Types of Exudates

Types of Exudates

1. blister or pleural effusions will have serous exudates – primarily plasma & a few proteins

2. an injury that is moderate to severe has sanguineous fluid or hemorrhagic – has large # RBCs

3. a combination of serum & RBCs is called serosanguineous

As the plasma protein fibrinogen leaves the blood it is turned into fibrin, by products of injured cell tied into DIC

1. fibrin strengthens the clot that is formed by platelets

2. in the tissue it functions to trap bacteria, to prevent spread of bacteria, to serve as a framework for healing process

3. fibrinous exudate causes thick, sticky, meshwork of fibrinogen

Cellular Response – occurs less than 1 hr. after injury

1. blood flow through the capillaries is decreased due to fluid loss & thickness of fluid

2. leukocytes migrate to the inner surface of capillaries called "margination"

3. the lymphocytes move to the edge of the capillary wall & attach themselves – called "pavementing" - lemone p 293

4. after margination & pavementation have occurred then leucocytes leave blood & go into damaged tissues

5. the leukocytes are pulled into the injured tissue via "immigration" by chemotactic signals

6. Lemone states that the infectious agents, damaged tissues, & activated plasma substances ie.

   complement fractions, provide chemotactic signals that attract an army of neutrophils, monocytes, & macrophages at injury site.

7. Neutrophils are there first. The neutrophils are able to phagocytize bacteria & other damaged material

8. Lemone states neutrophils can digest 5-20 bacteria before they become inactivated or die

9. an accumulation of inactived neutrophils occurs

10. the bone marrow releases more neutrophils to keep up with ones inactivated or dead

11. these results in elevated WBCs (↑neutrophils)

When bone marrow not able to keep up with↑demand of neutrophils

1. immature neutrophils released into bloodstream

2. called "bands"

3. mature neutrophils are called "segmented neutrophils"

4. a "shift to the left" occurs when there are more bands than segmented neutrophils

5. healing is the last part of the inflammatory response

Inflammation: initial part of healing process

1. debridement occurs when particular matter, bacteria, damaged cells, & inflammatory exudates are removed by phagocytosis

2. this process sets wound for healing

3. nutrition is vital during inflammation process

4. leukocytes need the following: protein, glucose, O₂ for chemotactic, phagocytosis, & intracellular killings

5. diabetics are thought to have poor wound healing due to the small vessel disease which inhibits microcirculation &↓availability of O₂ to cells

6. glycosylated hemoglobin consumes O₂

7. the combination of the two further↓availability of O₂ to tissues

8. many of the symptoms of inflammation are produced by inflammatory mediators, histamines, kinins, & prostaglandins

Cardinal signs of inflammation (lemone) are: erythema, local heat caused by increased blood flow to the injured area, swelling due to accumulated fluid at the site, pain form tissue swelling, & chemical irritation of nerve endings & loss of function caused by swelling & pain