Healing Flashcards
Define healing
Body tissue replacement
Describe this tissue (2 points)
Destroyed
Lost
What is the destroyed lost tissue replaced by?
Living tissue
What are the 2 processes of healing?
Regeneration
Repair
Which tissues replace the destroyed lost tissue in Regeneration?
Similar
What are these tissues similar in?
Type
Which tissue replaces the destroyed lost tissue in Repair?
Granulation
What happens to this Granulation tissue?
Matures
What tissue does this Granuloma tissue mature into?
Scar
What is this process known as?
Scarring
What is healing done by in regeneration?
Fibrosis
When is healing by Fibrosis becomes inevitable?
When cells lack proliferative capacity
Which cells do not have the capacity to proliferate?
Surrounding cells
Describe these cells
Specialized
What are the 2 factors that determine which healing process of the destroyed lost tissue is used?
Cell type
Destruction/Intactness
Which organ’s cell type determines the healing process of the destroyed lost tissue used?
Damaged
The destruction/intactness of which organ’s structure determines the healing process of the destroyed lost tissue used?
Stromal frame work
According to what are cells classified?
Proliferative capacity
What are the 3 types of cells?
Liable
Stable
Permanent
Describe the chances of Regeneration of Liable cells
Excellent
What are Liable cells characterized by?
Continuous turn over
Describe the division of Liable cells
Programmed
Where are the liable cells found in? (3 points)
GIT
Urinary tract
Skin
What are the liable cells which are found in these 3 sites?
Surface epithelium
What are other 2 examples of Liable cells?
Lymphoid system
Haemopoietic system
Which cell that divide is an example of liable cells?
Stem
Describe the chances of Regeneration of Stable cells
Good
Describe the level of replication of Stable cells compared to Liable cells
Lower
Describe the division of Stable cells
Rapid
What do these Stable cells respond to in order to divide rapidly?
Injury
Describe the number of stem cells which are an example of Stable cells
Few
What is an example of a stable cell which can proliferate?
Mesenchymal cell
What are the 4 examples of Mesenchymal cell?
Smooth muscle cells
Endothelial cells
Fibroblasts
Osteoblasts
What are examples of organs in which their stable cells can regenerate? (3 points)
Liver
Endocrine glands
Renal tubular epithelium
Describe Permanent cells
Non-dividing
What cannot happen to Permanent cells if they are lost?
Replacement
What do Permanent cells lack so that they cannot be replaced if lost?
Proliferative capacity
What are examples of Permanent cells?
3 points
Adult neurons
Striated muscle cells
Lens cells
What is Angiogenesis known as?
Neovascularization
Define Angiogenesis
New blood vessels formation
Where are these new blood vessels formed in?
Adult
What are the new blood vessels formed from? (2 points)
Pre-existing ones
Endothelial precursor cells
What is the type of these blood vessels?
Capillaries
When does Angiogenesis occur in?
6 points
Wound healing Infarction healing Chronic inflammation Serofibrinous inflammation Thrombus Abscess
Describe the capillary surface
Granular
What is the color of the capillary surface?
Red
What happens to the capillary when touched?
Bleeds easily
How does the capillary feels like when touched?
Moist
What will also be newly formed alongside the capillaries?
Fibroblasts
What are the functions of Fibroblasts?
4 points
Migration
Proliferation
Deposition of extracellular matrix
Tissue remolding
What are the 2 fates of Angiogenesis?
Fibrosis
Scar
What are used to control Angiogenesis? (4 points)
Growth factors
Receptors
ECM proteins
Inhibitors
What are the ECM proteins considered as for Angiogenesis?
Regulators
What is skin wound healing an example of?
Regeneration and Repair Combination
What are the 2 types of skin wound healing?
First Intention
Second Intention
What is the First Intention known as?
Primary Union
Describe the wound in First Intention type?
3 points
Clean
Uninfected
Surgically incised
What are the edges/margins of the wound approximated by?
