Characteristics of the stage of imbibition. Skin changes in the area of cadaveric spots

From Wikipedia, the free encyclopedia

Imbibition(lat. imbibere - absorb) - the third and last stage of the formation of cadaveric spots on dead flesh. Manifested 10-12 hours after death. A characteristic feature for this stage is the special "persistence" of purple-purple spots. When pressed, they do not become paler and do not disappear. It is used in forensic practice as a term for inaccurate determination of the time of death.

Process flow

Imbibition is applied to cases of impregnation of body tissues with some liquid (for example, blood during hemorrhages, dropsy liquid during edema). However, most often they talk about cadaveric imbibition - impregnation of the tissues of the corpse with blood hemoglobin. Cadaveric imbibition occurs 10-12 hours after death and consists in the fact that during the decomposition of blood, hemoglobin leaves the red blood cells and stains the blood plasma; in the future, plasma with hemoglobin seeps through the walls of blood vessels, impregnating the surrounding soft tissues. The most pronounced cadaveric imbibition is expressed in places of the greatest accumulation of blood, namely in the lower parts of the corpse.

Types of imbibition

The term imbibition is usually used to denote the impregnation of some denser material with one or another liquid medium. In this case, however, in the physical sense, the mechanism of this impregnation can be different:

Forensic examination

Cadaveric imbibition is of great forensic importance, as it can help establish the time that has passed since death. In addition, familiarity with the imbibition-dependent changes in the corpse is necessary for the forensic expert in view of the fact that such changes can sometimes simulate intravital hemorrhages from injuries, and in the lungs - pneumonia.

Write a review on the article "Imbibition"

Notes

Links

forensicmedicine.ru/wiki/Corpse_stains

An excerpt characterizing Imbibition

- Let's go, father. They deigned to leave at Vespers yesterday,” said Mavra Kuzmipisna affectionately.
The young officer, standing at the gate, as if hesitant to enter or not to enter, clicked his tongue.
“Oh, what a shame!” he said. - I wish yesterday ... Oh, what a pity! ..
Mavra Kuzminishna, meanwhile, carefully and sympathetically looked at the familiar features of the Rostov breed in the face of a young man, and the tattered overcoat, and worn-out boots that were on him.
Why did you need a count? she asked.
– Yeah… what to do! - the officer said with annoyance and took hold of the gate, as if intending to leave. He again hesitated.
– Do you see? he suddenly said. “I am related to the count, and he has always been very kind to me. So, you see (he looked at his cloak and boots with a kind and cheerful smile), and he wore himself, and there was nothing; so I wanted to ask the count ...
Mavra Kuzminishna did not let him finish.
- You could wait a minute, father. One minute, she said. And as soon as the officer released his hand from the gate, Mavra Kuzminishna turned and with a quick old woman's step went to the backyard to her outbuilding.
While Mavra Kuzminishna was running towards her, the officer, lowering his head and looking at his torn boots, smiling slightly, walked around the yard. “What a pity that I did not find my uncle. What a nice old lady! Where did she run? And how can I find out which streets are closer to catching up with the regiment, which should now approach Rogozhskaya? thought the young officer at that time. Mavra Kuzminishna, with a frightened and at the same time resolute face, carrying a folded checkered handkerchief in her hands, came out around the corner. Before reaching a few steps, she, unfolding her handkerchief, took out of it a white twenty-five-ruble note and hastily gave it to the officer.
- If their excellencies were at home, it would be known, they would, for sure, by kindred, but maybe ... now ... - Mavra Kuzminishna became shy and confused. But the officer, without refusing and without haste, took the paper and thanked Mavra Kuzminishna. “As if the count were at home,” Mavra Kuzminishna kept saying apologetically. - Christ be with you, father! God save you, - said Mavra Kuzminishna, bowing and seeing him off. The officer, as if laughing at himself, smiling and shaking his head, ran almost at a trot through the empty streets to catch up with his regiment to the Yauzsky bridge.
And Mavra Kuzminishna stood for a long time with wet eyes in front of the closed gate, shaking her head thoughtfully and feeling an unexpected surge of maternal tenderness and pity for the unknown officer.

