Week 1 Flashcards
body defense system
- non-specific / general
- specific
what mediates specific defense system
B-cells = humoral immunity = antigen specific ABs
T-cells = cell-mediated immunity = triggers apoptosis in infected cells
irreversible injury leads to __
necrosis & apoptosis
cellular adaptation types
Hand HM
- hyperplasia
- atrophy
- neoplasia
- dysplasia
- metaplasia
- hypertrophy
atrophy
size reduction
hyperplasia
increase in number of cells due to cell proliferation stimulation
hypertrophy
increase in cell size
metaplasia
healthy mature cells replaced by different kind of mature cells in same tissue such as changes in morphology & function
dysplasia
abnormal growth of other cells types within tissues
neoplasia
uncontrolled growth of tissues which may be malignant
cell injury causes
genetics, environment, infections, damage, foreign body, electrolyte imbalance
phases of repair in acute wound healing
hemostasis > inflammation > proliferation > remodeling
HIPR
how long does inflammation take
0.1 - 10 days after wounding
how long does cell proliferation & matrix deposition
1 - 30 days
how long does matrix remodeling occur
1 - 300 days
hemostasis
clot formation to stop bleeding
primary vs secondary hemostasis
primary = initial clot to form primary platelet plug
secondary = strengthening clot via coagulation cascade such as fibrinogen > fibrin
aim of inflammation
- eliminate initial cause of injury
- initiate repair process
inflammatory response steps
- injury
- chemical mediators released
- vasodilation
- increased capillary permeability
- leukocytes move to injury
- phagocytosis
list 2 hormones that promote inflammation
bradykinin & histamine
vascular events of acute inflammation
redness > head > swelling > pain
erythema
redness of skin
cellular events of acute inflammation
fluid exudation > stasis > margination > diapedesis > chemotaxis
stasis
RBC engorgement in vessels
margination
WBC accumulate & adhere to vessel wall
diapedesis
oozing of WBC out of blood vessel
chemotaxis
directional migration of WBC to injury site
leukocyte examples
neutrophils, basophils, eosinophils
neutrophil function
microbe phagocytosis
basophil function
histamine release causing inflammation
eosinophils function
enhances allergic response
lymphocyte examples
T-cells, B-cells, macrophages
T-cell function
activates cell mediated immune response
B-cell function
antibody production
macrophages function
matured monocytes for phagocytosis
how is injury cause eliminated during inflammation
degradation & removal of necrotic tissue via neutrophils & macrophages
how does differential count assist with inflammation diagnostic testing
distinguish type of bacterial infections
high eosinophil count indicates
allergic response
high neutrophil count indicates
pyogenic bacterial infection
high lymphocyte count indicates
viral infection
high basophil count indicates
parasitic infection
how does cell enzymes assist with inflammation diagnostic testing
locate site of necrotic cells
what parameters are monitored for inflammation screening
plasma proteins, C-reactive proteins, increased ESR
what parameters are unable to determine site of inflammation
plasma proteins, C-reactive proteins, increased ESR
when does C-reactive protein production increase in blood
24-48hrs
anorexia
appetite loss
characteristic differences between acute & chronic inflammation
A has more exudation & swelling than C
A involves migration of leukocytes but C has more presence of lymphocytes, macrophages, fibroblasts
C has more severe damage and scar tissue than A
causes of chronic inflammation
persistent infection, persistent indigestible material, immune mediated reactions, repeated/continuous acute inflammation
PRIP
acute management of inflammation
RICE = rest, ice, compression, elevation
non selective COX inhibitors
Naproxen + ibuprofen
selective COX inhibitors
Diclofenac, Etoricoxib
Arachidonic Acid breaks down into
COX-1 & COX-2
which COX is present in normal tissues
COX-1
which COX is induced during inflammation
COX-2
what are the products of COX-1
PGI2 & TXA2
PGI2 function
Gastric protection
TXA2 function
platelet function
what are the products of COX-2
PGE2
PGE2 effects
pain, inflammation, fever
which inflammatory stimuli stimulates COX-2
IL 1,6,8
which anti-inflammatory stimuli controls COX-2
IL-10
pharmacological effects of NSAIDs
anti-inflammatory, anti-pyretic, analgesic
how do NSAIDs have anti-inflammatory effect
decrease synthesis of prostaglandins involved in increasing vasodilation
how do NSAIDs have anti-pyretic effect
- inhibits COX-2 in hypothalamus
- IL-1 stimulates prostaglandins in hypothalamus which increases body temp
how do NSAIDs have analgesic effect
reduces peripheral prostaglandin synthesis which sensitizes nociceptors to inflammatory mediators
diff ways to administer glucocorticoids
- PO; orally
- intramuscularly
- intravenous
- topical
- inhalation
- rectal
- inject into joints
anti-inflammatory mechanisms of glucocorticoids
inhibits NKfB = inhibits production of inflammatory cytokines, chemokines, adhesion molecules
inhibits phospholipase A2 & cox enzyme = decreases PG, thromboxane production
increases transcription of anti-inflammatory
ASA
aminosalicyclic acid
ASA mechanism of anti-inflammatory action
irreversibly inhibits COX-1 & 2
