Gould's Pathophysiology for the Health Professions: Inflammation and Healing Flashcards

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1

First Line of Defense

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  • non specific defense
  • mechanical barrier
    • such as: unbroken skin or mucous membrane
  • blocks the entry of bacteria and other harmful substances into the tissues
  • body secretions such as tears and saliva that contain enzymes that destroy potentially damaging material

2

Second Line of Defense

  • includes the non specific processes of phagocytosis and inflammation

3

Phagocytosis

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  • process by which neutrophils and macrophages engulf and destroy bacteria, cell debris, or foreign matter

4

Neutrophils

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  • a leukocyte
  • phagocytosis of microorganisms

5

Inflammation

suffix: -itis

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  • a sequence of events intended to limit the effects of injury or a dangerous agent in the body
  • is intended to localize and remove an injurious agent
  • the general signs and symptoms serve as a warning of a problem which may be hidden within the body
  • non specific response
  • results in redness, swelling, warmth, and pain

6

Interferons

  • nonspecific agents
  • protect uninfected cells against viruses

7

Third Line of Defense

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  • specific defense
  • provides protection by stimulating the production of specific antibodies and sensitized lymphocytes

8

Normal Capillary Exchange

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  • usually not all capillaries in a particular capillary bed are open
    • unless the cells' metabolic needs are not being met by the blood supply to the area
    • or an accumulation of wastes occurs

9

Arterial End of Capillary

  • movement of fluid, electrolytes, oxygen, and nutrients
  • based on net hydrostatic pressure (pushes things out)

10

Venous End of Capillary

  • hydrostatic pressure is decreased
  • osmotic pressure (pulls things in)- relatively high
    • b/c plasma proteins remain within the vessels

11

Glucocorticoids

  • acts as an anti-inflammatory by decreasing capillary permeability

12

Causes of Inflammation

  • direct physical damage
    • such as: cuts or sprains
  • caustic chemicals
    • such as: acids or drain cleaner
  • ischemia or infarction
    • local deficiency of blood
  • allergic reactions
  • extremes of heat and cold
  • foreign bodies
    • ex: splinter or glass
  • infection

13

Steps of Inflammation

  • An injury to capillaries and tissue cells will result in the following reactions:
    1. Bradykinin is released from injured 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
      • results in an increase in blood flow and increased capillary permeability
    5. Break in skin allows bacteria to enter the tissue
      • results in migration of neutrophils and monocytes to the site of injury
    6. Neutrophils phagocytize bacteria
    7. Macrophages (mature monocytes) leave the bloodstream and phagocytose microbes

14

Acute Inflammation

  • When tissue injury occurs, the damaged mast cells and platelets release chemical mediators into the interstitial fluid and blood.
  • examples of chemical mediators:
    • histamine
    • serotonin
    • prostaglandins
    • leukotrienes
  • Chemical mediators affect blood vessels and nerves in the damaged area
  • Cytokines
    • serve as communication in the tissue fluids sending messages to induce fever

15

Histamine

  • released immediately from granules in mast cells and exert their effects at once
  • immediate vasodilation and increase capillary permeability to form exudate

16

Leukotrienes

  • synthesized from arachidonic acid in mast cells
  • responsible for the later effects
  • prolongs inflammation
  • vasodilation
  • increased capillary permeability
  • chemotaxis

17

Hyperemia

  • increased blood flow to a particular area

18

Increase in Capillary Permeability

  • allows plasma proteins to move into interstitial space along with fluid.
  • Increased fluid dilutes any toxic material, while globulins serve as antibodies, and fibrinogen forms fibrin mesh around the area to localize the injurious agent

19

Chemotaxis

  • attract cells of the immune system
  • first Neutrophils and later monocytes and macrophages

20

Vasodilation

  • relaxation of smooth muscles causing an increase in the diameter of arterioles

21

Basophils

  • release of histamine, leading to inflammation

22

Eosinophils

  • numbers are increased in allergic responses

23

T Lymphocytes

  • active in cell-mediated immune response

24

B Lymphocytes

  • produce antibodies

25

Monocytes

  • phagocytosis

26

Macrophages

  • active in phagocytosis
  • mature monocytes that have migrated into tissues from the blood

27

Diapedesis

  • The movement or passage of blood cells, especially white blood cells, through intact capillary walls into surrounding body tissue.

28

Redness and Warmth

(inflammation symptom)

  • caused by increased blood flow into the damaged area

29

Swelling or Edema

(inflammation symptom)

  • caused by the shift of protein and fluid into the interstitial space

30

Pain

(inflammation symptom)

  • results from increased pressure of fluids on the nerves; release of chemical mediators (ex: Bradykinin & prostaglandins)

31

Loss of Function

(inflammation symptom)

  • may develop if cells lack nutrients
  • edema may interfere with movement

32

Exudate

  • a collection of interstitial fluid formed in an inflamed area

33

Serous/Watery Exudate

  • watery
  • consists primarily of:
    • fluid
    • some proteins
    • and some white blood cells
  • occurs with allergic reactions and burns

34

Fibrinous Exudate

  • thick and sticky
  • high cell and fibrin content
  • increases the risk of scar tissue in the area

