2300 Module 2: Basic Pathophysiology II

Learning Objective Answer Chapter Notes

Chapter 4: Pain
State the causes of pain. Pain can be caused by infection, ischemia and tissue Somatic Pain: arise from the skin
necrosis, stretching of tissue, chemicals, or burns. (cutaneous) or from deeper structures
Skeletal muscle can have pain as a result of such as bone or muscle, to be
ischemia or hemorrhage. Organs characterize pain conducted by sensory nerves.
by receptors in the covering capsule, and pain if felt
when the capsule is stretched by inflammation. Visceral Pain: originates in the organs
Stretching of tendons, ligaments, and joint capsules and travels by sympathetic fibers.
cause pain as a result of inflammation or muscle
spasm.
Describe the pain pathway 1. Nociceptors sense pain created by a change Dermatomes are from each spinal
in thermal, chemical or mechanical/physical nerve conducting impulses from a
means. Once stimulation reaches the pain specific area of the skin. Can be used
threshold the nerve will activate. to test for areas of sensory loss or pain
2. Afferent fibers conduct pain towards the sensation and determine site of
dorsal root ganglia or substantia gelatinosa. damage
a. Myelinated A Delta Fibers- transmit
impulses rapidly. Transmit what we
perceive as acute pain (sharp,
localized)
b. Unmyelinated C Fibers- Transmit
impulses slowly. Transmit what we
perceive as chronic pain (dull,
diffuse, aching)
3. At the spinal cord synapse, a reflex
response results in a motor, or Efferent,
impulse back to the muscle that initiates
and involuntary muscle contraction
4. Connecting neurons transmit the pain

Relate the methods of pain control to the
gate-control theory
Discuss the signs and symptoms of pain in
adults and children
stimulus to the brain via the
neospinothalamic (fast, acute pain) or
paleospinothalamic (slow, chronic pain)
tracts.
5. Spinothalamic tracts connect to the
Reticular Formation in the brain stem to
perceive pain (brain stem, hypothalamus,
thalamus)
Gate Control Theory: Control systems, or “gates,”
are built into the normal pain pathways in the body
than can modify the entry of pain stimuli into the
spinal cord and brain. If a gate is ‘open’ pain
impulses can ascend to the brain. If the gate is
‘closed’ it will reduce or modify the passage of pain
impulses to the brain.
Interneurons can secrete opiate-like chemicals
(Endorphins: enkephalins, dynorphins, beta-
lipotropins) which block conduction of pain
impulses to the CNS (they close the gate). Adding
opiates via medication will assist in blocking the
pain impulses from the afferent pain receptor.
Adults: able to describe pain, show pain throught
pallor, sweating, high blood pressure and
tachycardia. Nausea/vomitting. Anxiety or fear in
relation to pain. Clenching fists, restless or
constantly moving, guarding area.
Children: Can show pain with tachycardia, increased
BP, characteristic facial expressions (eyes tightly
closed, eyebrowns low and drawn together, mouths
open and square). Older children flail their legs or
resist comfort measures. Children are not good at
describing pain verbally so it is better to use

Compare referred and phantom pain
Explain the factors that may alter pain
perception
Compare acute and chronic pain
Discuss the types of headache
drawings of happy or sad faces or other
multicolored scales/drawings.
Referred Pain: Are characteristic of visceral damage
in the abdominal organs. Multiple sensory fibers
from different sources connecting at a single level
of the spinal cord make it difficult for the brain to
discern the actual origin of the pain.
Phantom Pain: Phenomenon not fully understood,
but it appears the brain “understands” the limb is
still present when processing incoming stimuli.
Factors such as age, culture family traditions, and
prior experience with pain shape one’s perception
and response to pain. Anticipatory fear or anxiety
can magnify pain because the CNS is at a higher
level of awareness.
Acute Pain: Sudden and severe but short term.
Indicates tissue damage and decreases once it has
been treated. Can initiate physiologic responses
such as increased BP, HR, cool, pale, moist skin,
increased respiratory rate and increased skeletal
muscle tension.
Chronic Pain: Patient often perceives the pain as
more generalized, and it is difficult to discern an
exact location. It is impossible to sustain a stress
response over a long period so a person becomes
fatigued, irritable, and depressed. Sleep
disturbances are common and appetite may be
affected causing changes in weight. Constant pain
can affect activities of daily living and it can be the
primary focus or a person.
Sinus Headache: associated with congested sinuses,
nasal congestion, and eyestrain. Relieved once

