Chapter 2 (Cellular Adaptation And Injury) Pathophysiology

Front 1

Decrease in cell size and functional ability

Back 1

Atrophy

Front 2

Increase in cell size and functional ability due to increased synthesis of intracellular components

Back 2

Hypertrophy

Front 3

Increase in the number of cells in a tissue or organ

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Hyperplasia

Front 4

A reversible change in which one adult type is replaced by another adult cell type.

Usually in response to irritation or inflammation.

Back 4

Metaplasia

Front 5

An abnormal proliferation of cells that is characterized by changes in cells size, shape, and loss of cellular organization.

Back 5

Dysplasia

Front 6

Incomplete growth of an organ.

Back 6

Hypoplasia

Front 7

A change in the structure of cells and in their orientation to each other that is characterized by a loss of cell differentiation, as in cancerous cell growth.

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Anaplasia

Front 8

1. Decreased functional demand (immobilization)
2. Ischemia (atherosclerosis)
3. Lack of hormonal or neutral stimulation (denervation)
4. Malnutrition (Marasmus; Kwashiorkor)
5. Aging (Alzheimers)

Back 8

Causes of Atrophy

Front 9

1. Increased functional demand (physiological, pathological)
2. Increased endocrine stimulation (puberty [GH, androgen/ estrogen]; Gravid uterus [estrogen]; lactating breast [prolactin and estrogen])

Back 9

Causes of Hypertrophy

Front 10

1. Physiologic (compensatory hyperplasia; hormonal hyperplasia)
2. Pathologic (endometrial hyperplasia, prostatic hyperplasia of aging)

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Causes of Hyperplasia

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1. Replacement cell is better able to tolerate the environment stresses
2. Bronchial columnar epithelium --> squamous metaplasia (smoking)
3. Laryngeal respiratory epithelium --> metaplastic squamous epithelium (smoking)
4. Esophageal squamous mucosa --> Gastric type columnar mucosa (GERD)

Back 11

Causes of Metaplasia

Front 12

Chronic inflammation or inflammation.

Adaptive and potentially reversible after the irritant is removed.

Back 12

Causes of Dysplasia

Front 13

1. Hypoxia (ischemia, cardiopulmonary failure, decreased oxygen-carrying capacity of blood)
2. Immunologic reaction (hypersensitivity reaction, autoimmune disease)
3. Infection (virus, bacteria, parasite, fungus, prions)
4. Congenital disorder (inborn errors of metabolism)
5. Chemical agents (drugs, poision, pollution)
6. Physical form of injury (trauma, burn)
7. Nutritional or vitamin imbalance

Back 13

Causes of Cell Injury

Front 14

Decrease in oxidative phosphorylation (ATP production)

1. Decrease ATPase pump --> Increase Na+ & H20 --> swelling
2. Increase gylcolysis --> Increase Lactic acid --> Decrease pH
3. Ribosomal detachment --> Decrease protein synthesis

Back 14

Reversible Cell Injury

Front 15

Decrease oxidatitive phosphorylation --> Severe membrane damage

1. Ca 2+ Increase
2. Cytoplasmic enzyme leak

Back 15

Irreversible Cell Injury

Front 16

A sequence of morphologic changes that follow cell death in living tissue

Back 16

Necrosis

Front 17

A specialized form of programmed cell death

An active process regulated by genes and involves RNA and protein synthesis

Cell shrinks in size and has eosinophilic cytoplasm

Back 17

Apoptosis

Front 18

A lack of an inflammatory response (differing from necrosis)

Back 18

Apoptosis

Front 19

(Most common)
Due to the denaturing and coagulation of protein within the cytoplasm.

Common in the most organs including the heart, liver, and kidney.

