Inflammation: Acute vs Chronic
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Questions and Answers

What is a primary distinction between acute and chronic inflammation concerning the timing of the body's response?

  • Both acute and chronic inflammation exhibit an immediate response, differing only in intensity.
  • Acute inflammation involves a rapid initial response, whereas chronic inflammation develops over time. (correct)
  • Both acute and chronic inflammation are characterized by delayed responses but differ in the types of immune cells involved.
  • Acute inflammation occurs after a delay, while chronic inflammation is an early response.

In chronic inflammation, a fibrotic appearance is often observed in the affected tissue. What best explains this observation?

  • The rapid regeneration of parenchymal cells leads to excessive collagen deposition.
  • The decreased vascular permeability causes tissue dehydration and subsequent fibrosis.
  • The prolonged inflammatory process stimulates fibroblast activity, resulting in increased collagen production. (correct)
  • The accumulation of neutrophils promotes the breakdown of extracellular matrix and replacement with fibrotic tissue.

In cases of chronic inflammation where the host defense is unable to clear the initial insult, what is a common subsequent response?

  • Transformation of the inflamed tissue into scar tissue to isolate the area.
  • Formation of a granuloma to contain the persistent irritant. (correct)
  • Apoptosis of the affected cells to prevent further damage.
  • Systemic immune suppression to reduce the inflammatory response.

What type of immune cells are predominantly involved in chronic inflammation, differing from those typically seen in acute inflammation?

<p>Lymphocytes (D)</p> Signup and view all the answers

What key challenge do healthcare clinicians face when managing patients with chronic inflammatory conditions?

<p>The potential for increased tissue damage over time. (A)</p> Signup and view all the answers

Which of the following factors associated with obesity most significantly impairs wound healing?

<p>Increased subcutaneous fat, leading to poor vascularization and reduced oxygen supply to the wound site. (B)</p> Signup and view all the answers

A patient develops a keloid scar after surgery. Which of the following best describes the underlying mechanism contributing to keloid formation?

<p>Unregulated synthesis of collagen and other extracellular matrix components by fibroblasts. (D)</p> Signup and view all the answers

After abdominal surgery, a patient reports a sudden 'popping' sensation followed by wound rupture. Which complication is the MOST likely cause?

<p>Dehiscence (A)</p> Signup and view all the answers

A patient with a chronic wound develops a fistula. What is the MOST significant concern related to fistula formation?

<p>Increased risk of infection and contamination of adjacent tissues or organs. (B)</p> Signup and view all the answers

A surgeon is evaluating a patient's surgical wound 48 hours post-operation. Which finding would be MOST indicative of a developing infection rather than normal healing?

<p>Disproportionate pain at the wound site accompanied by purulent drainage and fever. (B)</p> Signup and view all the answers

During primary intention healing, epithelial cell proliferation begins when?

<p>Before the end of the inflammatory stage, overlapping with it. (D)</p> Signup and view all the answers

In the maturation phase of primary intention healing, what indicates the start of this phase?

<p>The point at which collagen production equals collagen degradation. (A)</p> Signup and view all the answers

Which of the ensuing events occurs during the proliferative phase of primary intention healing?

<p>Angiogenesis. (A)</p> Signup and view all the answers

In secondary intention healing, what role do myofibroblasts play during the proliferation phase?

<p>They start the contraction process to reduce the wound size. (D)</p> Signup and view all the answers

What is a distinctive characteristic of collagen deposition in secondary intention healing compared to primary intention healing?

<p>Collagen is laid down horizontally. (B)</p> Signup and view all the answers

What indicates the conclusion of the proliferation phase in primary intention healing?

<p>Separation of the scab. (B)</p> Signup and view all the answers

Which of the following factors primarily affects wound healing locally rather than systemically?

<p>Ischemia. (C)</p> Signup and view all the answers

How does secondary intention healing differ from primary intention healing?

<p>It is characterized by a more pronounced wound contraction (D)</p> Signup and view all the answers

Which of the following is the MOST accurate description of tertiary intention wound healing?

<p>A wound is left open initially to allow for drainage and cleaning before closure. (A)</p> Signup and view all the answers

A patient undergoing chemotherapy is at a higher risk of developing a wound due to impaired wound healing. Which factor MOST directly contributes to this increased risk?

<p>Compromised immune function and reduced cell proliferation. (C)</p> Signup and view all the answers

A patient presents with a deep laceration to the leg sustained during a hiking accident. Upon assessment, there is visible dirt and debris within the wound. Which type of wound is this MOST accurately classified as?

<p>Contaminated wound (C)</p> Signup and view all the answers

During the inflammatory phase of primary wound healing, which of the following processes is MOST critical for initiating the repair cascade?

