1. scar tissue 2. Regeneration (replacement by same type of cell) 3. Resolution (damaged cells recover)

Ch3 - Inflammation And Tissue Repair Flashcards by Lysza Sabanal

Inflammation is a non-specific response of body to local tissue injury. Part of the _________ of defense.

2nd line defense

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Functions of inflammation?

Increase blood flow to site (vascular response)
Increase healing cells at site (cellular response)
Prepare for tissue repair

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Lines of defense:
▫️first:
▫️second:
▫️third:

1st: skin and mucous membranes
2nd: Inflammatory
3rd : immune response

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Causes of inflammation?

▫️infection - microbial agent
▫️physical agents - trauma, electrical, temperature
▫️radiation - ionizing, nonionizing, UV
▫️chemicals - acid, alkali, toxins
🔹drugs, lead, ethanol, mercury
▫️nutritional - excesses or deficiencies
▫️ischemia/infarction- auto, allo, allergy
▫️Genetic and metabolic disorders

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Advantages of inflammation?

▫️serves to isolate and localize injured area, protecting normal tissue
▫️can neutralize and inactivate toxic substances
▫️destroys and limits growth of microorganism
▫️prepares the area for wound healing and repair by cleaning debris

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Disadvantages of inflammation:

▫️Infection: microorganisms ca more easily penetrate oedematous tissues
▫️deep ulcers: result of severe or prolonged inflammation
▫️scar tissue: due to excessive tissue damage
▫️local complications: depend on site of inflammation but may include obstruction, loss of sensation, and decreased cell function.
▫️Pain

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Chemical mediators?

🔹Cell-derived

🔹plasma derived

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Cell-derived?

🔺white blood cell
🔺platelets
🔺endothelial or damaged tissue cells

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Plasma-derived:

🔺complement system
🔺kinin system
🔺clotting system

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it’s primary role is to destroy and remove microorganisms to prevent infection through opsonization (making bacteria vulnerable to phagocytosis) and cell lysis (destruction)

*produced in the liver

Complement

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promotes coagulation through a cascade of clotting factors

Clotting

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Source of highly potent vasoactive inflammatory mediators. Amplifies the inflammatory response by triggering other inflammatory mediators.

Kinin

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Vascular response?

▫️increased capillary membrane permeability
▫️vasodilation
▫️hyperaemia

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Cellular response ?

▫️chemotaxis
▫️cellular adherence
▫️cellular migration

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_______cells are housed in connective tissues of body and near all blood vessels - allows for immediate release of chemical mediators into blood stream

Mast cell

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_________are released from WBC platelets and injured cells and signal to trigger, enhance or discontinue the inflammation response.

Cytokines

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Cells Active in cellular response:

▫️leukocytes
▫️neutrophils
▫️macrophages
▫️erythrocytes
▫️platelets

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Role of these cell is phagocytosis; removal of dead tissue

Leukocytes

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A type of WBC; earliest phagocytize responders

Neutrophils

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A type of WBC; Large, king-lived phagocytes associated with a prolonged (chronic) inflammatory response; monocytes are immature macrophages

Macrophages

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It’s a type of cell that carry oxygen to tissues

Erythrocyte

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It’s a type of cell that trap harmful substances; stop bleeding; form structural origin of repair

Platelets

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Healing undergoes:

scar tissue
Regeneration (replacement by same type of cell)
Resolution (damaged cells recover)

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Local Manifestation of acute inflammation:

5 cardinal clinical signs

Redness (erythema)
Heat
Incapacitation
Pain
Exudate and edema

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Other possible systemic manifestations:

1. Malaise Headache 2. Fatigue 3. Anorexia 4. Mild fever - due to pyrogens from macrophages 5. Increased circulating leukocytes and plasma proteins

Benefits of fever

▫️stimulates phagocytosis ▫️decreases rate of multiplication of pathogens ▫️prevents release of Fe & Z from liver which bacteria feed on ▫️increased tissue repair process

Treatment of inflammation:

▫️reduced blood flow ▫️ decrease swelling ▫️block the action of chemical mediators ▫️decrease pain

type of inflammation, usually rapid onset w/ minimal damage and rapid resolution. It is characterized by the formation of exudates/edema.

