Inflammation & Healing Flashcards
(166 cards)
1
Q
Inflammation
A
- vascular and cellular responses of living tissue to injury
- involves; blood, vessel, cell
- purpose is to eliminate offending irritant/stimulant
- reaction of living tissue to injury which comprises series of changes in the TERMINAL VASCULAR BED, and BLOOD, and TISSUE.
- remove and repair
- series of complex reactions by VASCULAR connective tissue elements in order to address injury
2
Q
Causes of inflammation
A
° pathogenic microorganism
° chemical injuries
° mechanical and thermal injuries
° immune reactions
3
Q
accumulation of fluid in the injured area (functions)
A
- to dilute
- to localize
- to destroy
- to remove
4
Q
advantages of inflammation
A
- protect the surrounding tissue by localizing and isolating the injured tissues
- to neutralise and inactivate toxins
- destroys and inhibit the growth of pathogenic microorganisms
- prepares injured area for healing and repair.
5
Q
disadvantages of inflammation
A
- excessive scar formation
- varying degrees of disabilities as a result of pain swelling
- tissue compression, vessel rupture, hemorrhage
- formation of cavities, sinus, fistula
- aggregates inflammation by destruction of surrounding intact tissue
- development of inflammatory diseases (hypersensitivity)
6
Q
Cardinal Signs
A
° rubor (redness)
° tumor (swelling)
° calor (heat)
° dolor (pain)
° functio laesa
7
Q
redness
A
rubor
8
Q
swelling
A
tumor
9
Q
heat
A
calor
10
Q
pain
A
dolor
11
Q
caused by vasodilation
A
rubor (redness)
12
Q
fluid exudate, increase vascular permeability
A
tumor (swelling)
13
Q
rapid inflow of warm blood thru dilated vessels
A
calor (heat)
14
Q
vasoactive chemicals will be released
A
dolor (pain)
15
Q
loss of function
A
functio laesa
16
Q
vasoactive chemicals
A
histamine, serotonin
17
Q
10 generalities of inflammatory response
A
- process
- living tissue
- series of events; overlapping into a continuum
- a response; requires initiation by some kind of stimulus
- response can be more harmful than the stimulus
- survival oriented
- fairly stereotype of any initiating stimuli
- always component of blood
- carefully coordinated defense mechanism essential to life
- complicated but understandable
18
Q
escape of fluid and blood cells from the vascular system into the interstitial tissue
A
exudation
19
Q
- fluid with high protein concentration
- high specific gravity increase 1.020
A
exudate
20
Q
- fluid with low protein content
- specific gravity less than 1.012
- ultra filtrate of blood plasma
- result of hydrostatic imbalance across vascular endothelium
A
transudate
21
Q
excess of fluid in the interstitial tissue/serous cavities
A
edema
22
Q
purulent inflammatory exudate rich in leukocytes and parenchymal debris.
A
pus
23
Q
cells involve in inflammation
A
° granulocytes
° agranulocytes
° plasma cells
24
Q
example of granulocytes
A
✓ neutrophils
✓ eosinophils
✓ basophils
25
- first to arrive in the site of inflammation
- a phagocytic cells by releasing lytic lysosomal enzymes and some chemotactic factors
neutrophils
26
examples of lysosomal enzymes released by neutrophils
✓ myeloperoxidase
✓ acid hydrolysis
✓ lysosomes and muramidase
✓ cationic proteins
27
- prominent in allergic reactions, parasitic infections
- contains; lysosomal granules/enzymes, histamines
- also a phagocytic cells
eosinophils
28
-least numerous
- shared common properties of mast cells
- secrete and release vasoactive amines/chemicals
- non phagocytic cells
basophils
29
not found in circulation but in tissues
mast cells
30
example of agranulocytes
monocyte and lymphocytes
31
- peripheral blood phagocytes
- becomes part of the tissue, then become macrophage
- involved immune response as an antigen preventing cell
- phagocytic cells
monocytes
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- found in tissues of all types of inflammation esp, after acute increase of neutrophils
- derived from bone marrow stem cells thru hematopoiesis
- both involved in cell mediated and humoral cell responses
lymphocytes
33
primary lymphoid organs
bone marrow
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3 types of lymphocytes
1. T-lymphocyte
2. B-lymphocyte
3. natural killer cells
35
70%. involved cell mediated lymphocytes
T-lymphocytes
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derived from bursa
B-lymphocytes
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- formed by a process of maturation and deviation of B-lymphocytes into 2 distinct cells
plasma cells
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2 distinct cells
memory cells and plasma cells
39
surface contains immunoglobulins + antibodies
plasma cells
40
macrophages (important component of immune system)
a. histiocytes
b. skin
c. liver
d. lungs
e. kidney
f. brain
