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EMS - MoD > 17. Abnormalities of growth, differentiation and morphogenesis > Flashcards

17. Abnormalities of growth, differentiation and morphogenesis Flashcards

1
Q

What is a cellular adaptation?

A

Reversible changes in cellular size/number/phenotype/metabolic activity/function due to changes in environment or demand

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2
Q

During cellular adaptation, the cell may make changes in what?

A
  • size
  • number
  • phenotype
  • metabolic activity
  • function
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3
Q

How is cellular adaptation different to cell injury and neoplasia?

A

Cell injury and neoplasia are irreversible whereas cellular adaptation is most often reversible

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4
Q

What is the role of cellular adaptation?

A
  • acquire new, steady state of metabolism and structure

- better equips cell to survive in new environment

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5
Q

What may failure of adaptation lead to?

A

Sub-lethal or lethal cell injury

  • marked susceptibility to injury
  • stimulus is too severe
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6
Q

Tissues differ in their susceptibility to stress. Give examples

A

Cerebral neurons = very sensitive to hypoxia, rapidly die when subject to hypoxic stress

Fibroblasts = very resistant to damage, can survive for long periods in challenging environments

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7
Q

Depending on the cell population type, tissues either
- don’t need to adapt
- adapt easily
- cannot adapt
Give an example of a tissue type that does not need to adapt

A

Fibroblasts

Survive severe metabolic stress without harm eg. absence of O2

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8
Q

Depending on the cell population type, tissues either
- don’t need to adapt
- adapt easily
- cannot adapt
Give an example of a tissue type that can adapt easily

A

Epithelial cells

Labile cell population, active stem cell population, highly adaptive in number and function

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9
Q

Depending on the cell population type, tissues either
- don’t need to adapt
- adapt easily
- cannot adapt
Give an example of a tissue type that cannot adapt

A

Cerebral neurons

Terminally differentiated, permanent cell population, highly specialised function, easily damaged by environmental change

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10
Q

What is PHYSIOLOGICAL cellular adaptation?

A

Responding to normal changes in physiology or demand

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11
Q

What is PATHOLOGICAL cellular adaptation?

A

Responding to disease related changes

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12
Q

What are 3 types of adaptive responses

A
  • increased cellular activity
  • decreased cellular activity
  • changes in cell function and/or morphology
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13
Q

In what ways can a cell adapt to increase cellular activity?

A

Increase size and/or number of cells

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14
Q

In what ways can a cell adapt to decrease cellular activity?

A

Decreased size and/or number of cells

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15
Q

Increase in SIZE of cells is called what?

A

Hypertrophy

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16
Q

Increase in NUMER of cells is called what?

A

Hyperplasia

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17
Q

Hypertrophy and hyperplasia may co-exist. What do they both lead to?

A

Hypertrophy/hyperplasia = increased cell mass = increased capacity

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18
Q

Hypertrophy is an increase in size of existing cells and therefore an increase in functional capacity. What does this lead to?

A
  • increased synthesis of structural components

- increased metabolism

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19
Q

In which tissues is hypertrophy particularly seen in?

A

Permanent cell populations, especially cardiac and skeletal muscle

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20
Q

Under what circumstances might a uterus be pathologically hypertrophied?

A

Adhered placenta causing post-partum haemorrhage

Causes uterus to be significantly larger after delivery

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21
Q

The prostate becomes enlarged as part of the ageing process, by a process of ….? hyperplasia

A

Adenomyomatous hyperplasia

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22
Q

When the prostate undergoes hyperplasia, what effect does this have on the bladder?

A

Detrusor muscle has to work harder during micturition - undergoes hyperplasia

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23
Q

Hyperplasia of the prostate can lead to further hyperplasia of the detrusor muscle of the bladder. What appearance does this give?

A

Trabeculated appearance

Can also get bladder diverticuli

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24
Q

Permanent cell populations can only respond to increased demand by doing what?

A

Increasing cell size

hypertrophy

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25
Q

How many cusps does the aortic valve have?

