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ESA 2 - Pathological Processes > Session 4: Healing - Regeneration & Repair > Flashcards

Session 4: Healing - Regeneration & Repair Flashcards

1
Q

What processes are involved in wound healing? (3)

A
  1. Haemostasis
  2. Inflammation
  3. Regeneration and/or repair
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2
Q

What is haemostasis?

A

Stopping of flow of blood

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3
Q

What is regeneration?

A

Restitution with no, or minimal, evidence that there was a previous injury

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4
Q

What is an abrasion?

A

Damage to top layer of cells (epidermis)

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5
Q

What is an ulcer?

A

Sever form of abrasion - damage to cells as deep as muscularis mucosae

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6
Q

Which cells replicate in regeneration?

A

Stem cells

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7
Q

What are stem cells?

A

Cells with prolonged proliferative activity and asymmetric replication - mature cell and self-renewal (2 daughter cells)

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8
Q

What are unipotent stem cells? Give an example.

A

Only produce one type of differentiated cell

  • most adult stem cells
  • eg. Epithelia
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9
Q

What are multipotent stem cells? Give an example.

A

Produce several types of differentiated cells

- eg haematopoietic stem cells

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10
Q

What are totipotent stem cells?

Where are they found?

A

Produce any type of cell and therefore any tissues of the body
- embryonic stem cells

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11
Q

What are labile tissues? Give examples.

A

Tissues with short-lived cells that are replaces by cells derived from stem cells
- eg. Surface epithelia, haematopoietic tissues

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12
Q

What are stable tissues? Give examples.

A

Normally low level of replication but if necessary can undergo rapid proliferation
- eg. Liver parenchyma, bone, fibrous tissue, endothelium

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13
Q

What are permanent tissues? Give examples.

A

Mature cells that cant undergo mitosis with few or no stem cells present
- eg. Neural tissues, skeletal muscle, cardiac muscle

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14
Q

When can regeneration occur?

A
  1. Damage to labile or table tissue

2. Not very extensive tissue damage - connective tissue scaffold/collagen still intact

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15
Q

What is fibrous repair?

A

Healing with formation of fibrous connective tissue that results in scarring

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16
Q

When does fibrous repair occur? (3)

A
  1. Necrosis of labile or stable tissues with destroyed collagen framework
  2. Necrosis of labile or stable tissues that leads to on-going chronic
  3. Necrosis of permanent or complex tissue
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17
Q

How does a scar form? (6)

A
  1. Haemostasis
  2. Acute inflammation
  3. Chronic inflammation
  4. Granulation tissue forms
  5. Early scar
  6. Mature scar
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18
Q

How does an early scar differ from a mature scar?

A

Mature scar has less cells and blood vessels, increased collagen

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19
Q

What does granulation tissue consist of? (3)

A
  1. Developing in capillaries
  2. Fibroblasts and myofibroblasts
  3. Chronic inflammatory cells
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20
Q

What are the functions of granulation tissue?

A
  • contract and close the gap
  • provide oxygen, nutrients and cells
  • fills the gap
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21
Q

Which cells are involved in fibrous repair? (3)

A
  1. Inflammatory cells - neutrophils, macrophages, lymphocytes
  2. Endothelial cells
  3. Fibroblasts and myofibroblasts
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22
Q

What is the role of inflammatory cells in fibrous repair? (2)

A
  • phagocytosis of debris: macrophages, neutrophils

- production of chemical mediators: macrophages, lymphocytes

23
Q

What is the role of endothelial cells in fibrous repair?

A

Angiogenesis (growing new blood vessels)

24
Q

What is the role of myo/fibroblasts in fibrous repair?

