Paramedic Care: Principles & Practice

Volume 1 Introduction to Advanced Prehospital Care

Chapter 8 General Principles of Physiology and Pathophysiology

Chapter 8, Part 1 The Cell and the Cellular Environment

Part 1 Topics     The Normal Cell How Cells Respond to Change and Injury The Cellular Environment: Fluids and Electrolytes Acid-Base Balance .

CELL THEORY All Living Things Are Composed of Cells  Cells Are the Functional Unit of the Body  Continuity of Life: Cells come from other cells  .

CELL DIVERSITY  Human Body contains 50-106 trillion cells  200 different cell types  Range from 2 micrometers to 1 meter in length .

The Normal Cell .

Three main elements:    Cell membrane Cytoplasm Organelles .The Normal Cell   The cell is the fundamental unit of the human body.

Cellular Components  Membrane encircles and protects the cell.  The membrane is selectively permeable  Cytoplasm viscous fluid that fills and gives shape to the cell  Electrolytes. and lipids  Organelles  Structures that perform specific functions within the cell . proteins. glucose (sugar).

The Cell Membrane .

Organelles       Nucleus Endoplasmic reticulum Golgi apparatus Mitochondria Lysosomes Peroxisomes .

site of ribosome assembly Multinucleate . the nuclear envelope Contains genetic information (DNA) in the form of genes Nucleolus .many nuclei Anucleate .no nucleus .NUCLEUS       Cell control center.directs activities Bounded by a double membrane.


CYTOPLASM  Cell forming material    viscous transparent fluid organelles .“little organs” Inclusions .chemical substances that may be stored in the cytoplasm .

sort and modify proteins and lipids for export or cell use .series of flattened membrane sacs that process.synthesize proteins Golgi apparatus .ORGANELLES  Endoplasmic reticulum   rough ER .lipid synthesis & drug detoxification   Ribosome .transport & membrane synthesis smooth ER .




digest bacteria Microtubules / Microfilaments .often single. short.ORGANELLES    Mitochondria . transport substances across the membrane Flagella .contain hydrolytic enzymes that break down molecules. used to propel the cell .ATP formation Lysosome .form part of the cytoskeleton that serve as support structures and assist with cell movement   Cilia -numerous.



contain enzymes that oxidize toxic substances (neutralize free radicals) Centrosomes/centrioles .Vacuoles. may contain:  fats. Vesicles. oils.ORGANELLES    Peroxisomes .function in cell division Storage organelles . melanin .


2 m) determined by space needed for ribosomes.Size does matter!    Cells range from 1–200 m Lower limit (0. Upper limit determined by need to transport materials across surface  Large cells have lower surface to volume ratio . DNA.

5 µm no organelles.Prokaryotic Cell Structure  bacteria & archaea      very small 0. internal membranes rare DNA localized in nucleoid region. NO NUCLEUS growth due to increase in numbers rather than size high surface to volume ratio .5 .

Eukaryotic Cells  Internal membranes form different compartments to carry out specific activities     Energy metabolism Protein processing Recycling Information storage .

Essential Chemistry .

Atom acquires a net charge. A charged atom or group of atoms is called an ion.charge) become imbalanced. .Ions/Ionic bonds  Some atoms can donate or accept electrons     # of protons (+ charge) and electrons (. Oppositely charged atoms are attracted to each other. forming an ionic bond.

S – 2 bonds H – 1 bond .Covalent Bonds    Some atoms share electrons – forming covalent bonds Shared electrons spend time orbiting both atoms Important elements     C – 4 bonds N – 3 bonds O.

Polar Covalent Bonds    Some atoms such as O. N attract electrons strongly Unequal sharing of electrons creates partial charges at ends (poles) of covalent bond Opposite partial charges on the same or separate molecules are attracted to each other – forming hydrogen bonds (H-bonds) .

Water molecules stick to each other and to other things.Why is water special?    Water is a polar molecule.      Surface tension adhesion. capillary action and redwood trees collapsed lungs surfactants cohesion . Two ends of molecule have opposite charges.

.Water as a solvent    Water can interact with other polar substances. therefore they dissolve well Charged on ions are stabilized by partial charges in water Non.polar molecules do not interact with water.

Hydrophobic “interactions”   Substances that do not interact with water referred to as hydrophobic hydrophobic molecules are aggregated to minimize disruption of water’s H-bonding network. .

