Download The inflammatory process

A Massage Therapist’s Guide to
Pathology
Chapter One
Fundamental Concepts in Pathology
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Introduction
• Part I: Terminology
• Part II: Hygienic Practices
• Part III: Infectious Agents
• Part IV: The Inflammatory Process
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Terminology
• A- , an-: without
• Cep-, Ceph-: head, brain
• Acro-: extremity
• Chole: bile
• Adeno-: glandular
• Com-, con-: with, together
• -Algia: pain
• Contra-: against
• Angio-: blood or lymph
vessels
• Cyst: hollow organ
• Arthr-: joint
• Derm-: skin
• Brady-: slow
• Carcin-: crab (cancer)
• Cardio-: heart
• Demo-: people
• Dia-: through
• Dys-: difficulty
• Cervi-, cervico- : neck
• Ecto-, -ectomy: outside,
removal
• -Cele: swelling, hernia
• -Emia: blood
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Terminology
• Endo-: inside
• Hyper-: above, too much.
• Epi- upon
• Hypo-: below, too little
• Erythr-: red
• -Itis: inflammation
• Ex-: out of
• -Lepsis: seizure
• -Gen: beginning, producing • Leuko-: white
• Lipo-: fat
• Glyco-: relating to sugar
• -Graphy: recording, writing • Litho-: rock
• -Logy: study
• Hemo-: blood
• Hemi-: one-half
• -Lysis, -lyso: destruction
• Hepat-: liver
• Mega-: large
• Hydro-: water
• Meno-: month
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Terminology
• Metr-: mother (uterus)
• Onco-: tumor
• Micro-: small
• Orchi-: testes
• Myco-: fungus
• -Osis: pathologic condition
• Mye-: marrow or spinal cord
• Osteo-: bone
• Myo-: muscle
• Para-: alongside, near
• Narco-: stupor
• Peri-: around
• Necro-: death
• Phagia-: eating
• Neo-: new
• -Philia: affinity
• Nephro-: kidney
• Phleb-: vein
• Neuro-: nerve
• Phyto-: plants
• -Oid: resembles
• -Plasia: growth
• -Oma: tumor
• -Plasm, -plasma: formed
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Terminology
• Patho-: disease state
• Spondy-: spine
• Physio-: nature
• -Stasis: stagnation, standing
still
• Pseudo-: false
• Stoma-: an opening; mouth
• Psych-: the mind, mental
• Syn-, Sym-: with
• Ren-: kidney
• Thrombo-: clot
• -Rrhagia, -rrhea: flowing
• Therm-: temperature
• Rhino-: nose
• Sarco-: flesh
• -Trophy, -trophic: nutrition,
growth
• Sclero-: hardness, scarring
• Vaso-: blood vessel
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Terminology
• Acute
• Lesion
• Chronic
• Morbidity
• Complication
• Mortality
• Contraindicated
• Pandemic
• Demographic
• Prevalence
• Diagnosis
• Prognosis
• Endemic
• Sign
• Epidemic
• Stenosis
• Idiopathic
• Subacute
• Incidence
• Symptom
• Indication
• Syndrome
• Trauma
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Infectious agents
Pathogen: disease-causing organism
• Resistance is based on genetics, virulence, and lifestyle
habits
Five basic classes:
• Prions
• Viruses
• Bacteria
• Fungi
• Animals
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Infectious agents
• Prions
No DNA, RNA
Grow within CNS
Spread through eating contaminated tissue,
contaminated blood, transplant tissue, surgical tools
–
BSE (“mad cow”), CJD, kuru…
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Infectious agents
• Viruses
Packets of DNA, RNA
wrapped in capsid (protein coat)
Cannot replicate outside a host
Reprogram target cell to produce virus
Infected cells rupture, releasing viral copies
Many disintegrate outside a host
Some are stable, especially herpes
simplex, hepatitis B, hepatitis C
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Infectious agents
• Bacteria
Single-celled microorganisms
Can survive outside a host
Not all pathogenic; some are beneficial
Pathogenic bacteria attack cells/ release toxic
wastes that damage cells
Antibiotics interfere with bacterial reproduction
(Slow-growing infections less responsive)
Some bacteria have “spore”: tough waxy coat
TB, tentanus, anthrax
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Infectious agents
• Types of bacteria:
– Cocci: spherical
• Diplococci
• Staphylococci
• Associated with localized skin
infections
• Some are becoming antibioticresistant
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Infectious agents
– Streptococci
• Associated with systemic infections
– Bacilli: elongated, rod-shaped (most likely to
form spores)
– Spirochetes: spiral-shaped
