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Response and Recovery to Injury Flashcards

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1
Q

List 3 remnants that can be produced from Injury and Inflammation

A
  1. A mass of dead necrotic tissue
  2. Remnants of inflammatory cells
  3. Remnants of initial stimulus (e.g bacteria)
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2
Q

List 3 consequences of inflammation/injury

A
  1. Resolution (Scavenging-Clearing up, happens in both regeneration and repair)
  2. Regeneration
  3. Repair - formation of scar
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3
Q

Scavenging is achieved by

A

Macrophages

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4
Q

Macrophage present in a tissue is known as

A

Histiocytes

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5
Q

Function of Macrophage in Scavenging

A
  1. Goes to sinusoids (specialised capillary areas) in liver, bone marrow and spleen
  2. Clears offending stimuli
  3. Clears dead tissue and inflammatory cells
  4. Produce growth factor for proliferation of cells in healing response
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6
Q

List 5 activities of Macrophages

CHPPP

A
  1. Chemotaxis- migration towards damaged tissues
  2. Hypertrophy -Histiocytes become larger and accumulate enzymes
  3. Pseudopodia - Active movement
  4. Pinocytosis - Ingest fluid
  5. Phagocytosis
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7
Q

List 3 ways tissue grows with explanation

A
  1. Multiplicative: Increase in cell number by mitotic division
  2. Auxetic: Increase in cell size
  3. Accretionary: Increase in extracellular tissue
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8
Q

List 3 different cell ability to proliferate

or 3 different regenerative cell types

A
  1. Labile cells - continuously proliferate, rapid turnover e.g blood cells, epithelial cells
  2. Stable cells - good regenerative ability, low cell turn over e.g hepatocytes
  3. Permanent cells - have little or no regenerative ability- terminally differentiated cells e.g brain cells, neurons, keratinocytes,cardiac cells
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9
Q

List 4 cell responses to stress

A
  1. Adapt
  2. suffer Reversible cell Injury
  3. Suffer Irreversible cell Injury
  4. Die
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10
Q

List 4 Cellular Adaptation

A
  1. Hyperplasia
  2. Hypertrophy
  3. Atrophy
  4. Metaplasia
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11
Q

What is Hypertrophy

A

An increase in cell size as a result of increase in its structural component.

This is the only adaptive process of all 4 available to permanent cell

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12
Q

Which adaptive process can Permanent cell undergo

A

Hypertrophy

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13
Q

List 2 examples of Physiological Hypertrophy and Pathological Hypertrophy

A

Physiological Hypertrophy:

  1. Skeletal muscle hypertrophy owing to exercise
  2. Uterine hypertrophy owing to hormone stimulation during pregnancy

Pathological Hypertrophy:

  1. Cardiac hypertrophy owing to hypertension
  2. Bladder hypertrophy owing to prostatic enlargement
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14
Q

What is Hyperplasia

A

Increase in cell number. This requires cells that are able to divide(labile and stable cells).

Often hyperplasia and hypertrophy happens together

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15
Q

List 2 examples of Physiological hyperplasia and pathological hyperplasia

A

Physiological hyperplasia:

  1. Hormonal hyperplasia - increase in cells involved in breast feeding
  2. Compensatory hyperplasia - regrowth of lost tissue e.g liver

Pathological hyperplasia:
1. endometrial hyperplasia as a result of excess oestrogen
2. prostatic hyperplasia
as a result of excess androgens

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16
Q

What is Atrophy

A

A reduction in cell size and cell numbers

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17
Q

List 2 examples of Physiological Atrophy and pathological atrophy

A

Physiological Atrophy:

  1. Testicular atrophy
  2. Ovarian atrophy

Pathological Atrophy:

  1. Vascular atrophy of the brain
  2. Starvation
  3. Disuse atrophy of muscle
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18
Q

What is metaplasia

A

Metaplasia is a reversible change where one differentiated cell/tissue is replaced by another differentiated cell/tissue. Usually occurs in epithelium.

Stem cell differentiates to a different type of cell.

The cell does not change. The regeneration from stem cell changes

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19
Q

List 2 example of physiological metaplasia and 2 example of pathological metaplasia

A

Physiological metaplasia:
1. Endocervix exposure to vagina acid when it gets bigger in pregnancy. Converts columnar epithelium into squamous epithelium

Pathological metaplasia:
1. Bronchi ciliated columnar epithelium is metastasise into stratified squamous epithelium in response to smoking

2.oesophagus stratified squamous epithelium metastasise into columnar epithelium as a result of acid reflux

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20
Q

List 3 ways of how cell injury occurs

A
  1. Depletion of ATP
  2. Cellular swelling- osmotic influx of water caused by ion imbalances
  3. Changes in intracellular organelles and cytoskeleton
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21
Q

