Raonaq Fatima Nisha

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Cell Adaptations, Cell Injury, Cell Death

Pathology
 Devoted to the study
 Structural
 Biochemical
 Functional changes
 Cells
 Tissues
 Organs that underlie disease
 Four aspects of a disease process
 Etiology
 Pathogenesis
 Morphologic changes
 Clinical manifestations
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Hypertrophy
Refers to an increase in the size of cells, that results in an increase in the size of the affected organ.
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Hyperplasia
Defined as an increase in the number of cells in an organ or tissue in response to a stimulus.
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Atrophy
Defined as a reduction in the size of an organ or tissue due to a decrease in cell size and number.

Metaplasia
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Is a reversible change in which one differential cell type (epithelial or mesenchymal) is replaced by
another cell type.
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Coagulative Necrosis
Is a form of necrosis in which the architecture of dead tissues is preserved for a span of at least some
days.
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Liquefactive Necrosis
Is characterized by digestion of dead cells, resulting in transformation of the tissue into a liquid
viscous mass.
It is seen in focal bacterial or, occasionally, fungal infections, because microbes stimulate the
accumulation of leukocytes and the liberation of enzymes from these cells.

Caseous Necrosis
Is encountered most often in foci of tuberculous infection.
The term “caseous” (cheese like) is derived from the friable white appearance of the area of necrosis.

Fat Necrosis
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Is a term that entrenched in medical parlance but does not in reality denote a specific pattern of
necrosis.
Rather, it refers to focal areas of fat destruction, typically resulting from release of activated
pancreatic lipases into the substance of the pancreas and the peritoneal cavity.

Fibrinoid Necrosis
Is a special form of necrosis usually seen in immune reactions involving blood vessels.
This pattern of necrosis typically occurs when complexes of antigens and antibodies are deposited in
the walls of arteries.

Gangrenous Necrosis
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Is not a specific pattern of cell death, but the term is commonly used in clinical practice.

- Pathology is the study of the structural, biochemical, and functional changes in cells, tissues, and
organs that underlie disease.
- It serves as the bridge between the basic sciences and clinical medicine, providing the scientific
foundation for all of medicine.
- General pathology focuses on the common reactions of cells and tissues to injurious stimuli, which
are often not tissue-specific.
- Systemic pathology examines the alterations and underlying mechanisms in organ-specific diseases.
- Pathogenesis refers to the sequence of cellular, biochemical, and molecular events that follow
exposure to an injurious agent.
- Understanding pathogenesis is crucial to identify specific molecular abnormalities, disease
manifestations, and design new therapeutic approaches.
- Morphologic changes in cells or tissues can be characteristic of a disease or diagnostic of an
underlying process.
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- The limitations of pathology include the fact that morphologically identical lesions can arise from
distinct molecular mechanisms.
- The study of pathology involves examining the end results of genetic, biochemical, and structural
changes in cells and tissues, as well as their associated symptoms and signs.
- Survival and maintenance of homeostasis involve reversible functional and structural changes that
allow cells to survive and continue functioning.
- There are four types of reversible changes: hypertrophy (increase in cell size), hyperplasia (increase
in cell number), atrophy (reduction in organ size), and metaplasia (replacement of one cell type with
another).
- Cell injury occurs when cells are exposed to damaging agents or conditions beyond their adaptive
capacity.
- There are two principal pathways of cell death: necrosis (unregulated cell death) and apoptosis
(programmed cell death).
- Necrosis is characterized by enlarged cell size, nuclear changes (pyknosis, karyorrhexis, karyolysis),
disrupted plasma membrane, and release of cellular contents.
- Apoptosis is characterized by reduced cell size, fragmentation of the nucleus into nucleosome-sized
fragments, intact plasma membrane, and intact cellular contents.
- Different types of necrosis include coagulative, liquefactive, caseous, fibrinoid, fat, and gangrenous
necrosis, each with distinct characteristics and patterns.
- Cell injury can result from depletion of ATP, mitochondrial damage, influx of calcium,
accumulation of oxygen-derived free radicals, defects in membrane permeability, and damage to
DNA and proteins.
- Cellular stress responses can be protective and promote cell survival, or they can lead to cell death if
the stress is too severe.
- The DNA damage response is an important cellular stress response that involves DNA repair
processes and activation of effector systems to mediate cell death if the damage is irreparable.

