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KMMS > Cellular response to injury; recovery from injury > Flashcards

Cellular response to injury; recovery from injury Flashcards

1
Q

One or more cell types that are functionally connected

A

Tissue

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2
Q

List the three factors associated with tissue growth/proliferation (three different things that INCREASE)

A
  1. Increase in cell number by mitosis (multiplication)
  2. Increase in cell size
  3. Increase in extracellular tissue
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3
Q

What types of tissue are highly proliferative in adults? (3)

A

Skin cells, epithelium of gut and respiratory tract, blood cells

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4
Q

The acquisition of specialised function and related morphology of cells or tissue

A

Differentiation

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5
Q

List three qualities of cells that are able to proliferate

A
  1. Labile
  2. Stable
  3. Permanent
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6
Q

This describes cells that continuously proliferate, have a short life span and rapid turnover (e.g. blood cells, epithelial cells like oral mucosa)

A

Labile

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7
Q

This describes cells that have a good regenerative ability, but would normally have a low cell turnover (e.g. hepatocytes after liver resection)

A

Stable

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8
Q

These cells have either limited or no regenerative ability (e.g. cardiomyocytes, neurons)

A

Permanent

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9
Q

The increase in cell size resulting from an increase in structural components. Leads to increase in tissue/organ size and function

A

Hypertrophy

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10
Q

What is the only adaptive response seen in permanent cells?

A

Hypertrophy

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11
Q

Name an example of physiological hypertrophy

A

Weight training resulting in skeletal muscle hypertrophy, or increase in size of pregnant uterus

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12
Q

Name an example of pathological hypertrophy

A

Left ventricular hypertrophy or BPH

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13
Q

An increase in cell NUMBER is known as

A

Hyperplasia

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14
Q

Name an example of physiological hyperplasia

A

Change in breast tissue due to lactation, or regrowth of hepatocytes after liver resection

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15
Q

Name an example of pathological hyperplasia

A

Gynecomastia in men, endometrial hyperplasia, or prostatic hyperplasia

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16
Q

Pathological hyperplasia is often the result of excess _________ stimulation

A

hormonal

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17
Q

True or false: adaptive changes are reversible

A

True

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18
Q

The reduction in the cell size and number. Related to decrease of function in the tissue or organ. Often hormonally regulated.

A

Atrophy

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19
Q

Reduced hormonal stimulation of tescticular, ovarian, breast, or endomentrial tissues results in

A

physiological atrophy

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20
Q

List some examples of pathological atrophy

A
  1. Denervation of muscle due to trauma or neurological disorders
  2. Muscle atrophy in immobilisation
  3. Vascular atrophy of the brain in ageing
  4. Atrophy that results from malnutrition/starvation
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21
Q

Reversible change where one differentiated cell type or tissue is replaced by another differentiated cell (often seen in epithelium)

A

Metaplasia

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22
Q

The type of change that takes place when the epithelium in the squamo-columnar junction changes from simple columnar to stratified squamous in response to declining estrogen levels

A

physiological metaplasia

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23
Q

List examples of pathological metaplasia

A
  1. Bronchial metaplasia in response to smoking (ciliated columnar –> stratified squamous epithelium)
  2. Barrett’s oesophagus (stratified squamous epithelium –> columnar epithelium incl intestinal goblet cells)
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24
Q

Cellular injury occurs when _________ is no longer possible

A

adaptation

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25
Q

In which type of cell death does the cell membrane rupture?

A

Necrosis

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26
Q

In which type of cell death does the nuclei fragment?

A

Apoptosis

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27
Q

In which type of cell death does the nuclei shrink?

A

Necrosis

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28
Q

In which type of cell death do the cell contents leak?

A

Necrosis

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29
Q

Which type of cell death causes an inflammatory response?

A

Necrosis

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30
Q

Which type of cell death is always pathological?

A

Necrosis

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31
Q

In which type of cell death does the cell membrane remain intact, but altered?