35

Purulent

  • thick, yellow-green
  • contains more leukocytes, cell debris, and microorganisms
  • indicates bacterial infection
  • aka "pus"

36

Abscess

  • localized pocket of purulent exudate in a solid tissue

37

Other General Manifestations of Inflammation

  • mild fever (pyrexia)
    • if inflammation is extensive
  • malaise
    • feeling unwell
  • fatigue
  • headache
  • anorexia
    • loss of appetite

38

Pyrogens

  • fever-producing substances
  • circulate in the blood and cause the body temperature control system in the hypothalamus to be reset at a higher level

39

Leukocytosis

  • increased white blood cells in the blood
  • especially neutrophils

40

Differential Count

  • the proportion of each type of WBC
  • may be helpful in distinguishing viral from bacterial infection

41

Cell Enzymes in blood

  • may be elevated in the blood in the presence of severe inflammation and necrosis
  • helpful in locating the site of necrotic cells

42

Ulcers

  • erosion of tissue

43

Infection & Inflammation

  • infection may develop in an inflamed tissue b/c microorganisms can more easily penetrate when the skin is damaged and blood supply is impaired
  • some microbes resist phagocytosis
  • inflammatory exudate provides an excellent medium for microorganisms to reproduce and colonize the inflamed area

44

Chronic Inflammation

  • may develop following an acute inflammation, when causative agent is not completely eradicated

45

Characteristics of Chronic Inflammation

  • less swelling and exudate
  • presence of more lymphocytes, macrophages, and fibroblasts than acute inflam
  • more tissue destruction occurs
  • more collagen is produced resulting in more fibrous scar tissue

46

Granuloma

  • small mass of cells with a necrotic center covered by connective tissue
  • may develop around foreign objects such as splinter

47

Acetylsalicylic Acid (ASA)

  • an anti-inflammatory agent
  • decrease prostaglandin synthesis, reducing the inflammatory response
  • decrease pain and fever
  • DO NOT GIVE TO CHILDREN WITH VIRAL INFECTIONS DUE TO RISK OF LEADING TO REYES SYNDROME
  • aspirin

48

Acetaminophen

  • decreases fever and pain
  • does not diminish the inflammatory response
  • TYLENOL or PARACETAMOL

49

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

  • has anti-inflammatory, analgesic, antipyretic activities
  • act by reducing production of prostaglandins
  • used to treat inflammation in musculoskeletal system

50

Anti-Inflammatory Effects of Glucocorticoids

  • act as an anti-inflammatory by decreasing capillary permeability
  • enhance effectiveness of epinephrine and norepinephrine
  • reduced number of leukocytes and mast cells, decreasing the release of histamine and prostaglandins
  • reduces immune response

51

RICE Therapy for Injuries

  • Rest
  • Ice
    • cold causes vasoconstriction, decreasing edema and pain
  • Compression
    • reduces the accumulation of fluid
  • Elevation
    • improve fluid flow away from damaged area

52

Resolution

  • the process that occurs when there is minimal tissue damage
  • the damage cells recover and tissue returns to normal within a short period
  • ex: sunburn

53

Regeneration

  • the healing process that occurs in damaged tissue in which the cells are capable of mitosis
  • the damaged tissue is replaced by identical tissue from the proliferation of nearby cells

54

Replacement

  • takes place when there is extensive tissue damage
  • cells are incapable or mitosis
  • functional tissue replaced by scar tissue
  • loss of function

55

The Healing Process

  • the process of tissue repair begins following injury when a blood clot forms and seals the area
  • after 3 to 4 days foreign material and cell debris has been removed granulation tissue grows into the gap

56

Complication due to Scar Formation

  • loss of function
    • results from the loss of normal cells and lack of specialized structures or normal organization in scar tissue
      • ex: hair follicles, nerves, receptors

57

Contractures and Obstructions

  • scar tissue is nonelastic
  • shrinks over time
  • contracture
    • An abnormal, often permanent shortening, as of muscle or scar tissue, that results in distortion or deformity, especially of a joint of the body

58

Adhesions

  • bands of scar tissue joining two surfaces that are normally separated

59

Hypertrophic Scar Tissue

  • overgrowth of fibrous tissue
  • leads to hard ridges of scar tissue or keloid formation

60

Ulceration

  • blood supply may be impaired around scar
  • results in further tissue breakdown and ulceration at future time

61

Burn

  • a thermal (heat) or nonthermal (electrical or chemical) injury to the body, causing acute inflammation and tissue destruction
  • may be mild or severe
  • classified by the depth of skin damage and the percentage of body surface area involved

62

Superficial Partial-Thickness Burns (First Degree)

  • involves epidermis and may involve upper part of dermis
  • little, if any, blister formation
  • usually appears red and painful but readily healed without scar tissue

63

Deep Partial-Thickness Burn (second degree)

  • involve the destruction of the epidermis and part of the dermis
  • area is red, edematous, blistered, and often hypersensitive
  • easily infected

64

Full Thickness Burns (third and fourth degree)

  • destruction of all skin layers and underlying tissues
  • burn area may be painless b/c of destruction of the nerves

65

Effects of Burn Injury

  • both local and systemic
  • shock
  • dehydration and edema
  • respiratory problems
  • pain
  • infection

66

Hematocrit

  • the percentage of RBCs in a volume of blood