Introduction to Pathology and Cell Injury
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Questions and Answers

What is the primary difference between reversible and irreversible cellular injury?

  • Irreversible injury occurs only with genetic mutations.
  • Reversible injury is always associated with necrosis.
  • Irreversible injury is characterized by membrane blebs.
  • Reversible injury allows for recovery if the stressor is removed. (correct)
  • Which of the following accurately describes pathogenesis?

  • It looks at the clinical symptoms after disease onset.
  • It evaluates the genetic predispositions to diseases.
  • It focuses on how underlying causes disrupt normal cellular function. (correct)
  • It identifies the specific infectious agents causing disease.
  • What initiates a cascade of damaging events at the cellular level?

  • Nutritional imbalances affecting metabolic pathways.
  • Genetic mutations causing cellular adaptations.
  • Physical trauma leading to immediate necrosis.
  • Infections from bacterial or viral agents. (correct)
  • Which change is NOT typically associated with reversible cellular injury?

    <p>Complete breakdown of the plasma membrane. (B)</p> Signup and view all the answers

    Which of the following best describes the outcome of persistent or intensified cellular injury?

    <p>The cell eventually undergoes apoptosis or necrosis. (D)</p> Signup and view all the answers

    What is the primary consequence of anaerobic glycolysis when oxidative phosphorylation is compromised?

    <p>Lactic acid accumulation leading to pH drop (C)</p> Signup and view all the answers

    Which of the following is a direct effect of mitochondrial damage?

    <p>Cell necrosis and inflammation (B)</p> Signup and view all the answers

    What is the role of DAMPs in cellular injury?

    <p>Trigger inflammation and activate the immune system (B)</p> Signup and view all the answers

    Which of the following cells can survive the longest without a blood supply?

    <p>Hepatocytes (D)</p> Signup and view all the answers

    What occurs as a result of ATP depletion in cells?

    <p>Detachment of ribosomes from the rough endoplasmic reticulum (B)</p> Signup and view all the answers

    Which molecules are released during cellular damage that signal to the immune system?

    <p>Uric acid and uridine triphosphate (D)</p> Signup and view all the answers

    What cellular abnormality is associated with necrosis?

    <p>Chromatin clumping in the nucleus (B)</p> Signup and view all the answers

    Which condition primarily leads to fat necrosis due to the digestion of fat tissue?

    <p>Stress on pancreatic acinar cells (A)</p> Signup and view all the answers

    What role do lipases play in the process of fat necrosis?

    <p>They split triglycerides into fatty acids (C)</p> Signup and view all the answers

    In pancreatitis, ischemia results from which of the following?

    <p>Compression of blood vessels (A)</p> Signup and view all the answers

    What is formed during the process of saponification in fat necrosis?

    <p>Chalky white deposits (A)</p> Signup and view all the answers

    Which of the following is a secondary reaction that highlights the involvement of calcium in fat necrosis?

    <p>Saponification (C)</p> Signup and view all the answers

    What triggers the premature release of digestive enzymes in acinar cell injury?

    <p>Injury to the acinar cells (A)</p> Signup and view all the answers

    Duct obstruction can lead to fat necrosis primarily due to which underlying mechanism?

    <p>Activation of digestive enzymes (B)</p> Signup and view all the answers

    What pathological change drives inflammation in the context of fat necrosis?

    <p>Autodigestion of pancreatic proteins (C)</p> Signup and view all the answers

    What effect does chronic alcoholism have on pancreatic acinar cells?

    <p>Promotes enzyme activation (B)</p> Signup and view all the answers

    What is primarily responsible for the chalky white deposits seen in fat necrosis?

    <p>Calcium and fatty acid interaction (A)</p> Signup and view all the answers

    What characteristic appearance is associated with caseous necrosis?

    <p>Cheese-like consistency (B)</p> Signup and view all the answers

    What types of cells typically surround the necrotic core in caseous necrosis?

    <p>Macrophages and lymphocytes (A)</p> Signup and view all the answers

    Which statement is true regarding fibrinoid necrosis?

