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Pathophysiology > Chapter 9 > Flashcards

Chapter 9 Flashcards

1
Q

What are the 3 lines of defense against invaders / injury?

A
  • 1st line of defense- Mechanical barriers, chemical barriers
  • 2nd line of defense - inflammation response, phagocytosis
  • 3rd line of defense - specific immune responses, natural killer cells
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2
Q

Inflammatory Response

A

fast non- specific, no memory

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3
Q

Immune Response

A

slower, specific, has memory

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4
Q

What triggers acute inflammation?

A

Cellular injury/ tissue injury

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5
Q

Why do we need inflammation

A
  • To wall off the area of injury
  • Prevent spread of the injurious agent
  • Bring the body’s defenses
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6
Q

What are the 5 local cardinal signs of inflammation and why do they occur?

A
  • Rubor (redness) :histamine
  • Tumor (swelling): increase in vascular permeability. WBCs leak out
  • Calor (heat): histamine
  • Dolor (pain)
  • Loss of function
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7
Q

Stage 1 of acute inflammation

A
  • Vascular Permeability
  • Inflammatory mediators (histamine & bradykinin) – blood vessels dilate and become permeable
  • Permeability- fluids, WBCs, and platelets travel out the site of injury or infection
  • Vasodilation- enhanced capillary permeability
  • Allowing fluid to flow out of the blood vessels to the injured tissues
  • swelling
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8
Q

Stage 2 of acute inflammation

A
  • Cellular Chemotaxis
  • attract microbial agents, endothelial cells, and WBCs to the site of injury/infection
  • Line up along the area of inflammation (margination)
  • Releases inflammatory mediators that amplify the inflammatory process
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9
Q

Stage 3 of acute inflammation

A
  • Systemic Responses
  • Fever, Pain, General malaise, Lymphadenopathy, Anorexia, Sleepiness, Lethargy, Anemia, Weight loss
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10
Q

What is chemotaxis?

A

chemical signal from microbial agents, endothelial cells, WBCs attracts platelets and other WBCs to the site of injury

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11
Q

What are systemic S/S of inflammation?

A

Acute- Fever, Pain, General malaise, Lymphadenopathy, Anorexia, Sleepiness, Lethargy, Anemia, Weight loss

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12
Q

What is a pyrogen? What chemical mediator is released to cause fever?

A

*Pyrogen- substances that cause fever
*Chemical mediator- cells (cytokines) or the bacteria (prostaglandins)
*Pyrogens activate prostaglandins to reset the hypothalamic temperature-regulating center in the brain to a higher level.
*An antipyretic agent = drug that brings down fever.

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13
Q

What meds are antipyretic and which one should never be given to children or adolescents with fever?

A
  • Tylenol, Ibuprofen, Acemetophine, and Aspirin
  • Never give children or adolescents aspirin or any salicylate-containing products for fever.
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14
Q

Leukocytosis is an increase in WBCs. What is the normal range of WBCs? What is a WBC differential count? Whatare bands, and what does it mean if they are present? What is a shift-to-the-left?

A
  • Normal Range of WBC - 5,000-10,000
  • Shift to the left= bacterial, acute inflammatory process is occurring. Neutrophils and Bands will be above normal range.
  • Shift to the right= viral
  • Bands= immature neutrophils
  • Differential Count- measures the total number of WBCs and calculates the percentages of specific types of WBCs within the total
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15
Q

Know the cells involved in inflammation. (WBC)

A
  • Neutrophils
  • Lymphocytes
  • Eosinophils
  • Basophils
  • Monocytes
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16
Q

What leukocytes arrive first?

A

Neutrophils are the first responders and begin the process of phagocytosis

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17
Q

What bacteria are resistant to being killed by macrophages?

A

TB, myobacterium

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18
Q

What does release of histamine cause?

A

An increase in Arteriolar vasodilation, large artery vasoconstriction, and increased permeability of venuoles

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19
Q

What are cytokines?

A

Cytokines- Amplify or deactivate inflammation (messengers, signaling proteins)

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20
Q

What are the 3 major types of cytokines?

A

3 major types:
* Tumor Necrosis Factor alpha (TNFa)
* Interleukins
* interferons

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21
Q

What does IL-1 cause?

A

causes fever/systemic response

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22
Q

What is the function of interferon?

A

(effective against viruses) - a group of signaling proteins made and released by host cells in response to the presence of several viruses.

23
Q

What does too much tumor necrosis factor cause?

A

is a cell signaling protein (cytokine) involved in systemic inflammation and is one of the cytokines that make up the acute phase reaction.

24
Q

What are the different types of exudate and what do they contain?

A

Serous- clear
Sanguineous- bright red
Serosanguinous- pink Purulent- yellow, stinky, thick

25
Q

Purulent exudate

A

edema fluid thats rich in protein from WBCs, microbial organisms, and cellular debris; also called pus

26
Q

Transudate

A

edema fluid that contains little protein and is mainly a watery filtrate of blood (fluid in blister)

27
Q

Acute inflammation

A

occurs rapidly in reaction to cell injury, rids the body of the offending agent, and enhances healing, and terminates after a short period, either hours or a few days

28
Q

Chronic inflammation

A
  • occurs when the inflammatory reaction persists, inhibits healing, and causes continual cellular damage and organ dysfunction, long term
  • Chronic inflammation often causes a granuloma.
29
Q

What are some examples of disorders associated with chronic inflammation?