IMBIBITION , imbibitio (from lat. imbibe - re-absorb), impregnation. The term I. is customary to denote the impregnation of some denser material by one or another liquid medium; at the same time, however, in physical sense, the mechanism of this impregnation can be different. In nek-ry cases it is possible to speak about molecular And., assuming in the basis of the mechanism of impregnation molecular adsorption of liquid by dense material; in other cases, the penetration of liquid into the tissue proceeds according to the laws of capillarity (capillary I.), in third cases, one can think of the swelling of colloids as the basis of I. Often, a combination of the above factors can also be assumed. In particular, I. can be attributed to the impregnation of fabrics with certain artificial dyes (I. paint); further, when impregnating certain integuments or other materials (for example, necrotic Peyer's plaques with typhus) with bile, they speak of I. bile; Impregnation of tissues with transuding fluid during edema is also I. - Finally, in pathology, anatomy and forensic medicine, cadaveric I. is of great importance, that is, impregnation of the tissues of a corpse with Hb decomposing blood. The essence of this phenomenon boils down to the fact that during cadaveric decomposition of blood, Hb is leached from erythrocytes and becomes dissolved in the plasma; in connection with this, the inner surface of the vessels and cavities of the heart, containing blood and blood clots, is exposed to I. Hb dissolved in the plasma, which is expressed in staining these parts in a dirty red color. In the future, due to the penetration of Hb-stained plasma through the walls of the vessels into the surrounding tissue, I. plasma with Hb of soft tissues located along the vessels occurs. The latter kind of phenomenon is observed first of all and is most pronounced in those places where there are cadaveric hypostases; at position of a corpse on a back such place is skin of a back surface of a trunk and extremities, on a cut as a result And. on the course of the veins stretched by blood there is an original network from brownish-crimson strips. Near the jugular veins (bulbus ven. jugul.) there is also a noticeably limited impregnation of loose fiber, resembling a bruise. From the internal organs of cadaveric I., the posterior sections of the lungs, the underlying loops of the intestines, the posterior wall of the stomach, the kidneys, the membranes, and the substance of the brain in their posterior parts are exposed. In particular, in the lungs with a pronounced I., the back parts become almost black and airless, and on the back wall of the stomach from the I., coffee-colored stripes appear along the blood-filled veins due to a change in Hb under the influence of the acidic contents of the stomach. Cadaverous I., belonging to the group of cadaveric changes, usually begins to be detected on a corpse 12-15 hours after death; however, cadaveric I. reaches its full development, expressed in the appearance of the above network on the skin of the posterior parts of the corpse and abrupt changes in the posterior sections of the lungs and other internal organs, only after 3-4 days. On the other hand, however, on the corpses of persons who died from septic processes, especially when the corpse is stored in a warm room, very intense manifestations of cadaveric I. occur within a few hours. the point of view of the phenomenon of cadaveric I. are important because in some cases they help to judge the time that has passed since death. Besides acquaintance to the changes depending on And., it is necessary for court. - medical. expert in view of the fact that such changes can sometimes simulate intravital hemorrhages from injuries, and in the lungs - pneumonia.

Learn:

PROTARGOL (Protargol, Argentum proteini-cum), a colloidal preparation of silver, in Krom protective colloid products are...

bruises(contusio, singular) - mechanical damage to soft tissues without a visible violation of the integrity of the skin. They occur when struck with a blunt object or when falling from a small height onto a flat surface. With bruises, as a rule, there is no gross anatomical damage to tissues or organs. bruises can be an integral part of wounds, such wounds are called bruised. bruises are also observed in closed bone fractures resulting from a direct blow (for example, the so-called bumper fractures).

Bruises usually damage small blood vessels, resulting in the development of interstitial hemorrhage. Its degree and prevalence depend on the area of damage, kinetic energy and the area of the traumatic object. So, with small blows in the thigh, buttocks, back (where there are many soft tissues), limited bruises occur, often without external manifestations and clinical symptoms. With bruises of the joints, damage to the vessels of the capsule is possible, which is accompanied by hemorrhage into the joint cavity. Hemorrhage into soft tissues leads to their impregnation (imbibition) with blood. In the case of an oblique direction of impact, detachment of the skin and subcutaneous tissue is possible with the formation hematomas. Hematomas with large cavities can subsequently be encysted with an outcome in traumatic cysts filled with hemolyzed blood (see. Hip). In rare cases, hematomas calcify (heterotopic ossification), for example, after hemorrhage into the thickness of the quadriceps femoris muscle. In areas where large blood vessels pass (femoral, brachial arteries), sometimes there are bruises or tears of the walls of blood vessels with their subsequent thrombosis. As a result, soft tissue necrosis is possible. With bruises in the area where the peripheral nerves (most often the ulnar, radial and peroneal) are located close to the bone, symptoms of loss of their function appear (see Fig. Neuritis). Usually, sensory and motor disorders pass quickly, but sometimes with intra-stem hemorrhages or hematoma compression, they persist for a long time.

