Review related terms: dilated, distended, swollen

[rays22]

Review and if necessary revise the related terms:

• PATO:0001571 dilated
• PATO:0001602 distended
• PATO:0001851 swollen
  • Consider removing 'temporal' from the definition.
  • Discussed on the UPheno call 10/20
    • What is the distinction between swollen and dilated?
    • Unclear which is more appropriate to use at the subcellular level.
    • For anatomical entities we probably want both swollen and dilated but the distinction needs to be clear.

[sbello]

Discussed on the UPheno call 10/20/22
Some of the issues:

• swollen is a child of structure while dilated and distended are children of increased size but all 3 mention enlargement or increased size in the definitions
• distinction between all 3 is fuzzy
• swollen can be used interchangeably with dilated for some structures (swollen/dilated mitochondria, dilated/swollen allantois)
• swollen and distended can be used interchangeable for some structures (swollen/distended stomach, swollen/distended illeum)
• but there are cases where we would not want to use these interchangeably (swollen eyelids, swollen gums)

We need to decide

1. do we need all 3 terms
2. if we keep them how do we clarify the definitions and usage
3. can we revise placement to makes these all siblings under increased size?

[sbello]

Discussion 2/23/24

1. do we need all 3 terms
   

Yes, we need the terms
3. if we keep them how do we clarify the definitions and usage
clarify definition

• dilated - diameter of a hollow entity, make this a child of increased diameter
• distended - increased size due to outward extension caused by pressure from within
• swollen - leave definition alone, keep 'transient'

5. can we revise placement to makes these all siblings under increased size?
   

move swollen under 'increased size

To do:

• check existing usages to make sure tweaks to definitions do not cause issues
• make PATO changes

[sbello]

Discussed on 4/19/24

For dilated increased diameter doesn't always work

We could leave this term where it is but tweak the definition to make it clear that dilation is increased size of the lumenal space of a hollow entity. The term only applies to entities with a hollow space within.

Current definition is
A size quality inhering in a bearer by virtue of the bearer's being made wider or larger in all dimensions

Modify to
A size quality inhering in a bearer by virtue of the luminal space within or opening of the bearer being made wider or larger in all dimensions
xref - https://www.cancer.gov/publications/dictionaries/cancer-terms/def/dilate

Add comment
Examples include; dilated heart ventricle (MP:0008022), dilated aorta (MP:0010574), dilated bile duct (MP:0003253), mydriasis (MP:0002546)

Add additional examples

[sbello]

distended - increased size due to outward extension caused by pressure from within

Do we know that it is really always pressure from within?
In some cases MP has dilated and distended as synonyms (distended stomach, MP:0009511)

Should distended be a synonym of dilated? Do we ever need to make a distinction between distended and dilated? Would distended be a child term or dilated?
The distinction for swollen is the entity does not need to be hollow.

[sbello]

Is the distinction that dilation should relate to muscle contraction?
https://study.com/academy/lesson/what-is-dilation-definition-meaning-quiz.html
"In medical terms, dilation is defined as an involuntary contraction, or relaxation, of smooth muscle that opens, widens, or relaxes an orifice of the body. Common examples of this occur inside the eye and cervix."

This would keep things like dilated heart atrium and dilated pupil as dilated. Distended would then be for things where muscle contraction is not a factor like distended stomach, distended epicardium, other distended membranes.

[sbello]

Alternate option (from Leigh) is to drop these words altogether and just go with
increased size
increased lumen size - dilated pupils would use this
increased lumen size due to internal pressure - dilated cardiac ventricle would go here, synonyms of distended and dilated
increased size due to inflammation synonym - swollen

additional complexity - swollen is often a synonym for edema but edematous is under structure in PATO http://purl.obolibrary.org/obo/PATO_0001450

additional consideration - need to distinguish increased sized meaning the physical mass of the entity is increased vs increased size meaning the volume of space taken up is increased - distinguish between the hollow part and the solid part of an entity
Possibly this would be better handled by having terms for the spaces in Uberon - many of these exist already
example

• dilated cervix we could use 'increased size' and 'cervical cavity' http://purl.obolibrary.org/obo/UBERON_0013761 don't bother using distended or dilated at all

still need to deal with dilatation and aneurysm
for aneurysm we would like to capture that it is localized increased size - possibly have a pattern that used increased size and localized and cavity/lumen of entity

[sbello]

should edematous (http://purl.obolibrary.org/obo/PATO_0001450) be a child of swollen as well as a child of composition
Can you ever have an entity that is edematous and not swollen? I don't think so.
What about inflamed? Often swollen is used as a synonym for inflamed (swollen gums).

[sbello]

Based on the UPheno editors call on 6/14 it seems like we need to get back to the key questions

1. What is anything is the distinction between dilated and distended? Is this real or are these terms used interchangeably? Is the difference really just about preference or common usage rather than a real difference in meaning?
2. Are these terms always used with hollow entities or in some cases can you have a distended solid entity? The PATO definitions do not specify a hollow entity.