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Pathophysiology > Exam 1 - Innate Immunity: Inflammation, Infection, & Wound Healing > Flashcards

Exam 1 - Innate Immunity: Inflammation, Infection, & Wound Healing Flashcards

1
Q

What is the purpose of physical barriers?

A

To prevent injury

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2
Q

Where can physical barriers be found in the body?

A
  • the skin
  • lining of the gastrointestinal tract
  • lining of the genitourinary tract
  • lining of the respiratory tract
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3
Q

What are some examples of mechanical barriers?

A
  • sloughing off of cells
  • coughing and sneezing
  • flushing
  • vomiting
  • mucus
  • cilia
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4
Q

How do physical barriers work in defense?

A

By mechanically removing infectious microorganisms

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5
Q

How do biochemical barriers work?

A

Secrete substances to trap / destroy microorganisms

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6
Q

What are examples of biochemical barriers?

A
  • synthesized and secreted saliva, tears, ear wax, sweat, and mucous
  • antimicrobial peptides
  • normal bacterial flora
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7
Q

How does normal bacterial flora act as a biochemical barrier?

A
  • help get rid of toxins by knocking off “bad” bacteria

- don’t allow room for the “bad” bacteria

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8
Q

What are 4 main factors about the inflammatory response?

A

1- Occurs in tissues with blood supply
2- Is activated rapidly after damage occurs
3- Depends on activity of both cellular and chemical components, including plasma and protein
4- Is non-specific

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9
Q

How is the inflammatory response non-specific?

A

It takes place in the same way regardless of the type of stimulus or whether exposure to the same stimulus has occured in the past

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10
Q

What type of defense is the inflammatory response?

A

A second line of defense

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11
Q

What are examples of injury that can activate the inflammatory response?

A 
A variety of materials including:
- Infection
- Mechanical damage
- Ischemia
- Nutrient deprivation
- Temperature extremes
- Radiation
Etc.
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12
Q

What are other names for Local manifestations?

A

Clinical manifestations

Signs and symptoms

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13
Q

What are other names for signs and symptoms?

A

Local manifestations

Clinical manifestations

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14
Q

What are other names for clinical manifestations?

A

Local manifestations

Signs and symptoms

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15
Q

What does ischemia mean?

A

A tissue or area does not have good blood flow

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16
Q

What are the local manifestations of inflammation?

A
  • redness
  • heat
  • pain
  • swelling
  • loss of function
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17
Q

What is another name for redness?

How do you spell it?

A

Erythema

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18
Q

What is a big reason patients go into shock?

A

Vascular permeability during the inflammatory response

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19
Q

What are the microscopic changes that occur during the inflammatory response?

A
  • Vascular response
  • Increased vascular permeability
  • WBC adherence
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20
Q

What occurs during the vascular response of inflammation?

A

Vasodilation

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21
Q

What symptoms does the vascular response cause during inflammation?

A

Vasodilation = more blood = more ERYTHEMA

More blood flow = more HEAT

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22
Q

What symptoms occur due to vascular permeability?

A

Leads to SWELLING, ERYTHEMA, and HEAT

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23
Q

What does increased vascular permeability mean?

A

Cellular walls become more flexible and they allow substances to freely move in and out of the cell

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24
Q

What is the purpose of WBC adherence during the inflammatory response?

A

Provide some foundation work for clotting

Start to clean up the injury

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25
Q

What occurs during the vascular response of inflammation?

A
  • Blood vessel dilation
  • Increased vascular permeability and leakage
  • White blood cell adherence to the inner walls of the vessels and migration through the vessels
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26
Q

What are the goals of inflammation?

A
  • Limit and control the inflammatory process
  • Prevent and limit infection and futher damage
  • Initiate adaptave immune response
  • Initiate healing
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27
Q

How does inflammation initiate healing?

A

Through removal of bacterial products, dead cells, etc.

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28
Q

How long does it take for microscopic changes to occur during the inflammatory response?

A

They occur within seconds

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29
Q

What is acute inflammation?

