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What is inflammation?
- boides repsonse to injury at the cellular level
- followed by -itis
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Physiology of Acute Inflammation
- Altered hemodynamics (blood flow)
- Fluid balance is altered
- Compare normal capillar exchange and inflammation
- 1st vascular responce
- 2nd cellular response
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Vascular Response of Inflammation
- chemical mediators are released (histamine, prostaglandin, bradykinin)
- Vasodilation
- Increased capillary permeability, proteins & fluids leak out in the interstitial space
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Cellular Response of Inflammation
- Leukocytes are attracted to the area
- Functions vary pers cell type
- Cells work together to destroy & remove foreign material
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Leukocytes and thier function
- Neutrophils - phagocytosis of microorganisms
- Basophils - Release of histamine leading to inflammation
- Eosinophil - Numbers are increased in allergic responses
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Lymphocytes and their function
- Y Lymphocytes - active in cell-mediated immune response
- B Lymphocytes - porduce anitbodies
- Monocytes - Phagocytosis
- Macrophages - Active in phagocytosis (mature monocytes)
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Signs of Inflammation
- Redness & Warmth
- Swelling & decreased movement
- Pain
- Inflammatory exudate
- Possible loss of function
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Causes of Redness & warmth
Vasodilation and increaced blood flow
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Causes of Swelling and Decreased Movement
Increased Capillary permeability and shift of protein / fluid into the area
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Causes of Pain
pressure on nerve ending (due to fluid in area chemical mediators)
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Causes of Inflammatory exudate
Interstitail fluid builds up
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Causes Possible loss of Function
Can affedt function of specific tissue affected (lung, muscle)
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Serous Inflammatory Exudate
- watery, small amount of protein, & WBC's
- Allergic Reaction burns
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Fibrinous Inflammatory Exudate
- Thick, sticky, with high cell and fibrin content
- Trauma with increased risk of scar
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Purulent Inflammatory Exudate
- Thick, yellow green, containes leukocyes, cell debris, microbes
- Indicates infection
- Localized pocket - abscess
- Bug and Bacteria
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Hemorrhagic Inflammatory Exudate
- Blood in fluid
- Damagede blood vessels
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Systems Effects of Inflammation
- Malaise - discomfort, uneasiness, indisposition
- Fatigue Headache
- Anorexia
- Mild Fever - Pyrogen
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Define Pyrogen
- Fever producing substance.
- Can occur if inflammation is severe or porlonged
- More common with infection
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`Potential Complication of Inflammtion
- Infections
- Ulcers
- Skeletal Muscle Spasm
- Local Effects Decreased lung expantion, decreased joint ROM
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Chronic Inflammation
- RA, Crohns's Disease
- Pathophysiology:
- Less Swelling. more lymphocyes & fibroblasts
- More Tiddue Destruction
- More scar Formation
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Aspirin
- decreases prostaglandin synthesis
- decreases inflammation
- decreases clotting time
- hard on stomach
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Acetaminophen
- Tylenol
- Decreases fever and pain
- Does NOT decrease inflammation
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NSAID's
- Motrin, Advil Ibuprofen
- Decreases prostaglandin synthesis
- Decreases inflammation fever and pain
- good for musculoskeletal pain
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Glucocorticoids
- Steroids - prednisone dezamethasone
- Effects vs side effects
- decreases capillary permeability : stabilizes vascular system
- decreases number of leukocytes and chemical mediators
- Blocks immune response
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None medication treatment options
- RICE
- Cold
- Heat
- Exercise to prevent long term complications and effects of immobility
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Resolution
- minimum tissue damage
- can have scar formations
- mild sunburn
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Regeneration
- More significant damage
- cell must be capable of mitosis
- cells are replaced by smae type of cell
- often have scar formation
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Replacement by Connective Tissue
- Extensive tissue damage
- cells are incapable of mitosis (brain, myocardium)
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The order of cells arriving the injury site
- Injury and inflammation- scab, Neutrophils blood clot, and inflammation
- Granulation tissue and epithelial growth- epithelial regeneration, inflammation, macrophages, fibroblast, new capillaries
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Factors that Promote Healing
- Youth
- Good nutrition: protein vitamins A & C
- Adequate Hemoglobin
- Effective Circulation
- Clean, Undisturbed wound
- No complications
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Factors that delay healing
- Advanced age, reduced mitosis
- Poor Nutrition dehydration
- Anemia (low hemoglobin)
- Decreased circulation
- Irritation, bleeding, or excessive mobility
- Infection, foreign material, exposure to radiation (slows mitosis) insulin deficit
- Presense of other disorders: DM cancer
- Chemotherapy or porlonged use of steroids
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Complication of Healing By Scar Formation
- Loss of function
- Contractures, obstructions
- Adhesions
- Hypertrophic Scar Tissue
- Ulceration
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