    <p>It shows bright pink, amorphous material in vessel walls. (B)</p> Signup and view all the answers

    What is a common mechanism that triggers fibrinoid necrosis?

    <p>Immune complex deposition (B)</p> Signup and view all the answers

    Which type of necrosis is primarily associated with Mycobacterium tuberculosis?

    <p>Caseous necrosis (D)</p> Signup and view all the answers

    In which disease is fibrinoid necrosis prominently observed?

    <p>Systemic lupus erythematosus (SLE) (D)</p> Signup and view all the answers

    What does the pink staining in caseous necrosis represent?

    <p>Protein-rich debris from dying cells (A)</p> Signup and view all the answers

    Which of the following is NOT a common cause of fibrinoid necrosis?

    <p>Viral infections (B)</p> Signup and view all the answers

    What histological feature distinguishes caseous necrosis from coagulative necrosis?

    <p>Absence of recognizable tissue architecture (A)</p> Signup and view all the answers

    Which type of necrosis primarily results from immune-mediated vascular damage?

    <p>Fibrinoid necrosis (D)</p> Signup and view all the answers

    What is the primary characteristic of a white kidney infarct?

    <p>Sharp demarcation line between healthy and infarcted tissue (C), Intact cellular architecture despite necrosis (D)</p> Signup and view all the answers

    Which process mainly results in the formation of a depressed scar on the renal surface following an infarct?

    <p>Fibrosis (B)</p> Signup and view all the answers

    What indicates the absence of cell viability in an acute kidney infarct?

    <p>Absence of cellular nuclei (B)</p> Signup and view all the answers

    What triggers the inflammatory response after a kidney infarct?

    <p>Neutrophil infiltration (D)</p> Signup and view all the answers

    What condition is predominantly associated with the occurrence of kidney infarcts?

    <p>End-artery occlusion (D)</p> Signup and view all the answers

    Which histological feature is indicative of a white infarct?

    <p>Increased eosin binding due to necrosis (B)</p> Signup and view all the answers

    What is the mechanism by which coagulative necrosis occurs following ischemia?

    <p>Decreased oxidative phosphorylation and increased lactic acid (C)</p> Signup and view all the answers

    How does a red infarct differ from a white infarct?

    <p>Red infarcts have reduced structural integrity (C)</p> Signup and view all the answers

    Which factor contributes to the histological absence of neutrophils in early stages of kidney infarction?

    <p>Delayed immune response (C)</p> Signup and view all the answers

    Flashcards

    Etiology

    The study of the underlying causes of diseases, such as infections, trauma, or genetic abnormalities.

    Pathogenesis

    The mechanisms by which diseases develop and progress, focusing on how these causes disrupt normal cellular function.

    Morphologic changes

    Structural and functional abnormalities in cells and tissues that result from disease processes, such as swelling or abnormal formations.

    Reversible cell injury

    The ability of cells to adapt to mild, transient stressors by undergoing changes like organelle swelling, membrane blebbing, and lipid accumulation.

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    Irreversible cell injury

    The point where cell damage becomes permanent and irreversible, leading to either uncontrolled cell death (necrosis) or programmed cell death (apoptosis).

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    Mitochondria Damage

    Mitochondria are the powerhouses of the cell responsible for producing ATP. When mitochondria get damaged, they produce less ATP, leading to energy depletion in the cell.

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    Reactive Oxygen Species (ROS)

    Damaged mitochondria produce harmful molecules called reactive oxygen species (ROS) that can damage cellular components.

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    Necrosis

    A form of cell death where the cell swells and bursts, releasing its contents into the surrounding environment.

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    DAMPs

    Damage-associated molecular patterns are molecules released from dying cells that signal the immune system about cellular damage. These molecules trigger an inflammatory response.

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    ATP Release

    When cells die, ATP, usually confined within mitochondria, leaks out into the surrounding area.

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    Uric Acid and UTP Release

    Uric acid and UTP are released when DNA breaks down during cell death.

