Module 1-3 - RadPatho.pdf

Republic of the Philippines UNIVERSITY OF EASTERN PHILIPPINES University Town, Northern Samar Web: http://uep.edu.ph Email: [email protected] COLLEGE OF NURSING AND ALLIED HEALTH SCIENCES BS RADIOLOGIC TECHNOLOGY M...

Republic of the Philippines UNIVERSITY OF EASTERN PHILIPPINES University Town, Northern Samar Web: http://uep.edu.ph Email: [email protected] COLLEGE OF NURSING AND ALLIED HEALTH SCIENCES BS RADIOLOGIC TECHNOLOGY MODULE 1 Prepared by: JEMUEL FRED O. CAPOQUIAN, RRT  2 Over View As a third year BSRT student, soon you will be in hospitals for your internship. This subject is one of the requirements before you can proceed to clinical setup. Studying radiographic pathology was chosen for many reasons and this module will help you to establish knowledge on how pathology is consequential. During your previous years as a student, you have studied anatomy and physiology. Without basic knowledge in anatomy and physiology, it would be impossible to understand pathology. In this subject you will learn many types of diseases that may develop or may acquire by our body. But the most important thing about considering pathology as radiologic technologist is to provide good quality radiographs as doctors allow them to better see tissues architectures and abnormalities, and you should be aware of that. RT 316 - RADIOLOGIC PATHOLOGY Prepared by: JFOC  3 Learning Outcomes At the end of this course, student will recognize common pathologic conditions and apply appropriate examination procedure and technique for best presentation of body part of interest. Student will  review the human body as a structural and functional unit;  explain the significance of surface anatomy and identify locations of different radiographic structures;  define basic terms related to pathology;  discuss the classifications of trauma;  describe the major categories of pathologic basis of disease formation as to its cause, biochemical, and tissue change and result;  describe the basic manifestations of pathological conditions and their relevance to radiologic procedures;  differentiate and describe various pathological conditions of the different body systems as to etiology, inflammation, neoplasm, and trauma or injury;  identify imaging procedures and interventional techniques appropriate for diseases common to each body system;  identify common pathological conditions affecting the organ system as presented/viewed on the radiograph;  describe the radiographic appearance of diseases. RT 316 - RADIOLOGIC PATHOLOGY Prepared by: JFOC  4 Lesson Review of Human Body Welcome to the study that will you give you the means to learn the fundamentals of radiographic pathology (study of diseases). Since radiography is one of the primary methods of diagnosing disease, studying certain pathologies will provide you knowledge in clinical setting. Before that, you need to review the basic of human body. Learning objectives On completion of this lesson, you should be able to:  Describe the levels of structural components within the body  State the boundaries of the body cavities  Define and understand directional terms and body planes. Abstraction The human body is rather like a highly technical and sophisticated machine. It operates as a single entity, but is made up of a number of systems that work interdependently. Each system is associated with a specific function that is normally essential for the well- being of the individual. Should one system fail, Figure 1.1 levels of structural organization complexity RT 316 - RADIOLOGIC PATHOLOGY Prepared by: JFOC  5 the consequences can extend to others, and may greatly reduce the ability of the body to function normally. Within the body are different levels of structural organization and complexity. The most fundamental of these is chemical. Atoms combine to form molecules, of which there is a vast range in the body. I – STRUCTURAL ORGANIZATION OF HUMAN BODY 1.1 Cells Cells are the smallest independent units of living matter and there are trillions of them within the body. They are too small to be seen with the naked eye, but when magnified using a microscope different types can be distinguished by their size, shape and the dyes they absorb when stained in the laboratory. Each cell type has become specialized, enabling it to carry out a particular function that contributes to body needs. In complex organisms such as the human body, cells with similar structures and functions are found together, forming tissues. 1.2 Tissues Tissue consists of a group of cells that work together to accomplish one or more specific functions. In an adult human, there are Figure 1.2 Somatic cells vs. Germ cells RT 316 - RADIOLOGIC PATHOLOGY Prepared by: JFOC  6 only four distinct types of tissue. 