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Tissues > T22 - Cell Injury I > Flashcards

T22 - Cell Injury I Flashcards

1
Q

What are physiologic adaptations?

A

response of cells to normal stimuli

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2
Q

What are pathologic adaptations?

A

response of cells to stress that allow them to modulate structure/function and escape injury

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3
Q

Give an example of a physiologic adaptation.

A

hormone-induced enlargement of uterus and breasts during pregnancy

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4
Q

Give an example of a pathologic adaptation.

A

reversible changes in number/size/metabolic activity of cells

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5
Q

What are the four primary morphologic adaptations to stress in cells?

A

hyperplasia

hypertrophy

metaplasia

atrophy

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6
Q

What cellular processes are associated with hyperplasia? (2)

A

DNA synthesis

mitosis

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7
Q

What cellular processes are associated with hypertrophy?

A

synthesis of cell components

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8
Q

What cellular processes are associated with metaplasia?

A

genetic reprogramming of stem cells

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9
Q

What cellular processes are associated with atrophy?

A

deeply eosinophilic cytoplasm

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10
Q

What is hyperplasia? (2)

A

increase in number of cells because of proliferation of differentiated cells by tissue stem cells

this is the response when cells are capable of division

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11
Q

What is hypertrophy?

A

cells can’t divide, so cells increase in size instead

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12
Q

What is metaplasia?

A

reversible change from one differentiated cell type to another (i.e. reprogramming of stem cells)

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13
Q

What is atrophy?

A

decrease in cell size because of loss of cell substance

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14
Q

Give an example of hormonal physiologic hyperplasia.

A

female breast enlargement at pregnancy and puberty

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15
Q

Give an example of compensatory physiologic hyperplasia.

A

liver regenerates after resection

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16
Q

Explain how hyperplasia differs from cancer.

A

if signal abates, hyperplasia disappears (hyperplastic responses remain controlled)

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17
Q

Give two examples of physiologic hypertrophy.

A

estrogen-stimulated smooth muscle hypertrophy in uterus during pregnancy

striated skeletal muscle hypertrophy in response to weightlifting

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18
Q

Give an example of pathologic hypertrophy.

A

left ventricle enlargement of heart (cardiomyocytes can’t divide) due to hypertension or aortic valve disease

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19
Q

What is the basis of metaplasia?

A

reprogramming of stem cells (not due to transdifferention)

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20
Q

Give three examples of metaplasia.

A

esophagus: stratified squamous → simple columnar
lungs: pseudostratified → stratified squamous
cervix: simple columnar → stratified squamous

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21
Q

What is the basis of atrophy?

A

decrease in cell size because of loss of cell substance

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22
Q

What system mediates the degradation associated with atrophy?

A

ubiquitin-proteasome pathway

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23
Q

Give two examples of physiologic atrophy that result from decreased work load.

A

immobilization of a limb (casts/arthritis)

space flight

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24
Q

What two factors can contribute to physiologic atrophy?

A

decreased work load

aging

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25
Q

Give an example of aging-induced physiologic atrophy.

A

postmenopausal atrophy of breast and vaginal tissue because of decreased hormone stimulation

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26
Q

What two factors contribute to pathologic atrophy?

A

loss of innervation

endocrine stimulation

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27
Q

Give two examples of pathologic atrophy resulting from loss of innervation.

A

neuromuscular disease

spinal trauma

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28
Q

Give an example of pathologic atrophy resulting from endocrine stimulation.

A

adrenal cortical atrophy secondary to exogenous steroids

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29
Q

What are the two primary causes of cellular injury?

A

hypoxia

ischemia

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30
Q

What is hypoxia?

A

oxygen deficiency due to interference with aerobic oxidative respiration

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31
Q

What is the most common cause of cell injury/death?

A

hypoxia

32
Q

What is ischemia?

A

loss of blood supply in tissue due to impeded arterial flow or reduced venous drainage

33
Q

What causes hypoxia? (3)

A

ischemia

pneumonia (inadequate oxygenation of blood)

reduction in oxygen-carrying capacity of blood

34
Q

What are the histological changes observed following reversible cell injury? (2)

A

cellular swelling: failure of ion pumps in plasma membrane

fatty change

35
Q

What are the electron microsocope changes observed following reversible cell injury? (4)

A

ER swelling

mitochondrial swelling

membrane blebs

clumped chromatin

36
Q

What is coagulative necrosis? (3)

A

cell is dead, but underlying tissue architecture intact

affected tissue is firm

characteristic of infarcts in all solid organs except brain

37
Q

What are three subtypes of coagulative necrosis?

A

gangrenous

dry gangrene

wet gangrene

38
Q

What is gangrenous coagulative necrosis?

A

type of coagulative necrosis applied to necrosis of distal limb

39
Q

What is dry gangrene?

A

results from loss of blood supply (common in DM patients)

40
Q

What is wet gangrene?

A

gangrene involving bacterial infection that has “wet” appearance due to release of bacterial enzymes and associated neutrophil response

41
Q

Define pyknosis.

A

irreversible condensation of chromatin in nucleus of cell undergoing necrosis or apoptosis

42
Q

Define karyorrhexis.

