Inflammation/Wound Healing Flashcards
Three phases of wound healing and timing
Inflammation (1-10days), Proliferation (5-21days) and Maturation/remodeling (3wks-1yr)
Proinflammatory cytokines important in modulating immune response in wound healing and promoting production of new RNA and proteins
Interferons
Central enzyme in apoptoisis
Caspases
Newborn immune protection first 6months
IgG across placenta and IgA through breast milk
Amphotericin B; MOA
Binds to fungal cell wall sterols
Most abundant collagen in human body
Type I
Platelets aggregate and growth factors/cytokines released; Phase of wound healing and time after injury
Hemostasis, minutes
Phagocytosis by neutrophils, mast cells, vasodilation; Phase of wound healing and time after injury
Inflammation, first few days
Angiogenesis, collagen deposition, granulation, epithelialization, wound contraction; Phase of wound healing and time after injury
Proliferation, days to weeks
Collagen crosslink, remodeling and strengthening; Phase of wound healing and time after injury
Remodeling, weeks to months
Primary lymphoid organs
Liver, bone, thymus
Secondary lymphoid organs
Lymph, Spleen, Peyers, Tonsils, Adenoids
Phase of wound healing in which collagen deposition is greatest
Proliferative
Collagen cross linking is dependent on this for hydroxylation of proline
Vit C
When are anastomotic leaks likely to occur
POD3, old collagen is being broken-down but new collagen hasn’t quite caught up
Single most important molecule for intestinal wall strength
Collagen
When does collagen breakdown begin in wound healing and as a result of what enzyme
within 24hrs from metalloproteinases
Promotes hemostasis in the inflammatory phase of wound healing
Thromboxane A2
Stimulates vasculogenesis and angiogenesis
VEGF
Responsible for adhesion of leukocytes to endothelial cells
Integrins
Most common pathogen causing late graft infection
S. Epidermidis
Post-op prolonged NPO on TPN now with jaw pain and leukocytosis; dx and organism
Postop parotitis, Staph aureus
Leukopenia, fatigue, retinitis s/p renal transplant; dx and tx
CMV, gancyclovir
Dx test for pleural TB, result
Sputum and pleural fluid sample with mycobacterium
Pleural TB tx
Rifampicin, isoniazid, pyrazinamide, ethambutol
Most common organism in VAP
PsA and Staph aureus
Recommended surgical prep
Chloraprep
Altered penicillin-binding protein produced by MRSA is encoded by which gene
mecA
Uninfected operative wounds in which no inflammation is encountered and the respiratory, alimentary, genital, or uninfected urinary tracts are not entered; wound calss
Clean
Operative wounds in which the respiratory, alimentary, genital, or urinary tract is entered under controlled conditions and without unusual contamination; wound class
Clean-contaminated
Open, fresh, accidental wounds, operations with major breaks in sterile technique or gross spillage from the gastrointestinal tract, and incisions in which acute, nonpurulent inflammation is encountered; wound class
Contaminated
Old traumatic wounds or wounds with retained devitalized tissue and those that involve existing clinical infection or perforated viscera; wound class
Dirty
SSI risk clean wounds
1-5%
SSI risk clean-contaminated wounds
3-11%
SSI risk contaminated wounds
10-17%
SSI risk dirty wounds
> 27%
HIV periop medical management
Continued without break
Sulbactam MOA
beta-lactamase inhibitor
Infected diabetic foot ulcer and signs of septic shock
Amputation
Only monotherapy regimen approved for parenteral tx of amp-susceptible enterococci infections
Augmentin
Ampicillin-resistant E faecium
Linezolid and daptomycin
Abx that lacks cross-reactivity to other beta-lactams
Aztreonam
Suspected colonic injury, appropriate pre-op abx
Ancef + flagyl, cefoxitin, Cefotetan, Augmentin
Risk factor for gastric adenocarcinoma
Nitroso compounds
Bite wound, first line abx
Augmentin, cefoxitin, bactrim + clinda
Immunocompromised, pulmonary fungal infection; dx and tx
Invasive aspergillosis, Voriconazole
Indication for palliative gastrectomy with Stage IV gastric lymphoma
Bleeding or obstruction
STOP-IT trial guidelines
Abxs 4 days from source control
Immunosuppressed with brain abscess; dx
Aspergillus brain abscess
MOA fluoroquinolones
Inhibit DNA gyrase
MOA macrolides
Inhibit 50S ribosomal subunit
MOA aminoglycosides
Inhibit 30S ribosomal subunit
MOA vancomycin
Inhibit cell wall synthesis
CMV tx
Ganciclovir, Foscarnet, Cidofovir
Immunotherapy Non-Small-cell lung cancer; tx and target
Pembrolizumab -> PD-L1
Immunotherapy Melanoma; tx and target
Ipilimumab, CTLA-4
Immunotherapy Medullary thyroid MEN IIa/IIb; tx and target
Selpercatinib, RET
Immunotherapy ER+ breast cancer; tx and MOA
Anastrozole, Aromatase inhibitor
Immunotherapy HER2+ breast cancer; tx and target
Trastuzumab, HER2 receptor
Immunocompromised with fever, chills, weight loss, crackles and rhonci in lower lung fields, pancytopenia, diffuse bilateral infiltrates from perihilar region; dx and prevention
Pneumocystis Jiroveci, Bactrim ppx
Cavitating lung lesion
Mycobacterium tuberculosis
Ohio River Valley spelunker
Histoplasmosis
Pneumonia or meningoencephalitis
Cryptococcus neoformans
Southwest US lung lesion
Coccidioidomycosis
Immunosuppressant associated with gallstone formation
Calcineurin inhibitors like Tacrolimus and Cyclosporine
Immunosuppressant associated with gallstone formation
Calcineurin inhibitors like Tacrolimus and Cyclosporine
Immunosuppressant that disrupts purine synthesis and causes GI SE
Mycophenolate
Immunosuppressant that inhibits cytokines and lymphocytes, SE include DM, impaired wound healing
Steroids like prednisone
Immunosuppressant that blocks nucleotide synthesis and has GI SEs
Azathioprine
Immunosuppressant that inhibits mammalian target of rapamycin, SEs include impaired healing, mouth ulcers, pneumonitis
mTOR inhibitors like sirolimus and everolimus
