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Chronic inflammation and healing and tissue repair Flashcards

1
Q

Parenchymal tissue are

A

Parenchymal tissue are funcitoning cells of a body part ( such as myocyte, hepatocyte ect.)

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2
Q

Stromal Tissue is

A

Stromal Tissue is connective, supportive framework that promotes or helps to enable the function o the parenchymal tissue

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3
Q

Labile cells - _____________________

A

Labile cells - continually divide and replicate
ex epithelial cells

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4
Q

Stable cells -

A

Stable cells - normally stop dividing when growth ceases, but can regenerate when given an appropriate stimulus

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5
Q

Permanent cells (fixed cells) - _______________
ex. neurons cardiac myocytes, occular lens

A

Permanent cells (fixed cells) - rarely or never regenerate or divide

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6
Q

extracellular matrix is Material secreted by_______________ throughout the body that _________ and ________ the cells

A

extracellular matrix is Material secreted by local cells throughout the body that surrounds and supports the cells

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7
Q

What are the three substances found within the extracellular matrix

A

fibrous structural proteins
water hydrated gels
adhesive substances

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8
Q

What does ground substance refer to

A

all the Extracellular matrix except the fibrous structural proteins

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9
Q

What are the fibrous structural protein types that are found in the ECM

A

collagen and elastin

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10
Q

what are the water-hydrated gels found in the ECM

A

hyaluronan and proteoglycans

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11
Q

what are the adhesive glycoproteins

A

fibronectin and laminin

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12
Q

Basement membrane - underlying _______, _______, and __________cells; separates ________ from ____________

A

Basement membrane - underlying epithelial, endothelial, and smooth muscle cells; separates lining from connective tissue

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13
Q

Interstitial matrix - ___________ substance between ________

A

Interstitial matrix - gel-like substance between body cells

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14
Q

Integrins - transmembrane proteins that allow for:
attachment to the ______ and
communication between ______ and ______ environments

A

Integrins - transmembrane proteins that allow for:
attachment to the ECM and
communication between intracellular and extracellular environments

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15
Q

Granulation tissue

precursor to

develops when

what does it look like

that does it contain

A

Precursor to scar tissue - develops when there is a wound that cannot be resolved with regeneration alone

highly vascularized, typically reddish, moist, soft and bumpy (or “granular”) in appearance, fragile and bleeds easy

will contain many new capillaries (angiogenesis), prolierfating fibroblasts, and residual inflammatory cells

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16
Q

Angiogenesis is the Generation of __________ from __________

relies heavily on:

A

Angiogenesis is the Generation of new blood vessels from existing blood vessels

angiogenesis Relies heavily on vascular endothelial growth factor (VEGF), produced by cells deficient in oxygen

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17
Q

What are the four major steps of angiogenesis:
1.___________________- of parent vessel basement membrane (this allows “capillary sprout”)
2.Migration of endothelial cells from __________
towards the ____________
3.___________ of endothelial cells behind the
leading edge of migrating cells
4.___________ of endothelial cells and vessel walls

A

What are the four major steps of angiogenesis:
1.Proteolytic degradation of parent vessel basement membrane allows “capillary sprout”
2.Migration of endothelial cells from parent vessel
towards the angiogenic stimulus
3.Proliferation of endothelial cells behind the
leading edge of migrating cells
4.Maturation of endothelial cells and vessel walls

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18
Q

What are examples of angiogenesis (3)

A

damaged or disrupted tissue
cancerous lesions
diabetic retinopathy

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19
Q

Scar formation builds on ___________________ of new vessels and loose ECM

What is the main job of fibroblasts in scar tissue

what happens to scar tissue over time

A

Scar formation builds on granulation tissue framework of new vessels and loose ECM

fibroblasts emigrate to area of injury and proliferate
they secrete COLLAGEN, proteoglycans, fibronectin and hyaluronan

scar tissues increase collagen synthesis and decrease fibroblast proliferation

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20
Q

Angiogenesis can regress over weeks-months as the tissue repair process resolves and ______________

A

Angiogenesis can regress over weeks-months as the tissue repair process resolves and extra blood flow is no longer needed

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21
Q

Chemical Mediators:
-Released from ______________

-includes _________, _________, _________, __________

-Promote ________-

-Mediates _________

A

Chemical Mediators:
Released from cells that participate in tissue regeneration and healing process

Interleukins, interferons, prostaglandins, leukotrienes

Promote chemotaxis of leukocytes and fibroblasts

Mediate inflammatory response

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22
Q

Growth Factors
- Numerous types named by source of origin or effect on tissues
__________________(VEGF)
______________ (PDGF)
__________________(FGF)
___________________(EGF)
- Mediate ______, _______, and ________-
- Mediate ____________ response
- Promote ___________________
- Stimulate _____________
- Contribute to generation of _____-

A

Growth Factors
- Numerous types named by source of origin or effect on tissues
Vascular endothelial growth factor (VEGF)
Platelet-derived growth factor (PDGF)
Fibroblast growth factor (FGF)
Epithelial growth factor (EGF)
- Mediate proliferation, differentiation, and cell metabolism
- Mediate inflammatory response
- Promote chemotaxis of leukocytes and fibroblasts
- Stimulate angiogenesis
- Contribute to generation of ECM