A

Apoptosis

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32
Q

The pathway of programmed cell death is also called

A

apoptosis

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33
Q

Which type of cell death utilises the activation of intracellular enzymes to degrade DNA & proteins?

A

Apoptosis

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34
Q

Which type of cell death is associated wtih ATP depletion, influx of calcium ions, mitochondrial damage, and an increase in oxygen radicals?

A

Necrosis

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35
Q

Name the three different patters of necrosis

A
  1. Coagulative (kidney wedge)
  2. Liquefactive (brain in strokes)
  3. Caseating (TB)
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36
Q

The death-receptor mediated pathway to apoptosis is also known as the

A

extrinsic pathway of initiation

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37
Q

The mitochondrial mediated pathway to apoptosis is also known as the

A

instrinsic pathway of initiation

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38
Q

Name the four phases of apoptosis

A
  1. Induction
  2. Effector
  3. Degradation
  4. Phagocytosis
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39
Q

Examples of this type of apoptosis include embryogenesis, involution of hormone dependent tissues after hormone withdrawl, and destruction of inflammatory cells

A

Physiologic apoptosis

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40
Q

DNA damage or accumulation of abnormal proteins may result in what type of cell death?

A

Pathological apoptosis

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41
Q

A type of cell death that may be associated with neoplasia is

A

autophagy-associated cell death

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42
Q

When the cell breaks down its own contents as a survival mechanism in nutrient deprivation, this is known as

A

autophagy-associated cell death

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43
Q

What are the typical symptoms of injury/inflammation? (4)

A

Redness, swelling, heat, and pain

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44
Q

What the Latin terms for the clinical signs of injury/inflammation?

A

Rubor, Tumor, Calor, Dolor, and Functio laesa

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45
Q

The local response of living tissue to injury from any agent which could be microbial, immunological, physical, or chemical.

A

Inflammation

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46
Q

Bacteria at the site of the wound relase _________ that reach the bloodstream, which send a message to the brain to produce a _________.

A

cytokines, fever

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47
Q

A clinical condition characterised by widespread activation of the inflammatory system, secondary to infection or significant trauma

A

Systemic inflammation

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48
Q

What are the three major phases of the acute inflammatory response?

A
  1. The vascular phase
  2. Neutrophil phase
  3. Macrophage phase
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49
Q

Describe what happens in the vascular phase of acute inflammation

A
  1. Increased blood flow
  2. Dilation of small blood vessels
  3. Increased movement of fluid from blood to tissue producing swelling/edema
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50
Q

Describe what happens in the neutrophils phase of acute inflammation

A

This is the initial appearance of neutrophils, the first type of leucocyte at the site of injury, which predominate in the inflammatory infiltrate during the first 6 - 24 hours after injury.

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51
Q

Describe what happens in the macrophage phase of acute inflammation

A

This is the later appearance of macrophages, the second type of leukocyte to arrive at the site of injury, generally after 24-48 hours.

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52
Q

What causes the swelling and oedema in the vascular phase of acute inflammation?

A

Short answer:
Increased movement of fluid from blood vessels to the tissues.

Long answer:

  1. Endothelial cells at the site of injury initially swell, then contract to increase the space between them, thereby increasing the permeabillity of the vascular barrier.
  2. Exudation of fluid leads to a net loss of fluid from the vascular space into the interstitial space, resulting in oedema.
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53
Q

What is the predominant cell of acute inflammation?

A

Neutrophil

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54
Q

What attracts neutrophils to the site of injury?

A

Chemotaxins

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55
Q

List the four stages of neutrophil migration

A
  1. Margination
  2. Rolling
  3. Adhesion
  4. Emigration
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56
Q

This stage of neutrophil migration is where WBC’s line up against the endothelium

A

Margination

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57
Q

This stage of neutrophil migration is where receptor ligands, called selectins, help the neutrophil loosely adhere to the endothelium. The neutrophils can then roll along the endothelium.

