Paramedic Care: Principles & Practice

Volume 1 Introduction to Advanced Prehospital Care

Chapter 8 General Principles of Physiology and Pathophysiology

Chapter 8, Part 1 The Cell and the Cellular Environment

Part 1 Topics

The Normal Cell How Cells Respond to Change and Injury The Cellular Environment: Fluids and Electrolytes Acid-Base Balance

CELL THEORY
All Living Things Are Composed of Cells Cells Are the Functional Unit of the Body Continuity of Life: Cells come from other cells

CELL DIVERSITY

Human Body contains 50-106 trillion cells 200 different cell types Range from 2 micrometers to 1 meter in length

The Normal Cell

The Normal Cell

The cell is the fundamental unit of the human body. Three main elements:

Cell membrane Cytoplasm Organelles

Cellular Components

Membrane encircles and protects the cell.

The membrane is selectively permeable

Cytoplasm viscous fluid that fills and gives shape to the cell

Electrolytes, proteins, glucose (sugar), and lipids

Organelles

Structures that perform specific functions within the cell

The Cell Membrane

Organelles

Nucleus Endoplasmic reticulum Golgi apparatus Mitochondria Lysosomes Peroxisomes

NUCLEUS

Cell control center- directs activities Bounded by a double membrane, the nuclear envelope Contains genetic information (DNA) in the form of genes Nucleolus - site of ribosome assembly Multinucleate - many nuclei Anucleate - no nucleus

CYTOPLASM

Cell forming material

viscous transparent fluid organelles - little organs Inclusions - chemical substances that may be stored in the cytoplasm

ORGANELLES

Endoplasmic reticulum

rough ER - transport & membrane synthesis smooth ER - lipid synthesis & drug detoxification

Ribosome - synthesize proteins Golgi apparatus - series of flattened membrane sacs that process, sort and modify proteins and lipids for export or cell use

ORGANELLES

Mitochondria - ATP formation Lysosome - contain hydrolytic enzymes that break down molecules, digest bacteria Microtubules / Microfilaments - form part of the cytoskeleton that serve as support structures and assist with cell movement

Cilia -numerous, short, transport substances across the membrane Flagella - often single, used to propel the cell

ORGANELLES

Peroxisomes - contain enzymes that oxidize toxic substances (neutralize free radicals) Centrosomes/centrioles - function in cell division Storage organelles - Vacuoles, Vesicles, may contain:

fats, oils, melanin

Size does matter!

Cells range from 1200 m Lower limit (0.2 m) determined by space needed for ribosomes, DNA. Upper limit determined by need to transport materials across surface

Large cells have lower surface to volume ratio

Prokaryotic Cell Structure

bacteria & archaea

very small 0.5 - 5 m no organelles, internal membranes rare DNA localized in nucleoid region, NO NUCLEUS growth due to increase in numbers rather than size high surface to volume ratio

Eukaryotic Cells

Internal membranes form different compartments to carry out specific activities

Energy metabolism Protein processing Recycling Information storage

Essential Chemistry

Ions/Ionic bonds

Some atoms can donate or accept electrons

# of protons (+ charge) and electrons (- charge) become imbalanced. Atom acquires a net charge. A charged atom or group of atoms is called an ion. Oppositely charged atoms are attracted to each other, forming an ionic bond.

Covalent Bonds

Some atoms share electrons forming covalent bonds Shared electrons spend time orbiting both atoms Important elements

C 4 bonds N 3 bonds O, S 2 bonds H 1 bond

Polar Covalent Bonds

Some atoms such as O, N attract electrons strongly Unequal sharing of electrons creates partial charges at ends (poles) of covalent bond Opposite partial charges on the same or separate molecules are attracted to each other forming hydrogen bonds (H-bonds)

Why is water special?

Water is a polar molecule. Two ends of molecule have opposite charges. Water molecules stick to each other and to other things.

Surface tension adhesion, capillary action and redwood trees collapsed lungs surfactants cohesion

Water as a solvent

Water can interact with other polar substances, therefore they dissolve well Charged on ions are stabilized by partial charges in water Non- polar molecules do not interact with water.

Hydrophobic interactions

Substances that do not interact with water referred to as hydrophobic hydrophobic molecules are aggregated to minimize disruption of waters H-bonding network.

Major Theme!!

Nature builds big things by organizing and connecting little things.

The whole is greater than the sum of its parts.