A
  • Inflammation with a nonspecific protective response to cellular injury
  • Has a rapid onset
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30
Q

Where does acute inflammation occur?

A

Only in vascularized tissue

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31
Q

What are the macroscopic hallmarks of acute inflammation?

A
  • Redness
  • Swelling
  • Heat
  • Pain
  • Loss of function
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32
Q

What are the microscopic hallmarks of acute inflammation?

A

Accumulation of fluid and cells (edema)

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33
Q

In order to have a vascular response, what type of tissue must it take place in?

A

Must have good blood flow

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34
Q

What causes the start of the acute inflammatory response, after injury?

A

ACTIVATION of plasma systems

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35
Q

What plasma systems are activated during the acute inflammatory response?

A
  • the Complement system
  • clotting
  • Kinin
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36
Q

What occurs at the same time as the activation of plasma systems during acute inflammatory response?

A

** Vasodilation
Also,
- Mast cell degranulation
- Release of cellular products

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37
Q

What is the first clotting factor?

A

Kinin

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38
Q

What does kinin do?

A

Builds the fiber that is the basis for the clot

Activate and assist the inflammatory cells

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39
Q

What symptom(s) does vasodilation cause?

A

Redness, heat

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40
Q

What symptom(s) does vasular permeability cause?

A

Edema

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41
Q

What symptom(s) does cellular infiltration cause?

A

Pus

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42
Q

What symptom(s) does thrombosis cause?

A

Clots

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43
Q

What symptom(s) does stimulation of nerve endings cause?

A

Pain

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44
Q

What are mast cells? Where are they located?

A

Cellular bags of granules located in the loose connective tissues close to blood vessels

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45
Q

What occurs when the cellular bags of mast cells open?

A
  • degranulation

- release of chemicals

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46
Q

What are examples of where mast cells are located?

A
  • Skin
  • Digestive lining
  • Respiratory tract
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47
Q

What causes the activation of mast cells?

A
  • Physical injury
  • chemical agents
  • immunologic processes
  • toll-like receptors (TLRs)
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48
Q

Biochemical mediators first released from mast cells during inflammation:

A

1- Histamine

2- Chemotactic factors

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49
Q

What are examples of chemotactic factors, and where do the chemotactic factors come from?

A
  • neutrophil chemotactic factor
  • eosinophil chemotactic factor of anaphylaxis
    (ECF-A)

Found in mast cell granules

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50
Q

What is histamine?

A

A vasoactive amine

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51
Q

What does histamine do?

A
  • Causes temporary, rapid constriction of the large blood vessels
  • Causes dilation of the postcapillary venules
  • Causes retraction of endothelial cells lining the capillaries
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52
Q

What is the first chemical released during the inflammation process?

A

Histamine

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53
Q

Why is histamine so helpful during the inflammatory response?

A

Causes constriction which:

  • keeps inflammation localized
  • keeps inflammation in as small of an area as possible
  • keeps blood pressure balanced
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54
Q

What is the general function of Histamine’s H1 receptor?

A

Promotes inflammation

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55
Q

What is the general function of Histamine’s H2 receptor?

A
  • Anti-inflammatory

- Suppression of leukocye function

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56
Q

Where is Histamine’s H1 receptor located?

What does it do there?

A
  • Smooth muscle cells of the bronchi

- Cause bronchi to contract

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57
Q

Where are Histamines H2 Receptors located?

What do they do there?

A
  • Parietal cells of the stomach mucosa

- Induces secretion of gastric acid

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58
Q

How do H2 blocker medications work? (Antacids)

A

Block the H2 receptor from making acid

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59
Q

What is chemotaxis?

A

Directional movement of cells along a chemical gradient formed by a chemotatic factor
(Something that attracts cells - acts like a pheromone)

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60
Q

Function of neutrophil chemotatic factor

A

Attracts neutrophils

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61
Q

Function of eosinophil chemotactic factor of anaphylaxis

A

Attracts eosinophils

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62
Q

What does eosinophil chemotactic factor of anaphylaxis have to do with anaphylaxis?

