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| {{review}} | | {{review}} |
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− | {{toplink
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− | |linkpage =General Pathology
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− | |linktext =General Pathology
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− | |maplink = General Pathology (Content Map)
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− | |pagetype =Pathology
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− | |sublink1=Inflammation - Pathology
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− | |subtext1=INFLAMMATION
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− | }}
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− | <br>
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| ==Introduction== | | ==Introduction== |
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| * There are several factors on which the ability to heal and repair depends: | | * There are several factors on which the ability to heal and repair depends: |
| *# '''Species''' | | *# '''Species''' |
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| ==Repair== | | ==Repair== |
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| * Repair occurs through one of two mechanisms: | | * Repair occurs through one of two mechanisms: |
| ** '''Regeneration''' | | ** '''Regeneration''' |
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| ===Regeneration=== | | ===Regeneration=== |
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| * In mammals, only epithelial and connective tissues regenerate extensively. | | * In mammals, only epithelial and connective tissues regenerate extensively. |
| * The ability of tissue to regenerate depends upon whether the tissue is | | * The ability of tissue to regenerate depends upon whether the tissue is |
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| ====Labile Tissues==== | | ====Labile Tissues==== |
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| * Labile tissues constantly replenish their cells throughout life. | | * Labile tissues constantly replenish their cells throughout life. |
| ** For example skin and mucous epithelia normally desquamate their outer layer of cells during life, maintaining their overall composition by division of their basal layers. | | ** For example skin and mucous epithelia normally desquamate their outer layer of cells during life, maintaining their overall composition by division of their basal layers. |
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| ====Stable Tissues==== | | ====Stable Tissues==== |
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| * Stable tissues have a limited ability to replace themselves. | | * Stable tissues have a limited ability to replace themselves. |
| * They retain the ability to | | * They retain the ability to |
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| ====Permanent==== | | ====Permanent==== |
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| * Permanent tissues have poor or no regenerative capacity. | | * Permanent tissues have poor or no regenerative capacity. |
| * This group includes tissues in which the cells are highly specialised and generally have only one function, for example: | | * This group includes tissues in which the cells are highly specialised and generally have only one function, for example: |
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| ===Replacement=== | | ===Replacement=== |
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| * Replacement is essentially endothelial and fibrous tissue proliferation to replace severely damaged tissue. | | * Replacement is essentially endothelial and fibrous tissue proliferation to replace severely damaged tissue. |
| ** This classical dual replacement gives rise to granulation tissue. | | ** This classical dual replacement gives rise to granulation tissue. |
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− | ==Repair in the Skin== | + | ==[[Skin Repair|Repair in the Skin]]== |
− | ''Back to [[Integumentary System - Pathology|Integumentary System Pathology]]
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− | * Healing of a wound or surgical incision may be by:
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− | ** '''First intention'''
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− | ** '''Second intention'''.
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− | | |
− | ===Healing by First Intention===
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− | | |
− | * Healing by first intention occurs when the incised ends remain in close apposition to each other anf bacterial contamination is minimal.
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− | ** This may be induced by suturing.
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− | ** For example, a surgical incision.
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− | * Results in minimal scarring.
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− | | |
− | ====Process====
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− | | |
− | * Initially, the incision ruptures the dermal blood vessels.
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− | ** The exuded blood forms a fibrinous clot between and above the incision.
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− | *** The clot functions to:
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− | ***# Stem the flow of blood from the injured site.
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− | ***# Adhere the two ends together.
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− | ***# Prevent infection from entering the injured area.
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− | * The basal layer of epithelium wthin 1mm of the wound edge begins to lose its connections with adjacent basal and overlying epithelium.
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− | ** Undergoes mitosis.
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− | ** Begins to migrate down both sides of the wound under the clot using pseudopodia.
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− | *** As they are migrating, cells differentiate to some degree to form more superficial layers of the epithelium.
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− | **** Gives a rather thick, if not very strong, barrier of epidermis.
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− | *** In the area of migration, the skin is usually hypopigmented and lacks hair follicles.
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− | * Within 2-4 days, the migrating basal layer of epithelium from either side meet together under the clot.
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− | ** It is thought that there is passage of substances, from one side to another that prevents further migration and mitosis.
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− | ** This gives reconstituion of an intact barrier to micro-organisms.