Back 19

Coagulative Necrosis

Front 20

Cellular destruction by hydrolic enzymes

Occurs in abscesses, brain infraction, pancreatic necrosis

Back 20

Liquefactive Necrosis

Front 21

Combination of coagulation and liquefaction necrosis

"Cottage-cheese like" appearance

Characteristic of TB

Back 21

Caseous necrosis

Front 22

The necrosis of immunology injury

ex. Henoch-Schonlein purpura, rheumatic heart disease, and SLE

Back 22

Fibrinoid necrosis

Front 23

Commonly seen in acute pancreatitis due to release of amylase and lipase

Back 23

Fat necrosis

Front 24

Dead tissue (gross term)

Common site- lower limbs, GI tract, gallbladder

Back 24

Gangrenous necrosis

Front 25

Microscopic pattern is coagulative necrosis

(Diabetic foot)

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Dry gangrene

Front 26

Microscopic pattern is liquefactive necrosis

The lack of blood flow causes some cells to die and leak fluid, which moistens the surrounding tissue

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Wet gangrene

Front 27

A type of wet gangrene that usually is caused by the bacterium called Clostridum

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Gas gangrene

Front 28

Damaged or worn-out cells commit "suicide"
Turn on their own enzymes inside the cell
Digest their own cell proteins and DNA
Then destroyed by WBCs

Back 28

Apoptosis

Front 29

Cell injury and DNA damage
Lack of hormones, cytokines, or growth factors

Back 29

Stimulus for apoptosis

Front 30

Inhibits apoptosis

Back 30

bcl-2

Front 31

Stimulates apoptosis

(Elevated by DNA injury, if DNA repair is impossible, this stimulates apoptosis)

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p53

Front 32

Embryogenesis (organogenesis and development)
Hormone dependent apoptosis (menstrual cycle)
Thymus (selective death of lymphocytes- shrinks after puberty)

Back 32

Physiological examples of apoptosis

Front 33

Viral infection (viral hepatitis)
Graft verus host disease
Cystic fibrosis (duct obstruction and pancreatic atrophy)
Carcinogenesis (follicular lymphoma by bcl-2 expression)

Back 33

Pathological examples of apoptosis

Front 34

Molecules with an unpaired electron in the outer electron shell

Extemely unstable and reactive

Can react with inorganic or organic chemicals damaging them or changing them

Normally removed from body by antioxidants

Back 34

Free Radicals

Front 35

Toxic chemicals induce cell injury by one of two general mechanisms

Back 35

Chemical Injury

Front 36

Example of a chemical that acts directly by combining with a critical molecule component

Back 36

Mercury poisioning

(Mercury binds to the sulfhydryl groups of the cell membrane)

Front 37

Examples of chemicals that are not intrinsically biologically active but must be converted to reactive toxic indirectly

Back 37

CCl4 is converted by cytochrome P450 to the toxic free radical CCl3 which damages liver cells

Acetaminophen is converted by cytochrome P450 to FR, which binds to sulfhydryl group and damage liver cells.

Front 38

Cells may adapt to the environment by undergoing changes in __________, _________, and _________.

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size, number, and shape

Front 39

Atrophy is seen as a decrease in cell _______.

Back 39

size

Front 40

Denervation will result in cellular _________.

Back 40

atrophy

Front 41

Hypertrophy is an _______ in cell size.

Back 41

Increase

Front 42

An increase in muscle mass associated with exercise is an example of ______.

Back 42

Hypertrophy (physiologic)

Front 43

An increase in the number of cells in an organ or tissue is known as ________.

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Hyperplasia

Front 44

Liver regrowth is an example of ________ hyperplasia.

Back 44

compensatory

Front 45

________ or ________ hyperplasia is due to excessive hormonal stimulation or excessive growth factors.

Back 45

Pathologic or nonphysiologic

Front 46

__________ represents a reversible change in which one adult cell type is replaced by another adult cell type.

Back 46

Metaplasia

Front 47

Metaplasia usually occurs in response to chronic _________ and _________ and allows for substitution of cells that are better able to survive stressful or harmful conditions.

Back 47

irritation and inflammation

Front 48

Deranged cell growth of a specific tissue that results in cells that vary in size, shape, and organization is known as _________.

Back 48

Dysplasia

Front 49

Dysplasia is strongly implicated as a precursor of _______.

Back 49

Cancer

Front 50

Intracellular ________ represent the buildup of substances that cells cannot immediately use or eliminate.

Back 50

accumulations

Front 51

_________ radicals are highly reactive chemical species having an unpaired electron in the outer valence shell of the molecule.

Back 51

Free

Front 52

________ deprives the cell of oxygen and interrupts oxidative metabolism and the generation of adenosine triphosphate (ATP).

Back 52

Hypoxia

Front 53

Reversible cellular injury is seen as either cellular ________ or _______ accumulation.