Societies Families individuals/organisms organs tissues cells molecules

Hydrated Carbon

Carbohydrates have a base formula of (CH2O)n names end with ose, e.g. - pentoses (n=5) Ribose, ribulose; hexoses (n=6) - glucose, fructose Monosaccharide = 1 sugar

Macromolecules

The most important chemical reactions in living organisms

Condensation - Removal of H and OH from two separate molecules forms water and connects the two molecules. Hydrolysis - Water used to split a molecule Can be continued ad infinitum - monomers

polymer

Disaccharides

2 monosaccharides can be linked to form a disaccharide Oligosaccharides contain several different sugars linked in different types of linkages.

Present on cell surface proteins and lipids.

Polysaccharides

Sugars (monosaccharides) can be connected to form polysaccharides usually only 1 or 2 types of linkage. Glucose is used to produce glycogen (animals), starch (plants) and cellulose (plants).

Polysaccharides

Cellulose is also a polymer of glucose, but sugars are linked differently, difficult to breakdown.

Fiber in the diet, paper, wood, Extra stomachs in ruminants (cows, sheep) with cellulose degrading bacteria

Starch & Glycogen - branching creates more ends - allows more rapid breakdown to individual sugars

Nucleotides (nts)

Sugar - ribose vs. deoxyribose Base - A,C,G and T (DNA) or U (RNA) Phosphates - 1 (mono), 2 (di) or 3 (tri) Important nts

ATP - energy GTP - regulates protein activity NAD, NADP carry electrons

Nucleic Acids

Nucleotides are linked together via dehydration synthesis reactions

sugar phosphate backbone bases project to side

RNA has one strand DNA is double stranded

Proteins are polymers of amino acids

Amino acids are connected together to form a chain linked by peptide bonds. Linkage by peptide bonds maintains amino and carboxyl termini, directionality 20 different amino acids have R groups or side chains with different chemical properties.

Phospholipid structure

Phospholipids - glycerol + 2 fatty acids + phosphate + something else. amphipathic

hydrophobic tail + hydrophilic head

Lipid Bilayers

When mixed with water, phospholipids spontaneously form a lipid bilayer.

Hydrophilic portion of phospholipid on surface, exposed to water. Hydrophobic portion in central region, away from water.

Lipid bilayers form the basis of membrane structure

Triglycerides = Fats/Oils

Triglycerides = glycerol + 3 fatty acids

Function as energy storage and insulation

Saturated vs. Unsaturated Fats

Saturated

Unsaturated

maximum number of hydrogens no double bonds more energy storage (more calories) less fluid because straight butter, lard, fat

less than maximum number of hydrogens double bonds present less energy storage more fluid because bent vegetable oils

Other Lipids

Isoprenoids - carotene, vitamin A, E, K Sterols

cholesterol, a component of membranes steroid hormones, testosterone, estrogen, cortisone

good cholesterol vs. bad cholesterol

Good cholesterol

Bad cholesterol

bound to high density lipoprotein (HDL) transports cholesterol to liver blocks synthesis of more cholesterol

bound to low density lipoprotein (LDL) transports cholesterol to cells of the body does not prevent synthesis of more cholesterol by liver

Other lipids

Waxes - 1 fatty alcohol, very hydrophobic

surface of leaves, ear wax

amphipathic - hydrophobic part associates with grease on your jeans, hydrophilic part associates with water to allow grease to be washed away emulsification - allows oil and water to mix often forms micelles

detergents - fatty acid salt

Fat substitutes - Olestra

Olestra = sucrose + 8 fatty acids not absorbed by digestive track Advantage(s)

can be used to fry foods without adding calories negative nutritional value - prevents absorption of many fat soluble vitamins that help prevent cancer diarrhea oily anal leakage

Disadvantages

Cell Function

All human cells have the same general structure and genetic material. Differentiation, or maturation, causes cells to become specialized. There are seven major functions of cells.