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− | * While the epithelial changes are occuring, there is a sudden proliferation of local fibroblasts and accompanying endothelial cells in the dermis surrounding the incision.
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− | ** These grow across the narrow divide from each side and link up in the middle.
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− | *** Takes about 12 hours to accomplish.
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− | ** In the early stages (days 4-7), their alignment may be vertical, but in later stages (7-21 days) both fibroblasts and capillaries line up horizontally across the incision.
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− | ** This dermal repair forms the major portion of strength between the two sides at this time.
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− | *** Gains in strength over a long period of time as the collagen contracts and remodels according to the stresses imposed upon it.
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− | | |
− | ====Factors Inhibiting Healing====
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− | | |
− | * Factors inhibiting proper wound healing include:
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− | *# '''Protein deficiency'''
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− | *#* May be absolute, as in starvation, or resolute, as in some of the endocrine deficiencies.
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− | *#** E.g. [[Thyroid Gland - Pathology#Hypothyroidism|hypothyroidism]]
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− | *# '''Vitamin C deficiency '''
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− | *#* Vitamin C is essential for fibroplasia and to maintain the integrity of endothelial and epithelial cells.
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− | *# '''Cold'''
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− | *# '''Ageing'''
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− | *# '''Contamination'''
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− | *#* Infection tends not to be a complication as bacteria are generally excluded.
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− | *#** Retained foreign material such as hair portions or suture material inadvertently left in the wound will cause infection and/or a foreign body reaction.
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− | *# '''Movement'''
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− | *#* Gives persistent trauma.
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− | | |
− | ===Healing by Second Intention===
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− | | |
− | * Healing by second intention occurs when the gap between the ends of the incision is too wide to allow close approximation of the ends.
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− | * This process of granulation tissue repair in a large wound is also the underlying process in the repair of:
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− | ** Infarcts and thrombi in vessels.
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− | ** Surface ulcers and diphtheresis.
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− | ** Pyogenic membrane in abscesses.
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− | ** Diffuse fibrosis ( cirrhosis ) in the [[Liver - Anatomy & Physiology|liver]].
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− | | |
− | ====Process====
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− | | |
− | * In comparison to healing by first intention, there is a more massive fibroblastic and endothelial proliferation in the wound which fills and repairs the defect.
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− | * There is also considerable surface exudation.
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− | ** The exudate is composed of fibrinous fluid and numerous inflammatory cells, mainly neutrophils and macrophages.
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− | *** The cells are scavengers, and engulf necrotic debris and any bacteria present
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− | *** Macrophages and their secretions are also important for the promotion of fibroplasia.
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− | * The fibroblasts tend to align themselves roughly horizontal to the surface, but the endothelium is perpendicular to the surface.
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− | ** The upper vessels form loops near to the surface.
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− | *** Gives the gross appearance of red granules - this is [[Chronic Inflammation - Pathology#Granulation Tissue|granulation tissue]].
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− | * Well-formed granulation tissue tends to be fairly resistant to surface infection; however, it is rather delicated and so susceptible to trauma and subsequent introduction of infection.
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− | ** Infection is therefore a common complication in the early stages of healing.
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− | * Once the gap has been filled with granulation tissue and is free of infection, the epithelium migrates across.
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− | ** As it migrates, the epithelium secretes collagenolytic substances.
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− | * The epidermis is usually hypopigmented and lacks hair follicles unless they have survived in the granulation tissue.
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− | | |
− | ==== Factors Inhibiting Healing====
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− | | |
− | * Several factors inhibit healing by second intention.
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− | *# '''Movement'''
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− | *#* Movement before sufficient strength has been attained in the bond between the edges can inhibit healing.
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− | *# '''Infections'''
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− | *# '''Corticosteroids'''
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− | *#* Prevent proper collagen matrix formation.
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− | *#* Inhibit leukocyte emigration and phagocytosis.[[Image:scar tissue.jpg|thumb|right|150px|Scar tissue (Courtesy of BioMed Archive)]]
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− | *#* Diminish any acute inflammatory response by generally stabilising cellular membranes.
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− | | |
− | ====Scarring====
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− | | |
− | * As the fibroblasts mature into fibrocytes, the collagen also matures and contracts and there may be extensive scar formation.
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− | ** There may be considerable depression of the surface in such a scar.
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− | ** The scar may interfere with movement in the area.