A

Ex: TB, RA, atherosclerosis

30
Q

Regeneration

A

injured cells are replaced with the same cell type and structure and function is returned

31
Q

Repair

A

replacement with connective fibrotic tissue (formation of scar tissue) that doesn’t function in the same way as
original cells

32
Q

Briefly describe 5 stages of the cell cycle?

A
  • GO (resting)- cells are resting and not undergoing mitotic division
    *G1 (growth)- Cells enter the cell cycle during this stage, where they make preparations for mitosis
    *S (synthesis)- Cells undergo chromosomal duplication in preparation for mitotic division
    *G2 (gap)- Cells continue to undergo necessary activities before mitosis. RNA and protein synthesis occurs.
    *M (mitosis)- Cell completes mitosis and divides to regenerate itself. Includes both nuclear and cytoplasmic division
33
Q

What are the 3 classifications of cells according to their regenerative potential?

A

Labile, stable, permanent

34
Q

Labile

A

continually divide and replicate throughout life, replacing cells that are constantly eliminated - Ex. Skin, hair, nail, and cancer cells

35
Q

Stable

A

cells that are in a resting stage until stimulated, when they then enter the cell cycle
- Ex. Bone cells and hepatocytes

36
Q

Permanent

A

cannot regenerate and do not enter the cell cycle
- Ex. Neurons and cardiac myocytes
*Adult “stem cells” can be stimulated to regenerate permanent cells

37
Q

What are the 3 phases of the wound healing process?

A
  • Inflammation: prepares would for healing by attracting cells to the injured area
  • Proliferation, granulation tissue formation, and epithelialization
38
Q

Angiogenesis

A
  • Step 1
  • new capillaries begin form to provide blood / oxygen
  • needed to nourish growth of granulation tissue and epithelial cells
  • fibroblasts release growth factors attracting epithelial cells
39
Q

Granulation tissue

A
  • step 2
  • fibroblasts form fragile, moist, red tissue collagen bed (24-48hrs)
  • fills wound; needed for early ECM
  • Fibroblasts produce collage for days, weeks, months
40
Q

Epithelialization

A
  • epithelial cells begin to grow into the wound from the healthy surrounding tissue
  • gradually matures covering wound in epidermal layers
  • requires a moist wound bed of granulation tissue with no necrotic tissue
  • slowed if basement membrane not intact
41
Q

Collagen Deposition

A
  • granulation is replaced and fibroblasts die off
  • collagen and other substances fill the wound / scar tissue
42
Q

Whats involved in wound contraction and remodeling

A
  • Long-term phase that occurs approximately 3 weeks after the injury and may last several years
  • Myofibroblasts contract the wound edges to gradually close the wound
  • Tissues mature and strengthen
  • If possible, cells are remodeled to resemble and function like tissue of origin
  • If damage is too extensive, scar tissue becomes fibrotic with limited function
43
Q

What do fibroblasts do?

A

A connective tissue cell that synthesizes collagen and provides the extracellular matrix

44
Q

What are the 4 types of tissue?

A

Epithelial, connective, muscle, and nervous

45
Q

What are the differences between the 3 types of muscle tissue?

A

*Cardiac- involuntary (striation)
*Smooth- involuntary (no striation)
*Skeletal- voluntary (striation)

46
Q

What are the 3 processes, skin wounds heal by?

A

Primary intention
Secondary Intention
Tertiary Intention

47
Q

What is primary intention

A

a clean laceration that requires simple re- epithelialization when edges are approximated (surgical laceration)

48
Q

What is secondary intention

A

a wound with a large gap in tissue; some of the tissue has been gouged out (decubitus ulcer)

49
Q

What is tertiary intention

A

missing large amount of deep tissue
- cleaned and left open
- temp packing w sterile gauze
- prominent scarring
(pressure ulcers and severe burns)

50
Q

Why might a wound develop scar tissue?

A

When myofibroblasts overproduce collagen during the healing process, a hypertrophic scar may form

51
Q

What are factors that affect wound healing? Give examples of each.

A
  • Nutrition
  • oxygenation - circulation
  • immune strength - diabetes (weakens healing)
  • obesity
  • corticosteroids (diminishes healing)
  • use of immunosuppressant agents
  • contamination
  • surgically inserted devices
  • age
52
Q

What can cause dysfunctional healing?

A
  • Keloid: hyperplasia of scar tissue
  • Contractures: inflexible shrinkage of wound tissue that pulls the edges toward the center of the wound
  • Dehiscence: opening of a wound’s suture line
  • Evisceration: opening of wound with extrusion of tissue and organs
  • Stricture: an abnormal narrowing of a tubular body passage from the formation of scar tissue
  • Fistula: an abnormal connection between two epithelium-lined organs or vessels
  • Adhesions: internal scar tissue between tissues or organs
52
Q

What is the specific name for wound rupture? What can happen in rare cases? What needs to be done?

A

Dehiscence evisceration
COA: hold moist sterol gauze over organs and call HCP

53
Q
A

Pathophysiology (4 decks)

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