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Week 2
Inflammaation, Tissue Healing and Edema
| Question | Answer |
|---|---|
| Where are mast cells located? | Connective tissue, especially around blood vessels and under mucosal surfaces |
| How do mature basophils become mast cells? | When stimulated by cytokines, mature basophils can migrate to connective tissue. Once in the tissue, they are called mast cells and can not reenter circulation |
| Structure of mast cells? | Have IgE receptors that allow them to bind and display IgE antibodies on cell surfaces. |
| What causes mast cells to release granules/degranulate? | When an appropriate stimulus occurs, such as antigen binding to IgE antibodies |
| What do the granule/degranulates released by mast cells contain? | Proinflammatory chemicals |
| What are the proinflammatory chemicals that mast cell granules contain? | Histamines, platelet activating factor and other vasoactive amines that are important mediators of immediate hypersensitivity responses (inflammation) |
| ____ cells are involved in wound healing and chronic inflammatory conditions | Mast cells |
| Phagocytosis begins when what 2 types of cells enter tissue? | Neutrophils and monocytes (macrophages) |
| Phagocytosis involved enzymes that digest _______. | Protein structures |
| What are some phagocytic enymes? | Lysozyme, neutral proteases, collagenase, elastase, acid hydrolases |
| What do neutrophils and macrophages do? | Specialize in collagen and extracellular matrix degradation |
| What is a phagosome? | When a microbe is small enough to be internalized, a phagocyte will endocytose it into a phagosome, which is then merged with a lysosome containing degradative enzymes |
| What is a lysosome? | Contains degradative enzymes |
| Large antigens may cause neutrophils to... | Release degradative enzymes extracellularly, causing damage to local tissues |
| What is interstitial fluid? | Fluid located between cells, but not in blood vessels |
| What are the events of the inflammatory process? (3) | 1. Increased vascular permeability 2. Recruitment and emigration of leukocytes 3. Phagocytosis of antigens and debris |
| During inflammation, what vasoactive chemicals are released? | Histamine, prostaglandins, leukotrienes |
| What do mast cells do in response to injury? | Mast cells in area of injury degranulate and release packets of histamine, prostaglandins and leukotrienes, initiating inflammation |
| True or false: Immediately after injury, there is a short period of vasoconstriction. | True. |
| What causes vasodilation in area of injury after short period of vasoconstriction? | Chemical mediators released by injured tissues |
| With vasodilation, round up of endothelial cells cause _____. | Increased capillary permeability |
| With vasodilation, the greater volume of blood increases ______. | Hydrostatic pressure. Amount of pressure within blood vessels |
| Increased _____ and increased _____ pushes fluid out of blood vessels into surrounding tissue. | Pressure; permeability |
| What contributes to local swelling after an injury? | Increased pressure and increased permeability pushes fluid into surrounding tissues |
| Because of dilated blood vessels and open capillaries, more blood is carried to injured area and causes.... (4) | Redness, pain, heat and swelling |
| What are the 4 classic manifestations of inflammation? | Redness, heat, pain and swelling (and loss of function) |
| Prostaglandins contribute to... (4) | Vasodilation, increased permeability. Also act as chemotactic factor and stimulates neutrophil emigration. Cause pain by enhancing sensitivity of pain receptors |
| What is hemostasis? | Stopping the bleeding |
| How is hemostasis achieved? | Platelets are activated and clotting cascade is activated |
| What initial vascular event helps to stop bleeding? | Initial transient vasoconstriction |
| What causes vasodilation? | Chemicals released by mast cells |
| Chemicals released by ____ causes vasodilation. | Mast cells |
| ______ brings increased blood flow to area of injury. | Vasodilation |
| Vasodilation and increased blood flow result in... (3) | 1. Brings more WBC to area, 2. Dilutes toxins (if present), 3. Causes edema |
| What does increased microvascular permeability cause? | Cause endothelial cells to retract, opening space between cells. Results in swelling |
| During inflammation, swelling is caused by _____ and _____. | Increased blood flow/pressure and increased permeability |
| What is endothelial activation? | Increase of adhesion molecules (selectins, etc). WBCs bind to receptors on endothelial cells |
| Through what processes do WBCs leave blood vessels and enter tissues (4)? | 1. Margination, rolling and adhesion 2. Diapedesis (transmigration) 3. Chemotaxis 4. Phagocytosis |
| What WBCs accumulate in tissues initially? | Neutrophils |
| What are some functions of neutrophils? | Early responders to acute bacterial infection. Have receptors on cell surfaces that enable them to bind to endothelial cells in areas of inflammation. Attracted to areas of inflammation via chemotaxis. Produce potent chemical mediators that destroy. |
