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Patho Exam 1 > Wounds and Wound Healing > Flashcards

Wounds and Wound Healing Flashcards

1
Q

___ is growth of cells and tissues to replace lost structures (involves stem cells)

A

regeneration

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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

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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

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4
Q

___ is fibrosis developing in a tissue with inflammatory exudate

A

organization

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5
Q

____ are able to differentiate into multiple cell lineages and have self-renewal properties

A

stem cells

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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

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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

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8
Q

___ tissues are terminally differentiated and nonproliferative–they do not divide

A

permanent

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9
Q

cell ___ is driven by signals provided by growth factors and from the extracellular matrix

A

proliferation

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10
Q

___ are the most common source of growth factors after injury

A

macrophages

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11
Q

What is the 5 most important growth factors?

A

VEGF, EGF, TNF, TGFbeta, PDCF

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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

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13
Q

What are the 2 fibrous structural proteins of the ECM?

A

collagen and elastin

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14
Q

___ is responsible for tissue strength

A

collagen

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15
Q

The ECM has collagen and elastin as well as ____, ____, and hyaluronic acid

A

adhesive glycoproteins, proteoglycans

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16
Q

___ is the most common protein with a rope-like structure like a helix

A

collagen

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17
Q

Type __ collagen is the most common and provides tensile strength to tendons and cornea

A

1

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18
Q

Type __ collagen is thinner and seen in distensible organs

A

3

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19
Q

Type _ collagen is present in a new wound and is later replaced by Type _ collagen

A

3; 1

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20
Q

Type _ collagen is fibrillar in structure but is found in cartilage and intervertebral discs

A

2

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21
Q

Type _ collage is nonfibrillar sheets found in basement membrane and laminin

A

4

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22
Q

The first step in production of fibrillar collagen is when the ___ produces two types of pro-alpha collagen

A

cell

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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

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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

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25
Q

The 4th step in production of fibrillar collagen is after the procollagen leaves the cell and peptidases clip off terminals to form ___

A

tropocollagen

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26
Q

The tropocollagen produced in the 4th step of fibrillar collagen production is able to form ____ which are cross-linked and assemble into fibrils

A

microfibrils

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27
Q

Most of the amino acids in collagen are ___ and many of the others are proline or hydroxyproline

A

glycine

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28
Q

The major disease caused by defects in collagen synthesis is ___

A

Ehler Danlos

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29
Q

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

A

synthesis or structure of the fibrillar collagen tissue itself

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30
Q

____ 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

A

Chondrodysplasia

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31
Q

____ 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

A

Osteogenesis imperfecta

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32
Q

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

A

Vitamin C

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33
Q

___ is a complex polymer of at least 19 proteins that are very resistant to breakdown

A

elastic fiber

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34
Q

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

A

desmosine

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35
Q

The most common disease caused by a defect in elastic tissue synthesis

A

Marfan

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36
Q

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 ____

A

elastin fibers and excessive activation of TGFbeta

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37
Q

The biggest problem associated with Marfan syndrome is cardiovascular abnormalities that include ___, ____, and ___

A

mitral valve prolapse, aortic root abnormalities, and aortic dissection

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38
Q

___ 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!

A

aging

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39
Q

___ is an acquired elastic tissue defect where chronic skin changes occur due to sun exposure

A

solar elastosis

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40
Q

___ is when a lesion does not extend through the epithelial layer; it is a superficial wound

A

erosion

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41
Q

___ is when a lesion extends through the epithelial layer

A

ulceration

42
Q

___ is an irregular wound through the epithelial layer

A

laceration

43
Q

___ is a regular wound, usually from surgery

A

incision

44
Q

___ is when the superficial epidermis is torn off by friction or force; scrape

A

abrasion

45
Q

___ is the formation of new blood vessels in response to growth factors

A

angiogenesis

46
Q

___ is the growth factor responsible for angiogenesis and it increases vascular permeability

A

VEGF

47
Q

___ is the hallmark of would healing; it is made up of fibroblasts, loose CT, vessels, and WBCs

A

formulation of granulation tissue

48
Q

___ is the removal of granulation tissue and formation of scar

A

remodeling

49
Q

What are the 3 phases of skin wound healing?

A

1-inflammation
2-proliferation and granulation tissue formation
3-maturation–scarring and tissue remodeling

50
Q

How do macrophages play a role in connective tissue deposition?

A

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
Q

____ is the growth factor most important for angiogenesis

A

VEGF

52
Q

___ is the growth factor most important in stimulating connective tissue production for healing but it can lead to fibrosis

A

TGFbeta

53
Q

___ are enzymes for remodeling

A

MMP

54
Q

What are the 3 functions that platelets have that play a key role in connective tissue deposition?

