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Pathology > L6 - Healing And Repair > Flashcards

L6 - Healing And Repair Flashcards

1
Q

3 types of cells in cell renewal (partial tissue injury)

A

Labeled cells, stable cells, permanent cells

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2
Q

What are labile cells?

A

Regenerate regularly

Surface epithelium of the GIT , Skin

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3
Q

What are stable cells?

A

Slow regeneration
Divide when necessary
Regenerate/ scar
Ex. Hepatocytes

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4
Q

What are permanent cells?

A

No effective regeneration
Scar
Ex. Neural cells of CNS, cardiac muscle

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5
Q

Regeneration meaning

A

Growth of cells to replace the lost structure

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6
Q

Healing tissue responses (3)

A
  1. Wound
  2. Inflammatory process
  3. Cell necrosis
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7
Q

When does scar formation occur?

A
  • Permanent cell damaged
  • Destruct connective tissue
  • Extensive/ total cell injury
  • Chronic inflammation
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8
Q

What are the steps of repairing by scar tissue?

A

Inflammatory response-> migration of parenchymal and CT cells-> angiogenesis and granulation tissue-> ECM proteins and collagen synthesis-> tissue remodeling-> wound contract and strengthens

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9
Q

What is angiogenesis?

A

Form blood vessels from:
Endothelial cells in bone marrow
Pre-existing vessels

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10
Q

What is granulation tissue?

A

highly vascularized CT made of newly formed capillaries, proliferating fibroblasts, and inflam. Cells in oedematous stroma

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11
Q

Granulation tissue macroscopically

A

Pink, granular, soft and fleshy

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12
Q

What are the growth factors of forming new vessels

A

VEGF and FGF

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13
Q

What are the growth factors to stabilize new vessels

A

Angiopoietin 1&2- Periendothelial cells
PDGF- smooth muscle cells
TGF beta- ECM protein secretion

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14
Q

VEGF

A

Initial ECM protein production

Angiogenesis and vascular permeability

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15
Q

What does deposition of ECM and increased fibroblast migration involve

A

Growth factors- TGF-beta, PDGF, FGF

Cytokines- TNF, IL-1, IL-13

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16
Q

ECM deposition and scar= ??

A

It stimulates fibroblasts to produce collagen

Net collagen dependent on both production and degradation

17
Q

Tissue remodeling process

A

Degrade collagen and other ECM proteins w/ MMPs
(TIMs inhibit MMPs)
= a vascular firm white scar

18
Q

What inhibits degradation by MMPs

A

TIMs (tissue inhibitor of metaloprotinases)

19
Q

How does a wound contract?

A

Myofibroblasts in granulation tissue contract = wound decreased in size

20
Q

What are the harmful effects of wound contraction?

A

Stenosis and contractures

21
Q

How is wound strength acquired?

A

Increase collagen deposition
Collagen fibers cross linking
Collagen fibers change from type 3 to type 1

22
Q

Cutaneous wound healing steps

A

1- early and late inflammation
2- Granulation tissue formation and re-epithelialization
3- Wound contraction ECM deposition and remodeling

23
Q

Types of wound healing (2)

A

First intention (primary union) and second intention (secondary union)

24
Q

First intention (primary union) healing

A

Surgically incised
Clean uninflected
Low death of epithelial and CT
Edges approximated by surgical sutures

Gap will be filled by blood w/ fibrin and blood cells + scab formation

25
Q

Second intention healing

A

Extensive cell death
Large defects and might have infection
Wound not approximated by sutures

26
Q

Healing process within 24hrs

A

Neutrophils enter

27
Q

Healing process within 24-48hrs

A

Epithelial cells move and fuse in the midline

28
Q

Healing process day 3

A

Macrophages move in
—Granulation tissue forms —
Collagen laid down
—epithelial cell layer forms

29
Q

Healing process day 5

A

Granuation tissue fills the gap
Maximal neovascularization
—Collagen fibrils increases
—Epithelial cells thickens

30
Q

Healing process week 2

A

Accumulation of collagen and fibroblast proliferation

— Regression of vascular channels, inflammation and oedema

31
Q

Healing process week 4

A

Scar
—Covered by epidermis
—Dermal appendages are absent
—Wound strength - over several months

32
Q

Secondary union characteristics in comparison to primary union

A 
Larger fibrin clot
More necrotic debris and exudate
Intense inflammatory reaction
Abundant granulation tissue
Wound contraction (by myofibroblasts) 
 Scar formation and thinning of epidermis
33
Q

What are the local factors that affect wound healing (7)

A

-Poor blood supply - arteriosclerosis, venous abnormalities(ex: varicose veins)
— -Denervation
— -Local infection
— -Foreign bodies – interfere with healing and cause infection
— -Presence of a haematoma
— -Mechanical stress
— -Presence of a necrotic tissue

34
Q

What are the systemic factors that affect wound healing (11)

A
  1. Anaemia
    —2. Drugs- Steroids ( anti-inflammatory) , cytotoxic drugs
  2. —Genetic disorders with collagen defects
  3. Ehlers – Danlos syndrome Osteogenesis imperfecta Marfans syndrome
    — 5. Diabetes
    — 6 .Malignancy
  4. Nutrition deficiencies
  5. Systemic infection
  6. Trauma, hypovolaemia, hypoxia
  7. Uremia
  8. Hematological abnormalities

Pathology (4 decks)

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