Introduction to Introduction to PathologyPathology

Module AModule A

Topics for Module ATopics for Module A

Prefixes, suffixes and root wordsPrefixes, suffixes and root words Pathologic termsPathologic terms Disease classificationsDisease classifications Disease stagingDisease staging Patient interview processPatient interview process ProfessionalismProfessionalism

Student ObjectivesStudent Objectives Recognize, understand and be able to apply Recognize, understand and be able to apply

knowledge of terminologyknowledge of terminology Define terms in italicDefine terms in italic Differentiate between signs and symptomsDifferentiate between signs and symptoms Distinguish between disease diagnosis and Distinguish between disease diagnosis and

prognosisprognosis Differentiate between endemic, epidemic, and Differentiate between endemic, epidemic, and

pandemicpandemic Name and explain the disease classificationsName and explain the disease classifications Understand the process of disease stagingUnderstand the process of disease staging Understand the importance of patient interview Understand the importance of patient interview

and how professionalism affects that processand how professionalism affects that process

Learning Activities for Learning Activities for Module AModule A

Read appendix A and be able to define the Read appendix A and be able to define the listed prefix, suffix or root wordslisted prefix, suffix or root words

Define words derived from your knowledge Define words derived from your knowledge of the prefixes, suffixes and root words in of the prefixes, suffixes and root words in

appendix Aappendix A Be able to match words in italic with their Be able to match words in italic with their

meaningmeaning

Body PlanesBody Planes

SAGITTAL PLANESAGITTAL PLANE Used to determine Used to determine anterior / posterior or anterior / posterior or

superior / inferiorsuperior / inferior placement of a structure.placement of a structure.

Used to demonstrate Used to demonstrate anterior/posterior or anterior/posterior or superior/inferior displace-superior/inferior displace-ment of a facture.ment of a facture.

CORONAL PLANECORONAL PLANE Used to determine Used to determine

right/left or superior/inferior right/left or superior/inferior placement of a structure.placement of a structure.

Used to demonstrateUsed to demonstrate right/left or right/left or superior/inferior superior/inferior displacement of a fracture.displacement of a fracture.

the Greek pathos, which translates to feeling, pain, suffering; and logos, which means the study of

(Wikipedia,2006).

PathologyPathology

Disease is classified as “any abnormal disturbance of the function or structure

of the human body as a result of some type of injury(Mace, Kowalczyk, 2004).”

Upon injury, the sequence of events producing cellular changes

within the body is termed pathogenesis.

Pathogenesis can bring about changes which are observable (Mace, Kowalczyk, 2004).

Observable changes are termed manifestations

Disease, Pathogenesis, Disease, Pathogenesis, ManifestationManifestation

Symptoms are the “patient’s perception of the disease.

Symptoms are subjective, and are only identifiable by the patient (Mace, Kowalczyk, 2004)”.

A sign is an “objective manifestationdetected by a physician during an examination (Mace,

Kowalczyk, 2004)”.

There are some disease processes which do not produce symptoms

and are classified as asymptomatic (Mace, Kowalczyk, 2004).

Symptoms / Sign / Symptoms / Sign / AsymptomaticAsymptomatic

The study of the cause of disease is termed etiology.

Nosocomial disease or infection is acquired by the patient while in the hospital.

As many as 100,000 deaths a year can be attributed to

nosocomial disease (Adler, Carlton, 2003).

Etiology / NosocomialEtiology / Nosocomial

Iatrogenic reactions are adverse responses

which can occur from medical treatment. (Mace, Kowalczyk, 2004)

i.e.: Bleeding or pneumothorax after a biopsy

IatrogenicIatrogenic

There has been an increase of infectious diseases within the past two decades.

Science attributes this increase to(CDC,2001):

“changes in human demographics and behavior(CDC,2001)”

“advances in technology and changes in industry practices(CDC,2001)”

“economic development and changes in land-use patterns(CDC,2001)”

“dramatic increases in volume and speed of international travel and commerce—

movement not only of people but of animals, foodstuffs, and other commodities

microbial adaptation and change(CDC,2001)”

“breakdown of public health capacity required for infectious diseases

at the local, state. national. and global levels(CDC,2001)”

CDCCDC

Some geographic areas may have prevalence for a particular disease.

This disease is thought to be endemic to that area

(Mace, Kowalczyk,2004).

If the same disease, not normally found in an area occurs in

large numbers, it becomes classified as an epidemic.

Endemic / EpidemicEndemic / Epidemic

A pandemic is an infectious disease of global proportions (Mace, Kowalczyk,2004).

The study of disease based on large populations is called epidemiology.

The Center for Disease Control and Prevention CDC

National Center for Health Statistics NCHS

Epidemiology / CDC / Epidemiology / CDC / NCHSNCHS

“Mortality rate is the number of deaths caused by a particular disease

averaged over a given population (Mace, Kowalczyk, 2004).”