- Cells are the building blocks of all living things and carry out essential life activities.
- Cell structure includes the cell membrane, cytoplasm, and nucleus.
- Cells communicate, adhere, and form connections through the extracellular matrix.
- Cells can adapt, degenerate, or undergo cell death in response to stress or injury.
- Adaptation can occur through hypertrophy or hyperplasia.
- Degeneration involves the deterioration and dysfunction of cells.
- Cell death can occur through apoptosis or necrosis.
- Pathology involves the study of disease and understanding the mechanisms of cell and tissue injury.
- Disease can have various causes, including genetic abnormalities, infections, and environmental
factors.
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- Etiology refers to the origin of a disease, such as genetic, infectious, immunologic, or environmental
factors.
- Pathogenesis describes the events leading to the onset of a disease, involving tissue repair, immune
responses, and inflammation.
- Morphologic changes are structural alterations seen in tissues and organs due to disease.
- Clinical manifestations are the symptoms and physical characteristics of a disease.
- Understanding cell structure, function, and injury responses is crucial for accurate diagnosis and
effective treatment in pathology.

Inflammation
Causes of Inflammation:
- Infective agents (bacteria, viruses, fungi, parasites) and their toxins
- Immunological agents (cell-mediated and antigen-antibody reactions)
- Physical agents (heat, cold, radiation, mechanical trauma)
- Chemical agents (organic and inorganic poisons)
- Inert materials (foreign bodies)

Signs of Inflammation (Five cardinal signs):

1. Rubor (redness)
2. Tumor (swelling)
3. Calor (heat)
4. Dolor (pain)
5. Functio laesa (loss of function)

Types of Inflammation:
1. Acute inflammation:
- Causes: Infection, trauma, physical and chemical agents, necrosis, foreign bodies,
immune reactions
- Stages: Vasodilation, increased vascular permeability, movement of white blood cells
from blood vessels into soft tissue
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2. Chronic inflammation:
- Prolonged inflammation with active inflammation, tissue destruction, and repair occurring
simultaneously
- Causes: Chronic inflammation following acute inflammation, recurrent acute
inflammation, chronic inflammation starting de novo
- Types: Chronic non-specific inflammation, chronic granulomatous inflammation

Fate of Acute Inflammation:

- Resolution: Complete return to normal tissue
- Healing: Fibrosis (extensive tissue destruction without regeneration) or regeneration
(superficial tissue loss is restored)
- Ulcer: Loss of mucosa and deeper tissues
- Fistula: Anomalous connection between two organs with a lumen
- Suppuration: Severe tissue necrosis leading to the formation of pus and abscess
- Scar formation: Replacement of lost parenchyma with disorganized connective tissue

Cells Involved in Chronic Inflammation:

- Macrophages: Produce various substances and growth factors
- Lymphocytes: Produce fibroblast growth factor (FGF) and platelet-derived growth factor
(PDGF)
- Other cells involved: Endothelial cells, mesenchymal cells, platelets

Systemic Effects of Chronic Inflammation:

- Fever
- Anemia
- Leukocytosis
- Elevated ESR (erythrocyte sedimentation rate)
- Amyloidosis (long-term, chronic suppurative inflammation may lead to secondary systemic
amyloidosis)

Granulomatous Inflammation:
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- Granuloma: Small lesion composed of epithelioid cells (modified macrophages) surrounded

by lymphoid cells
- Examples: Tuberculosis, leprosy, syphilis, actinomycosis, sarcoidosis

Overview of Inflammatory Processes:

- Inflammation begins as a response to stimuli causing cellular damage.
- Mediators involved: Eicosanoids, biological oxidants, cytokines, adhesion factors, digestive
enzymes
- Eicosanoids: Prostaglandins (COX pathway) and leukotrienes (lipoxygenase pathway)
- Biological oxidants: Superoxide anion, hydrogen peroxide, nitric oxide, peroxynitrite,
hypochlorous acid, hydroxyl radical, singlet oxygen
- Cytokines: Tumor necrosis factor-a (TNF-a) and interleukin 1(1-1)

Repair and Healing:

- Healing involves regeneration (complete restoration of tissues) and repair (replacement with
fibrous tissue).
- Regeneration: Proliferation of parenchymal cells regulated by growth factors.
- Repair: Proliferation of connective tissue elements resulting in fibrosis and scarring.