1.3 Organs Organs are made up of a number of different types of tissue and have evolved to carry out a specific function. Figure 1.1 shows that the stomach is lined by a layer of epithelial tissue and that its wall contains layers of smooth muscle tissue. Both tissues contribute to the functions of the stomach, but in different ways. 1.4 Systems Systems consist of a number of organs and tissues that together contribute to one or more Figure 1.3 Types of Human tissues survival needs of the body. For example, the stomach is one of several organs of the digestive system, which has its own specific function. The human body has several systems, which work interdependently carrying out specific functions. All are required for health. II – BODY CAVITIES The body organs are contained and protected within four cavities: cranial, thoracic, abdominal, and pelvic. 2.1 Cranial Cavity Also known as intracranial space, is the space within the skull. The space inside the skull is formed by eight cranial bones known as the neurocranium. The neurocranium is the upper back part that forms the protective case around the Figure 1.4 Bones forming the right half of the cranium and the face RT 316 - RADIOLOGIC PATHOLOGY Prepared by: JFOC  7 brain. The presence of the cerebrospinal fluid makes a cushion for safety of brain inside the cranial cavity. 2.2 Thoracic Cavity Also called chest cavity, the second largest hollow space of the body. It is enclosed by the ribs, the vertebral column, and the sternum, and is separated from abdominal cavity by a muscular and membranous partition, the diaphragm. The thoracic cavity has compartments: the mediastinum and two pleural cavities. Figure 1.5 Structures forming the walls of the thoracic cavity and associated structures 2.3 Abdominal Cavity The abdominal cavity is a large cavity found in the torso between the thoracic cavity, and the pelvic cavity. A protective layer that is called the peritoneum, which plays a role in immunity, supporting organs, fat storage, lines the abdominal cavity. Figure 1.6 Organs occupying the anterior part of the abdominal cavity 2.4 Pelvic Cavity A body cavity that is bounded by the bones of the bones of the pelvis. Its oblique roof is the pelvic inlet (the superior opening of the pelvis). Its lower boundary is the pelvic floor. The pelvic cavity primarily contains reproductive organs, the urinary bladder, the pelvic colon, and the rectum. Figure 1.7 Female reproductive organs and other structures in Figure 1.8 Male reproductive organs and other structures in the the pelvic cavity. pelvic cavity. RT 316 - RADIOLOGIC PATHOLOGY Prepared by: JFOC  8 III – Body Plane There are three body planes, which lie at right angles to each other. These divide the body into sections and are used to visualize or describe its internal arrangement from different perspectives. The anatomical position is used as a reference position in descriptions using body planes. Figure 1.9 Regions of the abdominal cavity. Median plane. When the body is divided longitudinally through the midline into right and left halves it has been divided in the median plane. A sagittal section is any section made parallel to the median plane. Coronal plane. A coronal or frontal section divides the body longitudinally into its anterior (front) and posterior (back) sections. Transverse plane. A transverse or horizontal section provides a cross section dividing the Figure 1.10 Body Planes body or body part into upper and lower parts. This may be at any level e.g. through the cranial cavity, thorax, abdomen, a limb or an organ. Anatomical position. The body is upright position with the head facing forward, the arms at the sides with palms of the hands facing forward with the heels of the feet together. IV – DIRECTIONAL TERMS These paired terms are used to describe the location of body parts in relation to others. Directional Terms Meaning Medial Structure is nearer to the midline. The heart is medial to the humerus Lateral Structure is further from the midline or at the side of the body. The humerus is lateral to the heart Proximal Nearer to a point of attachment of a limb, or origin of a body part. The femur is proximal to the fibula Distal Further from a point of attachment of a limb, or origin of a body part. The fibula is distal to the femur Anterior/Ventral Part of the body being described is nearer the front of the body. The sternum is anterior to the vertebrae Posterior/Dorsal Part of the body being described is nearer the back of the body. The vertebrae are