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Pathology > 3.8 wound healing > Flashcards

3.8 wound healing Flashcards

1
Q

Wound healing process

A 
injury, 
inflammation, 
cleanup, 
angiogenesis, 
collagen deposition (fibrosis), 
remodeling, 
maturation
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2
Q

neutrophil halflife is

A

short so inflammation needs to be cleand up soon

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3
Q

lipoxins bring in

A

macrophages for clean up

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4
Q

angiogenesis can be

A

buding and growing at end of vessels, or

endotheial cells break off and invade tissues, divide and reassemble

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5
Q

Fibrosis

A

scar formation by fibroblasts - done randomly

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6
Q

remodling

A

eat collagen and relay it down

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7
Q

maturation

A

if it is a big scar wound contracts

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8
Q

angiogenesis mechanisms

A

endothelial precurso cells (EPCs) and from pre-existing vessels

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9
Q

Endothelial precursor cells (EPCs)

A

formation of new vessels from EPCs that reside in the BM and travel via blood to sites of injury.
EPCs can differentiate into all cells that form vessels

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10
Q

Angiogenesis from pre-existing vessels

A

endothelial cells from vessels in surrounding tissues migrate into site of injury and form new vessels

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11
Q

steps in angiogenesis

A 
proteolytic degredation of vessel releasing endothelial cells, 
migration of endothelial cells, 
proliferation, 
modling into capillary tubes, 
recruitment of supporting cells
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12
Q

factors in proliferation

A

VEGF-VEGF R2

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13
Q

factors in tube formation

A

VEGF-VEGF R1 - at some poiut you stat to upreg rec 1 and binding causes cells to stop dividing and form tubes

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14
Q

angiopoietin 1 (Ang-1) and Tie2

A

recruit peri-Ecs and tube maturation

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15
Q

in growht of vessel stimulated by

A

VEGF with VEGF R1 and R2

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16
Q

Ang2-Tie2 with high VEGF

A

enhanses response to VEGF –>mature vessels

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17
Q

Ang2-Tie2 with low VEGF

A

signal for angiogenesis becomes inhibitory

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18
Q

Maturation remodling factors

A

PDGF, TGFbeta and their receptors and Ang2/Tie2

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19
Q

granulation tissue

A

the end result of angiogenesis, where there are newly formed capillaries in a loose connective tissue mix

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20
Q

how long does granulation tissue take to form

A

approx 5 dyas

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21
Q

what takes longer middle or edge

A

middle

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22
Q

new leaky bloodvessels are

A

very prone to trauma –so more dangerous at 5 days than 2 days

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23
Q

Fibrosis

A

migration and proliferation of fibroblasts,
collagen synthesis/ECM deposition,
tissue remodling

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24
Q

leaky blood vessels leak out

A

plasma proteins like fibronectin and other adhesive glycoproteins to form the cell stratum/ early ECM for fibroblasts

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25
Q

Macrophages, endothelial cells, and platelets secrete

A 
chemotactic and mitogenic factors for fibroblasts: 
TGFbeta, 
PDGF, 
EGF, 
FGF, and 
cytokines IL1 and TNF
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26
Q

PDGF and TNF

A

migration,
proliferation ,
collagen synthesis,
collagen secretion

27
Q

EGF and FGF

A

migration,
proliferation ,
collagen secretion

28
Q

TGF beta

A

migration and collagen synthesis,

inhibits collagenase secretion

29
Q

monocyte chemotaxis

A

PDGF,
FGF,
TGF beta

30
Q

angiogenesis factors

A

VEGF,
Ang,
FGF

31
Q

fibroblasts fill the hole and then

A

you need to remodle

32
Q

collagen degredation

A

collagen is insolulbe and only matrix metalloproteinases (MMPs) activated by GFs (gollagenases, gelatinases, stromelysis) can degrade it

33
Q

mechanism of MMPs

A

cleave collageninto soluble peptides and then collagen fragments are digested by serine proteases

34
Q

TIMPs

A

tissue inhibitors of metalloprteases

35
Q

MMPs

A

Zn ion dependent matrix metalloproteinases

36
Q

MMPs are secreted as

A

zymogens or pro-peptides requiring clevage for actiation

37
Q

MMPs are secreted by

A

macrophages,
neutorphils,
fibroblasts,

38
Q

MMP secretion is induced by

A

PDGF,
FGF,
IL1,
TNF

39
Q

MMPs is inhibited by

A

TGF beta and steroids

40
Q

MMP timing and activity is

A

strictly regulated bc we don’t want to be chewing up our collagen all the time

41
Q

Macrophage debridement removal of injured tissue and debris

A

phagocytosis,
collagenase,
elastase

42
Q

Macrophage antimicorbial activity

A

Nitric acid,

ROS

43
Q

Macrophage chemotaxis and proliferation of fibroblasts and keratinocytes

A 
PDGF, 
TGF beta, 
TNF, 
IL1, 
KGF 7
44
Q

Macrophage angiogenesis

A

VEGF,
FGF2,
PDGF

45
Q

Macorphage Deposition and remodling of ECM

A 
TGF beta, 
PDGF, 
TNF, 
OPN, 
IL1, 
collagenase, 
MMPs
46
Q

If you want to date a lesion you have to start at the

A

edge bc it is the oldest part and fist to begin healing

47
Q

Fibrin clot and appearance of neutrophils time

A

24hrs

48
Q

mitotic activity of epitheial cells at periphery time

A

48 hrs

49
Q

neutrophils replaced by macrophages. Granultion tissue starts time

A

3 days

50
Q

full granulation tissue. Collagen deposition begins. Epithelial cells mature time

A

5 days

51
Q

decreased vascularity, increased collagen deposition

A

week 2

52
Q

maturation into acellular scar. Epithelial covering complete

A

Month 1

53
Q

primary or 1st intention healing

A

approximate the wound by suturing and epending you can get a fine line scar

54
Q

secondary or 2nd intention healing

A

we don’t put the edges together and you get a larger scar.
There are times when you don’t want to suture and allow for the wound to granulate instead of sowing up debris and bacteria (polyps)

55
Q

wound strength at week 1

A

10%, with rapid increase ofver the next 4 weeks

56
Q

Wound strength plateau

A

70 - 80% at 3 months

57
Q

factors affecting healing

A 
nutrition (vit C), 
metabolic status (diabetes), 
blood supply (atherosclerosis), 
hormones and steroids, 
infection, 
froeign bodies, 
immune status
58
Q

dehiscence

A

frequent after abdominal surgery, breakdown of the wounds, fat does not approximate and you see dehiscence of wounds in overweight patients of abdominal surgery

59
Q

Ulceration

A

inadequeate blood supply/innervation

60
Q

Excessive collagen fromation and deficient remodlign with raised scar

A

hypertrophic scar

61
Q

Keloid

A

scar grows beyond the bounds of original wound and does not regress

62
Q

exuberant granulation tissue

A

bloks re-epithelizalization

63
Q

contracture

A

scar contracts causing deformities

Pathology (26 decks)

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