List 3 types of cell death

A
  1. Necrosis
  2. Apoptosis
  3. Autophagy Associated cell death
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22
Q

6 Difference between Necrosis and Apoptosis

A

Cells swell vs cell shrinks
Nuclei shrink vs nuclei fragments
cell membrane ruptures vs membrane is intact but altered
cell content leak vs apoptotic bodies
causes inflammatory response vs no inflammation
Always pathological vs often physiological but may be pathological (if abnormally high)

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23
Q

List the 5 mechanisms of Necrosis (Necrosis of cardiomyoctes occurs in this steps as well)

A
  1. Mitochondrial damage
  2. ATP Depletion
  3. Increased membrane permeability
  4. Influx of calcium ion
  5. DNA and protein damage
  6. Disintegration of the cell
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24
Q

List 3 macroscopic patterns/Types of necrosis on tissue

A
  1. Coagulative necrosis - spleen/ most solid organs
  2. Liquefactive necrosis- brain
  3. Caseous necrosis - lungs. cheese like appearance. Usually from infection
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25
List 3 processes where physiological apoptosis takes place
1. Embryogenesis - fingers 2. Elimination of self-reaction/ autoimmune lymphocytes 3. Apoptosis of inflammatory cells at the end of inflammatory response
26
List 2 processes where pathological apoptosis occurs
1. DNA damage- i.e in cancer | 2. HIV infection
27
What is Autophagy associated cell death
The cell breaks down its own contents as a survival mechanism in nutrient deprivation. Regulated by autophagy genes. It is like reversible apoptosis. the cell can go back to its normal state as soon as you replenish its nutrients
28
List 4 causes of inflammation
1. Foreign bodies (dirt, sutures, splinters) 2. Infection 3. Immune reaction (autoimmune reactions, allergy) 4. Tissue necrosis (trauma, physical or chemical injury)
29
List the steps of an Inflammatory Response 5 R's
1. Recognition (of the injurious agent) 2. Recruitment (of leucocytes) 3. Removal (of the injurious agent) 4. Regulation (of the inflammatory response) 5. Resolution (or repair)
30
Local patterns (what is present in site) of acute inflammation
Lots of neutrophils + (blood cells) in site like in Acute bronchopneumonia and Acute meningitis
31
Increased volume of blood in an area of insult and slower flow leads to
Increase in hydrostatic pressure
32
Histamine and nitric oxide causes 2 response in Acute inflammation. List them
1. Vasodilation | 2. Increase permeability of endothelial cell in blood vessels
33
How does Oedema occur
Escape of protein from BV into tissue. Water/fluid follows into tissue by osmosis
34
Difference between Exudate and Transudate
In Exudate - escape of protein rich fluid In Transudate - escape of protein poor fluid Both can result in oedema
35
Leucocytes (Neutrophil and Macrophage) leave the blood vessels in 3 steps
1. Rolling along the blood vessels 2. Adhesion to endothelium 3. Emigration through the vessel into surrounding tissue Amoeboid movement (cytoplasm forms into pseudopodia for movement)
36
What is Amoeboid movement
Amoeboid movement (cytoplasm forms into pseudopodia for movement). Leucocytes moves towards chemical mediators = chemotaxis
37
List 5 benefits/advantages of inflammation
1. Degradation of bacteria and toxins 2. Stimulation of the immune response 3. Facilitation of drug transport 4. Initiates healing 5. Fever via hypothalamus thermoregulation- (degradation of pathogen)
38
List 5 harms/disadvantages of inflammation
1. Bystander damage of healthy tissue 2. Inappropriate inflammatory response e.g allergies 3. Excessive inflammatory response - autoimmune disease 4. Swelling 5. Fever (shape of proteins) 6. Weight loss
39
Fever in inflammation can be positive and negative. Give examples
+ve Fever - leads to increase in metabolic processes e.g chemotaxis and blood flow. Also helps in degradation of pathogen -ve Fever - can lead to damage of body proteins, active site denature.
40
List 3 (local) effects of acute inflammation
1. Fibrinous inflammation 2. Abscess formation 3. Ulcer Fever
41
Abscess ?
Neutrophils + dead cells/tissue | - Within the tissue
42
Ulcer ?
A break/hole in between membrane. Neutrophils also present at site
43
List 3 outcomes of Acute inflammation
1. (complete) Resolution 2. Repair by scarring 3. progression to Chronic inflammation
44
List 4 causes of Chronic Inflammation
1. Persistent Infections 2. Inability to heal 3. Prolonged exposure to toxic agents 4. Auto-immune disease (rheumatoid arthritis)
45
List cells of acute inflammation and chronic inflammation
Acute inflammation: numerous neutrophils Chronic inflammation: Lymphocytes (b-cells - blue stain), eosinophils (red stain), plasma cells, macrophage, fibroblast, few neutrophils
46
List 2 distinct patterns/features of chronic inflammation (under stains)
