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HLSC 222 > Cellular injury, inflammation, & tissue repair > Flashcards

Cellular injury, inflammation, & tissue repair Flashcards

1
Q

In the face of injurious stimuli and stress, what are the 2 options possible for the injured cell?

A
  1. Injured cells may recover (reversible injury)
  2. Injured cells may die (irreversible injury)
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2
Q

List all 10 possible injurious stimuli

A
  • Chemical agents
    -Lack of sufficient oxygen (hypoxia)
  • Free radicals
  • Infectious agents
  • Physical & mechanical factors
  • Immunological reactions
  • Genetic factors
  • Nutritional imbalances
  • Workload imbalance
  • Aging
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3
Q

What is the #1 reason for cell injury (most common), described as oxygen insufficiency?

A
  • Hypoxia
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4
Q

Physical agents include….
Nutritional imbalances include…
Workload imbalances include…

A
  • Physical agents include: Trauma
  • Nutritional imbalances include: Deficiencies or surpluses in nutrition (vitamins). Ex. fat-soluble vitamins such as vitamin A can damage your body in excess since it stays in your fat. Whereas, water-soluble vitamins are eliminated in urine, such as vitamin C
  • Workload imbalances include: Deman>supply. Ex. Cardiac cells are under stress from rigorous exercise, but the coronary arteries that feed the heart oxygen are obstructed.
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5
Q

Hypo- means….
Oxy means…
-emia means…
isch- means…

A
  • Below
  • Oxygen
  • Refers to blood
  • To hold back
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6
Q

What refers to a lack of sufficient oxygen within cells? (p177)

What refers to low blood oxygen levels or reduced transfer of oxygen from lungs to blood?

What refers to the most common cause of hypoxia and is the damage or dysfunction of oxygen-sensitive tissues due to a reduction of blood supply? Most often caused by the gradual narrowing of arteries (arteriosclerosis) or complete blockage by blood clots (thrombosis) or both.

A
  • Hypoxia
  • Hypoxemia
  • Ischemia
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7
Q

What is the injury induced by free radicals, especially by Reactive oxygen species (ROS) called?

And how does this form of cellular injury occur?

A
  • Oxidative stress
  • Occurs when excess ROS overwhelms endogenous antioxidant systems, or when not enough antioxidants break down free radicals
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8
Q

What refers to electrically uncharged atoms or a group of atoms with an unpaired electron?

What are the primary form of these atoms called, and how are they created?

How do these atoms injure body cells? And, how does the body fight against them

What are the other sources that create this unstable atom?

A
  • Free radicals, which are by-products of normal metabolism
  • Includes reactive oxygen species (ROS) – created through the metabolism of oxygen
  • They invade other atoms that have paired electrons and stealing their electrons, making them unstable as well.
  • Antioxidants, fight against free radicals, by giving them an electron to make them stable. Which include vitamins & peptides
  • Inflammation, ionizing radiation, UV light exposure, air pollution, smoking, & processed foods (selami, sausages, smoked foods…)
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9
Q

List some sources of antioxidants

A
  • Berries have lots of antioxidants
  • Fruits
  • Vegetables
  • Vitamin C & E are potent antioxidants
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10
Q

What refers to the mechanical injury to body resulting in tearing, shearing, or crushing?

And, provide examples

A
  • Trauma
  • Blunt or sharp force trauma, gunshot wounds etc..
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11
Q

What refers to injuries that are caused by a failure of cells to receive or use oxygen? Kind of like hypoxia

And list the major categories

A
  • Asphyxiation
  • Strangulation, drowning, foreign objects, chemicals, asthma & anaphylaxis
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12
Q

What refers to a blunt trauma that is not deep, but injures some of the superficial blood vessels, and creates bruises?

A
  • Contusions
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13
Q

What refers to Tear or rip resulting when tensile strength of skin or tissue is exceeded; is ragged & irregular with abraded edges?

A
  • Lacerations
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14
Q

What refers to blunt-force blows or impacts can cause bone to break or shatter?

