Transcript 16.Module A_Introduction

Introduction to
Pathology
Module A
Topics for Module A
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Prefixes, suffixes and root words
Pathologic terms
Disease classifications
Disease staging
Patient interview process
Professionalism
Student Objectives
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Recognize, understand and be able to apply
knowledge of terminology
Define terms in italic
Differentiate between signs and symptoms
Distinguish between disease diagnosis and
prognosis
Differentiate between endemic, epidemic, and
pandemic
Name and explain the disease classifications
Understand the process of disease staging
Understand the importance of patient interview
and how professionalism affects that process
Learning Activities for Module A
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Read appendix A and be able to define the
listed prefix, suffix or root words
Define words derived from your knowledge
of the prefixes, suffixes and root words in
appendix A
Be able to match words in italic with their
meaning
Body Planes
SAGITTAL PLANE
 Used to determine
anterior / posterior or
superior / inferior
placement of a structure.
CORONAL PLANE
 Used to determine
right/left or superior/inferior
placement of a structure.
Used to demonstrate
anterior/posterior or
superior/inferior displacement of a facture.
Used to demonstrate
right/left or
superior/inferior
displacement of a fracture.
Pathology
the Greek pathos, which translates to
feeling, pain, suffering;
and logos, which means the study of
(Wikipedia,2006).
Disease, Pathogenesis, Manifestation
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
Symptoms / Sign / Asymptomatic
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 manifestation
detected 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).
Etiology / Nosocomial
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).
Iatrogenic
Iatrogenic reactions are adverse responses
which can occur from medical treatment.
(Mace, Kowalczyk, 2004)
i.e.: Bleeding or pneumothorax after a biopsy
CDC
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)”
Endemic / Epidemic
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.
A pandemic is an infectious disease of global proportions
(Mace, Kowalczyk,2004).
Epidemiology / CDC / NCHS
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
Mortality / Morbidity
“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)”.
Disease classifications
• congenital
• hereditary
• inflammatory
• degenerative
• metabolic
• traumatic
• neoplastic
Congenital and Hereditary disease
Congenital disease – “diseases present at birth and
result from genetic or
environmental factors.
Not necessarily hereditary in nature, can be acquired in
utero (Mace, Kowalczyk, 2004).”
•
Hereditary disease- is caused by “developmental
•
disorders
genetically transmitted from
either parent to child through abnormalities
of individual genes in chromosomes.
Derived from ancestors (Mace, Kowalczyk 2004).”
INFLAMMATORY DISEASE
“results from the body’s reaction to a localized injurious agent.”
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).”
Degenerative disease / Metabolic disease
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).”
Traumatic disease / Neoplastic disease
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).
Types of Traumatic Injury
Mechanical injury
mechanical injury – this injury can have multiple locations.
Complications can include
1. Infection
2. hemorrhage.
Disability or death can result.
Prognosis dependent on severity of the injury.
• abrasions
• contusions
• lacerations
• incisions
• stab
• puncture, and
• bullet wounds
Traumatic 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
Head Injury
head injuries – complications can include:
1. memory loss,
2. infection,
3. coma,
4. hemorrhage
5. 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
Asphyxiation
1. brain damage
2. 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
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 / infection
sepsis / 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 injury
2. nerve or vessel involvement
3. location of the injury
4. introduction of foreign matter (secondary
infection)
Types of CancerThe “…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).”
Neoplasm
Neoplam cells…….can be differentiated or
undifferentiated (Mace, Kowalczyk, 2004,p.12):
differentiated – “…small differences in the cells of the
growth
compared to the cells of the host organ
Low 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).”
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
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TMN system developed 1950
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Endorsed by the:
American Joint Committee on Cancer (AJCC)
 American Cancer Society
 American College of Radiology (ACR)
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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 differentiation
Grade 1 is the least malignant
Grade 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 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 conversations
2. 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
successful patient interview
1. technologist should begin by introducing
themselves
2. maintain a polite but professional demeanor
3. do not use affectionate terms
4. 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. Facilitation
3. 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. quality
3. onset
4. quality
5. chronology
6. aggravating or alleviating factors
7. associated manifestations
Summary
Read the chart - for all inpatients!
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Review the chief complaint to look for indications for
performing the ordered examination.
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Review the written order by the physician. Look for
discrepancies between the physician’s written orders and
the orders received from the nursing unit.
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Review for previously performed exams within the
radiology department as well as other modalities.
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Check for contra-indications for performing the exam.
Continue…
Summary
Localization of pain or other
manifestation…
Find the specific location of the patient’s complaint
Have the patient physically point to area of pain.
Continue…
Summary
Chronology of disease….
This is the time element of the disease.
(duration or frequency)
(Write the patient information by days or weeks)
Continue…
Summary
The quality of the disease process….
chronic or acute
What type of pain ……..
What kind of cough…….
Continue…
Summary
Severity of patient symptoms…..
Can the patient still use the injured hand?
Can the patient still walk on the injured foot?
Is the patient still able to eat, drink etc?
Continue…
Summary
What are the
aggravating or alleviating factors……
circumstances which facilitate
or
intensify the problem?
Continue…
Summary
What are the Associated manifestations?
Are patient’s symptoms related
to a totally different
problem or disease?
Continue…
Summary
Was there recent trauma?
Has the patient had any previous surgeries?