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WVSOM path lec5&6

WVSOM renewal and repair lec 5&6 pathology

What does the renewal and repair of tissue begin with? cell/tissue loss, process of renewal from natural cell loss differs from cell loss due to injury
What are some responses to the loss of cell/tissue? cell migration to site of loss/injury, cell proliferation, reorganization, deposition, and remodeling of extracellular matrix (ECM) components
What causes cell loss? can be natural or pathologic
What are the different types of cell/tissue loss? natural and pathologic
What are the natural cell/tissue cell loss? sloughed epithelia (skin from any surface of the body, mucosa), usually a balance of proliferation and apoptosis, senescence, or mechanical loss
What are the pathologic cell/tissue loss and what do you lose? injury/inflammatory destruction, loss of parenchymal cells (epithelial cells that form a function), loss of stromal cells (mesenchymal, fibroblasts) that support function
What is the function of stroma cells? support function
What is the function of parenchymal cells? perform the function of the tissue
How can repair after injury occur? by regeneration of cells or tissues that restores normal tissue structure, or by healing which leads to the formation of a scar.
What may cause massive fibrosis? chronic inflammation
What is included in all loose cells that replenish? Hair, Dermis, epidermis, sebaceous gland, hair follicle bulge, epidermal stem cell
In the center of the hepatic globule is what? central vein
What delivers nutrients from the gut to the liver? The portal vein
What can happen when there is injury to cells within the liver? When the hepatocytes proliferate to repopulate what has been lost they do along this reticular fibers, If the reticular fibers have been lost you end up with just reticular fibers or just fibrosis
When ever you have inflammation what is the result? destroys everything
The cells that are involved in the repair process are what? inflammatory cells, parenchymal cells, fibroblasts and other stromal cells, and endotheilial cells
What does the inflammatory cells do for the repair process? macrophages remove damaged or degenerated cells/tissue and prevent infection
What does the parenchymal cells do for the repair process? could include stem cells to repopulate tissue with primary functional cell type
What does the fibroblasts and other stromal cells do for the repair process? fibrosis is deposition of collagen and other ECM in process of repair, this provide structural integrity to damaged tissue
What does the endothelial cells do for the repair process? think angiogenesis, renew blood flow that is vital for repair process
What is Angiogenesis? the growing of new blood flow vital for repair process
What removes the dead or dying cells? inflammatory cells
Which collagen type is present in early wounds and hollow structures? Collagen type 3
Which collagen is more globular, type 4 usually forms the basemement membrane? Non Fibrilar collagen
What break down elastins? Elastases
What are the fibrous structural proteins? collagens
Which collagen consists of type 1,2,3,5,6? fibrilar
When is type 1 collagen present and describe its character? present in late wounds, strong and rigid
What collagen type makes up the basement membrane? type 4 collagen
What type of tissue does the liver falls into? quiescent tissues
What are quiescent tissues? They can easily proliferate if they need to
What are labile tissues? continuously dividing tissues like surface epithelium, blood cells progenitors
What are stabile tissues? quiescent tissues, stay in Go with limited ability to proliferate until needed then stimulated to enter G1 of cell cycle such as perenchyma of many solid organs and fibroblasts, endothelial cells
What are permanent, post-mitotic tissues? terminally differentiated tissues, they don’t divide to replace what is lost such as cardiac myocytes and neurons
If you have a superficial injury to the skin what is involved and what is the goal? epidermis and superficial dermis, minimal granulation tissue formation, goal to renew the epithelium
If you have a deeper injury to skin and sub-Q tissue what is involved? more extensive granulation tissue formation with replacement of lost connective tissue, fibrosis scarring, may require help such as sutures and skin grafting
What is hemostasis? fibrinogen forming fibrin which forms scabs or eschar
What is the provisional matrix? temporary ECM; loose (supports cell migration) has type 3 collagen and proteoglycans
What is the granulation tissue? transient, specialized for repair containing type 3 collagen, monocytes, plasma cells, and macrophages, angiogenesis with activation of fibroblasts
What is the sequence of wound healing? hemostasis, inflammation, provisional matrix, granulation tissue, fibroblast proliferation and collagen deposition/ remodeling, re-epithelialization, wound contraction, increase in wound tensile strength
What does fibroblast proliferation and collagen deposition/remodeling consist of? ECM remodeling; action of enzymes to degrade MMPs and deposition of new proteins
What is involved in re-epitheliazation? parenchymal recovery (cell proliferation and migration)
What is involved in wound contraction? myofibroblasts
How much of the original strength integrity do you achieve after injury and what type of collagen is used to form the scar? ~75%, Type1 collagen
What is the earliest process of wound healing? Inflammation is the earliest process but there is a lot of over lap with granulation tissue
As the inflammation is still there granulation tissue comes into play and at the end of granulation tissue, what happens next? you have collagen accumulation and remodeling as well as wound contraction
What happens in the early stages of repair in skin? thrombosis, inflammation, reepitheliazation
What happens in the mid stages of repair of skin? granulation tissue formation and function, contraction
What happens in the late stages of repair of skin? accretion of final tensile strength, remodeling and conformation to stress lines in the skin
With a Trichrome stain what color does collagen stain? blue
With the trichrome stain of a mature scar what do you see? lots of blue with dense collagen with only scattered vascular channels
Why do they call it Granulation tissue? because of the gross appearance it has a granular look to it
