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internal med unit 1 > Chapter 7: Tissue Healing and Repair > Flashcards

Chapter 7: Tissue Healing and Repair Flashcards

1
Q

what is an indication of an active inflammatory reaction?

A

increased number of circulating leukocytes (leukocytosis)

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2
Q

what is an indictor of grave prognosis in severe systemic infections (sepsis)

A

decreased WBC count (leukopenia)

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3
Q

What does histamine do?

A

cause endothelial contraction –> formation of gaps –> increase blood vessel permeability –> allow fluids and blood cells to exit into the interstitial spaces

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4
Q

What are inflammatory mediators derived from phospholipids?

A

PFA, Prostaglandins, Leukotrienes

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5
Q

What are the autocrine effects of cytokines?

A

it affects the cytokine-producing cells themselves

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6
Q

what are cytokines?

A

polypeptide substances produced by leukocytes

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7
Q

what are the paracrine effects of cytokines?

A

it affects the adjacent cells

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8
Q

What does IL-I do?

A

causes fever

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9
Q

what does TNF do?

A

induce IL-I

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10
Q

What are plasma protein systems?

A

blood coagulation and fibrinolytic

kinin enzymatic system

complement system

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11
Q

what does blood coagulation and fibrinolytic do?

A

blood coagulation –> bandage injuries with clots

fibrinolytic –> dissolves the clots

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12
Q

what is phagocytosis?

A

the process of ingestion of microorganisms, other foreign substances, necrotic cells, and connective tissues constituents by specialized cells

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13
Q

what is the purpose of phagocytosis?

A

to inactivate and remove the inflammatory stimulus and to begin the process of healing

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14
Q

What are the outcomes of acute inflammation?

A

resolution, chronic inflammation, or healing by fibrosis

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15
Q

What are the components of tissue healing?

A

fibronectin, proteoglycans, elastin, and collagen

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16
Q

what is fibronectin?

A

acts like glue and helps cells stick together

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17
Q

what are proteglycans?

A

provide structure and support tissues (chains of sugar molecules and carbs)

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18
Q

what is elastin?

A

provides tissues with elasticity

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19
Q

What is collagen?

A

provides structural support and tensile strength for almost all tissues and organs of the body

20
Q

What are some factors that affect tissue healing?

A

local blood supply is vital (impediment of local circulation or depletion of the necessary materials could delay rehab)

certain tissues such as tendons, ligaments, cartilage may have decreased blood supply (healing process takes longer)

21
Q

Describe Phase I of healing.

A
  1. occurs immediately
  2. stops the bleeding by initiating coagulation
  3. degeneration is the formation of a hematoma, necrosis of dead cells, and the start of the inflammatory response
22
Q

What is the ultimate goal of Phase II?

A
  1. To inactivate the injurious agent
  2. To break down and remove the dead cells
  3. Initiate the healing of tissue
  4. Replace the injured tissue with healthy regenerated tissue, a fibrous scar, or both
23
Q

What is the goal of phase III?

A

to establish a vascular network that can transport oxygen and nutrients and support the metabolism of the healing tissue

24
Q

What is tissue contraction?

A

the newly formed extracellular matrix draws together, causing shrinkage of the healing tissue

25
Q

What is a contracture?

A

excessive shrinkage of the healing tissue occurs and pulls the deeper tissue to approximate the healing site

-limits mobility and organ function (can be disfiguring)

26
Q

What is tissue regeneration?

A

the process of replacement of dead parenchymal cells by new cells to restore normal tissue structure and function

27
Q

Name and describe the three type of parenchymal cells.

A

Permanent: regeneration does not occur and tissues cannot divide (cardiac myocytes or central/peripheral neuron)

Labile: divide continuously (epithelial cells, blood cell forming stem cells)

Stable: normally do not divide but can be induced to undergo mitosis (hepatocytes, skeletal muscle fibers, and kidney cells)

28
Q

Describe the healing process of a skeletal muscle.

A

it is slow and often incomplete, resulting in a loss of strength and high rate of reinjury

29
Q

When does loss of bone occur?

A

there is an imbalance between destruction and production of bone cells

there is a defective mineralization of bone matrix

30
Q

Describe the five steps of fracture healing and repair.

A
  1. Inflammatory phase: body sends inflammatory cells to the site, causing swelling and starting the healing process. Blood vessels respond, and new cells start to grow
  2. Blood clotting factors form a mesh at the injury to stabilize the area
  3. a soft callus forms around the break and is replaced by a harder callus
  4. the hard callus holds the broken pieces in place. The soft callus is replaced by bone tissue, connecting the broken parts
  5. This is the process where soft tissue turns into bone.
31
Q

What factors affect time for bone healing?

A
  1. types of bones involved
  2. the fracture site and type
  3. the treatment required
  4. degree of a soft tissue injury
  5. treatment complications
  6. other factors (age, vascular supply)
32
Q

Tendons may heal in what conditions?

A
  1. proliferation of the tenoblasts from the cut ends of the tendon
  2. blood vessels grow bringing oxygen and nutrients and fibroblasts from the surrounding injured tissues multiply and help form new tendon tissue to repair the damage
33
Q

When does homeostasis begin during tendon injury?

A

begins immediately

first 72 hours (3 to 5 days) after injury or surgical intervention

34
Q

When does the inflammatory phase start?

A

occurs 2 to 3 weeks after tendon injury but can begin as early as 48 hours after injury

35
Q

When does the maturation and remodeling phase begins?

A

around week 3 after the initial injury

36
Q

When do the tendons and ligaments regain normal strength?

A

40 to 50 weeks postoperatively

37
Q

What is tendinitis?

A

implying an inflammatory process

38
Q

what is tendinosis?

A

a degenerative process with little or not inflammation but histopathologic changes in the collagen matrix

39
Q

What does the quality of the repaired tissue depend on?

A
  1. the load and stressed subjected to the ligament during the healing process
  2. return to aggressive high impact sports too soon
  3. too little load and stress brought about by prolonged immobilization
  4. the use of NSAIDS
40
Q

What is the timeline of the menisci?

A
  1. at birth, it is vascular
  2. by 9 months, the inner one third has become avascular
  3. adulthood, only the outer 10 to 30% of vascularity remains
41
Q

what are some common causes of menisci laceration?

A

injury and degeneration

42
Q

what are clinical symptoms of a menisci tear?

A

pain, swelling, locking and catching, and loss of motion

43
Q

What is a synovial membrane?

A

lines the inner surface of the joint capsule and all intra articular structures

44
Q

what are the two components of the synovial membrane?

A
  1. intimal layer (next to the joint space)
  2. subintimal or supportive layer made of fibrous and adipose tissue
45
Q

Injury to any of the joint structures affects the synovium and results in…

A
  1. hemorrhage
  2. hypertrophy
  3. hyperplasia
46
Q

What are four predictable patterns of disk degeneration?

A
  1. The center of the disc (nucleus) starts losing its ability to hold water.
  2. As the amount of proteoglycans (water-binding molecules) in the disc decreases, the disc dries out.
  3. The center becomes thicker and more fibrous, like the outer part (annulus), making it less able to absorb shocks.
  4. Small tears, called fissures, start to form in the outer part of the disc.
47
Q

what can further slow the ability of the disc to heal through continued compressive forces?

A
  1. inactivity, weight gain, poor posture, and poor tone of the muscles supporting the spine
  2. calcification of the vertebral end plates

internal med unit 1 (5 decks)

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