Major Functions of Cells

Movement Conductivity Metabolic absorption Secretion Excretion Respiration Reproduction

Tissues

Tissue refers to a group of cells that perform a similar function. Four basic types of tissue

Epithelial Muscle Connective Nerve

TISSUE ORGANIZATION
Histology - is the study of tissues

MAIN TISSUE TYPES

Epithelial Connective Muscle Nervous

EPITHELIAL TISSUE

Location

sheets or layers lining body tubes, cavities, or covering body surfaces Form many glands

GENERAL CHARACTERISTICS

Form sheets, layers Cells fit together tightly One edge attached to basement membrane No blood supply Regenerate quickly Many are secretory Supported by connective tissue

FUNCTIONS

Protection Absorption Filtration Secretion Gas exchange

EPITHELIAL TISSUE TYPES

Number of layers

simple epithelium stratified epithelium pseudostratified epithelium squamous (flat) cuboidal ( cubed) columnar ( tall) transitional (varies)

Shape of cells

Glandular Epithelial Tissue Types

endocrine (ductless) - secrete hormones into blood exocrine- secrete through ducts to specific locations
unicellular - goblet cells multicellular

modes of secretion apocrine - apex pinches off holocrine - accumulate until rupture merocrine -most common;secrete by exocytosis

CONNECTIVE TISSUE
Most abundant and widespread tissue found in the body

GENERAL CHARACTERISTICS

Many types with great diversity Very good blood supply Cells usually spaced apart from each other Intercellular material (matrix) separating cells No free surface Derived from mesenchyme Consist of ground substance, fibers, cells

Connective Tissue Functions

Physical protection Support Binding Absorb shock Insulation Stores energy Blood production Immunity

Types of Fibers

Collagen - very tough and strong

contains collagen protein contains elastin protein contains collagen & glycoprotein

Elastic - very flexible and stretchable

Reticular - forms network mesh

Connective Tissue Proper

Loose Connective(Areolar) - attaches skin to underlying body parts; superficial fascia

Adipose - energy storage; insulation Reticular - binds smooth muscles together

Regular dense connective tissue(fibrous)

tendon; ligaments fascia, periosteum blood vessels, lung tissue

Irregular dense

Elastic connective

Cartilage

Hyaline cartilage (gristle)

ends of long bone, nose tip, connects ribs to sternum external ear

Elastic cartilage

Fibrocartilage

between pubic symphysis discs between vertebrae

OSSEOUS TISSUE - BONE

MATRIX 30% collagen fibers 70% mineral salts

Osseous Tissue

Types of Cells

osteocytes osteoblasts osteoclasts Cancellous (Spongy) Bone - trabeculae Compact Bone - Haversian Canal System

Types of Bone

Blood Tissue (Vascular)

Hemopoietic Tissue (blood forming tissue) Types of Cells:

erythrocytes (RBCs) leukocytes (WBCs) platelets (thrombocytes)

MUSCLE TISSUE
Contractile tissue Responsible for movement

Skeletal Muscle - Voluntary

Long, threadlike cells with parallel fibers

Cells are multinucleate with nuclei located peripherally; striated

Usually attached to long bones

Smooth Muscle - Involuntary

Spindle shaped cells with single nucleus per cell No striations Located in blood vessels, walls of hollow organs, and the gastrointestinal tract

Cardiac Muscle - Involuntary

Branched cells with striated fibers Intercalated discs Only a single nucleus per cell Only found in the heart

NERVE TISSUE
Characterized by the ability to conduct electrical signals

Nervous Tissue

Located in the brain and spinal cord (CNS) and in the nerves (PNS) Sensitive to changes in the internal and external environment Conducts nerve impulses to other neurons/body parts

NERVE TISSUE

Functions in coordinating, regulating, and integrating body activities Types of Cells:

neuroglial cells - support cells neuron - cell body, axon, dendrites

MEMBRANES
Thin sheet or layer of tissue that covers a structure or lines a cavity

Epithelial Membranes

Cutaneous membrane - skin Serous membrane - (serosa)

found in closed cavities

parietal membrane - lines inside of cavities visceral membrane - covers organs

Mucous membrane - mucosa

line cavities that open to the exterior

Connective Tissue Membranes

Synovial Membrane

line spaces between bones in joints secrete synovial fluid

Organs, Organ Systems, and the Organism

An organ is a group of tissues functioning together. A group of organs working together is an organ system. The sum of all cells, tissues, organs, and organ systems makes up an organism.

Organ Systems

Cardiovascular Respiratory Gastrointestinal Genitourinary Reproductive

Nervous Endocrine Lymphatic Muscular Skeletal

System Integration

Homeostasis is the bodys natural tendency to keep the internal environment and metabolism steady and normal.

Cells do not tolerate extreme environmental fluctuations.

