Cell Injury, Death, and Adaptations Flashcards
_____ is the origin of disease.
etiology
_______ is the development of disease
pathogenesis
What are the two studies of pathology?
etiology and pathogenesis
Which branch of pathology seeks to identify WHY a disease occurs?
etiology
Which branch of pathology seeks to describe HOW a disease occurs?
pathogenesis
True or False: Cell injury is not common to all forms of pathology.
False
True or False: Clinical signs or symptoms are usually several steps removed from the biochemical changes associated with cell injury.
True
Cell injury results from disruption of one or more components that maintain ______.
viability
Cell injury induces a _____ of effects.
cascade
True or False: Cell injury may be reversible.
True
What are the three options that follow cell injury?
- Reverse injury
- cell adaptation to injury)
- cell death
Stress + Adaptation = ______.
strengthening (i.e: exercise)
What are the 4 events that follow “etiologic agent” in the cascade?
- cell injury
- cell response
- disease state
- disease treatment
What are four rapid causes of cell injury?
hypoxia
infectious agents
physical injury
chemicals/drugs
What are three causes of cell injury that are more slowly progressing?
immune response
genetic abnormalities
nutritional imbalance
Which cells are most susceptible to hypoxia?
brain cells
heart cells
An “aspirin burn” is an example of a _______ reaction.
chemical
What are three examples of genetic abnormalities that have oral signs?
Down’s Syndrome
Ehrlos-Danlos
Cancer
Diabetes and Scurvy are examples of cell injury from _____ _____.
nutritional imbalance
What are the four important targets in cell injury?
cell membrane
mitochondria
cell proteins
DNA
Cell injury can result from _____ depletion.
ATP
Cell injury can result from generation of ______ ______ species.
reactive oxygen
Cell injury can result from loss of ______ homeostasis.
calcium
Cell injury can result from altered _____ permeability.
membrane
Cell injury can result from _______ , ____, or _____ damage.
mitochondrial, DNA, protein
According to the Hypoxia-Ischemia Model, a thrombus in a blood vessel (ischemia) results in a decrease in ____ ______ within the mitochondria.
oxidative phosphorylation
A decrease in oxidative phosphorylation results in a _____ in ATP.
decrease
According to the Hypoxia-Ischemia Model, a reduction in ATP will increase ____ and ____ influx, while it will also increase _____ efflux.
Sodium and Calcium (influx)
Potassium (efflux)
What is the result of increased sodium/calcium influx and potassium efflux?
Increased water influx–> cellular swelling, membrane blebs, loss of villi, and ER swelling
How does an increase in glycolysis influence pH?
decreases pH (increases acid)
How does an increase in glycolysis influence glycogen stores?
decreases glycogen stores
Free radicals have a(n) _________ electron.
unpaired
Name five processes that will generate ROS.
- inflammation
- oxygen toxicity
- chemicals/drugs (metabolism of)
- Radiation
- Aging
How do ROS cause cellular injury?
- lipid peroxidation
- protein fragmentation
- single strand breaks in DNA
What is lipid peroxidation?
The oxidative degradation of lipids. It is the process in which free radicals “steal” electrons from the lipids in cell membranes, resulting in cell damage. This process proceeds by a free radical chain reaction mechanism (initiation, propagation, termination).
ROS cause single strand breaks in DNA by causing _____ _______ in both purines and pyrimidines.
base modifications
What are the major sites that ROS cause base modification/breaks in DNA?
thymidine and guanine
What are three basic mechanisms for controlling/preventing ROS damage?
- Enzymes
- Antioxidants
- Serum proteins that reduce/bind iron
What is a major enzyme involved in controlling ROS?
Super Oxide Dismutase (SOD)
Is there a significant difference between extracellular and cytoplasmic calcium concentration?
YES, 1000-fold difference (higher extracellular) allows for maintenance of diffusion gradient. If there is a problem with diffusion, the membrane and DNA is destroyed. The cell viability depends on calcium
Other than ROS, what are five other causes of cell membrane injury?
- complements (C5-C9 Membrane Attack Complex)
- Cytotoxic T Cells and NK Cells
- Viruses
- Bacterial Endotoxins and Exotoxins
- Drugs
________ ________ occur prior to morphologic changes.
biochemical alterations
The degree of cell injury is determined by physiological state of the cell, number of exposures to insult, _____ of insult, and ______ of insult.
intensity
duration
Micronutrient composition and amount of oxygen are two aspects that describe the ______ state of the cell.
physiologic
What are the three possible outcomes of cell injury?
- reversible
- cell adaptation
- cell death
What are two forms of cell death?
necrosis
apoptosis
What are four possible cell adaptations?
- cell size
- cell number
- functional modifications
- intracellular accumulations
Reversible cell injury is often an _____ process that is usually _____ duration and ____ intensity.
acute
short duration
low intensity
Ischemia, exposure to toxins, infectious agents, and thermal injury are possible causes of what type of cell injury?
reversible
The increase in intracellular _____ leads to an isosmotic gain in water and cell swelling.
sodium
______ occurs when an insult overcomes compensation mechanisms.
cell death
True or False: There is a signature biochemical event that equates with cell death.
False
As the duration of injury increases, what are the three changes that follow cell death (in order)?
cell death –> ultrastructural changes–> light microscopic changes–> gross morphologic changes
What are the four morphologic types of necrosis?
