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Healing Flashcards

1
Q

What 3 processes are involved in wound healing

A
  • haemostasis
  • inflammation
  • regeneration
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2
Q

Why does haemostasis occur

A

As the vessels are open

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3
Q

What is regeneration

A

Restitution with no or minimal evidence that there was previous injury - healing by primary intention

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4
Q

What is the alternative to regeneration

A

Fibrous repair (organisation)

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5
Q

What is an abrasion

A

Heeling by regeneration to the superficial layer of the skin (epidermis)

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6
Q

What is an ulcer

A

Injury to the mucosa (deep layers)

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7
Q

Which cells replicate in regeneration

A

Stem cells

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8
Q

What are stem cells

A

Cells that have a prolonged proliferative activity and show asymmetric replication

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9
Q

What is asymmetric replication

A

When they divide into daughter cells and 1 cells remains as a stem cell whereas the other differentiates into a mature cells

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10
Q

What tissues are stem cells found in

A
  • epidermis (basal layer)
  • intestinal mucosa (bottom of the crypts)
  • liver (between hepatocytes and bile ducts)
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11
Q

What does unipotent mean

A

Stem cells which only differentiate into 1 type of cell e.g. Epithelia

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12
Q

What are mulitpotent cells

A

Stem cells which can differentiate into several different types of cells e.g. Haematopoietic cells

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13
Q

What are totipotent stem cells

A

Stem cells which which can differentiate into any type of cell in the body e.g. Embryonic stem cells

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14
Q

What type of stem cells do blood cells derive from

A

Multi potent stem cells in the bone marrow

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15
Q

What types of tissue can regenerate

A

Labile and stable tissue

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16
Q

What type of tissue doesn’t regenerate

A

Permanent tissue

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17
Q

What are labile tissues

A

Tissues which contain short-lived cells that are replaced by stem cell derived cells e.g. Surface epithelia and haematopoietic cells

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18
Q

What are stable tissues

A

Cells which normally have low levels of replication but can undergo rapid proliferation of stem cells and mature cells when needed e.g. Liver, bone, endothelium and fibrous tissue

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19
Q

What are permanent tissues

A

Tissues made up of mature cells that cant undergo mitosis and don’t have stem cells present e.g. Neural tissue, skeletal muscle and cardiac muscle

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20
Q

When does regeneration take place

A
  • if there’s damage in labile or stable tissue

- if tissue damage is not extensive so the connective tissue scaffold is not damaged

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21
Q

What is fibrous repair (organisation regeneration)

A

The healing causing the formation of fibrous connective tissue to give a scar
Healing by secondary intention

