Inflammation & Repair Flashcards by Annabella Moody

Nomenclature of inflammatory diseases include:

Name of organ/tissue + “itis” = inflammation in that organ/tissue

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Inflammation of the tonsils:

Tonsillitis

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Diagnose this image:

Tonsillitis

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Inflammation of the appendix:

Appendicitis

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Diagnose this image:

Appendicitis

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Inflammation of the periotoneum:

Peritonitis

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Diagnose this image:

Peritonitis

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Inflammation of the lymph node:

Lymphadenitis

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Means the lymph node is enlarged due to being inflamed:

Lymphadenitis

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Diagnose this image:

Lymphadenitis

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Some of the following organs do not follow the typical nomenclature for inflammation- define the correct term for inflammation of the following organs:

fallopian tube
cornea
glans penis
bladder

salpingitis
keratitis
balanitis (Reiter’s syndrome)
Cystitis

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What are some terms to classify inflammation: (3)

acute or chronic inflammation
exudative or non-exudative inflammation
morphologic patterns (serous, fibrinous, suppurative, ulcerative)

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We may classify inflammation based on morphologic patterns, including: (4)

serous
fibrinous
suppurative
ulcerative

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What type of inflammation is categorized as:

-rapid onser, short duration (minutes to days)
-emigration of leukocytes, predominately neutrophils
-exudation of fluid and plasma proteins

Acute inflammation

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Describe the onset & duration of acute inflammation:

Rapid onset, short duration (minutes to days)

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Describe the cells involved in acute inflammation:

Emigration of leukocytes, predominately neutrophils

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Describe the exudation pattern of acute inflammation:

Exudation of fluid and plasma proteins

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The following image represents acute inflammation- what cells are indicative of this?

Leukocytes, primarily neutrophils

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What type of inflammation is being described?

-Longer duration
-Mononuclear cells- macrophages, lymphocytes, plasma cells
-Proliferation of blood vessels & fibroblasts

Chronic inflammation

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Describe the duration of chronic inflammation:

Longer duration

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What cells are present in chronic inflammatiom?

Mononuclear cells- macrophages, lymphocytes, plasma cells

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Chronic inflammation is characterized by mononuclear cells such as:

Macrophages, lymphocytes, plasma cells

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“proliferation of blood vessels and fibroblasts” describes what type of inflammation?

Chronic

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“exudation of fluid and plasma proteins” describes what type of inflammation?

Acute

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What type of cells are present in this image of chronic inflammation?

Macrophages, lymphocytes, plasma cells

What cell can be seen in the following image? What type of inflammation is characterized by this cell type?

Neutrophil; acute inflammation

What cell can be seen in the following image? What type of inflammation is characterized by this cell type?

Neutrophils; acute inflammation

What cell can be seen in the following image? What type of inflammation is characterized by this cell type?

Plasma cells; chronic inflammation

How is acute vs. chronic inflammation determined by a pathologist?

Based on types of cells present

How is acute vs. chronic inflammation determined by a clinican?

Based on intensity & duration

What cell can be seen in the following image? What type of inflammation is characterized by this cell type?

Neutrophil; acute inflammation

What cell can be seen in the following image? What type of inflammation is characterized by this cell type?

Plasma cell; chronic inflammation

What cell can be seen in the following image? What type of inflammation is characterized by this cell type?

Macrophage; chronic inflammation

What cell can be seen in the following image? What type of inflammation is characterized by this cell type?

Lymphocyte; chronic inflammation

If a cell under a microscope appears to have its nucleus pushed off to the side, this is characteristic of:

Plamsa cells

If a cell under a microscope appears to be darkly staining, small, and contains little cytoplasm this is characteristic of:

Lymphocyte

Inflammation accompanied by production of fluid:

Exudative inflammation

Inflammation accompanied by no production of fluid:

Non-exudative inflammation

_____ inflammation tends to be more exudative

Acute inflammation

The following image shows what type of inflammation?

