Healing And Repair: Inflammation

Question 1

Injury to cells and tissues sets in motion a series of events that contain the damage and initiate the healing process.
 This process can be separated broadly into _______ and ______

Answer 1

regeneration and repair .

Question 2

Regeneration results in the ___________ of lost or damaged tissue

Answer 2

complete restitution

Question 3

Repair may ___________ but can cause ________

Answer 3

restore some original structures

structural derangements.

Question 4

Regeneration refers to the ______ of cells and tissues to _______. e.g liver growth after partial resection or necrosis

Answer 4

proliferation

replace lost structures

Question 5

Repair most often consists of a combination of ________ and _________ by the deposition of ______.

Answer 5

regeneration and scar formation

collagen

Question 6

The relative contribution of regeneration and scarring in tissue repair depends on the _____________ and __________

Answer 6

ability of the tissue to regenerate and the extent of the injury.

Question 7

For instance, a superficial skin wound heals through the ________ of the surface epithelium.

Answer 7

regeneration

Question 8

Scar formation is the predominant healing process that occurs when the —————— is damaged by severe injury .

Answer 8

extracellular matrix (ECM) framework

Question 9

____________ (ECM)

Answer 9

extracellular matrix

Question 10

Control of normal cell proliferation and tissue growth

 In adult tissues, the size of cell populations is determined by the _____ of cell proliferation, ________ , and ______

Answer 10

rates; differentiation

death by apoptosis.

Question 11

Cell proliferation can be stimulated by only physiologic conditions.

T/F

Answer 11

F

can be stimulated by both physiologic and pathologic conditions.

Question 12

The tissues of the body are divided into three groups on the basis of the proliferative activity of their cells:
___________ (labile tissues),
_______ (stable tissues), and
___________ (permanent tissues).

Answer 12

continuously dividing

quiescent

nondividing

Question 13

Continuously dividing tissues proliferate throughout life.

T/F

Answer 13

T

Question 14

Labile cells

These tissues include :
 surface _____, such as ___________________, oral cavity, vagina, and cervix;
 the lining ____ of all the ______ of the body; the columnar epithelium of the ______________; the transitional epithelium of the ———-, and cells of the ________ and hematopoietic tissues.

In most of these tissues mature cells are derived from ______ cells.

Answer 14

epithelia; stratified squamous epithelia of the skin

mucosa; excretory ducts of the glands

GI tract and uterus

urinary tract; bone marrow

adult stem

Question 15

 Quiescent tissues normally have a (low or high?) level of replication

The cells can undergo ______ in response to stimuli and are thus capable of reconstituting the tissue of origin. The examples include
 Parenchymal cells of _____,_____, and ______;
 Mesenchymal cells such as ______ and ______; vascular _______ cells; and ___- and other _________.

Answer 15

Low

rapid division

liver, kidneys, and pancreas

fibroblasts and smooth muscle

endothelial; lymphocytes; leukocytes

Question 16

Nondividing tissues contain cells that have ______ and cannot undergo _______ in ______ life.

 The examples include
 ______,______, and ________ cells.

Answer 16

left the cell cycle

mitotic division ; postnatal

Neurons, skeletal and cardiac muscle

Question 17

Wound healing is a (simple or complex?) and (static or dynamic?) process of replacing _____- and ______ cellular structures and tissue layers.

Answer 17

Complex ; dynamic

devitalized

missing

Question 18

The human adult wound healing process can be divided into 3 or 4 distinct phases. Earlier authors referred to 3 phases denoted as ________,_______ and _______

In the 4-phases concept, there are the _____,______,_______,_______phase.

In the 3-phases approach, the ______ phase is contained within the ______ phase.

Answer 18

inflammatory, proliferative, and remodeling .

hemostasis phase, the inflammatory phase, the proliferative phase, and the remodeling

hemostasis; inflammatory

Question 19

Types of wound healing

_______ wound healing or healing by first intention.

___________ wound healing

_________ healing or healing by secondary intention

Answer 19

Primary

Delayed primary

secondary

Question 20

Category 1

Primary wound healing or healing by first intention occurs within ____ of repairing a full-thickness surgical incision.

This surgical insult results in the death of a (minimal or maximal?) number of cellular constituents.

__________ to close the wound occurs with formation of a relatively (thin or thick?) scar.

Answer 20

hours

Minimal

Re-epithelialization

Thin

Question 21

Category 2

If ________________________________, delayed primary wound healing transpires.

