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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
Macrophages, endothelial cells, and platelets secrete
``` chemotactic and mitogenic factors for fibroblasts: TGFbeta, PDGF, EGF, FGF, and cytokines IL1 and TNF ```
26
PDGF and TNF
migration, proliferation , collagen synthesis, collagen secretion
27
EGF and FGF
migration, proliferation , collagen secretion
28
TGF beta
migration and collagen synthesis, | inhibits collagenase secretion
29
monocyte chemotaxis
PDGF, FGF, TGF beta
30
angiogenesis factors
VEGF, Ang, FGF
31
fibroblasts fill the hole and then
you need to remodle
32
collagen degredation
collagen is insolulbe and only matrix metalloproteinases (MMPs) activated by GFs (gollagenases, gelatinases, stromelysis) can degrade it
33
mechanism of MMPs
cleave collageninto soluble peptides and then collagen fragments are digested by serine proteases
34
TIMPs
tissue inhibitors of metalloprteases
35
MMPs
Zn ion dependent matrix metalloproteinases
36
MMPs are secreted as
zymogens or pro-peptides requiring clevage for actiation
37
MMPs are secreted by
macrophages, neutorphils, fibroblasts,
38
MMP secretion is induced by
PDGF, FGF, IL1, TNF
39
MMPs is inhibited by
TGF beta and steroids
40
MMP timing and activity is
strictly regulated bc we don't want to be chewing up our collagen all the time
41
Macrophage debridement removal of injured tissue and debris
phagocytosis, collagenase, elastase
42
Macrophage antimicorbial activity
Nitric acid, | ROS
43
Macrophage chemotaxis and proliferation of fibroblasts and keratinocytes
``` PDGF, TGF beta, TNF, IL1, KGF 7 ```
44
Macrophage angiogenesis
VEGF, FGF2, PDGF
45
Macorphage Deposition and remodling of ECM
``` TGF beta, PDGF, TNF, OPN, IL1, collagenase, MMPs ```
46
If you want to date a lesion you have to start at the
edge bc it is the oldest part and fist to begin healing
47
Fibrin clot and appearance of neutrophils time
24hrs
48
mitotic activity of epitheial cells at periphery time
48 hrs
49
neutrophils replaced by macrophages. Granultion tissue starts time
3 days
50
full granulation tissue. Collagen deposition begins. Epithelial cells mature time
5 days
51
decreased vascularity, increased collagen deposition
week 2
52
maturation into acellular scar. Epithelial covering complete
Month 1
53
primary or 1st intention healing
approximate the wound by suturing and epending you can get a fine line scar
54
secondary or 2nd intention healing
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
wound strength at week 1
10%, with rapid increase ofver the next 4 weeks
56
Wound strength plateau
70 - 80% at 3 months
57
factors affecting healing
``` nutrition (vit C), metabolic status (diabetes), blood supply (atherosclerosis), hormones and steroids, infection, froeign bodies, immune status ```
58
dehiscence
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
Ulceration
inadequeate blood supply/innervation
60
Excessive collagen fromation and deficient remodlign with raised scar
hypertrophic scar
61
Keloid
scar grows beyond the bounds of original wound and does not regress
62
exuberant granulation tissue
bloks re-epithelizalization
63
contracture
scar contracts causing deformities

Pathology (26 decks)

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