Inflammation

Question 1

Hypoxia Injury

Answer 1

• most common cause of cellular injury
• decreased O2 delievery, loss of hemoglobin or decreased production of RBCs
• ischemia is most common cause of hypoxia (reduced blood flow)

Question 2

Reperfusion Injury

Answer 2

• restoration of circulation causes inflammation

Question 3

Free Radicals

Answer 3

• Reactive Oxygen Species (ROS)
• atom or group of atoms having an unpaired electron
• byproducts of normal metabolism (under stress, antioxidants overwhelmed)

Question 4

Effects of Free Radicals/ROS

Answer 4

• lipid peroxidation, leading to membrane damage and increased permeability
• protein alterations, causing fragmentation of PPPchains
• DNA fragmentation, causing decreased protein synthesis
• mitochondrial damage, causing the liberation of calcium into the cystol

Question 5

Chemical Injury

Answer 5

• drugs
• lead, mercury
• asbestos
• carbon monoxide
• carbon tetrachloride
• air pollutants
• insecticides, herbicides

Question 6

Mechanical Forces: Blunt Force Injury

Answer 6

• application of mechanical energy to the body resulting in the tearing, shearing, or crushing of tissues
• motor vehicle collisions, gunshot, knife-wounds

Question 7

Other Mechanisms

Answer 7

• electrical currents
• temperature extremes (burns, frostbite)
• genetic:
  ex. sickle cell anemia, Huntington disease- infection
• nutritional imbalances: ex. protein deficiency
• changes in atmospheric pressure
• environment (noise, light): ex. tinnitus

Question 8

Results of Cellular Injury

Answer 8

• mitochondrial damage
• ATP depletion (Na/K pump)
• defects in membrane permeability
• disruption of Ca+ Homeostasis

Question 9

Systemic Manifestation of Cellular Injury

Answer 9

• Fatigue
• Malaise: feeling of uneasiness
• Fever
• Loss of appetite (anorexia)
• Elevated plasma enzymes (e.g., LDH, CK, Troponin, etc.)
• Inflammatory Response

Question 10

Second Line of Defense

Answer 10

• Important part of innate immunity
• Non-specific
• Activated by cellular injury or cell death due to: Infection, mechanical damage, ischemia, nutrient deprivation, temperature extremes, radiation, etc.

Question 11

Goals of Inflammatory Response

Answer 11

• limit and control the injury process
• prevent and limit infection and further damage
• initiate adaptive immune response
• initiate healing

Question 12

Vascular Response

Answer 12

• blood vessel dilation
• increased vascular permeability and leakage
• fluid moves into the tissues
• blood more viscous (clotting occurs)

Question 13

Cellular Response

Answer 13

• WBCs adhere to capillary (then squeeze through- emigration)
• Phagocytosis

Question 14

Exudates

Answer 14

• fluid, WBCs, tissue debris

Question 15

Cellular Components

Answer 15

• Neutrophils

- other WBCs, mast cells, platlets

Question 16

Chemical Compounds

Answer 16

• histamine

- leukotrienes, prostgladins, bradykinin, complement, serotonin, clotting system

Question 17

Local Manifestations of Inflammation

Answer 17

5 Signs:

- red, swelling, heat, pain

Question 18

Systemic Manifestations of Inflammation

Answer 18

• fever: caused by exogenous and endogenous pyrogens; act directly on the hypothalamus
• leukocytosis: increased numbers of circulating leukocytes
• fatigue, anorexia, lymphadenitis
• elevated erythrocyte sedimentation rate (ESR)

Question 19

Chronic Inflammation

Answer 19

• inflammation lasting 2 weeks or longer
• often related to an unsuccessful acute inflammatory response due to:
• high lipid and wax content of microorganism
• ability to survive inside the macrophage
• toxins
• chemicals

Question 20

Chronic Inflammation: Immune Response

Answer 20

• phagocytic cells: macrophages and lymphocytes rather than neutrophils
• immune and inflammatory substances: can further injure cells and delay healing
• fibroblasts and scar tissue formation leading to loss of function: replace normal tissue (arthritis)

Question 21

Systemic Manifestations of Chronic Inflammation

Answer 21

• same as acute: leukocytosis and increased antibody production; elevated ESR, low grade fever, fatigue, and anorexia
• hyperplasia of spleen or lymph nodes
• anemia
• pain
• activity intolerance
• depression
• insomnia
• weight loss

Question 22

Resolution VS Repair

Answer 22

• returning injured tissue to the original structure and function
• replacement of destroyed tissue with scar tissue; scar tissue: composed primary of collagen to restore the tensile strength of the tissue but not function

Question 23

Healing Process

Answer 23

• debride, seal, fillin, and shrink
• primary intention: wounds that heal under conditions of minimal tissue loss (sutured surgical wound)
• secondary intention: wounds that require a great deal more tissue replacement (open wound)

Question 24

Factors Affecting Healing and Repair: Age

Answer 24

• progressive stiffness or ridgity that affects many systems
• movement of intra/extra cellular substances decreases
• blood flow decreases
• loss of muscle mass and strength
• fratility in older adults

Question 25

Other Factors

Answer 25

• blood supply
• temperature
• moisture
• nutrition
• tension on tissue (obesity)
• drugs and stress hormones
• chronic diseases

Question 26

Phases of Helaing

Answer 26

1. Inflammation: cleans up injured area
2. Proliferation and New tissue Formation
   - fibroplast proliferation (collagen synthesis)
   - epithelialization
   - contraction
3. Remodeling and Maturation phase
   - cellular differentiation
   - scar tissue formation
   - scar remodeling

Question 27

Complications of Wound Healing

Answer 27

• adhesions
• structures and contractures
• infection
• excess scar formation (Keloids)
• dehiscence or evisceration