A
  • Fractures
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15
Q

What refers to a wound that is longer than it is deep; wound can be straight or jagged with sharp, distinct edges without abrasion, which most commonly happens intentionally as a result of surgery or unintentionally via a sharp knife or paper cut?

A
  • Incised wounds
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16
Q

What refers to a penetrating sharp-force injury that is deeper than it is long, that can damage internal organs?

A
  • Stab wounds
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17
Q

What refers to instruments or objects with sharp points but without sharp edges that produce puncture wounds; classic example is wound of foot after stepping on a nail; wounds are prone to infection, have abrasion of edges (untidy), and can be very deep

A
  • Puncture wounds
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18
Q

What refers to a sharp strait wound, that is most commonly made through surgery?

A
  • Incision
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19
Q

What refers to a wide area of tissue that is pulled away or part of the skin is loose or torn?

A
  • Avulsion
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20
Q

What refers to a deep, narrow wound?

A
  • Puncture
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21
Q

What refers to the top layer of skin being scrapped off ?

A
  • Abrasion
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22
Q

What refers to part of the body being detatched?

A
  • Amputation
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23
Q

What refers to a partial or full thickness thermal chemical injury to skin?

A
  • Burn
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24
Q

List the 3 possible cell outcomes following an injurious stimuli

A
  • Reversible injury, where the cell recovers
  • Cell death or necrosis, where the cell dies
  • Programmed cell removal or cell apoptosis, where our bodies get ride of those dead cells or makes dead tissue smalled, such as cardiac necrosis.
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25
Q

Auto- means…
-phag means…

A
  • Self
  • Consumption
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26
Q

What refers to a form of cellular death that is an active process of cellular self destruction called “programmed cellular death”?

A
  • Apoptosis
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27
Q

What refers to a self destructive process & a survivial mechanism that involves the delivery of cytoplasmic contents to the lysosome for degradation?

A
  • Autophagy
28
Q

What refers the sum of cellular changes after local cellular death & the process of cellular self-digestion? That is passive, disorganized, & unregulted

A
  • Necrosis
29
Q

List the different types of necrosis

A
  • Coagulative, liquefactive, caseous, fatty, & gangrenous necrosis
30
Q

What refers to necrosis that occurs primarily in the kidneys, heart, & adrenal glands; it commonly results from hypoxia caused by severe ischemia or hypoxia caused by chemical injury, especially ingestion of mercuric chloride. This form of necrosis is a result of protein denaturation, which causes the protein albumin to change from a gelatinous, transparent state to a firm, opaque state?

A
  • Coagulation necrosis
31
Q

What refers to necrosis that commonly results from ischemic injury to neurons and glial cells in the brain. Dead brain tissue is readily affected by this form of necrosis because brain cells are rich in digestive hydrolytic enzymes and lipids, and the brain contains little connective tissue. Cells are digested by their own hydrolases, so the tissue becomes soft, liquefies, & segregates from healthy tissue, forming cysts. This process can be caused by bacterial infection, especially Staphylococci, Streptococci, & Escherichia coli?

A
  • Liquefactive necrosis
32
Q

What refers to necrosis that usually results from tuberculous pulmonary infection, especially by Mycobacterium tuberculosis. It is a combination of coagulative & liquefactive necroses. The dead cells disintegrate, but the debris is not completely digested by the hydrolases. Tissues resemble clumped cheese in that they are soft & granular. A granulomatous inflammatory wall encloses areas of this form of necrosis?

A
  • Caseous necrosis
33
Q

What refers to necrosis that is cellular dissolution caused by powerful enzymes, called lipases, that occur in the breast, pancreas, & other abdominal structures . Lipases break down triglycerides, releasing free fatty acids that then combine with calcium, magnesium, & sodium ions, creating soaps (saponification). The necrotic tissue appears opaque & chalk-white.