This type of healing is seen in cases of _______

Answer 21

the wound edges are not reapproximated immediately

Question 22

Category 2

By the ____ day, phagocytosis of contaminated tissues is well underway
 There is ongoing ______, _____ deposition, and maturation.
 Foreign materials are walled off by _______ that may metamorphose into ______ cells, which are encircled by _________, forming ______.
 Usually the wound is closed ______ at this juncture.
 If the “cleansing” of the wound is incomplete, _______ can ensue, resulting in ________

Answer 22

fourth; epithelization; collagen

macrophages; epithelioid; mononuclear leukocytes; granulomas

surgically; chronic inflammation ; prominent scarring.

Question 23

Category 3
 Secondary healing or healing by secondary intention.
 Secondary healing results in _________ that is more intense than with primary wound healing.
 In addition, a larger quantity of ________ is formed.
 Secondary healing results in pronounced _______ of wounds.
 Fibroblastic differentiation into _____ contribute to wound contraction.

Answer 23

an inflammatory response

granulomatous tissue

contraction

myofibroblasts

Question 24

Formation of Blood Clot.
 Wounding causes the rapid activation of coagulation pathways, with formation of a blood clot on the wound surface .
 The clot contains ___ cells, ____,_______,_ and ______ components.
 The clot serves to stop bleeding and also as a scaffold for migrating cells, which are attracted by growth factors, cytokines and chemokines released into the area.
 In large wounds , the fibrin clot is larger, and there is more exudate and necrotic debris in the wounded area.
 Within _______, ______ appear at the _____ of the incision. They release proteolytic enzymes that clean out debris and invading bacteria.

Answer 24

red; fibrin, fibronectin, and complement

24 hours; neutrophils; margins

Question 25

Inflammatory phase commences during the hemostasis phase, the early component of the inflammatory phase is predominated by the influx of the _________  The later component predominated by __________  Within the first 6-8 hours, the next phase of the healing process is underway, __________ .

Answer 25

polymorphonuclear leukocytes (PMNs) monocytes/macrophages. PMNs engorging the wound.

Question 26

TGF-β facilitates _______ from surrounding blood vessels.

Answer 26

PMN migration

Question 27

The PMNs attain their maximal numbers in _______ hours.

Answer 27

24-48

Question 28

Monocytes are termed macrophages once they ________

Answer 28

leave the vessel.

Question 29

Macrophages clear extracellular debris, fibrin, and other foreign material at the site of repair, and promoting _______ and _________ deposition.

Answer 29

angiogenesis and ECM

Question 30

Formation of Granulation Tissue/Proliferation. Fibroblasts and vascular endothelial cells proliferate in the first _______ of the repair process to form _____ tissue, which is a hallmark of tissue repair. It is ____ color and ______ with ______ appearance on the surface of wounds. It is characterised by the presence of ________ and the proliferation of _______.

Answer 30

24 to 72 hours granulation pink and soft with granular new small blood vessels (angiogenesis) fibroblasts

Question 31

Granulation tissue progressively invades the incision space; The amount of granulation tissue that is formed depends on the _______ created by the wound and the ________  Hence, it is much more prominent in healing by _______  By __________, granulation tissue fills the wound area and neovascularization is maximal.

Answer 31

size of the tissue deficit intensity of inflammation. secondary intention. 5 to 7 days

Question 32

Scar formation/ wound contraction The leukocytic infiltrate, edema, and increased vascularity largely disappear during the _________ There is increased accumulation of _____ within the wound area and regression of _____  The granulation tissue scaffolding is converted into a _____,______ scar, composed of spindle- shaped _____, dense _____, fragments of elastic tissue, and other ECM components.  The dermal appendages that have been destroyed in the _____________ are permanently lost

Answer 32

second week. collagen; vascular channels. pale, avascular fibroblasts; collagen line of the incision

Question 33

Scar formation/wound contraction By the end of the first month, the scar is made up of ______ connective tissue devoid of __________, covered by intact ______  Wound contraction generally occurs in (small or large?) surface wounds.  The contraction helps to close the wound by ____________ and by reducing the wound surface area.

Answer 33

acellular; inflammatory infiltrate epidermis; large decreasing the gap between its dermal edges

Question 34

The initial steps of wound contraction is the formation, of a network of _______ that express smooth muscle ______ and ______  These cells produce (small or large?) amounts of ECM components.

Answer 34

myofibroblasts α-actin and vimentin Large

Question 35

Myofibroblasts are formed from tissue _____ , bone marrow ______, or from _____ cells, through the process of ________ transition.

Answer 35

fibroblasts fibrocytes epithelial epithelial-to-mesenchymal

Question 36

Connective Tissue Remodeling.  The replacement of granulation tissue with a scar involves changes in the composition of the _______.  The balance between _______ and ___________ results in remodeling of the connective tissue framework .

