Inflammation and Tissue Repair Flashcards
Inflammation (Acute & Chronic), tissue healing, and tissue repair
Inflammation and Tissue Repair
3 lines of defense = ?
- Skin and mucous membrane
- Inflammation
- Immunity
Inflammation and Tissue Repair
What are Leukocytes = ?
- What are the 5 types = ?
Nancy Makes Easy Bake Lasagna
White blood cells / Leukocytes:
- A type of blood cell that is made in the bone marrow and found in the blood and lymph tissue.
- It may be used to look for conditions such as infection, inflammation, allergies, and leukemia
Types:
- Neutrophil
- Monocytes
- Eosinophils
- Basophils
- Lymphocytes (T and B)
Inflammation and Tissue Repair
Neutrophil
- Cell Function = ?
- Absolute Count = ?
- Differential Count = ?
(a) Neutrophil:
- Type of white blood cell.
(b) Cell Function
- Defense against foreign substances like bacteria, fungi.
(c) Absolute Count
- 2500-8000
(d) Differential Count
- 55-70
Inflammation and Tissue Repair
Monocytes
- Cell Function = ?
- Absolute Count = ?
- Differential Count = ?
Monocytes: Type of white blood cell.
Cell Function:
- Immature macrophages, clean up debris and damaged cells.
Absolute Count:
- 100-700
Differential Count:
- 2-8
Inflammation and Tissue Repair
Eosinophils
- Cell Function = ?
- Absolute Count = ?
- Differential Count = ?
Eosinophils: Type of white blood cell.
Cell Function
- Attack parasites, cancer cells and play a role in asthma and allergy
Absolute Count
- 50-500
Differential Count
- 1-4
Inflammation and Tissue Repair
Basophils
- Cell Function = ?
- Absolute Count = ?
- Differential Count = ?
Basophils: Type of white blood cell.
Cell Function:
- Produce allergic response like sneezing.
Absolute Count:
- 25-100
Differential Count:
- 0.5-1
Inflammation and Tissue Repair
Lymphocytes (T and B)
- Cell Function = ?
- Absolute Count = ?
- Differential Count = ?
Lymphocytes (T and B):
- Type of white blood cell.
Cell Function:
- Produce antibodies, kills antigens.
Absolute Count:
- 1000-4000
Differential Count
- 20-40
Inflammation and Tissue Repair
Inflammation = ?
Inflammation:
- Reaction of vascularized tissue to injury; host’s protective response; essential for healing.
- Generally, localizes, eliminates microbes, foreign particles, and abnormal cells and paves the way for repair of injured tissue.
- All disease process cause injury and healing occurs with an effective inflammatory response.
Inflammatory conditions are named by adding the suffix- itis to the affected organ or system.
Inflammation and Tissue Repair
Types of inflammation = ?
Types of inflammation:
(1) Acute inflammation:
- Appears within minute to hours, expected body response to injury.
- Important for restoration of tissue homeostasis, aimed at removing the noxious agent and limiting the extent of tissue damage.
(2) Chronic inflammation:
- Days to years
- Altered inflammatory response because of the unrelenting injury.
Inflammation and Tissue Repair
Cardinal signs of inflammation = ?
Cardinal signs of inflammation:
(A) At the site of injury:
- Rubor (redness)
- Tumor (swelling)
- Calor (heat)
- Dolor (pain)
- Functio Lasea (loss of function)
(B) Systemic manifestations:
- Fever (as cytokines (chemical mediators) produced at the site of inflammation gain entrance to circulatory system).
- Leukocytosis (elevation in WBC’S or leukocytes)
Inflammation and Tissue Repair
Acute inflammation;
- goal = ?
- phases = ?
(a) Acute inflammation:
- Highly coordinated program to control and eliminate altered cells, micro-organisms and antigens and allow tissue repair to take place.
(b) Phases:
- Vascular phase
- Cellular phase
Inflammation and Tissue Repair
Acute inflammation:
- Vascular phase = ?
(a) Acute inflammation - Vascular phase:
- Response of blood vessel near the site of injury, marked by tissue edema.
- Clotting of blood occurs, aids in localizing the spread of infection
(b) Momentary vasoconstriction followed rapidly by Vasodilation
- Increase in capillary blood flow causing heat and redness.
(c) Permeability
- Increase in capillary permeability
- Increased blood flow + increased permeability = loss of exudate (protein rich fluid, fibrin, leucocytes) from blood vessels into the extracellular space causing swelling, pain and impaired function.
Inflammation and Tissue Repair
Fibrinogen = ?
Fibrinogen:
- Is an abundant plasma protein that, when converted to fibrin by thrombin, provides the main building blocks for the clot.
Acute inflammation - Vascular phase:
Inflammation and Tissue Repair: Acute inflammation
Acute inflammation - Cellular Response:
- Events = ?
- Active cells = ?
Acute inflammation - Cellular Response: After dilation and increased permeability; cells essential for healing are needed at the site of injury.