A

fragmentation of nucleus of dying cell in which chromatin irregularly distributed throughout cytoplasm

43
Q

Define karyolysis.

A

complete dissolution of chromatin of dying cell due to enzymatic degradation by endonucleases

44
Q

Where is caseous necrosis most commonly observed?

A

caseous necrosis most commonly seen in foci of tuberculosis infection

45
Q

Describe the histologic presentation of caseous necrosis. (2)

A

tissue architecture lost and replaced with amorphous pink material

surrounded by epithelioid cells and giant cells (granuloma)

46
Q

What is liquefactive necrosis?

A

transformation of the tissue into a liquid viscous mass, often in response to focal bacterial or fungal infection

47
Q

Define homeostasis.

A

ability of organism/cell to maintain internal equilibrium by adjusting physiological processes

48
Q

Describe the events that occur in liquefactive necrosis. (2)

A

microbes attract neutrophils

neutrophilic enzymes digest (liquefy) tissue, producing pus

49
Q

Hypoxic death in the brain is typically attributed to what cell adaptation?

A

liquefactive necrosis

50
Q

What is fat necrosis?

A

focal areas of fat destruction, typically resulting from release of activated pancreatic lipases into peritoneal cavity and mesenteric fat

51
Q

Give two examples of diseases/events that can result in fat necrosis.

A

acute pancreatitis

motor vehicle accidents

52
Q

In a gross specimen of the pancreas, what features indicate fat necrosis?

A

chalky white lesions scattered throughout tissue

53
Q

Describe the process of fat necrosis on a cellular level. (4)

A

lipases split TGs in adipocytes

liberated fatty acids combine with calcium

results grossly in chalky white areas (saponification of fat)

results histologically in basophilic calcium deposits

54
Q

What is fibrinoid necrosis?

A

immune reactions with deposition of antigen-antibody complexes in blood vessels

55
Q

Describe how fibrinoid necrosis is observed.

A

can only be observed histologically

immune complexes with fibrin that’s leaked from blood vessels produces bright, pink amorphous appearance

absence of nuclear material

56
Q

What is dystrophic calcification? (2)

A

serum calcium is normal

deposition of calcium in degenerating of necrotic tissue

57
Q

Give an example of dystrophic calcification.

A

deposition of calcium in arotic valve of person with left ventricular failure

[note: in the image, an antecedent bacterial infection damaged the valve]

58
Q

What is metastatic calcification?

A

serum calcium abnormal

ectopic calcification in setting of elevated serum calcium, caused by increased parathyroid hormone

59
Q

Give three examples of diseases/conditions that can lead to metastatic calcification.

A

primary parathyroid tumor

parathyroid related hormone (malignant tumors)

renal failure (phosphate retention causes secondary parathyroid hormone)

60
Q

What is the relationship between dystrophic and metastatic calcification?

A

metastatic calcification can exacerbate dystrophic calcification

61
Q

What are the symptoms of benign prostatic hyperplasia?

A

problems with urinary retention or urinating, caused by urinary obstruction

62
Q

What causes benign prostatic hyperplasia?

A

problem with the 5-alpha reductase enzyme, which converts testosterone to dihydrotestosterone

63
Q

What are the histologic changes associated with benign prostatic hyperplasia?

A

increase in glandular areas caused by papillary infoldings

intervening stroma that is smaller than normal

64
Q

What is the relationship between hypoxia and ischemia?

A

ischemia, a reversible injury, is the most common cause of hypoxia

65
Q

What are the two mechanisms that can lead to cardiac hypertrophy?

A

mechanical triggers, such as stretching

trophic triggers, such as growth factors or adrenergic hormones

66
Q

Describe how trophic triggers lead to cardiac hypertrophy. (4)

A

turn on genes → stimulate protein synthesis → more myofilaments → increased contractility to meet demand

67
Q

What are the histological changes observed following irreversible cell injury? (4)

A

disruption of cell membranes (leakage, dissolution)

pronounced eosinophilia (more eosin binding to cytoplasmic proteins)

changes to nucleus (shrinkage, breakdown)

inflammatory response (lysosomal enzymes)

68
Q

What are the electron microscope changes observed following irreversible cell injury? (3)

A

breaks in plasma membrane/organelle membranes

large amorphous densities in mitochondria

marked mitochondrial swelling

69
Q

(T/F) Pyknosis, karyorrhexis and karyolysis occur in sequence.

A

False. They do not happen in sequence. The order in which they occur depends on the injury and on time.

70
Q

What are the five common patterns of necrosis?

A

coagulative

caseous

liquefactive

fat

fibrinoid

71
Q

Necrosis most commonly results from (2)

A

metabolic failure

depletion of ATP

72
Q

What is an abscess?

A

inflammatory response to an infectious agent

73
Q

Caseous necrosis is most commonly observed in which organ?

A

lung

74
Q

Which forms of necrosis occur most commonly in the lungs? (2)

A

coagulative necrosis

caseous necrosis

75
Q

Which kind of necrosis commonly occurs in the brain?

A

liquefactive necrosis

Tissues (23 decks)

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