posterior to the sternum Superior Structure nearer the head. The skull is superior to the scapulae Inferior Structure further from the head. The scapulae are inferior to the skull Table 1 Common directional terms. RT 316 - RADIOLOGIC PATHOLOGY Prepared by: JFOC  9 V – REVIEW OF SURFACE ANATOMY Significance to radiography Surface anatomy is a descriptive science dealing with anatomical features that can be studied by sight and palpating the human body without dissecting. This knowledge is important for radiologic technologist to know as many surface landmarks are used for positioning. Also a good understanding of surface anatomy enables the radiologic technologist to perform the most beneficial views for the patient. Body Surface Landmarks Figure 1.11 Body landmarks Head Surface Landmarks Figure 1.12 Anatomical landmarks of head and face. Figure 1.13 Anatomical landmarks of head and face. RT 316 - RADIOLOGIC PATHOLOGY Prepared by: JFOC  10 Lesson Introduction to Pathology Now that you have reviewed your knowledge about human body, you can now start to study about pathology. Knowledge and understanding of pathology is essential for all general medical practitioners and specialists since unless they know the causes, mechanisms, nature and type of disease, and understand the language spoken by the pathologist in the form of laboratory reports, they would not be able to institute appropriate treatment or suggest preventive measures to the patient. Learning objectives On completion of this lesson, you should be able to:  Define pathology  List pathological terminologies  Know and differentiate some subdivisions of pathology  Understand and explain the classification of diseases Abstraction DEFINITION OF PATHOLOGY The word ‘Pathology’ is derived from two Greek words—pathos meaning suffering, and logos meaning study. Pathology is, thus, scientific study of structure and function of the body in disease; or in other words, pathology consists of the abnormalities that occur in normal anatomy DISEASE (including histology) and physiology owing - It is any abnormal change in the function to disease. Pathologists are the or structure within the body - It is a morbid process diagnosticians of disease. - It can affect one or more organs RT 316 - RADIOLOGIC PATHOLOGY Prepared by: JFOC  11 SUBDIVISIONS OF PATHOLOGY Depending upon the species studied, there are various disciplines of pathology such as human pathology, animal pathology, plant pathology, veterinary pathology, poultry pathology etc. Comparative pathology deals with the study of diseases in animals in comparison with those found in man. Human pathology is the largest branch of pathology. It is conventionally divided into General Pathology dealing with general principles of disease, and Systemic Pathology that includes study of diseases pertaining to the specific organs and body systems. Pathology has come to include the following subspecialities: A. HISTOPATHOLOGY. Histopathology, C. CHEMICAL PATHOLOGY. Analysis of used synonymously with anatomic pathology, biochemical pathologic anatomy, or morbid anatomy, is constituents of blood, urine, semen, CSF and the classic method of study and still the most other body useful one which has stood the test of time. fluids are included in this branch of pathology. The study includes structural changes observed by naked eye examination referred D. IMMUNOLOGY. Detection of to as gross or macroscopic changes, and the abnormalities in the changes detected by light and electron immune system of the body comprises microscopy supported by numerous special immunology and staining methods including histochemical and immunopathology. immunological techniques to arrive at the most accurate diagnosis. Anatomic pathology E. EXPERIMENTAL PATHOLOGY. This is includes the following 3 main subdivisions: defined as production of disease in the experimental animal and its study. However, 1. Surgical pathology. It deals with the study all the findings of experimental work in of tissues removed from the living body. animals may not be applicable to human beings due to species differences. 2. Forensic pathology and autopsy work. This includes the study of organs and tissues F. GEOGRAPHIC PATHOLOGY. The study removed at postmortem for medicolegal work of differences in distribution of frequency and and for determining the underlying sequence type of diseases in and cause of death. Postmortem anatomical populations in different parts of the world diagnosis is helpful to the clinician to enhance forms geographic pathology. his knowledge about the disease and his judgement while forensic autopsy is helpful G. MEDICAL GENETICS. This is the branch for medicolegal purposes. of human genetics that deals with the relationship between heredity and disease. 