Acute

A collection of interstitial fluid formed in the inflamed area.

Edema

Function of exudates:

1. Carry plasma proteins and leukocytes to injured area 2. Neutralize the inflammation reaction 3. Dilute toxins

Type of exudates - watery, with low protein; usually seen w/ burns or allergic reactions (mild inflammation)

Serous exudate

Type of exudate, blood vessels damage with leakage of RBCs from capillaries

Hemorrhagic exudate

Type of exudate, contains large amounts of fibrin increasing the risk of scar tissue build-up in the area

Fibrinous exudate

Type of exudate, contains pus (degraded WBC, proteins and tissue debris); caused by certain microorganisms. Indicates bacterial infection.

Purulent exudate

Type of exudate, firms on mucous membranes and contains lots of mucous, ex. Rhintis, bronchitis

Catarrhal

It's an inflammation that may last for weeks, months or years.

Chronic inflammation

Chronic inflammation may be the result of:

▫️an acute inflammation when the cause is not completely eradicated because the body is either: 🔺unable to remove the inflammatory agent 🔺 unable to destroy the inflammatory agent 🔺has an inadequate defense system ◽️an insidious dev't due to chronic irritation ▫️when it involves certain type of bacteria (TB)

In chronic inflammation, the major WBC moving to site?

Macrophages and lymphocytes

Proliferation of fibroblasts also occurs, w/c can lead to:

▫️scarring and deformity

What are the factors that inhibit repair?

1. Old age 2. Nutrition 3. Immune depression 4. Certain diseases (ex. Diabetes) 5. Malignancy (ex. Leukaemia) 6. Drugs 7. Superimposed infection

Increase blood flow to site

Vascular response

Increase healing cells at site

Cellular response

Inflammatory mediators

Mast cells and cytokines

An inflammatory mediator released from WBC, platelets and injured cells and signal to trigger, enhance or discontinue the inflammation response

Cytokines

An inflammatory mediator housed in connective tissues of body and near all blood vessels - allows for immediate release of chemical mediators into blood stream.

Mast Cells

It’s a type of WBC that release bradykinin - produces histamine

Basophil

What cell is activated by chemotaxis?

chemokines

Local manifestation of acute inflammation

1. Redness (erythema) 2. Heat 3. Incapacitation 4. Pain 5. Exudate and edema

Other possible systemic manifestations:

1. Malaise Headache 2. Fatigue 3. Anorexia 4. Mild fever 5. Increased circulating leukocytes and plasma proteins

In chronic inflammation, _____ and ; _____ instead of neutrophils are the major WBC moving to site

▫️macrophages and lymphocytes

Inflammatory cell in acute inflammation?

▫️neutrophil and macrophages

Inflammatory cells in chronic inflammation?

Lymphocytes, plasma cells, macrophages, fibroblasts (for scarring)

The body organs and structures contain 2 functional types of tissues:

▫️parenchyma (functioning cells) | ▫️stroma (supporting connective tissue)

The primary objective of healing process is to “fill the gap”

▫️restore the structural continuity of the injured part

Secondary objective of healing process is _______ of the injured part.

restore the functional continuity

Injured tissues heals by:

1. Resolution (if tissue damage is minimal) 2. Regeneration ofvparenchymal cells 3. Replacement with connective tissue

Chemical mediators are involved with healing process:

▫️chemotaxis; fibroblast recruitment | ▫️proliferation of cells

Ability to regenerate varies with cell type:

▫️labile Cells - skin and mucous membranes ▫️stable cells - undergo mitosis as necessary ▫️permanent cells - amitotic

A cell that form lining of stomach and esophagus and are continuously being replaced.

▫️Labile Cells

A bone cells divide only when necessary

▫️ Stable cells

Is a type of cell once injured from ischemia, cardic Cells cannot be replaced.

Permanent cells

Non-regenerated parenchymal Cells are replaced by a ________ (process also called fibrosis) when: 🔺extensive tissue damage occurred 🔺 cells are amitotic

▫️CT scar

Wound healing and closure occur by _______ or _______ intention depending on the extent of tissue damage.

