CH 10: Tissue Response to Injury, The Healing Process

Type 3 Collagen

(Reticulin) Found in skin, smooth muscle, nerves, and blood vessels. Has least tensile strength.

Proteins

______ play the most critical role in the healing process, making up the major structural components, needed for growth, maintenance, and repair of all body tissues. Also necessary for the synthesis of enzymes involved in healing.

collagen

Around day 6 or 7 during the fibroblastic repair phase, fibroblasts begin producing ________ fibers deposited in random formations throughout the scar

necrosis, fibrosis

As chronic inflammation persists, damage occurs to connective tissue, resulting in _________ and ___________, prolonging the healing and repair process.

maturation phase

As collagen continues to proliferate, the tensile strength of the wound increases and synthesizes, signaling the beginning of the

12-48 hours

Blood coagulation cascade: 1. Thromboplastin released from damaged cell 2. Thromboplastin changes prothrombin into thrombin 3. Thrombin causes a conversion of fibrinogen into a sticky fibrin clot shutting off supply to the injury When does this start and end post injury?

redness, swelling, pain, heat, loss of function

Cardinal signs of inflammation

Chemical Mediators

Cellular injury results in altered metabolism and the liberation of __________ that initiate the inflammatory process.

Leukotrines

Chemical substances that contribute to anaphylaxis; released by the immune system in allergic reactions.

microtraumas, overuse

Chronic inflammation occurs from repetitive acute __________ and _________

oxygen

During fibroblastic repair, the growth of endothelial capillary buds into the wound site is stimulate by a lack of _________

Macrophage

During the inflammatory response phase, __________ a type of leukocyte, arrives between 12 and 24 hours to phagocytose pathogens and release more cytokines to perpetuate the inflammatory process

Neutrophil

During the inflammatory response phase, __________ a type of leukocyte, arrives immediately (peak 6 hours) to begin cleaning debris

NSAIDs

Effective in minimizing pain and swelling associated with inflammation, and can enchance return to normal activity. However, some concern following acute injury can interfere with the healing process.

Extent of Injury, edema, hemorrhage, poor vascular supply, separation of tissue, muscle spasm, atrophy, corticosteroids, keloids and hypertrophic scars, infection, environment, health

Factors that impede Healing

collagen, elastin, ground substance proteoglycans, glycosaminoglycans

Fibroblastic cells begin to synthesize an extracellular matrix that contains Protein fibers: ___________, _____________, ______________ Non-fibrous Proteins: ___________, ___________

phagocytes

In response to chemokines, ____________ enter the site of inflammation within a few hours to begin cleaning the byproducts of inflammation.

Swelling (edema)

Increased pressure caused by ____________ retards the healing process, causes separation of tissues, inhibits neuromuscular control, produces reflexive neurological changes, and impedes nutrition

poor vascular supply

Injuries to tissues with a _____________ heal poorly and slowly. This response is likely related to a failure in the initial delivery of phagocytic cells and fibroblasts necessary for scar formation.

Prostaglandins

Intensify histamine and kinin effect by increasing capillary membrane permeability

energy, maintenance, regulation

Nutrients have 3 major functions 1. production of _______ 2. Growth, repair, and ___________ of tissues 3. ____________ of bodily processes

Fibroplasia

Period of scar formation, begins within the first few days after injury and may last for as long as 4-6 weeks, in which a patient may still experience tender pain.

plug

Platelets and leukocytes adhere to exposed collagen fibers to create a sticky matrix on the vascular wall forming a ______. (Obstructing lymphatic fluid drainage to localize inflammatory response)

vasoconstriction

The immediate vascular response to tissue damage is ____________________ of the vascular wall in the vessels leading away from the site of injury lasting 5-10 minutes to limit local blood flow.

24-36

The initial effusion of blood and plasma during the inflammatory response phase becomes stagnant and stasis, lasting for ______ hours

Type 1 Collagen

The most abundant form, found in the skin, fasciae, tendon, bone, ligaments, cartilage, and interstitial tissues.

