Pathophysiology: A Clinical Approach (2nd Ed.

) - Braun; Anderson [Chapter 3]

OriginalAlphabetical

Injury
Any form of damage or alteration to cells or tissues.

Vascular Response
Increased blood flow to the site of an injury.

Cellular Response
Alerts the products of healing to attend to the site of injury.

Why do blood vessels dilate (widen) during tissue injury?

To accommodate increased blood flow to site of injury.

Why does lining of blood vessel become more permeable

(loosen) during tissue injury?
To allow cells to easily move from vessel to injured tissue.

Endothelial Cells
Form a tight junction within the inner lining of the blood and
lymphatic vessels and the heart.

Basement Membrane
Outer membrane of vessels, which separates the vessel from the
tissues of the body.

Phagocytosis
Process of engulfing and removing harmful agents.

Exudate
Watery fluid that accumulates at the site of injury. Has a high
protein and leukocyte concentration.

Inflammatory Mediators
Specifically vasoactive inflammatory mediators that facilitate the
process of widening and loosening blood vessels at site of injury.

Degranulation
Release of chemical mediators in the form of extracellular
granules.

Basophil
Granulocyte that complements the actions of mast cells;
important in establishing allergic reactions.

Mast Cell
Leukocytes (WBCs) that are house throughout the connective
tissues of the body near all blood vessels. Responsible for
production and immediate release of chemical mediators.

Cytokines
Hormonlike cell protein that regulates the activity of many other
chemical mediators in an effort to trigger, enhance, and then
discontinue the inflammatory response.

Inflammatory Response
Second line of defense, which is a nonspecific defense
mechanism to protect from harmful invaders and prepare an
injury site for healing.

Platelet-activating Factor
Complex lipid stored in cell membranes, incl. those of
endothelial cells that line blood vessels and in many other types
of cells that can become injured.

Arachidonic Acid
Plasma membrane-driven substance that generates various
chemical mediators through a complex chemical conversion.

Autoimmunity
Self-attack against body tissues.

Chemotaxis
Process of moving certain cells to the site of injury.

Chemotactic Factors
Specific inflammatory mediators that are activated in the cellular
response, which attract specific types of cells (ex. neutrophil
chemotactic factor attracts neutrophils).

Cellular Adherence
Attraction and binding. A step essential for effective
phagocytosis.

Diapedesis
Process of cells moving between and through endothelial
junctions.

Cardinal Signs
Local manifestations of acute inflammation. They include
erythema (redness), heat, swelling, pain, and loss of funtion.

Erythema
Redness

Lymphadenitis
Enlargement and inflammation of lymph nodes near site of
injury.

Pyrexia
Fever (an elevated core body temperature). A result of
inflammatory mediators acting directly on the hypothalamus.

Leukocytosis
Elevation of WBCs with a count usually above 10,000/mm(3).
(Normal WBC range is 5,000 to 10,000/mm(3).)

Thrombus
Protective clot and subsequent scab that forms physical barrier
to prevent additional harmful substances from entering the
wound.

Extracellular Matrix (ECM)

Layers of the architectural structures that support the cells.

Re-epithelialization
The movement of epithelial cells to form a covering over a
wound.

Parenchymal Tissues
Those tissues made up of cells with a specific function (such as
neurons, myocardial cells, and epithelial cells).

Fibroblasts
Important cells that produce and replace the connective tissue
layer. They are stimulated by macrophages.

Collagen
AKA scar tissue. A substance manufactured by fibroblasts that
fills in the gaps left after the removal of extensively damaged
tissues or those tissues made up of cells that are unable to
regenerate.

Elastin
A substance that allows stretching and recoil of tissue.

Glycoproteins
Regulate cell movement across the matrix, provide a place for
attachment of the cells to the matrix, and prompt the cells to
function.

Provisional Matrix
Temporary matrix that promotes healing by decreasing blood
and fluid loss at the site and attracting and supporting
fibroblasts, endothelial cells, and epidermal (skin) calls.

Granulation Tissue
Connective tissue characterized by extensive macrophages and
fibroblasts, and the production of angiogenesis.

Angiogenesis
Generation of new blood vessels at the site of injury.

Resolution
Healing in response to mild injury with minimal disruption to
cells, such as with a small superficial scratch or mild sunburn.

Regeneration
A process of reformation of parenchymal tissues, which can only
occur in those cells that undergo mitotic division. Accomplished
through 1) Proliferation, 2) Differentiation, or 3) Diapedisis.

Proliferation
Growth and reproduction of cells.

Differentiation
Cells mature and become more specialized.