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connective tissue
histiocytes
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skin
langerhan cells
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liver
von kupffer cell
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lungs
alveolar macrophages
45
brain
microglial cells
46
responsible for hemodynamic + vascular changes
vasoactive amines
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histamines
- stored in granules of mast cells
- found in basophils and platelets
- released by degranulation in response to various stimuli
- once released, can cause vasoconstriction and vasodilation
- cause increase vascular permeability of small veins and venules
48
mediators of inflammation
✓ protein
✓ peptides
✓ glycoproteins
✓ cytokines
✓ arachidonic acid metabolites
✓ nitric acid
✓ oxygen free radicals
✓ vasoactive amines
49
once activated, it will lead to formation BRADYKININ
kinin system
50
once plasma comes into contact with;
* collagen
* endotoxins
* basement membrane proteins
51
proteases secreted serine proteins
kallikrein
52
most important mediators of inflammation process
complement system
53
serotonin
- stored in GIT, CNS, dense granules of platelets
- regulates almost all immune cells in response to inflammation following the activation of platelets
54
leukocytes substances (activation of inflammation)
- hydrolytic enzymes
- proteases
- cationic proteins
55
lipid found in mast cells
Slow Reactive Substance of Anaphylaxis (SRSA)
56
biologically active substances produced by T-cells during immune reaction.
lymphokines
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begins within 4-6 hours and can remain constant in appearance depending on the initiators for survival days
acute
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may cover considerable time span between acute reaction and those in which evidence of chronicity apparent.
subacute
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- prolonged inflammation
- caused by persistent agent
chronic
60
key features of chronicity
1. caused by persistent inflammatory stimuli in which the host failed to completely rid in the tissue of invader
2. inflammatory response is usually accompanied by an immune system due to persistence of invader
3. highlighted by evidence of host tissue contribution in terms of reparative responses
4. characterized histologically by both mononuclear cells infiltrates and by CT cells such as fibroblasts
61
Cellular Phase of Inflammation
° margination and pigmenting
° diapedesis
° chemotaxis
° phagocytosis
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major event of inflammation
after injury
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2 opposing forces in Inflammation
° hydrostatic pressure
° plasma colloid osmotic pressure
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due to vasodilation
hydrostatic pressure
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due to leakage of high protein fluid to interstitial resulting in marked net outflow and edema
plasma colloid osmotic pressure
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3 patterns of increased in Inflammation
1. immediate transient response
2. immediate sustained reaction
3. delayed prolonged leakage
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- elicited by chemical mediators such as histamine in mild injury
- occurs as a result of construction in endothelium
immediate transient response
68
caused by severe injury (endothelial necrosis)
immediate sustained reaction
69
occurs after mild, moderate injury and due to direct injury to endothelium causing intracellular gaps
delayed prolonged leakage
70
leukocyte exudation
✓ leukocyte adhesion
✓ immigration
✓ phagocytosis
✓ intracellular degradation of ingested particles
✓ extracellular release of leukocyte products
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occurs be of specific interactions complementary adhesion molecules present in leukocytes
leukocyte adhesion
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2 types of bactericidal mechanisms
✓ oxygen dependent mechanism
✓ oxygen independent mechanism
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oxygen dependent mechanism
✓ HOCl- Hypochlorous Acid
✓ HCI- Hydrogen Peroxide
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types of exudates
1. serous
2. cataract
3. hemorrhage
4. fibrinous
5. suppurative
6. granulomatous
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characterized by dominant vascular and cellular component
exudates
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implies a mild injury; serous fluids predominates
serous
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occurs in areas with mucous glands/secretions; predominated by mucous or cattarh.
