Path Final Additional cards Flashcards
What is hypertrophy?
1) General increase in the bulk, not due to tumor formation2) increase in size of cells not #
What happens to tissue once it stretches or stress is put on a tissue?
It will adapt to the stress
What is atrophy or hypotrophy?
wasting of tissue from death and reabsorption of cells, diminished cellular proliferation, decreased cellular volume, pressure, ischemia or malnutrition that leads to lessened function or hormonal changes
What causes atrophy in the brain?
Aging and reduced blood supply
How does a brain that has undergone atrophy appear grossly?
The brain has narrowed gyri and widened sulci
What causes atrophy of the thyroid gland?
Longstanding autoimmune disease
What is hyperplasia?
increase in # cells excluding tumor formation
What causes endometrial hyperplasia?
Estrogen.
What causes calluses on the heels of feet?
Stresses due to constant wear on feet (ie: tight shoes)
What is BPH?
Benigh Prostatic hyperplasia
What is hypoplasia?
incomplete development of tissue (ie: neural fold defects)
What is metaplasia?
reversible replacement of one differentiated cell type with another differentiated cell type (ie: barrett’s esophagus where cells have migrated from the stomach to the esophagus due to constant stress)
What is anaplasia?
A change in the structure of cells and a change in their orientation to each other.
What is aplasia?
The defective development, or congenital absence of an organ or tissue
What is dysplasia?
Abnormal tissue growth with loss of cell orientation, shape, and size
What is dysplasia?
Abnormal tissue growth with loss of cell orientation, shape, and size
Dysplasia is always what?
Pre-cancerous
What type of cell injury is found with lysosome swelling and rupture?
Irreversible as necrosis will occur
What cell injury occurs when fat calcification begins?
Irreversible
What happens to reversible damaged cells when looking at them with light microscope?
They have fatty changes (steatosis).
Is nuclear clumping the same as nuclear condensation?
NO!
What is the difference between necrosis and apoptosis?
Necrosis- common after ischemia and chemical injury CELL SWELLING. Apoptosis- is programmed cell death and CELL SHRINKAGE.
Does necrosis or apoptosis has neighbor or adjacent cell inflammation?
Usually necrosis
What happens to the plasma membrane during necrosis?
It is disrupted
What happens to the plasma membrane during apoptosis?
Intact/altered.
What happens with the cells contents with necrosis ?
enzymatically digested
What happens with the cells contents with apoptosis?
intact and packaged to be phagocytosed
What causes necrosis?
Inavriably pathologic
What causes apoptosis?
Often physiological
What does serum CK-MB check for?
Cardiac tissue ischemia
What does serum CK-BB check for?
Brain Tissue ischemia
What does serum CK-MM check for?
Generic muscle ischemia
What does cytochrome c do once it is outside of the mitochondrial membrane?
It induces secondary apoptotic effects
What are the sources of internal calcium?
1) mitochondrial damage2) cell injury (external calcium enters cell)3) ER damage
Where will Vitamin E be doing free radical protection?
In the membranes.
Glutothione is stored mostly where and to do what?
Stored in the retina to protect against all redox reactions.
What is the role of P-450?
Detox. It is enzymes that increase the solubility of compounds and help excrete them.
What is the down side of P-450?
While detoxing it can make some reactive oxygen intermediates which can injure cells.
Where are the P-450 enzymes found?
In the Smooth ER of hepatocytes.
What process is NADPH oxidase found in?
Pentose Shunt
Is iron required in the human body?
yes but excess can cause oxidative changes
Is copper required in the human body?
Yes but only in trace amounts
Free radical injury is induced through what?
membrane lipid peroxidation, protein modification, DNA breakage.
How are free radicals degraded?
Through enzymes, spontaneous decay, and antioxidants.
Why is homogenated milk bad for us?
Xanthine oxidase is better absorbed in body and causes more free radicals in circulation
Reperfusion after anoxia (an abnormally low amount of oxygen in the body tissues) induces what?
Free radical production.
What are some free radicals found in the body?
Super oxide, peroxide, hydroxide and nitrous oxide
What are some antioxidants that neutralize the free radicals in the body that are found in the cytosol?
Superoxide dismutaseGlutathionePeroxidaseFerritinCeruloplasminQuercitin
What is the function of ferritin?
