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Cellular Injury Flashcards

1
Q

What are the two major forms of cell death

A
  • Necrosis

- Apoptosis

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2
Q

List the 6 types of necrosis

A
  • Coagulative
  • Colliquative
  • Caseous
  • Gangrenous
  • Fibrinoid
  • Fat
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3
Q

When does coagulative necrosis occur

A

Ischaemic injury (except in the brain)

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4
Q

When does colliquative necrosis occur

A

Seen in the brain due to a lack of supporting stroma

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5
Q

What is caseous necrosis characteristic of

A

TB

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6
Q

Why is gangrenous tissue black

A

Due to iron sulphide from degraded Hb

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7
Q

What bacteria causes Gas Gangrene

A

Clostridium perfringens

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8
Q

What type of necrosis is associated with Malignant hypertension

A

Fibrinoid

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9
Q

Describe Fibrinoid necrosis

A

Necrosis of arteriole smooth muscle wall with seepage of plasma into the tunica media and deposition of fibrin

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10
Q

Define Apoptosis

A

Energy-dependent process for the deletion of unwanted individual cells. It is characterised by the activation of endogenous endonuclease.

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11
Q

What is the role of p53

A
  • Checks the integrity of the genome prior to mitosis

- Switches cells with damaged DNA into apoptosis

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12
Q

What is the role of bcl-2

A

Inhibits apoptosis

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13
Q

List the morphological features of apoptosis

A
  • Cell shrinkage with intact plasma membrane
  • Nuclear shrinking (pyknosis)
  • Nuclear fragmentation
  • Margination of chromatin
  • Surface blebbing of a cell
  • Formation of apoptotic bodies
  • Fragments are either shed or phagocytosed
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14
Q

Outline the differences between the fates of dead cells that underwent apoptosis vs necrosis

A
  • Apoptosis = phagocytosed by neighbouring cells

- Necrosis = phagocytosed by neutrophils and macrophages

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15
Q

In terms of the process of healing, what is meant by regeneration

A

Total healing of a wound with restitution of the original tissues in their usual amounts, arrangement and function

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16
Q

In terms of the process of healing, what is meant by repair

A

The process where the original tissue is not totally regenerated and the defect is made good to a variable extent by scar tissue

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17
Q

How are cells classified according to their capacity to renew

A
  1. Labile cell
  2. Stable cell
  3. Permanent cell
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18
Q

Which cell type has the greatest capacity to renew

A

Labile cell

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19
Q

Give examples of labile cell tissues

A
  • Skin
  • Oesophagus
  • Vagina
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20
Q

Give examples of stable cell tissues

A
  • Liver

- Renal tubular epithelium

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21
Q

Give examples of permanent cell tissues

A
  • Nerve
  • Striated muscle
  • Myocardium
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22
Q

Outline the process of organisation in tissue repair

A
  1. Fibrinous exudate produced
  2. Removal of fibrin, dead tissue, and phagocytes
  3. Migration of fibroblasts and capillaries forming granulation tissue
  4. Replacement of exudate by vascularised fibrous tissue
  5. Eventually a collagen-rich scar develops
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23
Q

