TISSUE PHYSIOLOGY

Tissue Damage and

Inflammation
• Inflammation (flamma, flame)
- response when tissues are damaged.
- Agents that cause injury are microorganisms, cold,
heat, radiant energy, chemicals, electricity and
mechanical trauma
- This response mobilizes the body’s defenses,
isolates and destroys microorganisms and other
injurious agents and removes foreign materials and
damaged cells, so that tissue repair can proceed
 What are the events in acute inflammation?

1. Alteration in blood flow and vascular permeability

2. Migration of WBC to injured site
3. Phagocytosis and enzymatic digestion of dead cells
4. Repair of injury by regeneration
• 5 clinical signs or manifestations of inflammation are:
rubor - redness
dolor - pain
tumor - swelling
calor – heat
functio laesa – loss of function
• Unpleasant may it seem but these processes usually
aid in recovery
• After a person is injured, chemical substances called
chemical mediators are released/ activated in the
tissues and the adjacent blood vessels
• Examples of mediators are histamine, kinins,
prostaglandins and leukotrienes
Some mediators induce dilation of blood vessels and
produce redness and heat. Dilation of blood vessels is
beneficial because it speeds the arrival of white
blood cells and other substances important for
fighting infections and repairing the injury.
Chemical mediators also stimulate pain receptors and
increase the permeability of blood vessels.
• The increased permeability allows materials such
as clotting proteins and white blood cells to move
out of the blood vessels and into the tissue, where
they can deal directly with the injury
• As proteins from the blood move into the tissue,
they change the osmotic relationship between the
blood and the tissue. Water follows the proteins by
osmosis and the tissue swells, producing edema.
• Edema increases the pressure in the tissue,
which can also stimulate neurons and cause pain
Increase in Permeability
Leucocyte Adhesion
• Clotting proteins present in blood diffuse into the
interstitial spaces and form a clot. Clotting also occur
by platelet aggregation in the injured blood vessels.
• Clotting isolates the injurious agent and separates it
from the rest of the body. Foreign particles and
microorganisms at the site of injury are “walled off”
from the tissues by clotting process.
• Pain and limitation of movement resulting from
edema and tissue destruction all contribute to
disturbed function (functio laesa)
Platelet Aggregation
Platelet Plug
• This disturbance is valuable in a sense that it warns
the person to protect the injury from further damage
• If the inflammatory response lasts longer or more
intense, he or she can be given drugs to suppress the
symptoms like antihistamines, aspirins (prevents the
synthesis of prostaglandins and the anti-inflammatory
drug) cortisone.
• There will be times when the body’s inflammatory
response is not enough to combat the effects of injury
or fight off an infection and that is the only time when
antibiotics is required
 Tissue Repair

• Tissue repair is the substitution of viable cells for

dead cells.
• Tissue repair can occur by regeneration or
replacement
Regeneration – new cells are produce that are of
the same type as those that were destroyed
Replacement – a new type of tissue is produced
as like producing a scar and causes loss of tissue
function
• Most wounds heal by regeneration and replacement which
process dominates depends on the tissue involved and the nature
and extent of the wound
• 3 classifications of cells according to ability to regenerate;
labile- continue to divide throughout life
- adult stem cells, cells of mucus membranes
hemopoietic and lymphatic tissues
stable- low level of replication and can regenerate when
signaled
- connective tissue and glands, liver, pancreas donot
divide after growth ceases but retain the ability to replicate
and are capable of regeneration
 permanent- very limited ability to replicate and if
killed a different type of cell will replace will replace it
- neurons, muscles (skeletal and cardiac)
- another factor is when the cell body is not
destroyed, recovery is imminent
- cardiac muscles and skeletal muscles have
limited ability to regenerate unlike smooth muscles
that readily
regenerate
 Basic Pattern of Repair
Primary union/ intention – if the wound is close
together like an incision from a scalpel
- wound edges have smooth borders and are in
close vicinity
- such wounds will heal within 6 – 8 days
 Events in Primary Union

• The wound fills with blood and a clot forms

• The clot contains the threadlike protein fibrin, which
binds the edges of the wound together.
• The surface of the clot dries to form a scab, which seals
the wound and helps prevent infection
• An inflammatory response induces vasodilation and
takes more blood cells and other substances to the area.
• Blood vessel permeability increases, resulting in edema
(swelling). Fibrin and blood cells move into the wounded
tissues because of the increased vascular permeability
• Fibrin isolates and walls off micro organisms and
other foreign matter.
• Some of the white blood cells that move into the
tissue are phagocytic cells called neutrophils (ingest
bacteria, thus helping fight infection. Also they ingest
tissue debris and clear the area for repair)
• Neutrophils are killed in this process and can
accumulate as a mixture of dead cells and fluid called
pus
Secondary union – if the edges are not close
together or there is extensive loss
- when a wound that cannot be stitched
causes a large amount of tissue loss
 Repair by secondary union
Because the wound edges are far apart, the clot may not
close the gap completely, and it takes the epithelial cells much
longer to regenerate and cover the wound
Increased tissue damage means that both the degree of
inflammation and the risk of infection are greater and there is
more cell debris for the phagocytes to remove
Much more granulation tissue forms, and the contraction of
fibroblasts in the granulation tissue leads to wound
contracture, resulting in disfiguring and debilitating scars
It is advisable to suture a large wound, so that it can heal by
primary rather than secondary union
Fibrin Formation
• Fibroblasts from surrounding connective tissue
migrate into the clot and produce collagen and
other extracellular matrix components.
• Capillaries grow from blood vessels at the edge of
the wound and revascularize the area and fibrin in
the clot is broken down and removed
• The result is the replacement of the clot by
granulation tissue, a delicate, granular-appearing
connective tissue that consists of fibroblasts,
collagen and capillaries.
revascularization
• A large amount of granulation tissue is converted to a
scar, which consists of dense irregular collagenous
connective tissue
• At first, a scar is bright red because numerous blood
vessels are present. Later, the scar becomes white as
collagen accumulates and the vascular channels are
compressed
• Healing is faster, with a lowered risk of infection and
a reduced degree of scarring
inflammation
Wound healing
FINISH