Pathophysiology 1

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Denotes a decrease in the size of a cell, tissue, organ, or the entire body

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atrophy

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can be classified as physiological or pathological

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atrophy

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physiological atrophy examples:

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thymus, ovaries, bones, muscles

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3 ways an elderly person may die after a broken hip:

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1)pulmonary embolism, 2) infection, 3) cardiac arrythmia

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A decrease in the size of a cell, tissue, organ, or the entire body that occurs as a result of inadequate stimulation or nutrition:

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pathologic atrophy

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A loss of weight, muscle atrophy, fatigue, weakness and significant loss of appetite in someone who is not actively trying to lose weight.

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cachexia

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Physically weakens patients to a state of immobility stemming from loss of appetite, asthenia, and anemia, and response to standard treatment is usually poor.

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cachexia

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The process resulting in a macroscopic area of necrotic tissue in some organ caused by loss of adequate blood supply.

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infarction

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Examples of pathologic atrophy:

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ischemic organs (usually small), cachexia caused by cancer, denervated muscles

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Atrophied kidney named after scientist that experimented w/dog kidneys by ligating blood supply to kidneys:

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Goldblatt

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An increase in the size of tissues or organs owing to an enlargement of individual cells.

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hypertrophy

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This enlargement of the left ventricular muscle is typically seen in hypertension and is an adaptive response to left ventricular pressure overload.

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concentric hypertrophy

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What is IHSS and what is it also called:

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ideopathyic hypertrophic subaortic stenosis, hypertrophic cardiomyopathy

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Often found in young athletes, the normal alignment of muscle cells is disrupted, a phenomenon known as myocardial disarray. Also causes disruptions of the electrical functions of the heart. Believed to be due to a mutation in one of many genes that results in a mutated myosin heavy chain

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ideopathyic hypertrophic subaortic stenosis, hypertrophic cardiomyopathy

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Characterized by myocardial disarray in which the normal alignment of cardiac muscle cells is disrupted

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ideopathyic hypertrophic subaortic stenosis, hypertrophic cardiomyopathy

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An adaptive increase in the number of cells which can cause an enlargement of a tissue or organ.

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hyperplasia

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By itself, it occurs as a result of hormonal stimulation,

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hyperplasia

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An abnormal mass of tissue, the growth of which exceeds and is uncoordinated with that of the normal tissues, and persists in the same excessive manner after cessation of the stimulus which evoked the change.

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Neoplasm

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true or false: term "neoplasm" is not synonymous with cancer, since neoplasms can be either benign or malignant

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true

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An example of hypertrophy with hyperplasia:

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uterine smooth muscle cells during pregnancy and smooth muscle cells in wall of urinary bladder when obstructed by hyperplastic prostate

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A form of adaptation characterized by the change of one cell type into another to suit the environment

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metaplasia

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Example of metaplasia

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columnar cells of the bronchial mucosa, when irritated by cigarette smoke, over long periods of time, change adaptively into stratified squamous epithelium.

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The coordinated action of tiny projections on the surfaces of cells lining the respiratory tract, which moves mucus up and out of the lungs

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mucociliary escalator

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Represents an reversible change usually, but if the stimulus that has induced the _______ persists, the metaplastic process may progress to a _______, which is considered precancerous

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metaplasia, dysplasia

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__________ (from Greek, roughly: "bad form") is a term used in pathology to refer to an abnormality in maturation of cells within a tissue. This generally consists of an expansion of immature cells, with a corresponding decrease in the number and location of mature cells. ________ is often indicative of an early neoplastic process

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dysplasia, dysplasia

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Dysplasia, in which cell maturation and differentiation are delayed, can be contrasted with ________, in which cells of one mature, differentiated type are replaced by cells of another mature, differentiated type

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metaplasia

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A term that means disordered growth.
Characterized by changes in tissues resulting from chronic irritation or infection that may cause a precancerous change.

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dysplasia

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The cells vary in size and shape (cellular pleomorphism), with large nuclei, and an increased mitotic activity.

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dysplasia

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best example of dysplasia

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detection of cervical dysplasia based on routine PAP smears

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__________ or CIN, is the abnormal growth of precancerous cells in the cervix. Most cases of CIN remain stable, or are eliminated by the host's immune system without intervention

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Cervical intraepithelial neoplasia

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CIN has three distinct grades:

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CIN1 (Grade I), the least risky type, represents only mild dysplasia, or abnormal cell growth[1] and is considered a low grade squamous intraepithelial lesion (LGSIL). [2]. It is confined to the basal 1/3 of the epithelium.
CIN2 (Grade II), as well as CIN III, are considered high grade squamous intraepithelial lesions (HSIL). [2] CIN2 represents moderate dysplasia, and is confined to the basal 2/3 of the epithelium
CIN3 (Grade III): In this lesion, severe dysplasia spans greater than 2/3 of the the entire epithelium, and may involve the full thickness. This lesion may also be referred to as cervical carcinoma in situ.