Describe methods of pain management
Chapter 5: Inflammation and Healing
Explain the role of normal defenses in
preventing disease
cause is removed.
Tension Headache: Associated with muscle spasm
and causing the neck muscles to pull on the scalp.
Can persist for days or weeks.
Temporomandibular Joint Syndrome (TMJ):
inflammation of the mandibular joint due to
arthritis or poor body alignment, which causes
muscle tension in the neck that is transferred to the
jaw.
Migraine: 1. Increased neural activity spread over
areas of the brain initiating pain stimuli in the
trigeminal system which are then conducted to the
thalamus and pain centers in the sensory cortex.
2. Reduction in serotonin, which may cause the
release of neuropeptides, which travel to the
meninges covering the brain, casing inflammation
and pain.
Mild Pain: Tylenol, ASA, NSAIDS, that work on
inflammation at the peripheral site
Moderate Pain: Codeine, or other morphine
derivatives act on the CNS and affect perception of
pain.
Severe Pain: Opiates/narcotic act on the CNS to
block pain pathway and cause euphoria and
sedation.
First-line Defense (non-specific): mechanical barrier
such as skin or a mucous membrane that block
entry of bacteria or harmful substances
Second Line of Defense (non-specific): Phagocytosis

Describe how changes in capillary exchange
affect the tissues and the blood components
Compare normal capillary exchange with
exchange during the inflammatory response
and the process by which neutrophils (leukocytes)
and macrophages randomly engulf and destroy
bacteria, cell debris, or foreign matter.
Inflammation involves of sequence of events
intended to limit the effects of injury or a
dangerous agent in the body.
Third Line of Defense (specific): Provides protection
by stimulating production of unique antibodies or
sensitized lymphocytes following exposure to
specific substances.
At the arteriolar end of a capillary; movement of
fluid, electrolytes, oxygen, and nutrients out of the
capillary is based on the net hydrostatic pressure
(difference between the pressure within the
capillary and interstitial fluid). Differences in
pressures promote diffusion across the capillary
membrane.
At the venous end hydrostatic pressure is
decreased but osmotic pressure remains
high (because plasma proteins remain
within capillaries), so this facilitates the
movement of fluid, carbon dioxide, and
other wastes into the blood.
Inflammatory response:
1. Bradykinin is released from injured cells
2. Bradykinin activates pain receptors
3. Sensation of pain stimulates mast cells and
basophils to release histamine
4. Bradykinin and histamine cause capillary
dilation, which increases blood flow and
increased capillary permeability
5. Migration of neurtrophils and monocytes to
site of injury

Describe both the local and systemic effects
of inflammation
Discuss the effects of chronic inflammation
6. Neutrophils phagocytize bacteria
Local:
1. Redness and warmth due to increased
blood flow to area
2. Swelling or edema due to shift of protein
and fluid into interstitial space
3. Pain from increased pressure on nerves,
and by local irritation of chemical mediators
such as bradykinins
4. Exudate is the collection of interstitial fluid
in the inflamed area.
a. Serous-watery, consists primarily of
fluid with small amounts of protein
and WBC
b. Fibrinous- Thick and sticky with high
cell and fibrin content. Increased
risk of scar tissue.
c. Purulent: thick, yellow-green, and
contain more leukocytes and cell
debris. Indicates bacterial infection
(pus)
d. Abscess: localized pocket of
purulent exudate
e. Hemorrhagic exudate if blood
vessels are damaged.
Systemic:
1. Fever or Pyrexia: a result from the release
of pyrogens from white blood cells or
macrophages. Can be beneficial if it impairs
the growth and reproduction of pathogenic
organism.
2. Pryrogens cause the hypothalamus to reset
at a higher level and cause heat production