– Mycoplasma: very tiny
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Infectious agents
• Fungi
– Yeasts and molds
•
Internal: associated with
imbalance between yeasts and
bacteria
•
External: skin infections
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Infectious agents
• Animal parasites
–
Single or multi-cellular organisms
–
Live in or on a host
–
Can be vector for other diseases
• Protozoa (Giardia, crypto)
• Helminths and roundworms
• Arthropods
Head lice, crab lice, mites
• Others
Mosquitoes, ticks, fleas don’t live on or in host, but
can spread disease
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Infectious agents
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Hygienic practices
• Definition of terms
– Cleaning
– Disinfection
– Sterilization
– Sanitation
– Plain soap
– Antimicrobial soap
– Detergent
– Alcohol- based hand rub
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Hygienic practices
• Universal and Standard Precautions
Protection from infectious fluids:
Semen
Vaginal secretions
Breast milk
Cerebrospinal fluid
Synovial fluid
Pleural fluid
Pericardial fluid
Amniotic fluid
Blood
Blood-tinged saliva
Vomit (emesis)
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Hygienic practices
• Hand washing
–
Work to preserve lipid layer, skin health
•
•
–
Transient bacteria: superficial, easy to remove
Resident bacteria: deep, harder to remove
(generally less aggressive)
Running warm water, plain soap, 30 seconds
•
•
Liquid soap is preferable
Antimicrobial soap more likely to cause allergic
reaction
(Watching for increased bacterial resistance)
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Hygienic practices
• Alcohol-based gels
– Can be faster, more convenient
– Doesn’t remove dirt
– Use according to manufacturers’
recommendations
• Alcohol-soaked towelettes not adequate
• Moisturizing lotions are important
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Hygienic practices
• Other Hand Care
– Hang nails and other lesions
• Cuticle nippers, cover sores
– Trim, clean fingernails
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Hygienic practices
• Care of surfaces, equipment
– Goal: create an environment where nothing
that one client touches directly or indirectly
is touched by another client before it is
cleaned
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Hygienic practices
• Fabrics
– All surfaces touched by client or therapist
must be cleaned or replaced with each
appointment
– Linens, face cradle covers, bolster/pillow
covers, etc.
– Therapist clothing: consider changing shirt or
apron with each client
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Hygienic practices
• Laundering:
– Professional laundering services use water
that is 160º F (71º C), 25 minutes of
agitation
– 71-77º F (21.6-25º C) with adequate
detergent for anti-microbial effect
– Bleach is most active at 135 -145º F (57.262.7º C), ratio of 50-150 ppm (parts per
million)
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Hygienic practices
– Thoroughly rinse bleached laundry
– Never leave laundry damp
– Dry on high heat; iron for extra protection
– Wrap, isolate clean laundry
• Laundry services rent out sheets: little quality control
• Other items must be laundered at home:
– Clothing, bolster covers, face cradle covers, etc.
• Watch for “seepage” of fluids through to fabrics usually
covered by linens
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Hygienic practices
• Other equipment
• Swab massage tables, face cradles, vinyl-covered
furniture
–
CDC recommends 10% bleach solution
Loses potency quickly: replace often
Alcohol evaporates too quickly to be useful
– Isolate massage lubricants
Solid at room temperature: individual
dispensers
–
Wash oil/lotion bottles with hands
–
Keep bottles off floor, other contaminated surfaces
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Hygienic practices
• Other items:
–
Hot or cold rocks and crystals may be sterilized
–
Tools, hot/cold packs, etc: wash contacting surfaces
• The massage environment
–
Curtains, upholstery, carpets probably not major vectors
Can harbor allergens: vacuum regularly
If carpet gets wet, can grow mold: replace
–
Other surfaces should be cleaned frequently:
Door knobs, switch plates, bathroom surfaces,
telephones, etc.
