Pathophysiology
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| Atrophy | Decrease in cell size, resulting in reduced tissue mass Reduced use or stimulation of tissue, aging
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| Hypertrophy | Condition: Increase in cell size, resulting in enlarged tissue mass Consistent exercises or excessive hormonal stimulation
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| Hyperplasia | Increased number of cells, resulting in enlarged tissue mass Increased demand from the body, excessive hormonal stimulation, inflammation
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| Metaplasia | Mature cell type is replaced by a different mature cell type, resulting in a new wall of tissues Vitamin A deficiency, chronic irritations
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| Dysplasia | Cells vary in size and shape within a tissue Chronic irritation infection, precancerous change
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| Anaplasia | Undifferentiated cells with variable nuclear and cell structures
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| Neoplasm | New growth, commonly called tumor
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| Ischemia | Deficit of oxygen in the cells
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| Hypoxia | Reduced oxygen in tissues
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| Exogenous | From environment
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| Endogenous | from inside the body
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| Abnormal metabolites | − Genetic disorders − Inborn errors of metabolism − Altered metabolism
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| Necrosis | The process when a group of cells die
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| Liquefaction Necrosis | Dead cells liquefy due to release of cell enzymes
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| Coagulative Necrosis | Cell proteins are altered or denatured
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| Fat Necrosis | Fatty tissue is broken down into fatty acids
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| Caseous Necrosis | • A form of coagulation necrosis • Formation of thick, yellowish cheesy substance
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| Infarction | An area of dead cells as a result of oxygen deprivation
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| Gangrene | An area of necrotic tissue that has been invaded by bacteria causing infection. It often leads to amputation.
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| Non-specific | • First line of defense - Mechanical barrier - Unbroken skin and mucous membranes - Secretions such as tears and gastric juices • Second line of defense - Phagocytosis - Inflammation
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| Specific | - A unique response to specific substances - The third line of defense (an immune response)
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| Phagocytosis | a cellular process where phagocytes (a type of white blood cells) surround, ingest, and destroy the microorganism.
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| Antibody-mediated immunity / Humoral immunity | Production of specific antibodies - By B lymphocytes
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| Cell-mediated immunity | activation of specific types of white blood cells) - By T lymphocytes
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| Inflammatory Response: Local Effects | • Redness - Increased blood flow to injury • Swelling (edema) - Protein and fluid move in the interstitial space • Pain - Increased pressure of fluid on nerve and the release of chemical mediators • Loss of function - cells continuously lack nutrients
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| Serous exudate | Watery, consists primarily of fluid, some proteins, and white blood cells
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| Fibrous exudate | Thick, sticky, high cell and fibrin content
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| Purulent exudate | Thick, yellow-green, contains more leukocytes, cell debris, and microorganisms
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| Abscess exudate | Localized accumulation of purulent exudate in a tissue
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| Hemorrhagic exudate | Exudate that causes blood vessels to rupture (pigments of blood)
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| Pyrexia | Mild fever - Common if inflammation is extensive - Release of pyrogens
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| Inflammatory Response: Systemic Effects | • Mild fever (pyrexia) • Malaise • Fatigue • Headache • Anorexia
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| Chronic Inflammation | • Presence of more lymphocytes, macrophages, and fibroblasts (white blood cells) • May lead to further tissue destruction • More fibrous scar tissue • May lead to granuloma developing around foreign object
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| Treatment of Inflammation | • Acetylsalicylic acid (ASA) • Acetaminophen • Non-steroidal anti-inflammatory drugs (NSAIDs) • COX-2 Inhibitors (a newer type of NSAID) • Glucocorticoids
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| Therapies for Inflammation | RICE approach - Rest, Ice, Compression, Elevation
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| Types of Healing: Resolution Regeneration Replacement | • Resolution Minimal tissue damage Tissue returns to normal when damaged cells recover • Regeneration Damaged tissue replaced with cells that are functional • Replacement Functional tissue replaced by scar tissue Loss of function
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| Granulation tissue | A tissue that forms during wound healing. It is surrounded by connective tissue and with a rich supply of new capillaries.
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| First Intention Healing | - Wounds with minimal tissue loss - Small wound/incision - e.g. Paper cut
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| Second Intention Healing | - Wounds that do not easily heal - Large open wounds - e.g. Pressure ulcers
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| Complications: Scar Formation Contractures and obstructions | - Scar tissue is non-elastic - Can restrict range of movement - Can cause shortening or narrowing of structures
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| Complications: Scar Formation Adhesions | Bands of scar tissue joining two surfaces that are normally separated
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| Complications: Scar Formation Hypertrophic scar | - Overgrowth of fibrous tissue - Leads to hard ridges of scar tissue or keloid formation
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| Antigens | - Often proteins, polysaccharides, or glycoproteins - On the cell's surface - Usually exogenous - Activates immune system by producing matching antibodies
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| Tolerance | Immune system under normal conditions ignores self(belonging to the person) cells
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| Specific response | Involves antigens, antibodies, immune cells, chemical mediators Store the specific response in its memory for future reference
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| Lymphoid structures | • Lymph nodes • Spleen • Tonsils • Intestinal lymphoid tissue • Lymphatic circulation
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| Tissue - Bone Marrow - Thymus | • Bone marrow - Origination of immune cells • Thymus - Maturation of immune cells
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| Self antigens | - Human Leukocyte Antigen (HLA) proteins label cells of the individual - Immune system ignores "self" cells
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| Antibodies | Proteins that bind to matching antigens to destroy it
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| IgG | Most common in blood
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| IgM | First to increase in immune response
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| IgA | In secretions e.g. Tears, saliva and mucous membranes, colostrum
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| IgE | Allergic response - Causes release of histamine and other chemicals - Results in inflammation
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| IgD | Attached to and activates B cells
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| Immune cells | - Macrophages - Lymphocytes Are white blood cells that play a role in the body
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| Macrophages | • Initiation of immune response • Phagocytic cells - engulf foreign material • Display antigens of foreign material • Secrete chemicals - Activates additional lymphocytes and the inflammatory response • Present in liver, lungs, lymph nodes
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| B-lymphocytes | • Responsible for production of antibodies • Matures in the bone marrow - Proceed to spleen and lymphoid tissue • Becomes: - Plasma cells (produce antibodies) - B-memory cells (form clones of plasma cells)
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| Plasma cell | Produce antibodies
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| B-memory cells | form clones of plasma cells
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| T Lymphocytes | • From bone marrow stem cells • Further differentiation in thymus
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| Cytotoxic T-killer cells | Destroys antigens
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| Helper T cells | Activates B or T cells)
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| Memory T cells | Remembers the antigen for re-exposure
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| Complement System | • A group of inactive proteins circulating in blood • When activated -> stimulates release of other chemical mediators promoting inflammation, phagocytosis • Causes destruction of antigen or may attach to a microorganism making it ready for phagocytosis
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| Chemical Mediators | • Can signal a cellular response or cause cellular damage • Involved in inflammation and immune reactions - E.g., histamine, interleukins
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| Titer | Measures levels of serum immunoglobulins
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| Indirect Coombs test | Detects Rh blood incompatibility
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| ELISA | Detect HIV antibodies
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| MHC typing | Tissue matching before transplant procedures
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