Cell injury & adaptive response Flashcards
Necrosis:
Gangrenous (Wet & Dry)
Wet: Seen in ischemia & is coagulative in nature
Dry: Seen in super infections (i.e clostridium perfringens) & is liquefactive in nature
Both present in distal limbs, testis & Gi tract
Necrosis:
Fat (Enzymatic vs Non-enzymatic)
Leaves dead fat cell outlines without peripheral nuclei
Seen in fat saponification (fat turns chalky white, looks dark blue on H&E)
Enzymatic: due to acute pancreatitis
Non-enzymatic: due to trauma
Necrosis:
Fibrinoid (Immune vs non-immune mediated)
Vessel walls are outlined by an eosinophilic layer of protein
Seen in type 3 hypersensitivity reactions or from plasma leaking out of blood vessels
Immune vascular reactions (PAN)
Non-immune (Preeclampsia or a hypertensive emergency)
Necrosis:
Coagulative
Outlines of cells with no nuclei and cytoplasmic eosinophilia are seen
Happens in ischemia or infarcts (not in brain)
Necrosis:
Liquefactive
Early stages show neutrophil/macrophage infiltration & cell debris
Late stages show cystic spaces
Common in bacterial abscesses & brain infarcts
Necrosis:
Caseous
Fragmented cells and lymph/macrophages (granuloma) that looks like cheese.
Seen in TB, systemic fungal infections, & nocardiosis
Rheumatic arthritis
Peptic ulcers
Immune vasculitis
Preeclampsia
Hypertensive emergency
Are all examples of:
Fibrinoid necrosis
Tuberculosis
Systemic fungal infection (Histoplasmosis)
Nocardiosis
Are all examples of:
Caseous necrosis
Peripheral arterial disease
Acute limb ischemia
Intestinal ischemia
Clostridium prefringes
Sepsis
All examples of:
Gas gangrenous necrosis
Ischemia & causes
Lack of/insufficient blood supply to tissues
Causes:
Low arterial perfusion (atherosclerosis)
Low venous drainage (Testicular torsion or Budd-Chiari syndrome)
Shock
Risky areas for ischemia
Brain (ACA, MCA, PCA)
Heart (Sub endocardium of the LV)
Kidney (Proximal tubule & thick ascending limb of renal medulla)
Liver (Zone 3 around the central vein)
Colon (Splenic flexure aka Griffith’s point & Rectosigmoid junction)
Red vs Pale infarcts
Red: Seen in venous occlusion & tissues with multiple blood supply (liver, lungs, intestines, & testes) with a reperfusion injury (usually from free radicals)
Pale: Happens in solid organs with a single blood supply (heart & kidneys)
What type of necrosis is shown here:
Fibrinoid necrosis
Necrosis:
Fibrinoid
Is associated with immune complex vasculitis and hypertension
ex. Hypersensitivity reactions 2 & 3 and Vascular hypertensive damage
What is the type of necrosis shown:
Fat necrosis
Outlines of necrotic fat cells with basophilic calcium deposits, surrounded with inflammation
Fat necrosis
Infection with mycobacterium tuberculosis, systemic fungi (histoplasma capsulatum) and nocardia can cause what type of necrosis
Caseous necrosis
Necrosis:
Caseous
Caseous (cheese like) with a granuloma (lysed cells and amorphous granular debris walled off by macrophages
Patient is an alcoholic and presents with a lung infection what should you automatically presume they have and what type of necrosis does it progress to?
Patient probably has aspiration which can develop into liquefactive necrosis
Nuclear shrinkage and more basophilia
Pyknosis
Nucleus undergoes fragmentation
Karyorrhexis
Fading/disappearing chromatin (loss of DNA vie endonucleases)
Karyolysis
60 Yr old patient presents with left lower quadrant pain and chronic constipation what is the next step of action for the test and the possible results?
Preform a Guaiac stool test (blood in stool)
+ test could mean Diverticulosis or colon cancer
Preform a colonoscopy:
Herniations(Diverticulosis)
Masses (Colon cancer)
Patient presents with cardiac hypertrophy, if no other info is given it’s the _____ side & if lung disease is involved it’s the ____ side
Left ventricular hypertrophy
or
Right ventricular hypertrophy
Breasts during puberty
(Hyperplasia or Hypertrophy)
Hypeplasia (estrogen)
Breast feeding mother
(Hyperplasia or Hypertrophy)
Hyperplasia (prolactin)
Chronic hypertension in a older man
(Hyperplasia or Hypertrophy)
Hypertrophy
Blood losses effect on bone marrow
(Hyperplasia or Hypertrophy)
Hyperplasia (erythropoietin)
Patient receives a partial liver transplant, & the organ regrows to it’s original size
(Hyperplasia or Hypertrophy)
Hyperplasia (Hepatocyte growth factor)
Iron deficient & anemic patient starts taking iron supplements. What happens to the bone marrow?
(Hyperplasia or Hypertrophy)
Hyperplasia (Iron increases heme levels which fuel more new RBC production)
Iron deficiency in hypothyroidism triggers what
(Hyperplasia or Hypertrophy)
Thyroid hyperplasia (TSH)
HPV types 6 & 8 warts (Hyperplasia or Hypertrophy)
Hyperplasia
Graves disease (autoimmune IgG against thyroid tissue) triggers (Hyperplasia or Hypertrophy)
Thyroid hyperplasia
Female patient, 40 yrs old presents with irregular menstruation. Testing shows a normal cervix what is the likely condition and ass risk
Hyperplastic endometrium and high risk of cancer
Patient presents with neck fat (buffalo hump), moon face, purple streaks in skin, and osteoporosis. What’s the diagnosis and pathology
Cushing’s disease due to a pituitary adenoma which increases ACTH secretions from the zona fasciculata in the adrenals
Continuous stress reprograms stem cells to differentiate into another cell type
Metaplasia
Patient has a positive guaiac test and colonoscopy shows polyps
colon polyps (Hyperplasia of colonic villi) super high risk of cancer (100%)
Menstrual period stops & the endometrium sheds
(what type of cellular adaptation?)
Apoptosis
A breastfeeding mother weans her baby, and her breast size shrinks
(What type of cellular adaptation?)
Apoptosis
Graft vs. host disease
(What type of cellular adaptation)
Apoptosis
What characteristic about mycobacterium TB causes caseous necrosis?
the waxy coat (usually presents in the apical lobe)
Patient presents with pain in the left lumbar region which radiates to the back, they said a few days prior they attended a Redskins tail gate party and drank their weight in alcohol
What’s the likely diagnosis?
Pancreatitis
Most common cause of pancreatitis?
Alcoholism
Patient presents with chronic hepatitis B, fever, and nodules in their hands, upon examination you notice multiple needle stick injuries. What is the type of necrosis they are experiencing?
Fibrinoid
Patient presents with stroke and chronic hypertension, what type of necrosis will they have?
Fibrinoid
A diabetic patient presents with discolored feet with no distal pedal pulse. What type of necrosis is this?
Additionally the same patient later in hospital develops exudate/pus within the discolored tissue what is the necrosis?
Dry gangrene
&
Wet gangrene
