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Pathology Exam 1 Lecture 2
Injury, Inflammation, Healing, and repair
64
Pathology
Graduate
07/11/2016

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Term
Components of tissue healing
Definition
-fibronectin
-proteoglycans and elastin
- collagen
- growth factor
- chemical mediators
Term
Stages of healing
Definition
-Hemostasis and degeneration
-inflammation
-proliferation and migration phase
-remodeling and maturation phase
Term
fibronectin
Definition
-formation of scaffold, provides tensile strength
-glue
-attracts fibroblasts and macrphages by chemotaxis
-fibroblasts secrete more fibronectin
-fibronectins binds to proteoglycans and collagen, further stabilizing
Term
Proteoglycans and elastin
Definition
-secreted by fibroblaasts
- proteoglycans bind to fibronectin and to collagen to stabilize
- retain water, aid in hydration of tissue
Term
collagen
Definition
-most important in providing structural support and tensile strength
- most abundant protein in the body, at least 27 different types
Term
growth factors
Definition
-protein that regulate the number of cellular reactions involved in healing
-
Term
hemostasis - goals and timeline
Definition
day 1-3
stop bleeding
form clot
begin inflammatory phase
Term
Inflammation and timeline
Definition
new framework for blood vessel growth
day 3-20
Term
Proliferation and granulation
and timeline
Definition
Pulls wound closed
week 1-6
Term
remodeling and maturation
and timeline
Definition
final proper tissue
week 6 - 2 years
Term
signs of inflammation
Definition
every ear has low piercing
erythema
edema
heat
loss of function
pain
Term
types of collagen
Definition
Type I - strong dermal
type II - thinner (cartilage, ear, nose)
Type III - Vascular and visceral tissues
Term
mechanical stress thresholds
components and effect of overload or underload stress
Definition
thresholds for injury, increased tolerance, maintenance, and atrophy.
baseline increases with increased stress
Term
cell injury can be the result of
Definition
-injurious stimuli
-inability to adapt to stress
Term
cell injury can result in
Definition
reversible injury - return to normality
irreversible injury - necrosis or apoptosis
Term
characteristics of reversible cell injury
Definition
mild, short duration
-cell swells with Intracellular fluid
-Sodium(Na) and Calcium(Ca) influx
-increased endoplasmic reticulum and mitochindria activity
-ribosomes released from endoplasmic reticulum
-blebs break off to protect the nucleus
Term
characteristics of irreversible cell injury
Definition
-mitochondria no longer produce ATP
-nucleus dies
-lysosomes break down the cell
-dead cells released to ECF - can be tested for to assist in diagnosis
Term
necrosis vs apoptosis
-cell size
Definition
necrosis - enlarged (swelling)
apoptosis - reduced (shrinkage)
Term
necrosis vs apoptosis
-nucleus
Definition
necrosis- pyknosis>karyorrhexis>karyolysis
apoptosis - fragmentation
Term
growth factors regulate
Definition
-cell growth/division
-differentiation
-migration
-biosynthesis/degradation of proteins
-angiogenesis
Term
chemical mediators of inflammation
Definition
histamine
platelet activating factor
Arachidonic Acid Derivatives
cytokines
blood coagulation
phagocytosis
Term
histamine role in inflammation
Definition
vasodilator, increasing permeability so blood cells can exit
Term
platelet activating factor
-role in inflammation
Definition
signals leukocytes
Term
arachidonic acid derivatives
-role in inflammation
Definition
formation of prostaglandins(pain) and leukotriens (fever)
Term
cytokines
-role in inflammation
Definition
affect metabolic and hemodynamic changes
Term
phagocytosis
-role in inflammation
Definition
inactivates and removes the inflammatory stimulus
Term
hemostasis
timeline and specific events
Definition
24-48 hours
-coagulation
-platelets send out growth factors to attract RBC & WBC
-Degeneration/necrosis of dead cells
-start inflammatory phase
Term
inflammation
-time line and goals
Definition
-starts day 3, lasts 2-3 weeks
goals
-inactivate the cause of injury
-break down/clean up dead cells
-initiate healing
Term
inflammation
-time line and events
Definition
-from day 3 for about 2-3 weeks
events
-neutrophils move in
-macrophages move in
-fibroblasts, epithelial cells, and vascular endothelial cells move in to form granulation tissue
Term
inflammation pain can be caused by
Definition
prostaglandins - chemical pain
pressure on nerve
swelling of nerve
Term
proliferation and migration phase
-time line
-components
Definition
-weeks 1-6
components
-phagocytosis
-macrophages
-angiogenesis
-lymphatic channels open to drain dead tissue
-at 3 weeks, greatest mass, but tensile strength only 15% normal
Term
angiogenesis
Definition
-endothelial cells from edge of necrotic tissue proliferate
-capillary budding w/in 24 hours
-granulation tissue from fibroblasts form collagen and elastin
-fibrinolysin produced to dissolve clots and fibrin
-vascular network established
Term
phagocytosis
Definition
-bacterium is coated with G antibody and compliment