A
  • Fatty necrosis
34
Q

What refers to gangrenous necrosis that is caused by infection of injured tissue by one of many species of Clostridium. These anaerobic bacteria produce hydrolytic enzymes & toxins that destroy connective tissue & cellular membranes & cause bubbles of gas to form in muscle cells. This type of gangrenous necrosis can be fatal if enzymes lyse the membranes of red blood cells, destroying their oxygen-carrying capacity. Death is caused by shock

A
  • Gas gangrene
35
Q

Describe the events that occur in ischemic cell death of particularly cardiac tissue

A
  • A blocked artery, which causes hypoxia past the blockage since the cells need oxygen via blood
  • The cells then change from aerobic to anaerobic metabolism, which produces less ATP or energy for the cells as a result
  • The by product of this anaerobic metabolism is increased lactic acid accumulation, creating an acidosis state
  • The patient experiencing this ischemia feels pain
  • Tissues can only be sustained for 20 mins via this metabolism before cellular death & tisue necrosis begin, which can be lethal
36
Q

Which vital organs are most susceptible to hypoxia?

A
  • Brain, liver, & heart
37
Q

What refers to the type of immunity in which we are born with, and is nonspecific (general)?

A
  • Innate immunity
38
Q

What refers to a type of immunity that is specfific to microorganisms in which we get immunity from adter an interactions or vaccine?

A
  • Adapative (acquired) immunity
39
Q

Describe how can hypoxia lead to inflammation

A
  • Since it creates cell injury, which triggers inflammation, because its our normal body’s response
40
Q

Describe how can inflammation lead to hypoxia

A
  • Since it creates obstruction which can prevent blood flow, or can increase our demand for oxygen.
41
Q

Hypo- means…
-ia means…

A
  • Below
  • Condition
42
Q

-itis means…

A
  • Inflammed or refering to an inflammation
43
Q

What refers to an inflmmation of the appendix?
What refers to an inflmmation of the tonsils?
What refers to a baccterial skin infection?

A
  • Appendicitis
  • Tonsillitis
  • Cellulitis
44
Q

List the inflammatory response goals

A
  • To limit & control the injury process
  • To limit bleeding
  • To limit infection
45
Q

Describe the events that take place in an inflammatory response when bacteria & viruses enter the body for example(p.279)

A
  • (1) When mast cells are damages, they release histamines, which dilate the blood vessels & increase blood flow to the affected area, leading to erythema (skin rash caused by inflammed capillaries) & warmth
  • (2) Increased vascular permeability with leakage of plasma from the vessels, leading to edema (swelling). Capillaries dilate & leak (causes the redness & heat); platelets & clotting factors migrate to site of injury to confine infection to wound site
  • (3) Movement of leukocytes (WBC) from the vessels into the site of injury. Phagocytic WBCs including neutrophils to come to injury site to destroy pathogens => WBC engulf pathogens & then die making up the pus we associate with infection => bloodwork drawn to determine level of infection include WBC count – most common is neutrophils
46
Q

Are inflammations specific or non specific responses?

A
  • Nonspecfific responses
47
Q

Signs of acute, local inflammation:

  1. Capillaries widen –> causing___ , which results in….
  2. Increased permeability –> causing___ , which results in….&…
  3. Attraction of leukocytes –> causing___ , which results in….
  4. Systemic response –> causing__&_ , which results in….
A
  • Increased blood flow, resulting in heat
  • Fluid release into tissues, resulting in redness & swelling
  • Extravasation of leikocytes to site of injury, resulting in tenderness
  • Fever & proliferation of leukocytes, resulting in pain
48
Q

List the 5 cardinal signs of inflammation

A
  • Pain
  • Heat
  • Redness
  • Swelling
  • Loss of function
49
Q

(Systemic signs of acute inflamamtion)
The release of cytokines in the acute phase of inflammation causes:

__ caused by the affects on the ___, which is the centre for body temp. Creating heat, & an uncomfortable environment for the possible invader

Increased ____ production caused by affecting ____. ____ are the cells that engulf the microorganisms. That’s why blood work shows an increased number ___

___ caused by affecting ____

Increased ____, because of the effects of cytokines on the ___. Also, increased ____ caused by affecting ___

A
  • Fever; Hypothalamus
  • Neutrophil; Bone marrow
  • Lethargy; CNS
  • ESR (erythrocyte sedimentation rate); C-reactive protein
  • C-reactive protein; liver
50
Q

What is the major difference between acute & chronic inflammation?

