Wounds and Wound Healing Flashcards
1
Q
___ is growth of cells and tissues to replace lost structures (involves stem cells)
A
regeneration
2
Q
____, versus actual regeneration, occurs when the body is trying to restore the functional capacity without necessarily reconstituting the original anatomy (no stem cells)
A
compensatory growth
3
Q
if tissue cannot regenerate or have complete restitution of tissue, a scar is produced which provides structural stability so the neighboring tissue can work properly– this is called
A
connective tissue deposition
4
Q
___ is fibrosis developing in a tissue with inflammatory exudate
A
organization
5
Q
____ are able to differentiate into multiple cell lineages and have self-renewal properties
A
stem cells
6
Q
___ tissues have cells continuously lost and replaced by maturation of stem cells and proliferation of mature cells–these cells are the best at regeneration
A
labile
7
Q
___ tissues have cells that are largely quiescent but can divide in response to injury or loss of tissue mass–have a limited ability to regenerate
A
stable
8
Q
___ tissues are terminally differentiated and nonproliferative–they do not divide
A
permanent
9
Q
cell ___ is driven by signals provided by growth factors and from the extracellular matrix
A
proliferation
10
Q
___ are the most common source of growth factors after injury
A
macrophages
11
Q
What is the 5 most important growth factors?
A
VEGF, EGF, TNF, TGFbeta, PDCF
12
Q
____ are macromolecules outside the cell that influence cell function; they form a network in which the cells live and a reservoir for growth factors and regulate cell differentiation
A
extracellular tissue matrix
13
Q
What are the 2 fibrous structural proteins of the ECM?
A
collagen and elastin
14
Q
___ is responsible for tissue strength
A
collagen
15
Q
The ECM has collagen and elastin as well as ____, ____, and hyaluronic acid
A
adhesive glycoproteins, proteoglycans
16
Q
___ is the most common protein with a rope-like structure like a helix
A
collagen
17
Q
Type __ collagen is the most common and provides tensile strength to tendons and cornea
A
1
18
Q
Type __ collagen is thinner and seen in distensible organs
A
3
19
Q
Type _ collagen is present in a new wound and is later replaced by Type _ collagen
A
3; 1
20
Q
Type _ collagen is fibrillar in structure but is found in cartilage and intervertebral discs
A
2
21
Q
Type _ collage is nonfibrillar sheets found in basement membrane and laminin
A
4
22
Q
The first step in production of fibrillar collagen is when the ___ produces two types of pro-alpha collagen
A
cell
23
Q
The 2nd step in production of fibrillar collagen has the cell enter the ER and undergo hydroxylation of proline and lysine, which requires ____ as a cofactor, and glycation
A
Vitamin C
24
Q
The 3rd step in production of fibrillar collagen is when three strands are twisted to form ____ which then leaves the cell
A
procollagen
25
The 4th step in production of fibrillar collagen is after the procollagen leaves the cell and peptidases clip off terminals to form ___
tropocollagen
26
The tropocollagen produced in the 4th step of fibrillar collagen production is able to form ____ which are cross-linked and assemble into fibrils
microfibrils
27
Most of the amino acids in collagen are ___ and many of the others are proline or hydroxyproline
glycine
28
The major disease caused by defects in collagen synthesis is ___
Ehler Danlos
29
The defect in Ehler Danlos is in the ____, resulting in markedly hyperextensible elastic and thin skin that is easily torn and scarred, hypermobile joints with recurrent dislocations, scoliosis, mitral valve prolapse, arterial vessel rupture, eye rupture (cornea), and retinal detachment
synthesis or structure of the fibrillar collagen tissue itself
30
____ is an inherited skeletal disorder that causes dwarfism; it affects type 2 collagen found in cartilage and can range in severity from lethal to early degenerative joint disease
Chondrodysplasia
31
____ is a group of disorders due to deficiencies in synthensis of Type 1 collagen; it is the most common inherited connective tissue disorder; it results in brittle bone disease with multiple fractures and bone deformities. It clinically presents with blue sclera
Osteogenesis imperfecta
32
Scurvy is a deficiency in ____ that leads to decreased hydroxylation of procollagen (proline and lysine) which reduces the cross-linking of collagen and impaired formation of mature connective tissue
Vitamin C
33
___ is a complex polymer of at least 19 proteins that are very resistant to breakdown
elastic fiber
34
There is a specific cross-linking of elastin fibers that creates a new amino acid called ___ that can be measured in the urine to see tissue breakdown
desmosine
35
The most common disease caused by a defect in elastic tissue synthesis
Marfan
36
Marfan's genetic mutations are in the fibrillin gene which is a glycoprotein of elastin associated microfibrils; clinical features are due to abnormal ___ fibers and excessive activation of ____
elastin fibers and excessive activation of TGFbeta
37
The biggest problem associated with Marfan syndrome is cardiovascular abnormalities that include ___, ____, and ___
mitral valve prolapse, aortic root abnormalities, and aortic dissection
38
___ is an acquired elastic tissue defect caused by increased cross-linking in arteries, increased acidic amino acids binding to calcium, and arteries become less resilient and calcify...wrinkles!
