Placeholder Image

字幕列表 影片播放

  • Post-Mortems are tightly controlled and access to them is strictly limited to protect the privacy and dignity of the deceased

  • Filming is not usually allowed

  • But for this post-mortem we have been allowed in to help understand a problem that costs the nation billions and ruin so many lives

  • obesity

  • Carla Valentine and Dr.. Mike Osborne are the specialist team responsible for carrying out the postmortem?

  • Carla is an anatomical Pathology technologist and technical curator of the Pathology Museum at London's, Queen Mary University

  • For this postmortem. I'll be carrying out the evisceration which means we're moving all of the organs

  • Being part of a filmed postmortem is a very unique opportunity

  • Death terrifies some people, but what it also does is it eventually gives you a real sense of the fragility of life?

  • The topic of obesity is a huge problem, and it's something that I get to see quite a lot

  • But it's not something that I get study in depth

  • Mind is a consultant pathologist and fellow of the Royal college of Pathologist

  • He's been working with death and disease for over 20 years

  • Obesity is very much there. It's seen but I think it's very very poorly understood

  • it seemed that making this film would be a way of exploring that and

  • Allowing a broader public to learn about the problems that are associated with obesity

  • Caller and Mike have performed thousands of Post-Mortems, but always behind closed doors

  • today

  • we will witness what really happens in an autopsy and

  • Discover what the body of our donor can tell us about the creeping effects of obesity over time

  • We don't know this woman's name, but we do know a few details about her

  • to within our only

  • 65 foot size

  • almost 17 stone

  • And just like a quarter of people in the uk clinically obese

  • But where did she come from and how did she end up here on a post mortem table in London?

  • and

  • Finally she arrived in London her body remains in a pool chamber for ten days to allow it to fall completely

  • Before it was brought to the post-mortem table

  • The first stage of every Post-Mortem before any cuts is made to the flesh is an external examination of the body

  • the donors Id number is confirmed against her medical records which details the cause of her death heart disease and

  • That you'd only had minor surgery and drank minimal alcohol

  • But what will her body go on to reveal about the way that she died?

  • This lady's died of heart disease. Which is one of the things that is associated with obesity and interestingly

  • Already in this lady. We've got signs of heart failure because if I press here particularly on this side

  • You can say I'm very demanding there, and that's because you've got too much fluid and that's the side effect of heart failure

  • The other obvious external damage to our donor are the blisters on her skin?

  • They are one of the earliest signs of her body decomposing after death, and they're particularly noticeable on larger bodies

  • But they're not what Mike and Carla are focusing on

  • The most important thing about this lady

  • Is that the obesity that she's got is centered on her abdomen, so this lady's carrying a lot of weight around her tummy

  • That's associated with more of the complications than if somebody weighs the same

  • But they carry their weight around the bottom and around the thighs so that's less

  • Associated with complications. That's more associated with complications

  • so we can see the

  • distribution of the fats from the external exam

  • But once we actually get inside

  • We'll see more of how that's affected the inside of her body and her internal organs as well

  • When we open this lady there may be other

  • Findings that are less easy to diagnose before somebody has died that won't have killed her

  • but are

  • Examples of problems that can get worse and leads to illness and death in other people so we may find some of those we may

  • not

  • To uncover if there are deadly medical truths lying, beneath the skin calamus first cut open the body

  • The incision is a large and deep single vertical cuts

  • Beginning at the suprasternal notch at the base of the neck and ending at the top of the pubis

  • It's a skill that requires both great precision and intense concentration

  • Especially performed on someone with so much fat

  • So what I can feel at the moment is an awful

  • lot of yellow very Sort of greasy fatty tissue which

  • Is quite a thick layer in the body to size?

  • Reflecting the skin back from the ribcage here, and what that means is. I'm just kind of loosening it away with the muscle and

  • Give me a bit of room to Maneuver within the body

  • What we seem to have here is a breast implant. This is an incidental find sometimes when we do post mortems

  • It's not just about what we're expecting to find and it's incidental

  • there is a very large amount of fat here and

  • The reason it makes it so difficult is it actually is greasy it feels very much like butter

  • so what I'm doing here is just

  • trying to make sure that my

  • Knife doesn't slip too much on it

  • Mike did you want to come and take a look at it okay?