3. Cytopathology. Though a branch of There have been important developments in anatomic pathology, cytopathology (studies the field of medical genetics e.g. in blood and diagnoses disease on the cellular level) groups, inborn errors of metabolism, has developed as a distinct subspeciality in chromosomal aberrations in congenital recent times. It includes study of cells shed off malformations and neoplasms etc. from the lesions (exfoliative cytology) and fine-needle aspiration cytology (FNAC) of H. MOLECULAR PATHOLOGY. The superficial and deep-seated lesions for detection and diagnosis of abnormalities at diagnosis). the level of DNA of the cell is included in molecular pathology. B. HAEMATOLOGY. Haematology deals with the diseases of blood. It includes laboratory haematology and clinical haematology; the latter covers the management of patient as well. RT 316 - RADIOLOGIC PATHOLOGY Prepared by: JFOC  12 DISEASE AND ILLNESS A term commonly confused with disease is illness. While disease suggests an entity with a cause, illness is the reaction of the individual to disease in the form of symptoms (complaints of the patient) and physical signs (elicited by the clinician). Though disease and illness are not separable, the study of diseases is done in pathology while the learning and management of illnesses is done in wards and clinics. In addition to disease and illness, there are syndromes (meaning running together) characterized by combination of symptoms caused by altered physiologic processes. Illness – first person perspective Disease – professional perspective Sickness – societal perspective TERMINOLOGY IN PATHOLOGY It is important for a beginner in pathology to be familiar with the language used in pathology:  Patient is the person affected by disease.  Lesions are the characteristic changes in tissues and cells produced by disease in an individual or experimental animal.  Etiology is the study of the cause of disease.  Idiopathic the cause of disease is unknown.  Iatrogenic cause is the result of the treatment given to the patient.  Pathologic changes or morphology consist of examination of diseased tissues.  Pathologic changes can be recognized with the naked eye (gross or macroscopic changes) or studied by microscopic examination of tissues.  Causal factors responsible for the lesions are included in etiology of disease (i.e. ‘why’ of disease).  Mechanism by which the lesions are produced is termed pathogenesis of disease (i.e. ‘how’ of disease).  Functional implications of the lesion felt by the patient are symptoms and those discovered by the clinician are the physical signs.  Clinical significance of the morphologic and functional changes together with results of other investigations help to arrive at an answer to what is wrong (diagnosis), what is going to happen (prognosis), what can be done about it (treatment), and finally what should be done to avoid complications and spread (prevention) (i.e. ‘what’ of disease). RT 316 - RADIOLOGIC PATHOLOGY Prepared by: JFOC  13 CLASSIFICATION OF DISEASES CLASSIFICATION OF DISEASES STRUCTURAL DISEASES FUNCTIONAL DISEASES Genetic and Developmental Impairs normal functioning of bodily Diseases processes that remains largely undetected under examination, dissection, or even under Acquired Injuries/Traumatic microscope. Inflammatory Degenerative Neoplastic Metabolic A. Genetic and developmental D. Metabolic disease diseases – occurs when abnormal chemical Congenital – birth defect, is a reactions in your body disrupt this condition present at birth regardless of its process. You can develop metabolic cause. disease or disorder when some organs, Hereditary – inherited disease or such as your liver become diseased or disorder. Are passed on from one do not function normally. generation to another through defective genes. E. Traumatic injury B. Inflammatory diseases – refers to physical injuries of Infective – invasion of sudden onset and severity which microorganisms such as virus, bacteria, require immediate medical attention. It or fungi caused by a variety of external forces Allergic – over reaction of body’s which affect the body. own defenses Toxic – having chemical nature F. Neoplastic disease that is harmful to health or lethal if – a condition that cause tumor consumed or otherwise entering into the growth – both benign and malignant. body in sufficient quantities. C. Degenerative disease TREATMENT AND CURE A treatment improves a condition and improves – result of continuous process the patient’s quality of