Fibrosis

The formation of excess fibrous connective tissue between the cells of various organs or tissues as a reactive process is called fibrosis. It can cause stiffening or hardening of tissues in skin, internal organs and joints. It can be reactive, pathological or in a benign state. When fibrosis arises from a single tissue, it is called Fibroma and in response to an injury it is called scarring.

Fibrosis may occur in many tissues within the body due to damage or inflammation, examples include:

• Pulmonary Fibrosis, affecting the lung
  
• Cystic Fibrosis affecting the mucus glands
  
• Heart Fibrosis, affects the heart that is damaged post myocardial infarction
  
• Liver Cirrhosis, accumulation of tough, fibrous scar tissue in the liver
  
• Bone marrow Fibrosis, affects the bone marrow and prevents normal production of blood cells
  
• Mediastinal Fibrosis, blocks respiratory channels and blood vessels due to calcified fibrosis of the lymph nodes
  
• Skin fibrosis, due to the formation of scar tissues due to injury.

Fibrosis formation

During the early stages of Lymphedema, tissues swell with protein-rich lymph that may not drain properly. The tissues are soft to touch; this condition is known as pitting edema. There is pressure on these tissues pushing the fluid aside thus leaving an indentation. If left untreated at this stage, the lymph may become fibrotic thus forming fibrosis. As fibrosis develops, the normal tissues are replaced by the scar-like structures that cause hindrance to lymph drainage. Fibrosis can occur in slightly swollen tissues too. As the lymph cannot drain properly, it leads to accumulation of protein molecules in the tissues thus increasing formation.

Fibrosis causes

• It may be caused by a disease or while treating the disease.
  
• Other causes could include burns, injuries, chemotherapy, radiation and gene mutation.
  
• It is also possible that the causes may remain idiopathic, i.e. the cause is unknown.
  

Effects of fibrosis

Symptoms of fibrosis can vary depending on the location and severity of the condition. Common symptoms include scarring.

• Fibrosis will harden the affected tissue, at times they also swell. These changes can make the tissues incapable of functioning properly; the fluid flow through these affected tissues might be reduced. When present in the lungs, the lung is unable to expand adequately leading to shortness of breath.
  
• Fibrosis of joints can cause pain and stiffness of the affected joint.
  
• Fibrosis in the shoulder may lead to frozen shoulder.
  
• Fibrosis of the tendons may lead to deformity of fingers and hand.

Histopathology

Histopathology involves study of diseased tissues thereby aiding diagnosis of tumors. Histopathological examination of tissues involves three stages - surgery, biopsy or autopsy.
After collecting the diseased tissues, they are first stabilized by placing in a fixative, to prevent decay. Formalin (10% formaldehyde in water) is the fixative used normally.

• The stabilized sample tissues are first transferred to a container where permitted reagents are allowed to act on the tissues.
  
• Concentrated ethanol helps to dehydrate the tissues. Toluene or Xylene is used after the above procedure to immerse the tissues followed by hot liquid paraffin wax. This process takes 12 to 16 hours, during which paraffin replaces the water in the tissue turning it soft and moist. Now the sample is ready for embedding.
  
• The tissue is transferred and set in a mold. During this process of embedding, additional paraffin is added to prepare a hard paraffin block.
  
• Microtome is used to section the embedded tissues into very thin sections of about 3-7 micrometer in thickness. These thin layers or sections are now ready for microscopic study.
  
• One or more pigments are used to stain the sections to view the details clearly. A combination of hematoxylin and eosin is used to stain the tissues. The cytoplasm pink is got by using eosin and nuclei blue by hematoxylin. Saffron, silver salts and some artificial dyes are the other compounds used to color tissue sections. For staining specific proteins, carbohydrates and liquids, antibodies are also used. The technique known as immunohistochemistry has helped scientists in the microscopic studies to identify different categories of cells specifically.
  
• A medically qualified expert or pathologist examines the histological slides microscopically.
  

Abdominal adhesions

Adhesions are formed in the body as repair process response to previously incurred surgery, infection and radiological procedures. Adhesions contain fragments of scar tissues that are arranged between previously damaged tissues. Adhesions are often significant post-operative complications, which predominantly occur in the pelvic and cardiac regions. Many cases of obstructive bowel disorders have been reported after pelvic surgeries due to the presence of abdominal adhesions.

Abdominal adhesions are asymptomatic in most but they gradually produce significant symptoms leading to complications. In case of obstructive diseases, abdominal adhesions result in ischemia of the intestines. Along with the abdominal region, adhesions also occur in the uterus, ovaries, fallopian tubes post cesarean sections, hysterectomy and treatments of pelvic inflammatory disease. Adhesions in the heart cause conditions such as rheumatic fever by affecting the pericardial region of the heart. It also causes damage to the valves in decreasing the cardiac activity resulting in ischemic heart disease.

Clinical manifestations of abdominal adhesions

Abdominal adhesions prevent the movement of intestines by adhering to their surfaces. Adherence of these adhesions gradually results in the formation of fiber-like structures along the intestinal region constricting the blood flow leading to the onset of tissue necrosis and inflammation. Abdominal adhesions occur as a result of surgical procedures. Some of the predisposing factors include the handling of the internal organs during surgeries, incisions, preexisting infections, and contacts with surgical instruments and absorbent materials such as gauze and cotton swabs which dry the tissues, remnants of blood clots after the surgical procedure and radiation. Other factors include appendicitis.

Symptoms of abdominal adhesions include vomiting, constipation, improper bowel movement, bloating and abdominal swelling. The classical symptom indicating the presence of abdominal adhesions is chronic abdominal pain followed by gastrointestinal bleeding. These symptoms are further correlated with the patient's history associated with previous surgical procedures.

Diagnosis and prevention

Abdominal adhesions can only be detected using laparoscopic procedure. However, X rays determine the presence of intestinal obstructions. Hence abdominal surgeries are only recommended when it is absolutely necessary. Abdominal adhesions can only be prevented by administering minimal invasive procedures such as laparoscopy. In cases of surgeries that require large incisions, a thin absorbable material called seprafilm is placed between the tissues to prevent the occurrence of adhesions. Seprafilm is gradually digested by the tissue fluids. Many studies indicate that the usage of latex free gloves can prevent adhesions to a greater extent. Tissue rehydration is very important during surgical procedure to prevent abdominal adhesions.

Treating of Abdominal adhesions

Abdominal adhesions are removed surgically followed by analgesic medication. An alternative to surgery in the treatment of these lesions includes the administration of complementary and alternative medicine (CAM). The CAM procedure consists of methodologies such as acupuncture and physical therapy.