A

1-hemostasis: stop bleeding
2-inflammation: release chemotactic factors
3-wound healing:PGDF, serotonin, prostaglandins

55
Q

___ is the growth factor that stimulates fibrogenesis

A

PDGF

56
Q

Granulation tissue is formed in response to angiongenic factors released by ___ and inflammatory cells

A

platelets

57
Q

Connective tissue is produced by ___

A

fibroblasts

58
Q

Wound contraction occurs by movement of the edges of the wound toward the middle by contractile fibers of ____ that are derived from fibroblasts

A

myofibroblasts

59
Q

Connective tissue remodeling begins after _ weeks and continues for months–it requires a balance between ECM synthesis and degradation by MMPs

A

3

60
Q

The type of collagen changes during connective tissue remodeling from type _ to type _ so it is less flexible and stronger

A

3; 1

61
Q

After about 3 months, the wound reaches ___ strength which is about the maximum

A

70-80%

62
Q

___ is when the wound is closed by bringing the opposing edges together intentionally

A

primary repair/ repair by first intention

63
Q

___ is when the wound is left with separated edges because there is a greater inflammatory response and a larger amount of granulation tissue

A

secondary repair/ closure by second intention

64
Q

What are the 7 local impediments to wound healing?

A

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
Q

What are the 4 systemic factors that impede wound healing?

A

1-inadequate nutrition (not enough protein or Vit C)
2-diabetes or poor metabolic status
3-poor circulatory status
4-hormones like glucocorticoids

66
Q

How do glucocorticoids impede wound healing?

A

they are anti-inflammatory; they inhibit TBGbeta and therefore inhibit collagen synthesis

67
Q

___ is a bacterial infection with non-replicating bacteria

A

contamination

68
Q

___ is when there are replicating bacteria present which do not cause a tissue response

A

colonization

69
Q

a ___ infection in a wound has altered healing but no outward signs of infection

A

local

70
Q

a ___ wound looks infected to the naked eye

A

infected

71
Q

a ___ is a community of microbes encased in an extracellular matrix; it provides a safe haven for pathogenic bacteria

A

biofilm

72
Q

Sometimes foreign materials may be the source of bacteria in a wound and it makes the infection harder to treat by what two things

A

1-reduces the infectious dose required to cause problem

2-allows biofilm formation

73
Q

a ___ operative wound is typically elective, nontraumatic, with no breaks in technique–an infection rate less than 4%

A

clean

74
Q

a ___ operative wound enters the GI, respiratory, GU tracts and has a break in technique with an infection rate of 3-4%

A

clean contaminated

75
Q

a ___ wound is a fresh traumatic wound, gross spillage from GI tract, infected GU tract, major break in technique, infection rate of 8.5%

A

contaminated

76
Q

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%

A

dirty

77
Q

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

A

superficial

78
Q

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

A

deep

79
Q

Deep operative wound infections are majority due to ____ or ____ bacteria unless it was a dirty wound

A

skin or mucosal bacteria

80
Q

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)

A

dehiscence and/or ulceration

81
Q

____ 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

A

arterial

82
Q

___ ulcers often occur over the medial malleolus and are associated with venous insufficiency and fibrin leakage from vessels with sclerosis

A

venous

83
Q

Atherosclerosis, arteritis, vasculitis, embolism, and sickle cell disease are associated with ___ ulcers

A

arterial

84
Q

Stasis dermatitis, hyperpigmentation, atrophie blanche and irregular borders are associated with ___ ulcers

A

venous

85
Q

____ 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

A

lipodermatosclerosis

86
Q

___ 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

A

neuropathic

87
Q

____ or “proud flesh” is reepithelialization of an injury that grows up higher than the wound itself and often is surgically resected

A

exuberant granulation tissue

88
Q

a ___ is an exuberant granulation tissue that does not overgrow the original injury and tends to regress over time

A

hypertrophic scar

89
Q

___ are an overgrowth of scar tissue that extend beyond the wound border and do not regress; they often recur after excision

A

keloids

90
Q

In keloids ___ cells are increased which results in itching

A

mast cells

91
Q

____ 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

A

desmoid tumors

92
Q

a ___ is a fixed deformity caused by excessive wound contraction

A

contracture

93
Q

When a wound is “stuck” in the inflammatory phase, ___ and ___ (cytokines) are high–possibly due to wound infection

A

IL-1 and TNF

94
Q

Which bacteria is most likely to cause a problem in wounds?

A

Staph aureus

95
Q

___ 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

A

fibrosis

96
Q

a ___ is something that easily bleeds, often at the site of trauma–it almost looks like a cyst

A

pyogenic granuloma

97
Q

a stage _ pressure ulcer is non-blanching erythema of intact skin

A

1

98
Q

a stage _ pressure ulcer has partial thickness skin loss

A

2

99
Q

a stage _ pressure ulcer has full thickness skin loss not involving the fascia–requires debridement and IV antibiotics

A

3

100
Q

a stage _ pressure ulcer has full thickness skin loss with extensive tissue destruction including bone and muscle

A

4

Patho Exam 1 (5 decks)

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