weakly selective to COX-1
Acetaminophen mechanism of anti-inflammatory action
selective COX-2 inhibitor property
NSAID mechanism of anti-inflammatory action
competitive inhibitor of COX-1 & 2
both ibuprofen & naproxen weakly selective to COX-1
glucocorticoids mechanism of anti-inflammatory action
inhibits NFkB
increases transcription of anti-inflammatory proteins, IL-1 antagonist, & IL-10
COX-2 mechanism of anti-inflammatory action
competitive COX-2 inhibitor at therapeutic dose
NSAID
non-steroid anti-inflammatory drug
common synthetic corticosteroids
cortisone/hydrocortisone
prednisone/prednisolone
dexamethasone
betamethsaone
half life of cortisone/hydrocortisone
6-12 hrs
half life of prednisone / prednisolone
12 - 36 hrs; 5x more potent than hydrocortisone
half life of dexamethasone
36 - 72 hrs; 25x more potent than hydrocortisone
half life of betamethasone
36 - 72 hrs; used topically to manage skin inflammation
3 Rs of healing
resolution, regeneration, replacement
tissue healing is achieved by __
cell regeneration & replacement process
resolution happens in tissues that are ___
capable of regeneration with intact extracellular matrix framework
regeneration occurs by
replacement of damaged tissue by identical tissue via mitosis
replacement occurs when __
tissues cannot regenerate and replaced by connective tissue scars
types of tissues
labile, stable, permanent
what are labile tissues
stem/undifferentiated cells
what are stable tissues
normally low proliferative activity unless stimulated to
what are permanent tissues
left cell cycle and cannot proliferate
cell proliferation process
granulation tissue formation > collagen synthesis + laydown by fibroblasts
what is granulation tissue metabolically active with
angiogenesis & fibroblast proliferation
key building blocks of tissue healing
fibronectin, proteoglycans, elastin, collagen
function of fibronectin + proteglycans
forms scaffolding that provides tensile strength and glues cells together
function of elastin
cross linking to form fibrils that provide tissue elasticity
function of collagen
structural support & tensile strength; main determinant of structural stability of extracellular matrix
MMP
matrix metalloproteinases
type of collagen for early & late scars
early = type III
late = type I
3 determinants of complete healing
tissue type, injury nature, extent of injury
difference between necrosis & apoptosis in terms of cell size
n = enlarged
a = reduced
difference between necrosis & apoptosis in terms of nucleus
n = clumped
a = fragmented
difference between necrosis & apoptosis in terms of plasma membrane
n = disrupted
a = intact
difference between necrosis & apoptosis in terms of cellular content
n = enzymatic digestion
a = intact & packaged into apoptatic body
difference between necrosis & apoptosis in terms of inflammation
n = frequent
a = none
difference between necrosis & apoptosis in terms of causes
n = pathological
a = physiological & pathological
coagulate necrosis
coagulation of dead cells
liquefactive
liquidifcation of dead cells
gangrenous
lack of blood supply
caseous
cheese-like necrosis
factors affecting healing
age, nutrition, circulation, existing tissues
when does collagen synthesis & fibroblast laydown occur
3-5 days post injury & continues for weeks depending on wound size
as collagen mass increases, cellularity & vascularity __
decreases
what specific plasma proteins do we look out for during diagnostic testing for inflammation
fibrinogen & prothrombin
what happens when COX-2 selective NSAIDs inhibit COX-2
decreased gastric & platelet function
analgesic
pain relief
pyretic
fever
other effects of glucosteroids
- increased blood sugar
- decreased serotonin, immunity, Ca2+ absorption
- regulates metabolism
- retains Na+
vascular events of injury
vasodilation & capillary permeability
cellular events of injury
leukocyte migration, phagocytosis
which process is important for recovery & mobility
cell proliferation
examples of labile cells
epithelial, hemopoietic stem cells
examples of stable cells
parenchymal / mesenchymal cells
examples of permanent tissues
skeletal / cardiac cells
what are essentials for recovery
Protein, Vitamin A & C
exacerbation
disease worsens
sequelae
unwanted outcome of primary condition
healing process
blood clot > inflammation > granulation tissue formation > epithelial regeneration > fibroblast laying collagen fibers > angiogenesis > cross-linking & realigning collagen fibers
pyknosis
clumped
karyorrhexis
fragmented
karyolysis
dissolution
clean vs dirty cell death
clean = apoptosis
dirty = necrosis
remodelling primarily mediated by __
matrix metalloproteinases
which enzyme indicates myocardial infarction
CK-MB isoenzyme
which enzyme indicates liver
ALT
adverse effects of NSAIDs
GI distress, stomach ulceration, allergies, blood clot delays
adverse effects of ASA
GI distress, stomach ulceration, allergies, blood clot delays
adverse effects of glucocorticoids
GI distress, stomach ulceration, allergies, blood clot delays, increased risk of infection, edema, increased BP
adverse effects of acetaminophen
none
which drug has no anti-inflammatory effect
acetaminophen
which drug has no anti-pyretic & anti-analgesia
glucocorticoids
which synthetic glucocorticoid is used topically for skin condition
betamethasone