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Exam 4 > Tissue Injury and Repair > Flashcards

Tissue Injury and Repair Flashcards

1
Q

The ____ ____ to infection and injury begins the process of repair.

A

Inflammatory response

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2
Q

Two main repair processes:
1. _____:restoration of normal cells
2. ____/____: deposition of connective tissue
Ultimate repair is usually a combination of both.

A

Regeneration
Scarring/fibrosis

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3
Q

Regeneration:
1. ____ of differentiated cells that survive injury
2. Tissue ____ ____ produce new differentiated cells

A

Proliferation
Stem cells

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4
Q

Regeneration is generally limited to some components of most tissue and requires ____ ____ ____.

A

Intact supporting structures

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5
Q

Scarring/fibrosis:
The injured area is ____ with connective (fibrous) tissue. Occurs when either cells of injured tissue are not capable of ____ or ____ ____ are too severely damaged.

A

Patched
Regeneration
Supporting structures

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6
Q

Scarring/fibrosis does not replace normal function of the tissue because the injured cells are replaced by ___ ___, which provides ____ but not function.

A

Connective
Structure

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7
Q

A tissue’s ability to repair depends on ____ capacity and ___ ___. There are three classes of tissue in this regard:

A

Proliferation
Stem cells

Labile tissue, stable tissue, permanent tissue

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8
Q

____ tissue is constantly dividing. ____ tissue is quiescent but not able to divid if needed. ____ tissue is not able to divid.

A

Labile
Stable
Permanent

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9
Q

Labile tissue is constantly turning over by stem cells and proliferation of mature cells.
Examples of Labile tissue and cells:

A

Lungs: type II pneumocytes, skin (basal cells), GI tract (Crypt cells), hematopoietic cells (CD34+ cells)

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10
Q

Picture of Labile tissue:

A
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11
Q

Stable tissue is made of ____ cells (G0). Capable of proliferating when tissue is injured or lost.
Examples:

A

Quiescent

Solid tissues such as liver, kidney, pancreas
Connective tissues such as endothelium, smooth muscle, and fibroblasts

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12
Q

Picture of stable tissue:

A
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13
Q

Permanent tissue cells are terminally differentiated and can’t ____. Repair is almost entirely ____.
Examples:

A

Proliferate
Fibrosis

Most neurons, cardiac and skeletal muscle.

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14
Q

Picture of permanent tissue repair:

A
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15
Q

Regeneration is driven by ___ ___ that are derived from activated ____ at the site of injury. Also derived from platelets, epithelial cells, Stromal cells, sequestered pool in extracellular matrix.

A

Growth factors
Macrophages

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16
Q

Regeneration depends on the integrity of the ____ ____. Some growth factors are present bound to the ___ ___ and therefore disruption of the ___ ___ could result in growth factor expression.

A

Extracellular matrix
Extracellular matrix
Extracellular matrix

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17
Q

Three phases of scarring/fibrosis:
1. _____: day 1 to 3. Cellular mediators involved are platelets, neutrophils, and macrophages. There is acute inflammatory response with macrophages clearing debris.

A

Inflammatory

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18
Q

Picture of inflammatory response:

A
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19
Q

Three phases of fibrosis:
2. _____: day 3 to weeks. Fibroblasts, myofibroblasts, endothelial cells, epithelial cells, and macrophages. They establish _____ ___, angiogenesis, epithelial cell proliferation, and type III collagen deposition

A

Proliferation
Granulation tissue

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20
Q

Picture of granulation tissue:

A
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21
Q

______ is stimulated by VEGF. It stimulates both migration and proliferation of endothelial cells. Promotes vasodilation by stimulating the production of ___ ___. Contributes to the formation of vascular lumen

A

Angiogenesis
Nitric oxide

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22
Q

Three phases of fibrosis:
3. _____: weeks to months. ____ are the cellular mediators. They replace type III collagen deposition with type I collagen. _____ contract to bring the wound edges together and add strength.

A

Remodeling
Fibroblasts
Macrophages

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23
Q

____ collagen provided a temporary structure in the injured area. ___ collagen is laid down in an orderly fashion facilitated by ____ and ___.

A

Type III
Type I
Fibroblasts
Macrophages

24
Q

After it’s deposition, the connective tissue in the scar counties to be modified and remodeled by ____ _____.