Surgical sutures
What are lost in the wound of the First Intention type? (2 points)
Cells
Tissues
Describe this loss in the First Intention type
Not much
What are the sequence of events of skin wound healing of the First type?
(4 points)
Initial Hemorrhage
Acute Inflammatory response
Epithelial changes
Organization
Describe the healing in the First Intention type
Rapid
What does this healing result in?
Scar
Describe this Scar (2 points)
Neat
Linear
What is the healing in the form of?
Granulation Tissue
Describe this Granulation tissue
Scanty
Describe the wound where this scanty granulation tissue is formed at
Incised
What is the wound filled with in initial hemorrhage?
Blood
What happens to the blood?
Clots
What do the blood clots do to the wound?
Seal it
What do the blood clots prevent when sealing the wound? (2 points)
Dehydration
Infection
Which cells are firstly involved in the Acute Inflammatory Response?
Polymorphs
Which cells replace the Polymorphs?
Macrophages
Which day do the Macrophages replace the Polymorphs in?
3rd
What also happens to the wound area in the 3rd day?
Invaded
Which cells invade the wound area?
Fibroblasts
What is the wound covered by?
Epithelium layer
Which day is when the wound become covered by Epithelium layer?
2nd
Which epithelium layer is where epithelial changes occur in?
Epidermis
Which epidermal cells are where epithelial changes occur in?
Basal cells
What are the changes of the epidermal basal cells? (3 points)
Proliferation
Migration
Separation
Where do the epidermal basal cells migrate towards?
Incisional space
What do the Epidermal cells separate?
Underlaying viable dermis
What do the Epidermal cells separate the underlaying viable dermis from?
Overlaying necrotic material
What does this separation results in forming?
Scab
What will then start to form?
New Collagen Fibrils
Which day are the new collagen fibrils formed in?
5th
Until when will the new collagen fibrils dominate?
Healing completion
What will then be formed later on?
Scar tissue
What will be formed with the scar tissue?
Elements
Which 2 elements will be formed later on?
Cellular
Vascular
Describe the cellular element
Scanty
When will the scanty cellular and vascular elements be formed in?
4 weeks
What are the complications of the First Intention type?
Epidermal inclusion cyst formation
Describe the formation of the Epidermal inclusion cyst
Infrequent
What is the Second Intention known as?
Secondary union
Describe the wound in Second Intention type?
5 points
Unclean Sometimes Infected Open Contracted Irregular
What is involved in this wound compared to the wound of the primary intention?
Larger tissue defect
What has to be done with this large tissue defect?
Bridging
What are the edges/margins of the wound not approximated by?
Surgical sutures
Describe the edges/margins of the wound
Irregular
What are lost in the wound of the First Intention type? (2 points)
Cells
Tissues
Describe this loss in the Second Intention type
Extensive
What does this healing result in?
Scar
Describe this scar (2 points)
Large
Ugly
What happens to this scar with time?
Mature
Describe the color of this Scar on maturation
Pale
What is the color of this Scar on maturation?
White
Describe the 2 factors that made this Scar pale and white on maturation
Increased collagen
Decreased vascularity
What are the sequence of events of skin wound healing of the First type?
(3 points)
Initial Hemorrhage
Acute Inflammatory Response
Epithelial changes
Describe the healing in the Second Intention type
Slow
What is the healing in the form of? (2 points)
Granulation tissue
Suture tracks
Describe the Granulation tissue
Exuberant
Where exactly does the healing occur from the Granulation tissue?
In its gap
Where exactly does the healing occur from the Suture tracks?
Along them
What do the granulation tissue and the suture tracks do?
Fill the gap
What will occur more in the Second Intention type? (3 points)
Inflammation
Granulation tissue formation
Scarring
What is the main bulk of the secondary healing by?
Granulation
What will not be replaced in the Second Infection type?
