Pathophysiology Infection, Immune & Inflammation
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the third line of defense
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immune response, specific
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Response in which there is increased blood flow to the site of an injury
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vascular response
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Type of response that alerts the products of healing to attend to the site of injury
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cellular response
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Part of vascular response to accommodate increased blood flow to the site of the injury
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dilate
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(vascular response) lining of the blood vessel loosens to allow cells to easily move from the vessel into the injured tissue
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permeable
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Plasma derived chemical mediators
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Complement, kinin, clotting systems
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Watery fluid that accumulates at the site of injury
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exudate
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An important inflammatory mediator, a leukocyte that is responsible for the production and immediate inflammatory mediators through a response of degranulation. (\"first responders\")
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Mast cell
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When the mast cell breaks apart and releases inflammatory mediators in the form of extracellular granules
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Degranulation
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A white blood cell that contains granules that acts in the same manner as mast cells
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Basophil
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mediators released by ________ include histamine, leukotrienes, and prostaglandins
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Mast cell
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Inflammatory mediators associated with arachidonic acid
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Prostaglandins, leukotrienes, thromboxane
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A process of moving certain cells to the site of injury - attracts specific types of cells
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Chemotaxis
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Three steps needed for a successful cellular response
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Chemotaxis, cellular adherence, cellular migration
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Attraction and binding, essential for effective phagocytosis
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Adherence
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Process in which cells can move between and through endothelial junctions
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Diapedesis
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Local manifestations of inflammation
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Heat, redness, swelling, pain, loss of function.
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Systemic manifestations of inflammation
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Fever, fatigue, weight loss, headache, lethargy, inc leukocytes
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Infection associated with breakdown of tissues and formation of pus
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Abscess
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overwhelming infection where pathogenic bacteria gain access to bloodstream
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Septicemia
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Stimulates inflammation, opsonization, and lysis of foreign cells
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The complement system
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Three steps in treatment of inflammation
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Reduce blood flow, decrease swelling, block the action of chemical mediators
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Three steps of healing and tissue repair
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Inflammatory, proliferative, remodeling
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Covers the wound - first step of healing and tissue repair
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Inflammatory phase
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Cleans the debris and restores structural integrity - second step of healing and tissue repair
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Proliferative phase
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Resolution, regeneration, replacement - third step of healing and tissue repair
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Remodeling phase
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Complication of wound healing. Open lesion of the skin prone to infection
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Ulcers
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Complication of wound healing. Deficient scar formation, in which the wound splits open, often at a suture line
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Dehiscence
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Complication of wound healing. Hypertrophic scars that result from excessive collagen production at the site of injury
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Keloids
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Formation of granulomas and scarring often occur
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Chronic inflammation
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2nd degree: Blistering occurs in this type of burn
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Deep partial burn
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3rd Degree: Redness, eschar, edema, and exudate characterize this type of burn
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Full thickness burn
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Diagnostic criteria used for burns
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Rule of nines. Face, hands, feet or groin are MAJOR burns.
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Bacterial infection of the blood
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Sepsis
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A process of mechanically removing debris, including necrotic tissue, from the wound.
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Debridement
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You get a paper cut and experience pain at the site. This response is related to: A. Increased perfusion at the site B. Increased exudate and chemical mediators at the site C. Bacteria that have entered the wound D. Vasoconstriction at the site
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B
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Inflammation is ultimately needed to: A. Increase inflammatory mediators at the site to vasoconstrict the area B. Increase platelets at the site for clotting C. Restore functional cells D. Prepare the site for healing
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D
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Type of healing where the wound is closed with all areas of the wound connecting and healing simultaneously (ex. paper cut)
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Primary intention
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Type of healing where the wound heals from the bottom up. Slower and more involved process (ex. open crater-like wound)
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Secondary intention
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A major difference between the acute and chronic inflammatory response is that in chronic inflammation: A. Inflammatory mediators are released B. Neutrophils are much more prominent C. Granulomas form around certain invaders D. Granulation tissue is present
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D
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Which is not a local manifestation of acute inflammation: A. Edema B. Redness C. Loss of function D. Leukocytes
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D
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The hospitalized burn patient want to know why you need to remove his dressings every day. You explain that removing the dressings promotes: A. Debridement B. Infection C. Skin function D. Drying and exudate
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A
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Which of the following is the most common cause of acute gastritis? A. Poor gastric perfusion B. Too much stomach acid C. Ingestion of aspirin, alcohol, or other chemicals D. H. Pylori infection
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D
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First line of defense
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non-specific, mechanical barrier, skin and mucous membranes an secretions
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Second line of defense
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non-specific, phagocytosis and inflammation.
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What are characteristic of the inflammatory response?
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1. It is a non-specific response to injury. 2. It is activated when first line of defense is inadequate. 3. It can be initiated by the activation of the complement system.
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What leukocyte functions as the first phagocytic responder during the inflammatory process?
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neutrophils
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WBC Differential shifts
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Shift to the left: increase bands % and WBC, neutrophils. Bands are immature neutrophils.
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Inflammatory Exudates
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Serous - water, consists of primarily fluid, some proteins, and white blood cells Sanguinous - bloody Serosanguinous - mostly serous with some red blood cells present (may be pinkish but still watery) Fibrinous - thick, sticky, high cell and fibrin content Purulent - thick, yellow-green, contains more leukocytes, cell debris, and microorganisms
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Potential complications of inflammation
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infections, deep ulcers, muscle spasms, local complications.
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Tissue repair
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resolution: Minimal tissue damage, regeneration: Damaged tissue replaced with cells that are functional, and replacement: Functional tissue replaced by scar tissue & Loss of function.
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pharmacologic treatment
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Acetylsalicylic acid (ASA): Aspirin Acetaminophen: Tylenol Non-steroidal anti-inflammatory drugs (NSAIDs): Ibuprofen (Advil, Motrin), Naproxen sodium (Aleve) Glucocorticoids: Corticosteroids (Prednisone)
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Pyrogenics
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cytokines and prostagladins