System Integration

Two systems work together to maintain homeostasis:

Nervous system

Endocrine system

Nervous system response is fast Endocrine response is longer lasting Responses are stimulated by pathological alterations

System Integration

Chemical signals are received by various types of receptors

Interact with, and then respond to, the chemical signals and other stimuli

Chemoreceptors Baroreceptors Alpha and Beta Receptors

System Integration

Endocrine Glands

Secrete hormones directly into the circulatory system Secrete hormones directly onto surface Endocrine and exocrine function

Exocrine Glands

Some glands are mixed

Intercellular Communication

Endocrine signaling

Hormones distributed throughout the body Secretion of chemical mediators by certain cells that act only upon nearby cells Cells secrete substances that act upon themselves Cells secrete neurotransmitters that transmit signals across synapses

Paracrine signaling

Autocrine signaling

Synaptic signaling

System Integration

Stressors on a body system are inputs. A system receiving input creates feedback. A negative feedback loop exists when body mechanisms work to reverse the input. Biological systems generally employ negative feedback loops to maintain stability.

Pathophysiology

The physiology of disordered function Our understanding is constantly expanding During your career you will encounter patient conditions or diseases that were not addressed in your initial paramedic education.

How Cells Respond To Change and Injury

Cell Reproduction

Human cells (except sex cells) reproduce by mitosis Most undergo division throughout the life of the individual

Epithelial cells Liver cells Bone marrow cells Nerve cells Skeletal muscle cells
Copyright 2006, 2001, 1994 by Mosby, Inc. All rights reserved.

Some divide until near time of birth

CELL DIVISION

Process by which a cell reproduces itself Involves nuclear division - mitosis, meiosis Involves cytoplasmic division cytokinesis Mitosis - somatic cell division in which the cell retains the same number of chromosomes Meiosis - reductional division in which the chromosome number is reduced

CELL CYCLE

Growth Phase 1 - synthesis of lipids, proteins and carbohydrates S Phase - DNA synthesis Growth Phase 2 - formation of spindle fibers for cell division, centrioles divide Mitosis / Meiosis INTERPHASE

STAGES OF MITOSIS PROPHASE METAPHASE ANAPHASE TELOPHASE

PROPHASE

Chromatin condenses into chromosomes Spindle Fibers appear Nuclear membrane disappears Nucleolus disappears Centrioles move to opposite poles Chromosomes begins to migrate toward equator

METAPHASE / ANAPHASE

Chromosomes line up along equator centromere of each pair attached to a spindle fiber

Centromeres split; sister chromatids separate Chromatids migrate to opposite poles

TELOPHASE & CYTOKINESIS

Opposite of Prophase Chromosomes elongate forming indistinct chromatin Nuclear membrane reappears Nuclear reorganization occurs Two new daughter cells formed

NUCLEIC ACID STRUCTURE

DNA - forms genetic code RNA - functions in the process of protein synthesis

DNA DEOXYRIBONUCLEIC ACID

Double stranded helix; nucleus Contains: 5 carbon sugar, phosphate group, nitrogenous base Nitrogenous bases

adenine-thymine cytosine- guanine

Base pairing occurs

DNA RELICATION

DNA makes an exact duplicate of itself DNA strands separate into separate strands and each one is used as a template for a new strand of nucleotides Two double- helix molecules are formed, each contains an original strand and a newly synthesized strand

RNA RIBONUCLEIC ACID

Single stranded Uracil substitutes for thymine consists of 5 carbon sugar ribose, phosphate group, nitrogenous base Bases: adenine, guanine, cytosine, uracil RNA types: mRNA, tRNA, rRNA

TRANSCRIPTION RNA SYNTHESIS

mRNA is synthesized using a DNA molecule as a template mRNA carries MESSAGE out of the nucleus to the ribsome in the cytoplasm

TRANSLATION PROTEIN SYNTHESIS

Genetic code is translated forming a specific sequence of amino acids mRNA attaches to the ribosomes in the cytoplasm tRNA molecules bring specific A.A. to the ribosome for placement in the dictated sequence Ribosome bonds amino acids together to form proteins / polypeptides Protein is released

Loose end - membranes

Lipid bilayer closes to form a sphere (vesicle) Inside of vesicle is a separate compartment Bilayer is semipermeable

Small, uncharged molecules pass through Large or charged molecules cannot pass through hydrophobic part of bilayer

Loose end protein folding

Proteins are incredibly diverse 20(# of amino acids) possible combinations (3,200,000 combinations for a 5 aa protein). Different amino acids have different chemical properties, causing polypeptide chain to fold up on itself.