  • so

  • We can see immediately the thickness of fat that is here and even though there is a large amount on the anterior

  • chest wall the front of the chest

  • But there's also a very large amount around the abdomen the abdominal fat that is the most dangerous

  • Associated with the problems of obesity

  • It's quite a lot of fat around the organs

  • It's fatter in the amendment

  • It would appear that this lady is carrying much of her way in the abdominal fat and possibly around organs as well

  • So there's lots of changes which I think we'll get a better view of when we've opened the rest of the body

  • Everybody knows what obesity looks like from the outside

  • But unless you do a job like ours most people don't see what obesity looks like inside

  • I've done thousands of Post-Mortems

  • It's always a fascinating procedure even if it's a case where you've seen lots and lots of similar cases in the past

  • That particular case will be individual and you'll certainly learn from that

  • we'll never know exactly why our donor became so overweight the reasons for obesity are multi-layered and complicated a

  • mixture of lifestyle and environment

  • biology and psychology

  • But now that overweight is the new normal weight in the uk there is a whole new Young generation living with the consequences of obesity

  • I'm going to take my rib shears, and we use these specifically for this job as they can cut through bone and

  • What I'm going to do is just make some very

  • Even cuts right through all of these bones

  • you can hear the bones of snapping this lady isn't exactly young and

  • The older people get the more calcified their bones become so they become very very

  • crunchy Whereas younger people ten have much more

  • soft Bones

  • In order to do this job you have to be

  • stronger stomach to start with but I think that's just something you even know or don't and

  • I never would have considered doing this job. If I didn't know I had a strong stomach

  • I'm now removing the breast bone or the breast plate

  • sternum with

  • upward strokes, and this way I don't damage any of the

  • Pericardium which is the Sac that keeps the heart safe

  • The first time I saw somebody doing a post-mortem

  • I think I was just absolutely rapt I was fascinated and it's because the human body is an

  • Incredibly complex machine to open human being to see all of that

  • Absolutely perfect sort of Jigsaw of organs and perfectly in place. It really did make me feel very we

  • would

  • When you do an autopsy on somebody who's very slim the organs are there and they're very evidence?

  • It's like a game of of operate should all like one of those anatomical models that you would use at school

  • In a woman this size a lot of it is really hidden by this extra yellow bar

  • it is making it quite difficult to see the structures and much more difficult than it would if she was a

  • person

  • before color removes the heart and lungs

  • Mike want to take a look at the organs while they're still in the body

  • To see if we will discover any early indications of trauma or damage

  • You can see the heart here

  • There's a large amount of fat around the heart

  • There's more here than you would see normally quite considerably more

  • Underneath the heart and lungs in this area here is what you call the diaphragm

  • It's a big muscle that helps you breathe

  • Evenly and the diaphragm I was going to ask you very fatty for me right even even on the surface with a heart fat in

  • the diaphragm I'm eating there's more fat than usual and actually the thing you can see most is an

  • extremely, enlarged liver this is very very large and

  • It's got what we call fatty liver change, so this is a fatty liver and fatty liver is very much associated

  • with obesity

  • you can see there's a lot of fat around these organs, so

  • What would be between my hands now would be the kidneys now the kidneys always have fat around them

  • I think it's important while we're talking about the fat to realize that is a normal thing

  • Everybody has fat in however thin you are there will be some fat and fat

  • It's got very very important roles and one of those roles is to protect things is that too much fat

  • That is the problem

  • five is made up of cells called adipocytes which are fat cells and

  • Really for a long long time until very recently people thought that that was

  • Just an inert substance that just sort of sat bone didn't really do anything, but it's becoming increasingly

  • Understood now that that is actually a very active substance

  • Fat cells work almost like an Endocrine organ the people would have heard of some endocrine organs things like the thyroid gland which

  • Related to how much energy you have how cold you are?

