Chronic Inflammation Response & Wound Healing GN PDF

Chronic Inflammation And wound healing Intended Learning Outcomes By the end of this session students should be able to:  Revise the signs of inflammation.  Describe chronic inflammation and the impact this may have on the patient and clinician  Explain contributing factors to chron...

Chronic Inflammation And wound healing Intended Learning Outcomes By the end of this session students should be able to:  Revise the signs of inflammation.  Describe chronic inflammation and the impact this may have on the patient and clinician  Explain contributing factors to chronic inflammation  Compare acute and chronic inflammation  Be aware of how chronic inflammation impacts dentistry - orally and systemically 2 Types of Inflammation Quick response Redness Heat Swelling Inflammation Pain Loss of function Long standing Acute Chronic Inflammation Inflammation 3  Inflammation - protection and destruction happening at the same time. Not a simple process. Inflammation - physiological process - tried to protect by generating series of processes - white blood cells, chemical mediators, wall/barrier, seepage (gingival crevicular fluid), vasodilation - long term condition periodontitis - chronic. Trying to stop the problem - bacteria invasions ALSO Trying to battle to create healing process - can create a wall during process - abscess 4  Healing VS destruction Acute Inflammation Chronic Inflammation Typical will feel pain, swelling or discomfort - notice something not normal Far less obvious - sits there for long period of time and goes unnoticed Due to early response by the body Occurs after a delay Short duration Longer duration Image from Waldem website Feb Image from Glendale 2021 periodontics website Feb 2021 5 Chronic 6 Consider the causative factors Rapid and aggressive Can go unnoticed or only little subtle Create discomfort differences over time and pain - be very aware of 7  Periodontal disease - Chronic Considerations of Chronic Inflammation  Process is longer  Therefore likely to have more Due to long term presence tissue damage  Main inflammatory cells are Phagocytosis lymphocytes (what is it in acute Secrete inflammatory mediators Fibroblasts - create collagen inflammation)? Destruction and healing at same time - acute turns into  You can see a more fibrotic chronic and collagen is laid appearance – why? down as trying to heal itself. Battle between destruction and healing -  The host defence cannot clear the insult – so what can it do?  Granuloma & Trying to wall off infection - part of protective process of inflammation as unable to clear infection 8 Try to prevent seepage into rest of body and will wall off infection. Granulomatous Will try to continue to grow How is this enlarge area surviving? Nutrients etc? Extension of tissue with own extended blood supply to supply nutrients. Angiogenesis - forming of new extended blood vessels. 9  Important as patient will see, act and feel differently. Comparison of acute and chronic inflammation Long period of time Usually long term immune respone 10 Part of natural aging process - inflammation A lot of conditions are to do with inflammation process Support patient with chronic inflammation conditions 11 As a healthcare clinician what challenges do you forsee for patients with chronic conditions? 12 Wound Healing 13 Intended learning outcomes By the end of the session students should be able to:  List and give examples of the causes of ‘wounds’  Explain risk factors that predispose an individual to develop a wound  Define the different types of wounds  Offer appropriate terminology to describe a wound  Describe the stages primary, secondary and tertiary intention (healing)  Recognise complications associated with wound healing 14 Causes of ‘wounds’ Surgical Trauma Pressure incisions Friction Poor circulation 15 Factors influencing tissue healing Wound is free from foreign Extent of bodies & damage pathogens Body’s Health status response Anything in patients medical history that can stop them from healing? Autoimmune condition that responds differently 18 Risk factors for developing a wound Types of wounds Medical therapies (steroids, Broken  Intentional skin chemo, radiation)  Unintentional Disease Age process (acute or (young or old)  Open wound chronic)  Closed wound Hereditary Nutrition  Clean wound status  Contaminated Stress  Infected 16 Description of wounds Abrasion Contusion Incision Penetrating Puncture Laceration wound wound 17 Stages