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− | * The scar tends to diminish in size over a long period of time, as the underlying collagen remodels according to the stresses imposed upon the area.
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− | | |
− | ==Repair in the Bones==
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− | | |
− | ===Causes of Fracture===
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− | | |
− | * The causes of fracture fit into two distinct categories:
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− | *# '''Fracture of trauma'''
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− | *#* Breakage of normal healthy bone due to excessive stress pressure of short duration.
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− | *# '''Pathological fracture'''
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− | *#* Breakage of bone weakened by some underlying metabolic, inflammatory or neoplastic condition.
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− | | |
− | ===Description of a Fracture===
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− | | |
− | * There are various terms to describe a fracture's appearance.
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− | * Separation of the ends of the fracture may be '''complete''' or '''incomplete'''.
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− | * When there is no penetration of the overlying skin, a the fracture is described as '''closed'''.
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− | * When the sharp ends penetrate the overlying skin, the fracture is '''compound'''.
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− | ** In this scenario there is the danger of introducing infection.
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− | *'''Comminuted''' describes a fracture where there are multiple small fragments of bone at the site of breakage.
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− | * Where the edges of the fracture are impacted into each other, the fracture is said to be '''compressed'''.
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− | * When one side of the fracture is depressed below the plane of the other, the term '''depressed''' is used.
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− | ** This occurs in the flat bones of the skull.
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− | * '''Microfractures''' are fractures that are only visible on histological section as cracks in the bone.
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− | ** Grossly, there might be evidence of some haemorrhage in the area.
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− | | |
− | ===Fracture Repair===
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− | [[Image:fracture repair.jpg|thumb|right|150px|Fracture repair (Courtesy of BioMed Archive)]]
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− | * On breakage, there is rupture of the periosteal, cortical and medullary vessels, causing:
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− | ** A blood clot in the breakage area.
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− | *** Fibrin is the important component.
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− | ** Local necrosis of tissue supplied by these vessels.
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− | *** This lowers the local pH.
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− | * The fate of the blood clot depends upon its location.
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− | ** The periosteal portion is lysed and disappears;
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− | ** The medullary portion is removed by macrophages.
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− | * The necrotic material is removed by phagocytosis.
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− | ** Necrotic [[Bone Marrow - Anatomy & Physiology|bone marrow]] is removed by [[Macrophages - WikiBlood|macrophages]].
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− | *** This is a fairly rapid process.
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− | ** Osteoclasts remove necrotic bone.
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− | *** This is a slow process.
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− | * On the periosteal side, the periosteum proliferates into the clot.
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− | ** Forms a fibrous collar around the bone called the soft callus.
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− | * The cells in the inner aspect of the soft callus, particularly those near the fracture fragments, differentiate into osteoblasts. [[Image:fracture callus.jpg|thumb|right|150px|Fracture callus (Courtesy of BioMed Archive)]]
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− | ** Grow across the divide between the two fragments, laying down coarse woven bone.
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− | * The woven bone laid is known as the hard callus.
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− | ** This periosteal coarse bone is of utmost importance in repair.
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− | *** It is responsible for much of the strength of the fracture repair.
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− | ** This is replaced over a period of time by mature compact bone.
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− | *** Aligns itself according to the stresses applied to it.
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− | * Periosteal cells that are further away from the fracture fragments differentiate into cartilage-producing cells.
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− | ** Produce a cone of cartilage between the two fragments.
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− | *** As the local pH changes to more alkaline conditions, this cartilage undergoes calcification, with invasion by blood vessels and osteoblasts.
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− | **** The cartilage is replaced by bone - endochondral ossification.
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− | * On the medullary side, the endosteum proliferates and invades the clot, laying down bone.
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− | ** This bone may totally occlude the medulla and is later remodelled to reconstitute a patent lumen.
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− | | |
− | ===Complications=== | |
− | | |
− | * There are several possible complications that may arise in the repair of bone.
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− | # Inadequate immobilisation of the fractured ends will lead to incomplete repair by callus formation.
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− | #* An intervening mass of fibrocartilage remains, forming a false joint.
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− | #** In some cases the false joint can even appear to form a synovial lining.
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− | #* If the fractured ends are sufficiently far apart, no substantial callus forms.
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− | #** The intervening space is taken up by connective tissue organisation.
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− | # Failure to align the fractured ends in proper apposition to one another will produce excessive callus.