“Morbidity rate is the incidence of sickness sufficient to interfere

with an individual’s normal daily routine(Mace, Kowalczyk, 2004)”.

Mortality / MorbidityMortality / Morbidity

Disease classifications Disease classifications • congenital

• hereditary

• inflammatory

• degenerative

• metabolic

• traumatic

• neoplastic

Congenital disease – “diseases present at birth and result from genetic orenvironmental factors.

• Not necessarily hereditary in nature, can be acquired in

utero (Mace, Kowalczyk, 2004).”

Hereditary disease- is caused by “developmental disorders

genetically transmitted fromeither parent to child through abnormalities

of individual genes in chromosomes. •Derived from ancestors (Mace, Kowalczyk 2004).”

Congenital and Hereditary disease

1. “Can be caused by invasion by microorganisms such as viruses, bacteria, or fungi

2. Toxic disease which results from poisoning by biological substances

3. Allergic disease which is the overreaction of the bodies own defenses

(Mace, Kowalczyk 2004).”

INFLAMMATORY DISEASEINFLAMMATORY DISEASE““results from the body’s reaction to a localized

injurious agent.”

Degenerative disease- “caused by a deterioration of the body.

Not always associated with aging (Mace, Kowalczyk 2004).”

Metabolic disease- “caused by a disturbance of the normal physiologic function of thebody.

Includes endocrine diseases (Mace, Kowalczyk, 2004).”

Degenerative disease / Metabolic Degenerative disease / Metabolic diseasedisease

Traumatic disease- diseases “resulting from mechanical forces

(Mace, Kowalczyk, 2004)”

Neoplastic disease- abnormal tissue growth.

Tissue growth can be benign or malignant tumor, or neoplasm (Mace, Kowalczyk, 2004).

Traumatic disease / Neoplastic Traumatic disease / Neoplastic diseasedisease

Types of Traumatic Injury

mechanical injury – this injury can have multiple locations. Complications can include

1. Infection2. hemorrhage.

Disability or death can result.

Prognosis dependent on severity of the injury.• abrasions• contusions• lacerations• incisions

• stab • puncture, and• bullet wounds

Mechanical injuryMechanical injury

trauma to bones and joints – any bony structure is at risk.

Complications can include:

1. necrosis of bone or soft tissue through the interruption of blood supply

2. infection 3. and hemorrhage

Disability or death can result. Prognosis dependent on severity of the injury.Ie: fractures, dislocations, sprains

Traumatic InjuryTraumatic Injury

head injuries – complications can include:1. memory loss,2. infection, 3. coma, 4. hemorrhage5. infarct of brain tissue, 6. permanent or temporary brain damage.

Disability or death can result.

Prognosis dependent on severity of the injury.

• hemorrhage• skull fracture• concussion

Head InjuryHead Injury

1. brain damage2. infection from aspiration into the lungs, 3. pneumonia.

Disability or death can result.

Prognosis dependent on severity of the injury•drowning •inhalation of carbon monoxide or other toxic gas•smoke •electrical shock•lodging of a foreign body in respiratory tract•poisoning•physical suffocation

Asphyxiation

Burns – complications can include inability of body to regulate its temperature in cases of severe burns

circulatory collapse / renal damage gastric atony / paralytic ileus

dehydration / infectionsepsis / skin grafts

septic shock.

Disability or death can result.

Prognosis dependent on severity of the injury.•thermal

•electrical•chemical

Common complications of trauma are:

1. shock - the state of collapse precipitated by peripheral circulatory failure

2. hemorrhage- excessive bleeding 3. infection 4. improper healing.

(AccessScience,McGraw-Hill, Stuart, Mottet, 2000

Tissue Disruption -

The healing of soft tissue trauma (tissue disruption) is determined by:

1. the extent or severity of the injury2. nerve or vessel involvement3. location of the injury4. introduction of foreign matter (secondary

infection)

The “…terms cancer and carcinoma are not synonymous (Mace, Kowalczyk, 2004,p.12)”.

•carcinoma is a “type of cancer and is derived from epithelial tissue”

•sarcoma is a type of cancer from connective tissue

•“…leukemias, and lymphomas arise from blood cells and lymphatic cells (Mace, Kowalczyk,

2004,p.12).”

Types of Cancer-

differentiated – “…small differences in the cells of the growth

compared to the cells of the host organLow probability for malignancy.

(Mace, Kowalczyk, 2004,p.12).”

undifferentiated or poor differentiated- “cells of the growth

have atypical characteristics in comparison with the host organ.

High probability of malignancy.(Mace, Kowalczyk, 2004,p.12).”

