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STEP 2: Inflammation PATHOMA > WOUND HEALING > Flashcards

WOUND HEALING Flashcards

1
Q

What are the 3 types of tissues based on REGENERATIVE CAPACITY?

A
  1. LABILE
  2. STABLE
  3. PERMANENT
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2
Q

Describe the regeneration process of LABILE tissues.

A

Labile tissues contain STEM CELLS that continuously cycle to regenerate new tissue

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3
Q

Name some labile tissues.

A

GI - Small bowel and large bowel
Skin
Lung
Bone marrow

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6
Q

Where are the stems cells of the SMALL/LARGE BOWEL located in?

A

BASE of intestinal crypts

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7
Q

Where are the stem cells of the skin located in?

A

STRATUM BASALIS of dermis

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8
Q

What are the stem cells of the bone marrow? What is the marker of these cells?

A

HSC - Marker = CD34+***

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9
Q

Describe the regeneration process of STABLE tissue.

A

Stable tissue cells are quiescent (Go) BUT can exit and re-enter cell cycle to regenerate when necessary -> Re-enter quiescence

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10
Q

What is the difference between GRANULOMA and GRANULATION TISSUE?

A

Granuloma = subtype of chronic inflammation (=Epithelioid histiocytes* + multinucleated giant cells/lymphocytic rim)

Granulation tissue = initial phase of REPAIR in wound healing (=Fibroblasts secreting Type III*collagen + Capillaries providing nutrients + Myofibroblasts contracting wound)

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11
Q

What are the stem cells of the lung?

A

TYPE II PNEUMOCYTE

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12
Q

Name two STABLE tissues.

A
  1. LIVER: Partial resection -> Hepatocytes exit quiescence -> Each hepatocyte produces additional cells -> Re-enter quiescence = COMPENSATORY HYPERPLASIA
  2. RENAL PCT: Takes some time for regeneration of this stable tissue. After ATN -> Pt requires dialysis for support until renal PCT fully regenerates
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13
Q

Name 3 permanent tissues. Do permanent tissues undergo REGENERATION or REPAIR?

A

Permanent tissues undergo REPAIR (=fibrosis + scar) since they lack stem cells

  1. Myocardial muscle - POST-MI: White fibrotic scarring
  2. Skeletal muscle
  3. Neurons
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14
Q

When are two circumstances that FIBROTIC SCAR REPAIR occur?

A
  1. When stem cells of LABILE or STABLE tissue are lost - e.g. deep skin cut (steak knife) to a point that stratum basalis is lost
  2. Healing of a PERMANENT TISSUE (e.g. myocardial muscle)
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15
Q

What distinguishes GRANULATION TISSUE from SCAR formation?

A

Granulation tissue = initial phase of repair (Type III collagen)

Scar formation = eventually replaces granulation tissue (Type I collagen) by COLLAGENASE

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16
Q

What is the co-factor required for COLLAGENASE to replace Type III Collagen with Type I collagen in the final phase of scar formation in REPAIR?

A

ZINC

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17
Q

Where is TYPE ONE I Collagen found in? What is its function?

A

BONES, SKIN, TENDONS, Most organs

Provide HIGH TENSILE STRENGTH (support and stability)

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18
Q

Where is Type TWO II Collagen found in?

A

CARTILAGE

Cart-TWO-lage

19
Q

Where is Type III collagen found in? What is its function?

A

BV + Granulation tissue + Embryonic Tissue + Uterus + Keloids
Provides pliability and flexibility

20
Q

Where is Type IV collagen found in?

A

Basement membrane

21
Q

Mechanism of tissue regen/repair: What is TGF-alpha?

A

FIBROBLAST and EPITHELIAL growth factor

22
Q

Mechanism of tissue regen/repair: What is TGF-beta?

A

Fibroblast Growth factor + Anti-inflammatory

23
Q

Mechanism of tissue regen/repair: What is PDGF?

A

Platelet-derived growth factor = Growth factor for ENDOTHELIUM + SMOOTH MUSCLE (BV) + FIBROBLASTS

24
Q

Mechanism of tissue regen/repair: What is FGF?

A

Important for ANGIOGENESIS + Skeletal muscle dvlm/endochondral bone formation

25
Q

Mechanism of tissue regen/repair: What is VEGF?

A

Vascular endothelial growth factor - Important for Angiogenesis

26
Q

What type of CUTANEOUS HEALING is the suturing of a surgical incision in the ER?

A

PRIMARY INTENTION: Edges ARE approximated to fill the defect and have the skin heal on its own

27
Q

Pt has a large wound healed by SECONDARY intention. 6wks later, you notice that the wound has significantly reduced in size. What is the mechanism of this size reduction?

A

MYOFIBROBLASTS of the granulation tissue

Secondary intention- Edges are NOT approximated and defect is filled with granulation tissue (= BV + fibroblasts + myofibroblasts that contract the wound)

28
Q

How does VitC Deficiency result in delayed, aberrant healing?

A

VitC = important co-factor of HYDROXYLASE that hydroxylates Pro/Lys residues necessary for cross-linking the collagen

29
Q

What are 3 possible pathologies that result in DELAYED ABERRANT wound healing?

A

Deficiencies of Zn, VitC, and Cu

30
Q

How does Zn Deficiency result in delayed, aberrant healing?

A

Zn = important co-factor of COLLAGENASE that replaces Type III collagen (secreted by myofibroblasts of granulation tissue) with Type I collagen (scar formation)

31
Q

How does Cu Deficiency result in delayed, aberrant healing?

A

Cu = important co-factor of LYSYL oxidase that cross-links the hydroxylated Lys residue of collagen molecules to form STABLE TYPE I COLLAGEN

32
Q

What is the most common cause of delayed, aberrant wound healing?

A

INFECTION - most commonly by S.aureus

Continued inflammation resulting in impaired wound healing

33
Q

Pt is an African American** who recently got her ear pierced. She noticed a large tumor-like mass growing out of her earlobes. What does she have?

A

KELOID = Excessive granulation tissue formaiton during tissue repair (THICK PINK COLLAGEN BUNDLES on histology)
Genetic predisposition to African Americans, Type III collagen
Classically affects earlobes, face, UE

34
Q

What are other causes of DELAYED aberrant wound healing?

A
  1. Foreign body - Induces chronic inflammation and is a cuase of non-caseating granuloma formation
  2. Ischemia - Lack of blood supply
  3. Diabetes
  4. Malnutrition - Lack of building blocks for wound healing
35
Q

COMPLICATION 1 OF WOUND HEALING: What is it called when a wound ruptures? When does this most commonly occur?

A

DEHISCENCE

Most commonly after abdominal surgery

36
Q

COMPLICATION 2 OF WOUND HEALING: What is it called when there is excess scar tissue localized to the wound? What collagen is it made of?

A

HYPERTROPHIC SCAR made of TYPE I COLLAGEN

37
Q

COMPLICATION 3 OF WOUND HEALING: What is it called when there is excess production of scar tissue OUT OF PROPORTION to the wound? What collagen is it made of? Where is it most commonly found?

A

KELOID made of TYPE III COLLAGEN

Most commonly found in the EARLOBES

38
Q

Which pathology is associated with type I collagen failure?

A

OSTEOGENESIS IMPERFECTA

39
Q

Which pathology is associated with type III collagen failure?

A

EHLERS-DANLOS SYNDROME Type 3 and 4 - Failure of granulation tissue, skin

40
Q

Which pathology is associated with type IV collagen failure?

A

ALPORT SYNDROME (Failure of basement membrane)

STEP 2: Inflammation PATHOMA (4 decks)

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