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Pathology lectures > 6th lecture (hypertrophy) > Flashcards

6th lecture (hypertrophy) Flashcards

1
Q

Adaptation definition?

A

The cell experiences an injury and has to adapt to it. They compensate their function to outer circumstances.
All responses to adaptation are reversible.
the adaptation allows the cell to escape injury.

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2
Q

What are the types of adaptation?

A
  • hypertrophy
  • hyperplasia
  • Atrophy
  • Metaplasia
  • Dysplasia
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3
Q

Hypertrophy definition?

A

an Adaption that causes an increase in size and function.

the cells that do this are stuck in G0 phase, and not capable of multiplying undergo hypertrophy.

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4
Q

what causes hypertrophy?

A

Functional alteration is a demand in activity and/or function.
Demand in activity and or function (force for example)
Demand in hormonal background
Growth factors.

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5
Q

what are the alteration of a cell during hypertrophy?

A
  • increase in protein synthesis,
  • increase in breakdown of un-needed protein, (remodeling)
  • increase in gene expression (growth monitoring genes)
  • increase in cell survival down regulating the pro-apoptotic genes and proteins.
  • remodeling of extracellular matrix
  • increase in DNA content. 2n,4n,8n,16n,32n etc. big nuclei.
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6
Q

Examples for hypertrophy?

A

-concentric left side hypertrophy of the heart. The thicker muscle causes narrowing of the lumen.

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7
Q

What causes concentric left sided hypertrophy? (3)

Left ventricular hypertrophy.

A

-hypertension (increased resistance of the arterioles)
-Aortic stenosis (narrowing of the aorta)
-coarctatio aortae (congenital narrowing) such as ligamentum arteriosum compresses the artery.
ALL OF THE ABOVE mechanism are related to increased peripheral resistance, pressure overload of heart.
-kidney failure, the high pressure = hyalinic arteriosclerosis.

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8
Q

How far can the heart hypertrophy?

A

the coronary blood supply. There is a certain size of the heart that could not be compensated by the coronary circulation, at around 500-600 grams.
later on the heart will have small ischemic foci that is replaced by fibrous tissue, called CHRONIC ischemic heart disease (increased demand but same blood supply)
If enough tissue is replaced by fibrin the end result is left sided heart failure.

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9
Q

apoplexis description?

A

The arteries near the basal gangalions experience an aneurysm called;
charcot bouchard aneurysm MAY RUPTURE; the resulting brain hemorrhage
any aneurysm where the pressure if over 200mmHg has a chance to rupture.
To have a brain hemorrhage the vessels have to be preconditioned by the hypertension. On precondition is the charcot bouchard aneurysm, the other is arteriosclerosis (high pressure arteries will be leaky, causing hyalinic arteriosclerosis of the arteries which are more fragile to rupture.

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10
Q

what are the consequences of concentric left sided hypertrophy

A

CIHD is one consequence of this increased resistance do to the fibrosis of the heart.
apoplexis (brain hemorrhage)

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11
Q

how does kidney failure cases left ventricular hypertrophy?

A

The high pressure that causes hyalinic thickening of the wall causes kidney failure.
Also called nephrosclerosis. (small kidney with irregular surface, “grain leather”)

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12
Q

what is the lethal consequence of hypertension? (3)

A
  • CIHD (chronic ischemic heart disease)
  • brain hemorrhage
  • kidney failure
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13
Q

what is concentric left side hypertrophy of the heart with terminal dilatation.

A

Heart increases in size but starts to reach the end point of its expansion, but still had to work harder. The Starling-mechanism takes effect at this point to increase the amount of work that the heart can do. (stretching of the fiber allows for more force).
Its terminal because this is the maximum stretching after which the patient dies.

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14
Q

what is eccentric left side hypertrophy of the heart?
(dilation). What causes it.

