1. Introduction to Pathology Module A

2. Topics for Module A Prefixes, suffixes and root words Prefixes, suffixes and root words Pathologic terms Pathologic terms Disease classifications Disease classifications Disease staging Disease staging Patient interview process Patient interview process Professionalism Professionalism

3. Student Objectives Recognize, understand and be able to apply knowledge of terminology Recognize, understand and be able to apply knowledge of terminology Define terms in italic Define terms in italic Differentiate between signs and symptoms Differentiate between signs and symptoms Distinguish between disease diagnosis and prognosis Distinguish between disease diagnosis and prognosis Differentiate between endemic, epidemic, and pandemic Differentiate between endemic, epidemic, and pandemic Name and explain the disease classifications Name and explain the disease classifications Understand the process of disease staging Understand the process of disease staging Understand the importance of patient interview and how professionalism affects that process Understand the importance of patient interview and how professionalism affects that process

4. Learning Activities for Module A Read appendix A and be able to define the listed prefix, suffix or root words 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 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 Be able to match words in italic with their meaning

5. Body Planes SAGITTAL PLANE Used to determine Used to determine anterior / posterior or anterior / posterior or superior / inferior placement of a structure. placement of a structure. Used to demonstrate anterior/posterior or superior/inferior displace- ment of a facture. CORONAL PLANE Used to determine right/left or superior/inferior placement of a structure. Used to demonstrate right/left or superior/inferior displacement of a fracture.

6. the Greek pathos, which translates to feeling, pain, suffering; and logos, which means the study of (Wikipedia,2006). Pathology

7. 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, Manifestation

8. 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). Symptoms / Sign / Asymptomatic

9. 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 / Nosocomial

10. Iatrogenic reactions are adverse responses which can occur from medical treatment. (Mace, Kowalczyk, 2004) i.e.: Bleeding or pneumothorax after a biopsy Iatrogenic

11. 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)” CDC

12. 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 / Epidemic

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

14. 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 / NCHS

15. “ 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 / Morbidity

16. Disease classifications congenital hereditary inflammatory degenerative metabolic traumatic neoplastic

17. 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).” Congenital and Hereditary disease

18. 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 DISEASE “ INFLAMMATORY DISEASE “results from the body’s reaction to a localized injurious agent.”

19. 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 disease

20. 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 disease

21. Types of Traumatic Injury

22. 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 Mechanical injury

23. 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 Injury

24. 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 Head Injury

25. 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 Asphyxiation

26. 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

27. 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

28. 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)

29. 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-

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

31. 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

32. Classification of malignant neoplasm determines the appropriate treatment and prognosis of the disease.

33. Staging Cancer TMN system developed 1950 TMN system developed 1950 Endorsed by the: Endorsed by the: American Joint Committee on Cancer (AJCC) American Joint Committee on Cancer (AJCC) American Cancer Society American Cancer Society American College of Radiology (ACR) American College of Radiology (ACR)

34. T – “…refers to the size of the untreated tumor N - refers to lymph node involvement M – indicates the presence or absence of metastasis

35. 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

36. 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”

37. 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”

38. 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)

39. 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)

40. 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

41. 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.

42. (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

43. Summary 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.

44. 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.

45. Continue… Summary Chronology of disease…. Chronology of disease…. This is the time element of the disease. (duration or frequency) (duration or frequency) (Write the patient information by days or weeks)

46. Continue… Summary The quality of the disease process…. chronic or acute What type of pain …….. What kind of cough…….

47. Continue… Summary Severity of patient symptoms….. 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?

48. Continue… Summary What are the aggravating or alleviating factors…… circumstances which facilitate circumstances which facilitate or or intensify the problem?

49. Continue… Summary What are the Associated manifestations? Are patient’s symptoms related to a totally different to a totally different problem or disease? problem or disease?

50. Continue… Summary Was there recent trauma? Has the patient had any previous surgeries?