D

Which Vitamin or Mineral stimulates the immune system by increasing the number of macrophages and monocytes in a wound during inflammation? A. Copper B. Zinc C. Magnesium D. Vitamin A E. Vitamin C

C

Which of the following describes picture A? A. Epithelium regenerates, and connective tissue fibrosis occurs in the maturation-remodeling phase B. Blood vessels regrow, and granulation tissue forms in the fibroblastic repair phase of healing C. Cut blood vessels bleed into the wound D. Blood clot forms, and leukocytes clean the wound

D

Which of the following describes picture B? A. Epithelium regenerates, and connective tissue fibrosis occurs in the maturation-remodeling phase B. Blood vessels regrow, and granulation tissue forms in the fibroblastic repair phase of healing C. Cut blood vessels bleed into the wound D. Blood clot forms, and leukocytes clean the wound

B

Which of the following describes picture C? A. Epithelium regenerates, and connective tissue fibrosis occurs in the maturation-remodeling phase B. Blood vessels regrow, and granulation tissue forms in the fibroblastic repair phase of healing C. Cut blood vessels bleed into the wound D. Blood clot forms, and leukocytes clean the wound

A

Which of the following describes picture D? A. Epithelium regenerates, and connective tissue fibrosis occurs in the maturation-remodeling phase B. Blood vessels regrow, and granulation tissue forms in the fibroblastic repair phase of healing C. Cut blood vessels bleed into the wound D. Blood clot forms, and leukocytes clean the wound

parallel

With increased stress and strain in the Maturation-Remodeling phase, the collagen fibers realign in the position of maximum efficiency ____________ to lines of tension.

Spasm

_______ causes traction on torn tissues, separating the torn ends, and preventing approximation. Local and general ischemia may result from this.

omega-3 fatty acids

__________ have anti-inflammatory actions, improve immune function, and reduce infection rates.

Cytokines

___________ (chemokines and interleukin) are major regulators of leukocytes traffic and help to attract leukocytes tot he actual site of inflammation.

Hemorrhage

___________ produces the same negative effects as edema, and its presence produces additional tissue damage.

corticosteriod

___________ use in the early stages of healing have been shown to inhibit fibroplasia, capillary proliferation, collagen synthesis, and increases in tensile strength of the healing scar.

Controlled mobilization

________________ is superior to immobilization for scar formation, revascularization, muscle regeneration, and reorientation of muscle fibers and tensile properties .

Bradykinin

a powerful vasodilator that increases capillary permeability and constricts smooth muscle

Inflammation

body's nonspecific response to harmful stimuli such as pathogens, injury, and metabolic stress.

Exudate

fluid that accumulates in a wound; may contain serum, cellular debris, bacteria, and white blood cells

Type 2 Collagen

found in hyaline cartilage and vertebral disks

fibroblasts, collagen, capillaries

granulation tissue consists of __________, ____________, ___________

Keloids and Hypertrophic Scars

occur when the rate of collagen production exceeds the rate of collagen breakdown during the maturation phase of healing. this process leads to hypertrophy of scar tissue, particularly around the periphery of the wound

Chronic inflammation

occurs when the acute inflammatory response does not respond sufficiently to eliminate the injuring agent and restore tissue to its normal physiological state.

phagocytosis

process in which extensions of cytoplasm surround and engulf large particles and take them into the cell

Fibroblastic Repair Phase

proliferative and regenerative activity, leading to scar formation and repair of the injured tissue.

hyperemia

redness of the skin due to increased blood flow

Homeostasis

refers to the body's ability to actively regulate various physiological processes to seek and maintain a steady and balanced equilibrium of internal bodily functions in response to continuously fluctuating conditions

Histamine

released from injured mast cells, causes blood vessel vasodilation and swelling and separation of endothelial cells which increases cell permeability.

protein-sparing action

the action of carbohydrate (and fat) in providing energy that allows protein to be used for other purposes.

necrotic debris

the formation of a scab occurs with the dehydration of the wound and traps wound drainage in dry climates, promoting infection. Keeping the wound moist allows __________ to move to the surface and shed.