NOTE:
Concentric (pressure overload)
eccentric (volume overload)

A

Large heart with DILATED lumen with some hypertrophy of the heart.
-Mitral insufficiency (mitral valve does not close properly), During contraction there is a volume of blood moving back and forth between Left atria and ventricle and thus the heart dilates to pump a greater volume of blood to compensate for the volume of blood that its unable to pump do to the valve.
Similar for Aortic insufficiency.

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15
Q

types of hypertrophy of the heart?

A
  1. concentric left side hypertrophy of the heart
  2. eccentric left side hypertrophy of the heart
  3. right sided hypertrophy of the heart.
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16
Q

what is Right sided hypertrophy of the heart?

A

The right side increases in size but not so severly since the right side is thinner. Anything that causes resistance in the lung will causes this. Also called cor pulmonale chronic (called chronic because it takes time to adapt.

17
Q

What lung diseases causes Right sided hypertrophy of the heart?

A 
A/ parenchymal disease of lung (affecting interstitial tissue)
-emphysema 
-bronchitits/Bronchiectasis
-Pneumoconiosis: 
-carnification pneumonia:
-sarcoidosis: 
B/ Vascular (vascular disease increasing resistance)
-embolism
-vasculitis
C/ Chest deformity
D/ Pleural diseases.
18
Q

Emphysema description?

A

(alveoli have septi that they loose along with the capillaries increasing resistance.)

19
Q

bronchitits/Bronchiectasis description?

A

(inflammation/dilation of bronchus) characteristic for chronic smokers, which have excessive mucus secretion. This mucus destroy the parenchyma through emphysema. The mucus plug causes air to go in but cannot leave destroying the alveoli causing emphysema.

20
Q

Pneumoconiosis description?

A

group of interstitial lung disease caused by breathing in certain kinds of dust particles that damage your lungs. (i.e. silicium inhalation causing silicosis the fibrotic spots form, destroying vascularity and increasing resistance.)

21
Q

Carnification pneumonia description?

A

inflammation of the parnchemay (alveoli) but the healing will lead to scars, destorying the architecture and increase the resistance.

22
Q

Sarcoidosis description?

A

abnormal masses or nodules (called granulomas) consisting of inflamed tissues form in certain organs of the body.

23
Q

embolism of the lung causes what?

A

cor pulmonale do to the obstruction of the vessels decreasing the circulatory capacity of the lungs and thus increasing the resistance.

24
Q

Examples of chest deformity that can affect the lungs?

A
  • Scoliosis of the spine; compresses the lungs making it harder to open the alveoli.
  • obesity compresses the diaphragm
  • muscular dystrophy: patient has no energy/force to breath.
25
Q

Examples of Pleural diseases that can affect the lungs?

A
  • fluid in the pleural cavity

- Hemathorax (blood in chest cavity)

26
Q

If the right side of the heart fails to compensate for increased resistance by hypertrophy what organ could be affected?

A

the Liver in the sense of the Nutmeg-liver.

27
Q

Hyperplasia definition?

A

cells that have the capacity to go from G0 to G1 to proliferate (increase in number).

In contrast to hypertrophy which is increase in size.

28
Q

What can result in hyperplasia?

A 
A/ HORMONAL: 
-Endometrium hyperplasia
-prostate hyperplasia, 
B/ INCREASED FUNCTIONAL DEMAND
-decreased Oxygen
-follicular hypertrophy (lymph nodes)
-chronic renal failure
C/ CHRONIC INJURY
-atrophy
-metaplasia
-Dysplasia
29
Q

describe the problems of Endometrium hyperplasia?

A

Endometrium is on hormonal cycle with estrogen promoting proliferation, excessive estrogen causes proliferation. Resulting in a endometrium that is hyperplastic and;

  • loss of menstrual cycle
  • irregular bleeding
  • High chance of endometrial cancer.
30
Q

describe the problems of prostate hyperplasia?