Wound Healing:
- Healing of skin wounds involves regeneration and repair.
- Healing by first intention (primary union): Clean, uninfected wounds approximated by
sutures.
- Healing by second intention (secondary union): Open wounds with large tissue defects or
infections, not approximated by sutures.

Stages of Wound Healing:

1. Hemostasis: Blood clotting, platelet plug formation.
2. Inflammation: Removal of damaged cells, pathogens, and bacteria.
3. Proliferation: Rebuilding of tissue with collagen, extracellular matrix, and new blood
vessels.
4. Maturation: Remodeling of collagen, scar formation, strengthening of the wound area.
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Failure of Wound Healing:

- Factors leading to chronic wounds: Venous disease, infection, diabetes, metabolic
deficiencies in the elderly.

Genetics
1. Allele: An allele is an alternative form of a gene that occupies the same position
(locus) on a pair of chromosomes. For example, the A, B, and O blood type genes are
different alleles.
2. Amorph: An amorph is a gene that does not produce a detectable product or antigen.
It is a silent gene.
3. Autosome: Autosomes are non-sex chromosomes, meaning they are not involved in
determining an individual's sex. In humans, autosomes are chromosomes 1 to 22.
4. Chromosome: Chromosomes are rod-shaped structures found in the nucleus of cells.
They carry genes, which are encoded by DNA.
5. Codon: A codon is a sequence of three DNA or RNA bases that codes for a specific
amino acid. Codons allow specific proteins to be synthesized by specific genes.
6. Transcription: Transcription is the process by which a single-stranded RNA
molecule is synthesized using DNA as a template. It is an important step in gene
expression. Consanguinity: Consanguinity refers to a close genetic relationship
between individuals due to shared ancestry, such as mating between first cousins.
7. Deletion: Deletion is a type of mutation in which a segment of DNA is lost or deleted
from a chromosome. This can lead to genetic disorders or changes in the functioning
of genes.
8. DNA: DNA (Deoxyribonucleic acid) is a molecule that contains the genetic
instructions used in the development and functioning of all living organisms. It carries
the genetic information passed from parents to offspring.
9. DNA polymerases: DNA polymerases are enzymes that play a crucial role in DNA
replication. They are responsible for synthesizing new DNA strands using existing
DNA strands as templates.
10. Dominant gene: A dominant gene is a gene that is expressed and produces its
characteristic trait when present in a heterozygous state, even if another allele is
present.
11. Translation: Translation is the process by which the genetic information carried by
messenger RNA (mRNA) is used to synthesize proteins. It involves the conversion of
the mRNA sequence into a specific sequence of amino acids.
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12. Gamete: Gametes are reproductive cells (sperm and egg) that have half the number of
chromosomes (haploid number) found in other cells. They are formed through a
process called meiosis and are involved in sexual reproduction.
13. Gene: A gene is a segment of DNA that contains the instructions for building a
specific protein or RNA molecule. Genes are the basic units of heredity and determine
the traits and characteristics of an organism.
14. Genome: The genome refers to the complete set of genetic material (DNA) present in
an organism. It includes all the genes and non-coding sequences of DNA that make up
an individual's genetic blueprint.
15. Genotype: Genotype refers to the genetic makeup of an organism, specifically the
combination of alleles present at a particular gene or set of genes.
16. 5. Haploid number: The haploid number is the number of chromosomes found in
gametes, which is half the number of chromosomes found in other cells. In humans,
the haploid number is 23.
17. X-chromosome: The X-chromosome is one of the two sex chromosomes. Females
have two X chromosomes (XX), while males have one X and one Y chromosome
(XY).
18. Human Genome Project: The Human Genome Project was an international scientific
research project that aimed to map and sequence the entire human genome. Its goal
was to identify and understand all the genes in human DNA.
19. Meiosis: Meiosis is a type of cell division that occurs in reproductive cells (gametes).
It involves two rounds of division, resulting in the production of four cells with half
the number of chromosomes as the parent cell. It is important for genetic diversity and
sexual reproduction.
20. Messenger RNA (mRNA): Messenger RNA is a type of RNA molecule that carries
the genetic information transcribed from DNA to the ribosomes, where it serves as a
template for protein synthesis.
21. Mitosis: Mitosis is a type of cell division that occurs in somatic cells (non-
reproductive cells). It results in the formation of two daughter cells, each with the
same number of chromosomes as the parent cell. Mitosis is involved in growth, tissue
repair, and asexual reproduction.
22. X-linked: X-linked refers to genes located on the X chromosome. X-linked
inheritance patterns are specific to genes carried on the X chromosome and can have
different patterns of inheritance in males and females.
23. Y-chromosome: The Y-chromosome is one of the two sex chromosomes found in
males. It determines male sex characteristics and is passed down from fathers to sons.

