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142 Cards in this Set
- Front
- Back
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What are 3 things mast cell degranulation triggered by?
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1. IgE
2. Physical Injury 3. Chemical agents |
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What 5 types of chemical mediators of inflammation are released?
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1. Histamine
2. Serotonin 3. Bradykinin 4. WBC chemotactic factors 5. Prostaglandins |
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What are the 3 types of cells that release histamine?
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1. Mast cells
2. Basophils 3. Platelets |
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What are the reactions of histamine after they are released?
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1. Arteriolar dilation
2. Increased vascular permeability |
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How does histamine react?
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Immediately and transient (temporary) reaction
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What are the 4 types of prostaglandins?
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1. E
2. A 3. F 4. B |
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True or False
Prostaglandins cause pain with inflammation |
True
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What are two types of symptoms that you can have with prostaglandins?
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1. Mucus production in stomach
2. Decreased gastric acid secreation |
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Define COX-2 inhibitors
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Relief of inflammation and pain from prostaglandins
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What does Cyclooxygenase (COX) stimulate?
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Production of prostaglandins
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Why will chemotactic factors use a chemical gradient?
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To attract a specific type of WBC (neutrophil) to the site of inflammation
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Define Chemotaxis
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WBC's move toward the site of injury following along a chemical gradient
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What are the two different types of Chemotaxes?
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1. Chemoattractant
2. Chemorepellent |
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What are 3 chemotactic factors for leukocytes?
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1. Bacterial products
2. Components of complement system 3. Various chemical mediators |
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What are the 3 key plasma protein systems that inflammation is mediated by?
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1. Complement system
2. Clotting system (fibrinolytic system to counter-regulate clotting) 3. Kinin System |
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What does the complement system consist of?
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At least 30 proteins which act on each other in a cascade
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What are two ways the complement system can cascade and become activated?
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1. Antigen-antibody complexes
2. Bacterial endotoxins, fungi, snake venom |
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What are 4 ways the complement system can become enhanced by inflammation?
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1. Opsonizing bacteria (binding enhancer for phagocytosis)
2. Attracting WBC's by chemotaxis 3. Causing degranulation of mast cells 4. C6-C9 create pores in bacterial membranes (Allows for lysis of bacteria |
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What is the main function of the clotting system?
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Forms a fibrinous meshwork at the site of inflammation that traps exudates and bacteria
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What 3 things does the clotting system help prevent?
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1. Prevents spread to adjacent healthy tissue
2. Keeps pathogens at site of greatest phagocytic activity 3. Forms a clot to stop bleeding and begin repair |
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Define Thrombin
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Converts fibrinogen to fibrin
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What are 3 ways thrombin helps with the clotting system?
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1. Enhances WBC adhesion to endothelium (Activates CAM's)
2. Increases vascular permeability 3. Is chemotactic for leukocytes |
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What does the activation of the kinin system lead to?
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Formation of bradykinin
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What are the 5 causes of the formation of bradykinin?
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1. Increased vascular permeability
2. Vasodilation 3. Pain 4. May increase WBC chemotaxis 5. Probably causes endothelial cell retraction |
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What two chemical mediators of inflammation cause pain?
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1. Prostaglandin
2. Bradykinin |
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True or False
Kinin system has similiar effects of histamine, but become more evident at a slower pace |
True
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What are the 4 step of Phagocytosis?
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1. Adherence to the antigen
2. Engulfment 3. Fusion of lysosomes with the phagosome 4. Destruction of the target by lysosomal enzymes |
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True or False
Opsonizaiton can happen by complement |
True
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Define Phagosome
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When pseudopods extend around the pathogen and surround it
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What are the 4 possible outcomes of acute inflammation?
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1. Complete resolution (like new)
2. Scarring or Fibrosis (repair) 3. Abscess formation (not cured, not spreading) 4. Progression to chronic inflammation |
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Define Chronic inflammation
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Active inflammation, tissue injury, and healing all take place simultaneously
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What are the two causes of chronic inflammation?
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1. Injurious agent persists
2. There is interference in the normal process of healing |
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What are 3 examples of Chronic inflammation?
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1. Persistent infections by certain organisms
2. Prolonged exposure to harmful agents 3. Autoimmune Diseases (SLE) |
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What are the two types of wound healing?