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22
Q

When does fibrous repair occur

A
  • significant tissue loss

- if permanent or complex tissue is damaged

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23
Q

After how long may stitches be taken out from a wound and why

A

After 7-10 days as an early scar has formed and so the wound wont fall apart

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24
Q

How long does scar maturation take

A

Can take up to 2 year

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25
What is granulation tissue
Tissue which consists of capillaries, fibroblasts, myofibroblasts and chronic inflammatory cells giving a granular appearance
26
What are the functions of granulation tissue
- fills the gaps in wounds - the capillaries supply oxygen, nutrients and cells - allows contraction to close the hole
27
Outline fibrous repair
- a blood clot forms in a wound - neutrophils infiltrate and digest clot - macrophages and lymphocytes arrive and secrete chemicals which causes capillaries to bud - capillaries grow and the myo/fibroblasts make glycoproteins - collagen synthesised, lots of capillaries and macrophage number reduced - lot of collagen, cell number reduces and the wound contracts and remodels
28
What cells are involved in fibrous repair
- inflammatory cells (neutrophils, macrophages and lymphocytes) - endothelial cells - fibroblasts and myofibroblasts
29
What do endothelial cells do in fibrous repair
Their proliferation results in angiogenesis
30
What is angiogenesis
The growing of new blood vessels
31
What are myofibroblasts
Fibroblasts which can also contract like smooth muscle cells so are responsible for wound contraction
32
What do fibroblasts do
Produce the extracellular matrix protein collagen
33
Why do scars form on the head and sweat glands
Hair follicles and sweat glands are complex tissues so cant regenerate so must undergo fibrosis repair
34
What does collagen do
Provided the extracellular framework to give cells their shape, hold the body of the cell together
35
What are the fibrillar collagens
Types I-III | This are responsible for strength
36
What are the amorphous collagens
Type IV-VI | These make up the basement membrane
37
Where is type 1 collagen mostly found
Bones, tendons, ligaments, skin, sclera, blood vessels
38
What cells secrete type IV collagen
Epithelial cells
39
Outline the production of fibrillation collagen
- polypeptide alpha chains are produced in the ER of fibroblasts and myofibroblasts - enzymatic modification - cross linkage between the alpha chains forming procollagen triple helix - pro collagen secreted and cleaved to give tropocollagen - tropocollagen polymerises to give fibrils which then bundle to form fibres - remodelling
40
What enzymes allow remodelling of collagen
Collengases
41
What does crosslinkage of collagen cause
Gives tensile strength
42
What is vitamin C need for in collagen production
Hydroxylation which allows for cross linkages
43
Give an example of an acquired collagen synthesis disease
Scurvy
44
What is scurvy
Deficiency in vitamin C reducing the cross linkages in the helix structure so there's less strength and is vulnerable to enzymatic degradation
45
What are the symptoms of scurvy
- poor wound healing - tendency to bleed - tooth loss (normal collagen replaced by defective collagen) - old scars break down
46
What is ehlers-danlos syndrome
Defective conversion of procollagen to collagen so they lack tensile strength
47
What are the symptoms of ehlers-danlos
- poor wound healing - hyper-extensible, thin, fragile skin - hypermobile and joint predisposed to dislocation - rupture of colon, arteries
48
Why can the skin in ehlers-danlos recoil
The skin still contains elastin
49
What is osteogenesis imperfecta
Defective collagen so there's little bone tissue and so the bones are very fragile
50
What are the symptoms of osteogenesis imperfecta
- repeated fractures | - blue sclera (too little collagen makes then translucent)
51
What is Alport syndrome
- abnormal type IV collagen | - gives disfunction of glomerular basement membrane, cochlea of ear and lens of eye
52
What inheritance pattern is Alport syndrome
X linked
53
What controls regeneration and fibrous repair
- hormones - local mediators (growth factors) - direct cell to cell or cell to stroma contact
54
What are growth factors
Polypeptides which act on cell surface receptors to stimulate transcription of genes that regulate entry of the cell into the cell cycle
55
What genes code for growth factors
Proto-oncogenes
56
What are the affects of growth factors
- proliferation - inhibition of division - contractility - differentiation - angiogenesis
57
Giver 4 examples of growth factors
- epidermal growth factor - vascular endothelial growth factor - platelet derived growth factor - tumour necrosis factor
58
What produces growth factors
Platelets, macrophages and endothelial cells
59
What is contact inhibition
Signalling through adhesion molecules where the Cadherins on cells allow them to bind and they grow up until the integrins of the outer cells bind to the extracellular matrix. Grow to fill the space
60
What happens if there is a loss of contact inhibition
Proliferation will continue after the space is filled so they will proliferate onto of eachother
61
What is healing by primary intention
Where there is disruption to the basement membrane but there's only death of a small number of epithelial and connective tissue cells.
62
What type of intention are surgical wounds healed by
Primary intention
63
What occurs in primary intention
- epidermis regenerates (basal epidermal cells at the edge of cut and fuses beneath scab) - dermis has fibrous repair - minimal contraction and scarring with good strength
64
What is healing secondary intention
When an open wound (which has tissue loss and separated edges or infected wounds) is filled by abundant granulation tissue
65
Outline healing by secondary intention
- same as primary but more so - more contraction to close wound - substantial scar formation - takes longer
66
Outline bone healing
- haematoma forms - granulation tissue forms - soft callus forms - hard callus forms - lamellar bone
67
What things can influence wound healing
- type, size and location of wound - mechanical stress - blood supply - local infection - foreign bodies
68
What are complications of fibrous repair
- insufficient fibrosis - formation of adhesions (fibrotic tissue which surrounds or is found inbetween organs) which can comprise function and block tubes - loss of function (when specialised functional tissue is replaced by fibrotic tissue) - overproduction - excessive contraction
69
What type of scar is produced from overproduction of fibrous scar tissue
Keloid scar
70
When may excessive scar contraction occur
Following burns

Pathology (13 decks)

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