A

Eosinophils have to do with allergic reactions

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63
Q

What ECF-A stand for?

A

Eosinophil chemotactic factor of anaphylaxis

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64
Q

What are the chemotactic factors released during mast cell degranulation?

A
  • Neutrophil chemotactic factor
  • Eosinophil chemotactic factor of anaphylaxis
    (ECF-A)
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65
Q

What mediators are released from mast cells later in the inflammation process?

A
  • Leukotrienes
  • Prostaglandins
  • Platelet-activating factor
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66
Q

What are leukotrienes and what do they do?

A
  • Product of anachidonic acid from mast cell membranes
  • Slow down the inflammatory process so it lasts longer through the healing process
  • Mimics histamine in later stages
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67
Q

Function of prostaglandins

A
  • Induces pain
  • They are the product that causes us to feel pain (NOT INJURY)
  • Mimics histamine in later stages
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68
Q

Lipid mediators released during the break down of mast cells:

A
  • Leukotrienes
  • Prostaglandins
  • Platelet-activating factor
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69
Q

What causes pain in the inflammatory process?

A

Prostaglandins

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70
Q

What is platelet-activating factor?

A
  • The chemical that causes platelet activation
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71
Q

What products are at work during the clotting process and what do they do?

A

1st- Kinin: initiates the clotting process
2nd- Platelet-activating factor: Chemical that causes platelet activation and strings platelets together to form clot (this is what causes the second layer of the clot and is what actually causes the clot to form)

(WBCs provide the first layer)

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72
Q

What are the early microscopic signs of inflammation?

A
  • Permeability

- Vasodilation

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73
Q

What are the early signs and symptoms of inflammation?

A

Erythema and heat

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74
Q

Cause all the hallmarks of inflammation:

A
  • Mast cell products
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75
Q

Function of histamine: dont study this

A
  • Dilation of blood vessels, slowing circulation in nearby vessels
  • Causes endothelial cells to change shape and open intercellular junctions (allows fluid to leak from blood into tissue)
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76
Q

What results from increased blood flow and vasodilation?

A
  • Increased redness and warmth

- Increased permeability results in local swelling from increased fluid in the tissues

77
Q

What are released later on in the inflammatory process? What do they do?

A

Lipid mediators (leukotrienes, prostaglandins, and platelet activation mediators) are released and continue the inflammatory process through histamine-like effects and cause pain

78
Q

Name the plasma protein systems

A

Complement system
Coagulation system
Kinin system

79
Q

Function of the compliment cascade

A
  • Eliminate pathogens or toxins
  • Activates every component of the inflammatory resonse
  • Generates anaphylactic-toxic fragments that target cell lysis (break up cells)

In general,

  • Antibodies hook onto pathogens
  • Released to clean up spread of injury and get rid of any unwanted bacteria
80
Q

What is the lectin cascade?

A
  • Bacterial toxins related to carbohydrates

- Carbohydrates are used to destroy toxins

81
Q

What is the alternate cascade?

A
  • Use carbohydrates to destroy all remaining bacterial debris
82
Q

What are clots made of?

A
  • Platelets & fibrin

Way more fibrin than platelets when looking under microscope

83
Q

Another name for the coagulation system

A

Clotting cascade

84
Q

Function of the coagulation cascade

A
  • Forms a fibrinous meshwork at an injured or inflamed site
85
Q

Why is it important for the clotting cascade to form a fibrinous meshwork at an injured or inflamed site?

A
  • Prevents the spread of infection (localizes microbes)
  • Keeps microorganisms and foreign bodies at the site of greatest inflammatory cell activity
  • Forms a clot that stops bleeding
  • Provides a meshwork for repair and healing
86
Q

What is the main substance involved in the clotting system?

A

Fibrin - an insoluble protein

87
Q
  • Place the clotting cascade in sequential order
A 
1- WBC adherance
2- Kinin released
3- Platelet activation factor
4- Platelets
5- Fibrin
88
Q

Does platelet activation factor appear in a clot? Why or why not?