 The whole is greater than the sum of its parts.Major Theme!!  Nature builds “big” things by organizing and connecting “little” things. Societies  Families  individuals/organisms  organs  tissues  cells  molecules  .

fructose Monosaccharide = 1 sugar .glucose.Hydrated Carbon    Carbohydrates have a base formula of (CH2O)n names end with “ose”. ribulose.g. hexoses – (n=6) . .pentoses (n=5) – Ribose. e.

Macromolecules .

The most important chemical reactions in living organisms    Condensation .monomers  polymer . Hydrolysis .Removal of H and OH from two separate molecules forms water and connects the two molecules.Water used to split a molecule Can be continued ad infinitum .

Disaccharides   2 monosaccharides can be linked to form a disaccharide Oligosaccharides contain several different sugars linked in different types of linkages.  Present on cell surface proteins and lipids. .

starch (plants) and cellulose (plants). Glucose is used to produce glycogen (animals).Polysaccharides   Sugars (monosaccharides) can be connected to form polysaccharides – usually only 1 or 2 types of linkage. .

wood.allows more rapid breakdown to individual sugars . difficult to breakdown. paper.  Fiber in the diet. sheep) with cellulose degrading bacteria  Starch & Glycogen . Extra stomachs in ruminants (cows. but sugars are linked differently.Polysaccharides  Cellulose is also a polymer of glucose.branching creates more ends .

deoxyribose Base . NADP carry electrons .Nucleotides (nts)     Sugar GTP .ribose vs.C.regulates protein activity NAD.G and T (DNA) or U (RNA) Phosphates . 2 (di) or 3 (tri) Important nts    ATP .1 (mono).

Nucleic Acids  Nucleotides are linked together via dehydration synthesis reactions   sugar phosphate backbone bases project to side   RNA has one strand DNA is double stranded .

. directionality 20 different amino acids have “R groups” or “side chains” with different chemical properties. Linkage by peptide bonds maintains amino and carboxyl termini.Proteins are polymers of amino acids    Amino acids are connected together to form a chain linked by peptide bonds.

glycerol + 2 fatty acids + phosphate + something else. amphipathic  hydrophobic tail + hydrophilic head .Phospholipid structure   Phospholipids .

Lipid Bilayers  When mixed with water. exposed to water. Hydrophobic portion in central region.  Lipid bilayers form the basis of membrane structure .   Hydrophilic portion of phospholipid on surface. phospholipids spontaneously form a lipid bilayer. away from water.

Triglycerides = Fats/Oils  Triglycerides = glycerol + 3 fatty acids  Function as energy storage and insulation .

fat     less than maximum number of hydrogens double bonds present less energy storage more fluid because bent vegetable oils .Saturated vs. Unsaturated Fats  Saturated     Unsaturated    maximum number of hydrogens no double bonds more energy storage (more calories) less fluid because straight butter. lard.

vitamin A. K Sterols   cholesterol.carotene. testosterone. cortisone . estrogen. E. a component of membranes steroid hormones.Other Lipids   Isoprenoids .

good cholesterol vs. bad cholesterol  Good cholesterol   Bad cholesterol    bound to high density lipoprotein (HDL) transports cholesterol to liver blocks synthesis of more cholesterol   bound to low density lipoprotein (LDL) transports cholesterol to cells of the body does not prevent synthesis of more cholesterol by liver .

hydrophilic part associates with water to allow grease to be washed away emulsification .1 fatty alcohol.allows oil and water to mix often forms micelles  detergents . very hydrophobic  surface of leaves. ear wax amphipathic .Other lipids  Waxes .fatty acid salt    .hydrophobic part associates with grease on your jeans.

Fat substitutes .Olestra    Olestra = sucrose + 8 fatty acids not absorbed by digestive track Advantage(s)  can be used to fry foods without adding calories negative nutritional value .prevents absorption of many fat soluble vitamins that help prevent cancer diarrhea oily anal leakage  Disadvantages    .

Differentiation. or maturation.Cell Function    All human cells have the same general structure and genetic material. There are seven major functions of cells. . causes cells to become specialized.

Major Functions of Cells        Movement Conductivity Metabolic absorption Secretion Excretion Respiration Reproduction .

Four basic types of tissue     Epithelial Muscle Connective Nerve .Tissues   Tissue refers to a group of cells that perform a similar function.

TISSUE ORGANIZATION Histology .is the study of tissues .

MAIN TISSUE TYPES     Epithelial Connective Muscle Nervous .

or covering body surfaces Form many glands .EPITHELIAL TISSUE  Location   sheets or layers lining body tubes. cavities.