catarrhal
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exudate predominated by RBC
hemorrhage
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predominated by fibrin and blood clot
fibrinous
80
pus, mostly consist by neutrophils
suppurative
81
predominates macrophages
granulomatous
82
hageman factor - formation - bradykinin - kallikrein
83
2 pathway
classical pathway and non-immunologic stimuli (such as bacterial toxins)
84
for antigen antibody complexes
classical pathway
85
how to activate;
activation- cleavage of complement C3 C5 which C3A into two pathways
86
example of arachidonic acid metabolites
prostaglandin and leukotrienes
87
potent vasodilators involved in edema formation by potentiating effects of histamines
prostaglandin
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produces pain potentiating the effect of bradykinin and act on yhe hypothalamic mechanism of fever production
prostaglandin E2
89
inhibit platelet aggregation
PG12 (prostacycline)
90
derived from lipoxygenase pathway
leukotrienes
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leukotrienes
✓ LTB4
✓ LTC4
✓ LTD4
✓ LTE4
92
potent chemotactic agent for neutrophil and monocyte macrophages
LTB4
93
-powerful stimulator of vascular permeability
LTC4 and LTD4
94
- 1000 times potency than histamines
- cause vasoconstriction and bronchoconstriction
LTE4
95
Distribution
° focal
° multi-focal
° locally extensive
° diffused
96
what attract the leukocytes to migrate to the injured site are chemical mediators of inflammation and this process is called?
chemotaxis
97
more leukocytes adhere to the walls until the luminal surface of the wall become covered with a layer of leucocytes called?
pavementing
98
began to stick to the walls and adhere to it for longer periods called?
adherence
99
leucocytes begin to appear in the marginal plasma stream of the venule
margination
100
the etiology of inflammation varies includes both living and non-living agents such as;
bacteria, fungi, viruses, metazoan parasites, protozoa, immunologic injury, trauma, heat, cold, toxins or poisons and irradiation
101
inflammation is a protective mechanism in that protective factor such as?
antibodies, complement and phagocytic cells
102
purpose of inflammation
✓ to minimize the effect of the irritant or injury
✓ to heal the damaged tissue
✓ restore the affected tissues to normal
103
2 phases of increased vascular permeability;
immediate phase (less than an hour)
prolonged phase (3-4 hrs)
104
AGENTS THAT CAUSE ANAPHYLAXIS is numerous and include:
•venom or stings of biting insects
•vaccines
•variety of drugs
•food substances
•blood donors/blood products
105
Clinical signs can be localized or generalized. Symptoms include:
✓restlessness and excitement
✓facial edema
✓pruritus on
✓affected area
✓salivation
✓lacrimation
✓vomiting
✓diarrhea
✓abdominal pains
✓dyspnea
✓cyanosis
✓shock
✓incoordination
✓convulsions
✓death
106
T lymphocytes
✓helper T cells- CD4
✓Suppressor and cytotoxic T cells –CD8 or T8
107
are tissue phagocytes
macrophages
108
macrophages are important components of immune system
✓T cell activation
✓Macrophage activation
✓B cell activation
109
Secretory functions of macrophage
✓release colony stimulating factor
✓release of alpha interferon
✓precursors of prostaglandins
110
formed from macrophages and are often found together in
chronic lesions.
epithelioid and Giant cells
111
Two types of giant cells are recognized
1. langerhan cells
2. foreign body giant cells
112
the nuclei are arranged throughout the cell.
foreign body giant cells
113
giant cell with nuclei around the periphery
langerhans cells
114
chemotactic factors
-Macrophage chemotactic factor (MCF)
-
Neutrophil (NCF)
-
Eosinophils (ECF)
115
is an atom or molecule that is capable of independent existence
and has one or more unpaired electrons that make it highly reactive and
potentially cytotoxic
free radical
116
inflammatory lesions are
usually small and surrounded by normal tissue.
focal
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lesions represent several scattered foci of inflammation
multi focal
118
lesion involves a considerable are of tissue within an organ
locally extensive
119
inflammatory lesions involve all of the tissue or the whole organ.