A

Rolling

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58
Q

This stage of neutrophil migration is where neutrophils firmly attach to the endothelium via integrins. These help the next process of attachment.

A

Adhesion

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59
Q

This stage of neutrophil migration is where cells move through the vessel wall to the affected area. The Ig family molecules invloved in transmigration are ICAM-1, VCAM-1, and PECAM-1.

A

Emigration

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60
Q

What happens immediately after extravasation in the acute phase of injury? (hint: where do the WBC’s have to get to?)

A

Leucocytes emigrate in tissues toward the site of injury by chemotaxis (along a chemical gradient).

61
Q

Examples of ____________ include complement protein C5a, leukotriene, and certain chemokines like MCP.

A

chemoattractants

62
Q

The process by which specialised cells engulf or ingest other cells or particles

A

Phagocytosis

63
Q

Phagocytosis involves the following three steps:

A
  1. Recognition and attachment
  2. Engulfment with subsequent formation of a phagocytic vacuole
  3. Killing or degredation of the ingested material
64
Q

The process of coating a pathogen to target it for phagocytosis is called

A

Opsonisation

65
Q

What is the role of opsonins?

A

They coat pathogens to target them for phagocytosis

66
Q

Name two types of opsonins

A
  1. Antibodies such as IgG

2. Compenents of the complement system such as C3

67
Q

Opsonins such as antibodies or C3 (of the complement system) are recognised by __________.

A

Phagocytes

68
Q

Describe the role of “scavengers”

A

Leukocytes (neutrophils and macrophages) ingest offending agents and get rid of necrotic tissue and foreign substances.

69
Q

What type of cell is the first line of defense in the innate arm of the immune system?

A

Neutrophils

70
Q

Where are neutrophils stored and released from?

A

The bone marrow

71
Q

Are neutrophils granulocytes or agranulocytes?

A

Granulocytes

72
Q

Which type of phagocyte is most abundant in the circulation?

A

Neutrophils

73
Q

Macrophages are derived from

A

monocytes

74
Q

Which type of phagocyte has a multi-lobed nucleate?

A

Neutrophil

75
Q

Are macrophages granular or agranular?

A

Agranular

76
Q

What phagocyte is considered second line in microbe destruction?

A

Macrophage

77
Q

What types of cells do neutrophils mainly send signals to?

A

Other neutrophils and also macrophages

78
Q

Do macrophages belong to the innate or adaptive arm of the immune system?

A

Adaptive

79
Q

What type of cell is the most important modulator of both inflammation and immune responses?

A

Neutrophil

80
Q

What is the mechanism that some neutrophils use to trap microbes that can’t be phagocytosed or attacked with granules?

A

NETosis, or extracellular traps

81
Q

What is the “parent cell” of a neutrophil?

A

Myeloblast

82
Q

Agranulocytes develop from

A

lymphoblasts and monoblasts

83
Q

Which leukocytes are considered granulocytes?

A

Neutrophils, basophils, eosinophils

84
Q

Which type of cell is most proficient at clearing away debris, dead neutrophils, and dead microbes?

A

Macrophages

85
Q

What types of cells do macrophages signal?

A

Other cell types to start healing, and antigen presenting cells

86
Q

What type of cell produces growth factors for the proliferation of various cells in the healing response?

A

Macrophages

87
Q

Monocytes circulate in the ________, and then migrate to the tissues to become __________.

A

blood, macrophages

88
Q

Collagenase and elastase are involved in removal of

A

injured tissue and debris

89
Q

Nitric acid and ROS are growth factors that have ___________ activity

A

antimicrobial

90
Q

PDGF, TGF beta, TNF, IL-1, and KGF-7 are growth factors involved in _____________ and the proliferation of fibroblasts and keratinocytes

A

chemotaxis

91
Q

Name the growth factors associated with angiogenesis

A

VEGF, FGF2, and PDGF

92
Q

TGF beta, PDGF, TNF, OPN, IL-1, and collagenase are growth factors involved in the deposition and remodelling of the ____________________

A

extra cellular matrix

93
Q

What are the two types/categories of mechanisms for intracellular killing?