  • And so forth the ovaries the testes so obviously these hormones

  • Related to the ovary in the testes define whether you're going to be a man or you're going to be a woman so those are

  • the Sorts of activities Hormones have so they're very very powerful things they become obvious that the adipocytes the fat cells duclair an

  • Endocrine type Role, and so have some very powerful effects that were previously unknown

  • The next stage of the Post-Mortem is the dissection of the heart and lungs

  • For might to be able to do this carla needs to remove the cardiorespiratory block from the body

  • I'm cutting through the diaphragm here just to make sure that I freeze the lungs completely

  • See them along Spine here

  • I'm going to do the exact same thing on the other side

  • And chop across the esophagus metric area here

  • And then all I need to do is basically pull the organs towards me at the same time as releasing these sort of white fibrous

  • Tissues that holding the organs for spine and then we'll get to a point

  • Where this blocks the cardiorespiratory block is completely free

  • Then we can take this out as one block

  • and we've got the heart and the lungs and the heart Sac the

  • pericardium

  • When you initially carry out post mortem?

  • and you hold an organs such as the heart in your hands and the heart is very symbolic and

  • You know using all sorts of logos. It's it has a sort of power and a sort of

  • agency that makes you kind of stop and think because it looks, so

  • Mundane, but then you realize that within it has the electrical impulses to keep a person alive

  • With the cardiorespiratory block removed from our donors body Mike can start his dissection of her lungs

  • Will we uncover any evidence of damage linked to her obesity?

  • I'm going to Detach the lungs

  • From the heart so we'll start off with the right lung

  • So just cutting through

  • Where the lung is attached, and that's the right lung detached to the left lung. I'm detaching

  • there

  • I'm just going to make some cuts across the lung just to see what the surface of the lung looks like these lungs actually look

  • quite healthy

  • There's no tumors or masses or anything like that in these lungs

  • But what there does seem to be and which should be evident now if I pick this lung up and squeeze it is

  • You can see the fluid dripping out of these lungs, and this is what we call pulmonary edema. That's

  • Essentially heart failure fluid this fluid is basically water. I know it looks red

  • That's because obviously it's within the body, and it's been mixed with blood. It isn't blood is much much thicker than that

  • This is really just a watery fluid and this is collected because this lady's got heart failure

  • this lady died from Heart failure from Hypertensive heart disease

  • But this lady is also obese she did not die from the obesity the obesity

  • increased the risk factors and

  • Was associated with the problems that led to her death?

  • Fluid has built up in this lady's lungs because her heart isn't working properly

  • She'd have probably been short of breath and had possibly had a cough

  • but also because the fluid sits in the chest when you lie flat

  • And that would have given her a sensation almost of drowning

  • When you become a doctor one of the questions that they teach you very early on is

  • How many pillows do you sleep with and that tends not to be because they're asking how comfortable you are at night?

  • It's because if somebody says oh, I can't sleep in a bed doctor

  • I have to sleep in a chair or I have to sleep with eight pillows sitting up that is very indicative of heart failure

  • And the startling discovery Mike has made in our donors lands

  • We now know that she would have felt the impacts of her obesity and heart failure every single day

  • Heart failure is not the same as a heart attack when a heart fails

  • It doesn't fail

  • immediately in this type of circumstance it fails over a long period of time, so the symptoms are gradual so

  • She met this lady may have been able to walk up ten flights of stairs three years ago

  • Then she suddenly found she got very breathless after five flights of stairs

  • Then she found that she was found it very very difficult to even walk up one flights of stairs or even carry her shopping it

  • Would have been a progressive disease as the heart became worse and worse and worse now the final event

  • Obviously when this lady's heart stopped working that would have been an Instantaneous event and led to her death

  • Now it's time for Mike to examine in detail the organ that catastrophic lee failed in our donor

  • What will we find out about how and why she might have died?