Granulation tissue

the tissue that normally forms during the healing of a wound with the breakdown of a fibrin clot

Macrophages, Mast Cells

1. Unstructural changes __________ (WBC) react to cell damage and releases pro-inflammatory cytokines. __________ release chemical mediators

Hemodynamic Changes

3. In response to an injury, arteries dilate and blood flow increases. At the same time, many previously inactive capillaries and venules open, thereby expanding the total blood flow to the area.

Diapedisis

4. "Leukocyte migration" The process by which white blood cells squeeze between the cells in a vessel wall to enter the tissue spaces outside the blood vessel (emigration)

intention

A wound with smooth edges in good apposition will tend to heal by primary ________ with minimal scarring. A wound that has jagged, separated edges must heal by secondary _________ with granulation tissue filling the defect.

irreversible tissue damage

Sometimes, a persistent inflammatory response and continued release of inflammatory product promotes extended fibroplasia and excessive fibrogenesis that can lead to ____________

Wolff's Law

States that bone and soft tissues will respond to the physical demands placed on them, causing them to remodel or realign along the lines of tensile force

atrophy

Strengthening and early mobilization of the injured structures retard __________

Maturation-Remodeling

The __________ Phase features realignment and development of type 1 collagen fibers that make up scar tissue.

swelling

The amount of _________ during the inflammatory response phase is directly due to the extent of vascular permeability and vessel damage

chemical mediators

The chain of events in the inflammatory response is initiated by a series of interactions involving several ___________________ which cause the vascular and cellular changes resulting from inflammation.

Platelets

The critical cells involved in stopping bleeding during the inflammatory response phase are ________

leukocytes

The fibrin clot causes the slow of dilated vessels in the injured area. This allows ___________ to slow and adhere to the vascular endothelium.

A

Which Vitamin or Mineral is important for the formation of hemoglobin? A. Copper B. Zinc C. Magnesium D. Vitamin A E. Vitamin C

inflammatory response, fibroblastic repair. maturation-remodeling phase

Three Phases of the Healing Process

pain

To a great extent, _______ dictates the rate of healing progression. Any exacerbation of swelling or other symptoms during or after a exercise or activity indicates the load is too great for the level of tissue remodeling.

3

Usually by the end of ____ weeks a firm, strong, contracted, nonvascular scar exists. The Maturation-Remodeling phase of healing can take several years to be complete.

Histamine, leukotrienes, cytokines, prostaglandins

What four chemical mediators are important in helping to limit the amount of exudate and swelling after an injury?

C

What phase of healing? A brief period of immobilization is recommended and will likely facilitate the process of healing and reduce clinical signs and symptoms. A. Remodeling Phase B. Repair Phase C. Inflammatory Response Phase

A.

What phase of healing? Aggressive active range of motion and strengthening exercises should be incorporated to facilitate tissue remodeling and realignment. A. Remodeling Phase B. Repair Phase C. Inflammatory Response Phase

B

What phase of healing? Controlled activity directed toward the return to normal flexibility and strength should be combined with protective support or bracing. Clinical signs and symptoms begin to disappear A. Remodeling Phase B. Repair Phase C. Inflammatory Response Phase

E

Which Vitamin or Mineral enhances capillary formation and neutrophil activity? A. Copper B. Zinc C. Magnesium D. Vitamin A E. Vitamin C

D, E

Which Vitamin or Mineral enhances wound healing by stimulating epithelialization and increasing collagen deposition by fibroblasts? A. Copper B. Zinc C. Magnesium D. Vitamin A E. Vitamin C

C

Which Vitamin or Mineral is a cofactor for enzymes necessary for protein and collagen formation and tissue growth during wound healing? A. Copper B. Zinc C. Magnesium D. Vitamin A E. Vitamin C

B

Which Vitamin or Mineral is essential in numerous aspects of cellular metabolism including immune function, DNA synthesis, and protein and collagen synthesis? A. Copper B. Zinc C. Magnesium D. Vitamin A E. Vitamin C