Hydrophobic amino acids are buried in the center Hydrophilic are on the surface Ionic and H-bonds can form between amino acids

Function is dependent on folded structure, which is dependent on sequence of amino acids.*******

Loose end enzymes

Enzymes are proteins that catalyze (stimulate/ accelerate) chemical reactions Names end in -ase Examples

DNA polymerase makes DNA ATPase breaks down or produces ATP Helicase unwinds the DNA double helix

Metabolic pathway is a series of reactions that produces (anabolic) or breaks down (catabolic) a molecule in the cell

Defects cause genetic diseases

Info Flow - What Information?

What is information?

Representation of knowledge, thoughts; series of symbols that have meaning. Digital 1s and 0s Alphanumeric letters and numbers Graphic illustration Genetic chemical order of bases (ACGTU) in a nucleic acid tells a cell how and when to make specific proteins which then perform some function for the cell.

Storage of Information

Information is stored in the sequence of bases in DNA. What Information?

Genes - instructions on how to make proteins

hemoglobin gene contains the information on the order of amino acids that are linked together to make hemoglobin

Regulation - when and where to make proteins

only bone marrow cells make hemoglobin

DNA

DNA = deoxyribonucleic acid

Sugar = deoxyribose Base

Purines (2 rings) = A, G Pyrimidines (1 ring) = C, T

Phosphate negative charge gives DNA a negative charge

Nucleic Acids

Nucleotides are linked together via dehydration synthesis reactions

sugar phosphate backbone bases project to side

Bases can form Hbonds

DNA structure

Cs and Gs pair A pairs with T or U

Two strands of DNA are said to be complementary Strands are antiparallel, have 5 phosphate & 3 OH 5-GCTAGGTAGTCCT-3 3-CGATCCATCAGGA-5

The Central Dogma

Information Flow within Organisms What Information? Replication: DNA DNA exact copy - photocopy Transcription: DNA RNA still a sequence of nucleotides writing notes from screen - still same letters, different form (cursive) Translation: RNA protein nucleotide seq. amino acid seq. english russian

Transcription

Messenger RNA (mRNA) functions as a working copy of the information on DNA. RNA polymerase uses 1 strand of DNA as a template to make mRNA. Starting position determined by RNA polymerase binding to PROMOTER RNA polymerase moves down DNA and connects nucleotides to make RNA bases - A,C,G in both RNA and DNA, T in DNA, U in RNA

Transcription

After RNA is made, the 2 DNA strands come back together, RNA molecule is released in eukaryotes - each RNA contains the info from 1 gene produces 1 protein in prokaryotes - RNAs may contain info from multiple gene produce multiple proteins

RNA processing

Once transcription does occur, RNA produced referred to as primary transcript In Eukaryotes, RNA is processed to form mRNA before export from nucleus to cytoplasm

RNA splicing

Eukaryotic genes are interrupted by DNA sequences called introns or intervening sequences, parts that will be used to make protein are exons. Introns are cut from primary RNA transcript, exons are spliced together.

RNA Processing

Poly-A tail added to 3 end to enhance stability of mRNA 7-methyl-guanine cap added to 5 end required for export from nucleus

The Genetic Code

What is a code? Morse Code The genetic code translates nucleotide sequence into amino acid sequence

codon - sequence of 3 nucleotides that specifies 1 amino acid. AUG=start codon UAA, UGA, UAG are stop codons.

The Genetic Code

Genetic code is degenerate - 64 possible combinations, but only 20 amino acids. Most amino acids are encoded by multiple codons
The Genetic Code is Universal - same for all organisms

The Genetic Code

Codons are read sequentially, notoverlapped. 3 Possible Reading Frames

AUG GGA UCC ACA UUU GCA UGA Met Gly Ser Thr Phe Ala Stop A UGG GAU CCA CAU UUG CAU GA Trp Asp Pro His Leu His AU GGG AUC CAC AUU UGC AUG A Gly Ile His Ile Cys Met

The Big Picture

Ribosomes

Translation occurs on ribosomes Ribosomes are ribonucleoproteins (RNA and protein components)

Small subunit contains 16S rRNA and 33 proteins Large subunit contains 23S rRNA, 5S rRNA and 45 proteins

rRNAs are functional components, proteins provide scaffolding

Functional RNAs

mRNA function is information transfer info is used to make protein Some RNAs are not translated tRNA, rRNA Intramolecular base pairing causes RNA to fold into a specific shape (like a protein) Paired regions twist to form helix

tRNA structure

Transfer RNA (tRNAs) are the adaptors that associate RNA codons with amino acids

anticodon at one end base pairs with codons on mRNA. amino acid at other end attached by amino acyltRNA synthetases Each amino acid has 1-2 tRNAs

Translation

1. 2. 3. 4.