▫️primary | ▫️secondary intention

▫️ ________ intention - small wound e.g. sutured surgical incision or paper cut ▫️_________ intention - e.g. burns, large surface wounds - tissues have undergone greater loss of tissue and contamination

▫️primary intention ▫️secondary intention

Tissue healing phases:

1. Inflammation 2. Proliferation (repair, regeneration, replacement) 3. Remodelling

Injury that heal by secondary intention undergo:

▫️wound contraction

chemotactic mediators, or ________, stimulate a cellular response: ▫️chemotaxis ▫️adherence ▫️migration ▫️phagocytosis

Chemokines

For chronic inflammation: ▫️macrophages ▫️lymphocytes

For acute inflammation ▫️PMNs ▫️Platelets ▫️Mast Cells

Cell derived chemical mediators:

▫️WBC ▫️Platelets ▫️endothelial or damage tissue cells

Plasma derived chemical mediators:

▫️complement system ▫️Kinin System ▫️clotting System

it’s a plasma derived cell whose primary role is to destroy and remove microorganisms to prevent infection through opsonization (making bacteria vulnerable to phagocytosis) or cell lysis (destruction)

Complement

Plasma derived cell that promotes coagulation through a cascade of clotting factors

Clotting

Is a plasma derived cell which is a good source of highly potent vasoactive inflammatory mediators. It amplifies the inflammatory response by triggering other inflammatory mediators

Kinin

What’s vascular response to these cell mediators?

▫️increased capillary membrane permeability ▫️vasodilation ▫️hyperaemia (excess blood in the body part)

Cells active in the cellular response:

``` ▫️leukocyte (WBC) ▫️neutrophils ▫️macrophages ▫️erythrocytes ▫️platelets ```

Is a cell that trap harmful substances; stop bleeding; form structural origin of repair

Platelets

A type of WBC; earliest phagocytic responder

Neutrophils

In blood test, it is elevated during inflammation to promote coagulation this is needed for scar formation

Fibrinogen

In blood test, is increased above 10,000/mm3 reference value: 5,000 - 10,000 blood cells/mm3

WBC count

Extra cellular fluid accumulation often in tissues because of increased vascular permeability

Exudate and edema

Other manifestation of acute inflammation:

▫️malaise headache ▫️fatigue ▫️anorexia ▫️mild fever - due to pyrogens from macrophages ▫️increased circulating leukocytes and plasma proteins

What are the benefits of fever?

▫️stimulates phagocytosis ▫️decrease rate of multiplication of Pathogens ▫️prevents release of Fe and Z from liver which bacteria feed on ( this happen w/ low fever only) ▫️increased tissue repair process

Treatment for inflammation

▫️reduce blood flow ▫️decrease swelling ▫️block the action of chemical mediators ▫️decrease pain

Functions of exudates:

▫️carry plasma proteins and leukocytes to injured area ▫️neutralize the inflammation reaction ▫️dilute toxins

Body organs and structures contain two functional types of tissues:

▫️parenchyma (functioning cells) | ▫️stroma (supporting connective tissue)

Tissue healing phase, usually begins w/ 2 to 3 days of injury and may lasts as long as 3 wks Fibroblast produce collagen healing by 2ndary intention - more granulation tissue

Phase 2 - proliferative phase

Healing phase where scar tissue remodels by breaking down old collagen (collagenase) and synthesizing new collagen (by fibroblasts) Injury that heal by secondary intention undergo wound contraction

Phase 3 - remodeling phase

complications of healing by scarring:

1. Contractures / obstructions 2. Adhesions ( connection of scar tissue between 2 separate tissues ex. Intestines) 3. Ulceration 4. Dehiscence (wound separation) 5. Hypertrophic scar formation (keloids) **dehiscence & ulceration can easily lead to infection

A type of mediator such as histamine, leukotrenes, and prostaglandins

Aspactive mediators

Also called chemokines. A type of mediators that stimulate cellular response

Chemotactic mediators

Two cells with active vasoactive mediators. Both WBC, causes hyperaemia (⬆️of blood to area)

Mast cell and basophil cell

Ch3 - Inflammation And Tissue Repair Flashcards

(91 cards)