aging
39
___ is an acquired elastic tissue defect where chronic skin changes occur due to sun exposure
solar elastosis
40
___ is when a lesion does not extend through the epithelial layer; it is a superficial wound
erosion
41
___ is when a lesion extends through the epithelial layer
ulceration
42
___ is an irregular wound through the epithelial layer
laceration
43
___ is a regular wound, usually from surgery
incision
44
___ is when the superficial epidermis is torn off by friction or force; scrape
abrasion
45
___ is the formation of new blood vessels in response to growth factors
angiogenesis
46
___ is the growth factor responsible for angiogenesis and it increases vascular permeability
VEGF
47
___ is the hallmark of would healing; it is made up of fibroblasts, loose CT, vessels, and WBCs
formulation of granulation tissue
48
___ is the removal of granulation tissue and formation of scar
remodeling
49
What are the 3 phases of skin wound healing?
1-inflammation
2-proliferation and granulation tissue formation
3-maturation--scarring and tissue remodeling
50
How do macrophages play a role in connective tissue deposition?
1-clear offending agents and dead tissue
2-provide growth factors
3-secrete cytokines to stimulate fibroblast proliferation and connective tissue synthesis and deposition
51
____ is the growth factor most important for angiogenesis
VEGF
52
___ is the growth factor most important in stimulating connective tissue production for healing but it can lead to fibrosis
TGFbeta
53
___ are enzymes for remodeling
MMP
54
What are the 3 functions that platelets have that play a key role in connective tissue deposition?
1-hemostasis: stop bleeding
2-inflammation: release chemotactic factors
3-wound healing:PGDF, serotonin, prostaglandins
55
___ is the growth factor that stimulates fibrogenesis
PDGF
56
Granulation tissue is formed in response to angiongenic factors released by ___ and inflammatory cells
platelets
57
Connective tissue is produced by ___
fibroblasts
58
Wound contraction occurs by movement of the edges of the wound toward the middle by contractile fibers of ____ that are derived from fibroblasts
myofibroblasts
59
Connective tissue remodeling begins after _ weeks and continues for months--it requires a balance between ECM synthesis and degradation by MMPs
3
60
The type of collagen changes during connective tissue remodeling from type _ to type _ so it is less flexible and stronger
3; 1
61
After about 3 months, the wound reaches ___ strength which is about the maximum
70-80%
62
___ is when the wound is closed by bringing the opposing edges together intentionally
primary repair/ repair by first intention
63
___ is when the wound is left with separated edges because there is a greater inflammatory response and a larger amount of granulation tissue
secondary repair/ closure by second intention
64
What are the 7 local impediments to wound healing?
1-wound infection (single most important)
2-mechanical factors--early motion, local pressure
3-foreign bodies
4-local tissue hypoxia, inadequate blood supply, large size
5-tissue dessication or drying
6-excessive wound exudates
7-aging
65
What are the 4 systemic factors that impede wound healing?
