PATHOPHYSIOLOGY

Cellular Injury, Adaptation, and Maladaptive Changes Chapter 2

etiology – the original cause of cellular alteration or death.

Cells exhibit characteristic changes associated with specific etiologic agents or changes in their environments.

Under the influence of different etiological agents, cells can do 1 of 2 things

1. Develop adaptive, compensatory changes in an attempt to maintain homeostasis
2. Develop maladaptive changes → derangements of structure or function.

Basic Concepts of Cellular Adaptations and Maladaptive Changes

The study of specific cell alterations assists clinicians in predicting the etiology and predicting the consequences
of cellular changed.
Histology – the microscopic study of tissues and cells.
Biopsy – extracts a cell sample from an organ or mass of tissue to allow for histological examination.
Pathognomonic changes – histological findings that represent distinct disease processes.

The Most Common Adaptive and Maladaptive (Clinically)

 Atrophy – Cellular adaptation in which cells revert to a smaller size in response to changes in metabolic
requirements or their environment.
- Smaller size = less demand
Example: Shrinking of skeletal muscle cells in a person with lower extremity paralysis.
Disuse/diminished workload
Loss of hormonal stimulation
Inadequate nutrition
Ischemia
Aging

 Hypertrophy – an increase in individual cell size which results in a enlargement of functioning tissue
mass.
- ↑ cells functional components = greater metabolic demands and energy needs.

Physiological Hypertrophy (Exercise)

- Normal physiological stimulus
- Enhances the functional components of each cell
- Increases the number of blood vessels that perfuse the enlarged muscle
 angiogenesis – the growth of new blood vessel branches.
- Increase in mitochondrian = ↑ energy production

Pathological Hypertrophy
- Increase in cellular size when there is not an increase in the supportive structure necessary for the
enlarged cell’s increased metabolic needs.
- Can either be as a result of disease process or a compensatory maladaptation to environmental
conditions.
Example: HTN - ↑ BP in aorta and systemic circulation = higher workload for L ventricle. Although each
cardiac muscle cell increases in size but there is no corresponding increase in blood vessel growth to
supply these muscle cells. Coronary blood flow is outgrown = ischemia – inadequate blood flow.

 Hyperplasia – an increase in the number of cells in a tissue or organ. Characteristic of mitotic cells
(epithelium, glandular)

- Stimulated by hormonal or compensatory cellular mechanisms.

Example: Estrogen in pregnancy stimulates mitotic division of breast gland cells.
BPH in elderly males

- Can occur as a maladaptive compensatory mechanism by exceeding the cell mass necessary for
regeneration.
Example: keloid

 Metaplasia – replacement of one cell type by another cell type.

- Occurs in response to chronic inflammation.
Example: GERD – Acid reflux in to the lower esophagus. Acid irritate the lower esophageal cells
causing inflammation. Squamous epithelial cells → Columnar stomach-like cells =
Barrett’sesophagus (can turn to CA)

 Dysplasia – deranged cellular growth within a specific tissue as a result of chronic inflammation or a
precarious condition.
- cells vary in size, shape, and architectural organization.
Example: Cervical dysplasia

 Neoplasia – means new growth and usually refers to disorganized, uncoordinated, uncontrolled
proliferative cell growth that is cancerous.
- Tumor/neoplasm are synonymous
- Benign
o Dependent upon differentiation → process whereby newly growing cells acquire the
- Malignant specialized structure of the cells they replace.
Basic Concepts of Cellular Injury – occurs when cells are exposed to a severe stress that no
longer allows them to maintain homeostasis which results in structural and functional changes.

 Dysfunction of the Na+ K+ Pump – caused by the cell’s inability to produce sufficient ATP and this
contributes to failure of active transport mechanisms like the sodium/potassium pump.
 Na+/K+ ATPase normally expels 3 Na+ from the intracellular environment
Pumps 2 K+ ions in

(Na+ is major extracellular and K+ is major intracellular)

Complication: Swelling

 Calcium pump – maintains intracellular calcium at low levels.

 Loss of Plasma Membrane Integrity