STUDENT INDUSTRIAL WORK EXPERIENCE SCHEME (SIWES)

REPORT AT DELTA STATE UNIVERSITY TEACHING HOSPITAL

OGHARA, DELTA STATE

BY

AKPOKONA OGHENERUKEVWE TAMARAEBRAGHA

CFB/20/21/270079

300 LEVEL

DEPARTMENT OF HUMAN ANATOMY AND CELL

BIOLOGY FACULTY OF BASIC MEDICAL SCIENCES

DELTA STATE UNIVERSITY

ABRAKA

NOVEMBER, 2023

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 ACKNOWLEDGEMENT

I would like to give God thanks for successful completion of my SIWES training. I

also would like to express my heartfelt gratitude to my parents who was dear to

support me ,and my industry based supervisor Mrs kehinde Racheal for constant

source of encouragement, support and valuable guidance throughout the duration

of my training in the establishment,my sincere gratitude to Dr ogochukwu

umeaku , consultant of anatomic pathology for his support.

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 ABSTRACT

Anatomy, the structural basis of medicine is the study of the internal structures and

forms of the body. Other fields like histology, embryology, physiology,

biochemistry etc. were derived from Anatomy. The history of Anatomy as a

science extends from the earliest examination of sacrificial victims to the

sophisticated analyses of the body performed by modern scientist. The importance

of human anatomy is to be able to appreciate gross structures of the body,

histological details of cells and tissues for the treatment and diagnosis of

pathological lesions.

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 CHAPTER ONE

INTRODUCTION

1.1 BRIEF STATEMENT ON THE HOSPITAL

The Delta State University Teaching Hospital (DELSUTH) is a renowned

and accredited University teaching hospital to the Delta State University (DELSU),

Abraka. Located in Oghara, Ethiope West Local Government Area of Delta State,

the hospital was built initially as a 180-bed ultra-modern specialist hospital. An

inaugural management board headed by Professor Joseph Otobo was sworn in June

2009 to manage the affairs of the Hospital when it kicked off initially. The earliest

staff of DELSUTH consisted of a team of qualified Nigerian medical professionals

drawn from the United Kingdom and the United States. The Hospital was officially

commissioned on the 19th of June, 2010 by the Former President of the Federal

Republic of Nigeria, Dr. Goodluck Ebele Jonathan

1.2 ORGANIZATIONAL STRUCTURE

The hospital is made up of different departments and sections. These can

be broadly divided into:

 The Clinical section and

 The Administrative section

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 A. The Clinical Section includes:

i. Accident and Emergency Department (A&E)

ii. Center for disease control (CDC),

iii. Consultant out-patient Department (COPD)

iv. General Practice Clinic Department (GPC)

The Administrative Section includes:

v. Pharmacy department,

vi. Physiotherapy department

vii. Radiological department

viii. Morbid anatomy department

ix. Catering department

x. Department of Obstetrics and Gynaecology

xi. Invitro fertilization center (IVF) etc.

B. The various Wards including:

i. Labour ward

ii. Maternity ward

iii. Pediatric ward

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 iv. Ophthalmology ward

v. Urology ward etc.

C. The Theatres including:

i. Main theatre

ii. A&E theatre

iii. Labour Ward theatre

D. The Laboratories including:

i. The Histopathology lab

ii. The chemical pathology lab

iii. Haematology lab

iv. Blood bank and medical microbiology lab and

v. Administrative section

1.3 CONTRIBUTIONS MADE BY EACH SECTIONS OF THE HOSPITAL

The Clinical sections listed above provide medical and health care services to

patients.

This includes the diagnosis, treatment and prevention of disease.

While the administrative section takes care of administrative matters. This includes
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keeping records and files of patients, documents and information relating to the

various section of the hospital and the files of each staffs in the hospital.

1.4 WORK DONE IN THE HOSPITAL

The Teaching Hospital serves for both academic and medical purpose

providing health care services to the entire state and neighboring cities.

1.5 SCOPE OF STUDY

Student industrial training aim at exposing student to the practical aspect of

their various course of study and also help prepare them for future job

opportunities.

This report contains the activities carried out in the various sections

of the department of Morbid Anatomy.

1.6 AIM

A. The aim of the Hospital is to provide health care services to individuals

B. The hospital also provides clinical training for medical student and

student related to medical field.