Moves iron around the body
What is the function of ceruloplasmin
Transports copper around the body
Where is quercitin found?
in orange peel (white part)
What can initiate injury via free radicals?
Radiation exposure, metabolism of drugs (phase I), redox reaction, nitric oxide, transition metals, leukocyte oxidative burst
How do free radicals cause cell injury?
Through membrane lipid peroxidation, protein modification and DNA breakage
What are the different types of necrosis?
1) Coagulative2) Liquefactive3) Caseous4) Fat5) Fibrinoid6) Gangrenous
Coagulative necrosis happens with necrosis to what areas?
Heart, liver, and kidney.
Coagulative necrosis is a result of what?
Protein denaturation.
What will coagulative necrosis look like?
Preservation of basic cell outline for several days.
Liquefactive necrosis happens where?
Brain
Liquefactive necrosis is characteristic of what 2 things?
- Bacterial infection. 2. CNS stroke.
Liquefactive necrosis is a result of what?
Enzymatic digestion.
Gangrenous necrosis is associated with what area?
Limbs and GI tract.
Gangrenous necrosis usually results in what?
limb with loss of blood and Coagulation necrosis.
What is wet gangrene?
Coagulation necrosis with liquifactive action of bacterial infection and attracted leukocytes.
Caseous necrosis occurs due to what?
It is seen in tuberculosis infections.
What is the appearance of caseous necrosis?
Cheesy white appearance.
Caseous necrosis is a distinct form of which type of necrosis?
Coagulative necrosis
What is makes caseous necrosis a special form of coagulative necrosis?
Tissue architecture is obliterated unlike coagulative necrosis
How does Caseous necrosis look microscopically?
1) amorphus granular debris of fragmented coagulated cell2) amorphus granular debris enclosed within distinctive inflammatory border (granulmatous reaction)
Can scarring from caseous necrosis be seen via x-ray? And how long does scarring last?
Yes it can be seen in x-ray and the scarring remains with the patient for life
Fat necrosis occurs where?
In the pancreas
Is fat necrosis a typical necrosis pattern?
No
What will fat necrosis look like under microscope?
Foci of shadowy outlines of fat cells with basophilic calcium deposits surrounded by inflammatory reaction.
What will fat necrosis look like grossly?
Chalky area due to fat saponification
Is fat necrosis focal or widespread?
Focal area of fat destruction usually due to lipase release
What does P-450 do? What is an unfortunate result?
P-450 neutralizes toxins but creates free radicals
What is the stimulus for coagulative necrosis?
Hypoxia, toxins
What is the stimulus for apoptosis?
Physiologic and pathologic
What is the histology of the coagulative necrosis?
Cellular swellingcoagulative necrosisorganelle disruption
What is the histology for apoptosis?
Cellular shrinkageChromatin condensationApoptotic bodies
What is the DNA Breakdown in coagulative necrosis?
Random, diffuse
What is the DNA Breakdown in apoptosis?
Internucleosomal
What are the mechanisms of coagulative necrosis?
ATP depletionMembrane injuryFree radical damage
What are the mechanisms of apoptosis?
Gene activationEndonucleasesProteases
What is the tissue reaction of coagulative necrosis?
Inflammation
What is the tissue reaction of apoptosis?
No inflammationPhagocytosis of ABs
During what instances does apoptosis occur?
1) Embryogenesis2) hormone induction (menstruation)3) immune cell-mediated death4) injurious stimuli (ie: radiation, hypoxia)5) regulation of cell population and tumor suppression6) atrophy (ie: endometrial lining during menopause)
Which type of cell death is more controlled?
Apoptosis
Which type of cell death involves more cells?
Necrosis
What are the two types of pathologic calcification?
Dystrophic calcificationMetastatic calcification
Where does Dystrophic calcification occur?
Deposition occurring locally in dying tissue
What happens to the serum calcium level of the dystrophic calcification?
Nothing, it is normal serum calcium level
Is there any calcium metabolism pathology associated with dystrophic calcification?
No, no calcium metabolism pathology
What are some examples of dystrophic calcification?
Atherosclerosis of arteries, damaged heart valves
Where does metastatic calcification occur?
Deposition in otherwise normal tissue
What happens to the serum calcium level of the metabolic calcification?
Systemic elevation calcium levels in the blood and all tissues
What usually causes metastatic calcification?
Usually due to secondary hypercalcemia
What happens to calcium levels in injured cells with dystrophic calcification?
