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Pathophysiology Chapter 5 - Inflammation and Healing
Terms in this set (78)
What is Phagocytosis?
The process by which neutrophils (a leukocyte) and macrophages randomly engulf and destroy bacteria, cell debris, or foreign matter.
What are Interferons?
Nonspecific agents that protect uninfected cells against viruses.
What is the first line defense used by the body to protect itself from any injurious agent?
Skin or mucous membrane with blocks entry of bacteria or harmful substances into the tissues. (Mechanical barrier)
Out of the three lines of body defense which are nonspecific and which are specific?
First and second: Non- specific
What is the Second line of defense?
Non-specific process of phagocytosis and inflammation
Interferons occur in what line of defense?
Second line of defense
What is the Third line of defense?
Specific defense which provides protection by stimulating the production of unique antibodies or sensitized lymphocytes following exposure to specific substances.
What is Inflammation?
Normal defense mechanism in the body that is intended to localize and remove an injurious agent. (Non specific response to tissue injury)
What are the five signs of inflammation?
Loss of function
What are the causes of inflammation?
Direct physical damage (cut or sprain)
Ischemia or infarction
Extremes of heat or cold
What are the seven steps of inflammation?
1. Bradykinin is released from insured cells
2. Bradykinin activates pain receptors
3. Sensation of pain stimulates mast cells and basophils to release histamine
4. Bradykinin and histamine cause capillary dilation (increased blood flow and increased capillary permeability)
5. Break in the skin allows bacteria to enter the tissue (results in the migration of neutrophils and monocytes to the site of injury)
6. Neutrophils phagocytize bacteria
7. Macrophages leave the blood stream and phagocytose microbes
What is the difference between acute and chronic inflammation?
Acute: May develop immediately and last a short period of time; may have delayed onset
Chronic: Delayed or prolonged over a significant period of time (follows acute episode of inflammtion)
Which cells are involved with acute inflammtion
Lymphocytes (if immune system involved)
Which cells are involved with chronic inflammation?
Which chemical mediators do mast cells and platelets release during acute inflammation?
The rapid release of chemical mediators causes
Hyperemia (increased blood flow in the area)
Increase in Capillary permeability
Chemotaxis to attract cells of the immune system
What is Diapedesis?
The passage of leukocytes through intact capillary wall to a site of inflammation
Redness and warmth are causes by
Increased blood flow into damaged area
Swelling or edema is caused by
Shift of protein and fluid into the interstitial space
Pain results because of
Increased pressure of fluid on the nerves
Loss of function may develop due to
The cells lack of nutrients or if swelling interferes mechanically with function; as happens in restricted joint movement
What is exudate?
Collection of interstitial fluid formed in the inflamed area
What is serous?
Watery exudate which consists primarily of fluid with small amounts of protein and white blood cells. Ex. allergic reaction or burns
What is fibrinous exudate?
Thick and sticky; Have a high cell and fibrin content
Which Exudate increases the risk of scar tissue?
What is Purulent exudate?
Thick, yellow- green in color
Contains more leukocytes and cell debris as well as microorganisms
Which type of exudate indicates a bacteria infection and is often referred to as pus?
What is an Abscess?
Localized pocket or purulent exudate or pus in a solid tissue
Hemorrhagic exudate may be present if
Blood vessels have been damaged
What are the Systemic Effects of inflammation?
Mild Fever (pyrexia)
Feeling unwell (Malaise)
Anorexia (loss of appetite)
Fever results from the release of
White blood cells
High fever can be beneficial because
It impairs the growth and reproduction of pathogenic organisms
What are the potential complications of inflammation?
Local complications; Decreasing diffusion of oxygen or affecting range of motion
Infection; microorganisms can more easily penetrate when skin or mucosa membranes are damaged and the blood supple is impaired
Skeletal muscle spasms; protective response to pain
What are the characteristics of Chronic inflammation?
Less swelling and exudate
Continued tissue destruction
More fibrous scar tissue
Granuloma may develop around foreign object
What is a granuloma?
A small mass of cells with a necrotic center and covered by connective tissue. Develops around foreign objects such as splinters, or as part of the immune response in some infections such as tuberculosis
What are potential complications of chronic inflammation?
Deep ulcers due to prolonged inflammation because of cell necrosis and lack of cell regeneration which cause erosion of tissue
What is perforation?
Erosion through cell wall
Involved in cell-mediated immunity
Elevated during allergic response
Involved in antibody production
First cells to migrate to an injured area
Elevated during chronic inflammation
Source of macrophages
What are the sequence of events involved in cellular response of inflammation?
Phagocytosis/ subsequent of lysosomal enzymes
What is Acetylsalicylic acid (aspirin, ASA) used for?
Acetylsalicylic acid (aspirin, ASA) is never recommended for children because it can contribute to what
Reye's syndrome; involves the liver and brain
Anti-inflammatory drugs interfere with
blood clotting by reducing platelet adhesion
What is Acetaminophen used for?
Decreases pain and fever
DOES NOT diminish the inflammatory response
NSAIDS are used to treat
inflammation in musculoskeletal system
What are the beneficial Anti-inflammatory effects of glucocorticoids?
Decreased capillary permeability
Enhanced effectiveness of epinephrine and norepinephrine
Reduced number of leukocytes and mast cells
Reduced immune response
Glucocorticoids are used for
Short term treatment
What are the adverse effects of glucocorticoids?
Atrophy of lymphoid tissue; reduced hemopoiesis (increased risk of infection)
Catabolic effects (increased tissue breakdown; decreased protein synthesis)
Delayed growth in children
Retention of sodium and water because of aldosterone-like affect in the kidney
What is RICE therapy?
Ice; local vasoconstriction which decreases edema and pain
Elevation; improve blood flow away from damaged area
What are the different types of healing?
What is Resolution?
Process that occurs when there is minimal tissue damage and the tissue returns to normal in a short period of time EX: sunburn
What is Regeneration?
Damaged tissue that is replaced with cells that are functional
What is Replacement?
Functional tissue replaced by scar tissue (connective tissue)
What are the steps in the healing process?
1. Blood clot forms and seals area (Inflammation develops in surrounding area)
2. three/ four days foreign material/ cell debris is removed by phagocytes, monocytes, macrophages and granulation tissue grows into gap by connective tissue
3. Epithelial cells undergo mitosis extending across wound
4. fibroblasts and connective tissue enter area and produce collagen
5. fibroblasts and macrophages produce growth factors (cytokines) to attract more fibroblasts (stimulates epithelial cell proliferation and migration and process known as angiogenesis)
5. Cross-linking and shortening of the collagen fiber promote formation of tight strong scar
6. capillaries in the area decrease and color fades
Highly vascular and appears moist and pink in color Contains new capillary buds from surrounding tissue
tissue is very fragile and is easily broken down by microorganisms or stress on the tissue
What is collagen?
Protein that is the basic component of scar tissue and provides strength for the new repair
What is angiogenesis?
development of new blood vessels
What are the complications due to scar formation?
Loss of function; results from loss of normal cells and the lack of specialized structures or normal organization in scar tissue (lacks hair follicles, glands and sensory nerve endings)
Contractures and obstructions; scar tissue is nonelastic and can restrict range of movement
Hypertrophic scar tissue
What are Contractures?
Restricted range of movement of a joint which may eventually result in fixation and deformity of the joint
What is Adhesions?
Bands of scar tissue joining two surfaces that are normally separated Ex: loops of intestines or between pleural membranes
What is Hypertrophic scar tissue?
Overgrowth of fibrous tissue which leads to hard ridges of scar tissue or keloid formation
What is Ulceration?
When blood supple is impaired around scar which results in further tissue breakdown
Burns can be caused by
Thermal - caused by flames or hot fluids
Partial thickness burns involve
epidermis and part of the dermis
Superficial partial thickness burns (1st degree burns)
damage epidermis may involve part of the upper dermis
appear red and painful but heal without scar (ex: sunburn)
Deep- partial-thickness burns (2nd degree burns)
involve the destruction of the epidermis and part of the dermis
Area is red, edematous, blistered, and often hypersensitive and painful
skin appears waxy with reddened margin
Full-thickness burns (third and fourth degree burns)
Destruction of all skin layers and often underlying tissues
wound area is coagulated or charred and is therefore hard and dry on the surface
Why are full thickness burns initially painless and the become very painful later?
The burn area may be painless because of the destruction of the nerves, but becomes very painful as adjacent tissue becomes inflamed due to chemical mediators released y damaged tissue
What is Body surface area (BSA) used for?
Provides a guideline for fluid replacement needs as well as other therapeutic interventions
Each area of the body is worth how much according to the rule of nines:
Arm: 9% Both arms: 18%
Leg: 18% Both legs: 36%
Groin Area: 1%
What are the effects of a burn injury
Dehydration and edema
Increased Metabolic needs form healing period
What helps with the healing process of burns?
Immediately covering of a clean wound is needed to prevent infection
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