Back 53

swelling or fatty

Front 54

__________ differs from apoptosis in that it involves unregulated enzymatic digestion of cell components, loss of cell membrane integrity with uncontrolled release of products of cell death into the intracellular space, and initiation of the inflammatory response.

Back 54

Necrosis

Front 55

The increased ________ levels may inappropriately activate a number of enzymes with potentially damaging effects.

Back 55

Calcium

Front 56

Acidosis develops and denatures the enzymatic and structural proteins of the cell during _______ necrosis.

Back 56

Coagulation

Front 57

Occurs in normal tissues as the result of increased serum calcium levels.

Back 57

Metastatic calcification

Front 58

Oxygen-containing molecules that are highly reactive

Back 58

Reactive oxygen species (ROS)

Front 59

Natural and synthetic molecules that inhibit the reactions of ROS with biological structures

Back 59

Antioxidants

Front 60

Programmed cell death

Back 60

Apoptosis

Front 61

Macroscopic deposition of calcium salts in injured tissue

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Dystrophic calcification

Front 62

Ice crystal formation in cytosol

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Temperature induced injury

Front 63

Impaired oxygen delivery

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Ischemia

Front 64

Dead cells persist indefinitely as soft cheeselike debris

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Caseous necrosis

Front 65

Causes injury by changes in electron stability

Back 65

Ionizing radiation

Front 66

Term applied when a considerable mass of tissue undergoes necrosis

Back 66

Gangrene

Front 67

Five categories of cellular injury

Back 67

Injury from physical agents, radiation injury, chemical injury, injury from biologic agents, and injury from nutritional imbalances

Front 68

Three major mechanisms of cellular injury

Back 68

free radical formation, hypoxia, and ATP deletion

Front 69

Complete or partial loss of blood flow to a body part is:

Back 69

Ischemia

Front 70

Failure of an organ to reach full size or full level of maturity is:

Back 70

Hypoplasia

Front 71

Enormous enlargement of the heart may occur. Often this enlargement is the result of increased thickness of its muscle. Such enlargement is most likely the result of:

Back 71

Hypertrophy

Front 72

Is the principle underlying cause of benign prostatic enlargement in elderly men.

Back 72

Hypertrophy

Front 73

Commonly occurs in the ectocervix (the portion projecting into the vagina)

Back 73

Metaplasia

Front 74

The coagulative type is the commonest form.

Back 74

Necrosis

Front 75

May be a physiological process.

Back 75

Apoptosis

Front 76

Not a characteristic of reversible cell injury:

a. reduced oxidative phosphorylation
b. ATP depletion
c. Cellular swelling
d. Calcium ion influx
e. Ribosomal detachment

Back 76

Calcium ion influx

Front 77

Increase in the number of cell (mitosis) in an organ or tissue.

Back 77

Hyperplasia

Front 78

Increase in individual cell size in an organ or tissue.

Back 78

Hypertrophy

Front 79

Reversible change in which one adult cell is replaced by another adult cell type.

Back 79

Metaplasia

Front 80

Ischemia reduces oxidative phosphorylation in mitochondria, resulting in a decrease in ATP production. Which of the following would not follow as a morphologic consequence?

a. Increased anaerobic glycolysis
b. Increase in pH and glycogen
c. Decrease in protein synthesis
d. Influx of Ca++, H20, and Na+
e. Efflux of K+

Back 80

Increase in pH and glycogen

Front 81

Which of the following is not involved in free radical neutralization?

a. Superoxide dismutase (SOD)
b. Nitric oxide (NO)
c. Catalase
d. Glutathione peroxidase and reductase
e. Fenton (ferritin)

Back 81

Nitic Oxide (NO)

Front 82

Occurs as a result of release of activated pancreatic enzymes and can leave white, chalky deposits representing calcium soap.

Back 82

Fat necrosis

Front 83

Has a cheesy, yellow-white appearance at the area of necrosis and is encountered most often in foci of TB.

Back 83

Causeous necrosis

Front 84

All of the following are features of apoptosis except:

a. cell shrinkage
b. programmed cell death
c. affects only single cell or small groups
d. an inflammatory response

Back 84

An inflammatory response

Front 85

Activated Oxygen Species

Back 85

Superoxide (SO)
Hydrogen peroxide
Hydroxyl radical