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    Immune System Activation

    The release of DAMPs activates immune cells, like macrophages, prompting them to generate pro-inflammatory cytokines, which initiate an inflammatory response to clear dead cells and repair damaged tissue.

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    Kidney Infarct Healing

    The process where an infarcted (dead) area of kidney tissue is replaced by fibrous scar tissue.

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    Sharp Demarcation Line

    A clear boundary between healthy kidney tissue and the infarcted area, representing the abrupt cessation of blood supply.

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    Coagulative Necrosis

    Preserved tissue structure despite cell death, a characteristic feature of coagulative necrosis in kidney infarcts.

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    Neutrophil Infiltration

    Neutrophils, white blood cells, arrive at the infarct site to initiate the inflammatory response, clearing dead cell debris.

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    End-Artery Occlusion

    A kidney infarct caused by a blockage in an end artery, completely cutting off blood supply.

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    Preserved Architecture (Early Infarct)

    The glomerulus and tubules remain visible in an early-stage kidney infarct, indicating structural integrity despite cell death.

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    Absence of Nuclei (Early Infarct)

    The absence of cell nuclei in an early-stage infarct, signifying cell death due to nuclear dissolution.

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    No Neutrophil Infiltration (Early Infarct)

    The lack of neutrophils in an early-stage infarct, indicating the inflammatory response has not yet begun.

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    White (Anemic) Infarct

    A kidney infarct where the affected area lacks erythrocytes (red blood cells), leading to a pale appearance.

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    Saponification in Fat Necrosis

    Fatty acids, released during the breakdown of fat tissue, react with calcium ions to form insoluble salts. This reaction is specific to fat necrosis and creates a chalky white appearance.

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    Fat Necrosis

    The death or destruction of fat tissue, often caused by the release of digestive enzymes in conditions like pancreatitis.

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    Pancreatitis

    Inflammation of the pancreas caused by the activation of digestive enzymes within the organ itself.

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    Lipid Hydrolysis

    The process by which digestive enzymes, like lipases, break down triglycerides into fatty acids.

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    Cholelithiasis

    A common cause of pancreatitis caused by the accumulation of gallstones in the bile duct, blocking the flow of digestive enzymes.

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    Intracellular Enzyme Activation

    The premature activation of digestive enzymes within the pancreas, leading to autodigestion of the organ.

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    Acinar Cell Injury in Pancreatitis

    The process by which injured acinar cells release digestive enzymes, causing local tissue damage.

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    Duct Obstruction in Pancreatitis

    The obstruction of the pancreatic duct, leading to interstitial edema, impaired blood flow, and activation of digestive enzymes.

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    Defective Intracellular Transport in Pancreatitis

    The process by which inactive digestive enzymes (proenzymes) are prematurely activated within the lysosomes, leading to acinar cell death.

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    Inflammation and Edema in Pancreatitis

    A key factor in pancreatitis, where the pancreas becomes inflamed and swollen due to tissue damage, leading to a cascade of detrimental events.

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    Reactivation of Latent TB

    Latent tuberculosis (TB) infection can reactivate in individuals with weakened immune systems, such as those with COVID-19, RSV, or HIV. This reactivation leads to active TB disease, causing widespread tissue damage and potentially fatal consequences.

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    Caseous Necrosis

    Caseous necrosis is a type of cell death, characterized by a soft, white, and cheese-like appearance of the necrotic tissue. It is often seen in chronic granulomatous diseases, like tuberculosis.

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    Tissue Structure in Caseous Necrosis

    In caseous necrosis, the necrotic tissue lacks any recognizable tissue architecture. This makes it distinct from coagulative necrosis, where the tissue structure is preserved.

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    Cause of Caseous Necrosis

    Caseous necrosis is caused by bacterial infections, primarily Mycobacterium tuberculosis, rather than ischemia or infarction.

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    Granuloma Formation in Caseous Necrosis

    Caseous necrosis is characterized by the presence of a granuloma, which is a cluster of inflammatory cells, including macrophages and lymphocytes, surrounding the necrotic core. This shows the immune system's attempt to contain the infection.