C. To provide clinical and research delivery.

1.7 RELEVANCE OF WORK TO STUDENT TRAINING

The vast knowledge acquired during my training in the department (made up

of the Histopathology Lab, the Mortuary and the Secretariat) is of great relevance
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to me as an Anatomist especially as Morbid Anatomy is an area of specialization in

Anatomy. The practical exposure has helped to complement the theoretical

knowledge acquired in the classroom and it also gave me the privilege of getting

acquainted with new and up to date machine and equipment that may not be

present in the School Laboratory.

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 CHAPTER TWO

2.1 Histopathology

Definition of histopathology: Histopathology is an absolutely crucial branch of

pathology that holds immense value in the diagnosis and treatment of various

diseases. One of the most critical steps in ensuring an accurate diagnosis is the

tissue preparation process. By utilizing the most advanced and precise tissue

preparation methods available, pathologists can confidently differentiate all the

structures in a tissue, which leads to a deeper understanding of diseases and an

even more effective treatment plan for patients. Therefore, it is imperative to use

the best techniques to ensure that diagnoses are accurate, and treatments are

successful. Through the implementation of accurate diagnoses and treatments,

patients can wholeheartedly trust in their medical team's expertise and feel secure

in the knowledge that they are receiving the absolute best possible care.

2.2 Types of Material Obtained In Laboratory

In the field of medicine, human tissue is a valuable resource that is obtained from

the surgery and autopsy room. There are two types of tissue obtained during

surgery - biopsy and excisional biopsy. Biopsy involves the extraction of a small

piece of the lesion or tumor for diagnosis before the final removal of the affected
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tissue. On the other hand, excisional biopsy involves the removal of the whole

tumor or lesion for examination and diagnosis by the pathologist.

Additionally, tissues obtained from the autopsy room are sent for the study of

diseases and their course. This is done to advance medicine and improve the

understanding of various conditions. The findings from this research can be used to

develop new treatments, improve existing ones, and ultimately save lives. As such,

the study of human tissue is crucial in the field of medicine and is highly valued by

medical professionals.

2.3Types of Histological preparation

The histological specimen can be prepared as

1. Whole mount

2. Sections

3. Smears.

1. Whole mounts- These are preparation for entire animals eg. fungus, and thickness.

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2. Sections- The majority of the preparations in histology are sections. The tissue is

cut in about 3-5 mm thick pieces processed and 5 microns thick sections are cut on

a microtome. These are then stained and permanently mounted. Microtomes are

special instruments that have an automatic mechanism for cutting very thin

sections. To cut the sections on the microtome; the tissue must be made hard

enough to not get crushed. There are 2 methods of hardening the tissues. One is by

freezing them and the other is by embedding them in a hard material such as

paraffin wax or gelatin.

3. Smears- Smears are made from blood, bone marrow, or any fluid such as pleural

or ascitic fluid. These are immediately fixed in alcohol to present the cellular

structures are then stained. Smears are also made by crushing soft tissue between

two slides or an impression smear is made by pressing a clean slide in contact with

the moist surface of a tissue. By doing this, the cells are imprinted on the slide and

these may be stained for cytological examination.

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 CHAPTER THREE

3.1. GROSSING

"Grossing" means Inspecting, describing, and measuring the tissue, inking if

necessary, and sectioning the tissue for diagnosis is commonly referred to as

"grossing". This procedure is carried out with utmost precision and accuracy to

ensure accurate results.

The gross description is an essential tool that helps the doctor or pathologist

to accurately diagnose the tissue during microscopic evaluation.

3.2 Principle of Grossing

Tissue grossing involves the transfer of specimens from surgery to pathology in a

reliable and speedy manner. The specimen can be grossed before or after fixation,

but it is recommended to gross larger samples when they are fresh and smaller

ones after fixation. Fixation is preferred if there are delays in transportation.

During my SIWES training, I learned about the important considerations and

techniques involved in grossing tissue specimens.

3.3 General Considerations During Gross Examination

1. The requisition and specimen container must match completely, including at

least three patient identifiers and the specimen site(s). Any discrepancies or

missing information must be dealt with before proceeding. Additionally, the

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cassette number/barcode must match the specimen and requisition. Errors

primarily occur during this pre-analytic phase.