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23
Q

Length of each stage of healing is significantly impacted on what “__________” a wound is healing by

A

Length of each stage of healing is significantly impacted on what “intention” a wound is healing by

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24
Q

__________ intention - small, incision-like wounds with well-approximated edges

A

Primary intention - small, incision-like wounds with well-approximated edges

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25
___________ intention - large, crater-like wounds with greater loss of tissue
Secondary intention - large, crater-like wounds with greater loss of tissue
26
___________ intention - large wound that is intentionally left open and then closed at a later date
Tertiary intention - large wound that is intentionally left open and then closed at a later date
27
Hemostasis -Initial ____________ at site -↑ ____________ and ________ -___________ forms to promote ___________- and prevent entry of foreign agents -Following blockage of vessel injury - ____________________
Hemostasis -Initial blood vessel constriction at site -↑ platelet attraction and aggregation -Thrombus forms to promote hemostasis and prevent entry of foreign agents -Following blockage of vessel injury - dilation and increased capillary permeability
28
macrophages also release ________ to stimulate __________, ________ attraction and __________.
macrophages also release growth factors to stimulate cell growth, fibroblast attraction and angiogenesis.
29
Restoring structural integrity usually begins within __________
Restoring structural integrity usually begins within 2 days.
30
Primary aim of restoring structural integrity is to _________
Primary aim of restoring structural integrity is to build new tissue to fill the wound.
31
During the early healing process a form of the ECM known as the ___________ is produced in the area of the injury. What does this do what happens to it later on
During the early healing process a form of the ECM known as the provisional matrix is produced in the area of the injury. this attracts and supports fibroblasts, endothelial cells, and epidermal cells. Macrophages and fibroblasts conver provisional matrix to granulation tissue
32
Fibroblasts and vascular endothelial cells begin __________ as early as 24 hours after injury to form _______________ they do this by secreting ________ and producing _______
Fibroblasts and vascular endothelial cells begin proliferating as early as 24 hours after injury to form granulation tissue. they do this by secreting collagen and other components needed for healing and producing growth factor to encourage healing process.
33
new epithelial barriers from between wound and external environment is called
reepithelialization
34
What are the 3 possible outcomes of restoring functional integrity
resolution regeneration replacement
35
resolution
very mild with minimal disruption rapid healing with minimal to no scarring
36
regeneration
primarily with labile or stable cell types cells may PROLIFERATE (reproduce and grow) cells may DIFFERENTIATe (local cells mature and become specialized) DIAPEDESIS may occur (local similar cells migrate to replace lost or damaged cells)
37
Replacement
production of scar tissue when regeneration is not possible. (seen with injuries to permanent cells and/or extensive/major injuries
38
Remodeling begins in about _________ in uncomplicated wounds and can continue for up to _________ or more. during this time ___________ removes old _________ and ___________ lay down new _____________.
Remodeling begins in about 3 weeks in uncomplicated wounds and can continue for up to 6 months or more. during this time collagenase removes old collagen and fibroblasts lay down new collagen.
39
Sutured wounds - ~______ of prior strength following closure
Sutured wounds - ~70% of prior strength following closure
40
After suture removal - ~___ of tensile strength
After suture removal - ~10% of tensile strength
41
3 months after injury - ______ strength
3 months after injury - maximal strength -70-80% of unwounded skin
42
Secondary intention - wounds often undergo _____________ during proliferative and remodeling phases
Secondary intention - wounds often undergo contraction during proliferative and remodeling phases scar tissue often stretches and is then smaller than the original wound, this can cause limited moevemnt and deformities
43
Ulcerations are oftn associated with also seen with frequent colonized by ______
Ulcerations are Open crater-like lesions of skin or mucous membranes oftn associated with poor perfusion. also seen with poor inflammatory and immune responses frequent colonized by microorganisms
44
dehiscence is ____________ scar formation where the wound _____________ at the site of injury. early following the injury indicates __________ stresses late following injury indicates deficient ______ or _______ formation
dehiscence is deficient scar formation where the wound splits or bursts open at the site of injury. early following the injury indicates mechanical stresses late following injury indicates deficient ECM or collagen formation
45
Keloid - excessive __________ production at site of injury which often exceeds ______ of wound
Keloid - excessive collagen production at site of injury which often exceeds margins of wound
46
Risk factors for keloids - _____________,_________,______
Risk factors - darker pigmented skin, age 10-30 yrs, + family hx
47
Hypertrophic Scar - excessive ___________ production at site of injury, less severe than ________; typically stays within ________
Hypertrophic Scar - excessive collagen production at site of injury, less severe than keloids; typically stays within wound margins
48
Adhesions are Inappropriate ______________ between injury and nearby tissues these inhibit ___________ of surrounding tissues are especially frequent in _____________________.