What are the two major components of granulation tissue? fibroblasts, myofibroblasts, and macrophage cells and proliferating capillaries
What are the fibroblasts and myofibroblasts derived from? mesenchymal stem cells
Where do the new capillaries arise from? adjacent vessels by division of the lining of endothelial cells by angiogenesis
What are pseudopodia? extensions from endothelial cells that grow toward the wound site
At its peak which tissue is the most richly vascularized tissue in the body? granulation tissue
What are the settings in which wound healing does not heal very well? some of this is determined by location, blood supply, and amount of nature of ECM at site of injury
What does the location of the wound determine? ability of wound to contract, example soft tissue over tibia is thin with poor contraction
List some examples of amount and nature of the ECM at site of injury determine: skin of aged has less collagen and elastin, corticosteroids impair wound healing
How does blood supply affect healing? Greater the blood supply the better the healing
What are some causes of impaired blood flow complications? pressure ulcers, areas affected by atherosclerosis, vericose veins, articular cartilage
Does depth of skin and soft tissue damage affect healing? yes, If you have a real deep wound you are going to destroy more structures and have to repair more
What can be a reason for portal hypertension? you have liver damage, and get regrowth without central veins, If you lack central veins there is no good way to remove the blood and this can lead to portal hypertension
What is cholestatic jaundice? jaundice caused by bile being static in the liver due to the fact of no central vein to remove it from the liver
What can lead to contractures? a deep wound
What can lead to cirrhosis of the liver? fibrosis with continued pernchymal and ECM damage
What are hepatocyte nodules? regrowths of liver tissue that lack central veins; expanding nodules obstruct blood and bile flow which can lead to portal hypertension and cholestatic jaundice
Which wound heals more readily and with better results, primary or secondary? primary
What is the result of secondary reaproximation? have more granular tissue and end up with less dense and weaker tissue, so you have a little bit of depression
Why do we use sutures? to help turn a secondary wound into a primary wound
As you go through wound healing from an ulcer what happens? you get a thin bed of epithelium as that continues you get the re-epitheliazation, and contraction
What is the consequence of chronic hepatic injury? Cirrhosis, the formation of regenerating nodules separated by fibrous bands
What happens if injury to the kidney does not significantly damage the framework (ECM)? leads to renal tubal epithelium regeneration
What happens if injury to the kidney damages the framework (ECM)? renal scarring, chronic glomerulonephritis
Where is the regenerative ability of the kidney maximal? in cortex, less in medulla, and glomeruli do not regenerate
Do renal glomeruli regenerate? NO
What does scar tissue in the kidney look like under a microscope? pink circles like slices of jawbreakers
When talking about regeneration of denuded or damaged epithelium in the larynx, trachea, and bronchi what is the outcome? reversible squamous metaplasia
When talking about regeneration of denuded or damaged epithelium in the Alveoli what is the outcome? type 2 pneumocytes proliferate and differentiate, so you have type 2 changing to type 1 cells
If the underlying stroma is damaged in the lung/respiratory tract what does it lead to? fibrosis, interstitial pneumonia and fibrosis from type 1 collagen
When looking at acute pneumonia what do you see under the microscope? The air spaces are filled with neutraphils but the septa are intact
When looking at chronic interstitial inflammation what do you see under the microscope? you see nodules of lymphocytes, you can see that the septa are thick
Which do you have a better chance of healing from, chronic interstitial inflammation or acute pneumonia? With acute you have pretty good healing in chronic you do not
What does a loss of cardiac myocytes result in? fibrosis
If you have patchy loss of cells in the heart what does it lead to? interstitial fibrosis, ischemic heart disease/cardiomhyopathy
If you have diffuse loss of cells in the heart what does it lead to? myocardial infarction which follows coagulative necrosis and repaired with type 1 collagen
What type of tissue does heart cells fall under? post-mitotic or permanent tissue meaning they do not regenerate
What happens if you get an acute inflammation in the heart? fibrosis tissue
If you took a section through a healed myocardial infarct what would you see? mature fibrosis and disrupted myocardial fibers
What type of cells make scar tissue in the nervous system? Astrocytes = glial cells
What type of tissue does neurons fall under? Post mitotic meaning they lack reliable capacity to proliferate
Explain axonal regeneration following trauma/injury for the PNS and CNS? PNS can elongate (grow) and remake synapses, CNS lack this ability
How is scarring accomplished in the CNS and PNS? CNS scaring is from glial cell proliferation (gliosis), and PNS fibrosis from fibroblasts
What is a hypertrophic scar? excessive scar formation due to excess collagen and poor primary or secondary intent wound healing
What is a keloid? exuberant, disorganized collagen deposition within dermis that extends beyond the anatomic confines of normal structure usually in dark skinned people
If you take a slice of a keloid and looked at it under a microscope what would you see? a crap load of connective tissue in the dermis
What is a contracture? deformity of wound and surrounding structures, common following burns, can produce bowel strictures when in abdomen
What areas are prone to pathologic contractures? areas that show minimal wound contraction, like palms and soles
What is pyogenic granuloma? exuberant overgrowth of granulation tissue, eg. Gingiva of pregnant women
What is proud flesh? granulation tissue extends above the epithelial surface and precludes re-epitheliazation
What are desmoids or aggressive fibromatosis? excessive, persistent fibrosis following injury or surgical incisions within soft tissues
Epulis is clinical term for what? pyogenic granuloma
Created by: hagerman