The most common injuries are soft tissue injuries of the extremities or torso. The clinical signs of these bruises are pain at the site of application of force and traumatic edema. After some time (the period depends on the depth of the hemorrhage), a bruise appears on the skin. By its size, it is impossible to accurately judge the strength or nature of the blow. So, with the so-called deep bruises or with increased fragility of blood vessels (with hypovitaminosis C, in the elderly), extensive bruising occurs, descending down in relation to the site of injury under the influence of gravity. The color of the bruise serves as an important criterion for determining the prescription of a bruise, which is important in forensic practice (see. Damage in forensic medicine).

Treatment of soft tissue bruises within 1 day. It consists in the local application of cold for the purpose of hemostasis, reducing pain response and swelling. For this purpose, you can apply an ice pack, a heating pad with cold water, etc. to the damaged area. A pressure bandage with a lead lotion is applied to the area of limb bruises. Extensive bruises of the extremities must be differentiated from fractures and dislocations. In these cases, a transport tire is applied (see. Splinting) and the victim is taken to the surgical department. From 2-3 days to accelerate the resorption of hemorrhage, a warming compress, a warm heating pad, warm baths, and UHF therapy are prescribed. Somewhat later, massage and therapeutic exercises are used to prevent the development of contractures, especially with bruises of large joints or the periarticular zone. In cases of formation of a subcutaneous hematoma, with hemarthrosis, a puncture and removal of blood is indicated. In some cases, if the patient asked for help after organizing a hematoma, an incision in the skin and subcutaneous tissue is made to remove it.

The clinical picture, diagnosis and treatment of contusions of the brain and spinal cord - see. Traumatic brain injury, Spinal cord injury.

With bruises of the abdomen and lumbar region, damage to parenchymal organs is possible - ruptures liver, spleen, kidneys; hollow organs (for example, the stomach) are less likely to be injured. For the clinical picture, diagnosis and treatment of these lesions, see the relevant articles, for example, tears and bruises kidneys - in Art. kidney, bruises of the bladder - in Art. Bladder.

With a significant impact on the chest, damage to soft tissues is possible (see. Breast) and light. I degree lung contusions are characterized by small, difficult to diagnose subpleural hemorrhages. With bruises of the lung of the II degree, hemorrhages occur within the segment of the lung. III degree lung contusions are accompanied by the formation of traumatic cavities (hematomas) in one or both lungs. When lung tissue is ruptured, hemothorax, pneumothorax(or hemopneumothorax). Clinical signs of lung contusions are pain during breathing, restriction of chest excursion. Shortening of a percussion sound and easing of breath in a bruise zone is characteristic.

Often with closed chest injuries occur bruises hearts(for example, when your chest hits the steering wheel during a sudden sharp braking of a car). Severe heart contusions are accompanied by traumatic myocardial infarction. Victims complain of pain in the region of the heart, often collapse . Such bruises are often found with fractures of the sternum or ribs in the parasternal region. To clarify the diagnosis of heart contusion and traumatic myocardial infarction, electrocardiographic and echocardiographic studies are performed.

If bruises of the abdomen, chest or heart are suspected, emergency hospitalization in the surgical department is indicated. Abdominal contusions with damage to internal organs require laparotomy, in unclear cases, laparocentesis is used. The clinical picture, diagnosis and treatment of bruises of the external genital organs - see. Scrotum , Penis , Testis .

The prognosis of bruises depends on the place of application and the intensity of the traumatic force, as well as the nature of the dysfunction of the musculoskeletal system, internal organs, central nervous system, peripheral nerves and blood vessels. With light bruises, it is usually favorable. With severe, extensive bruises, especially vital organs, the prognosis is often unfavorable.

Bibliography: Krasnov A.F., Arshin V.M. and Zeitlin M.D. Handbook of traumatology, M., 1984; Sokolov V.A. Traumatology department of the polyclinic, p. 79, M., 1988: Handbook of emergency surgery, ed. V.G. Astapenko, p. 223, 414, Minsk, 1985.

