Pathology: Types of Necrosis
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What is the most common cause of coagulative necrosis?

  • Hypoxia in the brain
  • Enzymatic digestion
  • Bacterial infections
  • Ischemia in solid organs (correct)

    • Which type of necrosis is characterized by a transformation of tissue into a liquid viscous mass?

  • Liquefactive necrosis (correct)
  • Fat necrosis
  • Caseous necrosis
  • Coagulative necrosis

    • During reversible cell injury, which of the following changes occurs?

  • Complete loss of membrane integrity
  • Clumping of nuclear chromatin (correct)
  • Total destruction of cellular details
  • Denaturation of cellular proteins

    • What defines caseous necrosis?

    <p>Combination of coagulative and liquefactive necrosis</p> Signup and view all the answers

    Which feature is NOT associated with reversible cell injury?

    <p>Denaturation of functional proteins</p> Signup and view all the answers

    What happens to the architecture of tissue during caseous necrosis?

    <p>It becomes completely obliterated</p> Signup and view all the answers

    What is a common consequence of liquefactive necrosis in the central nervous system?

    <p>Absence of cellular details</p> Signup and view all the answers

    What determines the occurrence of necrosis in cells?

    <p>Denaturation of structural proteins</p> Signup and view all the answers

    What characteristic distinguishes tuberculosis granuloma from coagulative necrosis?

    <p>Obliteration of tissue architecture.</p> Signup and view all the answers

    What refers to the destruction of fat cells due to activated pancreatic lipase?

    <p>Fat necrosis</p> Signup and view all the answers

    Which of the following changes occur in necrotic cells?

    <p>Pyknosis and karyorrhexis</p> Signup and view all the answers

    What histological change is associated with fat necrosis?

    <p>Foci of shadowy outlines of necrotic fat cells</p> Signup and view all the answers

    Which process involves programmed cell death, significant in both physiological and pathological contexts?

    <p>Apoptosis</p> Signup and view all the answers

    What is a potentiating factor in the development of fibrinoid necrosis?

    <p>Inflammation of vessels</p> Signup and view all the answers

    Which of the following is a physiologic process that can induce apoptosis?

    <p>Shedding of the endometrium</p> Signup and view all the answers

    What is typically observed in irreversibly damaged cells?

    <p>Myelin figures</p> Signup and view all the answers

    What is the primary focus of pathology?

    <p>The investigation of disease etiology and pathogenesis</p> Signup and view all the answers

    Which of the following is NOT a cause of cell injury?

    <p>Exercise-induced muscle growth</p> Signup and view all the answers

    How does hypoxia primarily cause cell injury?

    <p>By reducing aerobic oxidative respiration</p> Signup and view all the answers

    What distinguishes ischemia from hypoxia?

    <p>Ischemia involves loss of blood supply, while hypoxia is merely low oxygen levels</p> Signup and view all the answers

    Which of the following can lead to oxygen deprivation in tissues?

    <p>Anemia</p> Signup and view all the answers

    Which type of agent can cause cellular injury through immunologic reactions?

    <p>Foreign proteins or drugs</p> Signup and view all the answers

    Which of the following is a common infectious agent that can cause cell injury?

    <p>Bacteria</p> Signup and view all the answers

    What type of disorder is an example of genetic derangement causing cell injury?

    <p>Sickle cell anemia</p> Signup and view all the answers

    What type of epithelium replaces normal ciliated columnar epithelial cells in habitual smokers?

    <p>Squamous epithelium</p> Signup and view all the answers

    Which condition is an example of squamous to columnar metaplasia?

    <p>Barrett’s esophagus</p> Signup and view all the answers

    What describes the process of connective tissue metaplasia?

    <p>Formation of cartilage, bone, or adipose tissue</p> Signup and view all the answers

    Which of the following factors can lead to cell adaptations such as metaplasia?

    <p>Cytokines and growth factors</p> Signup and view all the answers

    Which term describes an increase in the number of cells?

    <p>Hyperplasia</p> Signup and view all the answers

    Which of the following is NOT a physiological cause of hyperplasia?

    <p>Endometrial hyperplasia</p> Signup and view all the answers

    What can persistent stimuli leading to metaplasia result in?

