Wounds, Injuries Flashcards
Classification of injuries by cause
- Mechanical caused
- Chemical caused
- Thermal caused
- Radioactive caused
Thermal caused injuries. Burns. Degrees
Burn - combustio
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1 degree: combustio erythematosa
Dry fur, swollen skin, warm, loss of epithelium
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2 degree: combustio bullosa
Vasodilation, leak of serum, vesicles, pain
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3 degree: combustio escharctica
Cell injuries, protein aggregation, thrombosis, necrosi
—
4 degree: carbonisatio
Thermal caused injuries. Frostbites. Degrees
Frostbite — congelatio
—
1 degree: ischaemia, hyperaemic, leak of serum, not sensitive
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2 degree: stasis, thrombus, vesicles, infection
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3 degree: cell degeneration, stop of circulation, necrosis, loss of larger body parts
Chemical caused necrosis
- acid caused -> coagulation necrosis
- alkali caused -> colliquation necrosis
Radioactive injuries
- very rare in vet medicine
- locally: redness, vesicles, loss of hair, necrosis, depigmentation, hyperkeratosis, ulceration
- generally: vomitus, diarrhoea, apathy
Electricity caused injuries
- above 50mA critic general status
- above 100mA always death
- local symptoms: cell degeneration, cell coagulation
Electricity caused injuries
- above 50 mA critic general status
- above 100 mA always death
- local symptoms: cell degeneration, cell coagulation
Determination of injury
Loss of continuity in the skin, mucous membrane or in the organ with or without underlying tissue damage
How do we classify wounds?
- Localisation
- Shape and size
- Types
- Origin
- Age
- Healing stadium
- In what way (?)
Classification of wounds. Localisation
- anatomical region (e.g. head, neck, thoracical region etc)
- skin, mucous membrane, muscle, tendon, joint, etc
Classification of wounds. Shape and size
- point-like
- line-like
- lobed
- cavernous (пещеристый)
- loss of materia
- loss of body part
— - regular
- irregular
Classification of wounds. Types
- superficial: e.g. graze (царапина), erosion, abrasion (натертость ?) (denuding of the epidermis, minimal bleeding, some serum exsudation)
- deep
Classification of wounds. Origin
- Surgical
- Traumatical
Classification of wounds. Age
- fresh
- old
Classification of wounds. Healing stadium
- regularity healing
- irregularily healing
- infected or with complication
Classification of wounds. In what way (specific wounds)
- incised -> vulnus scissum et caesum
- lacerated -> vulnus lacerum s. ruptum
- confused -> vulnus contusum
- puncture -> vulnus punctum
- gunshot -> vulnus scolopetarum
- bite -> vulnus morsum
Wound caused by incision?
Vulnus scissum et caesum
Wound caused by bite?
Vulnus morsum
Vulnus scissum et caesum (incised wounds)
- produced by sharp objects
- tissue damage is minimal
- edges of wound are linear and smooth
- pain is minimal
- underlying tissues are damaged only in the line
Lacerated wounds
- produced by irregular objects
- tissue damage is extensive
- edges of wound are smooth
- painful
- extensive damage of underlying tissue
Vulnus contusum - confused wounds
- produced by dull objects
- extensive tissue damage
- irregular edges of wound
- very painful
- extensive damage of underlying tissues
- prognosis is unfavourable
Vulnus punctum - puncture wounds
- produced by sharp ended objects
- superficial -> point-like; deep -> channel
- anaerobic infection very probable
Vulnus morsum - bite wounds
- carnivores -> puncture wounds
- herbivores -> contused wounds
- anaerobe infection very probable
Vulnus sclopetarium - gunshot wounds
- inlet: primer necrotical zone
- channel: necrobiotical zone
- outlet: molecular commotional zone
What are 2 processes involved in healing?
Repair and regeneration
—
Regeneration: replacement of damaged tissues with normal cells of type lost. Tissue type should be capable to mitosis (epithelium, bone and liver)
—
Repair: stopgap reaction designed to reestablish the continuity of interrupted tissues, results in scar tissue
Wound healing of partial thickness wounds (abrasion, erosion)
Primarily by migration and proliferation of epidermal cells from the underlying epithelium + adnexal structures (hair follicles, swear and sebaceous glands) with little participation of inflammatory or mesenchymal cells
Wound healing of full thickness wounds
Involves 3 coordinated phases:
1. acute inflammation
2. cellular proliferation
3. remodelling with scar formation
What is special in wound healing in horses?
- many traumatic wounds can not be sutured in horses because of massive tissue loss, extreme contamination, continuous movement and skin tension
- study: primary closure was successful in only 24% of horse wounds and 39% of pony wounds (>50% of wounds located on the limb)
Acute inflammation.
- Bleeding, pain - immediately
-
Vasoconstriction - 5-10 minutes
Mediated by: sympathomimetic amines, thromboxane (eicosanoid, produced by platelets. Main role is to promote platelet aggregation and vasoconstriction) - Vasodilation
-
Increased capillary permeability
Mediated by: histamine, bradykinin, prostaglandins (E1, E2) (pain!), leukotriene B4
=> cellular and non-cellular blood components can enter into the wound by diapedesis. Blood components will form fibrinogen-fibrin-fibronektin accumulation -
Fibrocellular clot
Barrier to protect subcutaneous tissues. PMNs (polymorphonuclear neutrophils) die - release enzymes - pus - Fibrocellular clot dehydrates -> scab
-
Accumulation of an inflammatory exsudate
—
Duration: 6-12 hours
Cellualar components in the wound during inflammatory stage of acute inflammation
- Neutrophils - break down tissue debris, kill microorganisms. (Although the neutrophils help create a favourable wound environment and serve as a source of pro inflammatory cytokines, the are not essential to repair in uninflected wounds
- Mononcytes, lymphocytes, complements, Ig - remove damaged tissues, combat infection, provide the building blocks needed for subsequent wound repair
Debridement stage of acute inflammatory phase
- 6 hours after injury
- removal of damaged and necrotic tissues
- elimination of any infection
- duration depends on quantity of necrotic tissue, contamination of the wound
- polymorphonuclear leukocytes - aid breakdown of injured tissues
- Igs and complement system - opsonins - removal of bacteria
-
monocytes and macrophages - phagocytosis, also regulate fibroblast functions and attract fibroblasts to the wound
—
fibroblasts influx means end of this stage