IMBIBITION , imbibitio (from lat. imbibe-re-to absorb), impregnation. The term I. is customary to denote the impregnation of some denser material by one or another liquid medium; at the same time, however, in physical sense, the mechanism of this impregnation can be different. In nek-ry cases it is possible to speak about molecular And., assuming in the basis of the mechanism of impregnation molecular adsorption of liquid by dense material; in other cases, the penetration of liquid into the tissue proceeds according to the laws of capillarity (capillary I.), in third cases, one can think of the swelling of colloids as the basis of I. Often, a combination of the above factors can also be assumed. In particular, I. can be attributed to the impregnation of fabrics with certain artificial dyes (I. paint); further, when impregnating certain integuments or other materials (for example, necrotic Peyer's plaques with typhus) with bile, they speak of I. bile; Impregnation of tissues with transuding fluid during edema is also I. - Finally, in pathology, anatomy and forensic medicine, cadaveric I. is of great importance, that is, impregnation of the tissues of a corpse with Hb decomposing blood. The essence of this phenomenon boils down to the fact that during cadaveric decomposition of blood, Hb is leached from erythrocytes and becomes dissolved in the plasma; in connection with this, the inner surface of the vessels and cavities of the heart, containing blood and blood clots, is exposed to I. Hb dissolved in the plasma, which is expressed in staining these parts in a dirty red color. In the future, due to the penetration of Hb-stained plasma through the walls of the vessels into the surrounding tissue, I. plasma with Hb of soft tissues located along the vessels occurs. The latter kind of phenomenon is observed first of all and is most pronounced in those places where there are cadaveric hypostases; at position of a corpse on a back such place is skin of a back surface of a trunk and extremities, on a cut as a result And. on the course of the veins stretched by blood there is an original network from brownish-crimson strips. Near the jugular veins (bulbus ven. jugul.) there is also a noticeably limited impregnation of loose fiber, resembling a bruise. From the internal organs of cadaveric I., the posterior sections of the lungs, the underlying loops of the intestines, the posterior wall of the stomach, the kidneys, the membranes, and the substance of the brain in their posterior parts are exposed. In particular, in the lungs with a pronounced I., the back parts become almost black and airless, and on the back wall of the stomach from the I., coffee-colored stripes appear along the blood-filled veins due to a change in Hb under the influence of the acidic contents of the stomach. Cadaverous I., belonging to the group of cadaveric changes, usually begins to be detected on a corpse 12-15 hours after death; however, cadaveric I. reaches its full development, expressed in the appearance of the above network on the skin of the posterior parts of the corpse and abrupt changes in the posterior sections of the lungs and other internal organs, only after 3-4 days. On the other hand, however, on the corpses of persons who died from septic processes, especially when the corpse is stored in a warm room, very intense manifestations of cadaveric I. occur within a few hours. the point of view of the phenomenon of cadaveric I. are important because in some cases they help to judge the time that has passed since death. Besides acquaintance to the changes depending on And., it is necessary for court. - medical. expert in view of the fact that such changes can sometimes simulate intravital hemorrhages from injuries, and in the lungs - pneumonia.

Photo 1. Dead spots

cadaveric spots(lat. livores mortis) appear after the onset of death on the underlying parts of the body, are a sign of the onset of biological death. They belong to early cadaveric phenomena and represent areas of the skin, most often of a bluish-violet color. Dead spots appear due to the movement of blood through the vessels to the lower parts of the body under the influence of gravity (photo 2, 3).

Those areas where the corpse comes into contact with the surface of the bed on which it lies remain pale because the blood is squeezed out of the vessels. The folds of clothes leave imprints in the form of pale stripes against the background of cadaveric spots.

Time of development and stages of cadaveric spots

Appear 2-4 hours after cardiac arrest.

Stages of development of cadaveric spots

1. Stage of hypostasis

Stage of hypostasis- is the initial stage of the development of a cadaveric spot, begins immediately after the cessation of active blood circulation and ends after 12-14 hours. At this stage, cadaveric spots disappear when pressed. When changing the posture of the corpse (turning over), the spots can completely move to the underlying sections.