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1. Resolution
2. Repair |
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Define Resolution
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Ideal wound healing
Injured tissue is replaced by cells of the same type and restoration of original structure and function |
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Define Repair
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Next best type of wound healing
Destroyed tissue is replaced by connective tissue and fills in the lesion and restores tensile strength, but can not carry out physiologic functions of the destroyed tissue |
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True or False
Both Resolution and repair begin late during the inflammatory process |
False
Begins early in the inflammatory process |
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What are 3 types of regenerative capacity cells?
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1. Continuously Dividing (Labile) Cells
2. Quiescent (Stable) Cells 3. Nondividing (Permanent) Cells |
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Define Continuously Dividing Cells
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Proliferate throughout life
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Define Quiescent Cells
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Usually demonstrate low level of replication and stimulation can lead to rapid increases in division
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Define Nondividing Cells
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Stopped dividing during prenatal life
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What are 5 examples of Labile Cells?
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1. Skin
2. Oral cavity 3. GI tract lining 4. Urinary Tract 5. Bone Marrow |
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What are 5 examples of Quiescent Cells?
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1. Bone
2. Kidney 3. Pancreas 4. Fibroblasts 5. Liver |
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What are 3 examples of Permanent Cells?
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1. Nerve Cells
2. Cardiac Muscle 3. Skeletal Muscle |
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Define Multinucleated
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Provide multiple copies of genes to speed up production of enzymes and structural proteins
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Define Myoblast
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Embryonic cells which fuse to create the muscle fibers
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Define Satellite cells
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Assist with repair of damaged fibers
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What are 7 factors which influence wound healing?
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1. Site of the wound
2. Mechanical factors 3. Size of the wound 4. Infection 5. Circulatory status 6. Nutritional and metabolic factors 7. Age |
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What types of bundles are collagen and elastin fibers shaped in?
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Parallel bundles
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What does the orientation of tension lines depend on?
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The stress placed on the skin during normal movement
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What is the clinical significance of surgery and tension lines?
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When an incision and/or laceration is made against the tension lines as opposed to perpendicular with the tension lines. Depends on how well the wound will heal.
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What is the absolute essential first step in wound healing?
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Debridement
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Define Debridement
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"Clean-up" of particulate matter (dirt, exudates, dead or dying tissue) in the inflammatory exudate by phagocytosis, dissolution of fibrin clots by fibrinolytic enzymes
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Define Natural Debridement
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Is slow (inflammation and phagocytosis)
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Define Surgical Debridement
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Speed up healing
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Define First Intention
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(primary union) faster
Wound with minimal tissue loss |
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What is an example of first intention?
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Sutured surgical wound
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True or False
First Intention is always preferred if possible |
True
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Define Second Intention
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Needs more care
Large, open defects and infected wounds |
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What is an example of a second intention?
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Degloving (avulsion) injuries, burns
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What type of tissue is formed during second intention?
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Granulation Tissue
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What is the third intention?
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Skin Graft
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What are the 5 steps of healing by second intention?
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1. Formation of a healthy granulation bed
2. Filling in the wound defect 3. Covering or sealing the wound (epithelialization) 4. Shrinking the wound (contraction) 5. Wound maturation |
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True or False
If you perform a second intention wound healing first you can go back to the first intention if the second does not succeed |
False
Because epithelialization has caused the could edges to become sealed down |
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Describe the appearance of granulation tissue
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Pink, soft, granular appearance
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True or False
Granulation tissue represents a temporary scaffolding that changes over time |
True
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What are the two types of cells that granulation tissue consist of?
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1. Angioblasts
2. Fibroblasts |
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Define Angioblast
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Cells that form new blood vessels
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Define Fibroblast
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Form collagen fibers for strong scar tissure
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What other type of cell does granulation tissue contain?
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Myofibroblasts (Fibroblasts and smooth muscle cells)
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What does Repair involve?
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1. Filling in the wound defect
2. Epithelialization 3. Contraction |
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Define Epithelialization
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Covering or sealing the wound
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Define Contraction
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Shrinking the wound
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What two overlapping phases occur during repair?
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1. Reconstruction phase
2. Maturation phase |
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True or False
During Epithelialization epithelial cells from the surrounding healthy tissue migrate into the wound |
True
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What type of enzyme is used to sever the connection between the clot and the wound surface?
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Proteolytic enzyme
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When will epithelialization stop?