2. The grossing station must be well-ventilated to prevent inhalation of

formaldehyde fumes. Personal protective equipment (PPE) should include

disposable gloves and lab coats, as well as protective eyewear. Proper disposal of

blades and sharps in approved biohazardous waste containers is crucial during

grossing.

3. One specimen container should be opened at a time to prevent confusion.

4. The number of pieces in each container should be noted. For curettage, samples

are measured in aggregate since there may be more than a dozen fragments

submitted.

5. Documentation of the sample's surface dimensions and depth is necessary. Any

small tissue that can slip through the cassette holes should be submitted whole and

wrapped in processing tissue paper (filter paper) or a processing mesh bag.

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6. Ink should be used only for conveying information such as orientation and

margins in excisions or which side to embed down. Inking cut surfaces of tissue

one color will help the embedding tech determine which surface should be

embedded down, where inked surfaces will meet the blade first during the

microtomy process. Inking margins on biopsies is not required since a second

procedure is anticipated based on the diagnosis of the biopsy.

7. Accepted protocols for the laboratory should be followed when sectioning tissue,

with sections generally being approximately 3-4 mm thick/wide. Standardization

of tissue grossing protocols for all grossing personnel is essential so that results are

consistent and quality is reproducible.

8. Tissue should be processed according to the appropriate paraffin processing

protocol, such as biopsy or routine processing.

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 3.4 Apparatus for Grossing

Fig. 3.0

Dissecting board: it is use for specimen dissecting, pinning and photography.

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Scapel and Blades - for making skin incisions, tissue dissections, and a

variety of surgical approaches

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Forcep: for gripping and manipulating small or delicate part.

Scissors: it is used to cut specimen.

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Knife-Dissecting Knives are extremely sharp bladed instruments used for medical

purposes like surgery, anatomical dissection, and podiatry.

Gloves-the Cut Resistant Glove forms a barrier that helps protect the hand from cuts.

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3.5 Fixation of Specimen

For routine tissue examination, 10% neutral buffered formalin is the most common

fixative used, especially for tooth specimens. However, decalcification may be

necessary for mineralized samples like bone or teeth. To ensure uniform

penetration of fixative, it's crucial to fix small volumes of tissues ranging from 5

mm to 1 cm, and the volume of fixative should be at least 20 times that of the

tissue. Typically, these processes require a minimum of 1 hour per mm of tissue

thickness, but for best results, tissues are fixed for 24 to 48 hours. In case of a high

percentage of blood in the specimen, it's recommended to replace the fixative with

a fresh solution. To enhance

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penetration and reduce surface drying, large specimens can be covered with

fixative-soaked gauze or cloth.

3 .6 Health Harzard and Safety Measures

During my training in the laboratory, I learned about the important safety measures

that need to be taken in the grossing room. Staff members working in this area face

many risks, including exposure to infectious materials, flammable and toxic

chemicals, allergens, and carcinogens, as well as physical hazards such as cuts and

needle stick injuries. Needle stick injuries are the most common hazard. Bone dust,

fragments, and crumbles in the working environment can also be potentially

biohazardous. Formalin fumes are another health hazard, as they can cause severe

eye and skin irritation and are toxic if ingested or inhaled.

To minimize these risks, it is important to handle and fixate the specimen

properly before grossing. All tissues must be considered potentially hazardous, and

universal precautions must be taken in accordance with Occupational Safety and

Health Administration regulations. Adequate protective gear should be used, and

contact with chemicals must be minimized. Measures to protect from infection,

such as disposable gowns, gloves, facemasks, and eye gear, should be taken, and

protective gear should be disposed of correctly. Laboratory personnel should clean

their instruments and wash their hands regularly to prevent the spread of infection.
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 CHAPTER FOUR

EMBALMING

4.1What is embalming

Embalming is a process that disinfects, preserves, and restores the dead

human body to a natural form and color. It helps prevent, retard, and control

postmortem changes that are associated with decomposition. Embalming

temporarily bypasses the rotting stages, allowing for eventual body breakdown

through oxidation and dissolution. (Oxidation is the loss of electrons from + to –, a

combination with oxygen. Dissolution is a separation of compounds). The primary

purpose of embalming is Sanibalming, which helps to interact with intrinsic and

extrinsic microbial agents and their enzymatic products. It also neutralizes the

body's normal enzymes, which, at death, activate the autolysis process called self-

digestion. Decomposition is an overall description of a series of processes that

occur within the body's components after death.