2. Stage of stasis or diffusion

Stasis or diffusion stage- cadaveric spots begin to pass into it approximately 12 hours after the onset of biological death. In this stage, there is a gradual thickening of the blood in the vessels due to the diffusion of plasma through the vascular wall into the surrounding tissues. In this regard, when pressed, the cadaveric stain turns pale, but does not completely disappear, and after a while restores its color. When changing the posture of the corpse (turning over), the spots can partially move to the underlying sections.

3. Stage of imbibition

Stage of hemolysis or imbibition- develops approximately 48 hours after the moment of biological death. When pressing on the cadaveric spot, there is no change in color, and when the corpse is turned over, there is no change in localization. In the future, cadaveric spots do not undergo any transformations, except for putrefactive changes.

Tissue fluids that accumulate in the underlying parts of the corpse penetrate into the blood vessels, thin the blood, causing hemoglobin to be leached from erythrocytes. The hemoglobin-stained liquid evenly stains the tissues.

In the overlying sections of the corpse - on the chest, neck, face, abdomen and limbs, where the blood in the vessels has become thicker due to loss of fluid, the processes of imbibition with such "concentrated" blood occur along the vessels and affect the appearance after 3-4 days (at an average t ° 15-23 °) on the skin of the putrid venous network: branching dark purple figures, putrid networks, which are a pattern of saphenous veins.

Differential diagnosis of cadaveric spots and intravital hemorrhages

Cadaveric spots may be mixed in some cases with bruising. You can distinguish a cadaveric stain from a bruise either by pressing on it with your finger, which makes the cadaveric stain turn pale, and the color of the bruise does not change, or by making an incision in the area under study with a belt. On the section of the cadaveric spot, the skin and tissue are uniformly colored lilac or slightly purple. From the cut vessels, droplets of blood protrude, easily washed off with water, the tissues on the cut do not differ in any way, except for the color, from the cut of pale skin. When a bruise is cut, the blood that has poured out of the vessels during life is released in the form of a dark red limited area that is not washed off with water. In the later stages of imbibition, pressure no longer causes a blanching of the cadaveric spot, and a pronounced bloody soaking of the tissues smoothes the boundaries of the existing bruises and may itself lead to mixing such imbibed areas with a bruise. The microscopic picture of the cadaveric spot does not represent anything characteristic and does not differ from unstained areas of the skin.

Against the background of cadaveric spots, small and large hemorrhages can form posthumously both in the skin and in deeper tissues from blood flow and subsequent rupture of blood vessels. They should not be confused with intravital ecchymosis. With T.'s position on the back, they can be found in the soft tissues of the occipital region, back, and neck; in the reverse position - in the muscles of the neck, chest. Especially sharply, such hemorrhages are expressed during asphyxial death, and they can give rise to mixing them with intravital bruising. Post-mortem hemorrhages can occur when an organ is injured, for example, when pulling the myocardium with tweezers; due to rigor mortis of the muscle, blood from damaged vessels is easily squeezed out here, giving something like hematomas. Hypostases of the internal organs can be mistaken for a stalemate. processes; in the meninges, cadaveric injection of blood vessels due to hyperemia; in the lungs due to hemorrhagic pneumonia, heart attacks, and in infants due to atelectasis; hypostases of the pancreas and its imbibition due to hemorrhagic pancreatitis. Posthumously, ecchymosis can also occur under the serous integument - peritoneum, pleura, epicardium. Life-time formation of ecchymosis is observed with rapidly occurring deaths - asphyxia, injuries, sudden death (in the conjunctiva, under the pleura, epicardium - Tardieu spots, in the soft tissues of the skull, in the tissue surrounding the esophagus and larynx in their upper sections, and other places). And intravital ecchymoses are sometimes so extensive that they can be mistaken for bruises formed from violent effects on tissues.

Significance of cadaveric stains for forensic medical examination of a corpse

Significance in ascertaining biological death

However, further analysis of the results of mathematical processing showed that the experimental data reject the hypothesis about the distribution of dynamometry data of cadaveric spots according to any mathematical regularity. Therefore, a specific digital gradation of dynamometry indicators for the corresponding intervals of the post-mortem period as an independent diagnostic test in forensic practice is unacceptable. Cadaveric spots are formed under the influence of many factors, this process is individual both for a particular corpse and for the area of localization of spots.

Currently, there are no scientifically based methods for determining the prescription of death by the state of cadaveric spots. The time for the restoration of the color of cadaveric spots after pressing on them can only be used for an approximate assessment of the duration of the onset of death when