Describe several modes of treatment for
inflammation
Describe the various ways of healing and list
problems associated with each
mechanisms. Shivering, cutaneous
vasoconstriction (which cause pallor and
cool skin).
Chronic Inflammation:
-Less swelling and exudate but increased prescence
of lymphocyctes, macrophages, and fibroblasts
(connective tissue cells)
-More tissue destruction with chronic inflammation
-Collagen is produced in the area which result in
more fibrous scar tissue
-rheumatoid arthritis
-deep ulcers
-perforation (erosion through wall)
-ASA and NSAIDS are given to reduce prostaglandin
synthesis
-Corticosteroids or steroidal anti-inflammatory
drugs
a. Decrease capillary permiability
b. Reduce number of leukocytes and mast
cells at site, decreasing release of histamine
and prostaglandins
c. Blocking immune response
-Rest, Ice, Compression, Elevation (RICE)
1. Resolution: damaged cells recover, and the
tissue returns to normal within a short
period of time
2. Regeneration: Damaged tissue is replaced
by identical tissue from the proliferation of
nearby cells (mitosis). Can be limited if a
complex tissue is altered. Ex: fibrous tissue
developing in the liver.
3. Replacement: By connective tissue (scars),
where there is extensive damage or the

List several factors that hasten healing
Identify the classification of burns and
describe the effects of burns
cells are incapable of mitosis (brain).
1. Youth
2. Good nutrition: Protein, vit A and C
3. Adequate hemoglobin
4. Effective circulation
5. Clean, undisturbed wound
6. No infection or further trauma to the site
1. First Degree Burn: (AKA superficial burn)
Damage the epidermis and may involve
upper dermis. Appear red and painful but
heal readily without scar.
2. Second Degree Burn (AKA Partial-
thickness): Involve the destruction of the
epidermis and part of the dermis. Area is
red, edematous, blistered, and often
hypersensitive and painful. Dead skin
usually sloughs off and healing occurs by
regeneration. These burns become easily
infected, causing additional tissue
destruction and scar tissue formation.
3. Third Degree (full thickness): Destruction of
all layers, and in fourth degree burns,
underlying tissue as well. Damaged tissue
shrinks, causing pressure on the edematous
tissue beneath it. If an entire limb is
involved, treatment (escharotomy, surgical
cuts through the crust) may be necessary to
relieve pressure and allow better circulation
to the area. Initially the burn may be
painless, but it becomes very painful as
adjacent tissue becomes inflamed due to
chemical mediators release by the damaged
tissues. Require skin grafts for healing
because there are no cells lefts for

Describe possible complications occurring in
the first few days of a burn
Provide some reasons why the healing of a
burn may be difficult
production of new skin.
1. Shock: Inflammatory response results in a
massive shift of water, protein, and
electrolytes into the tissue, making less
available for circulation (hypovolemic
shock)
2. Respiratory Problems: Due to inhalation of
toxic or irritating fumes. Also damage to
the mucosal lining of the respiratory tract,
or eschar limiting chest expansion.
3. Pain: from original injury, body movements,
and application of grafts
4. Infection: Microbes usually deep in glands
and hair follicles are able to get into open
sores. Opportunistic bacteria and fungi are
waiting to invade open areas when
defensive barriers and blood flow are Hypoalbuminemia: erythrocytes
reduced. damaged during burn including plasma
5. Hypermetabolism: Considerable heat loss albumin, which lead to increased
from the body until the skin is restored, extravascular fluid
therefore body must maintain heat. Also
increased demand for nutrients to heal.
-not a lot of epithelial cells are available in the burn
area for healing so a synthetic or biologic substitute
may be used but they have their disadvantages.
-Scar tissue is also hard to control even with skin
grafting