Pathology: Cell Injury And Death

Front 1

Cells can either adapt or die. What are the two forms of death?

Back 1

necrosis (death) and apoptosis (cell suicide)

Front 2

Describe the difference between hypoxia and ischemia.
What is an example of ischemia?

Back 2

Hypoxia is low oxygen in tissues and can be caused by ischemia.
Ischemia is insuffient blood flow to tissue.
Angina is decreased perfusion of heart through coronary vessels.

Front 3

Chemical agents and drugs cause degeneration or cell death. They are examples of ______ agents.

Back 3

etiologic

Front 4

Name the eight living and non-living "bugs" that can act like etiologic agents

Back 4

viruses, rickettsiae, bacteria, fungi, helminthes, arthropods, protozoa, prions

Front 5

What are the main categories of etiologic agents?

Back 5

infectious agents, immunologic reactions, genetic derangements, nutritional imbalances, emotional stress and inadequate coping, chemical agents, physiologic agents and hypoxia/ischemia

Front 6

Free radicals are _______, meaning they can destroy the entire cell membrane with their reactivity.

Back 6

autocatalytic

Front 7

Free radical reaction with nucleic acids causes _____.

Back 7

mutation

Front 8

Free radicals are generated in phase _ of the detox process?

Back 8

Phase 1. Also generated by: redox reactions, xanthine oxidase, free iron (Fenton rx), neutrophils, oxygen therapy, and irradiation

Front 9

________ is an important type of free radical scavenger in the intestines.

Back 9

Melatonin. Decreased melatonin increases generation of reactive oxygen species (superoxide, peroxide and hydroxide)

Front 10

ROS can damage the cells by peroxidation of lipids, thiol containing protein damage, DNA damage and mitochondrial damage. What are the outcomes?

Back 10

membrane damage
ion pump damage
impaired protein synthesis
Ca influx into the cell

Front 11

A build-up of Ca in the cytosol can lead to membrane damage, decrease ATP and nucleus chromatin damage.
What are the four main enzymes that are activated by high intracellular Ca?

Back 11

ATPase, phospholipase, protease, and endonuclease

Front 12

Free radicals can be oxygen or carbon derived. What are the oxygen derived species?

Back 12

superoxide, hydroxyl, peroxide (H2O2)

Front 13

Membranes are protected from ROS by ________.

Back 13

Vit E, A and beta carotene

Front 14

What is another name for hydropic degeneration and what is it?

Back 14

cloudy swelling
describes cellular swelling when cells are incapable of maintaining ionic and fluid homeostasis

Front 15

ROS damage leads to decreased ATP and decreased Na pump activity. What is the result?

Back 15

Iso-osmotic gain of water due to intracellular Na and Ca accumulation

Front 16

Irreversible damage can occur with cloudy swelling. Cell degeneration releases intracellular proteins such as _, ALT, __, AP and GGT in hepatocyte cell damage.

Back 16

AST, ALT, ferritin, AP and GGT released with liver damage

Front 17

What enzymes are released with heart muscle degeneration?

Back 17

CK-MB, LDH and troponin T

Front 18

______ is used to diagnose exocrine pancreas damage.

Back 18

Amylase

Front 19

Name 3 diseases that result from deposition of complex lipids and carbohydrates.

Which one is associated with degeneration on macula densa?

Back 19

Gaucher disease
Hurler disease
Tay Sachs disease

Tay Sachs disease

Front 20

What are the 3 iatrogenic accumulations that we discussed in class?

Which one can trigger Lupus-like illness?

Back 20

Talc
Silicon
Myelogram

Silicon

Front 21

What is hemosiderin?

Name 2 ways that too much iron may build up in the cells.

Back 21

Iron pigment

1. Hemolysis of RBC's (hemolytic anemia)
2. Transfusions

Front 22

TRUE or FALSE

Silica is a good mineral if ingested orally but deadly if inhaled.

Back 22

TRUE

(we don't have time to think about false statments)

Front 23

Name some things that could cause necrosis.

Back 23

Ischemia
Infection
Toxins
Hyperimmune reactions
Hypoxia/anoxia
Trauma
Extremes of temperature

Note: these are the same things that cause cellular injury

Front 24

What is the name for cloudy swelling that continues on to cell death?

Back 24

Coagulation necrosis

Front 25

This type of coagulation necrosis is associated with focal areas of destruction of fat (pancreas & breast)
a. Caseous necrosis
b. Liquefaction necrosis
c. Fat necrosis

Back 25

c. Fat necrosis

Front 26

What is the most common pathology that leads to caseous necrosis?