life, while a cure would completely based on degenerative cell changes, remove the disease from the patient. The term cure means affecting tissue or organs, which will that, after medical treatment, the patient no longer has the increasingly deteriorate over time. particular condition anymore. D. Metabolic disease RT 316 - RADIOLOGIC PATHOLOGY Prepared by: JFOC – occurs when abnormal chemical reactions in your body disrupt this process. You can develop metabolic  14 Lesson General Basis of Pathologic Condition Now that pathology has been introduced to you, you will get to know the general basis of pathologic condition. A pathological condition is the one caused by disease rather than occurring physiologically. One of those is inflammation, which we will discuss in this lesson. Learning objectives On completion of this lesson, you should be able to:  Define inflammation and know its causes  Differentiate the two types of inflammation  Know its outcomes and effects  List some examples of diseases Abstraction INFLAMMATION DEFINITION AND CAUSES. Inflammation is defined as the local response of living mammalian tissues to injury due to any agent. It is a body defense reaction in order to eliminate or limit the spread of injurious agent, followed by removal of the necrosed cells and tissues. The agents causing inflammation may be as under: 1. Infective agents like bacteria, viruses and their toxins, fungi, parasites. 2. Immunological agents like cell-mediated and antigen-antibody reactions. RT 316 - RADIOLOGIC PATHOLOGY Prepared by: JFOC  15 3. Physical agents like heat, cold, SIGNS OF INFLAMMATION radiation, mechanical trauma. The Roman writer Celsus in 1st century A.D. named the famous 4 cardinal signs of inflammation as: 4. Chemical agents like organic and  rubor (redness); inorganic poisons.  tumor (swelling); 5. Inert materials such as foreign bodies.  calor (heat); and  dolor (pain). To these, fifth sign functio laesa (loss of function) was Thus, inflammation is distinct from later added by Virchow. infection—while inflammation is a protective response by the body to variety of etiologic agents (infectious or non- infectious), while infection is invasion into the body by harmful microbes and their resultant ill-effects by toxins. TYPES OF INFLAMMATION Depending upon the defense capacity of the host and duration of response, inflammation can be classified as acute and chronic. A. Acute inflammation is of short duration (lasting less than 2 weeks) and represents the early body reaction, resolves quickly and is usually followed by healing. The main features of acute inflammation are: 1. accumulation of fluid and plasma at the affected site; Figure 1.3 Redness (rubor) and swelling (tumour), both characteristic features of acute inflammation 2. intravascular activation of platelets; and 3. polymorphonuclear neutrophils as inflammatory cells. Sometimes, the acute inflammatory ACUTE INFLAMMATION response may be quite severe and is termed as fulminant acute inflammation. Acute inflammation begins within seconds B. Chronic inflammation is of longer to minutes following injury to tissues. duration and occurs either after the causative agent of acute inflammation persists for a long time, or the stimulus is Phases of Acute Inflammation such that it induces chronic inflammation from the beginning. A variant, chronic active inflammation, is the type of chronic Acute inflammation can be discussed in inflammation in which during the course of terms of two stages; (1) the vascular disease there are acute exacerbations of phase, which is followed by; (2) the cellular activity. phase. The characteristic feature of chronic inflammation is presence of chronic inflammatory cells such as lymphocytes, plasma cells and macrophages, granulation Vascular Phase tissue formation, and in specific situations as granulomatous inflammation. In the vascular phase, small blood In some instances, the term subacute vessels adjacent to the injury dilate inflammation is used for the state of inflammation between acute and chronic. (vasodilatation) and blood flow to the area RT 316 - RADIOLOGIC PATHOLOGY Prepared by: JFOC  16 increases. The endothelial cells initially swell, then contract to increase the space between them, thereby increasing the permeability of the vascular barrier. This process is regulated by chemical mediators. Exudation of fluid leads to a net loss of fluid from the vascular space into the interstitial space, resulting in oedema (tumour). The formation of increased tissue fluid acts as a medium for which inflammatory proteins (such as complement and immunoglobulins) can migrate through. It may also help