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− | #* This takes a longer time to be remodelled by the adult compact bone.
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− | # [[Healing and Repair - Pathology#Description of a Fracture|Comminution]] delays healing due to persistent irritation.
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− | # Infection delays healing due to the effects of the toxins on theproliferating cells.
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− | #* May give rise to a systemic infection affecting the rest of the body.
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− | | |
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| + | ==[[Fractures|Repair in the Bones]]== |
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| ==Repair in the Respiratory Tract== | | ==Repair in the Respiratory Tract== |
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| * Severe damage to the alveolar wall results in fibrous tissue organisation of the entire alveolus. | | * Severe damage to the alveolar wall results in fibrous tissue organisation of the entire alveolus. |
| * The appearance of inflammation in the respiratory tract varies with the route of entry of the agent. | | * The appearance of inflammation in the respiratory tract varies with the route of entry of the agent. |
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| ===Airborne Agents=== | | ===Airborne Agents=== |
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| * Infectious droplets tend to deposit in the anterior ventral portions of the lobes. | | * Infectious droplets tend to deposit in the anterior ventral portions of the lobes. |
| ** I.e. in the apical, cardiac and anterior portions of the diaphragmatic lobes. | | ** I.e. in the apical, cardiac and anterior portions of the diaphragmatic lobes. |
− | * Airborne agents produce '''bronchopneumonia'''. | + | * Airborne agents produce [[Bronchopneumonia|'''bronchopneumonia''']]. |
| ** So-called because the inflammation is initiated and centred upon the airways. | | ** So-called because the inflammation is initiated and centred upon the airways. |
| * The usual appearance of bronchopneumonia in ruminants and the pig is as the name suggests. | | * The usual appearance of bronchopneumonia in ruminants and the pig is as the name suggests. |
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| *** Air trapped distal to the blockage is gradually absorbed into the bloodstream. | | *** Air trapped distal to the blockage is gradually absorbed into the bloodstream. |
| **** This causes increased pressure on the injured wall, dilating it further. | | **** This causes increased pressure on the injured wall, dilating it further. |
− | *** This is a progressive process and results in irreversible dilatation of the airway lumen and is called '''bronchiectasis'''. | + | *** This is a progressive process and results in irreversible dilatation of the airway lumen and is called [[Bronchiectasis|'''bronchiectasis''']]. |
| * Bronchopneumonia in the dog and cat often tends to be more diffusely spread. | | * Bronchopneumonia in the dog and cat often tends to be more diffusely spread. |
| ** These species have a poorly-developed interlobular septum and collateral ventilation between alveoli from different respiratory units. | | ** These species have a poorly-developed interlobular septum and collateral ventilation between alveoli from different respiratory units. |
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| ===Blood-borne Agents=== | | ===Blood-borne Agents=== |
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| * Blood-bourne agents tend to have a patchy distribution throughout the lung. | | * Blood-bourne agents tend to have a patchy distribution throughout the lung. |
− | * Cause '''interstitial pneumonia'''. | + | * Cause [[Interstitial Pneumonia|'''interstitial pneumonia''']]. |
| | | |
| ====Circulating Toxins==== | | ====Circulating Toxins==== |
− | | + | * For example, [[Acute Bovine Pulmonary Emphysema and Oedema|"Fog Fever"]] in adult cattle. |
− | * For example, "Fog Fever" in adult cattle. | |
| ** Interstitial emphysema. | | ** Interstitial emphysema. |
| ** 3-methyl indole is selectively toxic to Type 1 alveolar epithelium. | | ** 3-methyl indole is selectively toxic to Type 1 alveolar epithelium. |
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| ====Micro-organisms==== | | ====Micro-organisms==== |
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| * A predominantly mononuclear reaction in the alveolar wall can be caused by: | | * A predominantly mononuclear reaction in the alveolar wall can be caused by: |
| ** Viruses | | ** Viruses |
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| *** E.g. [[Salmonella|''Salmonella'']] | | *** E.g. [[Salmonella|''Salmonella'']] |