4.2 Modern Embalming

Modern embalming techniques are the result of decades, even centuries of

research, trial, error, and invention by many practitioners. Actual embalming

process usually involves four parts:

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Arterial embalming: The process of embalming entails the injection of

embalming chemicals into the blood vessels, typically through the right common

carotid artery, followed by drainage of blood from the right jugular vein. The

embalming solution is forcefully injected using an embalming machine, and the

embalmer diligently massages the cadaver to ensure a thorough distribution of the

embalming fluid. In case of poor circulation, alternative injection points are

utilized to ensure optimal preservation.

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ARTERIAL EMBALMING

Cavity embalming: It is the suction of the internal fluids of the cadaver and the

injecting embalming chemicals into body cavities by using an aspirator and trocar.

Hypodermic embalming: Is injecting embalming chemicals under the skin as

needed.

Surface embalming: Supplements the other methods especially for visible, injured body

parts.

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4.3 Embalming chemicals

Different types of the chemical are the components of embalming fluid. These are:

Embalming is a crucial process that requires the use of various chemicals to

preserve the body of a deceased person. These chemicals can be classified into

several categories based on their functions, and each category plays a crucial role

in the process.

The first category is preservatives that effectively inactivate saprophytic

bacteria and prevent the body from decomposing. This is achieved by altering the

enzymes and lysins of the body, and preservatives like formaldehyde,

glutaraldehyde, and phenol are used in specific

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concentrations. Formalin, which contains 37% aqueous formaldehyde, is a specific

type of preservative.

The second category is germicides, also known as disinfectants, which are

used to kill microorganisms and prevent the growth of bacteria. Germicides like

quaternary ammonium compounds (such as Roccal and ZephiranChloride) and

glutaraldehyde are used to ensure that the body remains free from

microorganisms.

Modifying agents, which make up the third category, play a crucial role in

controlling the action of the main preservative agents. They include buffers,

humectants, and inorganic salts, which influence the chemical reactions produced

by the preservative solution.

Buffers, the fourth category, help maintain the acid-base balance (pH) of the

embalming solution. Borax, sodium phosphate, citrates, and the sodium salt of

EDTA (ethylene diamine tetra acetic acid) are all examples of buffers that are used.

Inorganic salts make up the fifth category and play a crucial role in determining the

osmotic qualities of the embalming solution. Humectants, the sixth category,

effectively hydrate the tissues and prevent them from drying out. Examples of

humectants include glycerol (glycerine), sorbitol, glycol (ethylene and propylene

glycol), and lanolin.

The seventh category is anticoagulants, which retard the natural postmortem

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tendency of blood to become more viscous. Sodium citrate, sodium oxalate, and

the sodium salt of EDTA (chelate) are all examples of anticoagulants that are used.

Surfactants, the eighth category, effectively reduce the molecular cohesion of a

liquid so that it can flow through smaller apertures. Sulfonates like alkyl sulfonates

or alkyl aryl sulfonates and sodium lauryl sulfate are examples of surfactants that

are used. Dyes, the ninth category, impart a specific color to the embalming

solution. Eosin, ponceau red, erythrosin, and amaranth are all examples of dyes

that are used.

Perfuming agents, masking agents, and deodorants make up the tenth

category and effectively reduce the harshness or raw odor of the solution.

Benzaldehyde, oil of cloves, oil of sassafras, and methyl salicylate are examples of

these agents.

Finally, vehicles (diluents) make up the last category and serve as a solvent for the

numerous ingredients incorporated into embalming fluids. Water and alcohols like

methyl alcohol and glycerol are all examples of vehicles that are used.

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These chemicals are combined in various concentrations to produce different types

of embalming fluids, including vascular (arterial fluids) for injection into the

arterial system during vascular embalming, cavity fluids for injection into the

cavities of the body, supplementary fluids, jaundice fluids with special bleaching

and coloring qualities of use on the body with jaundice, high preservation demand

fluids, and accessory chemicals. It's important to note that each category plays a

crucial role in ensuring that the body is preserved effectively.