Specialized skin structures
What are the 2 specialized skin structures that are not replaced in the Second Infection type?
Hair follicles
Sweat glands
What is absent in the First Intention type but present in the Second Intention type?
Wound contraction
What causes wound contraction?
Myofibroblasts action
What size does the wound contract into?
One-third to One-fourth
Which size does the wound contract into One-third to One-fourth of it?
Original
What delays the healing process?
Bacterial contamination
What is released by the bacteria in case of bacterial contamination delaying the healing process?
Toxins
What do the bacterial toxins provoke?
3 points
Necrosis
Suppuration
Thrombosis
What does the release of bacterial toxins indicate?
Infection
What helps in healing?
Debridement
Define Debridement
Surgical removal of dead and necrotic tissue
Where does wound strengthened occur in?
Extracellular matrix
What is the wound strengthened by?
2 points
Proliferation of:
Fibroblasts and Myofibroblasts
What are the Fibroblasts and Myofibroblasts provided with?
Structural support
What provides structural support to the Fibroblasts and Myofibroblasts?
ECM
What does ECM directs? (4 points)
Cell migration
Attachment
Differentiation
Organization
What are the 5 main components of the ECM?
Collagen Adhesive glycoproteins Basement membrane Elastic fibers Proteoglycans
What is the complication of healing in the Second Intention type?
Suppuration
What may the suppuration require?
Debridement
What are the 2 types of factors that affect wound healing?
Systemic
Local
What features of healing are altered due to these factors?
2 points
Rate
Efficiency
What are the systemic factors that affect wound healing? (7 points)
Age Anemia Nutritional deficiency Glucocorticoid therapy Cytotoxic drugs Diabetes mellitus Malignancy Uremia
What nutrients ,if deficient, affect the wound healing? (3 points)
Protein
Vitamins
Minerals
What features of Diabetes mellitus affect wound healing? (2 points)
Infection
Bad Vascularity
What are the local factors that affect wound healing? (6 points)
Infection Cell type damage Tissue damage Blood supply Venous drainage Mechanical factors Foreign body
What are the 3 type of cell in which the damaged cell could be classified as?
Liable
Stable
Permanent
Describe the 2 forms of tissue damage which affect the wound healing
Sever
Mild
What is an example of a mechanical factor which affect the wound healing?
Blood vessels compression
What are the complications of wound healing? (8 points)
Wound Infection Implantation cyst Ulceration Pigmentation Incisional hernia Keloid Excessive contraction Neoplasia
What does wound infection does to the healing?
Delays it
Describe the implantation cyst
Epidermal
Which cells flow into the healing wound?
Epithelial cells
What do these Epithelial cells sometimes do later on? (2 points)
Persist
Proliferate
What do these Epithelial cells form after their proliferation?
Epidermoid cyst
What color does the pigment looks like?
Rust
What gives the rust-like color of the pigment?
Hemosiderin
Describe Incisional hernia
A Defect
What is this defect caused by?
Poor wound healing following surgery
Which organ will be affected by this poor wound healing?
Intestine
What happens to the intestine?
Protrude
Where does the Incisional hernia usually occur in?
Abdominal wall
Describe Keloid
Scar tissue area
Describe the area of this Scar tissue
Raised
Describe the Scar (3 points)
Excessive
Ugly
Painful
What results in a Keloid?
Collagenous tissue formation
Describe the formation of this Collagenous tissue
Excessive
What does the Excessive contraction result in?
Decrease in wound size
What does the decrease in wound size depend on? (3 points)
Myofibroblasts
Cell-cell contacts development
Sustained cell contraction
What are the 3 processes together known as?
Cicatrisation
What is the exaggeration of these 3 processes known as?
Contracture
What does the contracture result in?
Severe deformity
Which cell becomes neoplastic?
Squamous cell
What does this Squamous cell form?
Carcinoma
Where is this Carcinoma formed in?
Marjolin’s Ulcer