1. Numerous B cells, eosinophils and plasma cells | 2. Granuloma (epithelioid macrophages)
47
What is a Granuloma
A granuloma is an area of activated epithelioid (epithelium-like) macrophages which are surrounded by lymphocytes.
48
Epithelioid macrophages may fuse together to form ...
Multi-nucleated Giant cells
49
What is Active Chronic Inflammation
when there is a mixture of neutrophils and lymphocytes
50
What is a polyp
An oedema that shows presence of eosinophils when stained
51
A macrophage is a cell of : A. Acute inflammation B. Chronic inflammation
B. Chronic inflammation
52
List 2 conditions that are associated with granuloma (Giant cells)
1. TB | 2. Sarcoidosis
53
If resolution and scavenging isn't enough to resolve the injury. One of two process occurs. Name the 2 processes
1. Regeneration | 2. Repair
54
What is regeneration?
A process that involves re-growing of an injured tissue to its previous/original state
55
Regeneration depends on 2 factors. List them
1. The regenerative ability of the cell/tissue. E.g Labile and Stable cells can regenerate but permanent cells wont 2. The extent of injury. If extracellular matrix(scaffolding)/basement membrane is damaged. Regeneration is usually not possible
56
During regeneration, ________ interacts with extracellular matrix/stromal scaffolding to increase cell proliferation
Macrophages
57
In Repair, scarring is formed by ________ ? How?
Fibroblast patches up damage with fibrosis/ collagen
58
State the 5 steps of Repair
1. Angiogenesis 2. Formation of Granulation tissue 3. Fibroblast produce collagen 4. Remodelling and contraction of the area 5. Scar
59
Angiogenesis during scare formation can lead to _________ as a result of leaky blood vessels
Angiogenesis during scare formation can lead to Oedema as a result of leaky blood vessels
60
Fibroblast Growth factor, increases proliferation of Fibroblast. Which increases production of elastin and collagen in granulation tissue to complete scar formation. True or False
True
61
Scar has ___% of normal skin strength
80%
62
List 5 causes of Acute impairment of healing
1. Poor circulation/ischaemia 2. Excess movement 3. Infection 4. Foreign body 5. Denervation 6. Site (lip heals easily, foot takes longer to heal)
63
Why do obese patient tend to have poor wound healing
They have poor circulation. atherosclerosis ?
64
List 5 systemic impairment of healing
1. Diabetes Mellitus 2. Vitamin C deficiency 3. Age 4. Anaemia 5. Obesity 6. Soft tissue genetic disorder 7. Malnutrition
65
List 4 complications of wound healing
1. Deficient formation of scar leading to Ulceration 2. Excessive formation of scar leading to keloid 3. Abdominal Adhesions 4. Wound contractures (as a result of excessive scar formation and muscle shortening)
66
When giant cells eat up suture. They are called
Foreign body giant cell
67
What is Barrett's oesophagus
Acid reflux from stomach into oesophagus. Causes metaplasia. | stratified squamous epithelium changes to columnar epithelium to cope with the acid
68
Example of pathophysiological hyperplasia
Increase in cells of the prostate in older men. Causing Benign prostatic hyperplasia (BPH). Causes problem with urination- urine retention
69
``` In healing by secondary intention: A.There is ongoing inflammation B.There is background scarring C. Diabetes mellitus is a possible underlying cause D. May cause cosmetic disfiguring E. All of the above ```
E. All of the above
70
Blockage of the artery with plaque is called
Atheroma
71
Atheroma makes the blood vessels prone to _________ (formation of blood clots in the vessels), which can become free to form an ________ which can lead to an occlusion
Atheroma makes the blood vessels prone to THROMBOSIS(formation of blood clot in the vessels), which can become free to form an EMBOLUS which can lead to an occlusion
72
A blood clot forming within a vessel =
Thrombus
73
A blood clot moving within a vessel =
Embolus
74
A blocked vessel =
Occlusion
75
Lack of blood flow =
Ischaemia
76
List 5 consequences of Ischaemia
1. Hypoxia (lack of oxygen to cells) 2. Accumulation of toxic materials in cells 3. Reversible cell injury 4. Irreversible cell injury 5. Cell death- Necrosis
77
Lack of oxygen =
Hypoxia
78
What type of necrosis occurs in myocardial infarction
Coagulative necrosis
79
irreversible cell damage occurs when...
cells lose their nuclei and membrane integrity
80
Why do patient survive myocardial infarction but die about a week later
Repair process starts | Granulation tissue is weak - oedema - rupture of granulation tissue - Haemopericardium sudden cardiac death
81
What is haemopericardium
Rupture of granulation tissue in heart. Blood flow out of heart.
82
If collagen from repair is near electrical activity in the heart, electrical flow is impeded, causing
Arrhythmias

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