  • You can't really see the heart yet because the heart is sitting in a bag this is called the pericardial Sac

  • I'm just going to open that

  • and

  • so I can

  • Reflect that but and that's the heart there, so the heart now is in my hand

  • And you can see all the fat. I was talking to about earlier really isn't around the heart

  • It's really around the pericardium. There is a bit of fat around the heart which is here

  • This is absolutely typical in everybody's heart even a thin person's heart would have this and I'm going to cut off

  • the

  • pericardial Sac

  • This big blood vessel here is the Aorta this is the vessel that takes all the blood

  • From the heart around the body when I feel this heart it feels baggy a heart in someone who is very athletic

  • Their heart would be very tight very firm it would be like always picking up a piece of steak. This is more like a bad

  • What I'm going to do now is weigh this heart

  • So this heart is

  • 449 grams that's a heavy Heart this lady is

  • Despite her weight this lady is actually quite a petite person. So you would expect her heart to be perhaps

  • 275 grams something like that

  • So this is very much heavier than you would expect and that is the sort of sized heart you would expect

  • In someone who has got heart failure due to high blood pressure

  • which is what this lady suffered from

  • The heart basically has to pump to keep up the pressure the heart gets bigger and bigger and bigger

  • But there becomes a point where the heart can't get any bigger and it basically

  • exhausts itself

  • Now that he has discovered the shocking state of our donors heart might want to look at it from the inside

  • He cut some slices so he can examine the ventricles the walls of the heart that pump the blood

  • if you're 6 foot 8 all black

  • Second-row, or you're you know one of the professional footballers running around the pitch you need a lot of blood so the wall of the

  • left ventricle in a young fit person

  • It's usually an inch thick muscle all the way around now if you look at this lady

  • This lady's left ventricle is very very thin this is 8 millimeters something like that

  • That's because she developed high blood pressure to start off with the heart had spunk harder and harder in the end

  • What you get to is a state where the muscle can't keep the high blood pressure up and it starts to get thinner and thinner

  • And thinner and basically go from a thick muscular pump through to a paper bag that's not capable of pumping blood

  • Adequately around the body and we see a lot of these hearts. We see them on a background of hypertension

  • This is a common finding and becoming more common

  • Hypertension is high blood pressure obesity is well known to be one of the major risk factors for high blood pressure

  • So in this lady

  • they were not able to control that that led to

  • Changes within the heart which meant the heart failed it couldn't work properly, and that's what this lady died from

  • The next block of organs to be removed are the organs of the digestive system called the celiac block?

  • What I'm to do here is make sure that I've got the stomach and the lower bowel

  • liver and sleeve all together in one block for Mike to take a look at

  • And not damage the kidneys but at this point

  • I don't think I'm going to be able to damage them anyway because they also surrounded by such a large envelope of fat

  • So we've got some people mouth and we've got

  • Scott and bile and and then obviously a lot of blood the blood is mixed in with fat which is yellow

  • So that's giving us some orangie fluids

  • So multi-sensory rainbow at the moment every single thing that is in each of these blocks is incredibly important

  • and you know just amazing jobs for our body, and it's just a taste of

  • It's not very pleasant once they stopped working and they started to decompose a little bit

  • To completely free the organs

  • Carla needs to cut through the fibrous membrane that holds them to the spine at the back of the body

  • So this is a huge celiac block. It's incredibly heavy and the liver as you can see is taking up most of it

  • You can just see the spleen there and also the stomach and a bit of the small bowel as it hatched as well

  • When I first encountered a deceased person

  • I think what really struck me was just the stillness um and the cold

  • because of course I'd never that point felt flesh that was so cold and

  • It gave me a real sensation of kind of dipping my toe into very cold water

  • And then once I've done it that feeling had never quite left, and it was like if other

  • Subterranean World in

  • The next stage of the Post-mortem will we find any evidence of stack damage in the organs of our donors digestive system

  • this is the

  • Organs that include the liver the spleen

  • The stomach and the pancreas now this is much heavier than I would expect it to be in

  • A smaller individual largely because the liver is so big

  • First Mike is going to take a look at the organ that most people associate with obesity. This is the stomach

  • Basically just like a bag holds the food before the food goes through into the bow where it's actually

