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CELL INJURY
CELL INJURY
The cellular response to injurious stimuli depends
on the nature of the injury, its duration, and its
severity
1.
2.
3.
4.
5.
INJURIOUS STIMULUS
Decreased
ATP
MEMBRANE DAMAGE
MITOCHONDRIA
DAMAGE
LYSOSOME
RUPTURE
INCREASED
intracellular Ca++
PLASMA
MEMBRANE
RUPTURE
PROTEIN
BREAK
DOWN
DNA
DAMAGE
CELL
DEATH
LOSS OF
ENERGY
DEPENDENT
CELULAR
FUNCTIONS
ENZYMATIC DIGESTION OF
CELL COMPONENTS
REACTIVE
OXYGEN
SPECIES
LOSS OF
CELL
CONTENTS
DEPLETION OF ATP:
ATP generation: 2 pathways
1. Oxidative phosphorylation
2. Glycolytic pathway
ATP required for membrane transport,
protein synthesis, lipogenesis, etc.,
ATP depletion: associated with hypoxic &
chemical (toxic) injury to cell.
Decreased ATP increased anaerobic
glycolysis--accumulation of lactic acidincreased pH- acidosis.
MITOCHONDRIAL DAMAGE:
1.
2.
3.
ANTIOXIDANTS:
Necrosis:
Necrosis refers to a spectrum of
morphologic changes that follow
cell death in living tissue, largely
resulting from progressive
degradative action of enzymes on
the lethally injured cells.
Necrosis
Apoptosis
1. Reduced.
2. Fragmentation.
3. Intact; altered
structure.
4. Intact; released
into apoptotic
bodies.
5. No inflammation
6. Physiologic/
pathologic.
7. Agarose gel
electrophoresis: diffuse
smearing pattern
7. Ladder pattern
Pathogenesis:
Autolysis: Due to enzymatic digestion of
the cell and denaturation of intracellular
proteins.
Enzymes: released from lysosome of dead
cells themselves or from immigrant
leukocytes of inflammation.
Morphology:
Increased Eosinophilia: attributable to
loss of normal basophilia imparted by
RNA in the cytoplasm.
More glassy homogeneous appearance.
Cytoplasmic vacuolation: due to digestion
of cytoplasmic organelles moth eaten
appearance.
Normal Myocardium
Ischemic Myocardium
Morphology:
Dead cells replaced by:
Large,whorled phospholipid masses
called Myelin figures
Calcification
Phospholipids are degraded into fatty
acids which undergo calcification to yield
Calcium soaps.
Electron microscopy:
Discontinuous plasma membrane
Dilatation of mitochondria with
appearance of Large amorphous densities
Intracytoplasmic myelin figures
Amorphous osmiophilic debris
Aggregates of fluffy materialdenatured
protein.
Morphology:
Nuclear changes: 3 forms-1. Karyolysis: Basophilia of the
chromatin may fadeDNase activity+
+
2. Pyknosis: Nuclear shrinkage and
increased basophilia--- DNA is
condensed to solid, basophilic mass.
3. Karyorrhexis: Fragmentation of the
pyknotic nucleus.
Types of Necrosis:
1.
2.
3.
4.
5.
Coagulative Necrosis
Liquefactive Necrosis
Caseous Necrosis
Fat Necrosis
Fibrinoid necrosis
1. Coagulative Necrosis:
Implies preservation of basic outline of
the coagulated cell at least for some
days.
Example: Myocardial infarction
acidophilic, coagulated, anucleate cells
persisting for few weeks.
Ultimately it is removed by phagocytosis
by scavenger leukocytes.
COAGULATIVE
NECROSIS -KIDNEY
2. Liquefactive Necrosis:
Most common hypoxic death in CNS.
Transformation of tissue into a liquid
viscous mass.
Seen in fungal/ bacterial infections also.
Pus: creamy yellow material containing
dead white cells.
LIQUEFACTIVE NECROSISBRAIN
LIQUEFACTIVE NECROSISBRAIN
3. Caseous Necrosis:
Most often seen in TUBERCULOSIS.
Cheesy white- gross appearance of the
area of necrosis.
Amorphous, granular debris enclosed
within a distinctive inflammatory border
known as Granulomatous inflammation.
CASEOUS NECROSIS
4. Fat Necrosis:
Due to release of activated pancreatic
lipasesinto pancreatic substances and
peritoneal cavitydestroying the fat.
Most commonly seen in acute
pancreatits.
Lipases split triglycerides into fatty acids
that combine with calcium to produce
grossly visible chalky white areas- FAT
SAPONIFICATION.
Examples:
Acute pancreatitis- release of
pancreatic lipaseliquefy the fat cell
membranes.
Fatty acids+ Ca++ Saponification
Microscopy: foci of necrotic fat cells
surrounded by basophilic calcium
deposits and inflammatory reaction.
Finally may end in dystrophic
calcification.
FAT NECROSIS
5. Fibrinoid necrosis
It is characterised by deposition of fibrinlike material which has staining properties
of fibrin
Seen in various examples of immunologic
tissue injury like autoimmune diseases
Microscopy:
Bright eosiniphilic hyaline like deposition
in the vessel wall
Necrotic focus is surrounded by nuclear
debris of neutrophils.
Fibrinoid necrosis