    <p>Malignant transformation</p> Signup and view all the answers

    What does hypertrophy refer to?

    <p>Increase in the size of cells</p> Signup and view all the answers

    Which of the following is an example of physiological hypertrophy?

    <p>Muscle bulging in bodybuilders</p> Signup and view all the answers

    What is the primary mechanism responsible for atrophy?

    <p>Increased protein degradation</p> Signup and view all the answers

    Which condition can lead to pathologic atrophy?

    <p>Immobilization of a broken limb</p> Signup and view all the answers

    Which of the following best describes metaplasia?

    <p>Reversible change replacing one cell type with another</p> Signup and view all the answers

    What triggers myocardial hypertrophy primarily?

    <p>Increased functional demand</p> Signup and view all the answers

    Which of the following is NOT a cause of pathologic atrophy?

    <p>Hormonal stimulation</p> Signup and view all the answers

    What commonly happens to the uterus during pregnancy that represents hypertrophy?

    <p>Increase in organ size due to hormonal stimulation</p> Signup and view all the answers

    Which can lead to senile atrophy in the brain?

    <p>Age-related changes</p> Signup and view all the answers

    What characterizes apoptosis compared to necrosis?

    <p>Formation of apoptotic bodies</p> Signup and view all the answers

    Which statement is true about hyperplasia?

    <p>It can be pathological or physiological.</p> Signup and view all the answers

    Which type of hyperplasia occurs as a response to tissue damage?

    <p>Compensatory hyperplasia</p> Signup and view all the answers

    What is the likely consequence of pathological hyperplasia?

    <p>Potential for cancerous changes</p> Signup and view all the answers

    What triggers hormonal hyperplasia in the mammary glands?

    <p>Increased estrogen and progesterone</p> Signup and view all the answers

    What occurs during the intrinsic pathway of apoptosis?

    <p>Release of cytochrome c from mitochondria</p> Signup and view all the answers

    What structural change is NOT associated with apoptosis?

    <p>Vascular enlargement</p> Signup and view all the answers

    In which condition does endometrial hyperplasia commonly occur?

    <p>Prolonged estrogen stimulation</p> Signup and view all the answers

    Which of the following describes hypertrophy?

    <p>Increase in cell size</p> Signup and view all the answers

    What can result from excessive hormonal stimulation in pathological hyperplasia?

    <p>Increased risk of malignancy</p> Signup and view all the answers

    Which of the following is a primary mechanism that leads to cell injury due to insufficient blood supply?

    <p>Ischemia</p> Signup and view all the answers

    Hypoxia can occur without ischemia and refers only to the reduced amount of oxygen in the blood.

    <p>True</p> Signup and view all the answers

    What is the term for the condition that results from a lack of adequate oxygen supply to the cells?

    <p>Hypoxia</p> Signup and view all the answers

    _______ is a type of cell injury that occurs when cells cannot adapt to stress and become irreversibly damaged.

    <p>Cell injury</p> Signup and view all the answers

    Which of the following substances can cause cell injury as a result of chemical exposure?

    <p>Both A and B</p> Signup and view all the answers

    Match the type of necrosis to its characteristic description:

    <p>Coagulative necrosis = Often occurs due to ischemia Liquefactive necrosis = Results in a liquid viscous mass Caseous necrosis = Associated with tuberculosis Fat necrosis = Destruction of fat cells</p> Signup and view all the answers

    Genetic derangements can lead to congenital malformations and cell injury.

    <p>True</p> Signup and view all the answers

    Name a common agent that can cause cell injury through infectious processes.

    <p>Bacteria</p> Signup and view all the answers

    Which of the following is a physiological example of hypertrophy?

    <p>Bulging of muscles in body builders</p> Signup and view all the answers

    Atrophy can be caused by decreased workload and inadequate nutrition.

    <p>True</p> Signup and view all the answers

    Myocardial hypertrophy is an adaptation to increased _____________.