A

All males over 50 have some degree of prostate hyperplasia. The hypertrophy affects both the gland and the smooth muscle of the urethra.
The prostate has androgen receptors, but the prostate glands make dihydrotestosterone from Testosterone which acts on its androgen receptors, This hyperplasia compresses the urethra making urination difficult requiring more force to push the urine out. The urine bladder cannot completely empty the bladder since when the fibers of the bladder are more stretched it can generate more force, but force decreases as the bladder empties.
The force can cause hypertrophy of the bladder but weak point between the muscles exist causing diverticulosis trapping fluid inside since they have no muscle around them predisposing the person the cystitis (inflammation of the bladder).

31
Q

Examples of increased functional demand leading to hyperplasia?

A
  • patient with anemia: oxygen saturation drops, the bone marrow responds causing polycythemia (increased amount of RBC’s).
  • Follicular hyperplasia: Follicles (germinal centers) in the lymph nodes enlarge during bacterial infection. This is an adaptation to mobilize more immune cells in response to bacteria.
  • Chronic renal failure: Phosphate retention, the increased phosphate reduced the Calcium, causing parathyroidism.
32
Q

Examples of hyperplasia do to injury?

A

-cystitis (inflammtion of the bladder) there is a proliferation of the mucus cells to protect the cells from the inflammation.
Hypertrophy and hyperplasia mostly occur together (at different ratios) in clinical cases

33
Q

Describe atrophy in the context of hyperplasia in response to chronic injury.

A

ANALOGY: running out of money, you have 2 options; 1. decrease living expenses, or work harder.
Hyperplasia/hypertorphy: doing more (work harder)
atropy: (saving to adapt) Remodeling of the cells, and using their own structure to survive.
MECHANISMS:
-reduce protein synthesis
-degrading proteins (ubiquitin related proteasome degradation). ubiquitin tags the proteins and they are degraded by proteases S19, S20, forming amino acid fragments of 7-8 amino acids.
-decrease gene expression
-Increase the autophagy (eat up organelles of the own cells)

DIFFERENT types of atrophy:
Brown Atrophy, Gray atrophy.

34
Q

Describe metaplasia in the context of hyperplasia in response to chronic injury.
And examples?

A

one major cells changes to another type of cell (ciliary epithelium of bronchus change to squamous epithelium)
This sore of the alteration can be seen in smoker, since the smoke irritate the ciliary epithelium and thus the resulting squamous epithelium which is more resistant to the smoke.
(reprogramming cells)
barrett esophagus; reflux of the stomach juice to the esophagus causing the epithelium of the change to the glandular epithelium of the stomach.
BOTH of the above conditions predispose to cancers.

35
Q

What is barrett esophagus?

A

abnormal (metaplastic) change in the mucosal cells lining the lower portion of the esophagus, from normal stratified squamous epithelium to simple columnar epithelium with interspersed goblet cells that are normally present only in the small intestine, and large intestine.
An adaptation do to acid reflux.
This condition can predispose one to cancer.

36
Q

Describe dysplasia in the context of hyperplasia in response to chronic injury.

A

dysplasia is de-differentiation. loosing differentiation and maturation.
Example:
-In the epithelial cells; Basal cell layer of cuboidal cells and a layer of columnar cells ontop of it. The epithelial cells loose their basal cells loosing their differentations
-cells lose their polarity
-a cell with atypical shape (abnormal cell)

37
Q

How does dysplasia (de-differentiation of cells) predisposes someone to cancer?

Show the order of the events that lead up to cancer.

A
  • NORMAL CELL
  • cell has an injury causing adaptation
  • METAPLASIA
  • cell has a further repeated injury causing dysplasia
  • CELL HAS ACCUMULATION OF MUTATIONS
  • clonal selection of injured/mutated cell
  • NEOPLASIA (uncontrolled cell growth) especially if the cells mutation causes it to divide uncontrollably.

Pathology lectures (24 decks)

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