<p>Formation of a blood clot and infiltration of immune cells. (C)</p> Signup and view all the answers

A patient with a chronic non-healing ulcer is found to have significantly low levels of serum albumin. How does this nutritional deficiency MOST likely impede the healing process?

<p>By limiting the availability of amino acids necessary for collagen synthesis. (A)</p> Signup and view all the answers

A patient develops a surgical site infection following an appendectomy. The wound is now draining purulent fluid and showing signs of dehiscence. Which of the following factors is LEAST likely to contribute to this complication?

<p>Effective stress management techniques employed by the patient. (A)</p> Signup and view all the answers

Which of the following is the MOST significant difference between a contusion and a laceration?

<p>A laceration involves a break in the skin, while a contusion does not. (C)</p> Signup and view all the answers

A researcher is studying the effects of various growth factors on wound healing in vitro. Which stage of wound healing would be MOST directly influenced by stimulating fibroblast activity?

<p>Proliferative (B)</p> Signup and view all the answers

Flashcards

Chronic Inflammation

Inflammation of prolonged duration (weeks or months) in which active inflammation, tissue destruction, and attempts at repair are proceeding simultaneously.

Acute Inflammation

Early response by the body to injury or infection; short duration.

Impact of Chronic Inflammation

A longer inflammatory process that results in more tissue damage.

Cells in Chronic Inflammation

Lymphocytes are the main inflammatory cells involved.

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Granuloma

A mass of immune cells (macrophages, lymphocytes) attempting to wall off a substance the body cannot eliminate.

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Obesity

Excess body fat accumulation that presents a health risk.

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Wound Haemorrhage

Bleeding from a wound site.

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Wound Infection

Invasion of pathogens at the site of a wound.

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Wound Dehiscence

Separation of wound edges after closure.

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Keloid Scar

Abnormal scar formation resulting in a raised, thickened scar.

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What are wounds?

Physical injuries that disrupt the normal structure of the skin and underlying tissues.

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Causes of wounds

Surgical incisions, trauma, and pressure are all direct causes.

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Risk factors for wounds

Medical therapies, diseases, age, heredity, nutrition, and stress.

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Types of wounds

Intentional vs. Unintentional, Open vs. Closed, Clean vs. Contaminated vs. Infected.

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Wound descriptions

Abrasion, Contusion, Incision, Laceration, Penetrating Wound, Puncture Wound.

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Examples of wounds

Abrasions (scrapes), contusions (bruises), incisions (surgical cuts).

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Factors influencing healing

Foreign bodies / pathogens and extent of damage

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Stages of wound healing

Inflammation, Proliferation, Maturation (Remodeling).

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Phagocytes

Cells (macrophages) that engulf and digest cellular debris and pathogens.

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Fibroblasts

Cells that produce collagen and other components of the extracellular matrix.

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Angiogenesis

The formation of new blood vessels, crucial for delivering oxygen and nutrients to the healing tissue.

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Granulation Tissue

New connective tissue and tiny blood vessels that form on the surfaces of a wound during the healing process.

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Wound Contraction

The process where the edges of a wound draw closer together, reducing the size of the defect.

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Primary Intention Healing

Wound closure where the edges are directly approximated (e.g., surgical incision).

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Secondary Intention Healing

Wound closure where the wound is left open and allowed to heal gradually, filling in with granulation tissue.

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Factors Affecting Wound Healing

Factors that impede or facilitate the body's natural repair processes.

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Study Notes

  • Chronic inflammation can negatively affect both patients and clinicians.
  • Students should be able to revise the signs of inflammation, describe chronic inflammation and acknowledge contributing factors.
  • Students should also be able to compare acute and chronic inflammation, and understand how chronic inflammation impacts dentistry, both orally and systemically.

Types of Inflammation

  • Inflammation can be acute or chronic.

Acute Inflammation

  • An early response by the body.
  • Has a short duration.

Chronic Inflammation

  • Occurs after a delay.
  • Has a longer duration.

Causative Factors: Acute vs Chronic Inflammation

  • Allergic reaction, chemical irritants, infection, trauma injury, burns, lacerations/cuts/wounds, and frostbite can result in acute inflammation.
  • Cardiovascular and autoimmune diseases, rheumatoid arthritis, cancer, lupus, fibromyalgia, and chronic fatigue syndrome can result in chronic inflammation.

Considerations of Chronic Inflammation:

  • The process is longer.
  • More tissue damage is likely.
  • Main inflammatory cells are lymphocytes.
  • Can result in a more fibrotic appearance.
  • The host defence cannot clear the insult; granuloma may occur.
  • "Inflamm-aging" can lead to diseases such as Alzheimer's, Parkinson's, heart disease, atherosclerosis, age-related macular degeneration, multiple sclerosis and acute lateral sclerosis, and type 2 diabetes and osteoporosis.
  • Inflamm-aging can also increase morbidity and mortality.