A

Matrix metalloproteinases (MMP)

25
Q

Diagram of tissue repair:

A
26
Q

Regulation of regeneration and repair:
_____ M1 and M2 activation.
M1:
M2:

A

Macrophage

Clears offending agents and dead tissue

Provides growth factors causing proliferation of various cells

27
Q

M2:
Macrophages secrete cytokines that stimulates _____ to proliferate and deposited connective tissue ECM.

A

Fibroblasts

28
Q

M1 and M2 activation of macrophages is ___ ___. Macrophages are initially classically activated (M1), but are gradually replaced by alternatively activated type (M2).

A

Temporally regulated

29
Q

___ is the most important cytokine in fibrosis. It is produced by most cells in granulation tissue including M2 macrophages.

A

TGF-beta

30
Q

TGF-beta stimulates fibroblast ___ and ___. It increases synthesis of ___ and ___. It decreases degradation of ECM by inhibiting ___ ____. It also has anti-inflammatory properties

A

Migration
Proliferation
Collagen
Fibronectin
Matrix metalloproteinases (MMPs)

31
Q

____ limits and terminates the inflammatory response.

A

TGF-beta

32
Q

Table of growth factors:

A
33
Q

Wound strength:
At week one, the wound is at about ____ strength of normal skin. Gradually, more ___ and less ___ ___ increases the strength

A

10%
Collagen
Granulation tissue

34
Q

Wound strength:
After 2 moths, maximum strength is achieved, still only ___ of original tissue strength

A

75%

35
Q

Complications of tissue repair:
___ ___: clinical factors can impede the repair process
___ ___: hypertrophic scars and keloid. Contractures

A

Chronic wounds
Excessive scarring

36
Q

Delayed wound healing occurs in ____, causing prolonged inflammation and ongoing injury.

A

Infection

37
Q

____ results in delayed wound healing due to poor perfusion and neuropathy leading to mechanical factors

A

Diabetes

38
Q

___ ___ contributes to delayed wound healing. Vitamin C and protein deficiency both result in impaired ___ synthesis. Zinc deficiency inhibits replacement of ____ collagen to ___ collagen.

A

Nutritional deficiencies
Collagen
Type III
Type I

39
Q

____/____: can contribute to delayed wound healing. They reduce inflammation but also inhibit fibrosis (this can be good or bad).

A

Medications/steroids

40
Q

___ ___ can contribute to delayed wound healing. Healing wounds are weaker than native tissue and can be pulled apart

A

Mechanical stress

41
Q

____: is poor perfusion that can contribute to delayed wound healing. Lack of nutrients needed for repair.

A

Ischemia

42
Q

___ ___ can lead to delayed wound healing by serving as continued stimuli for chronic inflammation and ongoing injury

A

Foreign material

43
Q

____ is rupture of a wound, most common after abdominal surgery

A

Dehiscence

44
Q

____ ___ is excess production of scar tissue that is localized to the wound

A

Hypertrophic scar

45
Q

____ is excess production of scar tissue that is out of proportion to the wound. Characterized by excess ____ collagen. It classically affects earlobes, face, and upper extremities.

A

Keloid
Type III

46
Q

Pictures of hypertrophic scar:
It is limited to boundaries of original wound.

A
47
Q

Picture of keloids:

A
48
Q

Microscopy of keloid scarring:
Contains keloidal collagen that are disorganized

A
49
Q

Scar ____ is an exaggeration of normal contraction of the wound during healing. Prone to developing in the palms, soles, and anterior aspect of the thorax

A

Contracture

50
Q

____ ___: a sutured surgical incision with tightly apposed edges
___ ___: a wide open wound due to more inflammation and more granulation tissue

A

First intention
Second intention

51
Q

____ ____ plays a major role in ultimate wound closure.

A

Myofibroblastic contraction

52
Q

Cutaneous wound healing picture :

A
53
Q

Macrophages largely replace neutrophils by day 3. Granulation tissue starts to develop.

A
54
Q

Day 5: _____ aided by ___ and granulation tissue peaks. Fibroblasts begin to lay down type III collagen

A

Neovascularization
VEGF

55
Q

Two weeks: type I collagen replaces Type III and greatly increases cellularity and blood vessels decrease

A
56
Q

1 month: cellularity markedly diminished and scar contracts via action of ____.

A

Myofibroblasts

Exam 4 (13 decks)

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