    <p>work load</p> Signup and view all the answers

    Match the following causes of atrophy with their descriptions:

    <p>Physiologic = Normal developmental processes ending Pathologic = Caused by disease or dysfunction Denervation = Loss of nerve supply leading to atrophy Ageing = Natural reduction in tissue as part of aging</p> Signup and view all the answers

    Which type of atrophy is caused by the immobilization of a limb?

    <p>Pathologic atrophy</p> Signup and view all the answers

    Metaplasia is an irreversible change in cell type.

    <p>False</p> Signup and view all the answers

    Identify one mechanism of protein degradation in atrophy.

    <p>Ubiquitin-proteasome pathway</p> Signup and view all the answers

    Which of the following is NOT a cause of necrosis?

    <p>Normal physiological processes</p> Signup and view all the answers

    Hypoxia and ischemia are the same condition affecting cells.

    <p>False</p> Signup and view all the answers

    Name one characteristic feature of coagulative necrosis.

    <p>Preservation of the basic outline of the coagulated cell.</p> Signup and view all the answers

    ___ is characterized by dominant enzyme digestion and is often seen in bacterial infections.

    <p>Liquefactive necrosis</p> Signup and view all the answers

    Match the type of necrosis with its primary characteristic:

    <p>Coagulative necrosis = Ischemia in solid organs Liquefactive necrosis = Bacterial infection and pus formation Caseous necrosis = Cheesy white gross appearance Fat necrosis = Destruction of fat cells</p> Signup and view all the answers

    Which of the following correctly describes a cause of hypoxia?

    <p>Inadequate blood flow</p> Signup and view all the answers

    All types of necrosis result in complete destruction of the cell's architecture.

    <p>False</p> Signup and view all the answers

    What is the end result of liquefactive necrosis?

    <p>Transformation of the tissue into a liquid viscous mass.</p> Signup and view all the answers

    Study Notes

    Cell Injury

    • Cell injury occurs when cells are stressed or unable to adapt to severe conditions.
    • Causes of cell injury include:
      • Physical agents (e.g., mechanical trauma, extreme temperatures, radiation, electric shock)
      • Chemical agents and drugs (e.g., glucose, oxygen, poisons, alcohol, environmental pollutants, insecticides, herbicides)
      • Infectious agents (e.g., viruses, bacteria, fungi)
      • Immunological reactions (e.g., allergic reactions, autoimmune diseases)
      • Oxygen deprivation (e.g., hypoxia, ischemia)
      • Genetic derangements (e.g., Down syndrome, sickle cell anemia)
      • Nutritional imbalances (e.g., malnutrition, overnutrition)

    Definition of Pathology

    • Pathology is the study of suffering.
    • Patho means suffering.
    • Logos means study.
    • It bridges clinical practice and basic science, investigating the cause (etiology) and underlying mechanisms of disease (pathogenesis).
    • A disease is an abnormal condition negatively affecting the structure and function of an organism's organs.
    • Pathology is divided into general and systemic.

    Cellular Response to Stress

    • Normal cells experience homeostasis.
    • Stress/injury can cause adaptive changes.
    • Inability to adapt leads to cell injury.
    • Reversible injury can resolve with resolution of the stressor, resulting in various changes in the cells (e.g., cellular swelling, blebbing of the plasma membrane, detachment of ribosomes, clumping of nuclear chromatin).
    • Irreversible injury can lead to cell death, either necrosis or apoptosis.
    • Necrosis is cell death with an inflammatory response while apoptosis is cell death without an inflammatory response.

    Causes of Hypoxia

    • A deficiency of oxygen.
    • Loss of oxygen-carrying capacity (e.g., anemia)
    • Reduced amount of oxygen in the blood (e.g., hypoxemia)
    • Impacted blood supply due to impeded arterial flow or reduced venous drainage (ischemia).

    Ischemia

    • Loss of blood supply.
    • Impacts oxygen and metabolic substrates' supply to tissues.
    • Ischemic tissues experience injury more rapidly and severely than hypoxic tissues.

    Genetic Derangements

    • Genetic injury can result in severe defects, like congenital malformations associated with genetic abnormalities (e.g., Down syndrome) or hereditary disorders (e.g., sickle cell anemia).

    Nutritional Imbalances

    • Malnutrition or overnutrition can cause cell injury.