  • digested and there are actually many of

  • The treatments associated with obesity deal with the stomach and what they try to do is reduce the size of the stomach so that people

  • Have a feeling of being satisfied for meeting without eating so much

  • So there's a whole variety gastric bands fits around the stomach there's those I pass operations and so forth the stomach is

  • Very good at dilating

  • So if this lady had had a very large meal before she died and had not had opportunity to digest it

  • The stomach would be much more obvious, but this is a fairly typical

  • sized stomach

  • Next Mike will dissect the liver the organ he discovered showing such dramatic change when he saw it in the open body

  • But what would it reveal to us about the consequences of fats building up where it shouldn't?

  • First thing I saw when we opened the abdomen was the size of this liver and the fact that this liver showed marked fatty change

  • I'm going to make some slices through the liver just so I can see what the surface cut surface if the liver looks like

  • The sponge so I don't cut myself

  • So I've made some cuts across the liver there

  • And you can see that the surface of the liver is this sort of pinky color that's very characteristic

  • Of fatty liver change, it's very soft it almost feels like pate and consistency

  • Normal liver is quite soft, but not as soft as this in it

  • And it has a much meteor much redder bloody colour dark red the lightness in this is

  • caused by the fat within the liver and the fat is deposited within the hepatocyte which other liver cells and

  • this fat would obviously be pale in color and

  • liver cells themselves a dark, so the

  • Combination of the two gives uses light sort of pink color as much much lighter color than you'd expect a normal liver to be that

  • Is a classic sign of fatty liver disease, and it's becoming a major problem

  • And is one of the major reasons for liver transplant in the world the most common cause of fatty liver at the moment is

  • alcohol-related

  • Fatty liver, but we know that this lady drunk almost nothing

  • So it's very unlikely that this change is due to alcohol consumption

  • almost certainly an obesity related change

  • Fatty liver causes damage to the liver it can lead on to cirrhosis, and it can actually lead on to cancer as well

  • But even if people do not develop cancer or cirrhosis it can lead to liver failure

  • So there's a multiple ways that it can actually lead to the death of a patient it didn't lead to the death of this lady

  • Really because her heart was itself so bad, but this is very dramatic change within this liver

  • before the post mortem

  • We could never have known how dramatically damaged our donors liver would be or that should be carrying a second life threatening disease

  • But excess internal fat doesn't have to be a death sentence

  • The good news is the fight to beat the dangerous invisible fat can be won

  • It is a daily struggle

  • But the prize is big

  • Next Karla will remove the final group of organs, but even in the last stages of the postmortem. She takes nothing for granted

  • People who donate their bodies to medical science. We are giving a gift?

  • it's a gift that keeps on giving actually because as

  • A patient I think we all would prefer that our doctors and our surgeons have learned on

  • Something you know realistic to their job before they're let loose on other human limitations

  • You know you wouldn't really know a mechanic. Take care of your car

  • If you've never touched an engine, and it's very much the same thing with this

  • Wheel bodies are very unpredictable and very tale set compared to anything you don't fake anything like a virtual reality or a fake together

  • Because if you look here what you should be able to see are the kidneys

  • granted they always have a tiny capsule fat around them a bit like a sort of edamame being that you can pop out and

  • But these fatty capsules are very very large so all that you can really see at this point is a kind of yellow

  • glistening mess, really

  • So this is again indicative of the fact that she has an awful lot of extra fat around her organs

  • So I'm just slicing through the fibrous tissues and a bits of muscle that are keeping the kidneys

  • attached

  • to the spine and

  • It's really

  • Exactly the same thing that I've been doing with the rest of the organs and that is releasing them from the spine which is what?

  • Anchors them in Place and

  • Then I tend to deflect them all the way down and pull them out and this is the genitourinary block

  • And this is at least slightly smaller slightly easier to manage because we've only got the kidneys in this

  • How much fat you?