–
Cash is often contaminated
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
The inflammatory process
• What is inflammation?
• Response to tissue damage or the threat of invasion
by antigens
–
Triggered by
Physical trauma
Invasion with foreign bodies
Hormonal changes,
Autoimmune activity
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
The inflammatory process
• Purpose:
–
Protect from pathogenic invasion
–
Limit range of contamination
–
Prepare damaged area for healing
• Outcomes:
–
Complete resolution with no scar tissue
–
Accumulation of scar tissue
–
Formation of cysts/abscesses
–
Chronic inflammation
• See thePoint.lwww/Werner5e for more on inflammation
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
The inflammatory process
• Components of inflammation: vascular activity
–
Vasoconstriction
• Protective response, short-lived
–
Vasodilation
• Chemicals released by damaged endothelium and mast
cells
Increase permeability of capillaries
Reinforce capillary dilation
Attract platelets
Slow blood flow away from area
–
May last several minutes to hours or days
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
The inflammatory process
• (See Figure 1.10a and 1.10b)
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
The inflammatory process
• Components of inflammation: cellular activity
–
Many cells are recruited to manage tissue damage and
contamination risk with injury.
• Endothelial cells:
–
Release chemicals to activate platelets, allow WBCs to
migrate out of capillaries
–
Proliferate to grow new capillary beds in later stages
• Platelets:
–
Become jagged and sticky, adhere to damaged area
–
Release chemicals to bind with plasma proteins to create
fibrin, blood clots
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
The inflammatory process
• White blood cells:
– Several types involved:
• Granulocytes:
• Smallest, fastest
• Neutrophils 1st on the scene for bacterial
infection, musculoskeletal injury
• Eosinophils for allergies, parasites
• Basophils for allergies and histamine
release
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
The inflammatory process
• Mast cells:
–
Located in tissues vulnerable to injury
–
Release histamine to prolong inflammatory response
• Monocytes and macrophages:
–
Monocytes = large, mobile white blood cells
–
Can become permanently fixed macrophages
–
Associated with late-stage inflammation to clean up debris
• Lymphocytes:
–
Work with macrophages to clean up debris, promote scar
tissue, angiogenesis
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
The inflammatory process
• Fibroblasts
– Produce collagen, extracellular matrix
– Drawn to local blood clots, may proliferate to
form more scar tissue
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
The inflammatory process
• Chemical mediators
– Many sources of chemical mediators that help
coordinate cellular activity:
• Suspended in plasma, from platelets, mast
cells, basophils, endothelial cells…
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
The inflammatory process
Stages of healing
• Acute stage
– Damaged cells release chemicals
– Edema develops
– Platelets, early WBCs arrive
– Tissue exudate begins to form
– Time: depends on severity (1-3 days, usually)
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
The inflammatory process
• Subacute stage
– AKA proliferative stage
– Cells accumulate to fill in damaged area
• Endothelial cells grow new capillaries
• Fibroblasts create collagen fibers
– Slower WBCs arrive to start clean-up
– Time: depends; 2-3 weeks
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
The inflammatory process
• Postacute stage
– AKA maturation stage
– Collagen becomes denser and aligns according
to force
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
The inflammatory process
• Chronic inflammation
– Inflammatory process is not successful
• Pathogens/irritants not removed (leads to
cysts, abscesses)
• Excessive scar tissue interferes with organ
function
• Sinuses or fistulae develop
• Musculoskeletal structures never regain full
function: tendinosis
• Excessive external scar tissue
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
The inflammatory process
Signs and symptoms:
• Pain, heat, redness, swelling, and sometimes loss
of function
– Dolor (pain)
– Calor (heat)
– Rubor (redness)
– Tumor (swelling) and
– Functio Laesa (loss of function)
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
The inflammatory process
• Treatment:
– Anti-inflammatory drugs
• Medications:
– OTC anti-inflammatories
– Prescription NSAIDs
– Prescription steroidal anti-inflammatories
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
The inflammatory process
• Massage
– Risks: Acute localized infections locally
contraindicate circulatory massage
– Benefits: Post acute, maturation phase can
benefit from fluid turnover, mechanical
influence on scar tissue
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins