Cell Injury, Inflammation, & Tissue Repair
Terms in this set (80)
New altered steady state of cell
Limits of cell adaptation are exceeded
4 systems prone to injury
1.) Cell Membrane Integrity
2.) Aerobic Respiration
3.) Enzyme & Structural Protein Synthesis
4.) Nuclear Integrity
4 important biochemical themes common in cell injury and death?
1.) Change in MEMBRANE PERMEABILITY
2.) ATP DEPLETION
3.) O2 and O2 derived FREE RADICALS
4.) Intracellular CA2+ homeostasis
6 cell effects due to injury
[Swelling Lips, Hyper pigs, Cal Hya]
1.) Cell SWELLING
2.) Abnormal Accumulation of LIPIDS
4.) Abnormal PIGMENT Accumulation
6.) HYALINE Infiltration
How does hypoxia cause cellular swelling?
Decreased ATP production 2ndary to decrease in NA-K ATPASE PUMP ACTIVITY
What is steatosis?
Abnormal accumulation of TRIGLYCERIDES AND CHOLESTEROL especially in the Liver
What is lipofusion?
atrophied or chronically injured cells 2ndary to FREE RADICAL and LIPID PEROXIDATION
What dz can occur from abnormal pigment accumulation?
MELANOMA and ADDISON DZ (d/t ↑[ACTH])
What is hemosiderin?
insoluble form of Fe in the tissue (if [Fe] increases is causes tissue staining or a bruise)
Ca2+ precipitates in areas of what?
Hyaline inflitration or protein deposition is secondary to long standing what?
HTN or DM
Morphologic change: decrease in cell size
2 Types of atrophy?
1.) physiologic (w/ increasing age)
2.) disuse (like cast on arm)
Increase in cell size
Increase in cell mass 2ndary to increase # of cells
Change in cell size or shape with loss of architectural structure
Dysplasia (may be related to malignancy)
Cell type replaced by another cell type
Metaplasia (usually reversible as in smokers)
Abnormal appearing cells lacking differentiation
Excessive uncontrolled clonal cell proliferation
3 Causes of anoxic (lack of oxygen) cell injury/death?
Oxygen required > Oxygen supply
MCC of Ischemia?
Blood clot formation inside a blood vessel
MCC of thrombosis
Disruption exposing SUBENDOTHELIAL COLLAGEN
Free floating particle in the blood stream that lodges in a blood vessel and occludes flow
6 Causes of Embolism
- Amniotic Fluid
MCC of embolism
Localized area of tissue death 2ndary to decreased blood flow?
2 different types of infarctions?
1.) Red (tissue w/ profuse blood supply - lungs)
2.) Pale (tissue w/ single blood supply - brain, heart)
Cell tissue death with morphologic evidence
3 types of necrosis
1.) Coagulative or fibrinous (Pale)
2.) Liquefactive (Liquid)
3.) Gangrenous (Dry, Wet, or Gas Gangrene)
Highly controlled orderly process of cell self destruction.
Apoptosis ("programed cell death")
Mechanism that destroys, dilutes, and walls off injurious agents.
In tissue repair, injured tissue is replaced by what 2 things?
1.) Parenchymal cells for REGENERATION
2.) Filling of tissue by fibroblastic tissue (scarring)
5 cardinal signs of tissue injury
1.) Rubor (Redness)
2.) Calor (Hot)
3.) Dolor (Pain)
4.) Tumor (Swelling)
5.) Loss of function
Vascular changes in acute inflammation (2)?
- VASODILATION which increases blood flow causing Rubor and Calor & increases vascular permeability causing EDEMA
What is the process where fluid, proteins, and blood cells "leak through" the vascular system into interstitial tissue?
Exudate is fluid that contains _______&_______ and has a specific gravity of ________.
- cell debris & INCREASED [PROTEIN]
Purulent exudate with increased [WBCs] and parenchymal cell debris
What is the lymphatics role in inflammation?
Increase lymph flow bc lymphatics transport WBCs, CELL DEBRIS, and INJURING AGENT
Inflammation of lymph vessels?
Inflammation of lymph nodes?
Positive factors contributing to delivery of WBCs (3)?
- kill microbes
- degrade necrotic tissue & foreign antigen
Negative factors contributing to delivery of WBCs?
