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Samenvatting Gerechtelijke geneeskunde & criminalistiek
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Inhoud1 Inleiding Forensische geneeskunde ................................................................................................................ 6
1.1 De term ‘Forensische’ geneeskunde .......................................................................................................... 6
1.2 Forensische Geneeskunde als Specialiteit ................................................................................................ 6
1.3 Toepassingsgebied ................................................................................................................................... 6
1.3.1 Onderzoek van levenden ................................................................................................................. 6
1.3.2 Onderzoek van overledenen ............................................................................................................ 7
1.3.3 Varia .............................................................................................................................................. 7
1.4 Aanstelling van deskundigen in strafzaken ................................................................................................. 7
1.5 Strafzaken procedure ............................................................................................................................... 8
2 Klinische forensische geneeskunde ................................................................................................................ 9
2.1 Kindermishandeling en kinderverwaarlozing .............................................................................................. 9
2.1.1 Definiëren kindermishandeling & -verwaarlozing .............................................................................. 9
2.1.2 Accidenteel vs niet-accidenteel trauma ......................................................................................... 10
2.1.3 Vormen van ‘Child Abuse’ ............................................................................................................. 11
2.2 Fysiek geweld bij volwassenen ................................................................................................................ 14
2.2.1 Inleiding ....................................................................................................................................... 14
2.2.2 Stompgeweld ............................................................................................................................... 14
2.2.3 Mesverwondingen ........................................................................................................................ 14
2.2.4 Schotverwondingen ...................................................................................................................... 15
2.2.5 Brandwonden ............................................................................................................................... 15
2.2.6 Poging tot wurging; asfyxie ............................................................................................................ 15
2.2.7 Intoxicatie .................................................................................................................................... 15
2.2.8 Beetwonden ................................................................................................................................. 15
2.2.9 The Battered Wives ....................................................................................................................... 15
2.2.10 Ouderenmishandeling (Granny Battering) ...................................................................................... 16
2.3 Seksuele agressie .................................................................................................................................. 16
2.3.1 Wettelijke bepalingen seksuele misdrijven ..................................................................................... 16
2.3.2 Medicolegaal onderzoek ............................................................................................................... 16
2.3.3 Pathologie bij seksuele agressie .................................................................................................... 17
2.4 Gerechtelijke geneeskunde & Verkeer ..................................................................................................... 17
2.4.1 Alcohol & verkeer .......................................................................................................................... 17
2.4.2 Drugs en verkeer ........................................................................................................................... 18
2.4.3 Rijgeschiktheid ............................................................................................................................. 18
3 Tussenkomst van de arts bij een sterfgeval.................................................................................................... 19
3.1 Vaststelling & aangifte van overlijden ...................................................................................................... 19
3.2 Gerechtelijk geneeskundig bezwaar tegen begrafenis of crematie ............................................................. 20
3.2.1 Geen gerechtelijk geneeskundig bezwaar ....................................................................................... 20
3.2.2 Wel gerechtelijk geneeskundig bezwaar ......................................................................................... 20
3.2.3 Bijzondere situaties ...................................................................................................................... 20
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, 3.3 Schematisch overzicht ........................................................................................................................... 21
4 Forensisch postmortem onderzoek (De politionele lijkschouw) ..................................................................... 22
4.1 Inleiding ................................................................................................................................................ 22
4.1.1 Medicolegale begrippen ................................................................................................................ 22
4.2 Onderzoek op de plaats delict ................................................................................................................ 23
4.2.1 Uitwisselingsprincipe van Locard .................................................................................................. 23
4.2.2 Spoorbeveiliging en Spooronderzoek ............................................................................................. 23
4.3 Mortuarium: de forensische autopsie ...................................................................................................... 24
4.3.1 Medische Beeldvorming ................................................................................................................ 24
4.3.2 Inwendige Schouwing ................................................................................................................... 24
4.3.3 Microscopisch Onderzoek ............................................................................................................. 24
4.4 Nabestaanden en Lijktooi – Vrijgave lichaam ........................................................................................... 24
4.4.1 Nabestaanden.............................................................................................................................. 24
4.4.2 Lijktooi (Postmortale Verzorging).................................................................................................... 24
