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Pathophysiology, exam 1 > Healing/repair > Flashcards

Healing/repair Flashcards

1
Q 
Irreversible injury to the myocardial fibers will have occurred when which of the following cellular changes occurs? 
A. Blebs on cell membranes
B. Cytoplasmic sodium increases
C. Glycogen stores are depleted
D. Intracellular pH diminishes
E. Nuclei undergo karyorrhexis
A

E. Nuclei undergo karyorrhexis - all the other processes are part of the injury process, but they are all reversible. When the nucleus disintegrates (karyorrhexis), it is beyond repair.

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2
Q

Possible outcomes of injured cells

A

Adaptation
Repair
Death

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3
Q

When does repair of injured cells begin?

A

Initiated when inflammation begins

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4
Q

What are the two parts of the healing process?

A
  • Regeneration (replacement of damaged cells by replicating cells of the same type)
  • Scar formation (replacement by connective tissue)

Both occur simultaneously

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5
Q

When can regeneration occur?

A

Connective tissue framework of tissue remains intact and cells must have capacity to divide

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6
Q

Two forms of interstitial protein network in the extracellular matrix

A

Interstitial matrix and basement membrane

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7
Q

Protein composition in the extracellular matrix

A
  • Fibrous structural proteins (Collagens, elastins)
  • Water hydrated gels (proteoglycans, hyaluronan)
  • Adhesive glycoproteins
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8
Q

Define labile tissues

A

Continuously dividing cells that can be replaced by maturation from stem cells or proliferation of mature cells

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9
Q

Examples of labile tissues

A
  • Hematopoietic cells of bone marrow
  • Squamous epithelium of skin, oral cavity, cervix, vagina
  • Columnar epithelium of GI tract
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10
Q

Define stable tissues

A

Low/no level of replication; locked in G0 of the cell cycle. However, they can rapidly divide upon stimulation.

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11
Q

Examples of stable tissues

A

Liver, kidney, pancreas, smooth muscle cells, fibroblasts

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12
Q

Define permanent tissues

A

Terminally differentiated; non-proliferative in postnatal life

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13
Q

Examples of permanent tissues

A

Neurons and myocytes

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14
Q

Where does scar formation not occur?

A

In the brain

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15
Q

Pro to scar formation

A

Scar usually provides enough structural stability for the injured tissue to continue function

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16
Q

Con of scar formation

A

Fibrous tissue cannot perform the original function of the lost parenchymal cells

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17
Q

Components of scar formation

A
  • Angiogenesis
  • Migration/proliferation of fibroblasts
  • Formation/deposition of ECM by fibroblasts
  • Maturation/organization of fibrous tissue elements
18
Q

Important mediators of angiogenesis

A

VEGF, FGF, PDGF, and TGF-beta

19
Q

What does VEGF do?

A

Promotes angiogenesis, increases vascular permeability, and stimulates endothelial cell migration/proliferation

20
Q

What are the normal levels of VEGF in an adult tissue?

A

Low levels usually, but higher in podocytes of glomerulus and pigment epithelium of the retina

21
Q

Inducer of VEGF

A

Hypoxia

22
Q

In what pathology is VEGF indicated?

A

Kidney cancer

23
Q

What do fibroblasts do?

A

Synthesize connective tissue proteins

24
Q

Define granulation tissue

A

Specialized tissue that fills in defects in organs when non-regenerative cells and/or connective tissue framework is destroyed

25
Q

Components of granulation tissue

A

Proliferating fibroblasts that lay down immature connective tissue (type III collagen) and new blood vessels

26
Q

When is granulation tissue present?

A

Only during healing or attempt to heal destroyed tissue

27
Q

Definition of organization

A

Process of transforming granulation tissue into a dense scar

28
Q

What happens during organization?

A

With time, blood vessels become less prominent, collagen matures to type I collagen

29
Q

What type of staining is used to determine the difference between mature scar and granulation tissue?

A

Trichrome stain that stains mature collagen blue

30
Q

Myofibroblasts

A

Modified fibroblasts with functional features of contractile smooth muscle cells that will contract the wound

31
Q

Healing by first intention

A

Clean, uninfected surgical incision that is approximated by surgical sutures; leaves a small scar, minimal contraction of wound

32
Q

Healing by second intention

A

Large skin wound with extensive destruction, contamination, infection with unapproximated edges

33
Q

Wound strength after 1 week

A

10% of normal; collagen is still being synthesized and modified

34
Q

Wound strength after 3 months

A

70-80%

35
Q

Fibrosis definition

A

Excessive deposition of collagen and other ECM components in a tissue

36
Q

Eight factors influencing repair

A 
Infection
Nutrition
Glucocorticoids
Poor perfusion
Diabetes mellitus
Foreign bodies
Stable/labile vs permanent cells
Location of injury
37
Q 
Supplementation of which dietary deficiencies would be most appropriate for wound healing?
A. Copper and vit D
B. Folate and zinc
C. Iodine and vit E
D. Vit C and E
E. Vit C and zinc
A

E. Vitamin C and zinc: vitamin C helps in collagen synthesis and zinc is a cofactor in collagenase

38
Q

Keloid

A

Accumulation of exuberant amount of collagen, forming raised scars that grow beyond wound boundaries

39
Q

In which population are keloids more common?

A

African-Americans

40
Q

Aberrations

A

Hypertrophic scar; excess production of scar tissue localized to the wound that may regress

Pathophysiology, exam 1 (6 decks)

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