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  <head>
    <title>083-02 Connective tissue, extracellular matrix, blood, cartilage, bone, and adipose tissue</title>
    <ownerName>Integrated Medical Foundations</ownerName>
  </head>
  <body>
    <outline text="Connective tissue, blood, cartilage, bone, and fat">
      <outline text="Connective tissue plan">
        <outline text="Support, bind, nourish, defend, store, transmit force"/>
        <outline text="Abundant extracellular matrix between cells"/>
        <outline text="Properties from fibres, ground substance, minerals, cells"/>
        <outline text="Develops from embryonic mesenchyme"/>
        <outline text="Fibroblasts produce matrix">
          <outline text="Active cells: more basophilic cytoplasm"/>
          <outline text="Become myofibroblasts after injury"/>
        </outline>
      </outline>
      <outline text="Fibres and ground substance">
        <outline text="Collagen resists tension">
          <outline text="Type one: thick fibres in dermis, tendon, bone, scar"/>
          <outline text="Type two: cartilage and vitreous body"/>
          <outline text="Type three: reticular fibres of cellular organs"/>
          <outline text="Type four: basement-membrane sheets"/>
        </outline>
        <outline text="Elastic fibres: elastin core, fibrillin microfibrils">
          <outline text="Arterial lamellae store energy in systole"/>
          <outline text="Fibrillin defects: skeleton, eye, aorta"/>
          <outline text="Elastin degradation: emphysema, arterial change"/>
        </outline>
        <outline text="Ground substance is a hydrated gel">
          <outline text="Negative glycosaminoglycans attract cations and water"/>
          <outline text="Hyaluronan occupies space, aids migration"/>
          <outline text="Fibronectin links cells, laminins organise membrane"/>
          <outline text="Poorly preserved, looks like empty space"/>
        </outline>
      </outline>
      <outline text="Connective tissue types">
        <outline text="Loose: diffusion and immune surveillance">
          <outline text="Readily develops oedema"/>
        </outline>
        <outline text="Dense irregular resists multidirectional stress"/>
        <outline text="Dense regular aligns collagen with force"/>
        <outline text="Tendon: parallel bundles, tenocytes, few vessels">
          <outline text="Tensile strength but slow healing"/>
          <outline text="Repetitive load: disorganisation, failed repair"/>
        </outline>
        <outline text="Ligaments join bones, may add elastic fibres"/>
      </outline>
      <outline text="Resident cells and adipose tissue">
        <outline text="Macrophages phagocytose, present antigen, remodel"/>
        <outline text="Mast cells release histamine and proteases"/>
        <outline text="Plasma cells: clock-face nucleus, pale Golgi"/>
        <outline text="White fat: one large droplet, signet ring">
          <outline text="Stores triglyceride, secretes adipokines"/>
          <outline text="Visceral and subcutaneous depots differ"/>
        </outline>
        <outline text="Brown fat: many droplets, abundant mitochondria">
          <outline text="Uncoupling protein one leaks protons"/>
          <outline text="Heat instead of adenosine triphosphate"/>
        </outline>
      </outline>
      <outline text="Blood">
        <outline text="Plasma is the fluid matrix"/>
        <outline text="Erythrocytes: anucleate biconcave discs">
          <outline text="Pale centre about one third"/>
          <outline text="Size, colour, shape, inclusions as clues"/>
        </outline>
        <outline text="Neutrophils dominate acute bacterial inflammation"/>
        <outline text="Eosinophils: parasite defence, allergy"/>
        <outline text="Monocytes become macrophage-like cells in tissue"/>
        <outline text="Platelets: fragments of megakaryocytes">
          <outline text="Adhere, activate, recruit, support coagulation"/>
          <outline text="In-vitro clumping mimics a low count"/>
        </outline>
      </outline>
      <outline text="Cartilage">
        <outline text="Chondrocytes in lacunae, avascular matrix">
          <outline text="Nutrients diffuse from perichondrium or synovial fluid"/>
          <outline text="Poor repair in adult articular cartilage"/>
        </outline>
        <outline text="Hyaline: fine type two fibrils">
          <outline text="Articular cartilage lacks perichondrium"/>
        </outline>
        <outline text="Elastic cartilage: pinna and epiglottis"/>
        <outline text="Fibrocartilage resists tension plus compression"/>
      </outline>
      <outline text="Bone structure and formation">
        <outline text="Mineralised support, calcium and phosphate store"/>
        <outline text="Osteoblasts secrete osteoid"/>
        <outline text="Osteocytes sense load through canaliculi"/>
        <outline text="Osteoclasts resorb in sealed acid compartments"/>
        <outline text="Osteons: lamellae around a central canal">
          <outline text="Interstitial lamellae are old osteon remnants"/>
        </outline>
        <outline text="Trabecular bone aligns with load"/>
        <outline text="Woven bone remodelled into lamellar bone"/>
        <outline text="Intramembranous or endochondral ossification"/>
      </outline>
      <outline text="Growth, remodelling, and repair">
        <outline text="Growth plate zones">
          <outline text="Columns divide, enlarge, die, are replaced"/>
          <outline text="Plate closure ends longitudinal growth"/>
        </outline>
        <outline text="Remodelling couples resorption and formation">
          <outline text="Ligand and decoy receptor steer osteoclasts"/>
          <outline text="Hormones, loading, inflammation shift balance"/>
        </outline>
        <outline text="Repair: haemostasis through remodelling">
          <outline text="Granulation tissue is not granulomatous"/>
          <outline text="Type three collagen replaced, strength rises"/>
        </outline>
        <outline text="Healing follows vascularity, cellularity, turnover"/>
      </outline>
    </outline>
  </body>
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