Front 32

Refers to cells that are “undifferentiated” or lack differentiation (the extent to which parenchymal cells resemble comparable normal cells, both functionally and morphologically.

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anaplasia

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Associated with malignancy, _________ is considered to be the hallmark of malignant transformation, marked by a number of both morphologic and functional changes.

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anaplasia

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#1 type of cell in which cancer is found

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squamous

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An ______ is a collection of growths (-oma) of glandular origin. _______ can grow from many organs including the colon, adrenal, pituitary, thyroid, etc. These growths are benign, although over time they may progress to become malignant (at which point they are called adenocarcinomas). Though ______ are benign, they can cause serious health complications by compressing other structures (mass effect) and by producing large amounts of hormones in an unregulated manner (paraneoplastic syndrome).

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adenoma, adenomas, adenomas

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The cells and the nuclei display marked cellular pleomorphism, variation in size and shape.

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Anaplasia

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The nuclei are irregular and hyperchromatic

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Anaplasia

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Extremely high nuclear/cytoplasmic ratio (N/C ratio), about 1:1 instead of 1:4 or 1:6

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Anaplasia

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Large nucleoli present within the nucleus.

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Anaplasia

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Large numbers of abnormal mitotic figures

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Anaplasia

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Characteristics of anaplasia:

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1. The cells and the nuclei display marked cellular pleomorphism, variation in size and shape.
2. The nuclei are irregular and hyperchromatic
3. Extremely high nuclear/cytoplasmic ratio (N/C ratio), about 1:1 instead of 1:4 or 1:6.
4. Large nucleoli present within the nucleus.
5. Large numbers of abnormal mitotic figures.

Front 42

May occur as a result of an overload of various metabolites or exogenous material, or they may be attributed to metabolic disturbances that prevent excretion of metabolic by-products or normal secretions from cells.
In most instances, the underlying mechanisms are complex and involve both an overload and undersecretion/underutilization.

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intracellular accumulations of the cell

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The accumulation of coal particles, either released in the air from pollution, or from people who work in the coal mines.

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anthracosis

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Refers to the storage of this indigestible material in the alveolar histiocytes of the lungs and regional hilar and mediastinal lymph nodes.
Although the gross appearance is quite alarming, it is entirely normal, especially seen in city-dwellers.
Disease occurs when there is an overabundance of inhaled coal dust, causing black pulmonary lesions

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anthracosis

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Fat is normally stored in liver cells in the form of triglycerides, and excess fat accumulation is a typical finding in ________

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chronic alcoholics.

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Alcohol has a high caloric content and serves as a ______ for new fat formation in liver cells (neolipogenesis).
Alcohol also inhibits several degradation _________ and the utilization of fat.
Alcohol inhibits both ________ synthesis and the export of fat from the liver in the form of lipoproteins.

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substate, enzymes, protein

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________ is a consequence of chronic liver disease characterized by replacement of liver tissue by fibrotic scar tissue as well as regenerative nodules, leading to progressive loss of liver function

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Cirrhosis

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An accumulation of the blood-derived brown pigment ________, an iron-storage protein normally found in the spleen, BM and Kupffer cells of the liver.

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hemosiderosis, hemosiderin

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Excess iron (anemias or multiple transfusions) is stored intracellularly as both ferritin and ________ in other organs, such as the skin, pancreas, heart and kidneys, and if severe enough, can damage those organs.
The _____ in hemosiderosis can be demonstrated with a Prussian-blue Stain

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hemosiderin, iron

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what are the different types of intracellular accumulations:

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anthracosis, fat, hemosiderosis, lipofuscin

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Classically known as the “wear and tear” pigment, and is composed of a golden-brown granules found predominantly in neurons, myocardial cells and infrequently hepatocytes.

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lipofuscin

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It is a normal constituent of many cells, increases with age, and is derived from the normal turnover of membrane constituents of the cell

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lipofuscin

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Despite the occasional prominence of intracellular __________, this pigment does not interfere with cell function.