Comparison of acute and chronic inflammation

  • Acute inflammation has a short duration occurring over days, while chronic inflammation occurs over weeks to months.
  • Acute inflammation has an acute onset, while chronic inflammation as an insidious onset.
  • Acute inflammation is nonspecific, while chronic inflammation is specific to where the immune response is activated.
  • Neutrophils and macrophages are the main inflammatory cells in acute inflammation, while lymphocytes, plasma cells, macrophages, and fibroblasts are the main cells in chronic inflammation.
  • Active vasodilation and increased permeability are vascular changes in acute inflammation, but new vessel formation (granulation tissue) occurs in chronic inflammation.
  • Fluid exudation and edema is present in acute inflammation.
  • Cardinal clinical signs (redness, heat, swelling, pain) are present in acute inflammation.
  • Tissue necrosis is usually negative, and is suppurative and necrotizing.
  • Fibrosis (collagen deposition) is negative in acute inflammation, but positive (ongoing) in chronic inflammation.
  • Plasma factors such as complement, immunoglobulins, properdin, etc; neutrophils and nonimmune phagocytosis are operative host responses in acute inflammation, while immune response and phagocytosis are operative host responses in chronic inflammation.
  • Fever, often high, are systemic manifestations in acute inflammation.
  • A low-grade fever, weight loss, and anemia are systemic manifestations in chronic inflammation.
  • Neutrophil leukocytosis; lymphocytosis (in viral infections) occur regarding changes in peripheral blood in acute inflammation, while variable leukocyte changes and increased plasma immunoglobulin occur in chronic inflammation.

Wound Healing:

Intended Learning Outcomes

  • List and give causes of wounds, explain risk factors, and define different types of wounds.
  • Offer appropiate terminology, describe the stages primary, secondary and tertiary intention (healing).
  • Recognize complications of wound healing.

Causes of wounds

  • Surgical incisions, trauma, pressure, friction, and poor circulation.

Types of wounds

  • Wounds can be intentional or unintentional, open or closed, and clean, contaminated, or infected.

Descriptions of wounds:

  • Abrasion, contusion, incision, laceration, penetrating wound, and puncture wound.

Factors influencing tissue healing:

  • A wound is free from foreign bodies and pathogens.
  • Extent of damage.
  • Body's response.
  • Health status.

Stages of Wound Primary Healing (first intention) - Regeneration:

  • Inflammation, proliferative, and maturation.

Inflammation - Primary healing (1st intention):

  • The wound becomes inflamed, and a blood clot forms within the first few hours.
  • Cell debris and platelets fill the space.
  • Cellular involvement include phagocytes and macrophages, and fibroblasts.

Proliferation - Primary healing (1st intention):

  • Epithelial cells proliferate across the wound to begin closure and replace damaged cells.
  • Starts before the end of the inflammatory stage (so overlapping).
  • Angiogenesis
  • Granulation tissue
  • Contraction
  • Clot becomes a scab and separates after 3-10 days.

Maturation - Primary healing (1st intention):

  • Collagen starts to degrade as soon as produced.
  • When collagen production equals degradation, the maturation phase starts.
  • Can last for a year or more.
  • Stronger collagen is laid down.
  • Excess blood vessels are removed, and the scar loses redness.

Stages of Wound Secondary Healing (second intention) – Repair:

  • Inflammation, proliferative, and maturation.

Inflammation - Secondary healing (2nd intention):

  • The inflammatory reaction is more intense.
  • Necrotic tissue (slough) is on top of the wound.
  • Healing by indirect union of granulating surfaces.

Proliferation - Secondary healing (2nd intention):

  • Similar pprocess to primary but more intense.
  • Phagocytes.
  • Bloody supply is plentiful, reducing or preventing infection
  • Granulation tissue forms at the base of the cavity.
  • Fibroblasts convert to myofibroblasts to start the contraction process.

Maturation - Secondary healing (2nd intention):

  • Collagen is laid down horizontally.
  • Wound contraction is pronounced.
  • Tissue is uneven (scar tissue).

Comparing primary & secondary intention:

  • 1st intention = a "clean" incision, limited scarring or wound contraction is seen.
  • 2nd intention = ulcers or lacerations, often scarring and wound contraction is present.

Factors affecting wound healing

  • Local: Ischemia, foreign body, infection.
  • Systemic: Age and gender, hormones, stress, diseases and medications, obesity, immuniocomprimised, alcoholism, and nutrition.

Complications of wound healing:

  • Haemorrhage, infection, dehiscence, fistula, and keloid scar.

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Chronic Inflammation and Wound Healing - Lecture Slides PDF

Description

This quiz covers major concepts of acute and chronic inflammation and their physiological distinctions. It also addresses complications like impaired wound healing, keloid formation, and wound rupture post-surgery. Topics include immune cell involvement and challenges in managing chronic inflammatory conditions.

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