4.4.3 Deskundig Verslag ........................................................................................................................ 24
5 Postmortem identificatie ............................................................................................................................. 25
5.1 Inleiding ................................................................................................................................................ 25
5.1.1 Wie is de overledene? Belang van correcte identificatie! ................................................................. 25
5.1.2 Methodes en Uitdagingen.............................................................................................................. 25
5.2 Basisprincipes van postmortale identificatie ........................................................................................... 25
5.2.1 Reconstructieve Methode ............................................................................................................. 25
5.2.2 Vergelijkende Methode .................................................................................................................. 26
5.3 Elementen om tot identificatie te komen ................................................................................................. 26
5.3.1 Kledij en Voorwerpen .................................................................................................................... 26
5.3.2 Algemene Lichaamskenmerken ..................................................................................................... 26
5.3.3 Specifieke lichaamskenmerken ..................................................................................................... 26
5.4 Primaire Identificatie .............................................................................................................................. 26
5.4.1 Dactyloscopie (Vingerafdrukken) ................................................................................................... 26
5.4.2 Forensische Odontologie (Gebitsonderzoek) .................................................................................. 26
5.4.3 DNA-Onderzoek ........................................................................................................................... 26
5.5 Gegevensverzameling en Samenwerking ................................................................................................. 27
5.5.1 Specifieke Kenmerken .................................................................................................................. 27
5.5.2 Wetenschappelijke Methode van Identificatie ................................................................................ 27
6 Thanatologie ............................................................................................................................................... 28
6.1 Wat is Thanatologie? .............................................................................................................................. 28
6.1.1 Begrippen Gerelateerd aan de Dood .............................................................................................. 28
6.1.2 Van Leven tot Dood ....................................................................................................................... 28
6.2 Tekenen van de dood .............................................................................................................................. 29
6.2.1 Tekenen Onmiddellijk na de Dood .................................................................................................. 29
6.2.2 Situaties buiten het ziekenhuis (Extra Muros) .................................................................................. 29
6.2.3 Situaties binnen het ziekenhuis (Intra Muros) ................................................................................. 30
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, 6.3 Vroegtijdige postmortale veranderingen .................................................................................................. 30
6.3.1 Algor mortis (Daling lichaamstemperatuur) .................................................................................... 30
6.3.2 Livores - Postmortem hypostase .................................................................................................... 31
6.3.3 Rigor mortis (Lijkstijfheid) .............................................................................................................. 31
6.3.4 Uitdroging van het lijk .................................................................................................................... 32
6.4 Laattijdige Postmortale Veranderingen .................................................................................................... 32
6.4.1 Putrefactie (ontbinding door rotting) .............................................................................................. 32
6.4.2 Mummificatie ............................................................................................................................... 33
6.4.3 Adipocirevorming (“Fettwachsbildung”, “zeeplijk”) ......................................................................... 33
6.5 Postmortem interval (PMI) ...................................................................................................................... 33
6.5.1 Lijkvlekken ................................................................................................................................... 33
6.5.2 Lijkstijfheid (Rigor Mortis) .............................................................................................................. 34
6.5.3 Wetenschappelijke Methode ......................................................................................................... 34
6.5.4 Ontbinding ................................................................................................................................... 34
6.5.5 Forensische Entomologie .............................................................................................................. 34
6.5.6 Belang van Contextuele Informatie ................................................................................................ 34
6.6 Postmortale mutilatie ............................................................................................................................. 35
6.6.1 Accidentele Postmortale Kwetsuren .............................................................................................. 35
6.6.2 Intentionele Postmortale Kwetsuren .............................................................................................. 35
6.6.3 Postmortale Dierenvraat ............................................................................................................... 35
6.6.4 Herkenning van Postmortale Kwetsuren ......................................................................................... 35
7 Thanato-etiologie ........................................................................................................................................ 36
7.1 Asfyxie .................................................................................................................................................. 36
7.1.1 Inleiding ....................................................................................................................................... 36
7.1.2 Mechanische Asfyxie .................................................................................................................... 37
7.1.3 Suffocatie (Verstikking) ................................................................................................................. 38
7.1.4 Smoring ....................................................................................................................................... 38