to remove pathogens and cell debris in the area through lymphatic drainage. Cellular Phase The predominant cell of acute inflammation is the neutrophil. They are attracted to the site of injury by the presence of chemotaxins, the mediators released into the blood immediately after the insult. The stages of acute inflammation; vessel vasodilation, exudate formation and neutrophil migration The migration of neutrophils occurs in four stages: Margination – cells line up against the endothelium Rolling – close contact with and roll along the endothelium Adhesion – connecting to the endothelial wall Emigration – cells move through the vessel wall to the affected area Once in the region, neutrophils recognize the foreign body and begin phagocytosis, the process whereby the pathogen is engulfed and contained with a phagosome. The phagosome is then destroyed via oxygen-independent (e.g. lysozymes) or oxygen-dependent (e.g. free radical formation) mechanisms. OUTCOMES FATE OF ACUTE INFLAMMATION The acute inflammatory process can culminate in one of the following outcomes: 1. Resolution. It means complete return to normal tissue following acute inflammation. This occurs when tissue changes are slight and the cellular changes are reversible e.g. resolution in lobar pneumonia. RT 316 - RADIOLOGIC PATHOLOGY Prepared by: JFOC  17 2. Healing. Healing by fibrosis takes place when the tissue destruction in acute inflammation is extensive so that there is no tissue regeneration. But when tissue loss is superficial, it is restored by regeneration. 3. Suppuration. When the pyogenic bacteria causing acute inflammation result in severe tissue necrosis, the process progresses to suppuration. Initially, there is intense neutrophilic infiltration. Subsequently, mixture of neutrophils, bacteria, fragments of necrotic tissue, cell debris and fibrin comprise pus which is contained in a cavity to form an abscess. The abscess, if not drained, may get organised by dense fibrous tissue, and in time, get calcified. 4. Chronic inflammation. Persisting or recurrent acute inflammation may progress to chronic inflammation in which the processes of inflammation and healing proceed side by side. Figure 3.1 Fate of acute inflammation. MORPHOLOGY OF ACUTE INFLAMMATION Inflammation of an organ is usually named by adding the suffix-itis to its Latin name e.g. appendicitis, hepatitis, cholecystitis, meningitis etc. A few morphologic varieties of acute inflammation are described below: 1. PSEUDOMEMBRANOUS INFLAMMATION. It is inflammatory response of mucous surface (oral, respiratory, bowel) to toxins of diphtheria or irritant gases. As a result of denudation of epithelium, plasma exudes on the surface where it coagulates, and together with necrosed epithelium, forms false membrane that gives this type of inflammation its name. Figure 3.2 Person who has Pseudomembranous Diphtheria RT 316 - RADIOLOGIC PATHOLOGY Prepared by: JFOC  18 2. ULCER. Ulcers are local defects on the surface of an organ produced by inflammation. Common sites for ulcerations are the stomach, duodenum, intestinal ulcers in typhoid fever, intestinal tuberculosis, bacillary and amoebic dysentery, ulcers of legs due to varicose veins etc. Figure 3.3 Symptoms of stomach ulcer 3. SUPPURATION (ABSCESS FORMATION). When acute bacterial infection is accompanied by intense neutrophilic infiltrate in the inflamed tissue, it results in tissue necrosis. A cavity is formed which is called an abscess and contains purulent exudate or pus and the process of abscess formation is known as suppuration. The bacteria which cause suppuration are called pyogenic. Figure 3.4 Remnant of a drained pulmonary abscess at post-mortem Microscopically, pus is creamy or opaque in appearance and is composed of numerous dead as well as living neutrophils, some red cells, fragments of tissue debris and fibrin. In old pus, macrophages and cholesterol crystals are also present. 4. CELLULITIS. It is a diffuse inflammation of soft tissues resulting from spreading effects of substances like hyaluronidase released by some bacteria. 5. BACTERIAL INFECTION OF THE BLOOD. This includes the following 3 conditions: i) Bacteraemia is defined as presence of small number of bacteria in the blood which do not multiply significantly. ii) Septicaemia means presence of rapidly multiplying, highly pathogenic bacteria in the blood e.g. pyogenic cocci, bacilli of plague etc. Figure 3.5 Cellulitis RT 316 - RADIOLOGIC PATHOLOGY Prepared by: JFOC  19 iii) Pyaemia is the dissemination of small septic thrombi in the blood which cause their effects at the site where they are lodged. This can result in pyaemic abscesses or septic infarcts. SYSTEMIC EFFECTS OF ACUTE INFLAMMATION Figure 3.6 X-ray of a patient’s foot who has cellulitis The account of acute inflammation given up to now above is based on local tissue responses. However, acute inflammation is associated with systemic effects as well. These include fever, leucocytosis and lymphangitislymphadenitis. 