Inflammation and Tissue Repair

Question 1

Inflammation and Tissue Repair

3 lines of defense = ?

Answer 1

1. Skin and mucous membrane
2. Inflammation
3. Immunity

Question 2

Inflammation and Tissue Repair

What are Leukocytes = ?

• What are the 5 types = ?

Nancy Makes Easy Bake Lasagna

Answer 2

White blood cells / Leukocytes:

• A type of blood cell that is made in the bone marrow and found in the blood and lymph tissue.
• It may be used to look for conditions such as infection, inflammation, allergies, and leukemia

Types:

• Neutrophil
• Monocytes
• Eosinophils
• Basophils
• Lymphocytes (T and B)

Question 3

Inflammation and Tissue Repair

Neutrophil

• Cell Function = ?
• Absolute Count = ?
• Differential Count = ?

Answer 3

(a) Neutrophil:

• Type of white blood cell.

(b) Cell Function

• Defense against foreign substances like bacteria, fungi.

(c) Absolute Count

• 2500-8000

(d) Differential Count

• 55-70

Question 4

Inflammation and Tissue Repair

Monocytes

• Cell Function = ?
• Absolute Count = ?
• Differential Count = ?

Answer 4

Monocytes: Type of white blood cell.

Cell Function:

• Immature macrophages, clean up debris and damaged cells.

Absolute Count:

• 100-700

Differential Count:

• 2-8

Question 5

Inflammation and Tissue Repair

Eosinophils

• Cell Function = ?
• Absolute Count = ?
• Differential Count = ?

Answer 5

Eosinophils: Type of white blood cell.

Cell Function

• Attack parasites, cancer cells and play a role in asthma and allergy

Absolute Count

• 50-500

Differential Count

• 1-4

Question 6

Inflammation and Tissue Repair

Basophils

• Cell Function = ?
• Absolute Count = ?
• Differential Count = ?

Answer 6

Basophils: Type of white blood cell.

Cell Function:

• Produce allergic response like sneezing.

Absolute Count:

• 25-100

Differential Count:

• 0.5-1

Question 7

Inflammation and Tissue Repair

Lymphocytes (T and B)

• Cell Function = ?
• Absolute Count = ?
• Differential Count = ?

Answer 7

Lymphocytes (T and B):

• Type of white blood cell.

Cell Function:

• Produce antibodies, kills antigens.

Absolute Count:

• 1000-4000

Differential Count

• 20-40

Question 8

Inflammation and Tissue Repair

Inflammation = ?

Answer 8

Inflammation:

• Reaction of vascularized tissue to injury; host’s protective response; essential for healing.
• Generally, localizes, eliminates microbes, foreign particles, and abnormal cells and paves the way for repair of injured tissue.
• All disease process cause injury and healing occurs with an effective inflammatory response.

Inflammatory conditions are named by adding the suffix- itis to the affected organ or system.

Question 9

Inflammation and Tissue Repair

Types of inflammation = ?

Answer 9

Types of inflammation:

(1) Acute inflammation:

• Appears within minute to hours, expected body response to injury.
• Important for restoration of tissue homeostasis, aimed at removing the noxious agent and limiting the extent of tissue damage.

(2) Chronic inflammation:

• Days to years
• Altered inflammatory response because of the unrelenting injury.

Question 10

Inflammation and Tissue Repair

Cardinal signs of inflammation = ?

Answer 10

Cardinal signs of inflammation:

(A) At the site of injury:

• Rubor (redness)
• Tumor (swelling)
• Calor (heat)
• Dolor (pain)
• Functio Lasea (loss of function)

(B) Systemic manifestations:

• Fever (as cytokines (chemical mediators) produced at the site of inflammation gain entrance to circulatory system).
• Leukocytosis (elevation in WBC’S or leukocytes)

Question 11

Inflammation and Tissue Repair

Acute inflammation;

• goal = ?
• phases = ?

Answer 11

(a) Acute inflammation:

• Highly coordinated program to control and eliminate altered cells, micro-organisms and antigens and allow tissue repair to take place.