4.4 Purpose of Embalming

. The purpose of embalming is to temporarily preserve human remains and prevent

decomposition, making them suitable for display at funerals. Additionally,

embalming is done for anatomical research and study. The cadavers are well-

fixed, enabling their use not only for anatomical dissection, but also research on

the vascular system through vasography, kinematics of the joint, and other

histologic examinations.

4.5 Procedures for Embalming

During my course of siwes I was taught on how to embalm a corpse;

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Step 1: Pre-Embalming Prep

The mortician starts the process by laying out the remains on a stainless steel or

porcelain embalming table, similar to those used for an autopsy. The clothing is

then removed from the remains and either returned to the next-of-kin after being

cleaned or destroyed, just like any bedding that accompanies the remains. The

mortician takes great care to inventory any jewelry and secures them in place to

prevent them from disappearing. During the embalming process, other jewelry and

glasses are removed and then replaced on the remains.

When closing the mouth, the funeral director must ensure that the lips meet

naturally. If the mouth is closed too loosely, it will look unpleasant and if it is

closed too tightly, the area under the nose will pucker, giving the upper lip an

unnatural expression that can appear to scowl at the mourners. At times, the funeral

director may even widen the lower lip to improve the appearance of the face.

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Step 2: Preparation

The funeral director expertly cleanses the surface of the remains using a powerful

disinfectant spray or solution, skilfully sponging it onto the surface. With a

confident touch, the director positions the remains, deftly relieving rigor mortis by

flexing, bending, and massaging the arms and legs. The limbs are then carefully

moved into an appropriate position, usually with the legs extended and arms at the

sides. The embalming process is initiated with great precision, involving the

removal of blood and its replacement with a formaldehyde-based fluid. This is

achieved through a small incision made on the right side of the lower neck,

precisely where the two largest circulatory vessels are located - the carotid artery

and the jugular vein or the easily accessible femoral artery located in the femoral

sheath.

Step 3: Embalming Process

Incisions are made in both vessels - the carotid artery/femoral artery and the

jugular vein/femoral vein. A tube connected to the embalming fluid pump is placed

into the carotid artery/femoral artery, and another tube is placed into the jugular

vein/femoral vein, which is called a drain tube. The basic theory of embalming is

to pump embalming fluid into the artery, and this will cause the blood to return

through the veins and flow outside the remains for disposal. Approximately 3
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gallons (depending on body size) of a mixture of fluid and water are circulated

through the remains to ensure thorough disinfection and preservation. Usually, this

is the only point of injection of the embalming fluid. However, there are times

when clots and other factors stop the flow of fluid throughout the whole system,

and at these times, other points of injection are necessary to do a complete and

thorough embalming. Before embalming, the funeral director must assess many

factors such as the mode of death, the weight of the remains, the general overall

condition of the remains, any disease associated with the remains, etc.

These factors determine the types and strengths of fluids used, and the type

of embalming necessary to complete the task. Many fluids have a slight dye added

to them, which gives the remains a pinkish glow, and also acts as a guide for the

funeral director, making it visible for him to see the fluid as it travels through the

remains. This type of embalming is known as arterial embalming.

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Step 4: Washing

The funeral director then washes the remains with cool water, germicidal solution

containing bleach to kill viruses and bacteria. He or she then cleans the fingernails,

uses solvents to remove any stains on the remains, , funeral directors may do this

either before or after embalming.

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 CHAPTER FIVE

SUMMARY AND CONCLUSION

The industrial training had, at the department of Morbid Anatomy, has helped me

both morally and academically.

Morally, I have learnt to adopt the right attitude to work, to be diligent and

hardworking. It has also improved my interactions with people especially during

my posting to the secretariat and the Reception of the Laboratory. Academically,

the training has improved my understanding in, the gross structure and forms of the

Human body both internally and externally.

In conclusion, industrial training for student is paramount for tertiary institution.

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 REFERENCES

1. Bancroft, J. D. and Stevens, A. :theory and practice of histological

techniquesed. 3, Churchill living stone inc. 1990. Edinburgh. London, Melbourne

and New York.

2. Frederick, L. G. and Strub, C. U. (1989) The Principles and Practice of

Embalming.5th Edition, Professional Training Skills Inc.& Robertine Frederick,

Dallas, TX, 1-487.

3. Lillie, R. D. :Histopathologic technique and practice histochemistry ed.

4. NewYork, 1965 McGraw Hill Book co.

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