Inflammation Two Flashcards
(84 cards)
1
Q
Inflammation
A
A non-specific response to any agent that causes cell injury.
Absolutely necessary for healing, but potentially harmful to body as well.
2
Q
Agents of inflammation
A
Can be:
Physical
Chemical
Biologic
3
Q
Non-Specific Response
A
Same response regardless of cause
Amount of response can vary
Variable to: Virulence of agent Size Severity Host factors
4
Q
Suffix for -itis
A
Inflammation
5
Q
Are cardinal signs on inflammation always visible?
A
No, not always.
6
Q
Presentations of Loss of Function
A
Decreased ROM
Decreased performance
Decreased ability
7
Q
PRICE
A
Old theory to treatment of inflammation
Some studies still support
Protect Rest Ice Compress Elevate
8
Q
SHARP Mnemonic
A
S - Swelling H - Heat A - Abnormal function R - Redness P - Pain
9
Q
PT Actions When Swelling Presents
A
Generally, do not treat.
If significantly worsens, very uncomfortable, puts pressure on other structures, or makes ADL’s too challenging then should be treated for.
Acute = leave it, chronic = treat it
10
Q
Local Manifestations of Inflammation
A
Exudate formation; many potential types
Abscess formation
Ulceration
11
Q
Exudate
& Types
A
A local manifestation of inflammation
Appearance associated with name
Serous Fibrinous Sanguinous Serosanguinos Seropurulent/Prurulent
12
Q
Serous Exudate
A
Clear
Healthy response, normal
13
Q
Fibrinous Exudate
A
Yellow
Occurs later in healing, normal
14
Q
Sanguinous Exudate
A
Red
Indicative of blood, normal
15
Q
Serosanguinous Exudate
A
Pink
Indicative of minor blood, normal
16
Q
Seropurulent/Prurulent Exudate
A
Pus
Indicative of infection, abnormal
17
Q
Abscess formation
A
A local manifestation of inflammation
When exudate occurs in solid tissue
“Walled off” by fibroblasts & macrophages
Inhibits body from releasing infections
18
Q
Ulceration
A
A local manifestation of inflammation
When inflammation erodes epithelial surface
May require surgical intervention
19
Q
Hypothalamus function in inflammation
A
Directs body to increase temperature to fight off infection
20
Q
Systemic manifestations in inflammation
A
Occurs only in large injuries, infections, or autoimmune diseases
21
Q
Signs of systemic manifestations
A
Fever Leukocytosis Malaise Lymphadenitis Leukopenia
22
Q
What is the hallmark sign of systemic inflammation?
A
Fever
23
Q
Leukocytosis
A
Sign of systemic manifestation of inflammation
WBC growth
Potential leukopenia if overwhelming condition
24
Q
Malaise
A
Sign of systemic manifestation of inflammation
Unwell feeling
25
Lymphadenitis
Sign of systemic manifestation of inflammation
| Lymph nodes swelling
26
Leukopenia
Sign of systemic manifestation of inflammation
Low WBC count
Fight is using more cells than can produce
27
Leuko-
white
28
Cyto-
cells
29
-osis
growth of
30
Categories of Inflammation
Acute = short (less than a week)
Subacute = closer to healing, sign that still in inflammatory process but progressing
Chronic = long, need to intervene
Acute on Chronic = has existence of a chronic disease
31
Self-perpetuating
Viscous cycles of inflammatory response
Individual leaks cells to fight off
Usually severe exposure
Lasts weeks, months, years
32
Why can self-perpetuating cycles occur?
Cause still present
Chronic low intensity irritant, infection
Altered function of inflammatory/immune system response
33
How is chronic inflammation identified?