(b) Phases:

• Vascular phase
• Cellular phase

Question 12

Inflammation and Tissue Repair

Acute inflammation:

• Vascular phase = ?

Answer 12

(a) Acute inflammation - Vascular phase:

• Response of blood vessel near the site of injury, marked by tissue edema.
• Clotting of blood occurs, aids in localizing the spread of infection

(b) Momentary vasoconstriction followed rapidly by Vasodilation

• Increase in capillary blood flow causing heat and redness.

(c) Permeability

• Increase in capillary permeability
• Increased blood flow + increased permeability = loss of exudate (protein rich fluid, fibrin, leucocytes) from blood vessels into the extracellular space causing swelling, pain and impaired function.

Question 13

Inflammation and Tissue Repair

Fibrinogen = ?

Answer 13

Fibrinogen:

• Is an abundant plasma protein that, when converted to fibrin by thrombin, provides the main building blocks for the clot.

Acute inflammation - Vascular phase:

Question 14

Inflammation and Tissue Repair: Acute inflammation

Acute inflammation - Cellular Response:

• Events = ?
• Active cells = ?

Answer 14

Acute inflammation - Cellular Response: After dilation and increased permeability; cells essential for healing are needed at the site of injury.

Events:

• Chemotaxis (movement in response to chemical stimulus)
• Adhesion to the endothelium
• Transmigration across the endothelium

Cells active in the cellular phase:

(a) Leukocytes/ WBC’s

• Neutrophils (type of WBC, earliest phagocytic responders)
• Monocytes (immature macrophages)
• Macrophages (type of WBC, phagocytes associated with chronic inflammation)
• Red blood cells (carry oxygen to tissues)

(b) Platelets (traps harmful substances, stop bleeding)

(c) Connective tissues cells (fibroblast cells)

• Fibroblast- produce and replace connective issue

(d) Components of ECM - elastin, collagen

Question 15

Inflammation and Tissue Repair

Process of inflammation is carried out by = ?

Answer 15

Process of inflammation is carried out by inflammatory mediators.

Question 16

Inflammation and Tissue Repair

Good inflammation graphic

Answer 16

Question 17

Inflammation and Tissue Repair

Treatments for Inflammation:

• Non-pharmacological = ?
• Pharmacological = ?

Answer 17

Treatments for Inflammation:

Non pharmacological:

• Rest
• Ice
• Compression
• Elevation

Pharmacological:

• Aspirin
• NSAIDS
• Steroids

Question 18

Inflammation and Tissue Repair

Common blood tests used to detect acute inflammation = ?

Answer 18

(1) White blood cell count

• Values = 5,000-10,000 cells/mm3
• Changes w/inflammation = Increased

(2) C-reactive protein (CRP)

• Values = <10 mg/dl
• Changes w/inflammation = Increased

(3) Prothrombin (time to coagulate)

• Values = 11-13 seconds
• Changes w/inflammation = Reduced

(4) Fibrinogen

• Values = 175-400 mg/dl
• Changes w/inflammation = Increased

(5) White blood cell differential

• Values = ?
• Changes w/inflammation = Neutrophils increase in acute inflammation

(6) **Erythrocyte sedimentation rate **(ESR)

• Values =
• • 0-17 mm/hr for men
• • 1-25 mm/hr for women
• • 1-13 mm/hr for children
• • Increased, often above 100 mm/hr

Question 19

Inflammation and Tissue Repair

Erythrocyte sedimentation rate (ESR) = ?

• Conditions associated with high ESR = ?

Answer 19

Erythrocyte sedimentation rate (ESR): How fast blood samples (erythrocytes) sediments along a test tube in one hour.

• Results reported as mm of clear fluid (plasma) present at the top portion of tube after one hour.
• Non specific
• Fibrinogen enters the blood in high amounts and causes red cells to stick to each other.

Conditions associated with high ESR:

• Cancer
• Autoimmune diseases
• Infections

Question 20

Inflammation and Tissue Repair

CRP = ?