The calcium levels will increase due to release from ER and mitochondria
What happens to mitochondrial initiation with dystrophic calcification?
The mitochondrial permeability transition increases and therefore calcium diffuses through into the cell.
What is arachidonic acid?
Arachidonic acid is derived from phospholipids through the action of phospholipases
How is arachidonic acid metabolized?
1) Lipoxygenase pathway2) Cyclooxygenase pathway
What are the 5 arachidonic acid derivatives?
1) Leukotrienes2) Lipoxins3) Thromboxane4) Prostacyclin5) Prostaglandins
What is the function of leukotrienes?
Chemoxtaxis, vascular permeability and bronchospasm
What is the function of lipoxins?
vasodilatation, inhibition of neutrophil chemotaxis, and monocyte adhesion
What is the function of thromboxane?
Platelet aggregation, thrombosis
What is the function of Prostacyclin?
Opposes the effects of thromboxane
What is the function of Prostaglandins?
Smooth muscle contraction
Is Omega 3 fatty acids (fish oil) a good substrate for conversion?
No it is a poor substrate
Are animal fats good for conversion to substrate?
Yes, animal fat is a good substrate
Generally, what lymphokines are released with macrophage activation and lead to inflammation?
Interleukin-1 and Tumor Necrosis factor
What are the acute-phase reactions activated by interleukin-1 and tumor necrosis factor?
1) Fever2) increased sleep need3) decreased appetite4) Increased acute-phase proteins5) hemodynamic effects (shock)6) Neutrophilia (attract neutrophils)
What are the endothelial effects activated by interleukin-1 and tumor necrosis factor?
1) increased leukocyte adherence2) Increased prostacyclin synthesis3) Increased procoagulant activity4) decreased anticoagulant activity5) Increased Interleukin and platelet derived growth factor
What are the fibroblast effects activated by interleukin-1 and tumor necrosis factor?
1) increased proliferation2) increased collagen synthesis3) increased collagenase4) increased protease5) increased prostaglandin synthesis
What are the leukocyte effects activated by interleukin-1 and tumor necrosis factor?
Increased cytokine secretion (interleukin 6 and 8)
What does long term tumor necrotic factor production lead to?
Cachexia (wasting away syndrome)
What leads to the pathogenesis of fever?
TNF and IL-1 that changes the set point of internal temperature in the hypothalamus
What are two types of edema?
Exudate and Transudate
What is exudate made of?
It is rich in protein and blood cells and are typical of inflammation
What is transudate made of?
- Contains less protein and fewer cells
- an ultra-filtrate of plasma fluid
What is a typical cause of transudate?
Typical of hydrostatic or osmotic pressure pathology
What is the specific gravity of transudate?
Specific gravity is usually less than 1.012 and a protein content of less than 2gm/100mL
What are some factors towards the pathogenesis of Edema?
1) increase in hydrostatic pressure2) Increase in wall permeability3) Decrease oncotic pressure (decrease albumin concentration)4) Lymphatic obstruction
Is transudate hypocellular or cellular?
Hypocellular
Is transudate protein rich or poor?
Protein poor
What is the specific gravity of transudate?
Specific gravity <1.012
What is transudate due to?
Increased hydrostatic pressureDecreased Oncotic pressureNa+ retention
Is exudate hypocellular or cellular?
Cellular
Is exudate protein rich or poor?
Protein rich
What is the specific gravity of exudate?
Specific gravity >1.020
What is exudate due to?
Lymphatic obstruction or Inflammation
What are the 4 mechanisms of MMP regulation?
- regulation of synthesis by growth factors or cytokines. 2. Inhibition of synthsis by corticosteroids or TGF-beta. 3. secreted in inactive form. 4. Blockage of the enzymes by specific tissue inhibitors of metalloproteinase.
The inflammation phase of wound healing lasts how long?
3 days.
The granulation tissue phase of the healing process takes place when?
0.3 days until 10 days.
The wound contraction phase of the healing process takes place when?
3 days to 30 days.
What will clean up an injured site after the healing process?
Macrophages.
What type of scaring occurs with primary intention healing?
Minimal scarring
What type of scaring occurs with secondary intention healing?
Broader scar result of granulation
What type of scaring occurs with tertiary intention healing?
Wound is purposely left open
What type of injury is primary intention healing?