A

No. Because they’ve all been used up at that point

89
Q

Primary form of kinin:

A

Bradykinin

90
Q

Function of the kinin system

A
  • To activate and assist inflammatory cells

Kinins activate and help inflammatory response

91
Q

What does bradykinin do?

A
  • Causes vascular permeability (dilation of blood vessels)
  • Causes smooth muscle contraction
  • Continues pain
92
Q

What starts pain?

A

Prostaglandins

93
Q

What continues pain?

A

Bradykinin

94
Q

What are phagocytes?

A

Cellular component of inflammation that engulf and destroy microorganisms

95
Q

What is a neutrophil?

A

A phagocyte that removes debris from area of injury

96
Q

What is a “field of debris”?

A

The area around an injury

97
Q
  • When do neutrophils arrive to inflammatory site?
A

Within 6-12 hours of initial injury

They arrive first

98
Q

When are neutrophils most predominate?

A

During EARLY inflammatory responses

99
Q

What does a neutrophil do?

A

Ingests bacteria, dead cells, and cellular debris

100
Q

How long do neutrophils stay at the site of inflammation?

A

They are short lived and become a component of purulent exudate when they die

101
Q

Which white blood cells are characteristic of chronic inflammation?

A

Monocytes & macrophages

102
Q

Function of monocytes and macrophages

A

Provide LONG-TERM defense against infectious agents

103
Q

Where are monocytes and macrophages produced?

A

Bone marrow

104
Q

Specifically, when do macrophages arrive to inflammatory site?

A
  • 24+ hours after neutrophils

- about 3 to 7 days after initial injury

105
Q

How long do macrophages stay at the site of inflammation?

A

Stay through out the rest of the inflammation process

106
Q

Which white blood cells arrive early to the site of inflammation?

A

Neutrophils

107
Q

Which blood cells arrive late to the site of inflammation?

A

Macrophages

108
Q

When these show up, we know we’re near the end of the inflammatory process

A

Macrophages

109
Q

Function of eosinophils

A
  • Control vascular effects of serotonin and histamine (part of anaphylactic response)
  • Regulation of vascular mediators
  • Dissolve surface membranes of parasites
  • Mildly phagocytic but has more of an affinity for BALANCE
110
Q

Why do eosinophils balance serotonin and histamine?

A

To keep the inflammatory response down

111
Q

What do platelets do?

A

Once activated, result in degranulation and interaction with components of the coagulation system

112
Q

What do cytokines deal with?

A
  • Immunity

- Immune response

113
Q

What do chemokines deal with?

A
  • White blood cells

- White blood cell break-up

114
Q

Cellular products related to kinin:

A

Bradykinin
Cytokines
Chemokines

115
Q

Most important function of interleukins:

A

General enhancement or suppression of inflammation (can suppress immune response with anti rejection medications)

116
Q

What causes the local manifestations of inflammation to appear?

A

Results from vascular changes and corresponding leakage of circulating components into the tissue

117
Q

What is the heat in inflammation caused by?

A

Vasodilation

118
Q

What is the redness in inflammation caused by?

A

Vasodilation

119
Q

What is swelling in inflammation caused by?

A

Exudate

120
Q

What is the pain in inflammation caused by?

A

Exudate

121
Q

What is exudate?

A

Extra products coming out around injury

Ex: pus, drainage, etc.

122
Q

What is loss of function a result of?

A

The result of the other clinical manifestations of inflammation (redness, heat, swelling, pain) combine and result in loss of function

123
Q

What are the local manifestations of acute inflammation caused by?

A

Vascular changes and exudation

124
Q

What is exudate made up of?

A

Dilute toxins produced by bacteria (toxins, bacterial waste products, bacterial digestion)

125
Q

Function of exudate:

A
  • Carries plasma proteins and leukocytes to the site and holds them there for a bit
  • Carries away bacterial toxins, dead cells, debris, and other products of inflammation (left over from clean up)
126
Q

What does serous exudate indicate?

What does it look like?