Exudative inflammation

_____ inflammation is frequently non-exudative and is often associated with fibrosis and scarring

Chronic

Chronic inflammation is often associated with ____ & ____

fibrosis & scarring

What type of inflammation is associated with fibrosis and scarring (such as that seen in this inage)

Chronic inflammation

The body's response to injury:

Inflammation

Inflammation may be due to what type of injuries: (5)

1. thermal 2. physical 3. chemical 4. allergic 5. immune-mediated disease

Comes into play when inflammation is caused by a living organism (infection)

Immunity

_____ may provoke inflammation AND immunity

Infection

_____ may exist without infection

Inflammatino

_____ DOES NOT imply infection

Inflammation

Hypersensitivity (allergic disease) may cause:

Inflammation

The following image shows inflammation that may be caused by:

Hypersensitivity reaction

Autoimmune disease may cause:

Inflammation

The body's three lines of defense:

1. Barriers 2. Inflammatory response 3. Immune response

The body's barrier defense includes: (3)

1. skin 2. mucous membranes 3. secretions

The body's inflammatory response includes: (2)

1. cells (leukocytes) 2. molecules (mediators)

The body's immune response includes: (2)

1. antibodies (humoral) 2. cytotoxic T cell (cellular)

-skin -mucous membranes -secretions These are all:

Barriers

-Cells (leukocytes) -Molecules (mediators) These are both:

inflammatory responses

-Antibodies (humoral) -Cytotoxic T cells (cellular) These are both:

Immune responses

The bodies first and second line of defense are considered:

Nonspecific defenses

The bodies first line of defense includes: (3)

1. skin 2. mucous membranes 3. chemicals

The bodies second line of defense includes: (5)

1. phagocytosis 2. complement 3. interferon 4. inflammation 5. fever

The bodies third line of defense is considered:

Specific defenses

The bodies third line of defense includes: (2)

1. lymphocytes 2. antibodies

Components of inflammatory responses include: (3)

1. circulating blood cells and plasma cells 2. cells of the blood vessel walls 3. cells and proteins of the extracellular matrix

Inflammation is the bodies response to:

Injury

Most defensive elements are located in the:

Blood

inflammation is the means by which ___ and ____ leave the ____ and enter the ____

Cells; chemicals; blood; tissue

Inflammation is a complex reaction to injury as it includes: (4)

1. vascular responses 2. cellular responses 3. systemic reactions 4. repair

Inflammation is ____ unless excessive or prolonged which may be ____

Beneficial; harmful

When might inflammation transition to harmful?

If excessive or prolonged

The inflammatory response delivers:

Defensive materials

Defensive cells:

leukocytes

Defensive proteins:

Plasma

The inflammatory response 5 Rs:

1. Recognition of the injurious agent 2. Recruitment of leukocytes 3. Removal of the agent 4. Regulation (control) of the response 5. Resolution (repair)

-mechanical injury -chemical injury -radiation injury -thermal injury -infection -compromise of blood supply -immune injury These are all causes of:

Acute inflammation

Cardinal signs of inflammation include: (5)

1. Calor 2. Rubor 3. Tumor 4. Dolor 5. Functio laesa

1. calor: 2. rubor: 3. tumor: 4. dolor: 5. functio laesa

1. heat 2. red 3. swelling 4. pain 5. loss of function

all that is ___ is not inflamed

red (rubar)

Cellular events in acute inflammation include: (7)

1. margination 2. rolling 3. adhesion 4. diapedesis 5. chemotaxis 6. phagocytosis 7. killing

What type of cell is involved in the cellular events in acute inflammation?

Neutrophils

During margination, the neutrophil starts to line up along:

endothelial cells lining the blood vessel

This image is showing an events in:

vascular response of acute inflammation

Microbial killing by leukocytes inlvolves: (3)

1. opsonization 2. phagocytosis 3. lysosomal enzymes

What cells are involved in microbial killing?