A
  • Duration, since chronic inflammation is sometimes preceded by an unsuccessful acute inflammatory response. For example, if bacterial contamination or foreign objects (e.g., dirt, wood splinter, silica, & glass) persist in a wound, an acute response may be prolonged beyond 2 weeks. An incomplete wound healing may characterize this type of chronic inflammation
51
Q

Angio- means…
-genesis means…

A
  • Vessels
  • Creates
52
Q

Describe superficially how acute & chronic inflammation differ & how they are connected

A

Initiating simulus (Trauma/infection):
- In healthy inflammation, acute inflammation occurs, causing an immune response, which may or may not be resolved. Failure to resolve ends in a chronic inflammatory disease. Sucessful resolution returns tissues & cells to homeostasis
- In excessive inflammation, chronic inflammation occurs, cuasing an excessive immune response, which is not resolved. Failure to resolve ends in a chronic inflammatory disease.

53
Q

What are some characteristics of chronic inflmmation? (list 7)

A
  • It last longer than 2 weeks
  • It is related Related to unsuccessful acute inflammatory response, and most of the time its caused by autoimmune diseases (attacking its own cells, which is very hard to get rid of, since the antigens are always there)
  • Bacteria or foreign material remain in/at wound site
  • Microorganisms within cell walls are insensitive to breakdown by phagocytes
  • Microorganisms remain within the macrophage
  • Chemicals can also cause a prolonged inflammatory response
  • Autoimmune disorder
54
Q

Chronic inflammation is characterized by a dense infiltration of __ & ___.

If ___ are unable to protect the host from tissue damage, the body attempts to wall off & isolate the infected area, thus forming a __.

For example, infections caused by some bacteria (listeriosis, brucellosis), fungi (histoplasmosis, coccidioidomycosis), & parasites (leishmaniasis, schistosomiasis, toxoplasmosis) can result in __ ___.

A zone of __ surround the __.

A
  • Lymphocytes; macrophages
  • macrophages;granuloma
  • Granuloma formation
  • Lymphocytes; granuloma
55
Q

What refers to the cell that synthesizes the extracellular matrix & collagen, & produces the structural framework (stroma) for animal tissues? Aiding scar tissue formation following a chronic inflammation

A
  • Fibroblasts
56
Q

The Chronic Inflammatory Response:
1. Inflammation usually becomes chronic because of the __, __, or __ in the wound.

  1. Chronic inflammation is characterized by the persistence of many of the processes of acute inflammation.
  2. In addition, large amounts of __&__, __, & ___ result in the release of mediators that induce the (3.) infiltration of more lymphocytes & monocytes/macrophages & the beginning of wound healing & tissue repair (scar).
A
  • Persistence of an infection; an antigen, or a foreign body
  • Neutrophil degranulation & death; the activation of lymphocytes; & the concurrent activation of fibroblasts
57
Q

Hyper- means…
-plasia means…

A
  • Over
  • Growth
58
Q

How are the systemic signs of chronic inflammation similar to acute inflammation?

A
  • Fever
  • Lethargy caused by affect on the CNS
  • Increased ESR (erythrocyte sedimentation rate) & increased C-reactive protein in blood work
59
Q

How are the systemic signs of chronic inflammation different from acute inflammation? (List all 6)

A
  • Granuloma formation
  • Hyperplasia (overgrowth) of the spleen or lymph nodes
  • Fluid exudation (Fluids & leukocytes that move to the site of injury from the circulatory system in response to local inflammation) & edema
  • Depression
  • Insomnia
  • Weightloss/ weight gain
60
Q

Wound healing involves 3 phases: Describe these phases in depth
1. Inflammatory phase (acute phase - involving swelling)
2. Proliferative phase (sub-acute - regenerative)
3. Maturation phase (Scar tissue & remodeling)

A
  • Inflammatory phase: Includes coagulation or hemostasis & the infiltration of cells that participate in wound healing, including platelets, neutrophils, & macrophages. This occurs immidetiatly after the injury, limiting the extent of injury & the wound (cleaning it up)
  • Proliferative phase & new tissue formation: Is characterized by macrophage invasion of the dissolving clot & recruitment & proliferation of fibroblasts (connective tissue cells), followed by fibroblast collagen synthesis, epithelialization, contraction of the wound, & cellular differentiation. Trying to heal the wound
  • Remodeling & maturation phase: During this phase, there is continuation of cellular differentiation, scar formation, & scar remodelling
61
Q

What refers to wounds that heal under conditions of minimal tissue loss, having clean & tidy edges?

