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Surgery > Tissue Healing > Flashcards

Tissue Healing Flashcards

1
Q

Can central nerves regenerate?

A

no

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2
Q

Can peripheral nerves regenerate?

A

yes, often incompletely

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3
Q

?

  • severe contusion to nerve
  • decreased conduction
  • recovery takes several weeks
A

Neuropraxia

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4
Q

?

  • injury to axon with wallerian degen
  • recover in months-years
  • crush injuries
A

Axonotmesis

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5
Q

?

  • complete severence of a nerve
  • irreversible damage
  • nerve will never recover
  • can treat neuroma
  • cutting wounds
A

neurotmesis

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6
Q
  • NOTES-

- axonal degeneration does not begin immediately after injury; ie can still produce ap and xmit signals

A

-blood brain barrier is compromised

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7
Q

what happens to the axon distal to the injury site?

A

-swells

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8
Q

Calpain is activated and there is Ca2+ influx during nerve injury.
What is calpain?

A

Protease essential for the cytoskeleton degeneration and axonal degeneration

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9
Q

?

  • granular degeneration of cytoskeleton
  • fine debris produced
  • occurs within an hr
A

axonal degeneration

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10
Q

What is required for myelin sheath breakdown?

A

phospholipase a2

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11
Q

what aids in axonal regeneration, secrete trophic factors, secretes cytokines, and phagocytose myelin debris?

A

schwann cells

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12
Q

what removes myelin debris?

A

macrophages

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13
Q

What is the order of involvement of inflammatory cells during nerve inurjy?

A
  1. hours/days-neutorphils
  2. 3 days- t lymphocytes
  3. 1 week-macrophages
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14
Q

Why do we do manual muscle testing?

A

have to determine if any abnormalities are coming from the nerve, nm junction, or the muscle

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15
Q

?

  • tap along course of the nerve
  • what is it when you have pain distally and pain proximally?
A

Tinel’s=distal->less concerning

Valleaux=proximal -> more concerning

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16
Q

What do NCV studies test?

A

sensory component
motor component
f wave
h reflex

17
Q

what is the time it takes the electricity to travel from stimulation site to the recording site?

A

sensory and motor latency

-change in latency or amplitude indicates nerve injury

18
Q

What does the F-wave study?

A
  • measures the resulting action potential
  • not an reflex
  • electrical activity travels from site of stimulation through ventral horn to muscle
  • conduction velocity between the spinal cord and the limb
19
Q

What does H reflex study?

A
  • electrical discharge of muscle

- connection between the limb and the spinal cord

20
Q

What occurs in rapid myonecrosis? (degeneration)

A

-Sarcolema disruption-> inc permeability; inc serum creatine kinase, prevelent skeletal troponin I

-increased infiltration of inflammatory cells
neutrophils then macrophages

21
Q

what occurs during myogenic proliferation?

A

myogenic cells differentiate and fuse to existing damaged fibers

  • new fibers formed->cells enlarge->nuclei move to periphery
  • new fibers are identical
22
Q

why can muscle cells regenerate?

A

undifferentiated mononuclear monogenic cells at periphery of mature skeletal fibers

23
Q

What is the steriotypical blood vessel response to injury?

A

stimulation of smooth muscle cell growth and associated matrix synthesis that thickents the intima forming a neointima

24
Q

How is neointima formed?

A
  1. defect in endothelium
  2. epithelial cells migrate into the area to fill the deficit
  3. smooth muscle cells proliferate and synthesize ecm
  4. neointima is formed
25
Q

what happens when there is decrease in blood flow?

A
  • local tissues become hypoxic and ischemic
  • increase VEGF production
  • binds to cognate recepetor tyrosine kinases
  • angiogenesis
26
Q

6 P’s

-signs of vascular injury

A

Pale, Pallor, Polar, Pulselessness, Pokilothermia, pain

27
Q

what type of vascular injury is this?

  • embolic shower
  • crush/laceration injury
A

acute vascular injury

28
Q
  • What test is this?-
  • dependent rubor
  • palor with elevation
  • raise legs 60 degrees x1min
A

Brueger’s test

29
Q
  • What test is this?-
  • evaluates competency of valves in the veins
  • elevate legs 90 degrees
  • cuff around the high thigh occlude the grater saphenous vein
  • have pt stand
  • evaluate filling of the veins
A

Brodie-trendelenberg test

30
Q

What different in pressure indicates pathology when using abi/pvr with segmental pressures

A

greater than 30mmHg

31
Q

What indicates a healthy waveform?

A
  • brisk sharp rise

- dichrotic notch

32
Q

waveform pathology with absence of a dichrotic notch and gradual prolonged downstroke?

A

-early pathology

33
Q

waveform pathology with rounded systolic peak

A

moderate pathology

34
Q

flattened wave with slow upstroke and downstroke

A

severe occlusion

35
Q

what is photoplethysomography?

A

infrared frequency is emitted and reflected by hemoglobin molecules in microcirculation to show waveforms

36
Q

what are the aims for arterial duplex and when do you use it?

A
  • assess velocity of blood flow in the LE arteries
  • localize and characterize stenosis, collaterals, and occlusions
  • detailed assessment of the arterial tree

-evaluation of atherosclerotic, aneurysm, bypass grafts, evaluation of arterial trauma

37
Q

What is the gold standard test for DVT?

A

venogram

38
Q

What is the difference between arterial and venous hemorrhage?

A

artery-pulsatile flow, bright red blood

vein-oozing, red to dark red blood

Surgery (9 decks)

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