May result in further tissue destruction
More macrophages, lymphocytes, plasma cells
More fibroblasts
Little/no edema, exudate
34
Greater fibroblast proliferation
```
Scar tissue
Lack original tissue properties
Can interfere with tissue function
ROM decreased
Lack of function
```
35
Medical concerns with chronic inflammation
```
"Recurring systemic inflammation"
Alzheimers
Diabetes Mellitus
Athersclerosis (heart disease)
Some cancers
Some autoimmune disease
```
36
Atherosclerosis
Wearing down on lumen and plaque forms
37
Parenchymal Tissue
Actual function tissue
38
Stromal Tissue
Support structures
| Give stability
39
Tissue regeneration
Repair by same parenchymal type cells
Depends on cell proliferation and ability to move through cell cycle:
Labile, Stable, Fixed cells
40
Labile cells
Always replicating
They are used to dividing and do it easily
Ex: smooth tissue repair
Ex: skin, GI tract
41
Stable cells
Can be triggered to replicate/re-grow
| Ex: liver
42
Permanent or Fixed Cells
Will never proliferate or re-grow
Ex: neurons, cardiac, and skeletal
Think "expensive"
43
Phases of tissue healing and repair
Inflammatory phase
Proliferation phase
Maturation phase
44
Proliferation phase
"Fibroblastic phase", Granulation, Granular phase
If better vasculature, better healing
Generally days 3-20
Rebuilding stage done by fibroblasts
Has four major components
*First phase PT's can start to really help
45
Maturation phase
"Remodeling phase"
Can last months or years
New tissue laid down, but changing
MOST progress occurs here
Day 7 - or Years 1-2
```
Longest phase in healing
# of macrophages, fibroblasts, capillaries decrease
Scar whitens and collagen aligns
Capillaries decrease
Collagen fiber synthesis
```
No pain
No swelling
46
Components of Proliferative phase
Collagen production
Wound contraction
Revascularization
Epithelialization
47
Collagen production
| in Tissue Regeneration
First gets laid down
Basis for nearly all tissues
Produced by fibroblasts
Provides support/strength to tissue
Encourages correct "lay down"
48
Wound contraction
| in Tissue Regeneration
```
Make wounds smaller
Only for large defects
Edges of wound pull together
Similar to the way sutures work
From outside in
```
49
Revascularization
| in Tissue Regeneration
```
Good blood supply returns to area
"Angiogenesis"
Vessels from wound periphery migrate inward, providing blood
New scars often pink or bright red
Blood provides nutrients, O2
```
Bone fractures = quick
Ligaments = long
50
Epithelialization
| in Tissue Regeneration
Wound edges start to heal
| Cells start at wound edge and migrate along granulation tissue
51
Stages of healing in proliferation phase
```
Epidermal layer reestablished
Epithelialization
Collagen & fibroblasts proliferation continues
WBC leave
Edema decreases
Small blood vessels degenerate
Tissue blanches
Collagen production
Wound contraction
Revascularization
```
Variable time based on size of wound
52
Primary intention
Small wound
Easy to heal
Minimal scar tissue
No initial tissue loss
Little or no scar formation
53
Secondary intention
Larger injuries
Occurs if:
larger amount tissue loss
contamination or infection
Larger amount of scar/fibrotic tissue
54
Collagen fiber synthesis
Occurs in maturation phase
Reaches homeostasis during phase
Collagen fiber orientation resembles original tissue
Synthesis and lysis of collagen to reorient scar to increase tensile strength
70-80% of normal tissue strength at best
55
Maturation phase: regeneration
Injured tissue replaced with new tissue of same kind and properties
Begins with granulation tissue
56
Maturation phase: fibrosis
Scar tissue present
With more severe inflammation or larger tissue insults
Scar tissue not same as original tissue:
Lacks original strength
Lacks flexibility
Lacks original function
57
Impaired healing can occur due to what 12 factors?
```
Impaired blood flow, O2
Cardiac conditions
Respiratory conditions
Vascular conditions
Blood conditions
Malnutrition
Edema
Age (extremes = young and old)
Impaired inflammatory function
Impaired immune function
Foreign bodies
Some medications
```
58
Malnutrition
Many micro and macro nutrients needed for adequate tissue function and healing
59
Impaired inflammatory and immune function
Too much or too little action
| Can be primary or secondary conditions
60
What kind of system does the body work on?