Wounds are closed with surgical intervention, where the edges are brought together

Best choice for clean, fresh wounds, in sufficienctly vascularized areas

Ex. A surgical wound, closed by sutures

A
  • Primary intention
62
Q

What refers to tissues that sustained extensive damage or those incapable of regeneration heal by the process of repair resulting in the formation of a scar?

The wound is left open & allowed to heal spontaneously or local intervention is applied to get rid of infection

Good for contaminted/infected wounds. Ex. infected surgical incisions

Increased chance of scarring

A
  • Secondary intention
63
Q

What refers to a delayed primary closure, that is infected?

Good for wounds which are contamined/infected initially

The wound is left open for awhile til the infection is gone, then it is surgically sutured once it is decontaminated

A
  • Tertiary intention
64
Q

Complication of wound healing include: Adhesions, Strictures & contractures, Infection, Dehiscence and/or evisceration, & Excess scar formation

Describe these complications in more depth

A
  • Adhesions: Occurs mainly in big bowel surgeries, creating excessive proliferation. Casuing organs in the abdomen to attach to eachother, which need to be surgically cut apart
  • Strictures & contractures: Mostly happens with burn wounds, especially fingers. Creating scars which can limit the function of the fingers, due to the scar tissue in the area
  • Dehiscence &/or evisceration: Occurs mostly in abdominal surgery, due to excessive strain, infection or pressure going up (ex. constipation). In which the wound pulls apart at the suture line.
65
Q

Cause of dysfunctional wound healing includes ischemia, excessive bleeding, obesity, excessive fibrin deposition, a predisposing disorder such as diabetes mellitus, wound infection, inadequate nutrients, numerous medications, & tobacco smoke

Discuss these causes in depth

A
  • Oxygen deprived Ischemic tissue: Is susceptible to cellular death & infection, which prolongs inflammation & delays healing. Ischemia, reduces energy production & impairs collagen synthesis & the tensile strength of regenerating connective tissue.
  • Excessive bleeding: Large clots increase the amount of space that granulation tissue must fill, & they serve as mechanical barriers to oxygen diffusion. Accumulated blood is an excellent culture medium for bacteria & promotes infection, thereby prolonging inflammation by increasing exudation & pus formation.
  • Obesity: Delays wound healing because of impaired leukocyte function & predisposition to infection, decreases in the number of growth factors, & increases in the levels of proinflammatory cytokines.
  • Excessive fibrin deposition: Is detrimental to healing. Fibrin released in response to injury must eventually be reabsorbed to prevent organization into fibrous adhesions. Adhesions formed in the pleural, pericardial, or abdominal cavities can bind organs together by fibrous bands & distort or strangulate the affected organ.
  • Diabetes: Wounds are often ischemic because of the potential for small-vessel diseases that impair the microcirculation & alter (glycosylated) hemoglobin, which has an increased affinity for oxygen & thus does not readily release oxygen in tissues. Consequences of hyperglycemia also include suppression of macrophages & increased risk for wound infection.
  • Wound infection: caused by the infiltration of pathogens. Pathogens damage cells, stimulate the continued release of inflammatory mediators, consume nutrients, and delay wound healing.
  • Optimal nutrition: is important during all phases of healing because metabolic needs increase.
  • Medications: Including antineoplastic (anticancer) agents, Non-steriodal anti-inflammatory drugs (NSAIDs)–> Such as asprin & advil, & steroids, delay wound healing.

HLSC 222 (19 decks)

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