Give an abnormality

A

Normally has 3

Can get congenitally bicuspid aortic valve - often suffers from abnormal fibrosis and pathological calcification leading to inflexibility and narrowing of the orifice

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26
Q

What causes left ventricular failure?

A

Long standing systemic hypertension

Increased peripheral vascular resistance, increasing demand on left ventricle - hypertrophy will compensate for some time but if hypertension is left untreated, compensation may eventually fail

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27
Q

How might you diagnose left ventricular hypertrophy?

A
  • clinical examination
  • ECG
  • imaging
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28
Q

Which valve abnormality would lead to left ventricular hypertrophy (LVH)?

A

Aortic stenosis

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29
Q

What can LVH predispose to?

A
  • sudden degeneration of rhythm
  • ventricular tachycardia
  • ventricular fibrillation and sudden cardiac death
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30
Q

What is subcellular hypertrophy and hyperplasia?

A

Increase in size and number of subcellular organelles

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31
Q

Give an example of a subcellular hypertrophy and give the effect that this has

A

Smooth ER hypertrophy in hepatocytes with barbiturates, leading to an increase in P450 mixed function oxidases (the enzymes that live in the smooth ER) leading to an increased metabolism of other drugs

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32
Q

Smooth endoplasmic reticulum hypertrophy ultimately leads to what?

A

Increased metabolism of drugs

due to increase in P450 mixed function oxidases

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33
Q

Smooth endoplasmic reticulum hypertrophy is caused by which drug?

A

Barbiturates

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34
Q

What is hyperplasia?

A

Increase in number of cells caused by cell division

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35
Q

Which cell population types is hyperplasia possible in?

A

Labile and stable cell populations

36
Q

Give 2 types of physiological hyperplasia

A
  • hormonal

- compensatory

37
Q

Give 2 types of pathological hyperplasia

A
  • excess hormones

- growth factors

38
Q

What is gynaecomastia?

A

Enlargement of the male breast due to hyperplasia of the glandular and stromal tissue in the breast

39
Q

What may gynaecomastia be caused by?

A
  • physioloigcal at puberty
  • drugs (anabolic steroids, oestrogen)
  • pathology eg. cirrhosis of liver
40
Q

Why might you get hyperplasia of one kidney?

A

Due to hypoplasia of the other

41
Q

What is the mechanism behind Grave’s disease that causes hyperthyroidism?

A

An autoantibody binds to and switches on the TSH receptor in the thyroid, leading to prolonged, uncontrolled hyperplasia of the thyroid and hyperthyroidism (thyrotoxicosis)

42
Q

What are the characteristic eye signs called in Grave’s disease and what is this caused by?

A

Exophthalmos

Caused by abnormal deposition of ground substance in orbital tissues

43
Q

What feature do you get in adenomyomatous hyperplasia of the prostate?

A

Hyperplastic nodules

normal age-related change

44
Q

The abnormal healing process in a cirrhotic liver leads to the formation of what?

A

Hyperplastic nodules of hepatocytes

45
Q

What is atrophy?

A

Reduction in size of organ or tissue by decrease in cell size and number

46
Q

Give 2 examples of physiological atrophy?

A
  • embryogenesis

- uterus after pregnancy or menopause

47
Q

Pathological atrophy can be classified into which 2 categories?

A
  • localised

- generalised

48
Q

Which factors cause pathological atrophy?

A
  • decreased workload
  • loss of innervation
  • diminished blood supply
  • inadequate nutrition
  • loss of endocrine stimulation
  • pressure
49
Q

When atrophy is caused by decreased workload, what is this called?

A

Disuse atrophy

50
Q

When atrophy is caused by loss of innervation, what is this called?

A

Denervation atrophy

51
Q

Give an example of atrophy caused by inadequate nutrition

A

Cachexia

52
Q

Give an example of a situation which may cause disuse atrophy

A

Leg in cast

53
Q

Give an example of an organ which may atrophy due to loss of endocrine stimulation

A

Uterus

54
Q

Ageing and cerebrovascular disease has what effect on the brain?