7.1.5 Obstructie van interne luchtwegen ................................................................................................ 39
7.1.6 Wurging........................................................................................................................................ 40
7.1.7 Strangulatie door een ligatuur........................................................................................................ 41
7.1.8 Ophanging ................................................................................................................................... 41
7.1.9 Dooddrukking ............................................................................................................................... 42
7.1.10 Verdrinking - Waterlijk .................................................................................................................. 42
7.1.11 Inademen van toxische gassen ...................................................................................................... 44
7.2 Dodelijke verwondingen ......................................................................................................................... 45
7.2.1 Steek- & Snijwonden ..................................................................................................................... 45
7.2.2 Verwondingen veroorzaakt door stomp geweld ............................................................................... 48
7.2.3 Schotwonden ............................................................................................................................... 52
7.3 Fysische agentia .................................................................................................................................... 56
7.3.1 Elektrocutie .................................................................................................................................. 56
7.3.2 Hitte ............................................................................................................................................ 57
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, 7.3.3 Koude - Hypothermie .................................................................................................................... 58
7.4 Dodelijke intoxicaties ............................................................................................................................. 60
7.4.1 Definitie & geschiedenis ................................................................................................................ 60
7.4.2 Inleidende begrippen .................................................................................................................... 60
7.4.3 Verschillende soorten van stoffen .................................................................................................. 60
7.4.4 Kinetiek: hoe komt men tot intoxicatie ........................................................................................... 60
7.4.5 Scene of death ............................................................................................................................. 61
7.4.6 Lijkbevindingen ............................................................................................................................ 61
7.4.7 Richtlijnen postmortem stalen voor analytisch toxicologisch onderzoek .......................................... 62
7.4.8 Toxicologische postmortem analyse & interpretatie ....................................................................... 62
7.5 Plotselinge en onverwachte natuurlijke dood ........................................................................................... 63
7.5.1 Inleiding ....................................................................................................................................... 63
7.5.2 Niet-natuurlijke oorzaken van onverwacht overlijden ...................................................................... 63
7.5.3 Plotseling en onverwacht natuurlijk overlijden ................................................................................ 63
7.5.4 Plotseling overlijden bij kinderen ................................................................................................... 64
8 Criminalistiek.............................................................................................................................................. 65
8.1 Inleiding medische criminalistiek ............................................................................................................ 65
8.1.1 Sporenonderzoek ......................................................................................................................... 65
8.1.2 Sporen als bewijs ......................................................................................................................... 65
8.1.3 Grondslagen van Sporenonderzoek ............................................................................................... 66
8.1.4 Algemene principes in verband met sporenonderzoek .................................................................... 66
8.2 Onderzoek naar sperma ......................................................................................................................... 70
8.2.1 Belangrijke vragen bij onderzoek naar seksuele misdrijven .............................................................. 70
8.2.2 Criminalistisch Belang van Sperma ............................................................................................... 70
8.2.3 Anatomische structuren en samenstelling van zaadvocht ............................................................... 71
8.2.4 Aantonen van sperma: Methoden & tijdsduur ................................................................................. 72
8.3 Sporenonderzoek op de plaats delict ...................................................................................................... 73
8.3.1 Werking van Crime Scene Investigation .......................................................................................... 73
8.3.2 Dienstenaanbod ........................................................................................................................... 73
8.3.3 Inzet CSI in de praktijk - Types opdrachten...................................................................................... 73
8.3.4 Afstapping, definitie, schema en aspecten ..................................................................................... 74
8.3.5 Uitdaging: authenticiteit/integriteit fysische bewijsmateriaal .......................................................... 75
8.3.6 Basisprincipes en inrichting .......................................................................................................... 76
8.3.7 Kernfuncties bij plaats delict onderzoek ......................................................................................... 76
8.3.8 Crime scene safety ....................................................................................................................... 77
8.4 Dactyloscopie ....................................................................................................................................... 78
8.4.1 Inleiding ....................................................................................................................................... 78
8.4.2 Grondslagen dactyloscopie........................................................................................................... 78
8.4.3 Dactyloscopie in België ................................................................................................................. 79
8.4.4 Administratieve dactyloscopie ...................................................................................................... 80
8.4.5 Praktische dactyloscopie .............................................................................................................. 80
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