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When they make contact with similar cells from all sides of the wound and seal it
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What type of care does Epithelialization need and what does that care prevent?
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Keeping the wound moist and it prevents a fibrin clot from becoming a scab
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What are the 4 steps that happen during reconstructive phase?
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1. Wound is initially sealed off by a blood clot containing fibrin and trapped cells
2. debridement by macrophages and polymorphonuclear (PMN); Neutrophils 3. Chemical mediators secreted by macrophages promote of angioblasts and fibroblasts 4. Granulation tissue forms in 3-5 days |
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What is Angiogenesis also know as?
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Neovascularization
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True or False
Capillary buds sprout out of vascular epithelial cells on wound margins |
False
Capillary buds sprout out of vascular endothelial cells on wound margins |
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True or False
New endothelial cells migrate into the scaffolding and organize into vessels during angiogenseis |
True
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True or False
Angiogenesis allows influx of blood with oxygen, nutrients, and more phagocytic cells and chemical mediators |
True
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True or False
During Fibrosis fibroblasts enter the area and destroy tissue |
False
Fibroblasts enter the area and proliferate |
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What type of proteins are deposited by fibrosis?
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They deposit fibrous structural proteins
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True or False
Fibroblats produce collagen which gradually develops more strength |
True
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What is Fibrosis also known as?
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Fibroplasia
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What are two main features of Myofibroblasts?
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Have features of both fibroblasts and smooth muscle cells
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True or False
Myofibroblast will stand alone |
False
Myofibroblasts will establish connections with neighboring cells |
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True or False
Myofibroblasts anchor themselves to the wound bed and exert pull on neighboring cells |
True
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By how much per day will the contraction of cells move the wound edge?
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0.5mm per day
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What is the process for the Maturation Phase (Scar remodeling)?
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1. Continuation of collagen deposition, tissue repair, and wound contraction
2. Scar tissue is remodeled and gains its maximum strength 3. Process can go on from months to years |
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Wound Healing (Summary)
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1. Induction of acute inflammatory response by the initial injury
2. Debridement 3. Formation of a healthy granulation bed 4. Angiogenesis and fibroplasia 5. Epithelialization 6. Wound contraction 7. Remodeling of tissue elements to restore function and to increase wound strength |
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What are Glucocorticoids known as?
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Steroids
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True or False
Glucocorticoids are anti-inflammatory drugs |
True
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What are two reactions glucocorticoids have on phagocytic cells?
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1. Helps to slow the migration to the site of the injury
2. Causes phagocytic cells already in the area to become less active |
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What will happen to Mast cells when they are exposed to steroids?
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Become less likely to release histamine and other chemicals that promote inflammation
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What are Glucocorticoids good for?
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They decrease excess inflammation
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What are Glucocorticoids bad for?
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They suppress Normal adrenal gland function and immune system
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What does NSAID stand for?
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Non-steroidal Anti-Inflammatory drug
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Name 7 characteristics for steriods.
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1. Stronger
2. Prescription 3. Glucocorticoids 4. Pred, cortisone, hydrocortisone 5. Inhibit mast cells & phagocytes 6. Suppress Normal adrenal function 7. Result in suppressed immune system |
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Name 7 characteristics of NSAIDs
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1. Not as strong
2. OTC (over the counter) 3. Ibuprofen, naproxen, aspirin 4. Advil, Motrin, Aleve 5. Inhibit prostaglandin synthesis (Aspirin also anti-platelet) 6. No effect on adrenal gland 7. Results in decreased production of stomach mucus so can exacerbate ulcers |
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Define Hematocrit (Hct)
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Percentage of whole blood that is made up of red blood cells
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Define Anemia
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Conditions in which there is a decrease in the quality or quantity of hemoglobin
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What are 3 causes of anemia?
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1. Defective RBC's (Sickle cell)
2. Blood loss (Hemorrhage) 3. Increased RBC destruction |
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Define Polycythemia
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Conditions in which there is excessive RBC numbers or volume (increased Hct)
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Define Polycythemia vera
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myeloproliferative blood disorder (bone marrow makes too many RBC's)
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What is the most common kind of Polycythemia?
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Dehydration
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What can a decreased amount of RBC's or hemoglobin function lead to?
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Hypoxia
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What are 4 signs of Hypoxia?