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    Fibrinoid Necrosis

    Fibrinoid necrosis is characterized by the presence of bright pink, amorphous material in the vessel walls on histology. This material resembles fibrin.

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    Composition of Fibrinoid Necrosis

    Fibrinoid necrosis was initially thought to be composed primarily of fibrin, but now it is understood to also contain proteins and collagen, contributing to its fibrin-like appearance.

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    Trigger of Fibrinoid Necrosis

    Fibrinoid necrosis is triggered by immune complex deposition in blood vessels. This activates the immune response, leading to fibrin leakage and accumulation of plasma proteins within the vessel wall.

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    Common Causes of Fibrinoid Necrosis

    Fibrinoid necrosis is commonly found in immune-mediated vascular damage, such as vasculitis and autoimmune diseases like systemic lupus erythematosus (SLE).

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    Non-immune Causes of Fibrinoid Necrosis

    Fibrinoid necrosis can also occur due to non-immune causes, such as severe hypertension or mechanical stress on vessel walls.

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    Study Notes

    I. Introduction to Pathology and Cell Injury

    • Pathology is the study of structural, biochemical, and functional changes in cells, tissues, and organs.
    • General pathology focuses on common reactions of cells and tissues to injuries.
    • Systemic pathology focuses on specific organ systems.

    II. Cellular Responses to Stress and Noxious Stimuli

    • Homeostasis in cells maintains a steady state, adapting to physiological changes.
    • Adaptations include hypertrophy (increased cell size), hyperplasia (increased cell number), atrophy (decreased cell size and metabolic activity), and metaplasia (change in cell type).
    • Beyond a threshold, stress can lead to reversible or irreversible injury.

    III. Cellular Adaptations

    • Hypertrophy – increase in cell size due to increased workload or growth factors.
    • Hyperplasia – increase in cell number due to hormonal or compensatory stimuli.
    • Atrophy – decrease in cell size and metabolic activity due to reduced use.
    • Metaplasia – a change from one adult cell type to another, typically for better resistance to conditions.

    IV. Mechanisms of Cell Injury and Death

    • Reversible cell injury involves changes that are correctable if the stimulus is removed (cellular swelling and organelle changes).
    • Irreversible cell injury leads to cell death, either through necrosis (uncontrolled, inflammatory death) or apoptosis (programmed, non-inflammatory cell death).

    V. Intracellular and Extracellular Accumulations

    • Intracellular accumulations involve the buildup of substances inside cells, caused by metabolic disorders, or by genetic problems.
    • Pathological calcification is the deposition of calcium in normally not calcium-rich areas of the body, and it is most likely caused by tissue damage.
    • Dystrophic calcification develops in necrotic or degenerating tissue.
    • Metastatic calcification develops in healthy tissues due to increased blood calcium levels.

    II. Necrosis

    • Necrosis is tissue death accompanied by inflammation, occurring as a result of severe or prolonged injury.
    • Types of necrosis include coagulative (e.g., in myocardial infarction/kidney injury), liquefactive (e.g., brain and abscesses), caseous (e.g., tuberculous lesions), fat (e.g., pancreatitis), and fibrinoid (e.g., vasculitis).

    III. Apoptosis – programmed cell death

    • Apoptosis is a regulated, orderly process of programmed cell death that helps maintain homeostasis.
    • This process involves specific steps and is characterized by chromatin condensation, membrane blebbing, and fragmentation into apoptotic bodies.
    • Two major pathways regulate apoptosis: intrinsic and extrinsic.

    IV. Comparative Summary of Necrosis Types

    • Provides a table summarizing different necrosis types, their appearance, and the factors associated with them.

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    Description

    This quiz explores the fundamentals of pathology and the cellular responses to stress and injury. It covers key concepts such as homeostasis, adaptations, and the types of cellular injuries that can occur. Test your understanding of how cells respond to various stimuli.

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