Answer 20

CRP = C-Reactive Protein

• CRP is synthesized in the liver.
• Its physiologic role is to bind to phosphocholine expressed on the surface of dead or dying (apoptosis) cells in order to activate the complement/immune system, which enhances phagocytosis by macrophages.
• Non specific but more accurate than ESR.

Question 21

Inflammation and Tissue Repair

Two ways of tissue Repair = ?

Answer 21

Tissue Repair:

• Overlaps the inflammatory process; response to tissue injury- to maintain normal structure and function.

Two ways:

1. Regeneration: inured cells replaced with cells of same type leaving no evidence of previous injury.
2. Replacement with connective tissue - scar

Question 22

Inflammation and Tissue Repair

Phases of wound healing = ?

Answer 22

Phases of wound healing:

• Inflammation (phase 1)- onset to 5-10 days
• Proliferation and migration (phase 2)- 3-20 days
• Remodeling and maturation (phase 3)- past 21days

Question 23

Inflammation and Tissue Repair

Components of tissue healing include = ?

“Fast Penguins Ensure Cure”

Answer 23

Components of Tissue healing:

(a) Fibronectin

• Provides structural support to the healing tissue
• Stabilizes fibrin which helps with blot clot
• Attracts fibroblasts and macrophages to the healing tissue

(b) Proteoglycans

• Secreted by fibroblasts, helps aid in hydration and stabilizing tissue during repair

(c) Elastin

• Secreted by fibroblasts, provides elasticity to tissue.

(d) Collagen

• Structural support and tensile strength for all tissues and organs
• Each collagen type has a specialized function
• Skin - mostly type 1 collagen
• Hyaline cartilage - type 2 collagen
• Vascular and visceral structures - type 3 collagen

Question 24

Inflammation and Tissue Repair

Factors that affect tissue healing = ?

Answer 24

Factors that affect tissue healing:

(1) Growth factors

• Growth factors: regulate cell proliferation, differentiation, migration, angiogenesis (VEG-F).
• Platelets, endothelial cells, fibroblasts, macrophages are sources of growth factors.
• Fibroblasts growth factor- stimulate endothelial cells- to form new blood cells.

(2) General health of an individual

(3) Presence of comorbidities
Infection

(4) Off loading weight bearing surfaces may be necessary

(5) Lack of desire to exercise or follow plan of care

(6) Nutrition

• Iron, folic acid
• Vitamin C: essential for tissue repair.
• Vitamin A: essential to promote proper collagen formation.
• Arginine: enhances healing and immune function.
• High protein intake: provide amino acids to build new tissue

(7) Oxygen

• Edema and necrotic tissue can hinder oxygen reaching the wound.
• Keeping the wound warm, avoiding smoking, maintain hydration, controlling pain and anxiety.

Question 25

# *Inflammation and Tissue Repair* Phases of wound healing: * Inflammatory phase = **?**

Answer 25

Inflammatory phase: (**a**) Begins at the time of injury, critical as it prepares wound for healing. (**b**) Vascular and cellular phase. (**c**) Migration of phagocytic white blood cells into the injured area; * Neutrophils come first to ingest, remove bacteria and cellular debris. * Followed by macrophages in 24 hours. * These cells also release growth factors for the proliferative stage. * Fibroblasts, epithelial cells, endothelial cells move into wound to form granulation tissue, developing tissue not strong.

Question 26

# *Inflammation and Tissue Repair* Phases of wound healing: * Proliferative stage = **?**

Answer 26

Proliferative stage: * Building of new tissue to fill the wound space. * Fibroblast - synthesize collagen, glycoproteins, proteoglycans needed for wound healing. * Also release growth factors that promote **angiogenesis** (formation of new blood vessels) and endothelial cell proliferation and migration. * **Granulation tissue**: rich network of developing blood vessels with connective tissue matrix- reddish granular layer of tissue. * **Re-epithelialization**, epithelial cells at wound edges proliferate to form new surface layer

Question 27

# *Inflammation and Tissue Repair* Phases of wound healing: * Remodeling phase = **?**

Answer 27

(a) **Remodeling phase**: * Begins 3 weeks after injury, can continue for 6 months or longer. * Development of fibrous scar, continued remodeling of scar tissue by synthesis of collagen by fibroblast. * Scar tissue changes from red to pink to white.