  • Might need to dissect the kidneys to find out just how much damage has been caused by all that excess fat

  • In the right kidney this is the left kidney

  • this in the middle is the big blood vessel that carries blood all the way down the body and

  • the most important and the first thing I can see is there's an

  • Unusual amount of fat around these kidneys now the kidneys always have fat around them kidneys are not

  • Protected by bone which means that they can be bashed and they can be here if you walk into something or something hits you

  • So this fat protects them this lady has much much more fat than I would expect

  • What I'm going to do first is just cut through

  • This fat which is called the peri renal fat

  • and

  • You can see quite clearly

  • How much fat there really is in a thin person?

  • This would probably be

  • Half of a third as thick as I can see here

  • This is bad news for this lady it means that she's more likely to have the complications of obesity

  • Because of the way she's carrying the fat this pale area here is the kidney. I'm just going to cut into the kidney

  • So the kidneys got a thick capsule around it

  • Now there's a small amount of fat in the middle of the kidney that's completely normal

  • That's where basically the kidney is responsible for filtering your blood and for making the urine that

  • Urine has to go somewhere

  • So your kidneys got a funnel

  • that collects all the urine from all the bits of the kidney takes it down through your ureter into the bladder and then when you

  • Want to go to the loo it goes out so this bit of fat sits around

  • That funnel area and is quite normal

  • I'm going to take the thick capsule off of the kidney surface to see what the surface of the kidney looks like

  • The surface of the Kidney ideally should be very very smooth

  • This kidney has got some scarring on the surface

  • There's areas of indentation

  • And pop marking there is clear damage to this kidney

  • Which would be associated with high blood pressure, and we know this lady had high blood pressure

  • Which is what led to her the changes within her heart and which led to her death

  • the visible scarring and pot marking we've discovered on our donors kidneys are the last of the revelation she will yield

  • Before Carla completes the Post-mortem and closes the body forever

  • One like finished his examination. I then begin the reconstruction and in a way that's one of the most important parts of the postmortem

  • What I do is I place all of the organs into a special

  • Viscera bag which will contain all of the elements that we've removed in the different blocks and I place that into the body cavity

  • And then I use very heavy

  • Post-Mortem twine to stitch as neatly as I can

  • Right along the incision. I made and we describe this as a baseball stitch. It does look very much like a zig zaggy stitch

  • Each Post-Mortem is unique and everything they reveal valuable

  • This donors gift was an opportunity for Mike and Carla to unveil the shocking truths hidden inside one body

  • irreversibly damaged by too much fat

  • the evisceration

  • occurred and it wasn't as easy to do as

  • It would be with a slightly smaller patient and it takes a lot more

  • Strength to cut through this this yellow adipose tissue which kind of blooms out of the abdomen and in this

  • you know practically neon yellow and and it looks very much like butter, and it has a greasy feel and

  • it

  • makes you suddenly very aware of

  • the fact in your own body well it made me me aware of that in my own body and

  • the effect of that might have on my organs the strain it might put on my heart and

  • The way it may affect my liver. I think they're doing a post-mortem and such as this is a really fantastic way for people to

  • Consider their own health and their own mortality

  • you

  • You never really know what we're going to find when we examine the patient the first thing

  • I noticed when the body had been opened was the markedly fatty liver

  • I know from the history that was provided that this lady died from heart failure, but the findings in her heart are

  • Extremely marked and the severity of them actually surprises me, but before we did the post-mortem

  • There was no indication that this lady had a fatty liver

  • And it's a possibility that even if this lady had not developed heart failure

  • She may have gone on to develop liver failure Due to the fatty change within the liver

  • We already knew a little about the way that this woman lived and how she died

  • What we couldn't have known before the post-mortem was the extent to which obesity would have ravaged her internal organs

  • from the suffocating fluid in her lungs

  • to her scarred kidneys

  • Creating a potent mix of life-threatening

  • obesity-related disease

  • the

Post-Mortems are tightly controlled and access to them is strictly limited to protect the privacy and dignity of the deceased

字幕與單字

單字即點即查 點擊單字可以查詢單字解釋

B1 中級 美國腔

肥胖症:死後 (Obesity : The Post Mortem)

  • 179 1
    Book Liu 發佈於 2021 年 01 月 14 日
影片單字