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Form sheets, layers Cells fit together tightly One edge attached to basement membrane No blood supply Regenerate quickly Many are secretory Supported by connective tissue


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Protection Absorption Filtration Secretion Gas exchange


Number of layers
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simple epithelium stratified epithelium pseudostratified epithelium squamous (flat) cuboidal ( cubed) columnar ( tall) transitional (varies)

Shape of cells
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secrete through ducts to specific locations unicellular .Glandular Epithelial Tissue Types   endocrine (ductless) .accumulate until rupture  merocrine -most common.“goblet cells”  multicellular   modes of secretion  apocrine .apex pinches off  holocrine .secrete by exocytosis .secrete hormones into blood exocrine.

CONNECTIVE TISSUE Most abundant and widespread tissue found in the body .

GENERAL CHARACTERISTICS        Many types with great diversity Very good blood supply Cells usually spaced apart from each other Intercellular material (matrix) separating cells No free surface Derived from mesenchyme Consist of ground substance. cells . fibers.

Connective Tissue Functions         Physical protection Support Binding Absorb shock Insulation Stores energy Blood production Immunity .

forms network mesh  .Types of Fibers  Collagen .very tough and strong  contains collagen protein contains elastin protein contains collagen & glycoprotein  Elastic .very flexible and stretchable   Reticular .

energy storage.Connective Tissue Proper  Loose Connective(Areolar) .attaches skin to underlying body parts. superficial fascia Adipose .binds smooth muscles together   . insulation Reticular .






lung tissue  Irregular dense   Elastic connective  . ligaments fascia. Regular dense connective tissue(fibrous)  tendon. periosteum blood vessels.




Cartilage  Hyaline cartilage (gristle)  ends of long bone. connects ribs to sternum external ear  Elastic cartilage   Fibrocartilage   between pubic symphysis discs between vertebrae . nose tip.





BONE MATRIX 30% collagen fibers 70% mineral salts .OSSEOUS TISSUE .

Osseous Tissue  Types of Cells    osteocytes osteoblasts osteoclasts Cancellous (Spongy) Bone .trabeculae Compact Bone .Haversian Canal System  Types of Bone   .



Blood Tissue (Vascular)   Hemopoietic Tissue (blood forming tissue) Types of Cells:    erythrocytes (RBC’s) leukocytes (WBC’s) platelets (thrombocytes) .



MUSCLE TISSUE Contractile tissue Responsible for movement .

Voluntary  Long. striated   Usually attached to long bones . threadlike cells with parallel fibers Cells are multinucleate with nuclei located peripherally.Skeletal Muscle .

Smooth Muscle - Involuntary

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Spindle shaped cells with single nucleus per cell No striations Located in blood vessels, walls of hollow organs, and the gastrointestinal tract



Involuntary     Branched cells with striated fibers Intercalated discs Only a single nucleus per cell Only found in the heart .Cardiac Muscle .



NERVE TISSUE Characterized by the ability to conduct electrical signals .

Nervous Tissue

Located in the brain and spinal cord (CNS) and in the nerves (PNS) Sensitive to changes in the internal and external environment Conducts nerve impulses to other neurons/body parts


Functions in coordinating, regulating, and integrating body activities Types of Cells:
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neuroglial cells - support cells neuron - cell body, axon, dendrites

MEMBRANES Thin sheet or layer of tissue that covers a structure or lines a cavity .

skin Serous membrane .covers organs   Mucous membrane .mucosa  line cavities that open to the exterior .lines inside of cavities  visceral membrane .Epithelial Membranes   Cutaneous membrane .(serosa)  found in closed cavities parietal membrane .

Connective Tissue Membranes  Synovial Membrane   line spaces between bones in joints secrete synovial fluid .

tissues. and organ systems makes up an organism. The sum of all cells. A group of organs working together is an organ system. and the Organism    An organ is a group of tissues functioning together. Organ Systems. organs.Organs. .

Organ Systems      Cardiovascular Respiratory Gastrointestinal Genitourinary Reproductive      Nervous Endocrine Lymphatic Muscular Skeletal .

.  Cells do not tolerate extreme environmental fluctuations.System Integration  Homeostasis is the body’s natural tendency to keep the internal environment and metabolism steady and normal.

System Integration  Two systems work together to maintain homeostasis:   Nervous system Endocrine system    Nervous system response is fast Endocrine response is longer lasting Responses are stimulated by pathological alterations .

the chemical signals and other stimuli    Chemoreceptors Baroreceptors Alpha and Beta Receptors . and then respond to.System Integration  Chemical signals are received by various types of receptors  Interact with.

