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Gen Path > Tissue Repair > Flashcards

Tissue Repair Flashcards

1
Q

What are the 4 stages of tissue repair?

A
  1. Hemostasis
  2. Inflammation
  3. Proliferation and granulation
  4. Remodeling
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2
Q

Hemostasis

A

Occurs immediately

  1. Vasoconstriction
  2. Platelets adhere to exposed collagen
  3. Platelets secrete vasoconstrictive substances - TGF-B and PDGF - that initiate thrombogenesis and angiogenesis
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3
Q

Proliferation

A

Lasts 3-4 weeks

Involves:

  1. Endothelium (angiogenesis)
  2. Epithelium (epithelialization)
  3. CT (fibroplasia/desmoplasia)
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4
Q

What are the two requirements for proliferation?

A
  1. Retention of stromal elements of ECM

2. Normally functioning fibroblasts/endothelial cells/epithelial cells

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5
Q

Remodeling

A

3-4 weeks post-injury

  • Deposition of collagen
  • Only in tissues that cannot regenerate fully

Two parts:

  • Remodeling w/ immature CT
  • Maturation of collagen
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6
Q

Which cytokines participate in remodeling?

A 
TGF-B
PDGF
FGF-2
MMPs
Tissue inhibitors of MMP (TIMPs)
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7
Q

Describe the histological appearance of fibroblasts

A

Heterochromatic nuclei surrounded by wavy eosinophilic collagen

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8
Q

Which 2 factors stimulate angiogenesis in chronic inflammation?

A
  1. Hypoxia
  2. Endothelial cell growth factors
    - FGF
    - VEGF
    - PDGF
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9
Q

Which cell types produce metaloproteinase?

A

Macrophages
Fibroblasts
Mast cells
Leukocytes

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10
Q

What is a cofactor of metaloproteinases?

A

Zinc

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11
Q

Steps of scar formation

A
  1. Angiogenesis
  2. Immature granulation tissue formation
  3. Remodeling of immature granulation tissue (maturation)
  4. Wound contraction
  5. +/- fibrosis

AIR CF

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12
Q

Steps of angiogenesis

A
  1. Vasodilation/increased permeability
  2. Separation of pericytes/breakdown of basement membrane
  3. Migration of endothelial cells toward injury
  4. Proliferation of endothelial cells and remodeling into capillary tubes
  5. Suppression of endothelial proliferation and deposition of basement membrane
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13
Q

Describe appearance of granulation tissue

A

Grossly: hemorrhagic and friable

Histologically:

1) Proliferating capillaries - vertical
2) CT fibers - parallel to wound

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14
Q

Proud flesh is an example of

A

Granulation tissue

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15
Q

Describe the histological changes that occur as granulation tissue matures

A

Immature granulation:

  • Hypertrophic (plump) endothelial cells
  • Inflammatory cells (i.e. neutrophils/lymphocytes/plasma cells)
  • Very little collagen (pink material)
  • Mostly pale (due to edema)

Mature granulation

  • More eosinophilic material (pink) between cells -> collagen
  • Flat endothelial cells
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16
Q

What causes wound contraction?

A

Collagen

17
Q

Describe the gross and histological appearance of wound contraction

A

Grossly: Nodes/lumps

Histologically: Undulanting margins

18
Q

True or false: Kidneys can regenerate and do not form scars

A

False; kidneys cannot regenerate and therefore scar

19
Q

Which stain is used for collagen and what color does it stain it?

A

Trichrome stains collagen blue

20
Q

VEGF (vascular endothelial growth factor)

A
  1. Initiates capillary sprouting/proliferation of endothelial cells
  2. Increases vascular permeability
21
Q

FGFs (Fibroblast growth factors)

A
  1. Stimulate proliferation of endothelial cells

2. Promotes migration of macrophages, fibroblasts, and epithelial cells to injury

22
Q

Angiopoietins 1 and 2

A
  1. Angiogenesis

2. Maturation of vessels

23
Q

TGF-B

A
  1. suppresses endothelial proliferation
  2. promote ECM protein ad collagen production
  3. Induces macrophage chemotaxis
  4. Induces fibroblast migration/proliferation

Produced by platelets and macrophages

24
Q

PDGF

A

Recruits smooth muscle

25
Q

Notch signaling

A
  1. Interacts w/ VEGF

2. Regulates new vessel formation

26
Q

Primary Intention Healing

A
  • Begins after 2-3 days
  • Cut edges apposed an non-septic
  • Debris removed by phaocyrtosis
  • W/in weeks, ECM replaced by collagen
27
Q

Second Intention Healing

A
  • Prominent wound contraction mediated by myofibroblasts
  • Delayed epithelialization
  • Granulation tissue scaffold is transformed into PALE, AVASCULAR tissue
  • Dermal adnexa PERMANENTLY destroyed

Gen Path (7 decks)

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