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623: Physical Agents & Mech Modalities > Inflammation and Tissue Repair > Flashcards

Inflammation and Tissue Repair Flashcards

1
Q

3 most common causes of inflammation

A
  • Pathogens (germs) like bacteria, viruses or fungi
  • External injuries like scrapes or foreign objects
  • Effects of chemicals or radiation
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2
Q

3 Phases of Inflammation and Repair

A

1) Inflammation phase
2) Proliferation phase
3) Maturation phase

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3
Q

When does the inflammatory phase occur?

A

Days 1-6

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4
Q

What is the main goal of the inflammatory phase?

A

Attempts to destroy, dilute, or isolate cells/agents at fault

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5
Q

What are the 5 cardinal signs of inflammation and what causes each?

A

1) Heat - caused by increased vascularity
2) Redness – caused by increased vascularity
3) Swelling – caused by blockage of lymphatic drainage
4) Pain – caused by physical pressure of chemical reaction
5) Loss of Function – caused by pain and swelling

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6
Q

4 Responses of the Inflammatory Phase

A

1) Vascular Response
2) Hemostatic Response
3) Cellular Response
4) Immune Response

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7
Q

What initially occurs during the vascular response?

A

Vasoconstriction

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8
Q

What neurotransmitter mediates vasoconstriction?

A

Norepinephrine

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9
Q

What prolongs the vascular response and where?

A

serotonin in mast cells and platelets

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10
Q

What occurs after the initial vasoconstriction?

A

Vasodilation

The non-injured vessels around the injured area dilate, which causes increased capillary permeability

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11
Q

What neurotransmitters initiate vasodilation and increase capillary permeability?

A

Histamine, Hageman factor, bradykinin, prostaglandins, complement fractions

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12
Q

What else happens during the vascular response?

A
  • Adherence of blood vessel linings
  • Increased viscosity
  • Extravasation
  • Margination
  • Pavementing
  • Diapedesis
  • Emigration
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13
Q

What is extraversion?

A

Migration of neutrophils (type of leukocyte) to injured area

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14
Q

What is margination?

A

neutrophils line the margins of the vessels

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15
Q

What is pavementing?

A

cells accumulate and lay down in layers

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16
Q

What is diapedesis?

A

neutrophils squeeze through the vessel walls

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17
Q

What occurs during the hemostatic response?

A

Platelets bind to exposed collagen which release fibrin and stimulate clotting

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18
Q

What do platelets release during the hemostatic response? What does this protein do?

A

Platelets release a regulatory protein, platelet-derived growth factor (PDGF) that is chemotactic and mitogenic

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19
Q

How does clot formation occur?

A

Fibrin and fibronectin form cross-links with collagen to create fibrin lattice which forms a temporary plug in blood and lymph vessels to limit local hemorrhage and fluid drainage

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20
Q

What is the wound’s only source of tensile strength during inflammatory phase of healing?

A

Fibrin lattice

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21
Q

What occurs during the cellular response?

A

RBCs transport oxygen and WBCs help to clear the injured site of debris and microorganisms

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22
Q

Hematoma vs. Hemarthrosis

A

Accumulation of blood in a tissue or organ is called Hematoma
Bloody fluid present in a joint is called Hemarthrosis

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23
Q

6 types of leukocytes present during the cellular response

A
  • Neutrophils
  • Eosinophils
  • Basophils
  • Monocytes
  • Lymphocytes
  • Marcophages
24
Q

What 3 things occur during the immune response?

A

1) Increased vascular permeability
2) Increased phagocytosis
3) Chemotactic stimuli for leukocytes

25
Q

When does the proliferative (2nd) phase occur?

A

Days 3-20

26
Q

What are the 4 processes that occur simultaneously during the proliferative phase?

A
  • Epithelialization
  • Collagen production
  • Wound contracture
  • Neovascularizatio
27
Q

What is Epithelialization?

A

Covering the surface of the wound and closing the defect (i.e. reestablishment of the epidermis)

28
Q

Two types of epithelialization?

A

Primary and Secondary (Indirect)

29
Q

A small cut that can be closed with sutures will induce what type of epithelialization?

A

Primary Intention

30
Q

A large gapping cut that will first undergo contraction will induce what type of epithelialization?

A

Secondary intention

31
Q

When epithelialization does not provide enough strength what must occur?

A

Fibroplasia aka collagen production

32
Q

What do fibroblasts initially produce?

A

thin weak structured collagen called Type III collagen

33
Q

Around what day is type III collagen replaced by stronger type I collagen?

A

day 7

34
Q

When does wound contracture begin and when does it peak?

A

5 days after injury, peaks at 2 weeks

35
Q

What causes wound contracture?

A

Myofibroblasts

36
Q

What theory does wound contracture occur under?

A

“Picture frame theory” in which a ring of myofibroblasts moves inward from wound margin

37
Q

Describe the speed of wound healing between linear, square, and circular wounds

A

Linear wounds contract the most rapidly. Square wounds progress at a moderate pace. Circular wounds contract the slowest

38
Q

What may cause wound contracture?

A

Uncontrolled wound contraction

39
Q

What is Neovascularization?

A

Development of a new blood supply – the result of angiogenesis

40
Q

What causes scars to appear whitish?

A

Capillary loops eventually cease to function and retract

41
Q

When does the maturation phase occur?

A

Day 9 and on

42
Q

What determines the rate of maturation and the final characteristics of the scar?

A
  • Fiber orientation

- Balance of collagen synthesis and lysis

43
Q

What type of collagen is the major collagen found in cartilage?

A

Type II

44
Q

What is a keloid scar the result of?

A

Excessive collagen deposition caused by inhibition of lysis

45
Q

What occurs when oxygen is low and why?

A

The scar is less bulky and softer because collagen synthesis is oxygen dependent, collagen lysis is not

46
Q

What are the potential outcomes of Acute Inflammatory processes?

A
  • Replacement of the injured tissue with like tissue
  • Healing by scar formation
  • Formation of an abscess
  • Progression to chronic inflammation
47
Q

What is chronic inflammation?

A

Simultaneous progression of active inflammation, tissue destruction, and healing

48
Q

2 types of chronic inflammation

A

1) Follows acute inflammation – due to continued presence of injurious agent (i.e. continued microtrauma)
2) Due to immune response (i.e. implant or suture) or the result of autoimmune disease (i.e. RA)

49
Q

If the inflammatory response continues for more than 4 weeks what is it called?

A

subacute inflammation

50
Q

What is the difference between steroids and NSAIDS?

A

NSAIDS reduce pain indirectly by reducing inflammation, whereas steroids are a higher powered antiinflammatory

51
Q

When there is damage to cartilage what must occur and why?

A

Surgery, because it has a limited ability to heal with no lymphatics, blood vessels, or nerves

52
Q

The 1st two stages of tendon healing are similar to healing of other tissues, but what occurs in the last stage?

A

scar maturation

53
Q

Describe scar maturation in tendons

A

Collagen is oriented perpendicular to the long axis of the tendon early in healing, but around day 10 the fibers change to a parallel orientation

54
Q

What types of ligaments heal and which typically do not?

A

Capsular and extracapsular ligaments generally have adequate repair response (i.e. MCL), whereas intracapsular ligaments often do not (i.e. ACL)

55
Q

Can skeletal muscle regenerate?

A

No

56
Q

2 mechanisms of healing of bone healing

A

Primary Healing – occurs with rigid internal fixation

Secondary Healing – occurs without fixation

57
Q

4 stages of bone healing

A

1) Inflammation
2) Soft callus
3) Hard callus
4) Remodeling

623: Physical Agents & Mech Modalities (17 decks)

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