Ribosomes bind mRNA, position start codon. Initiator tRNA base pairs with AUG codon. tRNA that base pairs with next codon is lined up. Two amino acids are connected.

Translation

4. 5. 6. 7.

Two amino acids are connected. Ribosome moves down mRNA to next codon. New tRNA pairs with next codon. Return to step 4

Translation

When ribosome reaches a stop codon - no tRNAs can pair with it. Polypeptide is released, folds into a functional protein. See animation

The Big Picture

DNA is transcribed to mRNA. Ribosome binds mRNA. tRNAs with amino acids pair up with codons on mRNA. Amino acids connected to produce protein

Questions?

How Cells Respond To Change and Injury

Cellular Adaptation Cellular Injury Cellular Death

Cellular Adaptation

Cells, tissues, organs, and organ systems can adapt to both normal and injurious conditions. Adaptation results in alteration of structure and function. Many of these cellular adaptations are successful.

May also be part of the process of a disease

Types of Cellular Adaptations

Atrophy

Decreased size resulting from a decreased workload An increase in cell size resulting from an increased workload

Hypertrophy

Hyperplasia

An increase in the number of cells resulting from an increased workload

Types of Cellular Adaptations

Metaplasia

Replacement of one type of cell by another type of cell that is not normal for that tissue A change in cell size, shape, or appearance caused by an external stressor

Dysplasia

Cellular Injury

Hypoxic Chemical Infectious Immunologic or Inflammatory

Physical agents Nutritional balances Genetic factors

Cellular Injury

Hypoxic Injury

Usually a deficit in the respiratory or cardiovascular system Blockage or reduction of blood flow to a cell may result in ischemia.

Results in anaerobic metabolism Cell and some of its organelles then begin to swell

Reversible if intervention is early

Infarction occurs if no intervention

Cellular Injury

Chemical Injury

Cellular injury due to chemical products is very common.

Heavy metals, carbon monoxide, ethanol, drugs, and insecticides are examples Disruption of the cellular membrane Alteration of coagulation Death of the cell

Injuries include:

Cellular Injury

Infectious Injury

Caused by bacteria, viruses, prions, fungi, and parasites Majority are harmless

Pathogens cause disease

Degree of damage depends on the pathogens numbers, its virulence, and the bodys ability to contain or destroy it

Cellular Injury

Immunologic/Inflammatory Injury

Protective responses of the body can cause cell injury and even death. Hypersensitivity Anaphylaxis An immune response may harm healthy cells as well as damaged cells.

Cellular Injury

Injurious Physical Agents

Extreme variances in temperature Atmospheric pressure changes Exposure to ionizing radiation Illumination Noise Mechanical stresses

Cellular Injury

Injurious Nutritional Imbalances

Excessive intake of saturated fats and cholesterol Excessive carbohydrate (glucose) intake Insufficient intake of nutrients

Cellular Injury

Injurious Genetic Factors

Some cellular dysfunctions are caused by genetic predisposition. This can involve alterations to the nucleus or the cell membrane, the shape of the cell, the receptors on the cell membrane, or the transport mechanisms that carry substances across the cell membrane. The interaction of genes and environmental factors determine that persons development.

Manifestations of Cellular Injury

When cells are injured metabolism is changed, causing substances to infiltrate or accumulate to an abnormal degree in cells and tissues. The most commonly seen effects of cell injury and accumulation are cellular swelling and fatty change.

Manifestations of Cellular Injury

Cellular Swelling

Results from a permeable or damaged cellular membrane Caused by an inability to maintain stable intraand extra-cellular fluid and electrolyte levels Lipids invade site of injury Ominous sign of impending cellular destruction

Fatty Change

Manifestations of Cellular Injury

Systemic Signs and Symptoms of Cellular Change

Fatigue and malaise Altered appetite Fever Increased heart rate associated with fever Pain

Cellular Death

Apoptosis

The bodys way of ridding itself of destroyed or nonfunctional cells Result of both normal and pathological tissue changes In apoptosis, cells shrink Apoptosis has specificity

Contained to specific cells or areas

Cellular Death

Necrosis

A pathological process Cells swell and rupture Necrotic tissue changes

Coagulative, liquefactive, caseous, and fatty

Gangrenous necrosis