| What are cytokines? | Chemotactic factors that attract neutrophils to area of inflammation |
| Where are neutrophils stored? | Bone marrow |
| Neutrophils are also called...? | Polymorphonuclear leukocytes (polys or PMNs) |
| Which circulating WBCs accumulate in tissues after neutrophils? | Macrophages |
| What circulating WBCs become macrophages after they enter the tissues? | Monocytes |
| What causes redness of inflammation? | Vasodilation, increased blood flow to site (in vessels) |
| What causes heat of inflammation? | Vasodilation, increased blood flow to site (in vessels) |
| What causes pain in inflammation? | 1. Swelling: Pressure onto pain neurons 2. Prostaglandins: sensitize pain receptors 3. Histamine activates pain receptors |
| What causes swelling of inflammation? | Vasodilation, increased capillary permeability |
| Is acute inflammation bad/abnormal? | No. Acute inflammation is beneficial |
| Can a person have inflammation without having an infection? | Yes. Injury. Endogenous danger signals can be released by uric acid, parts of cell membranes, r/a, cancer, CVA, chemotherapy |
| What are systemic manifestations of inflammation? (3) | 1. Fever 2. Fatigue and lethargy 3. Leukocytosis |
| What causes fever? | Pyrogens. Some cytokines are pyrogens, and some are produced by bacteria |
| What is the mechanism of pyrogens? | Pyrogens cause prostaglandin synthesis and release in hypothalamus. Signals hypothalamus to conserve and produce heat |
| What is the body’s “thermostat”? | Hypothalamus |
| In relation to fever, prostaglandins cause...? | Increased SNS output, resulting in vasoconstriction to decrease heat loss. Other brain signaling results in shivering to generate heat |
| Fever and lethargy are caused by circulating _____. | Cytokines |
| What is leukocytosis? | Elevated WBC number due to inflammation |
| What happens to WBCs after they fight infection? | They die from apoptosis |
| What is acute inflammation? | Less than 2 weeks. First step of tissue healing. |
| If acute inflammation persists for longer than ____, can become ____ inflammation | Chronic |
| Chronic inflammation _____ with healing. | Interferes |
| What is regeneration in tissue healing? | Replaces injured tissue with parenchymal (functioning) cells of same type |
| What is an example of connective tissue repair/regeneration? | Scar tissue. Repair of cells that can not divide (enough) |
| What is scar tissue formation? | Replaces cells that cannot regenerate or cells that regenerate minimally, with connective tissue (scar formation). Also called wound healing, or simply, repair. |
| Compare scar tissue with surrounding tissue? | Scar tissue lacks properties of surrounding tissue. |
| What is an example of connective tissue repair/regeneration? | Scar tissue formed in cardiac muscle |
| What happens with healing in the liver? | Hepatocytes in the liver regenerate. Connective tissue repair with scar formation may also occur in the liver. |
| When can liver function be restored by regenerating hepatocytes? | If supporting framework is present |
| What is an example of restored liver function, with supporting framework still intact? - Some types of acute hepatitis | |
| What do nodules of regenerating cells in the liver cause? | Nodules can distort liver architecture and cause loss of function if supporting framework is damaged by scar formation |
| What is an example of liver damage to scar formation? | Cirrhosis |
| What are 2 terms used to describe healing of surface wounds? | First and second intention |
| What are the characteristics of a wound that heals by primary intention? | One that has its edges approximated/touching. Bc edges are together, tissue will heal relatively quickly following the processes of CT repair |
| What interferes with primary intention would healing? | Infection, other factors that impair healing |
| What are some examples of wounds that heal by primary intention? | Surgical incision |
| How long does is usually take for epithelial cells to grow over a wound? | 48 hrs |
| What should a nurse recommend to a patient with a wound healing by primary intention? | No soaking/swimming/immersion in water bc it loosens up the healing matrix |
| What are the characteristics of a wound healing by secondary intention? | One that is open or gaping, in which a lot of tissue has been damaged. Heals from bottom upward. Same processes of CT repair occur, but take longer, even without infection, etc. |
| What are some examples of wounds that heal by secondary intention? | Pressure ulcers, burns |
| What are the phases of tissue healing/connective tissue repair? | 1. Inflammation 2. Reconstruction (Proliferation) 3. Maturation (Remodeling) |
| How long does the inflammation phase last for primary intention wounds? | 1-2 days |
| When does the reconstruction/proliferation phase occur? | 2-3 days, up to 3 weeks after wound occurrence (for primary intention healing) |
| What is the reconstruction/proliferation phase? | Epithelial migration in response to growth factors released by macrophages in area |