Back 26

TB

Front 27

This type of coagulation necrosis results from enzymatic digestion by leukocytes (phagocytosis)
a. Caseous necrosis
b. Liquefaction necrosis
c. Fat necrosis

Back 27

b. Liquefaction necrosis

Front 28

This type of coagulation necrosis is common in the brain and other lipid-rich tissues
a. Caseous necrosis
b. Liquefaction necrosis
c. Fat necrosis

Back 28

b. Liquefaction necrosis

Front 29

What is gangrene?

Back 29

Death of a body part with putrification added; necrosis in an extremity (usually lower)

Front 30

Match the type of gangrene (dry, wet or gas) with its description.
a. Area with little or no blood sypply and no sepsis
b. specific to Clostridium perfringens
c. bacterial infection is superimposed on coagulative necrosis; smells

Back 30

a. DRY- Area with little or no blood sypply and no sepsis

b. GAS- specific to Clostridium perfringens

c. WET- bacterial infection is superimposed on coagulative necrosis; smells

Front 31

Name a population that is more prone to gangrene

Back 31

Diabetics

Front 32

TRUE or FALSE

Apoptosis is essential for cancer cures

Back 32

TRUE

P53 gene: if this gene is mutated, cell cannot do apoptosis

Front 33

In this pathway the mitochondria instigates apoptosis.

a. Intrinsic pathway
b. Extrinsic pathway

Back 33

a. Intrinsic

Front 34

In this pathway, radiation (for example) triggers apoptosis.

a. Intrinsic pathway
b. Extrinsic pathway

Back 34

b. Extrinsic pathway

Front 35

As a part of cloudy swelling, cellular injury induces what change in the mitochondria?

This can have what effect on the cell?

Back 35

Formation of non-selective pores. This can release pro-apoptotic proteins into cytosol which results in apoptosis of cell.

Front 36

What is the name for outcroppings of the cellular membrane seen in cell injury?

Back 36

Membrane Blebs

Front 37

What ion is released from the mitochondria and ER following cell injury? What does it do?

Back 37

Ca++. It activates enzymes that damage the cellular membrane and cytoskeleton and phosphorylate proteins.

Front 38

What is fatty degeneration (fatty change or steatosis)? In what tissues/cells does this occur? What is it usually caused by?

Back 38

Abnormal accumulation of triglycerides.

Liver, heart, muscle, kidneys, macrophages in athersclerosis

Cellular metabolic damage and increased lipids

Front 39

What condition is marked by intracellular inclusions of any protein that stains pink with H&E stain?

What are some examples?

Back 39

Hyaline degeneration

Viral inclusions, deposits in alcoholic hepatocytes, keloid collagen, proximal tubule epithelial cells, amyloid, fibrinoid

Front 40

What is myxomatous degeneration?

List some examples.

Back 40

Increased ground substance with damage to CT fibers. Causes increased "stretchiness" to the tissue

Cystic medial necrosis (seen in Marphan syndrome)
Mitral valve prolapse (valve balloons out--> heart is less efficient --> hypertrophy of L ventricle)

Front 41

Define calcification.


Are there body structures which normally calcify?

Back 41

Process in which tissue or non-cellular material becomes hardened as the result of deposits of insoluble salts of calcium.

Yes, in adults.

Front 42

What body structures normally calcify in adults?

Back 42

Pineal, Media of large arteries, Mitral valve annulus, Tracheal cartilages

Front 43

What is dystrophic (abnormal) calcification?

What are some examples?

Back 43

Local calcification of non-viable, injured tissues

-Atheroma (plaque in athersclerotic vessel)
-Lymph node calcification in TB
-Psammoma bodies in certain cancers
-Damaged heart valves
-Gastric?

Front 44

Metastatic calcification occurs with elevated serum levels of _____ or _____. What can lead to such elevation?

Back 44

Calcium or Phosphate

-Cancer destruction of bone
-Milk abuse
-Antacid abuse
-Parathyroid adenoma (demineralizes bone)

Front 45

What is amyloid? What is is the term for its extracellular accumulation in organs & tissues? In what clinical conditions is it found?

Back 45

Pathologic protein, beta pleated sheet.

Amyloidosis, that's logical...

Found in:
-B cell proliferations
-Chronic inflammation
-Chronic renal failure
-Alzheimer's disease
-Type II diabetes
-Prion disease

Front 46

What is term for more extracellular fat deposition, (i.e., macroscopic)?

Where does it most often occur?

Back 46

Fatty infiltration.

Most often occurs in:
-Pancreas
-Lymph nodes
-Right heart
-Muscle (in cystic fibrosis)