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Pathology, Lecture 4 (Lecture Notes)

Pathology, Lecture 4 (Lecture Notes)

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Published by Ali Hassan Al-Qudsi
Pathology, Lecture 4
Pathology, Lecture 4

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Published by: Ali Hassan Al-Qudsi on Oct 02, 2010
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05/27/2013

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Pathology - Lecture 4Tuesday 28/9/2010Done by: Hadeel Al-Kofahi
Cell Injury – Cellular Adaptations
In the last lecture, we've talked about hyperplasia, hypertrophy,atrophy, and so on, which are changes in growth, cell size,number of cells, and I’ve mentioned the different kinds of tissuesthat have different capacity to proliferate and replace any deadcells, okay ? :D We come now to another subject:
Metaplasia
(Meta-) means different. So metaplasia means: the cells have theability to change from one type to another. It’s reversible, but notalways, but usually it's a reversible change. It’s called “anadaptive change” in which one adult cell (it doesn't usually occurin the fetus, usually in adult cells) is replaced by another adultcell type that’s better suited to tolerate an abnormal environmentor injury. For example, if some of you are pale, you put skin lotionto become a little bit dark; as a protection for the skin (so it's aprotective mechanism). Metaplasia may also have a bad effect.It can usually occur in the epithelial cells & the mesenchymetissue. The usual types of cells which are changing are: bronchial,gastric, and cervical epithelium. The first part of the duodenumcan also change and the bone in injured soft tissue. For example:you have some trauma to a muscle; a strong trauma becomeschronic and then it becomes somewhat calcified, and then in thecalcification we find that there’s bone formation to make the softtissue harder, okay?
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نننننن نننن ننننننننن
 
What are the disadvantages? Now because of metaplasia, thenormal protective mechanisms may be lost and the best exampleof this is in the bronchial mucosa.Now what type of bronchial mucosa do you have? It’s ciliatedcolumnar epithelium, and what do the cilia do? They areprotective against infection; they prevent any particle goingdown, so it's beneficial to the cells to have cilia in the respiratorytract.For example, cilia also occur around the fallopian tube, and this isgood for the sperms and the ova and so on, so it's a beneficialfactor here.Let’s say somebody is a smoker, I guess many of you are (whichis VERY wrong), now this protective mechanism is lost, whathappens because of the smoke? The ciliated epithelium changesto squamous, and what is squamous epithelium? It’s just thickmulti-layers (cell layers) and has no cilia. This can be the effect of smoke, the absence of cilia, and that’s why somebody who’s asmoker will continue to have a chest infection, especially if he hasother chronic lung diseases. So metaplasia is sometimesbeneficial and sometimes is bad. The other point is that persistent of signals that results inmetaplasia may at one point progress from metaplasia todysplasia. We shall see in more details when we talk abouttumors, that dysplasia may be one step before the occurrence of tumors. So dysplasia may progress to carcinoma, not in all casesbut it does happen, so these are just some of the bad influencesof metaplasia.And here is an example: this is a ciliated columnar epithelium andthen it’s being changed to squamous epithelium in the respiratorytract of a smoker! (The doctor admits “it’s not a very clearpicture” :D )
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But this one (the picture below), shows the Gastric metaplasia inthe esophagus. Now, sometimes you have gravitation of acid fluidfrom your stomach into the esophagus, this is called (Reflux) andas this acidity goes up, (or if you have a very short esophagus),then sometimes as a protective mechanism it becomes squamousand sometimes becomes columnar. And sometimes the gastricepithelium goes into the first part of the duodenum (acidsecretion going to theduodenumwhich is more neutral). 
Dysplasia
What about
dysplasia
? We’ll take a short note about dysplasiabut we’ll talk more about it when we talk about tumors.It’s an abnormal change in the cell size, shape, appearance, andthe organizational structure of the cells. It becomes verydifferent. I’ll not talk in details about it; we’ll take about it later.Dysplasia is caused by persistent injury or irritation. It oftenoccurs in the cervix, oral cavity, gallbladder (not very much
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Columnar (gastric) metaplasia inesophageal squamous epithelium

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