Answer 36

ECM ECM synthesis and degradation

Question 37

Degradation of collagen and other ECM proteins is achieved by _____________

Answer 37

matrix metalloproteinases (MMPs).

Question 38

______ collagens (mostly _____ collagen) form a major portion of the connective tissue in repair sites and are essential for the development of _____ in healing wounds.

Answer 38

Fibrillar type I strength

Question 39

By the end of the first week, wound strength is approximately ____% that of unwounded skin.  Wound strength increases rapidly over the next ________, slows down at approximately the ______ after the original incision, and reaches a plateau at about ___% to __% of the tensile strength of unwounded skin.

Answer 39

10 4 weeks third month 70; 80

Question 40

Lower tensile strength in the healed wound area may persist for life. T/F

Answer 40

T

Question 41

Systemic factors that influence wound healing  Nutrition deficiency inhibit ______ synthesis and retard healing. ______ and ________ deficiency are common examples.  Metabolic status -________ for example, is associated with delayed healing.  Circulatory status - Inadequate blood supply impairs wound healing. E.g ________ or venous abnormalities (e.g., ________)  Hormones such as ______ have anti- inflammatory effects that influence various components of inflammation. They also inhibit collagen synthesis.

Answer 41

collagen; Protein and vitamin C Diabetes mellitus arteriosclerosis; varicose veins glucocorticoids

Question 42

Local factors that influence wound healing Local factors include : ______ - is the single most important cause of delay in healing, because it results in persistent tissue injury and inflammation.  Mechanical factors, such as ___________ delay healing, by compressing ______ and separating the ______ of the wound.  Foreign bodies, such as unnecessary sutures or fragments of steel, glass, or even bone, constitute impediments to healing.  Size, location, and type of wound.

Answer 42

Infection early motion of wounds; blood vessels; edges

Question 43

Wounds in richly vascularized areas, such as the ____, heal (slower or faster?) than those in poorly vascularized ones, such as the _____.

Answer 43

face Faster foot

Question 44

small incisional injuries heal (slower or faster?) and with (more or less?) scar formation than large excisional wounds or wounds caused by blunt trauma.

Answer 44

Faster Less

Question 45

Complications of wound healing Inadequate formation of granulation tissue or scar :  wound ______ and _______  Excessive formation of the components of the repair process: ______ scars ______. exuberant _______. exuberant proliferation of _____ and other connective tissue elements called _____, or aggressive _____.

Answer 45

dehiscence; ulceration hypertrophic; keloids; granulation fibroblasts; desmoids; fibromatoses

Question 46

Exaggerated contraction :  Contracture - Contractures are commonly seen after ______ and can compromise the __________

Answer 46

serious burns movement of joints

Question 47

Future and controversies _____ techniques, _____ techniques, and other modalities are being explored to enhance the proliferation of cells, the migration of cells, and the acceleration of the healing of wounds.  Human ___________ developed in ________-like conditions has been shown to improve healing times in _____ facial skin.

Answer 47

Laser; nonlaser cell–conditioned media embryologic; postlaser

Question 48

Fetal tissue can heal _____ due to the unique characteristics of ________ and _________ cells and the functioning of the _________ system.

Answer 48

scarless fetal epithelial and mesenchymal fetal immune

Question 49

The inclusion of transforming growth factor (TGF)–β3 during the healing of wounds in adults can be beneficial. T/D

Answer 49

T

Question 50

___________________ (TGF)

Answer 50

transforming growth factor

Question 51

________ oxygen has also been used to promote healing.

Answer 51

Hyperbaric

Question 52

Agents such as _____________ (PRP) and _______ (EPO) are modulators that have a positive effect on tissue regeneration and have been used successfully to enhance the healing of wounds.

Answer 52

platelet-rich plasma erythropoietin

Question 53

Nutritional aspects are also critical for proper wound healing. T/F

Answer 53

T

Question 54

Improvement in the nutritional status of adults correlates with enhanced wound healing. T/F

Answer 54

T

Question 55

Honey was been shown to be (more or less?) beneficial,

Answer 55

Less

Question 56

In a rat model, _____ from the ____ pine (Pinus _____) increased the rate of wound healing.

Answer 56

pine bark; Turkish brutia

Question 57

Aloe ______ has enhanced healing properties when compared to Aloe _____.

Answer 57

arborescens vera

Question 58

Appropriate neurological stimulation is also important in the healing of wounds. T/F

Answer 58

T

Question 59

Reparative strategies involving engineered tissue matrices, either exogenous or endogenous, have also been used in healing T/F

Answer 59

T

Question 60

______ cells continue to be a new frontier of research in the armamentarium of wound healing strategies.

Answer 60

Stem