Patho - module 3 inflammation - exam 1

inflammation

A protective immune response to injury or infection, aiming to eliminate the cause, remove damaged cells, and begin healing

acute inflammation

The early, immediate response to tissue injury; characterized by vasodilation, increased capillary permeability, and migration of leukocytes (especially neutrophils)

chronic inflammation

Long-term inflammation that persists due to ongoing injury, infection, or autoimmune responses

Healing

The process by which the body repairs tissue damage and restores function

Regeneration

The replacement of damaged tissue with identical tissue, restoring normal function

Replacement

The process where damaged tissue is replaced with scar tissue (fibrous connective tissue), which may not fully restore original function

Primary intention

Healing of a wound with minimal tissue loss, where edges are clean and close together (e.g., surgical incision)

Secondary intention

Healing of a wound with significant tissue loss, where edges are not close; takes longer and results in more scarring

scar tissue

Nonfunctional fibrous tissue that fills a wound when regeneration is not possible

chemical mediators

Substances like histamine, prostaglandins, and cytokines that regulate inflammation and healing

Neutrophils

First WBC responders to arrive at the injury site; phagocytize bacteria and debris

Macrophages

Long-lasting phagocytes that clean debris and promote tissue repair and regeneration, release cytokines (Fat F***)

Exudate

Fluid that leaks from blood vessels into tissue during inflammation, carrying proteins and immune cells

Granulation tissue

New tissue formed during healing, rich in fibroblasts and capillaries that fills a wound during healing

Contracture

permanent tightening of scar tissue during healing that limits movement and function

Three local signs of inflammation

1. Redness (erythema) Caused by increased blood flow to the area (vasodilation)

2. Swelling (edema) Due to fluid (exudate) leaking into tissues caused by increased capillary permeability

3. Pain – Caused by chemical mediators (like bradykinin) and pressure from swelling

What are two common systemic effects of inflammation?

Fever and Leukocytosis

What causes a fever?

caused by pyrogens resetting the hypothalamic temperature

What causes leukocytosis?

increased WBC’s in response to inflammation

Describe how scar tissue formation can lead to functional loss

Scar tissue lacks normal cells and elasticity. It may cause:

• loss of function

  • ex: lungs with fibrous tissue = reduced gas exchange

• Contractures/adhesions

  • ex: restricted joint movement or intestinal obstruction

Neutrophils

first responders, phagocytose debris, release enzymes

monocytes

enter tissue and differentiate into macrophages

macrophages

remove dead cells, secrete cytokines, promote healing

mast cells

release histamine, initiating vasodilation and permeability

histamine

vasodilation, increased permeability

bradykinin

vasodilation, pain induction

prostaglandins

intensify inflammation, pain, and fever

leukotrienes

cause prolonged vasodilation and increased permeability

Healing - Goal of healing ?

restore structure and function

Healing - why restore structure/function?

to regain normal tissue integrity and activity

Healing - why inflammation is necessary before healing?

it removes debris, pathogens, and sets the stage for repair

Healing - what if inflammation didn’t occur?

wounds would not be cleaned, delaying healing and increasing infection risk

3 phases of healing

• Hemostasis/inflammation

• proliferation (granulation tissue forms)

• maturation/ remodeling (scar strengthens)

Signals that promote repair

growth factors, cytokines, and angiogenesis

primary versus secondary intention

determined by wound size/edges

Wound size

larger wounds = secondary intention, slower healing

Surgical incision with suture

primary intention (clean, minimal scar)

Large pressure ulcer healing

secondary intention = infection, contracture, and significant scarring

why does understanding inflammation and healing help nurses explain symptoms to patients?

nurses can explain why redness, swelling, pain, and fever occur, reassuring patients these are part of the healing process

describe a clinical scenario where healing was delayed. what factors contribute?

a diabetic patient with a foot ulcer heals slowly due to poor circulation, neuropathy, and infection

how can inflammation be both helpful and harmful?

helpful: clears debris, fights infection, and initiates repair

harmful: excessive or chronic inflammation damages tissue and causes disease

how is inflammation involved in osteoarthritis and rheumatoid arthritis?

OA: inflammation is secondary to cartilage damage

RA: inflammation is the primary disease process, autoimmune- driven

why is RA considered inflammatory and OA is not?

RA: Autoimmune inflammation causes synovial damage

OA: Mechanical “wear and tear” causes cartilage loss; inflammation is secondary

How might a patient with RA describe a flare vs a patient with OA?

RA: swelling, warmth, stiffness, systemic symptoms (fatigue)

OA: joint pain worsens with activity, is relieved by rest, and has little systemic effect

How does chronic inflammation in RA lead to joint damage?

cytokines and enzymes from immune cells destroy cartilage and bone

how does joint damage differ in OA?

OA involves gradual cartilage degeneration without autoimmune attack

How do healing responses differ in OA vs RA?

RA: chronic inflammation interferes with repair, leading to deformity

OA: repair is limited, but inflammation is less aggressive

what challenges does chronic inflammation pose for healing in RA?

persistent cytokine activity prevents resolution, causing progressive damage and impaired function

Physiology of inflammation

protective defense mechanism, disorders are named using the -itis, signs and symptoms serve as a warning for a problem

5 cardinal signs

redness, warmth, swelling, pain, loss of function

serous exudate

clear, watery fluid that comes from small blood vessel

fibrinous exudate

Looks like: Thick, sticky, with strands of fibrin (a clotting protein)

Happens in: More severe inflammation
Think of: Body trying to "wall off" or protect the area

purulent exudate

Looks like: Thick, yellow or green pus
Happens in: Bacterial infections
What’s in it: Dead white blood cells, bacteria, and tissue debris

hemorrhagic exudate

Looks like: Bright red and bloody

Happens in: Severe damage to blood vessels Example: Trauma, severe inflammation, or in cancers where blood vessels are destroyed

systemic effects of inflammation

• Mild fever (pyrexia)
• Malaise
• Fatigue
• Headache
• Anorexia

potential complications

infections, skeletal muscle spasm, deep ulcer

healing process

hemostasis, inflammation, proliferation, maturation

hemostasis

The process that stops bleeding

proliferation

"Rebuilding" phase

Angiogenesis Granulation Epithelialization Contraction

maturation

The final stage of wound healing

regeneration, resolution, scar

resolution

minimal tissue damage

The process where inflammation completely ends and the tissue returns to normal

replacement

functional tissue replaced by scar tissue, loss of function

osteoarthritis

“wear and tear”

inflammation after, if you use hands too much inflamed - wear and tear

Chronic degenerative joint disorder
involving cartilage breakdown
• Common sites
• Hips
• Knees
• Hands
• Spine
• Onset – gradual
• Age
• Overuse, repetitive use

Rheumatoid Arthritis

Autoimmune inflammatory disease targeting
synovial membrane
• Common sites – small joints
• Hands
• Wrists
• Feet
• Onset
• Gradual

leukocytosis

a patients lab report shows an increased number of white blood cells after an infection

malaise

a patient who feels generally unwell with a low grade fever and fatigue

adhesions

a patient recovering from surgery develops tough, fibrous band that restricts intestinal movement

contracture

a patient with RA experiences joint deformity and limited range of motion due to scar tissue formation

Hyperemia

a condition where there is increased blood flow to an area, often causing it to appear red and swollen

ulcer

a patient with an open wound that heals slowly due to poor blood supply

granulation tissue

a patient with a chronic wound has new, shiny tissue with small blood vessels forming

erythrocyte sedimentation rate

a blood test shows that a patient’s RBC are settling faster than normal, suggesting inflammation