4. Internal examination113 261. The internal examination should clarify and augment the external examination insofar as injuries are concerned, and should identify and characterize any and all natural disease present. Remember to photograph the internal manifestations of injury and any other abnormalities identified. Ideally, photograph all organs and their cut surfaces. Before removing the organs, obtain fluid specimens, e.g. blood, urine, bile. (a) Be systematic in the internal examination. Perform the examination either by body regions or by systems, including cardiovascular, respiratory, biliary, gastrointestinal, reticuloendothelial, genitourinary, endocrine, musculoskeletal and central nervous systems. Record the volume, colour, consistency and nature of any collections of fluid, and retain samples for further investigation if required. Record the weight, size, shape, colour and consistency of each organ, and note any neoplasia, inflammation, anomalies, haemorrhage, ischemia, infarcts, surgical procedures, or injuries. Take sections of normal and any abnormal areas of each organ for microscopic examination. Take samples of any fractured bones for further radiographic and microscopic estimation of the age of the fracture (b) Examine the chest. Note any abnormalities of the breasts. Record any rib fractures, noting whether cardiopulmonary resuscitation was attempted. Before opening the chest, check for pneumothoraces. Record the thickness of subcutaneous fat. Immediately after opening the chest, evaluate the pleural cavities and the pericardial sac for the presence of blood or other fluid, and describe and quantify any fluid present. Save any fluid present until foreign objects are accounted for. Note the presence of air embolism, characterized by frothy blood within the right atrium and right ventricle. Trace any injuries before removing the organs. If blood is not available from other sites, collect a sample directly from the heart. Examine the heart, noting degree and location of coronary artery disease or other abnormalities. Examine the lungs, noting any abnormalities including the presence of blood or other material in the trachea and bronchi 114 42 (c) Examine the abdomen and record the amount of subcutaneous fat. Note the interrelationships between the organs. Trace any injuries before removing the organs. Note any fluid or blood present in the peritoneal cavity, and save it until foreign objects have been accounted for (d) Remove, examine and record the quantitative information on the liver, spleen, pancreas, kidneys and adrenal glands. Remove the gastrointestinal tract and examine the contents. Note (and photograph) any food present and its degree of digestion. Save the contents of the stomach. If a more detailed toxicological evaluation is desired, the contents of other regions of the gastrointestinal tract may be saved. Examine the rectum and anus for burns, lacerations, or other injuries. Locate and retain any foreign bodies present. Examine the aorta, inferior vena cava and iliac vessels (e) Examine the organs in the pelvis, including ovaries, fallopian tubes, uterus, vagina, prostate gland, seminal vesicles, urethra and urinary bladder. Trace any injuries before removing the organs. Remove these organs carefully so as not to injure them artefactually. Note any evidence of previous or current pregnancy, miscarriage, or delivery, and any surgery. Save any foreign objects within the cervix, uterus, vagina, urethra, or rectum (f) Palpate the head and examine the external and internal surfaces of the scalp, noting any trauma or haemorrhage. Note any skull fractures. Remove the calvarium carefully and note epidural and subdural haematomas. Quantify, estimate the age, and save any haematomas present. Remove the dura to examine the internal surface of the skull for fractures. Remove the brain and note any abnormalities. (Preferably, retain the brain in fixative for some days prior to examination, if possible, with the assistance of a neuropathologist.) Dissect and describe any injuries. Cerebral cortical atrophy, whether focal or generalized, should be specifically commented upon (g) Evaluate the cerebral vessels 113 Prior to the internal examination, preparations should be made for the sampling required for “Further Testing” (see subsection 5 below). 114 Some prosectors prefer to start with an examination of the head. This may be particularly appropriate where there are visible injuries to the neck. The Minnesota Protocol on the Investigation of Potentially Unlawful Death (2016)