A
  • Indicates early inflammation

- Water and clear with a reddish/pink tinge

127
Q

Example of where serous exudate can be found

A

Blister

128
Q

What type of exudate occurs early in the inflammation process?

A

Serous exudate

129
Q

What does fibrinous exudate indicate?

What does it look like?

A
  • Indicates severe or more advanced (or prolonged) inflammation
  • Looks like a clot - Thick and clotted
130
Q

Example of fibrinous exudate

A

Lobar pneumonia

131
Q

Which exudate occurs late in the inflammation process?

A

Fibrinous exudate

Because fibrin comes in later

132
Q

Another name for purulent exudate?

A

Suppurative exudate

133
Q

What does purulent exudate indicate?

What does it look like?

A
  • Indicates a bacterial infection

- White, may have green tinge

134
Q

What is an example of purulent exudate?

A

Abscess (walled-off lesion)

135
Q

What happens to form purulent exudate in particular?

A
  • Large number of leukocytes accumulate
136
Q

What does hemorrhagic exudate indicate?

What does it look like?

A
  • Indicates bleeding

- Looks like blood running out (because it contains erythrocytes (blood)

137
Q

What is fever caused by?

A

Exogenous and endogenous pyrogens

These act directly on the hypothalamus

138
Q

How are fevers risk/benefit?

A

They are beneficial - defense against microbes/infection

They are harmful - Increase host’s susceptibiliy to endotoxins

139
Q

How can an active infection be detected by lab work?

A

If there are >11,000 WBCs per mL of blood

140
Q

What is leukocytosis?

A
  • Increased numbers of circulating leukocytes
141
Q

What does a “shift to the left” mean?

A

Presence of circulating immature neutrophils

(because infection is so bad, so many new WBCs being made, all WBCs are immature. This slows down body’s ability to fight infection)

142
Q

What are the systemic manifestations of inflammation? (What is increased?)

A
  • Increased numbers of circulating leukocytes
  • Increased circulating plasma proteins
  • Increased plasma protein synthesis
143
Q

Where are the plasma protiens realeased during inflamation?

A
  • From the liver
144
Q

What is a C-reactive protein test?

A
  • An acute-phase reactant test that can determine whether there is prescence of chronic inflammation. Results will either be positive or negative
145
Q

What do the results of a C-reactive protein test indicate?

A
  • C-reactive protein is an acute-phase reactant, so:
  • If there is presence of the protein, we are in the first 24-48 hours of onset of inflammation
  • If it’s negative, there is chronic inflammation
146
Q

When does C-reactive protein appear after onset of inflammation?

A
  • Protein that appears 24 to 48 hours at onset of inflammation
147
Q

What does ESR stand for?

A

Erythrocyte sedimentation rate

148
Q

What is another name for ESR?

A

‘Sed rate’

149
Q

What is sed rate used for?

A

Most commonly, to monitor malignant disease.

Sometimes to monitor inflammation (but not used to identify where we are at in the inflammation process)

150
Q

What characterizes chronic inflammation?

A

Lasting weeks or longer, regardless of cause

151
Q

In general, what is chronic inflammation?

A
  • Unsuccessful acute inflammatory response
  • Without much acute response due to high lipid content microorganisms (microorganisms growing in patients with high lipid content)
  • Persistant irritation from chemicals, particulate matter, or physical agents
152
Q

Characteristics of chronic inflammation

What does the body do in this situation?

A
  • Dense infiltration of lymphocytes and macrophages

- If macrophages cannot protect the host, the body walls off the site and forms a granuloma

153
Q

What is an example of a granuloma formed from chronic inflammation?

A

Tuberculosis granuloma

154
Q

What does resolution mean?

A

Returning injured tissue to the origional structure and function

155
Q

What happens during tissue repair?

A
  • Body repairs what tissue it can, then replaces destroyed tissue with scar tissue
156
Q

What is scar tissue primarily composed of and why?

A

Collagen

To restore the tensile strength of the tissue

157
Q

What is the number one issue to address in an injury that has function-related issues?

A

Scar tissue because it usually causes loss of function

158
Q

If patient has injury that has a lot of scar tissue, which has caused loss of function, what happens?

