Baker - Tissue Repair

Question 1

What is primary intention?

Answer 1

Wound edges joined by fibrin plug

Regrowth of basal layer of epidermis

Lysis of fibrin and re-epithelializaiton

Restoration of intact skin

(Happens in an incision or laceration)

Question 2

What is secondary intention healing?

Answer 2

Large defect filled by fibrin clot

New blood vessels and fibroblasts grow FROM THE DERMIS into fibrin

Collagen laid down by granulation tissue fibroblasts to restore integrity

MATURATION OF COLLAGEN achieves structural integrity and allows regrowth of epidermis

(Happens in a burn)

Question 3

Tell me about repair.

Answer 3

Complete repair

Forms a scar at inflammation site

Forms a cavity - like in the brain or lung

Question 4

What are some problems during tissue repair?

Answer 4

Slow process

• up to 10% strength of normal tissue in about a week
• up to 75% strength at most
• Scarring

Too much repair (secondary intention)

• Hypertrophic scar
• Keloid - beyond site of injury
• Desmoid/fibromatosis - benign neoplasm

Too little repair

• Wound dehiscence
• Ulcer

Question 5

What are vocal nodules?

Answer 5

Growths on the vocal folds

Benign, not cancerous

Due to vocal abuse

Question 6

What is a keloid?

Answer 6

Type of scar composed of type III or type I collagen

Overgrowth of granulation tissue

Question 7

What is a desmoid/fibromatosis?

Answer 7

Most desmoid tumors is unknown and thus they are called sporadic

Mutation of beta catenin

Question 8

What is a pyogenic granuloma?

Answer 8

Gingiva, skin, nasal septum

Vascular lesion from irritation, trauma, or hormones

Question 9

Who is at risk for gangrene?

Answer 9

Diabetics

Cardiovascular challenged

Question 10

________ _________ can result in rupture and death.

Answer 10

Ventricular (Ususally left) aneursym

Question 11

Fibrosis, hypertrophy, loss of small blood vessels is characteristic of what?

Answer 11

Chronic ischemia

Question 12

What is an acute kidney injury?

Answer 12

Sudden episode of kidney failure

Build up of waste in blood

Common in hospitals, ICUs, and elderly

Question 13

What is the most common cause of kidney acute interstitial nephritis?

Answer 13

Adverse rxn to drug

Also due to bacterial infections

*Chronic can also occur

Question 14

What can be causes of poor wound healing?

Answer 14

Diffuse glomerulosclerosis

Kidney interstitial nephritis -chronic and acute

Chronic ischemia

Specific organs with issues

Cryptogenic organizing pneumonia (COP) - Masson plugs the airway

Question 15

What is the main cause of gastric antral ulcers?

Answer 15

H. Pylori

Question 16

What happens after an ulcer in the stomach?

Answer 16

Infection

Poor circulation

Question 17

What factors are associated with bed sores?

Answer 17

Sedentary positions

Extended hospital stays

Question 18

T/F - Cystic fibrosis can present nasal polyps.

Answer 18

TRUE

Question 19

T/F - Wound healing is associated with a true and chronic inflammation.

Answer 19

TRUE

Question 20

Tell me the phases of tissue healing at these time intervals:

Hours

Days

Weeks to months

Answer 20

Hours
-Coagulation
—Fibrin plug formation
—Release of growth factors
—Cytokines
—Hypoxia

In b/t hours and days: Inflammation
-Cell recruitment and chemotaxis, wound debridement

Days
-Migration/proliferation
—Fibroplasia, ECM deposition

Weeks to months
-Remodelling
—Scar formation and revision

Question 21

What are the main cell types associated with coagulation?

Answer 21

Platelets

Question 22

What are the main cell types associated with inflammation?

Answer 22

PMNs, monocytes

Macrophages

Question 23

What are the main cell types in migration/proliferation and remodeling?

Answer 23

Keratinocytes

Fibroblasts

Endothelial cells

Myofibroblasts