Negative Feedback Mechanism
61
Anti-Inflammatory medications
Common prescription for inflammation
62
Is inflammation normal?
Yes - normal response to cellular injury
| Vital for normal healing
63
Dangers of excessive inflammation
Prolonged or excessive inflammation can cause more damage than the initial cellular injury
64
Types of Anti-inflammatory meds
Analgesics
Non-steroidal anti-inflammatories
Corticosteroids
DMARD's
65
Analgesics
Strictly pain inhibitors
Symptom relief
"Not feeling"
Ex: acetaminophens, opiates, narcotics
66
Non-Steroidal Anti-inflammatories
Prescription or OTC
Interrupt pathway to prostaglandin production
NSAID, non-NSAID's, anti-feveretics
Ex: aspirin, ibuprofen, naprosyn, Celebrex
67
Corticosteroids
```
Sugar based
NOT anabolic
Either hormone from adrenal cortex (cortisol) or a synthetic derivative
Very potent anti-inflammatory properties
Many different kinds
```
-one's
Ex: cortisone, prednisone, hydrocortisone, dexamethasone
68
DMARD's
Disease modifying anti-rheumatic drugs
Symptom relief
Affect underlying disease processes
Most common for autoimmune conditions
Ex: methotrexate, Enbrel, Humira
69
Corticosteroid Potential Adverse Effects in Major systems
```
Muskuloskeletal
Immunological
Cardiovascular
Integumentary
Metabolic & Endocrine
Psychological
```
70
How are corticosteroids delivered?
Injection (tissue or IV)
Topical
Inhaled (nebuligens)
71
Conditions corticosteroids used for
Reduce inflammation for local OR systemic
Especially chronic
Allergies
Autoimmune disorders
-itis conditions (arthritis)
72
Adverse Musculoskeletal Effects Corticosteroids
Muscle, tendon, cartilage weakening
Myopathy, muscular atrophy
Osteoporosis
Osteonecrosis
73
Adverse Immunological Effects Corticosteroids
Immunosuppression
Bone marrow suppression
> intervene with RBC, WBC, platelet production
74
Adverse Cardiovascular Effects Corticosteroids
HTN
Elevated blood lipids
Atherosclerosis
High blood pressure
75
Adverse Integumentary Effects Corticosteroids
```
Acne
Stretch marks (breakdown of collagen)
Hair loss
Easy bruising/bleeding
Skin atrophy
Poor wound healing
"skin tears" - friction causes skin to rip
```
76
Adverse Metabolic & Endocrine Effects Corticosteroids
```
Fluid retention
Electrolyte imbalances
Obesity
Growth retardation in children
Elevates BP (cause diabetes)
```
Excess sugar means pancreas malfunction
77
Adverse Psychological Effects Corticosteroids
Mood changes
Behavioral changes
Can occur even in short doses;
anger, can't sleep, hungry
78
Adverse Psychological Effects Corticosteroids
Mood changes
Behavioral changes
Can occur even in short doses;
anger, can't sleep, hungry
79
PT Implications for Corticosteroids
Be aware of adverse effects with long term use
Systemic effects more likely when used for systemic conditions
Four major effects
80
Four major effects for PT implications and corticosteroid usage
1) Weakness, may not tolerate activity well
2) Immunosupression
Standard precautions, risk of infection, may need neutropenic precautions
3) Poor skin quality, poor wound healing
4) Edema, weight gain
= Everything with awareness!
81
Intra-cellular injections
Few months of effectiveness
Control acute pain and inflammation
Not to treat muscular, tendinous, or ligamentous injury
Less likely to result in systemic effects
Used as a bridge prior to surgery
Ex: cortisone shots
82
Erythrocyte Sedimation Rate (ESR)
"sed rate"
Nonspecific test for inflammation
Positive result if elevated
83
C-reactive protein (CRP)
Nonspecific test for inflammation
| Positive result if elevated
84
Current Considerations for Inflammation
Traditional Rx
-Halt/Limit inflammation following injury
Some newer proponents
- Calling RICE into question
- Allow normal inflammation to occur