| ** Protozoa | | ** Protozoa |
− | *** E.g. [[Tissue cyst-forming coccidia|Toxoplasma]] | + | *** E.g. ''[[Toxoplasma gondii]]'' |
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| ====Parasites==== | | ====Parasites==== |
− |
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| * Lungworms (''Dictyocaulus vivipara'') tend to affect the dorsocaudal areas of the diaphragmatic lobes in their invasion stage as larvae in the blood. | | * Lungworms (''Dictyocaulus vivipara'') tend to affect the dorsocaudal areas of the diaphragmatic lobes in their invasion stage as larvae in the blood. |
| * Later adult stages irritate the airways and also release larvae which are inhaled deeper into the lung. | | * Later adult stages irritate the airways and also release larvae which are inhaled deeper into the lung. |
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| ===Traumatic Implantation=== | | ===Traumatic Implantation=== |
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| * Traumatic implantation is fairly rare. | | * Traumatic implantation is fairly rare. |
| * Initially causes a pleural inflammation, with some extension to the adjacent lung tissue. | | * Initially causes a pleural inflammation, with some extension to the adjacent lung tissue. |
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| ** Stake wounds in horses. | | ** Stake wounds in horses. |
| *** Usually fatal and cause extensive purulent, smelly inflammation. | | *** Usually fatal and cause extensive purulent, smelly inflammation. |
− | ** Purulent pleuritis in dogs and cats due to [[Actinomycetes|''Nocardia'']] from a distant wound. | + | ** Purulent pleuritis in dogs and cats due to ''[[:Category:Nocardia species]]'' from a distant wound. |
| *** Not uncommon in cats. | | *** Not uncommon in cats. |
| *** May take some time to develop fully after the initial wound or cause has healed. | | *** May take some time to develop fully after the initial wound or cause has healed. |
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| ==Repair in the Alimentary Tract== | | ==Repair in the Alimentary Tract== |
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| ===The Gut=== | | ===The Gut=== |
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| * The gut is quite prone to infections. | | * The gut is quite prone to infections. |
| ** These are generally kept at bay by the profuse gut associated lymphoid tissue and the continuous movement of ingesta. | | ** These are generally kept at bay by the profuse gut associated lymphoid tissue and the continuous movement of ingesta. |
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| *** There is a reduced water absorption compounded by loss of electrolytes - '''malabsorption'''. | | *** There is a reduced water absorption compounded by loss of electrolytes - '''malabsorption'''. |
| **** Results in diarrhoea and progressive loss of weight. | | **** Results in diarrhoea and progressive loss of weight. |
− | **** E.g. in [[Intestines Proliferative Enteritis - Pathology#Paratuberculosis (Johnes disease)|Johne's Disease]]. | + | **** E.g. in [[Johne's Disease|Johne's Disease]]. |
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| ===The Liver=== | | ===The Liver=== |
− |
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| * The [[Liver - Anatomy & Physiology|liver]] retains limited powers to regenerate and has considerable functional reserve. | | * The [[Liver - Anatomy & Physiology|liver]] retains limited powers to regenerate and has considerable functional reserve. |
| * Acute inflammation is often due to viruses and bacteria. | | * Acute inflammation is often due to viruses and bacteria. |
− | ** E.g. Infectious Canine Hepatitis and [[Intestines Fibrinous/Haemorrhagic Enteritis - Pathology#Salmonellosis|Salmonellosis]] in young livestock. | + | ** E.g. Infectious Canine Hepatitis and [[Salmonellosis|Salmonellosis]] in young livestock. |
| ** The [[Liver - Anatomy & Physiology|liver]] is swollen and may display hyperaemia. | | ** The [[Liver - Anatomy & Physiology|liver]] is swollen and may display hyperaemia. |
| ** Small pinpoint foci of necrosis may be seen through the surface. | | ** Small pinpoint foci of necrosis may be seen through the surface. |
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| ===The [[Pancreas - Anatomy & Physiology|Pancreas]]=== | | ===The [[Pancreas - Anatomy & Physiology|Pancreas]]=== |
− |
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| * The [[Pancreas - Anatomy & Physiology|pancreas]] suffers both acute and chronic disease. | | * The [[Pancreas - Anatomy & Physiology|pancreas]] suffers both acute and chronic disease. |
| * The acute form called acute pancreatic necrosis is the important type in dogs. | | * The acute form called acute pancreatic necrosis is the important type in dogs. |