A

Oxygen dependent and non-oxygen dependent

94
Q

What is the oxygen-dependent mechanism of intracellular killing by neutrophils?

A

Myeloperoxidase

95
Q

What is the oxygen-dependent mechanism of intracellular killing by macrophages?

A

Peroxynitirite

96
Q

What types of oxygen-independent mechanisms do neutrophils and macrophages use for intracellular killing?

A

Granules containing multiple bactericidal proteins (neutrophils), and lysosomes containing enzymes

97
Q

Membrane-bound organelles filled with hydrolytic enzymes

A

Lysosomes

98
Q

List the three basic steps of how the body recovers from injury (the “3 R’s”):

A
  1. Resolution and scavenging
  2. Regeneration
  3. Repair
99
Q

The proliferation of cells and tissues of the same type to replace lost structures

A

Regeneration

100
Q

Continuously diving cells are known as

A

Labile

101
Q

Name a few examples of labile cells

A

skin, mucosa of GI, and blood cells

102
Q

Another word for cells that are stable is

A

quiescent

103
Q

Name a few examples of cells that are stable

A

Liver, kidney, endothelium

104
Q

Name some examples of tissues that are permanent

A

Heart, brain

105
Q

The ability of tissue to regenerate is dependent on what two factors?

A
  1. The extent of the damage (regeneration is possible with limited damage)
  2. The integrity/preservation of the ECM (scaffolding) or the basement membrane
106
Q

What results from either extensive tissue damage or disruption of the basement membrane?

A

Scarring

107
Q

Cell proliferation is dependent on production of polypeptides known as _________ factors and __________ factors acting on signalling pathways to unlock cell cycle controls.

A

growth, transcription

108
Q

Name some of the growth factors involved in regeeration of tissue

A 
Transforming growth factor
Epidermal growth factor
Vascular endothelial growth factor
Fibroblast growth factor
Platelet-derived growth factor
109
Q

What signals stem cells and local adjacent cells (near the damaged tissue) to proliferate?

A

Growth factors and transcription factors acting on signalling pathways, which unlocks cell cycle controls.

110
Q

These cells are characterised by the self-renewal properties and by their capcity to generate differentiated cell lineages

A

Stem cells

111
Q

Name some areas where stem cells “pool” in different tissues

A
  1. Crytps of the colonic epithelium
  2. Bone marrow
  3. Hair follicles
112
Q

This process is comprised of four parts:

  1. Clearance of injurious stimuli
  2. Clearance of mediators and acute inflammatory cells
  3. Replacement of injured cells
  4. Return to normal function
A

Resolution

113
Q

When tissue damage is too extensive for regeneration or resolution, this type of cell patches the damage through fibrosis:

A

Fibroblasts

114
Q

Scars are formed by the deposition of ___________ and other ECM componenents.

A

Collagen

115
Q

List the 5 steps of the repair process

A
  1. Angiogenesis
  2. Granulation tissue
  3. Fibrosis - scar formation
  4. Scar remodelling
  5. The final scar
116
Q

Name the two of the signalling molecules involved in angiogenesis

A

Histamine and NO

117
Q

Angiogenesis is mainly controlled by which growth factor?

A

Vascular endothelial growth factor

118
Q

What is granulation tissue composed of?

A

New blood vessels, fibroblasts, and the remaining inflammatory cells

119
Q

What is the result of newly formed blood vessels being leaky?

A

Oedema

120
Q

What type of cell produces growth factors associated with scar formation/fibrosis?

A

Macrophages

121
Q

Growth factors from macrophages leads to the migration and proliferation of ____________ into the granulation tissue.

A

Fibroblasts

122
Q

What type of cell produces collagen and ECM?