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lipofuscin

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There is no disease state associated with:

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lipofuscin, anthracosis

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________: the digestive tract of cells
they produce enzymes that work on substrates
Often genetic and may be found in groups of people
All have enzyme deficiency that results in substrate accumulation that causes functional derangement

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lysosomes

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The breakdown of certain complex lipids, mucopolysaccharides and glycogens are accomplished by a sequence of enzymatic steps.
Since these enzymes are located in the lysosomes of the cell, their absence results in these _______________ because the substrate accumulates in the lysosomes, causing functional derangements of cells, tissues and organs.
Examples include Tay-Sachs, Gauchers, Hurlers, Von Gierkes, Pompes and Niemann-Pick Diseases.

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lysosomal storage disease

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The disease occurs when harmful quantities of a fatty acid derivative called a ganglioside accumulate in the nerve cells of the brain. Gangliosides are lipids, components of cellular membranes, and the ganglioside GM2, implicated in __________ disease, is especially common in the nervous tissue of the brain.

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Tay-Sachs

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Seen when environmental changes exceed the capacity of the cell to maintain normal homeostasis.

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cell injury

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If the stress is removed in time, or if the cell is able to withstand the assault, cell injury is _________, and complete structural and functional integrity is restored.
If the stress is severe, irreversible injury may lead to cell death.
The moment at which reversible injury gives way to irreversible depends upon the tissue.

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reversible

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Reversible cell injury: Typically mild or short-lived.
Characterized by cellular swelling, also known as _______________, and reflects the increased influx of water into the cytoplasm and mitochondria from altered permeability of the plasma membrane.

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hydropic degeneration

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Anoxia, for example, causes dysfunction of the ATP-driven Na+-K+ pump altering the permeability
Once ATP function is restored, the Na+ and the water are pumped out of the cell and the swelling disappears. What is this an example of?

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reversible cell injury

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Swollen mitochondria generate less energy, so instead of oxidative ATP production, the cell reverts to anaerobic glycolysis which results in excessive production of lactic acid, the cell pH becomes acidic which further slows down cell metabolism.
Other organelles, like the RER swell and fragment, resulting in decreased protein synthesis.
If the nucleus remains untouched and if the energy source is restored, the cell will revert to its normal state. What is this an example of?

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reversible cell injury

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If acute stress to which a cell must react exceeds its ability to adapt, the resulting changes in structure and function lead to the death of a cell.
Morphologically recognized by changes in the nucleus or by rupture of the cell membrane and loss of cell integrity.
Many of these changes can be seen by both light microscopy as well as ultrastructurally (E.M.). What is this an example of?

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irreversible cell injury

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Damage to the nucleus can present in three forms:
1. ___________: condensation of the chromatin
2. Karyorrhexis: fragmentation of the nucleus into small particles (nuclear dust)
3. Karyolysis: involves dissolution of the nucleus and lysis of chromatin by enzymes.

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pyknosis

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Damage to the nucleus can present in three forms:
1. Pyknosis: condensation of the chromatin
2. ___________: fragmentation of the nucleus into small particles (nuclear dust)
3. Karyolysis: involves dissolution of the nucleus and lysis of chromatin by enzymes.

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karyorrhexis

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Damage to the nucleus can present in three forms:
1. Pyknosis: condensation of the chromatin
2. Karyorrhexis: fragmentation of the nucleus into small particles (nuclear dust)
3. ___________: involves dissolution of the nucleus and lysis of chromatin by enzymes.

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karyolysis

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________ is a proliferation of astrocytes in damaged areas of the central nervous system (CNS). Astrocytes are relatively large glial cells and have various functions, including accumulating in areas where neurons have been damaged. Gliosis and neuronal loss in certain brain regions are findings seen in various neurodegenerative disorders such as Korsakoff's syndrome and AIDS dementia complex.

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gliosis

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__________ is the formation or development of excess fibrous connective tissue in an organ or tissue as a reparative or reactive process, as opposed to a formation of fibrous tissue as a normal constituent of an organ or tissue.

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fibrosis

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The cytoplasm is fragmented and lost.
The dead cell, clinically, releases their cellular enzymes into the ECF and eventually the circulation.
Cytoplasmic enzymes, such as AST or LDH, are released from damaged cells and can be measured in the blood where they are useful signs of cell injury. High levels of these enzymes are typically found in patients with MI’s or viral hepatitis. What is this an example of?

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irreversible cell injury

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Reduced availability or complete lack of _________ are among the most important and most common causes of cell injury.

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oxygen

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Brain cells die quickly (____ minutes) when deprived of O2, whereas the heart muscle can survive for approximately ___ minutes. Kidney cells can survive for several hours.

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4 to 5, 30

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Means cell death, and represents the death of cells or groups of cells within a living organism.

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necrosis

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The death of cells and tissues in an already dead organism is called __________ and is a post-mortem event. The is self-dissolution by body enzymes released by the disintegrating cells.