1-inadequate nutrition (not enough protein or Vit C)
2-diabetes or poor metabolic status
3-poor circulatory status
4-hormones like glucocorticoids
66
How do glucocorticoids impede wound healing?
they are anti-inflammatory; they inhibit TBGbeta and therefore inhibit collagen synthesis
67
___ is a bacterial infection with non-replicating bacteria
contamination
68
___ is when there are replicating bacteria present which do not cause a tissue response
colonization
69
a ___ infection in a wound has altered healing but no outward signs of infection
local
70
a ___ wound looks infected to the naked eye
infected
71
a ___ is a community of microbes encased in an extracellular matrix; it provides a safe haven for pathogenic bacteria
biofilm
72
Sometimes foreign materials may be the source of bacteria in a wound and it makes the infection harder to treat by what two things
1-reduces the infectious dose required to cause problem
| 2-allows biofilm formation
73
a ___ operative wound is typically elective, nontraumatic, with no breaks in technique--an infection rate less than 4%
clean
74
a ___ operative wound enters the GI, respiratory, GU tracts and has a break in technique with an infection rate of 3-4%
clean contaminated
75
a ___ wound is a fresh traumatic wound, gross spillage from GI tract, infected GU tract, major break in technique, infection rate of 8.5%
contaminated
76
a ____ wound is trauma with dead tissue, foreign bodies, feces, perforated viscus, and pus--the wound is left open--infection rate of up to 40%
dirty
77
a ____ operative wound infection is above the fascia and occurs within 30 days of surgery; there is purulent discharge and the wound is opened deliberately by the surgeon
superficial
78
a __ operative wound infection is below the fascia that happens within 30 days unless there is a prosthesis in which case it is up to a year--the wound spontaneously dehisces or a surgeon opens it when the pt has fever or pain; there may be abscess
deep
79
Deep operative wound infections are majority due to ____ or ____ bacteria unless it was a dirty wound
skin or mucosal bacteria
80
Inadequate formation of granulation tissue or assembly of a scar can lead to wound ___ and/or ____ (the second one occurs in areas of poor vascularization)
dehiscence and/or ulceration
81
____ ulcers occur on thin, shiny, hairless skin usually over the lateral leg, with a lack of good granulation tissue and lack of epithelialization at the borders
arterial
82
___ ulcers often occur over the medial malleolus and are associated with venous insufficiency and fibrin leakage from vessels with sclerosis
venous
83
Atherosclerosis, arteritis, vasculitis, embolism, and sickle cell disease are associated with ___ ulcers
arterial
84
Stasis dermatitis, hyperpigmentation, atrophie blanche and irregular borders are associated with ___ ulcers
venous
85
____ is often due to venous stasis or DVT where there is a thickening of the dermis and subcutaneous scar-like tissue, fibrosis of subcutaneous fat, and "beer bottle" deformity
lipodermatosclerosis
86
___ ulcers are due to continuous injury concentrated in one area--they tend to be non-painful and often over the first metatarsal head and first toe; often in pts with DM or spinal cord issues
neuropathic
87
____ or "proud flesh" is reepithelialization of an injury that grows up higher than the wound itself and often is surgically resected
exuberant granulation tissue
88
a ___ is an exuberant granulation tissue that does not overgrow the original injury and tends to regress over time
hypertrophic scar
89
___ are an overgrowth of scar tissue that extend beyond the wound border and do not regress; they often recur after excision
keloids
90
In keloids ___ cells are increased which results in itching
mast cells
91
____ are exuberant proliferations of fibroblasts and other connective tissue elements that can recur; these straddle the line between benign proliferations and malignant tumors; they are relatively uncommon
desmoid tumors
92
a ___ is a fixed deformity caused by excessive wound contraction
contracture
93
When a wound is "stuck" in the inflammatory phase, ___ and ___ (cytokines) are high--possibly due to wound infection
IL-1 and TNF
94
Which bacteria is most likely to cause a problem in wounds?
Staph aureus
95
___ is the body's reaction to persistent or repeated insults leading to chronic inflammation and then chronic repair; there is a progressive increase in the amount of collagen; TGFbeta plays a key role
fibrosis
96
a ___ is something that easily bleeds, often at the site of trauma--it almost looks like a cyst
pyogenic granuloma
97
a stage _ pressure ulcer is non-blanching erythema of intact skin
1
98
a stage _ pressure ulcer has partial thickness skin loss
2
99
a stage _ pressure ulcer has full thickness skin loss not involving the fascia--requires debridement and IV antibiotics
3
100
a stage _ pressure ulcer has full thickness skin loss with extensive tissue destruction including bone and muscle
4
