tissue reponse to injury

Question 1

signs of inflammation

Answer 1

redness
swelling
tenderness
increase temperature
loss of function

Question 2

chemical mediators

Answer 2

histamine, leukotrienes and cytokines

Question 3

inflammation response phases

Answer 3

inflammation: day 1-4
fibroblastic repair phase: day 4 to week 6
maturation-remodling phase: 4 weeks to 3 years

Question 4

histamine

Answer 4

released from the injured mast cells, causes vasodilation and increased cell permeability, owing to a swelling to endothelial cells and then separation between the cells

Question 5

margination

Answer 5

leukotrienes and prostaglandins are responsible for margination: leukocytes (neutrophils and macrophages) adhere along the cell walls this will increase cell permeability affecting the passage of fluid, proteins and neutrophils though cell walls

Question 6

diapedisis

Answer 6

movement of white blood cells OUT of small arterial vessels

Question 7

exudate

Answer 7

accumulation of fluid that penetrates through vessel walls into joining extravascular space

Question 8

neutrophils

Answer 8

a type of white blood cell that engulf invading microbes and contributes to the nonspecific defences of the body against disease

Question 9

phagocytes

Answer 9

a type of white blood cell that ingests invading microbes

Question 10

vasoconstriction

Answer 10

narrowing of blood vessels

Question 11

inflammation response sequence

Answer 11

1. injury to cell
2. chemical mediators liberated (histamine, leukotrienes and cytokines)
3. vascular reaction (vasoconstriction, vasodilation and exudate creates stasis)
4. plateelts and leukocytes adhere to vascular wall
   5 phagocytosis
5. clot formation

Question 12

blood clot coagulation

Answer 12

thromboplastin
prothrombin
thrombin
fibrinogen
insoluble fibrin clot

Question 13

collagen

Answer 13

structural protein found in the skin and connective tissue

type 1: found in skin, fascia, tendon, bone, ligaments, cartilage, and interstitial tissues (*found most in fibroblastic repair phase)
type 2: found in hyaline cartilage and vertebral disks
type 3: found in skin, smooth muscle, nerves and blood vessels (less tensile strength)

Question 14

granulation tissue

Answer 14

fibroblasts, collagen and capillaries

Question 15

extracellular matrix

Answer 15

collagen, elastic, ground substance, proteoglycans, glycosaminoglycans

Question 16

maturation - remodling phases

Answer 16

a realignment or remodeling of the collagen fibers that make up scar tissue according to the tensile forces to which that scar is subjected

Question 17

fibroblastic repair phase

Answer 17

along with increased oxygen delivery comes an increase in blood flow, which delivers nutrients essential for tissue regeneration in the area. The formation of a delicate connective tissue called granulation tissue occurs with the breakdown of the fibrin clot. granulation consists of fibroblasts, collagen and capillaries.

Question 18

factors that impede healing

Answer 18

extent of injury (micro/macro tears)
edema
hemorrhage
poor vascular supply
separation of tissue
muscle spasm
atrophy
corticosteriods
kelod/hypertrophic scars
infection
humidity/climate/oxygen tension
health/age/nutrition

Question 19

ligament healing

Answer 19

• immediately after injury, ~72 hrs thee is a loss of blood from damaged vessels and attraction of inflammatory cells
• next 6 weeks, vascular proliferation w/ new capillary growth begins to occur along with fibroblastic activity, forming a fibrin clot
• gradually there is a decrease in fibroblastic activity, decrease in vascularity, and max increas in collagen density of a scar
• maturation of a scar may require at least 12 mos

Question 20

myelinated axon

Answer 20

transmission of action potential travels- acts as a catalyst to make these signals travel quicker

Question 21

schwann cell

Answer 21

supporting cells of the peripheral nervous system responsible for the formation of myelin

Question 22

NSAIDS

Answer 22

nonsteroidal antiinflammatory drugs

Question 23

therapeutic modalities

Answer 23

machines, devices, or substances that are used to enhance recovery from an injury

*heat facilitates an acute inflammatory response and cold slows down the inflammatory response

Question 24

bone healing

Answer 24

1. blood vessels are broken at the fracture line, the blood clots and forms hematoma
2. blood vessels grow into the fracture and fibrocartilage soft callus forms
3. fibrocartilage becomes ossified and forms a bony callus made up of spongy bone
4. osteoclasts remove excess tissue from the bony callus and the bon eventually resembles its original appearance

Question 25

acute pain

Answer 25

episode of pain that lasts from seconds to less than 6 months

Question 26

chronic pain

Answer 26

episode of pain that lasts for 6 months or longer

may be intermittent or continuous

Question 27

myofascial pain

Answer 27

small hyper-irritable areas within a muscle in which nerve impulse bombard the central nervous system and are expressed as a referral pain

Question 28

gate control theory

Answer 28

sensory information coming FROM cutaneous receptors in the skin enteres the ascending AB afferents and is carried to the substantia gelatinosa in the dorsal horn of the spinal cord.
likewise pain messages from the nociceptors are carried along the Ad and C afferent fibers and enter the dorsal horn.
sensory information coming from AB fibers overrids or inhibits the “pain information” carried along Ad/C fibers thus inhibiting or effectively “closing the gate” to, the transmission of pain information to second order neurons.
Pain information is not transmitted and never reaches sensory centers in the brain
this theory occurs at the spinal cord level

Question 29

neurotransmitters

Answer 29

serotonin, norepinephrine, substance P, enkephalins, beta-endorphins

Question 30

first order neurons

Answer 30

first-order or primary afferents tranmist impulses from a nociceptor to the dorsal horn of the spinal cord.

4 types:

1. Aalpha * LARGE DIAMETER
2. Abeta *LARGE DIAMETER
3. Adelta *small
4. C *smal

Question 31

efferent nerve fibers

Answer 31

nerve fiber, such as motor neurons, transmits impulses FROM the spinal cord TOWARDS the periphery

Question 32

afferent nerve fibers

Answer 32

nerve fibers transmit impulses FROM the nociceptors TOWARD the spinal cord

Question 33

A-Delta fibers

Answer 33

transmit sensation of pain and temperature
small
originate from nociceptors located in skin and transmit fast pain

Question 34

C-fibers

Answer 34

small
pain and temperature
orginate from both superficial tissure (skin) and deeper tissue (ligaments and muscles) and transmit slow pain

Question 35

neural transmission

Answer 35

first order (nociceptors to dorsal horn of spinal cord
second order (afferent carries sensory message from dorsal horn to brain and are then categorized as nociceptor specific
neuron synapse with third order which carry information via ascending spinal tracts to various brain centers, where the input is integrated, interpreted and acted upon

Question 36

descending pathway pain control

Answer 36

previous experiences, emotional influences, sensory perception, and other factors could influence the transmission of pain messages and thus the perception of pain
the information coming from higher centers in the brain along efferent descending pathways in the spinal cord causes a release of two neurotransmitter like substances, enkephalin and norepinephrine, into the dorsal horn, which together block or inhibit the synaptic transmission of impulses from the Adelta and C afferent to second-order afferent neurons

Question 37

beta endorphin

Answer 37

pain (noxious) stimulation of nociceptors resultant in the transmission of the pain information along adelta and C afferents can stimulate the release of an opiate like chemical called beta endorphin from the hypothalamus and anterior pituitary. Beta-endorphin is endogenous to the central nervous system and is konwn to have strong analgesic effects. The exact mechanism by which beta-endorphin produces these potent analgesic effect are unclear. Acupuncture, acupressure, point stim using electrical currents are all techniques that may stimulate the release of beta endorphin.