Question 28

# *Inflammation and Tissue Repair* Wound Healing: * Primary intention = **?** * Secondary intention = **?**

Answer 28

**Wound Healing**: Depending on the extent of the tissue loss, wound closure occurs by. * Primary intention (wound healing quick) * Secondary intention (eg. pressure ulcers, longer repair time)

Question 29

# *Inflammation and Tissue Repair* Factors that impact and complicate healing and tissue repair = **?**

Answer 29

Factors that impact wound healing: * Ineffective inflammatory / immune response * + (*People with diabetes, on corticosteroids*) * Inadequate nutritional status * Poor tissue perfusion Complications include Infection: * Ulceration (open craterlike lesion of the skin). * Adhesions (problems with collagen deposition). * Dehiscence (wounds pull apart). * Keloid development

Question 30

# *Inflammation and Tissue Repair* Wound dehiscence = **?**

Answer 30

(a) **Wound dehiscence**: * Deficient scar formation, wound bursts open at the suture line; Micro-organisms can invade. (b) **Causes**: * Early phase after surgery: mechanical stress placed on the wound. * Recovery period: poor development of ECM.

Question 31

# *Inflammation and Tissue Repair* Hypertrophic scar/ Keloid =

Answer 31

**Hypertrophic scar/ Keloid**: Excessive production of scar tissue

Question 32

# *Inflammation and Tissue Repair* Red wound = **?** ## Footnote Wound healing continuum

Answer 32

**Red wound**: * Granulation tissue * Indicates healing

Question 33

# *Inflammation and Tissue Repair* Yellow wound = **?** ## Footnote Wound healing continuum

Answer 33

**Yellow wound**: * Wound exudate + adherent = bacterial growth. * Debride (removal of dead damage tissue).

Question 34

# *Inflammation and Tissue Repair* Red / yellow wound = **?** ## Footnote Wound healing continuum

Answer 34

**Red / yellow wound**: * Remove yellow * Promote growth of red granulation tissue

Question 35

# *Inflammation and Tissue Repair* Black wound = **?** ## Footnote Wound healing continuum

Answer 35

**Black wound**: * Presence of necrosis / eschar (dry black hard necrotic tissue); delayed healing.

Question 36

# *Inflammation and Tissue Repair* What is chronic inflammation? * Cells are involved = **?**

Answer 36

**Chronic inflammation**: * Represents a persistent/ recurrent state of inflammation lasting several weeks or longer. * Related to a recurrent acute inflammation, persistent infectious process, or an autoimmune condition **Cells of chronic inflammation**: * Monocytes, macrophages * Fibroblasts (helps with collagen development, which contributes to extensive scarring), scarring- loss of function and deformity of organ/ tissue. **General manifestations**: * During flare ups: redness, swelling, heat, pain, loss of function, fever, malaise, anemia, fatigue, anorexia, weight loss or weakness. * During remission: no symptoms.

Question 37

# *Inflammation and Tissue Repair* In some cases, chronic inflammation results in = **?**

Answer 37

In some cases, chronic inflammation results in **granuloma**. * Form when injury is too difficult to control, such as with foreign bodies. * 1-2mm lesion, massing of macrophages surrounded by lymphocytes, attempt to surround the foreign body. * Inside, macrophages keep phagocytizing harmful substances, gradually necrosis fill inside granuloma - granuloma diffuses out- fibrotic capsule remains 

Question 38

# *Inflammation and Tissue Repair* Difference between acute and chronic inflammation: * Time = **?** * Chief phagocytic cells = **?** * Restoration = **?**

Answer 38

(**a**) Acute Inflammation: * **Time**: Resolution within a few weeks. * **Chief phagocytic cells**: Neutrophils. * **Restoration**: Minimal scarring (**b**) Chronic Inflammation: * **Time**: Present for a prolonged period of time, usually greater than 6 months. * **Chief phagocytic cells**: Monocytes, macrophages, lymphocytes. * **Restoration**: Marked by fibrosis, scarring, or granuloma formation.