Leukocytes

Systemic manifestations of acute inflammation include: (3)

1. fever 2. leukocytosis 3. acute phase response

The systemic manifestations of acute inflammation includes fever which is due to:

Pyrogens

The systemic manifestations of acute inflammation includes fever which is due to pyrogens which are: (2)

Cytokines and prostaglandins

TNF, IL-1 released by leukocytes are examples of:

Cytokines

Prostaglandins that cause fever in acute inflammation come from:

Membrane phosholipids

Elevated WBC count:

Leukocystosis

an increase in WBC count which can mimic leukemia:

leukemia reaction

A higher neutrophil account in the blood than normal:

Neutrophilia (left shift)

an increase in white blood cells (specifically lymphocytes):

lymphocytosis

Leukemia reactions, neutrophilia and lymphocytosis are all characteristic of:

leukocytosis (systemic manifestation of acute inflammation)

When cytokines stimulate hepatocytes to synthesize and secrete acute phase proteins this is considered:

acute phase response (of systemic manifestations of acute inflammation)

In the acute phase response of systemic manifestations of acute inflammation, _____ and _____ act as an opsonins

C-reactive protein (CRP); mannose-biding lectin

Lymphatic spread of bacterial infectionL

Lymphangitis

Lymphangitis may present as:

Painful red streaks and regional lymphadenopathy

Diagnose this image:

Lymphangitis

Chemical mediator of inflammation stored primarily in mast cells:

Histamines

Chemical mediators inflammation stored primarily in platelets:

Serotonin

Histamine and Serotonin are both:

Vasoactive amines

Unlike most other mediators, histamine and serotonin are:

Available in preformed supplies

Histamine is stored in:

Granules of mast cells

Serotonin is stored in:

Granules of platelets

The first mediators to be released after injury are:

Histamine and serotonin

What is the result of histamine and serotonin release?

Vascular dilation and leakage (helps neutrophils to squeeze out of blood vessels)

All acute inflammatory reactions may have one of three outcomes, these include:

1. completed resolution 2. healing by connective tissue replacement (fibrosis) 3. progression of the response to chronic inflammation

-infarction -bacterial infections -toxins -trauma These are all involved in:

injury that leads to ACUTE inflammation

Injury leads to ____ or ____

acute inflammation or chronic inflammation

-vascular changes -neutrophil recruitment -mediators These are all components of:

acute inflammation

If acute inflammation progresses, it can lead to:

chronic inflammation

If acute inflammation follows the healing pathway, it may lead to ____ or ____

Resolution or fibrosis

Following acute inflammation, -clearance of injurious stimuli -clearance of mediators and acute inflammatory cells -replacement of injured cells -normal function These are all components of:

resolution

If acute inflammation is followed by pus formation this is considered an:

abscess

If an abscess following acute inflammation heals, this healing occurs via:

fibrosis

What is the issue, regarding acute or chronic inflammation healing leading to fibrosis?

Loss of function

-viral infections -chronic infections -persistent injury -autoimmune diseases These are all injuries that can result in:

chronic inflammation

-angiogenesis -mononuclear cell infiltration -fibrosis (scar) These are all characteristic of:

chronic inflammation

Inflammation characterized by a watery exudate (most often seen in little blisters):

serous inflammation

What type of inflammation is represented in these images?

Serous inflammation

What type of inflammation is represented in these images?

Serous inflammation

Fibrinous pericarditis in rheumatic fever is an example of:

Fibrinous inflammation

Inflammation characterized by the formation of pus:

Suppurative (purulent) inflammation

What type of inflammation is represented in this image?

Suppurative (purulent) inflammation

What type of inflammation is represented in these images?

Fibrinous inflammation

What type of inflammation is represented in this image?

Suppurative (purulent) inflammation

What type of inflammation is represented in these images?

Suppurative (purulent) inflammation

a localized collection of pus that has accumulated in a tissue cavity, producing fluctuance:

abscess

Diffuse spread of an acute inflammatory process through the fascial planes of soft tissue, producing erythema, edema warmth, and pain without consolidation:

Cellulitis

a clinical type of exudative inflammation, occurs only on mucosal surfaces containing mucous-secreting cells, such as nasal or bronchial mucosa:

Catarrhal (seromucous) inflammation

Catarrhal inflammation, a clinical type of ____ inflammation occurs only on ____ surfaces containing _____ cells

exudative; mucosal surfaces; mucous-secreting cells

Recurrent aphthous stomatitis is an example of:

ulcerative inflammation

A defect in epithelial continuity:

ulcer

What can be seen in the following microscope image?