A

Surgical procedure called escarotomy

159
Q

What is an escarotomy?

A

Surgical procedure that involves removal of scar tissue so less grows back and patient can restore some movement in area of injury

160
Q

What is debridement?

A
  • Surgical procedure where areas of the wound is cut away

- Cleaning up the dissolved clots, microorganisms, erythrocytes, and dead tissue cells

161
Q

What steps occur during healing of a wound?

A
  • Filling in the wound
  • Sealing the wound (epithelialization)
  • Shrinking the wound (contraction)
162
Q

What occurs during the reconstructive phase of wound repair?

A
  • Development of granulation tissue (new growth of tissue)
  • Fibroblasts synthesize and secrete collagen
  • Contraction
163
Q

Most important cell during the reconstructive phase of repair

A

Fibroblasts

164
Q

What do fibroblasts do? During which phase do they do this?

A

Synthesize and secrete collagen during reconstructive phase of wound repair

165
Q

When does contraction of a wound occur? When is it noticable?

A
  • Takes place during the reconstructive phase of repair

* - Noticable 6-12 days after injury

166
Q

What is contraction of a wound?

A

Inward movement of wound edges

Body does this on its own

167
Q

What things are occurring during contraction of a wound?

A
  • Collagen deposits
  • Tissue regeneration
  • Further wound contraction
168
Q

What occurs during the maturation phase of wound repair?

A
  • Collagen deposits
  • Tissue regeneration
  • Wound contraction continues
  • Scar tissue is remodeled
  • Capillaries disappear
169
Q

Key resolution and repair product used in wound healing?

A

Collagen

170
Q

Overall, what happens during the reconstruction phase of healing?

A
  • Formation of granulation tissue
  • Fibroblast proliferation
  • Collagen synthesis
  • Epithelialization
  • Contraction
  • Cellular differentation
171
Q

Overall, what happens during the Maturation phase of healing?

A
  • Continuation of cellular differentation
  • Scar tissue formation
  • Scar remodeling
172
Q

Another name for primary intention?

A

Primary healing

173
Q

Another name for secondary healing?

A

Secondary intention

174
Q

What does primary healing mean?

A

A wound that has healed under conditions of minimal tissue loss
*This is a closed wound

175
Q

What is an example of a primary wound?

A

Surgical incision with ends approximated

176
Q

What does it mean if a wound’s ends are approximated?

A

The ends of the wounds are closed

177
Q

What does secondary healing mean?

A

A wound that requires a great deal more tissue replacement

*This is an open wound

178
Q

Examples of a secondary wound

A
  • Burns
  • Large surface wounds
  • Infection
  • Decubitus (ulcer)/bed sore
179
Q

Things that show dysfunction during inflammatory response:

A
  • Hemorrhage
  • Fibrous adhesion
  • Infection
  • Excess scar formation
  • Wound sepsis
  • Hypovalemia
  • Hypoproteinemia
  • Anti-inflammatory steroids
180
Q

What causes hypovalemia?

A
  • Vasodilation
  • Permeability
  • Loss of blood
181
Q

What is hypoproteinemia?

A

Low protein (protein is required for good wound healing, so this would slow healing process)

182
Q

Dysfunction that occurs during reconstructive phase of wound healing

A
  • Impared collagen matrix assembly
  • Impared epithelialization
  • Impared contraction
183
Q

Example of impared collagen matrix assembly

A

Keloid scar (overgrowth of collagen in a wound)

184
Q

Word for skin reproduction

A

Epithelialization

185
Q

What can cause impared epithelialization?

A
  • Anti-inflammatory steroids
  • Hypoxemia
  • Nutritional deficiencies
186
Q

What does impared contraction of a wound cause?

A

Contracture - if a body part is stuck in one position, it causes wound to not heal

187
Q

What is hypoxemia?

A

Low blood oxygen

*Blood oxygen under 94

188
Q

What product does platelet-activating factor have similar effects to?

A

Leukotrienes

Pathophysiology (14 decks)

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