Professional Documents
Culture Documents
Adapt
Reversible injury
Irreversible injury
Or cell death occur either by
necrosis
Or apoptosis.
The type of injury
:depends on
Its nature
Its severity
Duration of injury
its adaptability-
its metabolic demands-
.its nutritional &hormonal state-
:Causes of cell injury
1- Hypoxia ( reduced O2 supply):
As in respiratory diseases,
anaemia , cardiovascular
diseases.
2- Physical agents:
As mechanical trauma , excessive
heat or cold, radiation, electric
shock,…
:Chemical agents & drugs- 3
As alcohol, some drugs,
insecticides, or industrial ,or
.occupational hazards
:Biological agents- 4
As viruses, bacteria, parasites,
.….etc
:Immunologic reactions- 5
.As hypersensitivity reactions
:Genetic derangement- 6
As inborn errors of metabolism,
congenital anomalies
:Nutritional imbalances- 7
Either by deficiency( as protein or
vitamins) Or by excess( obesity,
(hyperlipidaemia
:Aging- 8
Which cause progressive loss of
function, lead to cell
.senescence& death
General mechanisms of cell
:injury
Four intracellular systems are targets to be
affected by the injurious agents:
1-Cell membrane integrity.
By affecting sodium potassium pump.
2-Aerobic respiration (ATP energy stores)
through affecting mitochondria
3-Enzymes& protein synthesis
through affecting ribosome & endoplasmic
reticulum.
4 -Genetic apparatus integrity.
Through affecting the nucleus..
Morphology of acute cell
:injury
1-reversible injury:
- Coagulative necrosis
- Liquefactive necrosis
- Caseous necrosis
- Fat necrosis
Two large infarctions (areas of coagulative necrosis) are seen in this sectioned spleen. Since the
etiology of coagulative necrosis is usually vascular with loss of blood supply, the infarct occurs in a
vascular distribution. Thus, infarcts are often wedge-shaped with a base on the organ capsule.
The contrast between normal adrenal cortex and the small pale infarct is good. The area just under
the capsule is spared because of blood supply from capsular arterial branches. This is an odd place
for an infarct, but it illustrates the shape and appearance of an ischemic (pale) infarct well.
Microscopically, the renal cortex has undergone anoxic injury at the left so that the cells appear
pale and ghost-like. There is a hemorrhagic zone in the middle where the cells are dying or have
not quite died, and then normal renal parenchyma at the far right. This is an example of
coagulative necrosis.
The liver shows a small abscess here filled with many neutrophils. This abscess
is an example of localized liquefactive necrosis.
At high magnification, liquefactive necrosis of the brain demonstrates many macrophages at the
right which are cleaning up the necrotic cellular debris. The job description of a macrophage
includes janitorial services such as this, particularly when there is lipid.
Grossly, the cerebral infarction at the upper left here demonstrates liquefactive necrosis.
Eventually, the removal of the dead tissue leaves behind a cavity
This is the gross appearance of caseous necrosis in a hilar lymph node infected with tuberculosis.
The node has a cheesy tan to white appearance. Caseous necrosis is really just a combination of
coagulative and liquefactive necrosis that is most characteristic of granulomatous inflammation.
This is more extensive caseous necrosis, with confluent cheesy tan granulomas in the upper portion
of this lung in a patient with tuberculosis. The tissue destruction is so extensive that there are areas
of cavitation (cystic spaces) being formed as the necrotic (mainly liquefied) debris drains out via the
bronchi
This is fat necrosis of the pancreas. Cellular injury to the pancreatic acini leads to release of powerful
enzymes which damage fat by the production of soaps, and these appear grossly as the soft, chalky
white areas seen here on the cut surfaces.
- Grossly : it appears few hours later ,
as an opaque pale area (or liquefied)
- Microscopically : increased
eosinophilia , disappearance of cell
boundaries (outlines are indistinct) ,
the nuclei either show pyknosis,
karyolysis, or karyohexis.
Later on calcification may follow.