A defect in the continuity of the epithelium (ulcer)

Leukocyte adhesion deficiency (LAD) is an example of:

Defects in neutrophil function

Lazy leukocyte syndrome is an example of:

Defects in neutrophil function

Lazy leukocyte syndrome results in impaired _____ due to mutations of ____

chemotaxis; contractile proteins

A rare autosomal recessive condition association with albinism:

Chediak-Higashi syndrome

Chediak-Higashi syndrome is characterized by: 1. giant _____ from fused ____ 2. both ____ and ____ formation are defective 3. recurrent ____ 4. _____ is abnormal

1. lysosomal inclusions; primary granules 2. chemotaxis and phagolysosome formation 3. infections 4. platelet function

-a rare autosomal recessive condition associated with albinism -giant lysosomal inclusions from fused primary granules -both chemotaxis and phagolysosome formation are defective -recurrent infections -platelet function is abnormal

Chediak-higashi syndrome

- X-linked (2/3) or autosomal (1/3) recessive - Deficient NADPH oxidase in the cell membranes of neutrophils and monocytes, resulting in an absent respiratory burst - no H2O2 produced- HOCl- is not synthesizes because of the absence of H2O2 - catalase-negative organisms (strep species) are killed - catalase-positive organisms (staph aureus) are NOT killed

Chronic granulomatous disease of childhood

Chronic granulomatous disease of childhood: Describe the inheritance of this disease:

2/3 x-linked recessive and 1/3 autosomal recessive

What is deficient in the cell membranes of neutrophils and monocytes and what does this result in, in Chronic granulomatous disease of childhood?

Deficient: NADPH oxidase Results in: absent respiratory burst

What is not produced in Chronic granulomatous disease of childhood? Because this is not produced, what else is not synthesized?

H2O2; HOCl-

Chronic granulomatous disease of childhood: What are organisms are killed? What organisms are NOT killed?

Killed: catalase-negative organisms (strep species) NOT killed: catalase-positive organisms (staph aureus)

- a common (1 in 2000 individuals) autosomal recessive absence of myeloperoxidase enzyme in neutrophil and monocyte granules - respiratory burst IS normal and H2O2 IS produced - absence of MPO prevents synthesis of HOCl- - no great clinical consequences in most people - diabetics may develop candidiasis

Myeloperoxidase (MPO) Deficiency

How does this disease affect neutrophils? -Agranulocytosis

Too few neutrophils

How does this disease affect neutrophils? -Cyclic neutropenia

Too few neutrophils

How does this disease affect neutrophils? -Leukocyte adhesion deficiency (LAD)

Failure in adhesion

How does this disease affect neutrophils? -"Lazy" leukocyte syndrome

Slow chemotaxis

How does this disease affect neutrophils? -Bruton Agammaglobulinemia

Failure to phagocytose

How does this disease affect neutrophils? -Complement deficiency

Failure to phagocytose

How does this disease affect neutrophils? -Chronic granulomatous disease of childhood

Failure to kill

How does this disease affect neutrophils? -Chediak-higashi syndrome

Failure to kill

How does this disease affect neutrophils? -Myeloperoxidase deficiency

Failure to kill

Label the following image:

1. a) agranulocytosis b) cyclic neutropenia 2. a) leukocyte adhesion deficiency 3. a) "lazy" leukocyte syndrome 4. a) Bruton's Agammaglobulinemia b) complement deficiency c) Hyper IgM syndrome 5. a) chronic granulomatous disease of childhood b) Chediak-higashi syndrome c) myeloperoxidase deficiency

List the causes of chronic inflammation: (8)

1. persistent infection 2. prolonged exposure to toxic agents 3. exogenous 4. endogenous 5. immune-mediated inflammatory disease 6. autoimmune diseases 7. unregulated immune responses against microbes 8. immune responses against environmental substances

Give an example of a persistent infection that may cause chronic inflammation:

