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factors that influence wound healing
- blood flow and oxygenation
- impaired immune response
- impaired inflammatory response
- wound separation
- foreign bodies
Differentiate b/w labile, stable, and permanent cell types.
- labile - divide constantly
- stable - retain ability to regenerate
- perm - have left cell cycle, cannot divide
examples of labile cells
- lymphoid organs
- mucus membranes of GI, urinary, and reproductive tracts
examples of permanent cells
- skeletal and cardiac mm
what is a shift to the left?
what is a band?
- ^ WBC count (up to 20K when normal is 4-10K)
- d/t increased # of bands
band = immature WBC
5 cardinal signs of acute inflam
- loss of fx
- (fever = systemic)
For what pop. is fever not useful as a sign of inflam? What is better sign?
elderly - don't display fever
look for confusion instead
what causes rubor?
hyperemia d/t vasodilation
what causes calor?
^ metabolism at site of inflammation
what causes pain (dolor)?
- nerve stimulation by chemicals (eg histamine, prostaglandins) pressure from fluid in area
- change in pH
- change in local ionic concentration
what causes swelling?
- fluid shift to interstitial spaces
- accumulation of exudate
what is primary intention?
healing where we approximate the edges ourselves. no tissue is lost.
ex: staples, stitches
what is secondary intention?
edges are not approximated. tissue it lost.
ex: scrapes, large wounds w/o stitches, anything that doesn't have edges physically put together by a person
tissue regenerates back to normal. back case scenario.
if there is no resolution of tissue damage, what happens?
repair: granulation tissue, angiogenesis, fibrinogenesis, scar tissue
why is resolution preferable to repair?
repair will not result in active tissue. collagen fills in wound area to give it strength, but it is not vascularized, active tissue.
diff. b/w keloid and hypertrophic scar? what causes them?
keloid goes beyond original wound border. hypertrophic scar is raised but stays within original border.
both caused by excess collagen production.
what is dehiscence? when does it occur?
when suture lines pull apart. usually 5-12 days post op.
What's a contracture? What kind of pt at most risk?
contracture = excessive mm contraction. Burn pts at risk.
list pss dysfunctional healing patterns
- adhesions - internal scars r/t excess fibrin formation
- impaired collagen synthesis: keloid, hypertrophic scars
- dehiscence - wound disruption
- impaired epithelialization
- impaired mm contraction - contractures
- excessive inflam. response
what do cytokines do?
examples of cytokines?
- regulate and direct actions of cells. they are intracellular communicators.
- IL, TNF, interferons, colony stimulating factors
"The role of the phagocyte begins when the inflammatory response causes it to stick to capillary walls in a process called?"
cleanup of a lesion involving breakup of fibrin clots by fibrinolytic enzymes
name the 2 sources of inflam mediators
which inflam mediators come from plasma?
- kinins - ^ cap perm, ^ pain
- complement fragments - vasodilate, ^ cap perm, promote phagocytosis
which inflam mediators come from cells?
- histamine - form mast cells, plts, basophils
- serotonin - from plts
- plt aggregating factor
what does NO do?
- powerful vasodilator
- antagonist of plt aggregation --> decreases clotting
- decreases leukocyte recruitment
5 types of exudate
- sanguinous / hemorrhagic
- membranous / pseudomembranous
- purulent / suppurative
3 phases of wound healing process
- proliferative - healing by primary or secondary intention
- remodeling / reconstruction
manifestations of inflam
- changes in plasma proteins
- increased ESR - erythro sedimentation rate (RBCs settle faster)
- WBC shift to the left
- ^ C-reactive protein (CRP flags germs)
- skeletal mm catabolism --> negative N balance
what secretes collagen?
What is it?
where is it found?
- secreted by fibroblasts
- found all over body