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House AMP > Healing And Repair: Inflammation > Flashcards

Healing And Repair: Inflammation Flashcards

1
Q

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 ______

A

regeneration and repair .

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2
Q

Regeneration results in the ___________ of lost or damaged tissue

A

complete restitution

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3
Q

Repair may ___________ but can cause ________

A

restore some original structures

structural derangements.

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4
Q

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

A

proliferation

replace lost structures

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5
Q

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

A

regeneration and scar formation

collagen

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6
Q

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

A

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

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7
Q

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

A

regeneration

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8
Q

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

A

extracellular matrix (ECM) framework

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9
Q

____________ (ECM)

A

extracellular matrix

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10
Q

Control of normal cell proliferation and tissue growth

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

A

rates; differentiation

death by apoptosis.

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11
Q

Cell proliferation can be stimulated by only physiologic conditions.

T/F

A

F

can be stimulated by both physiologic and pathologic conditions.

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12
Q

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).

A

continuously dividing

quiescent

nondividing

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13
Q

Continuously dividing tissues proliferate throughout life.

T/F

A

T

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14
Q

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.

A

epithelia; stratified squamous epithelia of the skin

mucosa; excretory ducts of the glands

GI tract and uterus

urinary tract; bone marrow

adult stem

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15
Q

 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 _________.

A

Low

rapid division

liver, kidneys, and pancreas

fibroblasts and smooth muscle

endothelial; lymphocytes; leukocytes

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16
Q

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

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

A

left the cell cycle

mitotic division ; postnatal

Neurons, skeletal and cardiac muscle

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17
Q

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

A

Complex ; dynamic

devitalized

missing

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18
Q

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.

A

inflammatory, proliferative, and remodeling .

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

hemostasis; inflammatory

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19
Q

Types of wound healing

_______ wound healing or healing by first intention.

___________ wound healing

_________ healing or healing by secondary intention

A

Primary

Delayed primary

secondary

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20
Q

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.

A

hours

Minimal

Re-epithelialization

Thin

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21
Q

Category 2

If ________________________________, delayed primary wound healing transpires.

This type of healing is seen in cases of _______

A

the wound edges are not reapproximated immediately

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22
Q

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 ________

A

fourth; epithelization; collagen

macrophages; epithelioid; mononuclear leukocytes; granulomas

surgically; chronic inflammation ; prominent scarring.

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23
Q

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.

A

an inflammatory response

granulomatous tissue

contraction

myofibroblasts

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24
Q

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.

A

red; fibrin, fibronectin, and complement

24 hours; neutrophils; margins

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25
Q

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, __________
.

A

polymorphonuclear leukocytes (PMNs)

monocytes/macrophages.

PMNs engorging the wound.

26
Q

TGF-β facilitates _______ from surrounding blood vessels.

A

PMN migration

27
Q

The PMNs attain their maximal numbers in _______ hours.

A

24-48

28
Q

Monocytes are termed macrophages once they ________

A

leave the vessel.

29
Q

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

A

angiogenesis and ECM

30
Q

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 _______.

A

24 to 72 hours

granulation

pink and soft with granular

new small blood vessels (angiogenesis)

fibroblasts

31
Q

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.

A

size of the tissue deficit

intensity of inflammation.

secondary intention.

5 to 7 days

32
Q

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

A

second week.

collagen; vascular channels.

pale, avascular

fibroblasts; collagen

line of the incision

33
Q

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.

A

acellular; inflammatory infiltrate

epidermis; large

decreasing the gap between its dermal edges

34
Q

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.

A

myofibroblasts

α-actin and vimentin

Large

35
Q

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

A

fibroblasts

fibrocytes

epithelial

epithelial-to-mesenchymal

36
Q

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 .

A

ECM

ECM synthesis and degradation

37
Q

Degradation of collagen and other ECM proteins is achieved by _____________

A

matrix metalloproteinases (MMPs).

38
Q

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

A

Fibrillar

type I

strength

39
Q

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.

A

10

4 weeks

third month

70; 80

40
Q

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

T/F

A

T

41
Q

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.

A

collagen; Protein and vitamin C

Diabetes mellitus

arteriosclerosis; varicose veins

glucocorticoids

42
Q

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.

A

Infection

early motion of wounds; blood vessels; edges

43
Q

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

A

face

Faster

foot

44
Q

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

A

Faster

Less

45
Q

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 _____.

A

dehiscence; ulceration

hypertrophic; keloids; granulation

fibroblasts; desmoids; fibromatoses

46
Q

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

A

serious burns

movement of joints

47
Q

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.

A

Laser; nonlaser

cell–conditioned media

embryologic; postlaser

48
Q

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

A

scarless

fetal epithelial and mesenchymal

fetal immune

49
Q

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

T/D

A

T

50
Q

___________________ (TGF)

A

transforming growth factor

51
Q

________ oxygen has also been used to promote healing.

A

Hyperbaric

52
Q

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.

A

platelet-rich plasma

erythropoietin

53
Q

Nutritional aspects are also critical for proper wound healing.

T/F

A

T

54
Q

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

T/F

A

T

55
Q

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

A

Less

56
Q

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

A

pine bark; Turkish

brutia

57
Q

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

A

arborescens

vera

58
Q

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

A

T

59
Q

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

T/F

A

T

60
Q

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

A

Stem

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