Practical applications of genetics in nursing explained in simple terms:

1. Understand genetic basis of disease: Nurses with genetic knowledge can understand that
many diseases have a genetic component. They learn about how genes contribute to genetic
disorders and defects, how normal and abnormal cell division is regulated by genetics, and
how diseases are inherited from one generation to the next.
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2. Early diagnosis of genetic disorders: Nurses with genetic knowledge can help in the early
and effective diagnosis of genetic disorders. They understand genetic risks, genetic testing,
and their implications. They can interpret the results of genetic tests and recognize the
possibility of an inherited or genetic component in a client's condition.

3. Contribution towards health promotion: By learning about genetics, nurses can enhance
their understanding of how genetics and the environment interact with individual differences.
They recognize the importance of a healthy prenatal environment in minimizing the risk of
genetic defects in newborns. They also understand that an individual's environment can have
a positive or negative impact on gene or chromosomal mutations.

4. Prevention of genetic conditions: Nurses can contribute to the prevention of genetic

conditions. For example, they can promote early newborn screening and diet management to
prevent conditions like phenylketonuria (PKU) related mental retardation. They understand
the interventions that can be used to prevent certain genetic disorders.

5. Management and care in genetic disorders: Nurses with genetic knowledge can effectively
manage and provide care for patients with genetic disorders. They learn about genetic
approaches to therapy, care management for adults with childhood genetic disorders, and care
management for individuals with adult genetic disorders. This knowledge helps them in
diagnosis and treatment applications.

6. Genetic information and counseling: Nurses learn about genetic information and
counseling. They develop a non-judgmental attitude towards genetic disorders, learn what
information needs to be collected before providing genetic counseling, and understand their
role in delivering genetic counseling. They apply their nursing skills, such as patient
education, confidentiality, and counseling, to genetic information.

7. Referral services: In areas with limited awareness about genetic disorders and healthcare
facilities, nurses can play a crucial role in providing effective referral services. They guide
individuals to the appropriate places for diagnosis and management of genetic conditions.

8. Social and ethical issues in genetics: Nurses learn about social and ethical issues related to
genetics, which are important in the care of patients with genetic disorders. They develop an
awareness of the impact of genetic conditions on individuals, groups, and societies, including
unique issues specific to genetic conditions.

By understanding these practical applications of genetics in nursing, nurses can identify

genetic risk factors, provide care during the diagnosis and management of genetic disorders,
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offer information and support services, meet referral needs, and provide long-term follow-up
to individuals affected by or at risk of genetic disorders.