    Mechanism of Cell Injury

    • Injury causes various cellular changes (e.g., ATP depletion, mitochondrial damage, increased cytosolic calcium, reactive oxygen species, membrane damage).
    • These steps eventually lead to irreversible damage, resulting in necrosis or apoptosis.

    Types of Necrosis

    • Coagulative necrosis: Denaturation of proteins is the primary pattern, often preserving the basic tissue architecture for some time. Common in most solid organs except the brain.
    • Liquefactive necrosis: Dominant enzyme digestion, resulting in tissue liquidification. Common in brain infections.
    • Caseous necrosis: A combination of coagulative and liquefactive necrosis, appearing as a cheesy material. A hallmark of tuberculosis.
    • Fat necrosis: Focal fat destruction due to activated pancreatic lipase, presenting with a chalky white appearance with calcium deposits.
    • Fibrinoid necrosis: Fibrin deposition in damaged blood vessels. Common in vasculitis and hypertension.
    • Gangrenous necrosis: Typically coagulative necrosis, often in a limb due to loss of blood supply. Wet gangrene involves bacterial infection superimposed.

    Change in Necrotic Cell

    • Nuclear alterations include:
      • Pyknosis: condensation of chromatin
      • Karyorrhexis: fragmentation of the nucleus
      • Karyolysis: Dissolution of the nucleus
    • Cytoplasmic alterations, including an eosinophilic appearance, granular changes, vacuolization.

    Irreversible Cell Injury and Necrosis

    • Irreversible damage leads to necrosis; this is a series of changes resulting from the enzymes' degrading action on severely damaged cells.
    • Causes include protein denaturation, enzymatic digestion, and loss of cell membrane integrity.

    Apoptosis

    • Apoptosis is a coordinated, internally programmed cell death.
    • It has significance in various physiological and pathological conditions.
    • Physiological processes trigger apoptosis, as seen in endometrial shedding, regression of lactating breast, and embryonic development.
    • Pathologic processes trigger apoptosis, as seen in viral infections, tumor suppression, and chemotherapy.

    Morphologic Changes in Apoptosis

    • Involvement of cells in a viable background is a characteristic feature.
    • Typically round or oval shrunken cell masses, with intensely eosinophilic cytoplasm.
    • The nucleus undergoes changes including chromatin condensation and fragmentation (apoptotic bodies form).
    • Importantly, unlike necrosis, no acute inflammatory reaction is associated with apoptosis.

    Cellular Adaptations

    • Adaptations are altered steady states allowing cells to cope with stress.
    • These changes are typically reversible when the stimulus is removed.

    Hyperplasia

    • Hyperplasia is an increase in cell number.
    • Can be physiological (needed) or pathological (excessive).
    • Physiological hyperplasia is prompted by hormonal stimulation, like in the proliferation of glandular epithelium during pregnancy or compensatory hyperplasia when tissues need to increase in mass post-damage.

    Hypertrophy

    • Hypertrophy is an increase in cell size.
    • Common in non-dividing cells like myocardial fibers.
    • It can be physiological (in response to increased functional needs, like in the growing uterus during pregnancy) or pathological (excessive) due to various stimuli (e.g., increased workload).

    Atrophy

    • Atrophy is a decrease in cell size and/or number.
    • Can be physiological (needed, as in embryonic structures or shrinkage after childbirth).
    • Pathological atrophy (excessive) due to diminished workload, denervation, decreased blood supply, nutritional deficiencies, endocrine stress, compression, aging.
    • Mechanism of atrophy involves decreased protein synthesis, increased protein degradation, and autophagy.

    Metaplasia

    • Metaplasia is the reversible replacement of one adult cell type (epithelial or mesenchymal) by another adult cell type.
      • Example: columnar to squamous epithelium in habitual smokers (trachea and bronchial changes) or squamous to columnar epithelium (Barrett's esophagus). Connective tissue metaplasias (tissues like cartilage, bone, and adipose tissue form in tissues that don't usually have these elements, like Myositis ossificans) are also observed.
      • Mechanism of metaplasia involves signalling events that stimulate reprogramming of stem cells or other resident cells to transform into other cell types.

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