What does granulation tissue consist of

A
  • Capillary loops

- Myofibroblasts

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24
Q

What complications are associated with organisation in wound healing

A
  • Abdominal adhesions

- Constrictive pericarditis

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25
Outline the process of wound healing by primary intention
- Edges of wound opposed - Fibrin 'sticks' edges together - Capillaries bridge tiny gap - Fibroblasts invade fibrin network - Suitable strength regained within 10 days - Remodelling occurs from then on
26
Outline the process of wound healing by secondary intention
- Tissue loss - Phagocytes remove any debris - Formation of granulation tissue in base of wound - Myofibroblasts cause wound contraction - Re-epithelialisation covers defect - Scar tissue formation
27
What causes Keloid scarring
Excessive fibroblast proliferation and collagen production
28
What differentiates Keloid scars from Hypertrophied scars
Collagen deposition beyond the confines of the wound
29
What is the outcome of Hypertrophied scars
Usually settle spontaneously within 18 months
30
What type of insult is most likely to cause a Keloid scar
Burns
31
List the stages of skin graft 'take'
1. Adherence 2. Plasmic imbibition 3. Inosculation
32
What occurs during the adherence stage of skin graft 'take' and how long does this take
- Fibrin bonds the graft to the recipient site | - <12 hours
33
What occurs during plasmic imbibition stage of skin graft 'take' and how long does this take
- Graft absorbs essential nutrients from recipient bed | - 24-48 hours
34
What occurs during inosculation stage of skin graft 'take' and how long does this take
- Revascularisation of the graft | - 48-72 hours
35
Which type of skin graft 'takes' better and why
Split thickness - thinner and therefore more likely to survive the imbibition phase
36
When will primary bone healing occur
When strain is <2%
37
When will secondary bone healing occur
When strain is 2-10%
38
What are the 3 phases of secondary bone healing
1. Inflammatory phase 2. Reparative phase 3. Remodelling phase
39
By what method does primary bone healing occur
Haversian remodelling
40
What occurs during the inflammatory phase of secondary bone healing
- Haematoma forms and provides a source of haematopoetic cells capable of secreting growth factors - Macrophages, neutrophils and platelets release several cytokines - Fibroblasts and mesenchymal cells migrate to the fracture site and granulation tissue forms around fracture ends
41
When does the inflammatory stage become fully established
Within 7 days
42
What occurs during the reparative phase of secondary bone healing
- Primary callus forms within 2 weeks - Bridging of soft callus forms if bone ends not touching - Fibroblasts lay down disordered matrix of Type 2 collagen - Endochondral ossification mineralises the soft callus to form hard callus and woven bone
43
When does hard callus begin to form
14 days post-fracture
44
What occurs during the remodelling phase of fracture healing
- Begins midway through repair phase | - Woven bone is converted to lamellar bone with ordered architecture
45
What is Wolff's law
Change in the internal structure of bone in response to load
46
Where are the osteoblasts that produce new bone derived from
Periosteum
47
When may complete restitution occur in liver damage
If the damage is confined to the hepatocytes only
48
What occurs to cardiac cells when damaged
Replaced with scar tissue
49
How do GI mucosal ulcers heal
- Granulation tissue in the base | - Centripetal growth of surface epithelium
50
What nutritional deficiencies can negatively impact wound healing
- Vitamin C deficiency | - Zinc deficiency
51
What are the three types of radiation-induced DNA damage
1. Strand breaks 2. Base alterations 3. Cross-linking
52
What is the effect of radiotherapy on the bone marrow
- Suspends renewal of all cell lines - Granulocytes are reduced before erythrocytes - Increased incidence of leukaemia in long-term survivors
53
What is the effect of radiotherapy on the intestines
- Loss of surface epithelium causes diarrhoea | - Full thickness damage causes fibrosis and stricture formation
54
What tissue have the most marked acute response to radiotherapy
- Gut epithelium - Bone marrow - Skin - Gonads
55
What is the effect of radiotherapy on the kidneys
- Gradual loss of parenchyma results in loss of renal function - Endarteritis obliterans of small vessels will cause intrarenal artery stenosis and HTN
56
What constitutes a low-voltage electrical injury
<1000 volts
57
What constitutes a high-voltage electrical injury
>1000 volts
58
How may high-voltage electrical injuries affect the kidneys
Rhabdomyolysis
59
What is used to treat hydrofluoric acid burns
Calcium gluconate (as can cause lethal hypocalcaemia)
60
Outline the 3 components of Jackson's burn wound model
1. Zone of necrosis 2. Zone of stasis 3. Zone of hyperaemia
61
What occurs in the zone of necrosis
- Area of maximum damage | - Rapid and irreversible cell death due to coagulation of cellular proteins
62
What occurs in the zone of stasis
- Adjacent to the zone of necrosis - Compromised tissue perfusion due to damaged microcirculation - Can progress to necrotic tissue if left untreated
63
What occurs in the zone of hyperaemia
- Outermost burn zone - Tissue perfusion is increased due to local inflammatory mediator release - Usually completely recovers
64
What factors can cause progression of the zone of stasis to necrosis
- Hypoperfusion - Infection - Oedema
65
At what extent of burn coverage is a systemic response seen
20%
66
What are the features of superficial epidermal burns
- Erythema - No blistering - Good capillary refill - Painful - NOT included in TBSA calculations
67
What are the features of superficial dermal burns
- Pink - Blistered and oedematous - Good capillary refill - Extremely painful
68
What are the features of deep dermal burns
- Red - Fixed staining or petechial points - Reduced or absent capillary refill - Reduced or absent sensation - Less painful
69
What are the features of full-thickness burns
- Appear thick - Can be white or black - Absent capillary refill - Absent sensation - Painless

Pathology (7 decks)

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