Mycobacteria

Prolonged exposure to ____ and _____ toxic agents may lead to chronic inflammation

exogenous & endogenous

Give an example of an endogenous agent in which prolonged exposure may lead to chronic inflammation:

atherosclerosis

Give an example of an exogenous agent in which prolonged exposure may lead to chronic inflammation:

silicosis

Give an example of an autoimmune disease that may cause chronic inflammation:

Rheumatoid arthritis

Unregulated immune responses against microbes, such as _____ may lead to chronic inflammation

Inflammatory bowel disease

Immune responses against environmental substances such as ______ may lead to chronic inflammation

bronchial asthma

What are the morphological features of chronic inflammation? (3)

1. mononuclear cell infiltration 2. tissue destruction 3. connective tissue replacement

mononuclear cell infiltration is a morphologic feature of chronic inflammation, what cells are associated with this?

1. Lymphocytes 2. plasma cells 3. macrophages

Why is tissue destruction a morphologic feature of chronic inflammation?

Due to a persistent offending agent, or by the inflammatory cells

Healing via connective tissue replacement is a morphologic feature of chronic inflammation, what processes does this include?

1. angiogenesis 2. fibrosis

Why is this image indicative of chronic inflammation? Label key cells

Contains plasma cells, lymphocytes and macrophages

Label the following cells:

A) lymphocyte B) macrophage C) plasma cell D) neutrophil E) macrophage

Granulomatous inflammation is a specific pattern of:

Chronic inflammation

What are two examples of granulomatous inflammation?

1. immune granulomas 2. foreign body granulomas

-aggregates of epithelia macrophages (activated) -multinucleated giant cells -mononuclear leukocytes, principally lymphocytes and occasionally plasma cells peripherally these are all characteristic of:

Granulomatous inflammation

There is a ____ variable in granulomatous inflammation

fibrosis

Label the cells in the following image: What condition do theses cells indicate?

A) Langhans giant cell B) Foreign body giant cells Granulomatous inflammation

The two classifications of granulomas include:

1. immune granulomas 2. foreign body granulomas

Coccidioides immitis is an example of:

Immune granuloma

Caseation necrosis in tuberculosis is an example of:

Necrotizing granulomatous inflammation

This image shows:

Caseation necrosis in tuberculosis

An intracellular pathogen that blocks fusion of phagosome with lysosome:

Mycobacterium tuberculosis

These images show:

Mycobacterium tubercilosis

This image shows:

Acid fast bacilli

Granulation tissue vs. Granulomatous tissue Reparative tissue:

Granulation tissue

A pyogenic granuloma is an example of _____ NOT ____

granulation tissue; granulomatous tissue

Restoration of tissue architecture and function after healing:

Repair

Repair may occur by:

Regeneration or by healing (scar formation)

Growth of cells and tissues to replace lost structures:

Regeneration

Healing consists of variable portions of two distinct processes:

1. regeneration 2. scarring

The tissues involved in regeneration include:

1. continuously dividing 2. stable tissues 3. permanent tissues

The "continuously dividing tissues" involved in regeneration are classified as:

Labile

The "stable tissues" involved in regeneration are classified as:

Quiescent

The "permanent tissue" involved in regeneration are classified as:

Non-dividing

The labile cells of regeneration are derived from the division of:

stem cells

The labile cells of regeneration are derived from the division of stem cells also known as:

hematopoietic cells

The labile cells of regeneration include what types of epithelium?

1. surface epithelium 2. stratified squamous epithelium (of the skin, mouth, pharynx, vagina and cervix) 3. gastrointestinal tract epithelium

_____ tissues can readily regenerate after injury as long as the pool of stem cells is preserved

Labile tissues

Labile tissues can readily regenerate after injury as long as:

the pool of stem cells is preserved

The most common forms of cancer arise from:

labile tissues

The most common forms of cancer arise form labile tissues, these include: (5) (name labile tissue + type of cancer)

1. epidermis- skin cancer 2. bronchial mucosa- lung cancer 3. oral mucosa- oral cancer 4. cervical mucosa- cervical cancer 5. hematopoietic tissues- leukemia

1. epidermis- skin cancer 2. bronchial mucosa- lung cancer 3. oral mucosa- oral cancer 4. cervical mucosa- cervical cancer 5. hematopoietic tissues- leukemia What do all of these cancers have in common?