| What triggers the epithelial migration involved in wound proliferation? | Growth factors released by macrophages |
| Which stage of wound healing is characterized by angiogenesis, epithelial migration, fibroblast migration and building of collage and extracellular matrix? | Reconstruction/proliferation phase |
| How long after a wound occurs does maturation/remodeling happen? | 3 wks to 2 yers (in primary intention) |
| What is maturation/remodeling? | Reorganization of collagen that increases tensile strength. New scar is formed that is not as strong as mature scar. |
| What happens during the maturation/remodeling phase of wound healing? | Collagen is taken down and put back neatly. There is increased tensile strength, as well as change in color (becomes whiter) |
| What are some local factors that can impair tissue healing? | Factors that cause excessive or prolonged inflammation, or factors that interfere with reconstruction and maturation |
| What are examples of factors that cause excessive or prolonged inflammation? | Wound infection, mechanical stress, repeated injury |
| What are some examples of local factors that interfere with reconstruction and maturation? | Foreign body, large hematoma (collection of blood), wound separation/ dehiscence, poor blood supply to injured area Local factors that interfere with reconstruction/maturation: poor blood supply to injured area: examples? |
| What are systemic factors that can impair tissue healing? | Like local factors, those that suppress inflammation and interfere with reconstruction and maturation |
| What are some examples of systemic factors that suppress inflammation? | High levels of glucocorticoids (corticosteroids) from medication or in response to chronic stressors; immunosuppressants, AIDs, diabetes, malnutrition, alcohol abuse, old age, poor oxygen supply |
| What are some examples of systemic factors that interfere with reconstruction and maturation? | Poor oxygen/nutrient supply, impaired fibroblast (and other reconstructive cells) function |
| What systemic factors of reconstruction and maturation interference cause poor oxygen supply? | Chronic ischemia, hypoxia. Anemia, cigarettes, diabetes |
| What contributes to poor nutrient supply that interferes with reconstruction/maturation in wound healing? | Poor nutrition or malnutrition, vitamin C deficiency |
| What is fibrosis? | Excessive secretion of collagen with scar formation. Interferes with normal organ function |
| What is an example of a condition that causes fibrosis? | Hepatitis C |
| What are the steps in bone healing? | HFCOC. 1. Hematoma formation 2. Fibrocartilage formation 3. Callus formation 4. Ossification 5. Consolidation and remodeling |
| What are some factors that impair bone healing? | Nutrition, immunosuppression, age, gender, alcohol, vitamins, stress/use |
| What is increased capillary hydrostatic pressure? | Pushes fluid out of capillary |
| Examples of increased capillary hydrostatic pressure? | Inflammation, venous congestion |
| Congestive heart failure increases capillary _____ pressure, and leads to ____. | Hydrostatic, edema |
| What causes decreased blood colloid osmotic pressure? | Decreased plasma albumin |
| Decreased blood colloid osmotic pressure can be due to ____ and _____ of albumin. | Loss of albumin, decreased albumin synthesis. |
| What is increased microvascular permeability? | Allows plasma proteins to leak into interstitial space, causing increased interstitial osmotic pressure |
| What is interstitial osmotic pressure? | Pull of fluid into interstitial space |
| What can cause increased interstitial osmotic pressure? | Increased capillary permeability. (inflammation) |
| What can impaired lymphatic drainage cause? | Edema, due to increased interstitial fluid |
| What are 4 factors that can cause edema? | 1. Increased capillary hydrostatic pressure 2. Decreased blood colloid osmotic pressure 3. Increased capillary permeability 4. Impaired lymphatic drainage |
| What are 5 ways to assess edema? | 1. Visual inspection 2. Palpation (pitting edema) 3. Measurement of girth of parts 4. Daily weight 5. Intake/output |
| Proteinuria indicates loss of _____ function | Kidney function |
| Liver disease indicates lack of _____ production | Protein |
| Do not take BP where _____ are removed | Lymph nodes |
| Chronic inflammation is marked by ______ tissue ____. | Continued tissue damage |
| What is cachexia? | Muscle wasting |
| What is a benefit of edema? | Can flush toxins by increasing blood flow |
| Lack of protein synthesis in liver disease causes low protein in the blood resulting in increased _____. | Interstitial fluid, edema |
| Who has more extracellular fluid than intracellular fluid? | Infants |
| Who has more intracellular fluid than extracellular fluid? | Adults |
| Who has the most water of body mass? | Males. Females typically less bc of more body fat |
| Who has the lowest amount of water in body mass? | Older adults |
| Which group is most vulnerable to fluid imbalances? | Neonates and infants and older adults |
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kangaloo
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