of wound healing 19 Stages of Wound Primary Healing (first intention) - Regeneration Inflammation Proliferative Maturation 20  Inflammation - Primary healing (1st intention) Remove insult and prepare sit for healing  1st few hours wound becomes inflamed & blood clot forms  Cell debris / platelet fill the space  Cellular involvement of: Break down any insult 1. Phagocytes – macrophages 2. Fibroblasts Forming to create collagen to help bring wound together What will you see? Feel? 21  Closure and replacement of damaged cells More fibroblasts forming - scroll of collagen Removal of angiogenesis process - nice vasculasation Proliferation - Primary healing (1st intention)  Epithelial cells profileration across wound to begin closure process and replace damaged cells.  Starts before end of inflammatory stage (so overlapping) 1. Angiogenesis 2. Granulation tissue 3. Contraction  Clot becomes a scab & separates after 3 – 10 days 22  Wound gains strength - now closed - redness disappear - strong collagen laid down and extra blood vessels removed. Maturation - Primary healing (1st intention)  Collagen starts to degrade as soon as produced  When collagen production equals degradation, maturation phase starts  Can last for a year or more  Stronger collagen laid down  Excess blood vessels removed and scar loses redness 23 Stages of Wound Secondary Healing (second intention) – Repair Extensive tissue destruction OR when wounds can be bought together - aposition Inflammation Proliferative Maturation 24 Inflammation - Secondary healing (2nd intention)  Inflammatory reaction is Due to open wound more intense.  Necrotic tissue – slough on Yellow slough - needs to be cleansed top of wound. Necrotic tissue  Healing by indirect union of granulating surfaces 25  Waiting for wound to heal at base, upwards. Blood supply in abundance - need vasodilation to keep prevention of infection going. Proliferation - Secondary healing (2nd intention)  Similar process as primary but more intense  Phagocytes  Bloody supply is plentiful – reduce or prevent infection  Granulation tissue forms at base of cavity  Fibroblasts in convert to myofibroblasts to start contraction process 26  Likely to get more scaring as wound is unable to be bought together. Maturation - Secondary healing (2nd intention)  Collagen laid down horizontally  Wound contraction pronounced  Tissue uneven (scar tissue) 27 Comparing primary & secondary intention 28  Intensional - happens when wounds is left open after debridement Wounds needs to be left open to be de-brided - removed destructed tissue - after period of time try to suture walls together. Tertiary Healing 29 Factors affecting wound healing Local Systemic Age & Ischemia Alcoholism gender Foreign Hormones Nutrition body Immuno- Infection Stress compromised Diseases & Medication e.g. Obesity 30 Complications of wound healing Haemorrhage Infection Dehiscence Fistula Keloid scar 31  Image references  http://archive.jpda.com.pk/volume-18-issue-1/multidisciplinary-treatment-in-a-patient-with-nifedipine-induced-gingival-enlargement/  https://insideouthealthwellness.com/how-to-combat-chronic-inflammation/  https://www.sciencedirect.com/science/article/pii/S1870199X18300156  https://en.wikipedia.org/wiki/Tuberculosis_radiology  https://www.cohenmedical.com/chronic-inflammation/  https://advancedtissue.com/2013/12/3-ways-know-difference-healing-infected-surgical-wounds/  https://mealsandmiles.com/2012/04/04/runner-down/  https://www.msdmanuals.com/en-gb/professional/multimedia/image/v34540251  https://www.medicalnewstoday.com/articles/325533  https://advancedtissue.com/2013/12/caring-diabetic-foot-ulcers/  https://www.cpcmg.net/cuts-scrapes-wise-advice-urban-legends/  https://www.thinglink.com/scene/640187830496133120  https://www.infobloom.com/what-is-a-suture.htm  https://lacerationrepair.com/wound-blog/absorbable-sutures/  https://www.sciencephoto.com/media/264214/view/close-up-of-penetrating-stab-wound  https://www.stopfootpaintoday.com/library/puncture-wounds-foreign-objects-in-foot.cfm  https://www.cpcmg.net/cuts-scrapes-wise-advice-urban-legends/  https://www.thinglink.com/scene/640187830496133120  https://www.infobloom.com/what-is-a-suture.htm  https://lacerationrepair.com/wound-blog/absorbable-sutures/  https://www.sciencephoto.com/media/264214/view/close-up-of-penetrating-stab-wound  https://www.stopfootpaintoday.com/library/puncture-wounds-foreign-objects-in-foot.cfm  https://quizlet.com/259935142/surgery-surgical-wound-healing-flash-cards/ 32