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1. Energy level: Decreased (Fatigue)
2. Skin/muscle membrane color: Pale or Jaundice 3. Respiratory rate: Increased rate and depth of breath 4. CNS: Dizziness, lethargy, faint |
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What are 4 systems that make compensations with anemia occurs?
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1. Cardiovascular system
2. Respiratory system 3. Renal system 4. Hematologic System |
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What 2 things does the cardiovascular system compensate for anemia?
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1. Increases heart rate
2. Capillary Dilation |
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What does the respiratory system compensate for anemia?
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Increases ventilation (rate and depth of breathing)
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What does the renal system compensate for anemia?
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Decreases blood flow to kidney which triggers the renin-angiotensin-aldosterone system
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What does the hematologic system compensate for anemia?
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Bone marrow stimulation (erythropoietin)
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What is a reticulocyte?
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Immature RBC
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When will there be a regenerative activity within the bone marrow of RBC's?
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1. Lots of reticulocytes
2. Hemolytic blood disorder 3. Blood loss |
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When will there be a non-regenerative activity within the bone marrow of RBC's?
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1. Little to no reticulocytes
2. Decreases erythropoiesis |
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Define Macrocytic-normochromic anemia
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Result from abnormal DNA sythesis and RBC's die permently
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Define Microcytic-hypochromic anemia
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Disorder of iron metabolism; disorder of prophyrin, heme, or globin synthesis
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Define Normocytic-normochromic anemia
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Relatively normal size and color, but insufficient number
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What are two types of Macrocytic-normochromic anemias?
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1. Pernicious anemia
2. Folate Deficiency anemia |
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Define Pernicious anemia and what it is caused by
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Definition: Lack of gastric intrinsic factor which is needed for vitamin B12 absorption
Cause: malabsorption of vitamin B12, Atrophy of gastric mucosa, chronic gastritis, autoimmune, heavy alcohol ingestion, hot tea and smoking |
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True or False
Can Pernicious anemia be fatal if untreated |
True
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Define Folate deficiency anemia
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Lack of folic acid which is essential for RNA and DNA synthesis in the RBC
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True or False
Human make enough folic acid within their bodies and do not need to take any dietary intake of folate |
False
Humans are totally dependent on dietary intake of folate |
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What are 3 dietary nutrients that can be taken to receive folic acid?
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1. Green Leafy Veggies (Spinach, Asparagus)
2. Liver 3. Whole grain cereal |
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What is a specific type of microcytic-hypochromic anemia?
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Iron Deficiency anemia
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What are 5 characteristics of Iron Deficiency anemia?
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1. Women - Pregnancy and menorrhagia
2. Ulcers, ulcerative colitis, cancer 3. Medications that cause GI bleeding 4. Insufficient dietary intake of iron (1-2mg perday) 5. Children <2 years of age |
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What can the lack of iron in the body result in?
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1. Gastritis
2. Irritability 3. Headache 4. Numbness |
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What are 5 food sources of Iron?
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1. Red meat
2. Leafy veggies 3. Beans 4. Pistachios 5. Tofu |
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What are 5 different types of Normocytic-normochromic anemias?
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1. Aplastic Anemia
2. Posthemorrhagic Anemia 3. Hemolytic Anemia 4. Anemia of Chronic Inflammation 5. Sickle Cell Anemia |
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Define Aplastic anemia
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Rare; can be caused by infections, drugs, toxins and autoimmune. Infiltrates bone marrow.
Symptoms is Pancytopenia |
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Define Posthemorrhagic anemia
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Sudden blood loss with normal iron stores
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Define Hemolytic anemia
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Many causes (aquired or hereditary) Autoimmune, drugs, toxins, blood parasites
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What are 4 anemias of chronic inflammation?
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1. AIDS
2. SLE 3. Malignancies 4. Renal Failure |
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Define Sickle Cell Disease
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Production of abnormal hemoglobin S due to an inherited autosomal recessive disorder
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What physical characteristics do RBC's take in Sickle Cell Disease?
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Become stretched into an elongated "sickle" shape
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True or False
Normal RBC's are very prone to hemolysis |
False
Abnormally shaped RBC's are very prone to hemolysis |
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What is the percentage of sickle cell trait in Afro-Americans
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7-13%
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What is the percentage of sickle cell trait in East Africans?
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45%
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What might the sickle cell trait provide protection against?
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Malaria
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