System Integration  Endocrine Glands  Secrete hormones directly into the circulatory system Secrete hormones directly onto surface Endocrine and exocrine function  Exocrine Glands   Some glands are “mixed”  .

Intercellular Communication  Endocrine signaling  Hormones distributed throughout the body Secretion of chemical mediators by certain cells that act only upon nearby cells Cells secrete substances that act upon themselves Cells secrete neurotransmitters that transmit signals across synapses  Paracrine signaling   Autocrine signaling   Synaptic signaling  .

A system receiving input creates feedback. Biological systems generally employ negative feedback loops to maintain stability. . A negative feedback loop exists when body mechanisms work to reverse the input.System Integration     Stressors on a body system are inputs.


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“The physiology of disordered function” Our understanding is constantly expanding During your career you will encounter patient conditions or diseases that were not addressed in your initial paramedic education.

How Cells Respond To Change and Injury

Cell Reproduction

Human cells (except sex cells) reproduce by mitosis Most undergo division throughout the life of the individual
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Epithelial cells Liver cells Bone marrow cells Nerve cells Skeletal muscle cells
Copyright © 2006, 2001, 1994 by Mosby, Inc. All rights reserved.

Some divide until near time of birth
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mitosis.CELL DIVISION      Process by which a cell reproduces itself Involves nuclear division .reductional division in which the chromosome number is reduced .somatic cell division in which the cell retains the same number of chromosomes Meiosis . meiosis Involves cytoplasmic division cytokinesis Mitosis .

CELL CYCLE      Growth Phase 1 .synthesis of lipids.DNA synthesis Growth Phase 2 .formation of spindle fibers for cell division. centrioles divide Mitosis / Meiosis INTERPHASE . proteins and carbohydrates S Phase .



PROPHASE       Chromatin condenses into chromosomes Spindle Fibers appear Nuclear membrane disappears Nucleolus disappears Centrioles move to opposite poles Chromosomes begins to migrate toward equator .


METAPHASE / ANAPHASE   Chromosomes line up along equator centromere of each pair attached to a spindle fiber   Centromeres split. sister chromatids separate Chromatids migrate to opposite poles .



TELOPHASE & CYTOKINESIS      Opposite of Prophase Chromosomes elongate forming indistinct chromatin Nuclear membrane reappears Nuclear reorganization occurs Two new daughter cells formed .



functions in the process of protein synthesis .NUCLEIC ACID STRUCTURE   DNA .forms genetic code RNA .

nucleus Contains: 5 carbon sugar. nitrogenous base Nitrogenous bases   adenine-thymine cytosine.DNA DEOXYRIBONUCLEIC ACID    Double stranded helix. phosphate group.guanine  Base pairing occurs .


helix molecules are formed. each contains an original strand and a newly synthesized strand .DNA RELICATION    DNA makes an exact duplicate of itself DNA strands separate into separate strands and each one is used as a template for a new strand of nucleotides Two double.


uracil RNA types: mRNA. guanine. phosphate group.RNA RIBONUCLEIC ACID      Single stranded Uracil substitutes for thymine consists of 5 carbon sugar ribose. nitrogenous base Bases: adenine. tRNA. cytosine. rRNA .

TRANSCRIPTION RNA SYNTHESIS   mRNA is synthesized using a DNA molecule as a template mRNA carries MESSAGE out of the nucleus to the ribsome in the cytoplasm .


A. to the ribosome for placement in the dictated sequence Ribosome bonds amino acids together to form proteins / polypeptides Protein is released .TRANSLATION PROTEIN SYNTHESIS      Genetic code is translated forming a specific sequence of amino acids mRNA attaches to the ribosomes in the cytoplasm tRNA molecules bring specific A.

membranes    Lipid bilayer closes to form a sphere (vesicle) Inside of vesicle is a separate compartment Bilayer is “semipermeable”   Small. uncharged molecules pass through Large or charged molecules cannot pass through hydrophobic part of bilayer .Loose end .

******* .200. Different amino acids have different chemical properties.    Hydrophobic amino acids are buried in the center Hydrophilic are on the surface Ionic and H-bonds can form between amino acids  Function is dependent on folded structure.000 combinations for a 5 aa protein).Loose end– protein folding   Proteins are incredibly diverse – 20(# of amino acids) possible combinations (3. which is dependent on sequence of amino acids. causing polypeptide chain to fold up on itself.

