Chapter 18 Inflammation

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Chapter 18Inflammation, Tissue Repair, and Wound Healing : 

Chapter 18Inflammation, Tissue Repair, and Wound Healing

Objectives : 

Objectives 1. State the five cardinal signs of acute inflammation and describe the physiologic mechanisms involved in production of these signs 2. Describe the vascular changes in an acute inflammatory response 3. Characterize the interaction of adhesion molecules, chemokines, and cytokines in leukocyte adhesion, migration, and phagocytosis, which are part of the cellular phase of inflammation

Objectives : 

Objectives 4. List four types of inflammatory mediators and state their function 5. Contrast acute and chronic inflammation 6. Define the systemic manifestations of inflammation, including the characteristics of an acute-phase response 7. Define the terms parenchymal and stromal as they relate to the tissues of an organ 8. Compare labile, stable, and permanent cell types in terms of their capacity for regeneration

Objectives : 

Objectives 9. Describe healing by primary and secondary intention 10. Explain the effects of soluble mediators and the extracellular matrix on tissue repair and wound healing 11. Trace the wound-healing process through the inflammatory, proliferative, and remodeling phases 12. Explain the effects of malnutrition; ischemia and oxygen deprivation; impaired immune and inflammatory responses; and infection, wound separation, and foreign bodies on wound healing 13. Discuss the effect of age on wound healing

Factors Involved in Protective Responses and Bodily Repair : 

Factors Involved in Protective Responses and Bodily Repair Inflammatory reaction Immune response Tissue repair and wound healing Learning Objective 1: State the five cardinal signs of acute inflammation and describe the physiologic mechanisms involved in production of these signs.

Causes of Inflammation : 

Causes of Inflammation Immune response to infectious microorganisms Trauma Surgery Caustic chemicals Extremes of heat and cold Ischemic damage to body tissues Learning Objective 1: State the five cardinal signs of acute inflammation and describe the physiologic mechanisms involved in production of these signs.

Basic Patterns of Inflammation : 

Basic Patterns of Inflammation Acute inflammation Of relatively short duration; nonspecific early response to injury Aimed primarily at removing the injurious agent and limiting tissue damage Chronic inflammation Longer duration, lasting for days to years A recurrent or progressive acute inflammatory process or a low-grade smoldering response that fails to evoke an acute response Learning Objective 1: State the five cardinal signs of acute inflammation and describe the physiologic mechanisms involved in production of these signs.

Cardinal Signs of Inflammation : 

Cardinal Signs of Inflammation Rubor (redness) Tumor (swelling) Calor (heat) Dolor (pain) Functio laesa (loss of function) Learning Objective 1: State the five cardinal signs of acute inflammation and describe the physiologic mechanisms involved in production of these signs.

Vascular Changes That May Occur With Inflammation : 

Vascular Changes That May Occur With Inflammation An immediate transient response Occurs with minor injury An immediate sustained response Occurs with more serious injury and continues for several days and damages the vessels in the area A delayed hemodynamic response Involves an increase in capillary permeability that occurs 4–24 hours after injury Learning Objective 2: Describe the vascular changes in an acute inflammatory response.

Cellular Stage of Acute Inflammation : 

Cellular Stage of Acute Inflammation Marked by movement of phagocytic white blood cells (leukocytes) into the area of injury Two types of leukocytes participate in the acute inflammatory response: Granulocytes (neutrophils, eosinophils, and basophils) Monocytes (the largest of the white blood cells) Learning Objective 3: Characterize the interaction of adhesion molecules, chemokines, and cytokines in leukocyte adhesion, migration, and phagocytosis which are part of the cellular phase of inflammation.

Direction of Cellular Response : 

Direction of Cellular Response Margination, adhesion, transmigration Cytokines Adhesion molecules Selectins, integrins, and immunoglobulin Initiation of adhesion Aggregation of inflammatory cells Movement into underlying tissue Learning Objective 3: Characterize the interaction of adhesion molecules, chemokines, and cytokines in leukocyte adhesion, migration, and phagocytosis which are part of the cellular phase of inflammation.

Inflammatory Mediators : 

Inflammatory Mediators Histamine Cytokines Arachidonic acid metabolites Eicosanoids Prostaglandins Leukotrienes Omega-3 polyunsaturated fatty acids Platelet-activating factor Plasma proteins Learning Objective 4: List four types of inflammatory mediators and state their function.

Classification of Inflammatory Mediators by Function : 

Classification of Inflammatory Mediators by Function Those with vasoactive and smooth-muscle–constricting properties Chemotactic factors such as complement fragments and cytokines Plasma proteases that can activate complement and components of the clotting system Reactive molecules and cytokines liberated from leukocytes, which when released into the extracellular environment can damage the surrounding tissue Learning Objective 4: List four types of inflammatory mediators and state their function.

Question : 

Question Which of the following molecules will induce endothelial cell retraction? Omega-3 fatty acids Leukotrienes Histamine Vascular cell adhesion molecule

Answer : 

Answer Omega-3 fatty acids Leukotrienes Histamine: Histamine is the primary activator of endothelial retraction and increased permeability of the vessels. Vascular cell adhesion molecule

Chronic vs. Acute Inflammation : 

Chronic vs. Acute Inflammation Acute inflammation: self-limited and of short duration Infiltration of neutrophils Exudate Chronic inflammation: self-perpetuating and may last for weeks, months, or even years Infiltration by mononuclear cells (macrophages) and lymphocytes Proliferation of fibroblasts Learning Objective 5: Contrast acute and chronic inflammation.