Little tissue loss.
Most surgical wounds heal by which intention?
Primary intention healing. (wound edges are directly next to each other)
How is a primary intention wound is closed?
By sutures, staples or adhesive.
What is allowed to happen to the wound with secondary intention healing?
It is allowed to granulate.
Why can the healing process be slower with secondary intention healing?
Due to the presence of drainage from infection and surgeons may pack the wound with gauze or use a drainage system.
How long will a tertiary intention scar be left open?
4-5 days.(where the wound is initially cleaned, debrided and observed before closure)
What is Keloid?
Excess collagen deposition in the skin forming a raised scar.
What is inflammation?
The reaction of the blood vessels, leading to the accumulation of fluid and leukocytes in the extravascular tissues
What is the function of inflammation?
A protective response- eliminate microbes and toxins- eliminate necrotic cells and tissues- prepare for tissue repair
What do neutrophils do?
First responder (acute inflammation) bacterial or fungal infection
What forms pus?
Increased activity and death of neutrophils
What general percentage of WBC’s do neutrophils make up?
60%
What do lymphocytes do?
Chronic inflammation- T cell and B cell response/activation
What general percentage of WBC’s do lymphocytes make up?
30%
What do monocytes do?
Long lived Phagocyte that present pathogen parts to T cells
What are monocytes when they are in tissue?
Macrophages
What general percentage of WBC’s do monocytes make up?
5-6%
What do eosinophils do?
Parasite and Allergic response
What general percentage of WBC’s do eosinophils make up?
2-3%
What do basophils do?
Allergic and antigen response and releasing the chemical histamine
What are basophils when they are in tissue?
Mast Cells
What general percentage of WBC’s do basophils make up?
<1%
What is the order from largest to smallest of the WBC’s?
NeutrophilsLymphocytesMonocytesEosinophilsBasophils(Never Let Monkeys Eat Bananas)
Where do T lymphocytes mature?
Thymus
Where do B lymphocytes mature?
Bone maroow
Are thrombocytes WBCs?
No they are platelets
What is the function of thrombocytes?
To plug up holes
What is the life span of an RBC?
120 days
What is the life span of WBC?
days to years
What is the life span of a platelet?
8 days
What are the two types of inflammation?
Acute and Chronic
What is the duration and onset speed of acute inflammation?
Rapid onset and short duration (min/hours/days)
Is there edema with acute inflammation?
Yes
What type of leukocyte is predominantly present with acute inflammation?
Predominantly neutrophils, but also eosinophils and antibody mediated
What is the duration and onset speed of chronic inflammation?
Slower onsetLong duration (wks, months, years)
What are some characteristic appearances of chronic inflammation?
Presence of new blood vessels, fibrosis, and tissue necrosis
What type of leukocyte is predominantly present with chronic inflammation?
Predominantly macrophages and lymphocytes
What are the key signs and symptoms of acute inflammation?
1) Redness2) Heat3) Swelling4) Pain5) Loss of function
What is the Latin term for redness?
Rubor
What is the Latin term for heat?
Calor
What is the Latin term for swelling?
Tumor
What is the Latin term for Pain?
Dolor
What is the Latin term for Loss of function?
Functio laesa
What vascular changes occur with inflammation?
1) Vascular dilation and increased blood flow (causing erythema and warmth)2) Extravasation and deposition of plasma fluid and proteins (edema)3) Leukocyte emigration and accumulation in the site of injury
What is the net flow of fluid of microvasculature in normal circulation?
Small flow out of the precapillary arteriole but returned in the precapillary venuole
What happens to the net flow of the microvasculature with acute inflammation?
Arteriole pressure is increased and the mean capillary pressure is increased due to arteriolar dilation. The venous pressure increases and the osmotic colloidal pressure is reduced due to protein leakage across the venule which results in an excess of extravasated tissue
What is oncotic pressure?
Pressure bringing in fluid into vasculature from tissue due to albumin concentration
What causes oncotic pressure?
Albumin concentration
What controls arteriole pressure?
Sphincters of muscles that clamp off blood flow
What collects the small flow out of the capillary bed?
Lymphatic system
What is hyperemia?
Increased blood flow
What occurs with the precapillary sphincter during normal circumstances?
The precapillary sphincters are closed
What occurs with the precapillary sphincter during acute inflammation?
The precapillary sphincters are open