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autolysis

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When necrosis occurs, there will be a reactive ___________ to the dead cells that is not seen after death.

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inflammation

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The most common form of necrosis.

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coagulative necrosis

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This necrosis occurs when cell proteins are altered or denatured, similar to the ___________ that occurs when cooking eggs.

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coagulative necrosis, coagulaiton

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This type of necrosis typically occurs in solid internal organs, I.e. heart, kidney, spleen and liver, and is most often caused by Anoxia (best example is heart tissue undergoing a myocardial infarction)
Histologically, the cell outlines are preserved and the cytoplasm appears finely granular.

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coagulative necrosis

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this type of necrosis is associated with acute MI

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coagulative necrosis

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This necrosis refers to a process by which dead cells liquify under the influence of certain cell enzymes.
The tissue becomes soft and gel-like.

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liquefactive necrosis

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It occurs most often in the brain where the brain cells lose their contours and liquify.This necrosis is typical of brain infarcts which are usually soft and are ultimately transformed into a fluid-filled cavity, or can be seen in certain bacterial infections in which a cavity may develop. (abscesses in the lungs)

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liquefactive necrosis

Front 81

Granulocytes are a category of white blood cells characterised by the presence of granules in their cytoplasm.[1] They are also called polymorphonuclear leukocytes because of the varying shapes of the nucleus, which is usually lobed into three segments. In common parlance, the term polymorphonuclear leukocyte often refers specifically to neutrophil granulocytes,[2] the most abundant of the granulocytes. Granulocytes or PMN are released from the bone marrow by the regulatory complement proteins.

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PMN or PML

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A form of coagulative necrosis in which a thick, yellowish, cheesy substance forms.

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caseous necrosis

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Is typically found in Tuberculosis, characterized by the development of lung granulomas, inside of which can be found ______ necrosis. This is called a ____ Complex, and usually heals, containing the infection.
Not unique to T.B., as it may also be seen in some fungal infections (I.e. Histoplasmosis)

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caseous necrosis, Ghon

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A specialized form of liquefaction necrosis caused by the action of lipolytic enzymes.

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fat necrosis

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Fat necrosis is limited to fat tissue, usually around the _______, where enzymes are released into the adjacent fat tissue, usually after rupture of the _________(trauma, acute pancreatitis), causing degradation of fat into glycerol and free fatty acids.
The free fatty acids rapidly bind with calcium, forming ________, causing white, calcified specks.

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pancreas, pancreas, soaps

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Necrotic tissue can provide a good medium for infection by bacteria.
The bacterial infection of coagulated tissue leads to inflammation and a secondary liquefaction clinically known as __________(I.e. advanced decubitus ulcers)

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wet gangrene

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If the necrotic tissue dries out, it becomes black and mummified (_____________).
Such infections frequently occur after an infarction of the intestines or in a limb and are usually caused be atherosclerosis or diabetes

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dry gangrene

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________ is necrosis and subsequent decay of body tissues caused by infection or thrombosis or lack of blood flow.

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gangrene

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Necrotic tissue attracts calcium salts and frequently undergoes calcification.
Refers to the macroscopic deposition of calcium in injured or dead tissues.

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dystrophic calcifications

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Represents an extracellular deposition of calcium from the circulation into dead or dying necrotic tissue, often visible to the naked eye, and range from gritty, sand-like grains to firm, rock-hard material.

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dystrophic calcifications

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Examples of dystrophic calcifications:

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Calcifications in Atherosclerotic coronary arteries contributes to narrowing of the vessels.
Calcifications of the Mitral or Aortic valves leading to impeded blood flow (Stenosis)
Calcifications seen around breast cancers that can be visualized by mammography.
Infant periventricular calcifications seen in congenital Toxoplasmosis (parasite)

Front 92

Reflects deranged calcium metabolism (not cell injury), usually associated with increased serum calcium levels, leading to deposition of calcium in other locations.

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metastatic calcifications

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Seen in various disorders including Hyperparathyroidism, Vitamin D toxicity, and Chronic Renal Failure.
Formations of Calcium Carbonate stones in sites such as the gallbladder, kidney and bladder are due to precipitation of the salts from solution into tissues.

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metastatic calcifications

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_____________ is deposition of calcium salts in otherwise normal tissue, because of elevated levels of calcium and other minerals in blood because of deranged metabolism, synthesis or disposal.

It occurs as opposed to dystrophic calcification where blood levels of calcium are normal.

________________ can occur widely throughout the body but principally affects the interstitial tissues of the vasculature, kidneys, lungs, and gastric mucosa.

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metastatic calcifications, metastatic calcification