Adhesions are Inappropriate fibrous connections between injury and nearby tissues these inhibit movement of surrounding tissues are especially frequent in intra-abdominal surgeries.
49
Proud flesh is ___________ that _______________. this can impair normal healing process from taking place _________or __________ can allow healing process to resume. like a keloid except with ________ instead of scar tissue.
Proud flesh is Excess production of granulation tissue that extends beyond anatomical edges of wound. this can impair normal healing process from taking place surgical removal or cauterization can allow healing process to resume. like a keloid except with granulation instead of scar tissue.
50
6 main factors affecting wound healing
-malnutrition -blood flow/oxygenation -immune and inflammatory response -infection -foreign bodies -age
51
how does protein play a role in wound healing
Protein - needed for mediation of inflammatory phase, fibroblast proliferation, collagen
52
How do carbs play a role in wound healing
Carbohydrates - needed for energy for WBCs and reduce use of proteins for energy
53
how do fats play a role in wound healing
Fats - needed for synthesis of new cells
54
how does Vitamin C play a role in wound healing
Vitamin C - needed for collagen synthesis scar remodeling is an active process so without Vc scars will weaken.
55
how does Vitamin A play a role in wound healing
Vitamin A - needed for epithelialization, capillary formation, collagen synthesis
56
how does Zinc play a role in wound healing
Zinc - needed for enzymes responsible for cell proliferation
57
how does blood flow play a role in wound healing
Blood Flow - supplies nutrients and cells to injury and removes waste products, toxins, pathogens
58
how does oxygen play a role in wound healing
Oxygen - needed for collagen synthesis and intracellular destruction of organisms by phagocytes
59
Hyperbaric oxygen -
Hyperbaric oxygen - thought to increase partial pressure of oxygen in plasma and improve healing
60
how does diabetes play a role in wound healing
decreased chemotaxis and phagocytosis impaired perfusion due to microvascular disease.
61
corticosteroid administration
62
how do foreign bodies play a role in wound healing
having a foreign body prolongs inflammatory phase, impairs granulation tissue and scar tissue formation and contribute to pathogen invasion.
63
how does being a child play a role in wound healing
Children - Greater capacity for healing but may lack reserves for proper tissue repair - Immature immune system =prolonged immune response -Increased baseline metabolic nutritional demands
64
how does being elderly play a role in wound healing
Elderly - Decreased dermal thickness, collagen content in skin, and elasticity of skin - ↓ collagen and fibroblast synthesis - Slower reepithelialization - ↑ vulnerability to slower wound healing and chronic wounds
65
Acute inflammation onset is _________________ duration is ___________ feedback is usually _____________ cellular infiltrate is ________ early; _________/_________ late tissue injury and fibrosis is usually ________, _________, and ________ local and systemic signs are ____________
Acute inflammation onset is fast minutes to hours duration is hours to days feedback is usually self-limiting cellular infiltrate is neutraphils early; monocytes/macrophages late tissue injury and fibrosis is usually mild, self-limited, and minimal local and systemic signs are prominent
66
chronic inflammation is onset - ____________ duration - _________ feedback - usually _________ cellular infiltrate - ________/______ and _______ tissue injury and fibrosis is usually _______, more _________ and ________ local and systemic signs are ____________ and may be _______.
chronic inflammation is onset - slow /days duration - weeks to years feedback - usually self-perpetuating cellular infiltrate - monocytes/macrophages and lymphocytes tissue injury and fibrosis is usually severe, more extensive and progressive local and systemic signs are less prominent and may be subtle.
67
Common causes of chronic inflammation is persistent _____ or ______ and ___________.
Common causes of chronic inflammation is persistent injury or infection and autoimmune conditions.
68
in chronic inflammation you MAY see the ___________ which is ____________-
in chronic inflammation you MAY see the five cardinal signs which is redness, heat, swelling, pain, and loss of function
69
What are examples of causes of chronic inflammation
persistent injury or infection autoimmune conditions
70
Prolonged _________ causes increased production of ________ which increases _____ which blocks ________ which allows absorption of _____ this is how chronic inflammation creates _______.
Prolonged chronic inflammation causes increased production of IL-6 which increases hepcidin which blocks ferroportin which allows absorption of iron this is how chronic inflammation creates anemia.
71
nonspecific chronic inflammation causes - diffuse accumulation of ________ and _______ at the site of injury -cytokines produced by underlying cause lead to persistent __________ of _____ and _______ -significant scar tissue formation often replaces normal ________ and ________ tissues.
nonspecific chronic inflammation causes - diffuse accumulation of macrophages and lymphocytes at the site of injury -cytokines produced by underlying cause lead to persistent chemotaxis of WBCs and fibroblasts -significant scar tissue formation often replaces normal stromal and parenchymal tissues.
72
granulomatous inflammation is nodular inflammatory lesions that encase substances that are not easily destroyed by usual inflammatory and immune responses. slide 59 go over cuz extra info
73
how does corticosteroids play a role in wound healing
decreased immune mediator production decreased capillary permeability impaired phagocytosis inhibited fibroblast proliferation and funciton

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