Events:
- Chemotaxis (movement in response to chemical stimulus)
- Adhesion to the endothelium
- Transmigration across the endothelium
Cells active in the cellular phase:
(a) Leukocytes/ WBC’s
- Neutrophils (type of WBC, earliest phagocytic responders)
- Monocytes (immature macrophages)
- Macrophages (type of WBC, phagocytes associated with chronic inflammation)
- Red blood cells (carry oxygen to tissues)
(b) Platelets (traps harmful substances, stop bleeding)
(c) Connective tissues cells (fibroblast cells)
- Fibroblast- produce and replace connective issue
(d) Components of ECM - elastin, collagen
Inflammation and Tissue Repair
Process of inflammation is carried out by = ?
Process of inflammation is carried out by inflammatory mediators.
Inflammation and Tissue Repair
Good inflammation graphic
Inflammation and Tissue Repair
Treatments for Inflammation:
- Non-pharmacological = ?
- Pharmacological = ?
Treatments for Inflammation:
Non pharmacological:
- Rest
- Ice
- Compression
- Elevation
Pharmacological:
- Aspirin
- NSAIDS
- Steroids
Inflammation and Tissue Repair
Common blood tests used to detect acute inflammation = ?
(1) White blood cell count
- Values = 5,000-10,000 cells/mm3
- Changes w/inflammation = Increased
(2) C-reactive protein (CRP)
- Values = <10 mg/dl
- Changes w/inflammation = Increased
(3) Prothrombin (time to coagulate)
- Values = 11-13 seconds
- Changes w/inflammation = Reduced
(4) Fibrinogen
- Values = 175-400 mg/dl
- Changes w/inflammation = Increased
(5) White blood cell differential
- Values = ?
- Changes w/inflammation = Neutrophils increase in acute inflammation
(6) **Erythrocyte sedimentation rate **(ESR)
- Values =
- 0-17 mm/hr for men
- 1-25 mm/hr for women
- 1-13 mm/hr for children
- Increased, often above 100 mm/hr
Inflammation and Tissue Repair
Erythrocyte sedimentation rate (ESR) = ?
- Conditions associated with high ESR = ?
Erythrocyte sedimentation rate (ESR): How fast blood samples (erythrocytes) sediments along a test tube in one hour.
- Results reported as mm of clear fluid (plasma) present at the top portion of tube after one hour.
- Non specific
- Fibrinogen enters the blood in high amounts and causes red cells to stick to each other.
Conditions associated with high ESR:
- Cancer
- Autoimmune diseases
- Infections
Inflammation and Tissue Repair
CRP = ?
CRP = C-Reactive Protein
- CRP is synthesized in the liver.
- Its physiologic role is to bind to phosphocholine expressed on the surface of dead or dying (apoptosis) cells in order to activate the complement/immune system, which enhances phagocytosis by macrophages.
- Non specific but more accurate than ESR.
Inflammation and Tissue Repair
Two ways of tissue Repair = ?
Tissue Repair:
- Overlaps the inflammatory process; response to tissue injury- to maintain normal structure and function.
Two ways:
- Regeneration: inured cells replaced with cells of same type leaving no evidence of previous injury.
- Replacement with connective tissue - scar
Inflammation and Tissue Repair
Phases of wound healing = ?
Phases of wound healing:
- Inflammation (phase 1)- onset to 5-10 days
- Proliferation and migration (phase 2)- 3-20 days
- Remodeling and maturation (phase 3)- past 21days
Inflammation and Tissue Repair
Components of tissue healing include = ?
“Fast Penguins Ensure Cure”
Components of Tissue healing:
(a) Fibronectin
- Provides structural support to the healing tissue
- Stabilizes fibrin which helps with blot clot
- Attracts fibroblasts and macrophages to the healing tissue
(b) Proteoglycans
- Secreted by fibroblasts, helps aid in hydration and stabilizing tissue during repair
(c) Elastin
- Secreted by fibroblasts, provides elasticity to tissue.
(d) Collagen
- Structural support and tensile strength for all tissues and organs
- Each collagen type has a specialized function
- Skin - mostly type 1 collagen
- Hyaline cartilage - type 2 collagen
- Vascular and visceral structures - type 3 collagen
Inflammation and Tissue Repair
Factors that affect tissue healing = ?
Factors that affect tissue healing:
(1) Growth factors
- Growth factors: regulate cell proliferation, differentiation, migration, angiogenesis (VEG-F).
- Platelets, endothelial cells, fibroblasts, macrophages are sources of growth factors.
- Fibroblasts growth factor- stimulate endothelial cells- to form new blood cells.
(2) General health of an individual
(3) Presence of comorbidities
Infection
(4) Off loading weight bearing surfaces may be necessary
(5) Lack of desire to exercise or follow plan of care
(6) Nutrition
- Iron, folic acid
- Vitamin C: essential for tissue repair.
- Vitamin A: essential to promote proper collagen formation.
- Arginine: enhances healing and immune function.
- High protein intake: provide amino acids to build new tissue
(7) Oxygen
- Edema and necrotic tissue can hinder oxygen reaching the wound.
