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:
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.
Effects of fibrosis
Symptoms of fibrosis can vary depending on the location and severity of the condition. Common symptoms include scarring.
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.
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.
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Diseases, Symptoms, Tests and Treatment arranged in alphabetical order:
Bibliography / Reference
Collection of Pages - Last revised Date: December 9, 2023