Loose end– enzymes    Enzymes are proteins that catalyze (stimulate/ accelerate) chemical reactions Names end in -ase Examples    DNA polymerase makes DNA ATPase breaks down or produces ATP Helicase unwinds the DNA double helix  Metabolic pathway is a series of reactions that produces (anabolic) or breaks down (catabolic) a molecule in the cell  Defects cause genetic diseases .

series of symbols that have meaning.Info Flow . . Digital – 1’s and 0’s Alphanumeric – letters and numbers Graphic – illustration Genetic – chemical – order of bases (ACGTU) in a nucleic acid tells a cell how and when to make specific proteins – which then perform some function for the cell. thoughts.What Information?  What is information?      Representation of knowledge.

Storage of Information   Information is stored in the sequence of bases in DNA.when and where to make proteins  only bone marrow cells make hemoglobin . What Information?  Genes .instructions on how to make proteins  hemoglobin gene contains the information on the order of amino acids that are linked together to make hemoglobin  Regulation .

G Pyrimidines (1 ring) = C.DNA  DNA = deoxyribonucleic acid Sugar = deoxyribose Base –     Purines (2 rings) = A. T  Phosphate – negative charge – gives DNA a negative charge .

Nucleic Acids  Nucleotides are linked together via dehydration synthesis reactions   sugar phosphate backbone bases project to side .

 Bases can form Hbonds   DNA structure C’s and G’s pair A pairs with T or U Two strands of DNA are said to be complementary  Strands are antiparallel. have 5’ phosphate & 3’ OH 5’-GCTAGGTAGTCCT-3’ 3’-CGATCCATCAGGA-5’  .

photocopy Transcription: DNA  RNA  still a sequence of nucleotides  writing notes from screen .  amino acid seq.The Central Dogma     Information Flow within Organisms  What Information? Replication: DNA  DNA  exact copy . different form (cursive) Translation: RNA  protein  nucleotide seq.still same letters.  english  russian .

A. RNA polymerase uses 1 strand of DNA as a template to make mRNA.Transcription     Messenger RNA (mRNA) functions as a “working copy” of the information on DNA. T in DNA.C. U in RNA .G in both RNA and DNA.  Starting position determined by RNA polymerase binding to PROMOTER RNA polymerase moves down DNA and connects nucleotides to make RNA bases .

RNAs may contain info from multiple gene – produce multiple proteins . RNA molecule is released  in eukaryotes . the 2 DNA strands come back together.Transcription  After RNA is made.each RNA contains the info from 1 gene – produces 1 protein  in prokaryotes .


RNA is processed to form mRNA before export from nucleus to cytoplasm .RNA processing   Once transcription does occur. RNA produced referred to as “primary transcript” In Eukaryotes.

exons are spliced together. Introns are cut from primary RNA transcript. parts that will be used to make protein are exons.RNA splicing   Eukaryotic genes are interrupted by DNA sequences called introns or intervening sequences. .

RNA Processing   Poly-A tail added to 3’ end to enhance stability of mRNA 7-methyl-guanine “cap” added to 5’ end – required for export from nucleus .

. AUG=start codon UAA.The Genetic Code    What is a code? Morse Code The genetic code translates nucleotide sequence into amino acid sequence    codon . UGA.sequence of 3 nucleotides that specifies 1 amino acid. UAG are stop codons.

but only 20 amino acids.64 possible combinations.same for all organisms  .The Genetic Code   Genetic code is degenerate . Most amino acids are encoded by multiple codons The Genetic Code is Universal .

notoverlapped. 3 Possible Reading Frames       AUG GGA UCC ACA UUU GCA UGA Met Gly Ser Thr Phe Ala Stop A UGG GAU CCA CAU UUG CAU GA Trp Asp Pro His Leu His AU GGG AUC CAC AUU UGC AUG A Gly Ile His Ile Cys Met .The Genetic Code   Codons are read sequentially.

The Big Picture .

5S rRNA and 45 proteins  rRNAs are functional components.Ribosomes   Translation occurs on ribosomes Ribosomes are ribonucleoproteins (RNA and protein components)   Small subunit contains 16S rRNA and 33 proteins Large subunit contains 23S rRNA. proteins provide scaffolding .