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| ==Repair in the Urinary Tract== | | ==Repair in the Urinary Tract== |
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| * The kidney has a great functional reserve. | | * The kidney has a great functional reserve. |
| ** Only 30% of the tissue is required to function properly. | | ** Only 30% of the tissue is required to function properly. |
| | | |
| ===Glomerulonephritis=== | | ===Glomerulonephritis=== |
− |
| |
| * Glomerulonephritis and glomerular deposition of amyloid may cause loss of substantial quantities of protein into the urine. | | * Glomerulonephritis and glomerular deposition of amyloid may cause loss of substantial quantities of protein into the urine. |
| * Oedema develops in the body, generally first in the back legs, then the ventral subcutis, and perhaps in the abdominal cavity. | | * Oedema develops in the body, generally first in the back legs, then the ventral subcutis, and perhaps in the abdominal cavity. |
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| ===Pyelonephritis=== | | ===Pyelonephritis=== |
− |
| |
| * Important in the cow and sow. | | * Important in the cow and sow. |
| ** It tends to be quite acute in the sow, and chronic in the cow. | | ** It tends to be quite acute in the sow, and chronic in the cow. |
| * Arises from infection ascending the urinary tract. | | * Arises from infection ascending the urinary tract. |
| * There is progressive loss of tissue. | | * There is progressive loss of tissue. |
− | ** Starts with necrosis in the pelvic area, then the inflammation spreads up into the cortex. *P oor prognosis even with therapy. | + | ** Starts with necrosis in the pelvic area, then the inflammation spreads up into the cortex. |
| + | *Poor prognosis even with therapy. |
| | | |
| ===Cystitis=== | | ===Cystitis=== |
− |
| |
| * Bladder inflammation. | | * Bladder inflammation. |
| * Common in females. | | * Common in females. |
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| ==Repair in the Genital Tract== | | ==Repair in the Genital Tract== |
− |
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− |
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| ===Female=== | | ===Female=== |
− |
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| * '''Inflammation of the uterus''' in livestock can take place at two periods: | | * '''Inflammation of the uterus''' in livestock can take place at two periods: |
| *# At service. | | *# At service. |
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| **# Life threatening mastitis. | | **# Life threatening mastitis. |
| **#* Occurs shortly after parturition. | | **#* Occurs shortly after parturition. |
− | **#* E.g. gangrenous mastitis due to [[Staphylococcus spp.#Staphylococcus aureus|''Staphylococcus aureus'']], and Coliform mastitis. | + | **#* E.g. gangrenous mastitis due to [[Staphylococcus aureus|''Staphylococcus aureus'']], and Coliform mastitis. |
| **# Chronic mastitis. | | **# Chronic mastitis. |
| **#* Results in progressive destruction of the glandular tissue and replacement by fibrous tissue. | | **#* Results in progressive destruction of the glandular tissue and replacement by fibrous tissue. |
− | **#* E.g. [[Streptococci|''Streptococcus agalactiae'']]. | + | **#* E.g. [[Streptococcal Mastitis - Cattle|''Streptococcus agalactiae'']]. |
− | ** Some organisms such as [[Staphylococcus spp.#Staphylococcus aureus|''Staphylococcus aureus'']] can cause gangrenous, acute and chronic mastitis. | + | ** Some organisms such as [[Staphylococcus aureus|''Staphylococcus aureus'']] can cause gangrenous, acute and chronic mastitis. |
| | | |
| ===Male=== | | ===Male=== |
− |
| |
| * '''Prostatitis''' | | * '''Prostatitis''' |
| ** Inflammation of the prostate. | | ** Inflammation of the prostate. |
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| ** Inflammation of the testis. | | ** Inflammation of the testis. |
| ** Rather uncommon. | | ** Rather uncommon. |
− | ** In bulls, a granulomatous inflammation occurs with [[Brucella species|''Brucella abortus'']]. | + | ** In bulls, a granulomatous inflammation occurs with ''[[Brucella abortus]]''. |
| | | |
| ==Repair in the Central Nervous System== | | ==Repair in the Central Nervous System== |
− |
| |
| * '''Encephalitis''' | | * '''Encephalitis''' |
| ** Inflammation of neural tissue of the brain. | | ** Inflammation of neural tissue of the brain. |
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| ** Inflammation of the meninges. | | ** Inflammation of the meninges. |
| ** Purulent meningitis follows haematogenous spread of infection from umbilical infections and certain septicaemias. | | ** Purulent meningitis follows haematogenous spread of infection from umbilical infections and certain septicaemias. |
| + | [[Category:Inflammation|B]] |
| + | [[Category:General Pathology]] |