Neoplasm

Neoplam cells…….can be differentiated or undifferentiated (Mace, Kowalczyk, 2004,p.12):

Both benign and malignant tumors are named “according to the tissue type of origin

(Mace, Kowalczyk, 2004,p.12)”.

benign tumors – the root word is added to “oma”

malignant neoplasms are named by adding the root word to the name of the tissue type

Classification of malignant neoplasm

determines the appropriate

treatment and prognosis

of the disease.

Staging Cancer

TMN system developed 1950TMN system developed 1950

Endorsed by the:Endorsed by the: American Joint Committee on Cancer (AJCC)American Joint Committee on Cancer (AJCC) American Cancer SocietyAmerican Cancer Society American College of Radiology (ACR)American College of Radiology (ACR)

T – “…refers to the size of the untreated tumor

N - refers to lymph node involvement

M – indicates the presence or absence of metastasis

Neoplastic cells are examined histologically.

Determine the degree of malignancy

Categorized according to their degree of differentiationGrade 1 is the least malignantGrade 4 is the most malignant

Benefits of the TNM system include: (Mace, Kowalczyk, 2004,p.13)

1. “…facilitates treatment planning”

2. “…provides an indication of prognosis”

3. “…assists in evaluating treatment results”

4. ….facilitates information exchange between treatment centers”

5. “…allows unambiguous categorization of malignancies to aid in the investigation of cancer”

Patient HistoryPatient History

“When you talk with the patient, you should listen, first for what he wants

to tell, secondly for what he does not want to tell,

and thirdly for what he cannot tell.”

-L.J.Henderson“Physician and Patient as Social Systems”

Speaking to each patient should be conducted with the desired outcome kept in mind.

1. Delay casual conversations2. Maintain a polite and professional demeanor

3. Have a genuine interest in what the patient says 4. Create a sense of cooperation

(Adler, Carlton, 2003,p.126)

Steps for conducting a Steps for conducting a successful patient interviewsuccessful patient interview

1. technologist should begin by introducing themselves

2. maintain a polite but professional demeanor3. do not use affectionate terms4. allow the patient see you write down the

information (Adler, Carlton, 2003,p.126)

Review the chief complaint

Determine Localization of pain or other manifestation

Establish Chronology of disease

Determine quality of the disease process….. chronic or acute Determine Severity of patient symptoms

Establish what are aggravating or alleviating factors

Ask about the associated manifestations

Determine the presence or absence of recent trauma

Determine if the patient has had any previous surgeries

There are several techniques useful for obtaining a good patient history.

1. Open ended questions

2. Facilitation3. silence

Using probing questions for clarification,

repetition, and summarization are all useful techniques which can be used for obtaining a good patient history.

(Adler, Carlton, 2003)There are seven elements which are recognizable

when evaluating a good patient history.

These elements are called the sacred seven:1. localization

2. quality3. onset4. quality

5. chronology6. aggravating or alleviating factors

7. associated manifestations

SummarySummary Read the chart - for all inpatients!

Review the chief complaint to look for indications for performing the ordered examination.

Review the written order by the physician. Look for discrepancies between the physician’s written orders

and the orders received from the nursing unit.

Review for previously performed exams within the radiology department as well as other modalities.

Check for contra-indications for performing the exam.

Continue…Continue… SummarySummary

LocalizationLocalization of pain or other of pain or other manifestation…manifestation…

Find the specific location of the patient’s complaint Find the specific location of the patient’s complaint

Have the patient physically point to area of pain.Have the patient physically point to area of pain.

Continue…Continue… SummarySummary

Chronology Chronology of disease….of disease….

This is the time element of the disease. This is the time element of the disease.

(duration or frequency) (duration or frequency)

(Write the patient information by days or weeks) (Write the patient information by days or weeks)

Continue…Continue… SummarySummary

The The qualityquality of the disease process…. of the disease process….

chronic or acutechronic or acute

What type of pain …….. What type of pain ……..

What kind of cough…….What kind of cough…….

Continue…Continue… SummarySummary

SeveritySeverity of patient symptoms….. of patient symptoms…..

Can the patient still use the injured hand?Can the patient still use the injured hand?

Can the patient still walk on the injured foot? Can the patient still walk on the injured foot?

Is the patient still able to eat, drink etc? Is the patient still able to eat, drink etc?

Continue…Continue… SummarySummary

What are the What are the

aggravating or alleviating aggravating or alleviating factors……factors……

circumstances which circumstances which facilitatefacilitate or or

intensifyintensify the problem? the problem?

Continue…Continue… SummarySummary

What are the What are the Associated Associated manifestationsmanifestations??

Are patient’s symptoms relatedAre patient’s symptoms related

to a totally differentto a totally different

problem or problem or disease?disease?

Continue…Continue… SummarySummary

Was there Was there recent traumarecent trauma??

Has the patient had any Has the patient had any previous surgeries?previous surgeries?