“Functional” RNAs     mRNA function is information transfer – info is used to make protein Some RNAs are not translated – tRNA. rRNA Intramolecular base pairing causes RNA to fold into a specific shape (like a protein) Paired regions twist to form helix .

tRNA structure  Transfer RNA (tRNAs) are the adaptors that associate RNA codons with amino acids    anticodon at one end base pairs with codons on mRNA. amino acid at other end attached by amino acyltRNA synthetases Each amino acid has 1-2 tRNAs .

position start codon.Translation     1. 2. 4. Two amino acids are connected. tRNA that base pairs with next codon is lined up. Initiator tRNA base pairs with AUG codon. 3. . Ribosomes bind mRNA.

7. Two amino acids are connected. Ribosome moves down mRNA to next codon. 5. 6. New tRNA pairs with next codon. Return to step 4 .Translation     4.

Polypeptide is released. folds into a functional tRNAs can pair with it. See animation .Translation    When ribosome reaches a stop codon .

The Big Picture     DNA is transcribed to mRNA. Amino acids connected to produce protein . tRNAs with amino acids pair up with codons on mRNA. Ribosome binds mRNA.

Questions? .

How Cells Respond To Change and Injury    Cellular Adaptation Cellular Injury Cellular Death .

and organ systems can adapt to both normal and injurious conditions.Cellular Adaptation    Cells. organs.  May also be part of the process of a disease . Adaptation results in alteration of structure and function. tissues. Many of these cellular adaptations are successful.

Types of Cellular Adaptations  Atrophy  Decreased size resulting from a decreased workload An increase in cell size resulting from an increased workload  Hypertrophy   Hyperplasia  An increase in the number of cells resulting from an increased workload .

Types of Cellular Adaptations  Metaplasia  Replacement of one type of cell by another type of cell that is not normal for that tissue A change in cell size. shape. or appearance caused by an external stressor  Dysplasia  .

Cellular Injury     Hypoxic Chemical Infectious Immunologic or Inflammatory    Physical agents Nutritional balances Genetic factors .

  Results in anaerobic metabolism Cell and some of its organelles then begin to swell  Reversible if intervention is early  Infarction occurs if no intervention .Cellular Injury  Hypoxic Injury   Usually a deficit in the respiratory or cardiovascular system Blockage or reduction of blood flow to a cell may result in ischemia.

drugs. ethanol.Cellular Injury  Chemical Injury  Cellular injury due to chemical products is very common.  Heavy metals. carbon monoxide. and insecticides are examples Disruption of the cellular membrane Alteration of coagulation Death of the cell  Injuries include:    .

prions. and the body’s ability to contain or destroy it . fungi. its virulence.Cellular Injury  Infectious Injury   Caused by bacteria. and parasites Majority are harmless  Pathogens cause disease  Degree of damage depends on the pathogens numbers. viruses.

Cellular Injury  Immunologic/Inflammatory Injury     Protective responses of the body can cause cell injury and even death. . Hypersensitivity Anaphylaxis An immune response may harm healthy cells as well as damaged cells.

Cellular Injury  Injurious Physical Agents       Extreme variances in temperature Atmospheric pressure changes Exposure to ionizing radiation Illumination Noise Mechanical stresses .

Cellular Injury  Injurious Nutritional Imbalances    Excessive intake of saturated fats and cholesterol Excessive carbohydrate (glucose) intake Insufficient intake of nutrients .

or the transport mechanisms that carry substances across the cell membrane. This can involve alterations to the nucleus or the cell membrane. . the shape of the cell.Cellular Injury  Injurious Genetic Factors    Some cellular dysfunctions are caused by genetic predisposition. the receptors on the cell membrane. The interaction of genes and environmental factors determine that person’s development.

.Manifestations of Cellular Injury   When cells are injured metabolism is changed. The most commonly seen effects of cell injury and accumulation are cellular swelling and fatty change. causing substances to infiltrate or accumulate to an abnormal degree in cells and tissues.

Manifestations of Cellular Injury  Cellular Swelling   Results from a permeable or damaged cellular membrane Caused by an inability to maintain stable intraand extra-cellular fluid and electrolyte levels Lipids invade site of injury Ominous sign of impending cellular destruction  Fatty Change   .

Manifestations of Cellular Injury  Systemic Signs and Symptoms of Cellular Change      Fatigue and malaise Altered appetite Fever Increased heart rate associated with fever Pain .

cells shrink Apoptosis has specificity  Contained to specific cells or areas .Cellular Death  Apoptosis     The body’s way of ridding itself of destroyed or nonfunctional cells Result of both normal and pathological tissue changes In apoptosis.

Cellular Death  Necrosis    A pathological process Cells swell and rupture Necrotic tissue changes  Coagulative. and fatty  Gangrenous necrosis . caseous. liquefactive.

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