Pathophysiology: A Clinical Approach (2nd Ed.) - Braun; Anderson [Chapter 3]OriginalAlphabeticalInjuryAny form of damage or alteration to cells or tissues.Vascular ResponseIncreased blood flow to the site of an injury.Cellular ResponseAlerts 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 CellsForm a tight junction within the inner lining of the blood and lymphatic vessels and the heart.Basement MembraneOuter membrane of vessels, which separates the vessel from the tissues of the body.PhagocytosisProcess of engulfing and removing harmful agents.ExudateWatery fluid that accumulates at the site of injury. Has a high protein and leukocyte concentration.Inflammatory MediatorsSpecifically vasoactive inflammatory mediators that facilitate the process of widening and loosening blood vessels at site of injury.DegranulationRelease of chemical mediators in the form of extracellular granules.BasophilGranulocyte that complements the actions of mast cells; important in establishing allergic reactions.Mast CellLeukocytes (WBCs) that are house throughout the connective tissues of the body near all blood vessels. Responsible for production and immediate release of chemical mediators.CytokinesHormonlike cell protein that regulates the activity of many other chemical mediators in an effort to trigger, enhance, and then discontinue the inflammatory response.Inflammatory ResponseSecond line of defense, which is a nonspecific defense mechanism to protect from harmful invaders and prepare an injury site for healing.Platelet-activating FactorComplex 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 AcidPlasma membrane-driven substance that generates various chemical mediators through a complex chemical conversion.AutoimmunitySelf-attack against body tissues.ChemotaxisProcess of moving certain cells to the site of injury.Chemotactic FactorsSpecific inflammatory mediators that are activated in the cellular response, which attract specific types of cells (ex. neutrophil chemotactic factor attracts neutrophils).Cellular AdherenceAttraction and binding. A step essential for effective phagocytosis.DiapedesisProcess of cells moving between and through endothelial junctions.Cardinal SignsLocal manifestations of acute inflammation. They include erythema (redness), heat, swelling, pain, and loss of funtion.ErythemaRednessLymphadenitisEnlargement and inflammation of lymph nodes near site of injury.PyrexiaFever (an elevated core body temperature). A result of inflammatory mediators acting directly on the hypothalamus.LeukocytosisElevation of WBCs with a count usually above 10,000/mm(3). (Normal WBC range is 5,000 to 10,000/mm(3).)ThrombusProtective 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-epithelializationThe movement of epithelial cells to form a covering over a wound.Parenchymal TissuesThose tissues made up of cells with a specific function (such as neurons, myocardial cells, and epithelial cells).FibroblastsImportant cells that produce and replace the connective tissue layer. They are stimulated by macrophages.CollagenAKA 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.ElastinA substance that allows stretching and recoil of tissue.GlycoproteinsRegulate cell movement across the matrix, provide a place for attachment of the cells to the matrix, and prompt the cells to function.Provisional MatrixTemporary 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 TissueConnective tissue characterized by extensive macrophages and fibroblasts, and the production of angiogenesis.AngiogenesisGeneration of new blood vessels at the site of injury.ResolutionHealing in response to mild injury with minimal disruption to cells, such as with a small superficial scratch or mild sunburn.RegenerationA 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.ProliferationGrowth and reproduction of cells.DifferentiationCells mature and become more specialized.Labile CellsCells that constantly regenerate through mitosis, particularly epithelial cells of the skin, GI tract, and urinary tract, and blood cells in the bone marrow.Stable CellsCells that stop regenerating when growth is complete but can resume regeneration if injured. Hepatocytes in the liver are one example.ReplacementOccurs through the production of scar tissue in extensive wounds and when regeneration is not possible.Permanent CellsCells that do not undergo mitosis and are unable to generate. Examples are neurons, cardiac myocytes, and the lens of the eye.Primary IntentionHealing 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 IntentionWounds 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.PerfusionPassage of oxygenated blood.UlcerCircumscribed, open, craterlike lesion of the skin or mucous membranes.DehiscenceSplitting or bursting open of a wound.KeloidsHypertrophic scars resulting from excessive collagen production at the site of injury.ProteinasesEnzymes that destroy elastin and other tissue components.GranulomaNodular inflammatory lesions that encase harmful substances. (Granuloma formation is regulated by macrophages.)AdhesionsFibrous connections between serous cavities and nearby tissues, which do not allow the surrounding tissues to move freely.Giant CellsPhagocytes that can engulf particles much larger than the typical macrophage.Epithelioid CellsGather and contain smaller substances by forming a wall, or fibrotic granuloma, around the affected area.Superficial Partial-thickness BurnsFirst-degree burns. Damage the epidermis. Example: mild sunburn.Deep Partial-thickness BurnsSecond-degree burns. Damage epidermal skin layers and penetrate some dermal skin layers. Example: severe sunburn.Full-thickness BurnsThird-degree burns. Damage epidermis and dermis, and penetrate subcutaneous layers as well. Example: exposure to a flame.ContracturesAreas of thick, shortened, and rigid tissue.ShockState of inadequate perfusion (oxygenated blood flow) to peripheral tissues.SepsisBacterial infection of the blood.EscharThick, coagulated crust that must be surgically removed to prevent extensive microorganism growth.DebridementProcess of mechanically removing debris, including necrotic tissue, from a wound.Serous ExudateA clear fluid that seeps out of the tissues.PannusGranulation tissue that forms over the inflamed synovium and cartilage as a result of accelerated angiogenesis.AnkylosisA debilitating fixation of a joint from extensive fibrosis.GastritisInflammation of the lining of the stomach, or gastric mucosa, thereby impairing gastric function. It can be both acute and chronic.FistulaAn abnormal track or passage that forms between two segments of bowel or other epithelial tissue.AbscessA pocket of purulent exudate.OccultHidden blood in the stool that is not visible.FriabilityA state where tissue readily bleeds.First Line of Defense in Protection of the BodyBlink 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 BodyInflammatory 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 BodyImmune response is activated; Immune cells recognize and destroy harmful substances.Immune ResponseConsidered to be the third line of defense.What triggers Acute Inflammation?Tissue injuryInjury 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 histology2. Vasodilation3. Increased vascular permeability4. Leakage of exudate5. Margination, rolling, adhesion6. Transmigration (diapedesis)7. Chemotaxis8. Polymorphonuclear (PMN) leukocyte (AKA Granulocyte) activation9. Phagocytosis10. Termination (100% resolution or fibrosis/scar or chronic inflammation)

Mnemonic:Never Venture Into Lush Mountain Terrain. Careful People Prefer Trails.