Most Prominent Systemic Manifestations of Inflammation : 

Most Prominent Systemic Manifestations of Inflammation Acute-phase response Alterations in white blood cell count (leukocytosis or leukopenia) Fever Sepsis and septic shock (severe) Learning Objective 6: Define the systemic manifestations of inflammation, including the characteristics of an acute-phase response.

Types of Inflammatory Exudates : 

Types of Inflammatory Exudates Serous exudates Watery fluids low in protein content Result from plasma entering the inflammatory site Hemorrhagic exudates Occur when there is severe tissue injury that causes damage to blood vessels or when there is significant leakage of red cells from the capillaries Learning Objective 6: Define the systemic manifestations of inflammation, including the characteristics of an acute-phase response.

Types of Inflammatory Exudates (cont.) : 

Types of Inflammatory Exudates (cont.) Membranous or pseudomembranous exudates Develop on mucous membrane surfaces Composed of necrotic cells enmeshed in a fibropurulent exudate Purulent or suppurative exudates Contain pus, composed of degraded white blood cells, proteins, and tissue debris Fibrinous exudates Contain large amounts of fibrinogen and form a thick and sticky meshwork Learning Objective 6: Define the systemic manifestations of inflammation, including the characteristics of an acute-phase response.

Granulomatous Inflammation : 

Granulomatous Inflammation Associated with foreign bodies such as Splinters Sutures Silica, asbestos Associated with microorganisms that cause Tuberculosis Syphilis, sarcoidosis Deep fungal infections Brucellosis

Types of Structures of Body Organs and Tissues : 

Types of Structures of Body Organs and Tissues Parenchymal tissues Contain the functioning cells of an organ or body part (e.g., hepatocytes, renal tubular cells) Stromal tissues Consist of the supporting connective tissues, blood vessels, extracellular matrix, and nerve fibers Learning Objective 7: Define the terms parenchymal and stromal as they relate to the tissues of an organ.

Basic Components of the Extracellular Matrix (ECM) : 

Basic Components of the Extracellular Matrix (ECM) Fibrous structural proteins Collagen and elastin fibers Water-hydrated gels that permit resilience and lubrication Proteoglycans and hyaluronic acid Adhesive glycoproteins that connect the matrix elements one to another and to cells Fibronectin and laminin Learning Objective 7: Define the terms parenchymal and stromal as they relate to the tissues of an organ.

Basic Forms of ECM : 

Basic Forms of ECM Basement membrane Surrounds epithelial, endothelial, and smooth muscle cells Interstitial matrix Present in the spaces between cells in connective tissue and between the epithelium and supporting cells of blood vessels Learning Objective 7: Define the terms parenchymal and stromal as they relate to the tissues of an organ.

Types of Body Cells : 

Types of Body Cells Labile Continue to divide and replicate throughout life, replacing cells that are continually being destroyed Stable Normally stop dividing when growth ceases Permanent cells Cannot undergo mitotic division Learning Objective 8: Compare labile, stable, and permanent cell types in terms of their capacity for regeneration.

Question : 

Question Is the following statement true or false? Permanent cells, once damaged, can easily be regenerated and their functions recovered.

Answer : 

Answer False: Many cells in the body cannot be replaced once they die. Neurons and cardiac cells are examples.

Healing by Primary or Secondary Intention : 

Healing by Primary or Secondary Intention Objective of the healing process is to fill the gap created by tissue destruction and to restore the structural continuity Primary healing: small, clean wound Secondary healing: great loss of tissue with contamination Learning Objective 9: Describe healing by primary and secondary intention.

Steps in Development of a New Capillary Vessel : 

Steps in Development of a New Capillary Vessel Proteolytic degradation of the parent vessel basement membrane, allowing for formation of a capillary sprout Migration of endothelial cells from the original capillary toward an angiogenic stimuli Proliferation of the endothelial cells behind the leading edge of the migrating cells Maturation of the endothelial cells and proliferation of pericytes (for capillaries) and smooth muscle cells (for larger vessels)

Two Phases of Scar Formation : 

Two Phases of Scar Formation Emigration and proliferation of fibroblasts into the site of injury Deposition of ECM by these cells

Factors Regulating the Healing Process : 

Factors Regulating the Healing Process Action of chemical mediators and growth factors that mediate the healing process Interactions between the extracellular and cellular matrix Learning Objective 10: Explain the effects of soluble mediators and the extracellular matrix on tissue repair and wound healing.

Stages of Wound Healing : 

Stages of Wound Healing Inflammatory phase Proliferative phase Maturational or remodeling phase Learning Objective 11: Trace the wound-healing process through the inflammatory, proliferative, and remodeling phases.

Causes of Impaired Wound Healing : 

Causes of Impaired Wound Healing Malnutrition Impaired blood flow and oxygen delivery Impaired inflammatory and immune responses Infection Wound separation Foreign bodies Age effects Learning objectives 13, 14

Question : 

Question Which of the following will promote wound healing? Malnutrition Increased blood flow and oxygen delivery Infection Foreign bodies

Answer : 

Answer Malnutrition Increased blood flow and oxygen delivery: This is one of the main objectives of the inflammatory response; it will allow for greater energy production and faster removal of dead material. Infection Foreign bodies