A
  • produce ECM proteins (collagen)

- wound contraction

25
What happens to the different layers/structures of the skin with scarring? (*hint: think of epidermis, dermis complex structures)
Epidermis - regenerated Dermis - repaired Complex structures (eg hair follicles, sweat glands) - lost
26
What is collagen?
Triple helices of polypeptide alpha chains
27
What are fibrillar collagens?
Type I-III responsible for tissue strength
28
What are amorphous collagens?
Type IV-VI eg in basement membrane
29
What diseases are the result of defective collagen synthesis? (4)
1. Scurvy 2. Ehlers-Danlos syndrome 3. Osteogenesis imperfecta 4. Alpert syndrome
30
What causes scurvy?
Vitamin C deficiency
31
How does vitamin C deficiency affect collagen?
Inadequate hydroxylation of procollagen alpha chains leads to reduced cross-linking and defective helix formation - collagen lacks strength
32
Why does vitamin C deficiency cause scurvy?
Defect in collagen particularly affects collagens supporting blood vessels - unable to heal wounds, tendency to bleed
33
What happens in Ehlers-Danlos syndrome?
- Skin is hyperextensible - hypermobile joints - Defective conversion of procollagen to tropocollagen - collagen fibres lack adequate tensile strength although elastic fibres are normal
34
What is osteogenesis imperfecta?
Brittle bone disease - too little bone tissue
35
What is Alport syndrome?
Type IV collagen abnormal
36
How are regeneration and repair triggered and controlled?
Cell to cell signalling 1. Hormones 2. Local mediators - growth factors 3. Direct cell-cell or cell-stroma contact
37
What are growth factors?
Local hormone polypeptides that stimulate transcription of genes that regulate entry of cell into cell cycle
38
What is contact inhibition?
A regulatory mechanism that functions to keep cells growing into a layer one cell thick (a monolayer)
39
What is the significance of contact inhibition in malignant cells?
Contact inhibition is altered and there is disrupted cell-cell adhesion - cells start piling on top of each other
40
How do cells adhere to each other and to ECM?
Proteins on cell membranes called adhesion molecules
41
Which adhesion molecules bind cells to each other?
Cadherins
42
Which adhesion molecules bind cells to the ECM?
Integrins
43
When does healing by primary intention occur?
occurs in incisional, closed, non-infected and sutured wounds (clean wounds with opposed edges)
44
Describe the wounds that undergo healing by primary intention.
Disruption of epithelial basement membrane continuity but death of only a limited number of epithelial and connective tissue cells
45
How does healing by primary intention occur?
- epidermis regenerates: growing new cells creep over denuded cells - dermis undergoes fibrous repair
46
What is healing by secondary intention and when does it occur? Give examples.
- open wound filled by abundant granulation tissue - excisional wound - wounds with tissue loss and separated edges - infected wounds - eg. Infarct, ulcer, abscess
47
What occurs in healing by secondary intention?
- same processes as in primary intention but more so - considerable wound contraction to close the wound - substantial scar formation
48
How does bone heal?
1. Haematoma 2. Granulation tissue forms 3. Soft calls 4. Bony callus 5. Remodelling
49
What local factors can influence wound healing? (10)
1. Type, size, location of wound 2. Mechanical stress 3. Blood supply 4. Denervation 5. Local infection/ protection from infection 6. Foreign bodies 7. Haematoma 8. Necrotic tissue 9. Mechanical stress 10. Surgical techniques
50
What general factors influence wound healing? (8)
1. Age 2. Anaemia, hypoxia, hypovolaemia 3. Obesity 4. Diabetes 5. Genetic disorders 6. Drugs 7. Vitamin deficiency 8. Malnutrition
51
What are the complications of fibrous repair? (6)
1. Insufficient fibrosis 2. Formation of adhesions - fibrotic tissues formed around organ 3. Loss of function - non-contracting area of myocardium 4. Disruption of complex tissues relationships within an organ 5. Overproduction of fibrous scar tissue - keloid scar 6. Excessive scar contraction - joint contracture (fixed flexures)
52
Comment on the cardiac muscle's capacity to regenerate.
Very limited, if any, regenerative capacity | - MI is followed by scar formation
53
Comment on liver's capacity to regenerate.
Remarkable capacity to regenerate
54
What happens when a nerve is severed?
Axons degenerate - proximal stumps of degenerated axons sprout and elongate - Schwann cells from distal degenerated axons guide them back to tissue

ESA 2 - Pathological Processes (4 decks)

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