1. Fever occurs due to bacteraemia. 2. Leucocytosis - commonly accompanies the acute inflammatory reactions, usually in the range of 15,000- 20,000/μl. 3. Lymphangitis - lymphadenitis is one of the important manifestations of localized inflammatory injury. The lymphatics and lymph nodes that drain the inflamed tissue show reactive inflammatory changes in the form of lymphangitis and lymphadenitis. 4. Shock may occur in severe cases. CHRONIC INFLAMMATION Complications Although chronic inflammation progresses DEFINITION AND CAUSES. silently, it is the cause of most chronic diseases and presents a major threat to the health and longevity of individuals. Inflammation is considered a major Chronic inflammation is defined as contributor to several diseases. prolonged process in which tissue Cardiovascular diseases destruction and inflammation occur at the Cancer same time. Diabetes Rheumatoid arthritis Allergic asthma Chronic inflammation can be caused by Chronic obstructive pulmonary disease (COPD): one of the following 3 ways: Alzheimer's disease 1. Chronic inflammation following acute inflammation. When the tissue destruction is extensive, or the bacteria survive and persist in small numbers at the site of acute inflammation e.g. in osteomyelitis, pneumonia terminating in lung abscess. RT 316 - RADIOLOGIC PATHOLOGY Prepared by: JFOC  20 2. Recurrent attacks of acute Risk Factors Associated with Chronic Inflammation inflammation. Several risk factors promote a low-level inflammatory response. These include: When repeated bouts of acute inflammation culminate in chronicity of the Age Obesity process e.g. in recurrent urinary tract Diet infection leading to chronic pyelonephritis, Smoking repeated acute infection of gallbladder Low Sex Hormones Stress and Sleep Disorders leading to chronic cholecystitis. 3. Chronic inflammation starting de novo. When the infection with organisms of low pathogenicity is chronic from the beginning e.g. infection with Mycobacterium tuberculosis. Deterrence and Patient Education SYSTEMIC EFFECTS OF CHRONIC INFLAMMATION Chronic inflammation can have a deleterious effect on the body and is a key factor causing almost all chronic degenerative diseases. The following Chronic inflammation is associated with are some of the most effective ways to prevent chronic following systemic features: inflammation. Increase uptake of anti-inflammatory foods: It is 1. Fever. Invariably there is mild fever, important to avoid eating simple sugars, refined carbohydrates, high-glycemic foods, trans fats, and often with loss of weight and weakness. hydrogenated oils. Consuming whole grains, natural 2. Anaemia. Chronic inflammation is foods, plenty of vegetables and fruits such as avocados, accompanied by anaemia of varying cherries, kale, and fatty fish like salmon is helpful in defeating inflammation. degree. 3. Leucocytosis. As in acute inflammation, Minimize intake of antibiotics and NSAIDs: Use of antibiotics, antacids, and NSAIDs should be avoided as it chronic inflammation also has leucocytosis could harm the microbiome in the gut causing but generally there is relative inflammation in intestinal walls known as leaky gut lymphocytosis in these cases. which in turn releases toxins and triggers chronic, body- wide inflammation. 4. ESR. Erythrocyte sedimentation rate is elevated in all cases of chronic Exercise regularly to maintain an optimum weight: It is largely known that adipose tissue in obese or inflammation. overweight individuals induces low-grade systemic 5. Amyloidosis. Long-term cases of chronic inflammation. Regular exercise is helpful not only in suppurative inflammation may develop controlling weight but also decreasing the risk of cardiovascular diseases and strengthening the heart, secondary systemic (AA) amyloidosis. muscles, and bones. Sleep longer: Overnight sleep (ideally at least 7 to 8 hours) helps stimulating human growth hormones and testosterone in the body to rebuild itself. Stress Less: Chronic psychological stress is linked to greater risk for depression, heart disease and body losing its ability to regulate the inflammatory response and normal defense. Yoga and meditation are helpful in alleviating stress-induced inflammation and its harmful effects on the body. RT 316 - RADIOLOGIC PATHOLOGY Prepared by: JFOC