- coagulative
- liquefactive
- caseous
- enzymatic
Which type of necrosis is most common?
coagulative
Coagulation is associated with _____ acidity.
high
Which type of necrosis is most often associated with tuberculosis?
caseous
Which type of necrosis is uncommon and often associated with pancreatic disease?
enzymatic
Which type of necrosis involves bacterial infections and pus?
liquefactive
The necrosis pattern is determined by the _______ of cells/ECM, the type of necrotic ______, and by bacterial ______ when present.
degradation
debris
products
The _____-____ appearance is indicative of coagulative necrosis.
cooked-egg
What are three histological features of coagulative necrosis?
- cell outline
- pink cytoplasm
- anucleated cells
Myocardium that has gone through coagulative necrosis will lose what important feature?
the “z bands”
A “hyper-cellular sea of neutrophils” is histologically evident in _____ necrosis.
liquefactive
True or False: In caseous necrosis associated with TB, macrophages act as a barrier to close off the lesion and kill the organisms.
False: the organisms are closed off but not killed
____ necrosis is associated with acute pancreatitis.
fat (enzymatic)
What is the “maintainer of homeostasis?”
apoptosis
What are three processes that are maintained by apoptosis?
- normal cell turnover
- embryogenesis
- immune function
True or False: Disease is associated with excessive apoptosis or inhibition of apoptosis.
True
AIDS, ischemia, neurodegenerative diseases, myelodysplasia, and toxin induced liver injury are all associated with _____ apoptosis.
excessive
Inhibition of apotosis is associated with _____, _______, and _______.
cancer
autoimmune diseases
viral diseases
List the five morphological stages of apoptosis.
- chromatin condensation
- progressive cell shrinkage
- plasma membrane blebbing
- formation of apoptotic bodies
- phagocytosis- no inflammation
What are the two pathway in the mechanism of apoptosis?
- Mitochondrial (intrinsic)
2. Death Receptor (extrinsic)
Bcl-2 is a ____ of apoptosis.
inhibitor/regulator
Bax/Bak are ______ of apoptosis.
initiators
True or False: Necrosis and Apoptosis are caused by both pathologic and physiologic stimuli.
False: Apoptosis is BOTH….Necrosis is only PATHOlogic
Which has a morphology that is “multiple cells,” necrosis or apoptosis?
necrosis
Which has a morphology in which the cells SHRINK, necrosis or apoptosis?
apoptosis
True or False: Necrosis and Apoptosis have an inflammatory host response.
False: no inflammation is associated with apoptosis
Cells undergo ________ changes due to persistent (chronic) stress or injury.
adaptive
True or False: Similar responses at the cell level can produce different morphological changes in different organs.
True
In chronic cell injury, what aspect is prolonged in comparison to acute cell injury?
duration of stress
Cellular adaptations include: alterations in cell size, number, or differentiation and abnormal intracellular _______.
accumulations
_____ is a decrease in cell SIZE and function with concurrent decrease in organ size and/or function.
atrophy
True or False: it is normal for the brain to atrophy with age.
True. the sulci tend to deepen and the width of gyri shrink
What are some possible etiologies of atrophy?
- decreased workload (ex. arm in a cast)
- loss of innervation
- decreased blood supply
- inadequate nutrition
- decreased hormonal stimulation
- aging
- local pressure
What is hypertrophy?
increase in cell SIZE and function with concurrent increase in organ size and/or function
What are the possible etiologies of hypertrophy?
- increased functional demand (hypertensive heart)
- increased or imbalanced nutrition
- increased hormonal stimulation (pregnancy, steroid use)
What is hyperplasia?
increase in cell NUMBER with concurrent increase in organ size and/or function
Traumatic Keratosis involves callus formation due to an increase in the number of cells. This is an example of ______
hyperplasia
What is metaplasia?
an alteration in cell DIFFERNTIATION with concurrent alteration of tissue/organ function
Give a common example of metaplasia.
- Smokers = squamous metaplasia of the bronchus…
the functional epithelium changes to a sturdy but non-functional epithelium - Gastric Reflux = intestinal metaplasia…
burning of stratified squamous epithelium and subsequent over production of mucus glands
Normal cellular accumulations include _____, lipids, ____, and carbohydrates.
water
proteins
True or False: Abnormal cellular constituents are always exogenous.
False: they can be exogenous or endogenous
True or False: Pigments and calcium are cellular accumulations.
True
What are the four mechanisms of intracellular accumulations?
- Abnormal metabolism
- Defective folding of proteins
- Lack of enzymes
- Ingestion of indigestible materials
In “fatty liver” there is an accumulation of _____.
triglycerides
What are xanthomas?
yellowish skin papules due to lipid (cholesterol) accumulation, often within macrophages
Alzheimer’s Disease and Mallory bodies are due to accumulation of _____.
protein
Von Gierke’s Disease is a glycogen storage disease that results from a decrease in what cellular activity?
decreased glucose 6-phosphatase
What is the common dental-related exogenous accumulation?
exogenous pigment= Amalgam Tattoo
To distinguish between melanoma and amalgam tattooing, the location of the pigment differs histologically: which pigment occurs at the border of the epithelium?
melanoma
Macules and Jaundice are two examples of _____ pigments.
endogenous