diffuse
120
term used to describe small nodular lesions of chronic
inflammation that has a caseous center walled off by epithelioid cells
granuloma
121
sometimes called exudative inflammation because of
the numerous tissue and plasma factors that pours into the inflammatory site
acute inflammation
122
have some classic features as hyperemia, fluid and cellular exudations
acute lesions
123
occurs when the injurious stimuli persist over a long period. It is often called proliferative inflammation
chronic inflammation
124
traditionally classified on a time basis as acute, subacute, and chronic
inflammatory response
125
They are less common than neutrophils, and arrive at the site of inflammation later than the polymorphs (granulocytes)
monocytes and macrophages
126
Considered as the circulating form of mast cells, their number in
circulation is very low.
basophils
127
are not phagocytic, and do not ordinarily migrate
during the acute phase of inflammation.
lymphocytes
128
present in lesions around small blood
vessels where they form a cuff
perivascular cuffing
129
they produce antibodies and their presence in an inflammatory site reflects a subacute or chronic process
plasma cells
130
These cells are very much like neutrophils in that they have
granules containing an assortment of
enzymes, are phagocytic, and react
to stimuli similar to that of neutrophils
eosinophils
131
Effects of Autacoids
• Vasodilation and Hyperemia.
• vasopermeability
• Leucocyte Emigration and Chemotaxis.
132
are chemical messengers that act on vascular endothelia and leukocytes to contribute to an inflammatory reaction.
autacoids
133
it influence the previously discussed changes in vascular caliber and permeability as well as chemotaxis of leukocytes
chemical mediators
134
lipid mediators collectively called?
eicosanoids
135
when coupled with a thin fluid where it imparts a red tinge color, the exudate are called?
serosanguineous exudates
136
when the exudates are admixed with mucus the term is?
mucopurulent
137
when exudates are admixed with fibrin
fibrinopurulent
138
a viable collection of pus within of beneath the epidermis of the skin
pustule
139
localized collection of pus, usually confined with a diphtheritic membrane or pyogenic membrane
abscess
140
rupture at a surface through a tract
sinus or fistulous tract
141
spread along fascial planes and subcutaneous tissues
cellulitis or phlegmonous inflammation
142
pus contained in body cavities
empyema
143
the principal element of catarrhal exudates are?
° secreted mucin
° admixed with neutrophils
° tissue debris
° fibrin and red blood cells
144
when admixed with pus, the exudates are called?
mucopurulent exudates
145
inflammatory lesions are usually small and surrounded by normal tissue
focal
146
if it is well demarcated the lesion is said to be?
discrete
147
if it blends well with the surrounding normal tissue, is said to be?
diffuse focal
148
lesion represent several scattered foci odf inflammation
multi-focal
149
if the lesion involves a considerable are of tissue within an organ, the lesion is said to be?
locally extensive
150
inflammatory lesions involve all of the tissue or the whole organ
diffuse
151
two processes of healing
repair and regeneration
152
occur at sites where there is only minimal loss tissue
healing by first intention
153
the process involved in healing by second intention also called?
healing by granulation
154
the tissue that fill-in the gap and is beneath the coagula is called?
granulation tissue
155
this could only occur when there is minimal damage. this type of repair is typified by what happens in the lungs.
repair by resolution
156
where there is incomplete resolution of inflammation
repair by organization
157
these cells continue to multiply throughout life to replace those shed or destroyed by normal physiological processes
labile cells
158
they retain their latent capacity to regenerate, but do not actively replicate under normal circumstances because they have a survival time measured in terms of years
stable cells
159
these cells cannot regenerate and therefore damage to these cells represents permanent loss
permanent cells
160
implies that lost cells are replaced by cells of the same kind, and indicates cellular division of the remaining viable cells to take over the place of those lost from injury
regeneration
161
two aberrations could occur in either of the first or second intention repair process. what are these two?
✓ keloid
✓ exuberant granulation or proudflesh
162
may occur accumulation of excessive amounts of collagen giving rise to a protruding tumor-like scar tissue
keloid
163
may be excessive formation of granulation tissues that protrudes above the level of injury
exuberant granulation or proudflesh
164
Several factors that influences the healing process
✓ tissue involved
✓ vascularity
✓ protective covering
✓ nutrition
✓ hormones
✓ age
✓ magnitude of injury
✓ presence of infection
✓ presence of nerve supply
165
these hormone are necessary for healing for they regulate metabolic activities
thyroid hormone
166
delays healing for they interfere in with the maturation of collagen and in the on-going inflammatory process
corticosteroid