Labile Cells

Cells that constantly regenerate through mitosis, particularly

epithelial cells of the skin, GI tract, and urinary tract, and blood
cells in the bone marrow.

Stable Cells
Cells that stop regenerating when growth is complete but can
resume regeneration if injured. Hepatocytes in the liver are one
example.

Replacement
Occurs through the production of scar tissue in extensive wounds
and when regeneration is not possible.

Permanent Cells
Cells that do not undergo mitosis and are unable to generate.
Examples are neurons, cardiac myocytes, and the lens of the eye.

Primary Intention
Healing whereby the wound is basically closed with all areas of
the wound connecting and healing simultaneously. Risk for
infection is reduced and scarring is minimal.

Secondary Intention
Wounds that heal from the bottom up, such as larger, open,
craterlike wounds. Process is much slower and more involved
than the primary intention process. Results in greater risk for
infection and scarring.

Perfusion
Passage of oxygenated blood.

Ulcer
Circumscribed, open, craterlike lesion of the skin or mucous
membranes.

Dehiscence
Splitting or bursting open of a wound.

Keloids
Hypertrophic scars resulting from excessive collagen production
at the site of injury.

Proteinases

Enzymes that destroy elastin and other tissue components.

Granuloma
Nodular inflammatory lesions that encase harmful substances.
(Granuloma formation is regulated by macrophages.)

Adhesions
Fibrous connections between serous cavities and nearby tissues,
which do not allow the surrounding tissues to move freely.

Giant Cells
Phagocytes that can engulf particles much larger than the typical
macrophage.

Epithelioid Cells
Gather and contain smaller substances by forming a wall, or
fibrotic granuloma, around the affected area.

Superficial Partial-thickness Burns

First-degree burns. Damage the epidermis. Example: mild
sunburn.

Deep Partial-thickness Burns

Second-degree burns. Damage epidermal skin layers and
penetrate some dermal skin layers. Example: severe sunburn.

Full-thickness Burns
Third-degree burns. Damage epidermis and dermis, and
penetrate subcutaneous layers as well. Example: exposure to a
flame.

Contractures
Areas of thick, shortened, and rigid tissue.

Shock
State of inadequate perfusion (oxygenated blood flow) to
peripheral tissues.

Sepsis
Bacterial infection of the blood.

Eschar

Thick, coagulated crust that must be surgically removed to

prevent extensive microorganism growth.

Debridement
Process of mechanically removing debris, including necrotic
tissue, from a wound.

Serous Exudate
A clear fluid that seeps out of the tissues.

Pannus
Granulation tissue that forms over the inflamed synovium and
cartilage as a result of accelerated angiogenesis.

Ankylosis
A debilitating fixation of a joint from extensive fibrosis.

Gastritis
Inflammation of the lining of the stomach, or gastric mucosa,
thereby impairing gastric function. It can be both acute and
chronic.

Fistula
An abnormal track or passage that forms between two segments
of bowel or other epithelial tissue.

Abscess
A pocket of purulent exudate.

Occult
Hidden blood in the stool that is not visible.

Friability
A state where tissue readily bleeds.

First Line of Defense in Protection of the Body

Blink reflex; Lashes catch particles; Tears wash particles away;
Enzymes in tears neutralize harmful substances; Intact
surrounding skin prevents entry of harmful substances.

Second Line of Defense in Protection of the Body

Inflammatory mechanisms are activated; Vasodilation and
increased capillary permeability cause redness (erythema) and

swelling; Phagocytes move in to engulf and destroy harmful

substances.

Third Line of Defense in Protection of the Body

Immune response is activated; Immune cells recognize and
destroy harmful substances.

Immune Response
Considered to be the third line of defense.

What triggers Acute Inflammation?

Tissue injury

Injury includes what?

Invasion by microorganisms, cellular mutations, hypoxia or
anoxia, nutritional deficiencies, and physical or chemical
damage.

What are the three major goals of the Acute Inflammatory

Response?
1) Increase blood from to the site of injury (vascular response), 2)
Alert products of healing to attend to the site of injury (cellular
response), 3) Remove the injured tissue and prepare the site for
healing.

What is the sequence of events surrounding inflammation?

1. Normal histology
2. Vasodilation
3. Increased vascular permeability
4. Leakage of exudate
5. Margination, rolling, adhesion
6. Transmigration (diapedesis)
7. Chemotaxis
8. Polymorphonuclear (PMN) leukocyte (AKA Granulocyte)
activation
9. Phagocytosis
10. Termination (100% resolution or fibrosis/scar or chronic
inflammation)
Mnemonic:
Never Venture Into Lush Mountain Terrain. Careful People
Prefer Trails.