Week 5: Tissue Damage and Trauma Flashcards

(45 cards)

1
Q

What are the causes of tissue damages?

A

Physical and Chemical Trauma

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2
Q

What are the 3 mechanisms of damage?

A

Disruption
Metabolic Interference
Free Radicals

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3
Q

What are some causative agents?

A
Trauma
Thermal Injury (Hot or Cold)
Poisons
Drugs
Infectious Organisms
Ionising Radiation
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4
Q

Ischaemia is caused by __________ and results in _________________________. The damage caused is _________________________________.

A

Reduced Blood flow
Accumulation of Metabolites
Repairable until a point of no return

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5
Q

Shock is a pathological process characterised by ____________________ resulting in life threatening ___________ of the bodies vital organs. Compensatory mechanisms maintain blood pressure until ________________________.

A

Profound circulatory failure
Hypo-perfusion
They fail leading to hypotension

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6
Q

What is Cardiogenic Shock?

A

Shock commonly due to myocardial infarction - it is the failure of the heart’s pumping mechanism

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7
Q

What is Hypovolemic Shock?

A

Shock due to reduction in the effective circulation blood volume - loss of blood, loss of fluid, shift of fluid into the cellular component and body cavities and away from the circulation

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8
Q

What are the consequences of shock?

A

Irreversible neural damage
Renal failure
Cerebral infarction
Infarction in any area/organ

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9
Q

What is inflammation?

A

Initial reaction of tissue to injury
Vascular phase - dilation and increased permeability
Exudative phase - fluid and cells escape from the permeable venules

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10
Q

What happens if the nucleus or nucleolus is damaged?

A
  • Damages both transcription and translation
  • If the cell goes into mitosis before the damage is repaired it leads to cell death
  • Damaged DNA can lead to mutations
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11
Q

What happens if the mitochondria is damaged?

A
  • Damage to mitochondria leads to impairment of the metabolic pathways
  • This results in energy deficiency, particularly of ATP within the cell
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12
Q

What is hypertrophy?

A

Increase in the size of individual cells resulting in overall increase in organ size

Example - increased workload on a muscle

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13
Q

What is hyperplasia?

A

Increase in the number of cells in an organ, also resulting in an increase in organ size

Example - Thickened keratinising squamous epithelium of skin in area of rubbing or chronic irritation

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14
Q

What is Atrophy?

A

Decrease in cell size and number of cells

Example - Disuse limb immobilised following fracture or loss of innervation

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15
Q

What is Metaplasia?

A

Reversible change from one differentiated cell type to another

Example - Intestinal metaplasia in the oesophagus in the setting of reflux disease

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16
Q

The effect of injury is dependent on:

A

Duration of the injury
Type of injurious agent
Type and number of cells involved
Ability of the tissue to resolve and regenerate

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17
Q

What are the possible outcomes after trauma?

A
Necrosis
Apoptosis
Inflammation
Cell Renewal
Organisation/Fibrosis
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18
Q

What is/are Bruising/Contusions?

A

Blunt impact tears the capillaries and larger blood vessels deep to the skin surface, leading to bleeding into the extravascular space

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19
Q

What are Lacerations?

A

When the blunt object injury exceeds the elastic capacity of the skin and underlying tissues forceful tearing of the skin occurs

20
Q

What is Avulsion?

A

Tearing away of tissue from its attachments for instance skin torn from thigh after fall from height

21
Q

What is the difference between a stab and an incision?

A

A stab is deeper than it is long

An incision is longer than it is deep

22
Q

What is Myocardial Infarction?

A

Irreversible necrosis of myocardium due to inadequate blood supply

23
Q

The site and degree of damage of myocardial ischaemia or infarction is dependent on:

A
  • Which vessel is affected and how far along
  • How narrow the stenosis
  • How great the demands
  • How long the imbalance (30 minutes)
  • How soon intervention
  • Other medical conditions i.e. lung disease
24
Q

What are the risk factors for atherosclerosis?

A
Family History
Cigarette smoke
Diabetes
Hyperlipidaemia 
Infections
Haemodynamic forces (Hypertension)
Immune mechanisms
25
What are some complications of atherosclerosis?
Ulceration, Rupture, Haemorrhage, Thrombosis
26
What are the signs and symptoms of myocardial infarction?
Angina - Radiating chest pain Nausea and vomiting Shortness of Breath
27
What sign on an ECG tell you a heart attack has occurred?
The ST segment is markedly raised above the baseline
28
What signs in a blood test tell you if a heart attack has occurred?
1 - 4 Hours after symptoms = Myoglobin 3 Hours - Days = Creatine Kinase 3 Hours - Days = Troponin
29
What are the general treatment options for heart attacks?
Rest, lying f lat, O2 Glyceryl trinitrate GTN (dilates arteries) Beta blockers (slows heart rate)
30
What are the acute treatments for heart attacks?
Thrombolysis (dissolves the clot) | Stenting (opens up the stenosis)
31
What are the chronic treatments for heart attacks?
Aspirin (decreases platelet stickiness) Stenting Bypass
32
What are the Acute consequences of heart attacks?
``` - Sudden death (40%) > from acute left ventricular failure > from an arrythmia - Other arrythmias - Mural thrombus and thromboembolism - Rupture (free wall or septum or papillary muscle) ```
33
What are the Acute consequences of heart attacks?
- Heart failure - Left ventricular or bi-ventricular - Arrythmias - Ventricular aneurysm > Mural thrombus > Thromboembolism
34
What is a stroke/Cerebro-Vascular Accident?
A focal neurological deficit that persists for >24hr | and is due to a vascular cause
35
What are the causes of CVA/stroke
1. Narrowing or blockage of blood vessels supplying the brain - Thrombus (50%) - Embolus (30%) 2. Rupture of a vessel (hypertension or aneurysm) with haemorrhage (20%)
36
The brain is highly dependent on ___________ and therefore is very sensitive to ________.
Aerobic Respiration | Hypoxia
37
Critical ischaemia occurs when the neuron receives ___% of it's normal blood supply, then it will __________.
30% | Shut-Down
38
The site and degree of damage due to a CVA depends on:
Which vessel is affected and where How complete the block How long the ischaemia (30 minutes) How soon intervention
39
What are the macroscopic features of CVA?
- Soften, loss of definition, pale or haemorrhagic | - Shrunken, yellow, cystic
40
What are the microscopic features of CVA?
- Neuronal necrosis, pallor of myelin, oedema, haemorrhage - Macrophages, gliosis but no fibrosis, cystic change instead of scarring - Haemosiderin
41
What are the symptoms of CVA?
- Pain - A decrease or loss of consciousness, ie coma. - Symptoms and signs are variable and depend on the site of damage and the function of that area
42
Why might a patient die from a CVA?
- Critical areas are affected (brain stem) - The damage is too massive - Increased intracranial pressure can cause coning, i. e. trying to squeeze the brain out of the skull through the foramen magnum
43
What are the acute treatments for CVA?
- Support - Thrombolysis - Clipping of an aneurysm - Evacuation of blood clot
44
What are the chronic treatments for CVA?
Aspirin
45
How do we prevent CVA?
Prevention of risk factors: - Atherosclerosis > HT, smoking, hypercholesterolaemia, DM - Stent, bypass, surgery of atherosclerotic stenoses - Aneurysm repair - Anti-platelet agents