NEOPLASIA
Certainly! Here's an explanation of neoplasia, tumor nomenclature, and different types of
tumors in a point form:
- Neoplasia is the abnormal growth of tissue, commonly known as a tumor.
- A tumor is another term for a neoplasm.
- Benign tumors are considered innocent-acting because they stay localized and do not
invade surrounding tissues.
- Malignant tumors are considered evil-acting because they can spread and invade
nearby tissues.
- Nomenclature refers to the naming of tumors.
- Benign tumors are named using the suffix "-oma" with the organ name as the root. For
example, a benign tumor of smooth muscle cells is called a leiomyoma.
- Some types of malignant tumors also use the "-oma" suffix, such as melanoma and
seminoma.
- Examples of benign tumor nomenclature include adenoma, which is a benign tumor of the
thyroid.
- Benign tumors are often encapsulated and well-defined.
- Cancers are classified based on the type of cell that the tumor resembles and is presumed to
be the origin of the tumor.
- Carcinomas are cancers derived from epithelial cells, which are cells that line the surfaces
of organs and body cavities.
- Examples of carcinomas include breast cancer, prostate cancer, lung cancer, pancreas
cancer, and colon cancer.
- Carcinomas can arise from different germ layers, which are the three primary layers of cells
in the early embryo.
- Adenocarcinoma is a malignant tumor of glandular cells, while squamous cell carcinoma is
a malignant tumor of squamous cells.
- Sarcomas are malignant tumors arising from connective tissues, such as bone, cartilage, fat,
or nerve tissues.
- Examples of sarcomas include chondrosarcoma (malignant tumor of chondrocytes),
angiosarcoma (malignant tumor of blood vessels), and rhabdomyosarcoma (malignant tumor
of skeletal muscle cells).
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In summary, neoplasia refers to the abnormal growth of tissue, known as a tumor.

Tumors can be benign or malignant, with benign tumors staying localized and malignant
tumors having the ability to spread.
The nomenclature for tumors follows specific naming conventions, with benign tumors using
the "-oma" suffix.
Cancers are classified based on the type of cell they resemble, such as carcinomas derived
from epithelial cells and sarcomas arising from connective tissues.

Adenocarcinoma:
- Adenocarcinoma is a type of malignant tumor that originates from glandular cells.
- In the colon, adenocarcinoma appears as irregularly shaped and sized cancerous glands that
invade the muscular layer of the colon.
- It is surrounded by fibrous stroma.

Squamous Cell Carcinoma:

- Squamous cell carcinoma is a type of malignant tumor that arises from squamous cells.
- The cells in squamous cell carcinoma show some differentiation, but they also exhibit
pleomorphism (variation in size and shape).
- The cells have hyperchromatic nuclei (dark-stained) and may have intercellular bridges.
- Mitotic figures (indicating cell division) are present.

Lymphoma and Leukemia:

- Lymphoma and leukemia are cancers that arise from hematopoietic (blood-forming) cells.
- Lymphomas typically mature in the lymph nodes, while leukemias mature in the blood.
- They arise from cells that leave the bone marrow.

Germ Cell Tumor:

- Germ cell tumors are cancers derived from pluripotent cells, commonly found in the
testicles or ovaries.
- Seminoma and dysgerminoma are examples of germ cell tumors.
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- Seminoma appears as lobules of clear cells with pale nuclei and a sparse lymphocytic
infiltrate.

Teratoma:
- Teratomas are tumors composed of a mixture of tissue types derived from germ layers
(ectoderm, mesoderm, endoderm).
- They can occur in the ovaries, testes, or extragonadal sites.
- Teratomas can be benign (mature) or malignant (immature).

Blastoma:
- Blastomas are a group of malignant tumors that arise from embryonal or partially
differentiated cells.
- They occur more frequently in infants and children under 5 years of age and affect various
organs.
- Examples include neuroblastoma, hepatoblastoma, retinoblastoma, medulloblastoma, and
primary blastoma.

Hamartoma:
- Hamartoma is a benign tumor consisting of disorganized, mature cells indigenous to a
specific organ.
- For example, a hamartoma of the lung may contain mature cartilage, smooth muscle, and
epithelial cells.

Choristoma:- Choristoma refers to ectopic islands of normal tissues, which are not true
tumors but represent heterotopia.

Difference between Benign and Malignant Tumors:

- Benign tumors grow slowly, have an encapsulated and well-defined appearance, and are
usually not life-threatening.
- Malignant tumors can grow rapidly, lack differentiation, invade surrounding tissues, and
have the potential to metastasize (spread to other parts of the body).

Features of Lack of Differentiation (Anaplasia):

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- Lack of differentiation or anaplasia is a characteristic of malignant tumors.

- It includes pleomorphism (variation in size and shape of cells and nuclei), abnormal nuclear
morphology, and a high nuclear-cytoplasmic ratio.

Mitoses:
- Mitoses are cell divisions.
- Malignant tumors often show increased mitotic activity, and atypical mitotic figures
(abnormal forms of mitosis) are a hallmark of malignancy.

