Pathophysiology

Pathophysiology Study Guide

©2018 of 131 substances, like proteases, that exacerbate the damage of tissues. These secretions lead to uncontrolled degradation of tissues, including new granulation tissue, and delay in the deposition of collagen, which all obstruct the healing process of the wounds. Nutritional Factors Nutrition plays a vital role in the healing and repair of wounds. Poor nutrition generally leads to impaired and delayed wound healing, making the wound vulnerable to breakdown. If the body suffers from inadequate supplies of nutrients, the body enters into a protein energy malnutrition (PEM) phase. PEM is the most serious malnutrition in which there is inadequate absorption of both energy and protein. This leads to the paucity of protein in the body, where protein is broken down to generate energy, which leads to a reduction in amino acid supply, and finally the lean body mass declines. This causes a delay in the healing of wounds. Efferent nutrients play specific roles in wound management. Proteins help in maintenance and repair, and a fall in protein leads to the development of collagen, which delays wound healing. Amino acids, like L- Arginine, help synthesize structural proteins in the body, stimulate the pathway of nitric oxide, enhance the immune system, and improve growth hormone and insulin secretion necessary for wound healing. Energy is an important element in wound healing and can be sourced from adequate amounts of carbohydrates and fats in the body, which help in the synthesis of collagen. Antioxidants, like vitamin C, vitamin A, and vitamin E, are also important in wound healing. Vitamin C not only helps in collagen synthesis, but also facilitates the formation of new blood vessels necessary for healing wounds. Vitamin A augments the inflammatory response in wounds and stimulates the synthesis of collagen. Inadequate Vitamin A and C not only delay wound healing, but become the cause of wound infections. Vitamin E helps to control the excessive free radicals. Minerals like zinc and iron help stimulate the healing of wounds. Inadequate zinc leads to delayed wound healing, reduction in the production of cells necessary for formation of skin, and a reduction in wound strength. Iron helps promote oxygen to the injured site and inadequacy of iron leads to reduced wound strength and impaired collagen production. Therefore, inadequate nutrition leads to impaired, as well as delayed, wound healing. Congenital Factors Any genetic deficiency impairs the normal healing process and leads to delayed wound healing. One such factor is the presence of glycosylation type X. In this disorder, the immunity of the body is hampered due to abnormal functioning of neutrophil. Therefore, these abnormal neutrophils do not move to the wound site as they are not able to adhere to specific components of the blood vessels. Complicating Factors An individual may be suffering from diseases that promote the malfunctioning of soft tissues. Some of these features include obesity, cardiovascular diseases, which influence tissue perfusion, respiratory diseases leading to inadequate oxygenation of blood, metabolic disorders, endocrine diseases, and renal and hepatic failure. For instance, individuals suffering from diabetes mellitus suffer from the metabolic, vascular, and neuropathic pathways that affect soft tissue healing. Achieve Page 29