A

Global atrophy

55
Q

Give 2 examples of how atrophy of the kidneys may be caused

A
  • renal artery stenosis (decreased blood supply)

- hydronephrosis (back pressure, from ureteric obstruction)

56
Q

What is hydronephrosis?

A

A condition where the kidney becomes stretched or swollen as a result of a build up of urine inside them (eg. due to ureteric obstruction)

57
Q

Which organ atrophies with age and is barely recognisable microscopically in the adult?

A

Thymus

physiological atrophy

58
Q

What can pathologically cause atrophy of the adrenal cortex?

A

Steroid therapy - reduce the ACTH drive causing decrease in hormonal stimulation

59
Q

What may patients be at risk of if long term steroids are stopped suddenly?

A

Addisonian crisis due to hypoadrenalism

Addisionian crisis = extremely low levels of cortisol (cortisol = important hormone produced by adrenal glands)

60
Q

What are 2 mechanisms of atrophy?

A
  • reduction in volume of individual cells

- death of individual cells (apoptosis)

61
Q

What is involution?

A

Physiological atrophy caused by apoptosis

62
Q

Reduction in volume of individual cells leads to formation of residual bodies. What can accumulation of residual bodies in cells be seen as?

A

Lipofuscin pigment

63
Q

What does reduction in volume of individual cells lead to the formation of?

A

Residual bodies

64
Q

Not all reduced cell mass is due to atrophy. What else can it be related to?

A

Developmental abnormalities

65
Q

Give some conditions in the steps of development from embryonic cell mass to normal organ, which may cause reduced cell mass

A
  • agenesis
  • aplasia
  • dysgenesis
  • hypoplasia
66
Q

What is metaplasia?

A

Transformation of one differentiated cell type into another

67
Q

Which tissues can metaplasia affect?

A

Epithelium and mesenchymal tissues

Can also have transdifferentiation of stem cells

68
Q

Why would cells undergo metaplasia?

A

Better adaptation to new environment

69
Q

What pathological metaplasia does cigarette smoke cause?

A

Pseudostratified ciliated bronchial epithelium CHANGES TO squamous epithelium

70
Q

What pathological metaplasia does bladder calculus/schistomosiasis/longstanding catheter cause?

A

Transitional epithelium of bladder CHANGES TO squamous epithelium

71
Q

What pathological metaplasia does chronic trauma cause?

A

Fibrocollagenous tissue CHANGES TO bone

72
Q

What pathological metaplasia does acid reflux cause?

A

Oesophageal squamous epithelium CHANGES TO columnar (glandular) epithelium

73
Q

Why does smoking cause squamous metaplasia?

A

Squamous epithelium is better able to cope with noxious environment - squamous cell carcinomas

74
Q

How are all these different types of adaptations linked to neoplasia?

A

Metaplasia/hyperplasia etc may form the basis on which neoplasia develops

75
Q

Squamous metaplasia in cervix may lead to which neoplasia?

A

CIN and squamous cell carcinoma

76
Q

Endometrial hyperplasia due to increased oestrogen may lead to which neoplasia?

A

Adenocarcinoma

77
Q

Parathyroid hyperplasia due to chronic renal failure may lead to which neoplasia?

A

Adenoma

78
Q

Squamous metaplasia in bronchus may lead to which neoplasia?

A

Dysplasia and squamous cell carcinoma

79
Q

Squamous metaplasia in bladder may lead to which neoplasia?

A

Squamous cell carcinoma

80
Q

Glandular metaplasia in oesophagus may lead to which neoplasia?

A

Adenocarcinoma

81
Q

Which is dysplasia?

A

Earliest morphological manifestation of multistage process of neoplasia (hence irreversible)

82
Q

Is dysplasia reversible or irreversible?

A

Irreversible

83
Q

Dysplasia in an in-situ disease. What does this mean?

A

It is non-invasive. The abnormal cells have not yet acquired the capacity for invasion so they cannot spread

84
Q

Carcinoma in-situ is another term for what?

A

Severe dysplasia

85
Q

Dysplasia shows no invasion but does show what?

A

Cytological features of malignancy

EMS - MoD (17 decks)

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