- Prolonged inflammation
- Induces TISSUE DAMAGE (by attacking normal, healthy tissues)
What is the process of delivery of WBC?
They migrate toward chemotactic factors (bacterial products, cytokines) & along chemical gradient (CHEMOTAXIS)
2 white blood cell types and when approximately they are delivery.
1.) Neutrophils (1st 24 hours)
2.) Monocytes ( > 24 hours)
What are the steps of phagocytosis (3)?
1.) Recognition and Attachment
How of WBCs bind to microorganisms or bacteria?
- Microorganisms are coated with OPSONINS that bind to the WBC receptor
- Bacterial lipopolysac binds directly to WBC
What are 2 mechanisms of "killing"?
1.) Oxidative via NADPH OXIDASE & myeloperoxidase
2.) Nonoxidative via lysosomal enzymes
What are 2 different types of inflammatory chemical mediators w/ examples?
1.) Cell derived
2.) Plasma derived
Name 3 cell derived inflammatory chemical mediators.
Name 3 plasma derived inflammatory chemical mediators.
1.) Factor XII
Cell derived chemical mediator that causes vasodilation ("leaky capillaries")? Which cells is it found in?
- MAST CELLS & BASOPHILS
Which cell derived chemical mediator has cell membrane phospholipids that are converted into ARACHIDONIC ACID?
How is ARACHIDONIC ACID transformed?
Cyclooxygenase & lipoxygenase
3 types of eicosanoids?
1.) Prostaglandins (PG)
2.) Thromboxane (TX)
3.) Leukotrines (LT)
Which of the eicosanoids causes FEVER & PAIN?
Which of the eicosanoids causes platelet aggregation?
Which of the eicosanoids is chemotactic for WBCs?
What inhibits Prostaglandins and Thromboxane?
STEROIDS AND NSAIDS
What inhibits leukotrines?
STEROIDS AND LT "MODIFIERS"
Which cell derived chemical mediator is produced by WBC and ENDOTHELIUM?
Which of the cytokines induce fever, apoptosis, and sepsis? What inhibits it?
- TUMOR NECROSIS FACTOR (TNF)
- TNF INHIBITORS
Which plasma derived cell mediator is activated by platelets or exposed collagen to turn on kinin, coagulation, and fibrinolysis?
Factor XII (Hageman)
Which plasma derived cell mediator increases vasodilation and capillary permeability?
Which plasma derived cell mediator is a blood protein that form MEMBRANE ATTACK COMPLEX and ANAPHYLATOXINS (C3A & C5A)?
What are some systemic effects of an acute inflammatory rxn (3)?
- DECREASED APPETITE
- INCREASED CATABOLISM
What peripheral WBC change occurs with an acute inflammatory rxn (2)?
- shift to the left, "bandemia", or INCREASE # IN IMMATURE PMNS
4 Post-Inflammatory outcomes?
1.) Complete Resolution
3.) Abscess Formation
4.) Chronic Inflamation
Which types of injuries usually return to normal tissue?
Short-lived and small injuries
With fibrosis how is tissue healed?
After substantial tissue destruction tissue is healed by CT REPLACEMENT (like scarring)
When does chronic inflammation occur (2)?
1.) persistence of INJURING AGENT
2.) interference in the HEALING PROCESS
What type of WBC is majorly involved in chronic inflammation?
What is a distinct type of chronic inflammation in response to INDIGESTIBLE SUBSTANCE?
Granulomatous Inflammation (macrophage produces a GRANULOMA)
In restoration of tissue integrity after injury (wound healing) what 4 things can a wound undergo?
2.) Formation of GRANULATION TISSUE
3.) SCAR FORMATION
4.) TISSUE REGENERATION
What wound healing methods would you use for wounds with opposed edges like lacerations and surgical incisions?
PRIMARY INTENTION (like suturing) -->
What wound healing methods would you use for wounds with largely separated edges like crushes, gouges, chronic wounds?
SECONDARY INTENTION (like allowing the wound to heal inside out)
Which of the wound healing methods would have a THIN SCAR and which would have an INTENSE LARGE SCAR?
- Thin: Primary
- Large: Secondary
What are 3 complications of wound healing methods?
1.) DEHISCENCE (reopening of wound)
3.) Exuberant Granulation
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