- Keeping the wound warm, avoiding smoking, maintain hydration, controlling pain and anxiety.
Inflammation and Tissue Repair
Phases of wound healing:
- Inflammatory phase = ?
Inflammatory phase:
(a) Begins at the time of injury, critical as it prepares wound for healing.
(b) Vascular and cellular phase.
(c) Migration of phagocytic white blood cells into the injured area;
- Neutrophils come first to ingest, remove bacteria and cellular debris.
- Followed by macrophages in 24 hours.
- These cells also release growth factors for the proliferative stage.
- Fibroblasts, epithelial cells, endothelial cells move into wound to form granulation tissue, developing tissue not strong.
Inflammation and Tissue Repair
Phases of wound healing:
- Proliferative stage = ?
Proliferative stage:
- Building of new tissue to fill the wound space.
- Fibroblast - synthesize collagen, glycoproteins, proteoglycans needed for wound healing.
- Also release growth factors that promote angiogenesis (formation of new blood vessels) and endothelial cell proliferation and migration.
- Granulation tissue: rich network of developing blood vessels with connective tissue matrix- reddish granular layer of tissue.
- Re-epithelialization, epithelial cells at wound edges proliferate to form new surface layer
Inflammation and Tissue Repair
Phases of wound healing:
- Remodeling phase = ?
(a) Remodeling phase:
- Begins 3 weeks after injury, can continue for 6 months or longer.
- Development of fibrous scar, continued remodeling of scar tissue by synthesis of collagen by fibroblast.
- Scar tissue changes from red to pink to white.
Inflammation and Tissue Repair
Wound Healing:
- Primary intention = ?
- Secondary intention = ?
Wound Healing: Depending on the extent of the tissue loss, wound closure occurs by.
- Primary intention (wound healing quick)
- Secondary intention (eg. pressure ulcers, longer repair time)
Inflammation and Tissue Repair
Factors that impact and complicate healing and tissue repair = ?
Factors that impact wound healing:
- Ineffective inflammatory / immune response
- (People with diabetes, on corticosteroids)
- Inadequate nutritional status
- Poor tissue perfusion
Complications include
Infection:
- Ulceration (open craterlike lesion of the skin).
- Adhesions (problems with collagen deposition).
- Dehiscence (wounds pull apart).
- Keloid development
Inflammation and Tissue Repair
Wound dehiscence = ?
(a) Wound dehiscence:
- Deficient scar formation, wound bursts open at the suture line; Micro-organisms can invade.
(b) Causes:
- Early phase after surgery: mechanical stress placed on the wound.
- Recovery period: poor development of ECM.
Inflammation and Tissue Repair
Hypertrophic scar/ Keloid =
Hypertrophic scar/ Keloid: Excessive production of scar tissue
Inflammation and Tissue Repair
Red wound = ?
Wound healing continuum
Red wound:
- Granulation tissue
- Indicates healing
Inflammation and Tissue Repair
Yellow wound = ?
Wound healing continuum
Yellow wound:
- Wound exudate + adherent = bacterial growth.
- Debride (removal of dead damage tissue).
Inflammation and Tissue Repair
Red / yellow wound = ?
Wound healing continuum
Red / yellow wound:
- Remove yellow
- Promote growth of red granulation tissue
Inflammation and Tissue Repair
Black wound = ?
Wound healing continuum
Black wound:
- Presence of necrosis / eschar (dry black hard necrotic tissue); delayed healing.
Inflammation and Tissue Repair
What is chronic inflammation?
- Cells are involved = ?
Chronic inflammation:
- Represents a persistent/ recurrent state of inflammation lasting several weeks or longer.
- Related to a recurrent acute inflammation, persistent infectious process, or an autoimmune condition
Cells of chronic inflammation:
- Monocytes, macrophages
- Fibroblasts (helps with collagen development, which contributes to extensive scarring), scarring- loss of function and deformity of organ/ tissue.
General manifestations:
- During flare ups: redness, swelling, heat, pain, loss of function, fever, malaise, anemia, fatigue, anorexia, weight loss or weakness.
- During remission: no symptoms.
Inflammation and Tissue Repair
In some cases, chronic inflammation results in = ?
In some cases, chronic inflammation results in granuloma.
- Form when injury is too difficult to control, such as with foreign bodies.
- 1-2mm lesion, massing of macrophages surrounded by lymphocytes, attempt to surround the foreign body.
- Inside, macrophages keep phagocytizing harmful substances, gradually necrosis fill inside granuloma - granuloma diffuses out- fibrotic capsule remains
Inflammation and Tissue Repair
Difference between acute and chronic inflammation:
- Time = ?
- Chief phagocytic cells = ?
- Restoration = ?
(a) Acute Inflammation:
- Time: Resolution within a few weeks.
- Chief phagocytic cells: Neutrophils.
- Restoration: Minimal scarring
(b) Chronic Inflammation:
- Time: Present for a prolonged period of time, usually greater than 6 months.
- Chief phagocytic cells: Monocytes, macrophages, lymphocytes.
- Restoration: Marked by fibrosis, scarring, or granuloma formation.
