

Summary = RingkasanSummary = Ringkasan1. Thanatology and Purposes of 1. Thanatology and Purposes of

Thanatology Thanatology 2. Vital signs and death2. Vital signs and death3. Brain death3. Brain death4. Changes after death4. Changes after death5. Postmortem changes 5. Postmortem changes (Early to late)(Early to late)

Reference.Reference.1. Forensic Medicine 1. Forensic Medicine 2. Forensic Pathology2. Forensic Pathology

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