Outcomes of Inflammation Flashcards
What is granulomatous inflammation? What cells are unique to a granuloma?
Morphological pattern of chronic inflammation with epitheloid cells (Macrophages), CD4+ lymphocytes, giant cells (fused macrophages), and fibroblasts
What unique macrophage is present in granulomas caused by tuberculosis?
Langhan’s giant cells
What is the name given to the initial “pre-scar” tissue seen in the early stages of healing by fibrosis?
Granulation tissue
What cell type is important in wound contraction?
Myofibroblasts
What is a primary wound healing response initiated in response to?
Stitches and surgical incisions
What is a secondary wound healing response initiated in response to?
Open wounds and abrasions
What are the four outcomes of acute inflammation?
Resolution, abcess/suppuration, fibrosis, becomes chronic inflammation
What is the usual outcome in an acute pattern of inflammation?
Resolution
What is an abscess made from?
Fibrin
What is the duration marker for chronic inflammation?
Three weeks or greater (anything shorter is acute)
What are the causes of chronic inflammation?
Persistent microbial infection, prolonged exposure to toxins, autoimmune diseases, cancers
What hypersensitivity reactions cause chronic inflammation?
Type II and III
What is the hallmark cell of granulomatous inflammation?
Epithelioid cell (activated macrophage)
What pathologies and foreign objects can cause granulomatous inflammation?
Tuberculosis, histoplasmosis, sutures, asbestos, silica gel, Crohn’s disease, sarcoidosis, leprosy, syphilis
What cells are present in a granuloma?
Epithelioid cells, giant cells, fibroblasts, CD4+ lymphocytes
What is the number one disease presenting with caseous necrosis? What other fungal pathology can cause it?
1 = Tuberculosis; #2 = Histoplasmosis
What are the outcomes involved in the wound healing repair process?
Total reconstruction by regeneration or resolution
Partial reconstruction
Universal repair tissue (fibrous scar)
What are the four components of wound healing and repair?
Angiogenesis (proliferating endothelial cells)
Proliferating fibroblasts
Deposition of ECM
Remodeling of CT
What is granulation tissue composed of?
Proliferating capillaries
Proliferating fibroblasts and myofibroblasts
Extracellular fluid
Macrophages
What are the functions of granulation tissue?
Fill in tissue “gaps”
Remove dead cell debris
Aid in wound contraction
Formation of “pre-scar”
What is universal repair tissue equivalent to?
Fibrous connective tissue scar
What is the first type of collagen laid down in wound healing?
Type III collagen
What is the function of a myofibroblast?
Wound contraction for primary and secondary union healing
Granulation tissue is always (Acute/Chronic)?
Acute
What immune response is granulation tissue associated with?
Innate immune response
What are the steps of primary and secondary union and timeframes?
Blood clot fills incision (4-16 minutes)
Neutrophils infiltrate (less than 24 hrs)
Epithelium continuity is restored (less than 24 hrs)
Macrophages infiltrate (Day 3)
Granulation tissue fills incision (Days 5-7)
Progressive Collagenization (Day 7)
Remodeling (3 months)
What is different about a secondary union wound healing process?
More granulation tissue
Prolonged inflammatory response
More debris and inflammatory exudate
More scar tissue formation
More myofibroblast activity
What are local factors that influence wound healing?
Type, size, and location
Vascular supply
Infection
Movement
What are systemic factors that influence wound healing?
Circulatory status
Infection
Malnutrition
What are examples of complications of normal wound healing?
Proud flesh, keloid, wound dehiscence, contracture
Where are the highest amount of continuous capillaries located in the body which can be implicated in faster wound healing?
Face
What is proud flesh?
Excessive granulation tissue
What is a keloid?
Hypertrophic scar with excessive collagen deposition
What is one way that a keloid commonly forms?
Piercings
In what population is a keloid most common?
African American
Diabetics have (Better/Worse) wound healing characteristics?
Worse
What is wound dehiscence?
Mechanical stress resulting in the reopening of a scar or wound
What is contracture?
Excessive wound contraction by myofibroblasts resulting in shortening of tendons
What traumatic injury can result in excessive wound contracture?
3rd degree burns, Achilles rupture repair
What are important characteristics/mechanisms regarding cauliflower ear?
- Inflammatory serous or purulent exudate due to traumatic injury resulting in injury to an arteriole
- may also result in dystrophic calcification
