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Medical science > week 2: chronic inflammation > Flashcards

week 2: chronic inflammation Flashcards

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USMLE® Step 1 flashcards Biology 101 flashcards
1
Q

what is chronic inflammation

A

it is when acute inflammation does not get rid of ofending agen and inflammation becomes prolonged, and collateral damge will occur

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2
Q

difference between acute and chronic inflammation

A

cell profile
- accute inflammation cell profile is mainly nuetrofils, with later attention from macrophages, chronic inflamm is more macropahes, T/B cells, it is more hypercellular

destruction and repair
- chronic inflammation is a process of destuction and repair

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3
Q

process of destruction in chronic inflammation

A

acute vascular and cellular process takes place

macrophages proliferate

phagocytose
- release growth factors (encourage repair process)
- lysosomal enzyme release (degrade cell material, has some specificity)
-causes respiritory bursts (non-specific, free radicals)
- release cytokines, MMP’s (dissolve cell material and are non-specific and damaging)

release of cytokines:
- activate surrounding cells
- activate B cells
- activate T cells
- activate endothelial cells (more adhesion)
- cause more cyokine release
- activate nuetrophils
- attract fibroplasts

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4
Q

what are the 2 types of healing that might take place after destruction

A
  • regenration: of parenchymal cells of same type
  • replacement: by connective tissue (scar) that si not functional and not as good

most of the time both take place

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5
Q

define labile cell

A

proliferate throughout life, cells are continuallly destroyed

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6
Q

define stable cells

A

low normal level of replication of tissue
- parenchymal cells (liver, kidney, pacreas)

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7
Q

define permenant cells

A

cannot be replaced
- nerve cells - CNS nuerons replaced with scar
- cardiac muscles: connective tissue scar

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8
Q

what are the 3 main phases of tissue healing

A
  • inflammation (chronic)
  • prolifferative (producing ganulation tissue
  • remodelling
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9
Q

descibe the proliferative phase

A

granulation tissue is formed

fibroplasia (fibroblasts laying down collagenous tissue)
- fibroblast drawn to wound
- macrophages release cytokines
- fibroblasts turn into myofibroblasts that proliferate into wound and “pull” it together
- produce fibronectin, collagen and ground substance
- type 3 collagen first appears 48-72 hours post injury

angiogenesis (development of new blood supply to area)
- growth factors and local cytokine release
- endothelial cell sprouting
- growth of new blood vessels into area

**granulation process
**- early stage=type 3 collagen
- late=type 1
- myfibroblast contract the granulation tissue and wound becomes smaller
- increase of collagen
- decrease of active fibroblasts and new vessels
- decrease pink colour
- more scar tissue

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10
Q

describe the remodelling stage

A
  • achive a balance between tissue synthesis and degradation
  • collagen conversion type 3 to type 1, by MMP’s and acc to stress
  • wound contracts (myofibroblasts)
  • scar formation
  • driven by weight bearing
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11
Q

what does healing by primary intention mean

A

when there is a defect int he skins/tissue and it is surgically dealt with
- there is minimal loss of tissue, it is aeseptic
- we see limited number of granulation tissue, less epithelial and connective tissues killed, less scaring

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12
Q

healing by secondary intention?

A
  • lareg tissue defect that must be filled with granulation tissue
  • more fibrin, necrotic debris, exudate
  • more intense inflammation process
  • no regeneration process, it reults in conversion to a scar
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13
Q

what are some general factors that affect healing

A
  • age
  • cortiosterioids (anti-inflamm effect)
  • nutirtion (zinc, vit c)
  • blood dearrangments (defect in nuetros )
  • chronic conditions (decrease in nuetos)
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14
Q

local factors that affect healing

A
  • blood supply
  • nerve supply
  • type of tissue
  • infection
  • foreighn bodies
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15
Q

name 3 types of muscle injury

A

contusions (bruise)
strains or tears
lascerations

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16
Q

define and name 2 types of haemotomas (bruises/contrusions)

A

haemontoma: blood into tissues following an injury
intra muscular
- the pressure within the intact muscle as bleeding continues, limits the amoujnt of bleeding and haemotoma is smaller

intermuscular:
- fascia is torn, blood free access to surrounding spaces, bleeding is more excessive

intramuscualr is more painful

17
Q

define strains and name 3 types

A

extensive tensile stress placed through a muscles, leading to rupture MTJ

first degree (mild)
- fewfibres affected, minor discomfort, minimal stength and ROM loss

second degree (moderate)
- greater damage, loss of contraction ability, increased welling/ inflamm

third degree (severe)
- tear over whole muscle, fucntion lost, greater swelling, ROM impacted

18
Q

name the sections of a muscle injury

A

Central Zone (CZ)
Regereation zone (RZ)
Survival zone (SZ)

19
Q

name the phases of muscle injury

A

destruction
repair + remodelling (happen at same time)

20
Q

describe the destruction phase

A

take place in the CZ

injury occurs

haemotoma from torn blood vessels

inflammation occurs
- eg. macrophages and fibroblasts living in tissue release mediators
- attract nuetrophils and monos, begining phagocytosis
- necrosis occurs

21
Q

describe the repair phase

A
  • fibroblasts, fibronectin, proteoglycan etc. move in
  • fibroblasts turn into myofibroblasts and form granulation tissue/early scaring
  • provides very weak protection, it should be protected
  • it also provides scaffolding for new blood vessels/growth factor release (angeogenesis), and myofibres
  • some fibroblast develop contractile protiens and contract the wound
22
Q

describe the remodelling phase

A

satelite cells
- live below basement membrane
- await activation following inflammation becuase macrophages release growth factors (satelite cells)
- proliferate into myoblasts which fuse together and lay down new muscle
- Grow in toward the CZ (contraction of the injury)
- pierce into and attach onto the newly formed CT(scar) of the CZ

23
Q

what should a muscle injury look like at the end of this process

A
  • myoblasts regenerating and scar contracting to a point where we have only a small septum or portion of connective scar tissue intervening
24
Q

define myositis ossificans

A

aka: heterotrophic bone formation
- post trauma calcification occuring in muscles
- assciated with contusion injury, intramuscular haemotomas, reoccurring injury, bad management, bad/too early physiotherapy,

25
Q

what are myotis ossificans characterised by/pathphys?

A
  • local swelling
  • local tenderness
  • limited ROM/stretch of muscle
  • pathophys: unknown, could be activation of osteoblasts in muscle, or lack of o2

Medical science (8 decks)

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