-pulled in
-vacuole and lysosomes destroy
Term
Remodeling and maturation phase
-time line
-events
Definition
3-4 weeks -- year or longer
events
-scar tissue reduced and remodeled
-scar tissue strengthens
--tissues contract to approximate the margins
Term
repaired skin
Definition
mature scar takes 12-18 months and is 20-30% weaker than original
Term
primary intention
(healing)
Definition
edges unite, no granulation
Term
secondary intention
(healing)
Definition
granulation fills in
Term
tertiary intention
(healing)
Definition
granulation fills wound but epithelium fills over the top - overshoot
Term
lung tissue repair
Definition
regeneration/repair can only occur when the basement membrane is intact
Term
peripheral nerve damage
Definition
wallerian degeneration, or the degeneration of axon detached from the cell body
Term
skeletal muscle damage/repair
Definition
repair/regeneration begin immediately
-repairs in the form of connective tissue scar
-structural integrity maintained, but not completely functional
Term
bone tissues
Definition
cortical - 80%
cancellous (spongy) - 20%
Term
bone regeneration and remodeling
Definition
1. fracture and bleeding stimulates cytokines, GF, and osteoprogenitor to form callous
2. clotting forms fibrous network/soft callous
3. soft callous to bony callous in 2 weeks
4. healed in 6-12 weeks, but remodeling can go on for a year+
Term
tendon and ligament damage/repair
Definition
-inflammatory stage -> proliferative phase at 2-3 weeks
-2 weeks, collagen fibril bundles provide tissue strength.
- Area remains immobilized, and lack of stress causes collagen to deposit in random alignment
-maturation and remodeling at 3 weeks
-type III collagen replaced with type I, which aligns along tensile forces
-12-16 weeks before tendon can be stressed, 40-50 weeks until normal
Term
tangential zone of articular cartilage
Definition
-type II collagen
-oriented tangentially
-offer greatest resistance to shearing
Term
tidemark of articular cartilage
Definition
located in the calcified zone, at the boundary between calcified and uncalcified cartilage
-separated hyaline cartilage from subchondral bone
Term
3 forms of cartilage
Definition
hyaline
fibrocartilage
elastc cartilage
Term
hyaline cartilage examples
Definition
ends of bones, ribs, nose, larynx, trachea
Term
fibrocartilage examples
Definition
intervertebral discs, joint capsule, ligaments
Term
elastic cartilage examples
Definition
ligamentum flavum, external ear, epiglottis
Term
cartilage healing
Definition
occurs by fibrous scar, if at all
Term
synovial membrane
Definition
lines the inner surface of the joint capsule
Term
effects on synovium from joint injury
Definition
hemorrhage
hypertrophy
hyperplasia of synovial lining cells
mild chronic inflammation
Term
immobilization of joint effects synovial membrane
Definition
synovial membrane hypertrophies and forms adhesions between itself and articular cartilage
Term
vertebral disk
-blood supply
-nerve supply
Definition
-blood supply only to the outer anulus
-sinuvertebral nerves supply outer annulus
Term
meniscus
-structure
-blood supply
Definition
-fibrocartilaginous structure, mostly collagen, oriented to resist compression and lateral loading
-vascular at birth
-only outer 10-30% vascular in adulthood
Term
phases to consider in rehab
Definition
inflammatory phase
proliferative phase
remodeling phase
Term
inflammatory phase treatment
Definition
-promote early healing & prevent negative effects of rest
-passive movement, massage, muscle setting (isometric)
-AAROM, resistive, modified aerobic in other areas
-proper dosage of rest and movement
Term
proliferation and migration phase treatment
Definition
5-21 days up to 6 weeks
-promote healing(monitor tissue)
-gentle active, open/closed chain stabilization, muscle endurance
-progressive PROM ->AAROM ->AROM
-multi-angle isometrics ->isotonic
-low intensity functional activity
-inflammation should be decreasing, there should not be lasting resting pain
Term
Remodeling and maturation phase treatment
Definition
1.5months----6-12months: return to function
-increase strength and alignment of scar
-stretching, strengthening, endurance
-increasing tissue mobility, joint mobilization, cross fiber massage, neuromuscular inhibition
-progress all exercise,
-should be no signs of inflammation
Term
immobilization response
Definition
-deeo vein thrombosis
-atrophy, decreased strength, decreased stress tolerance
-decreased fitness
-adhesions
-loss of motion
Term
muscle strain rehab
Definition
-immobilization followed by mobilization may help in regeneration, and fiber orientation with reduced scar formation
-return to sports is safe with 80% return of strength
Term
NSAID use
Definition
-good for early symptom control during early phases of healing
- long term use interrupts biologic healing process
Term
immobilizations that carry risk of DVT
Definition
bed rest
limb in cast or splint
extended non-weight bearing (after injury, or long plane flight)
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