Arise from labile tissues

Stable tissues of regeneration may also be called:

quiescent tissues

Stable cells of regeneration are quiescent meaning they have:

a very low rate of turnover

Stable tissues (quiescent) of regeneration include: (4)

1. viscera (liver, kidney, pancreas) 2. endothelial cells 3. fibroblasts 4. smooth muscle cells

Replacement of the stable cells of stable (quiescent) tissues is carried out by:

mitotic division of mature cells

With the exception of liver, stable tissues have:

limited capacity to regenerate

Malignant tumors of ____ tissues are among the rarer forms of malignancies

stable tissues

Cancers are different from malignancies in that they are specifically derived from:

epithelial cells

Permanent tissues of regeneration are considered:

Non-dividing

______ cells were generated during fetal life and never divide in postnatal life

permanent cells of regeneration

Discuss the generation of permanent cells:

Generated during fetal life and NEVER divide in postnatal life

What type of cells of regeneration cannot be replaced if lost?

Permanent cells

Permanent cells of regeneration include: (2)

Neurons & cardiac myocytes

In permanent tissues, repair is dominated by:

Scar formation

Fibrosis in simple terms is:

Scarring

In fibrosis (scarring) the tissue is intrinsically:

Unable to regenerate

The tissues of _____ & ____ must undergo fibrosis in order to heal because they are intrinsically unable to regenerate

heart & brain

Fibrosis will occur if the underlying tissue scaffolding is:

Disrupted

When the underlying tissue scaffolding is disrupted _____ occurs

Fibrosis (scarring)

_____ occurs following extensive exudates (organization)

Fibrosis (scarring)

This image shows a healed cerebral infarct, how does this healing occur and why?

Via fibrosis because brain tissue is intrinsically unable to regenerate (neurons)

How would this area of damage repair itself?

via fibrosis (due to inability to regenerate)

What are the two objectives of wound healing?

1. epithelial regeneration 2. connective tissue repair

Wound healing involves _____ regeneration and _____ repair

Epithelial regeneration; connective tissue repair

In wound healing, restoring the integrity of the epithelial surface is known as:

Epithelial regeneration

In wound healing, epithelial regeneration involves:

Restoring the integrity of the epithelial surface

In wound healing, restoring the tensile strength of sub-epithelial tissue is known as:

Connective tissue repair

In wound healing, connective tissue repair involves:

Restoring the tensile strength of the sub-epithelial tissue

Type of healing in which the goal is to approximate the margins:

Healing by primary intention/union

The goal of healing by primary intention/union is to:

approximate the margins

What do we mean by "approximate the margins" in healing by primary intention/union?

Wound margins are pulled neatly together (think stitches)

This image shows what type of healing?

Healing by primary intention/union (margin approximation)

This image shows what type of healing?

Healing by primary intention/union (margin approximation)

All wound healing involves an _____ even in the absence of infection

inflammatory reaction

Healing by secondary intention involves the:

inability to approximate the margin

Healing that occurs when wound margins are NOT pulled together:

Healing by secondary intention/union

What is one reason that healing by secondary intention/union may occur?

anatomical location

The following images would require what type of healing?

Healing by secondary intention/union

In healing by secondary intention/union the wound is left open and:

will heal by granulating in

What type of cells are seen in granulation tissue?

1. endothelial cells 2. fibroblasts 3. myofibroblasts (contractile)

What stain can be used to visualize granulation tissue?

Trichrome stain

The following images show a _____ stain used to view ____ tissue

Trichrome stain; granulation tissue

The following images show wound healing by:

secondary intention/union

Excessive scar formation within the boundaries of the original wound producing a raised scar:

Hypertrophic scar

These images show what type of scar?

Hypertrophic scar

Excessive scar formation that grows beyond the boundaries of the original wound:

Keloid

Keloids are often seen in what population?

African-american

The following image shows:

keloid

______ is required for the hydroxylation of proline and lysine

Vitamin C

Vitamin C is required for the hydroxylation of:

Proline and lysine

Vitamin C is important in wound healing but too much=

Scruvy