A

Fibroblasts

123
Q

Fibroblasts, and ultimately the process of fibrosis, is mainly controlled by which growth factor?

A

Transforming growth factor beta

124
Q

In scar remodelling, collagen changes into type ____ collagen

A

one

125
Q

Interactions of collagen deposition and degredation by matrix metalloproteinases (MMP’s) are associated with which phase of the repair process?

A
  1. Scar remodelling
126
Q

In scar remodelling, what causes contraction of the scar tissue?

A

myofibroblasts

127
Q

The final scar has a maximum of _____% of normal skin strength.

A

80

128
Q

Name some local factors which frustrate would healing

A 
Local infection
Foreign body
Haematoma
Denervation
Poor blood supply
Mechanical stress
Necrotic tissue
Site (lip vs foot)
Cause of insult is important (burns vs cuts)
129
Q

Name some systemic factors which frustrate wound healing

A 
Age
Anaemia
Drugs
Diabetes
Genetic disorders
Malignancy
Malnutrition
Obesity
Vitamin C deficiency
Trauma, shock
Systemic infection/sepsis
130
Q

Describe the vascular phase of the “wound healing timeline”

A
  1. Within minutes, vasoconstriction of damaged vessels leads to coagulation and stasis
  2. Then vasodilation leads to increased hydrostatic pressure, resulting in oedema
131
Q

When does granulation tissue begin forming in wounded tissue?

A

About 12-24 hours after injury

132
Q

How soon after injury does epithelialisation and reformation of the basement membrane occur?

A

About 6-12 hours after injury

133
Q

Tissue repair and regeneration depend on components of the _________

A

Extra cellular matrix

134
Q

What four things is ECM composed of?

A
  1. Fibrous structural proteins
  2. Adhesive glycoproteins
  3. Proteoglycans
  4. Hyaluronan
135
Q

The substances that provide ECM with resilence and lubrication are:

A

Proteoglycans and hyaluronan

136
Q

What connects matrix elements to one another and to cells (within the ECM?)

A

adhesive glycoproteins

137
Q

What are the fibrous structural proteins within ECM?

A

Collagen and elastins

138
Q

Name a few of the “resident cells” of the ECM

A
  1. Fibroblasts
  2. Macrophages
  3. Adipocytes
  4. Mesenchymal cell
139
Q

Protein fibres are composed of:

A
  1. Elastic fibres
  2. Collagen fibres
  3. Reticular fibres
140
Q

What is chronic inflammation?

A

Inflammation of prolonged duration- weeks or months

141
Q

What are the two main types of celss involved in chronic inflammation?

A

Lymphocytes and macrophages

142
Q

These are the three histological features of chronic inflammation:

  1. Collection of chronic _______________ cells
  2. Destruction of ______________
  3. Replacement by ___________ tissue
A
  1. inflammatory
  2. parenchyma
  3. connective
143
Q

A distinctive pattern of chronic inflammation that is encountered in a limited number of infections, where the body produces a cellular attempt to contain an offending agent that is difficult to eradicate

A

Granulomatous inflammation

144
Q

Name the four different types of granulomatous inflammation

A
  1. Necrotising
  2. Non-necrotising
  3. Caseating (think TB)
  4. Foreign body
145
Q

What is the main cell type in a granuloma?

A

Macrophage

146
Q

If the body cannot resolve the local inflammation, a whole-body response is initiated in an attempt to combat the insult. This is known as:

A

sepsis

147
Q

List four potential negative outcomes of sepsis

A
  1. Organ hypofunction
  2. Multiple organ dysfunction syndrome
  3. ARDS
  4. Death
148
Q

The cytokines that activate the immune response in systemic inflammatory response syndrome (SIRS), leading to the release of high amounts of inflammatory cells from the bone marrow are called

A

TNF and IL-1

149
Q

What stimulates leukocytes to release cytokines such as TNF and IL-1?

A

Bacterial products such as pyrogens

KMMS (58 decks)

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