Dysplasia:
- Dysplasia refers to disordered growth of cells.
- It is characterized by loss of uniformity, architectural disarray, pleomorphism,
hyperchromatic nuclei, and increased mitotic figures.

Grading of Dysplasia:
- Dysplasia can be graded as mild, moderate, or severe.
- Mild and moderate dysplasia is often reversible, while
severe dysplasia (carcinoma in situ) has a higher likelihood of progressing to invasive
carcinoma.

Carcinoma in situ:
- Carcinoma in situ refers to a preinvasive neoplasm where dysplastic changes involve the
entire thickness of the epithelium but remain confined by the basement membrane.
- It is considered a precursor to invasive carcinoma.

Cervical Intraepithelial Neoplasia (CIN):

- CIN is a classification system for dysplasia in the cervix.
- CIN I refers to mild dysplasia involving the lower third of the epithelium, CIN II involves
the middle third, and CIN III involves the upper third.

Hyperemia:
- Hyperemia is the active engorgement of vascular beds due to increased blood flow through
arterioles.
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- Physiologic Hyperemia:
- Occurs during normal physiological processes.
- Examples include increased blood flow to the stomach and intestines during digestion,
increased blood flow in muscles during exercise, increased blood flow in the skin to dissipate
heat, and high neurovascular hyperemia (blushing).
- Pathologic Hyperemia:
- Results from an underlying pathological process, usually inflammation.
- Arteriolar dilation is a response to inflammatory stimuli/mediators.
- Red coloration is a cardinal sign of inflammation, also known as "Hyperemia of
Inflammation."
- Gross appearance:
- Arteries are distended with blood and prominent.
- Affected part is swollen, enlarged, and heavier than normal.
- If the organ is incised, blood flows freely from the cut surface.
- Microscopical appearance:
- Capillaries are dilated and filled with blood.
- Capillaries appear more numerous than before due to increased blood flow.

Passive hyperemia/Congestion:
- Passive hyperemia is the passive engorgement of a vascular bed caused by decreased blood
outflow.
- Acute General Passive Hyperemia:
- Organs throughout the body appear cyanotic (bluish-red) due to a large amount of non-
oxygenated blood.
- Veins, particularly large ones, are distended with blood.
- Microscopical appearance: Capillaries and veins are dilated and full of blood.
- Effect: Severe cardiac and pulmonary changes can result in a lack of oxygen and nutrients,
leading to cell death.
- Chronic General Passive Hyperemia:
- Veins throughout the body are engorged with blood.
- Tissue edema and transudate in body cavities.
- Atrophy of parenchymatous organs, hyperplasia of connective tissue, and fibrosis can
occur.
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- Microscopical appearance:
- Venous capillaries appear dilated and engorged with blood.
- Edema appears perivascularly.
- Degenerative changes in parenchymatous organs.
- Other changes specific to organs such as brown induration of the lung, fibrosis of the
interalveolar septa, nutmeg liver, and congestive splenomegaly.

Acute Local Passive Hyperemia:

- Gross appearance: Swollen and increased weight of the affected tissue or organ.
- Blood oozes from the cut surface when the organ is incised.
- Veins in the area are distended, and the tissue appears bluish in color.
- Microscopical appearance: Veins and capillaries are distended with blood.
- Edema of interstitial connective tissue and disturbances of cell metabolism or necrosis may
be present.

Chronic Local Passive Hyperemia:

- Gross appearance: Edema of the organ or tissue due to increased capillary permeability as a
result of hypoxia.
- Multiple hemorrhages may be present.
- Increased connective tissue formation and shrinkage of the organ.
- Development of collateral circulation and enlarged veins (varicose veins).
- Microscopical appearance: Prominent dilatation of obstructed veins, new collateral
branches, degeneration, necrosis of organ cells, and increased fibrous connective tissue.

Edema:
- Edema is the abnormal accumulation of fluid in interstitial tissue spaces or body cavities.
- Gross appearance: Pale watery appearance, jelly-like subcutaneous tissue, fluid oozes from
cut surfaces, and pitting on pressure.
- Microscopic appearance: Enlarged intracellular spaces, faint pink staining fluid.