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Topic 1 To 2 Intro, Injury & Inflammation
Topic 1 To 2 Intro, Injury & Inflammation
ELSIE
PATHOLOGY
DR.
RANIA
Introduction
Pathology: scientific study of diseases.
Importance:
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OBJECTIVES
Definition of pathology.
Description and explanation of cell injury and
cellular adaptation.
Description & comparison between acute and chronic
inflammation.
Discussion on tissue repair.
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OBJECTIVES
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Development of Disease
Disease:
An abnormal variation of
the structure and function
of any organ or tissue of
the body.
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TERMS RELATED TO DISEASE
DEVELOPMENT
Etiology: predisposing factors, causes.
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TERMS RELATED TO DISEASE
DEVELOPMENT
Clinical features: symptoms and signs
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Classification of Diseases:
Congenital:
Acquired:
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DIVISION OF PATHOLOGY
General pathology :
Study of basic reactions of cells and tissues to abnormal
stimuli.
Systemic pathology:
Concerned with the study of specific responses of
specialized organs and tissues to well defined stimuli.
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Cell Injury, Necrosis& Apoptosis
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Causes of Cell Injury
Genetic abnormalities.
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Types of Cell Injury
Irreversible:
Apoptosis : programmed
single cell death
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Types of Cell injury
Reversible:
Causes of necrosis:
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“Types” of Necrosis
1. Coagulative necrosis:
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“Types” of Necrosis
1. Liquefactive Necrosis:
The necrotic tissue undergoes rapid
softening by hydrolytic enzymes
e.g. infarction of the nervous tissue,
suppurative inflammation.
Gross appearance: the affected
tissue appears as homogeneous
structure.
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“Types” of Necrosis
1. Caseous Necrosis:
Characteristic of tuberculosis.
Affected tissue undergoes slow
partial liquefaction forming yellow
cheesy material.
Grossly: soft friable tissue
resembling clumpy cheese.
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“Types” of Necrosis
1. Gangrenous Necrosis:
It is a term used to describe
necrosis & putrifaction.
Common sites: lower limbs, gall
bladder, GIT, and testes.
Dry gangrene:
Wet gangrene:
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“Types” of Necrosis
1. Fatty Necrosis:
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Fate of Necrosis
Local:
In small areas, repair by fibrous tissue occurs.
In large areas, cyst will form.
General:
Release of enzymes due to tissue destruction into the
blood: CK, LDH, and transaminases.
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APOPTOSIS
Falling or dropping off
Programmed cell death
An active process regulated by genes and involves RNA and protein synthesis.
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CHARACTERISRICS OF
APOPTOSIS
1) Cells shrink, not swell
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Feature Necrosis Apoptosis
Cellular Contents Enzymatic digestion – may leak out of Intact: may be released in apoptotic bodies
cell
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Cellular Adaptation
Cellular adaptations are those in which new physiologic &
morphologic changes occur in response to excessive
physiologic or pathologic stimuli, but preserving the cell
viability and modulating its functions.
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ADAPTIVE CHANGES
Hyperplasia.
Hypertrophy.
Atrophy.
Metaplasia .
Dysplasia.
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HYPERPLASIA
Definition:
It is an increase in the number of cells in tissue or organ.
Some cell types are unable to exhibit hyperplasia (e.g. nerve,
cardiac, & skeletal muscle cells).
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CAUSES OF HYPERPLASIA
Physiologic causes:
Compensatory, e.g. after partial hepatectomy.
Hormonal stimulation, e.g. breast development at puberty.
Pathologic causes:
Prostatic hyperplasia of aging.
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MEDIATORS OF HYPERPLASIA
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SUMMARY
Hyperplasia Neoplasia
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HYPERTROPHY
Increase in cell size and function activity due to
increased synthesis of intracellular components.
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CAUSES of HYPERTROPHY
1.
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MEDIATORS of HYPERTROPHY
Growth factors.
Cytokines.
Hormones.
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Hypetrophy Normal Muscle
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ATROPHY
Definition: decrease in cell size and functional ability.
Causes of atrophy:
Decreased work load (disuse atrophy).
Ischemia : due to atherosclerosis.
Malnutrition.
Aging.
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MORPHOLOGY of ATROPHY
Gross:
Microscopic:
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Muscular atrophy, Microscopic Appearance
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ATROPHY
Physiologic:
Post menopausal atrophy of breasts, uterus and
ovaries.
Aging: atrophy of heart, brain, and skin.
Postpartum involution of uterus.
Pathologic:
Disuse atrophy e.g. muscles after prolonged
immobilization.
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METAPLASIA
Definition: a reversible replacement of
one differentiated cell type to another,
usually in response to chronic irritation.
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DYSPLASIA
Definition:
It is an abnormal organization of individual cells.
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INFLAMMATION,
HEALING & REPAIR
INFLAMMATION
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Etiologies
Microbial infections: bacterial, viral, fungal, etc.
acid.
Redness : Hyperaemia.
Heat or Warmth:
Swelling : Exudation
Loss of Function:
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FEATURES ACUTE CHRONIC
Cause Pathogens, Injured Tissues Persistent acute inflammation/ FB or autoimmune
reactions
Primary Mediators Vasoactive amines Eicosanoids INF-γ & other cytokines, Growth Factors,
reactive O2 species, hydrolytic enzymes
Onset Immediate (Rapid) (< 48°) Delayed
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INFLAMMATORY PROCESS
1. Vascular changes
2. Cellular changes
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A. Vascular Changes:
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Changes in Vascular Flow & Caliber - 1
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Increased Vascular Permeability - 2
Mechanisms:
1. Contraction of endothelial cells resulting in increased
interendothelial spaces
2. Endothelial injury resulting in endothelial cell necrosis and
detachment
3. Transcytosis: increased transport of fluids and proteins
through the endothelial cells.
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B. Cellular Changes
Margination: WBCs move towards the periphery closer
to the endothelium due to slow blood flow in the dilated
capillaries & venules causing RBCs to stack on each
other leading to rouleaux formation.
Pavementing: WBCs attaches to the endothelium by
adhesion molecules.
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B. Cellular Changes
Attachment: due to the adhesion molecules normally
present in leukocytes and endothelial cells
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EDEMA
TRANSUDATE EXUDATE
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Pus: A purulent exudate exudate rich in leukocytes (mostly
neutrophils) and parenchymal cell debris.
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Phagocytosis:
Engulfment of invading microorganisms, damaged
(2) Engulfment.
Resolution
Injury Chronic
Acute Inflammation Inflammation
Fungus
Virus
Abscess Cancer
s
T.B.
Ulcer etc.
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Fistula Sinus
Acute inflammation has 1 of 4 outcomes:
1. Abscess formation
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Abscess Formation:
ABCESS: "A localized collection of pus (suppurative
inflammation) appearing in an acute or chronic
infection, and associated with tissue destruction, and
swelling.
SITE: skin, subcutaneous tissue, internal organs like
brain, lung, liver, kidney etc….
PATHOGENESIS: necrotic tissue is surrounded by
pyogenic membrane, formed by fibrin to help in
localizing infection.
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