1CHAPTER 1

Cell injury, Adaptation and Death Terminology: Pathology: Etiology: Pathogenesis: Necrosis: Apoptosis: Hyperplasia: Hypertrophy: Atrophy: Metaplasia: Causes of cell injury: hypoxia/ischemia - both result in decreased oxygen to a tissue. Most common cause o cell in!ury. hypoxia - loss o oxygen "may be caused by many things# anemia# pulmonary disease# etc$ ischemia - reduced blood lo% " causes hypoxia$ necrosis- tissue death due to prolonged ischemia or hypoxia chemicals "and drugs$ - any chemical# including %ater can be harm ul in certain circumstances. microbes - extremely &aried immunologic reactions - the immune system is protecti&e' but i it goes astray# can turn on the host. Ex.:Anaphylaxis is an acute allergic# potentially lethal# "immunologic$ response. Autoimmune diseases. All about loss o tolerance to host antigens. (he basis or many chronic diseases. genetic disorders - can be di&erse but )pure* genetic diseases account or only about 1+1,- o diseases. (hey may result rom chromosome abnormalities do%n to a single amino acid substitution. nutrition- malnutrition uncommon in this country. Probably &itamin de iciencies and intentional malnutrition "anorexia$ are most common. ).&er* nutrition o ar more concern in

%estern societies. physical agents - trauma# temperature# radiation# electrical# pressure aging - degeneration# reduced capacity to heal# cellular senescence.

Cellular Adaptation to njury "physiological and pathological$ Atrophy May exist at cellular or organ system le&el. /oss o mass due to decrease in cellular si0e. 1ell acti&ity reduced. !"ee #ig$ 1%&'

Hypertrophy An increase in the si(e o cells "and resultant increase in si0e o the organ$ Physiologic hypertrophy seen in the uterin %all during pregnancy "hormonal induced$. 2ncrease in muscle mass in exercise another example "cardiac muscle# too$. Mostly seen in organs made up o cells %ith limited capacity to replicate. Hyperplasia An increase in organ si0e due to increase in number o cells. Physiologic mostly related to hormones or compensatory reaction "breast hyperplasia during pregnancy an example$' endometrial hyperplasia %hen estrogen/progesterone out o balance. An example o pathologic hyperplasia. .ther examples o pathologic hyperplasia are HP3 in ections and neoplasia. Metaplasia (rans ormation rom one adult tissue type to another. A re&ersible process that is usually adapti&e "going rom a speciali0ed type o tissue to a more primiti&e type. 1an be seen in some )pre-malignant* situations such as s4uamous metaplasia in respiratory system in smo5ers. ntracellular Accumulations: (hree general path%ays normal endogenous substance but not remo&ed rom cell " atty li&er$ normal "or abnormal$ endogenous substance that cannot be metaboli0ed by cell exogenous substance %hich cannot be bro5en do%n by cell "blac5 lung$ (ypes o material accumulated: atty change - alcohol abuse most common cause - results in atty li&er. 2 se&ere# may result in scar ormation "cirrhosis o the li&er$ cholesterol - results in lipid stu ed macrophages creating ) oam* cells. Masses o these result in xanthomas. proteins mostly seen in 5idney and 6ussell bodies in plasma cells "immunoglobins$ glycogen glucose metabolic de ect "diabetes mellitus$ and glycogen storage diseases pigment - most common endogenous pigments are hemosiderin# melanin and lipo uscin. Exogenous pigments can be &aried# such as silica# asbestos.

Re)ersi*le and rre)ersi*le Cell njury: !see #ig$ 1%+' 7eneral Path%ays: 1. loss o osmotic pressure 8. reduced A(P production 9. reduced protein synthesis :. ;NA damage

,orphology of Cell njury: Morphologic eatures o 6e&ersible in!ury: cellular s%elling: hydropic change plasma membrane alteration "blebs and distortions$ mitochondria s%elling dilation o endoplasmic reticulum nuclear alterations atty change - intercellular at &acuoles Mani estations o cell death "2rre&ersible in!ury$--Necrosis (ypes o Necrosis: coagulati&e - proteins denature. 1ell outline aintly seen under microscope. usually results rom loss o blood supply to tissue "ischemia/hypxia$. Most common type o necrosis. eatures: 5aryolysis - ading o ;NA "stained tissue$ py5nosis- shrin5ing o nucleus 5aryorrhexis - ragmentation o nucleus li4ue acti&e - usually result o en0ymes "acute pancreatitis$ but may also occur in tissue %ith little ibrous connecti&e tissue such as brain. 2n ections may also cause li4ue acti&e necrosis. <een in abscesses. caseous - characteristic o (=. (issue has a cheesy consistency. gangrenous - a type o coagulati&e necrosis coupled %ith in ection. Apoptosis% programmed cell death$ !"ee #igure 1%- and Ta*le 1%1' A non-in lammatory cell death. ;i ers rom irre&ersible cell death due to en&ironmental insult.