Pathophysiology

for
Nursing Students
Amir Ahmed (MSc, Lecturer)
Department of Nursing
College Of Medicine & Health Sciences
Dire Dawa University
11/08/2023 1
 CHAPTER ONE
ALTERATION IN CELL FUNCTION AND GROWTH

Common terms:
• Pathophysiology’: the study about disease and
its mechanisms.
• It is the branch of medicine that analyzes the
causes, mechanisms of development, and
morphologic manifestations of a disease using
the methods of natural science.
• Pathology: focus on physical changes in
diseased organs and tissues.
 Common terms…

• Disease: loss of homeostasis, or when physical

or mental capacities cannot be fully utilized
(interruption, cessation or disorder in the
function of an organ or system).
• Etiology: cause of the disease. When the
etiology is unknown, the disease is said to be
idiopathic.
 Common terms…

• Genetic disease: genes are responsible for a

structural or functional defect.
• Congenital disease: genetic information is
intact, but the intrauterine environment
interferes with normal development.
• Acquired disease: disease is caused by factors
encountered after birth (biological agents,
physical forces, and chemical agents).
 Common terms…
• Clinical manifestations: indications that the
person is sick.
• Symptoms: unobservable effects of a disease
reported by the patient.
• Signs: observable or measurable traits.
• Syndrome: a characteristic combination of
signs and symptoms associated with a
particular disease
Cell Injury and Cellular Adaptive Changes

• Cells are active participants in their environment,

constantly adjusting their structure and function to
accommodate changing demands and extracellular
stresses.

• As cells encounter physiologic stresses or pathologic

stimuli, they can undergo adaptation, achieving a new
steady state and preserving viability and function.

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 Continued…….
• If the adaptive capability is exceeded or if the
external stress is inherently harmful, cell injury
develops.
• Within certain limits injury is reversible, and cells
return to a stable baseline; however, severe or
persistent stress results in irreversible injury and
death of the affected cells.

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Cellular injury and adaptive changes

Introduction
 Cell injury underlies all diseases. So to
understand diseases one, has to start by
knowing what cell injury is.
 When a cell is exposed to an injurious agent
the possible out came of cell may be:-
1. Adapt to the situation or
2. Acquire a reversible injury or
3. Obtain an irreversible injury & may die.
 Cont…
The injury depends of :-
1. On the injurious agent: like
Type of the injury,
Severity of the injury, &
Duration of the injury
2. on cellular factors (type of the cell)

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 Reversible cell injury
• Is cell injury which can be reversed when the
stimulus or the cause of injury is removed. Example
A) Ischemia:
 Refers to diminished blood flow in a particular
tissue's vascular bed.
 It is reversible in that tissue and tissue restore to
normal function when oxygen is supplied, but if late
it progress to ischemic infraction
 It usually occurs in the presence of atherosclerosis in
major arteries( eg IHD)
 Irreversible cell injury
• It is cellular injury that can not be corrected
(reversed) after the stimulus or cause has been
removed. Example:
A) Infraction:
₋Localized area of tissue death due to persistent lack of
blood supply.
 It also known as ischemic necrosis.
 Irreversible cell injury…
A) Infraction---
 It is irreversible cellular death due to lack of
blood supply, when ischemia is Persistent the
cell face "point of no return".
 Most of the time it is a result of occlusion of
blood vessels by thrombus or Embolus
 Example:- Acute myocardial infarction (AMI)
Irreversible cell injury…
B) Necrosis:-
₋Refers to a sequence of morphologic changes that
follow cell death in living tissue and characterized by
structural evidence of this death.
₋The structural change mostly associated with
mitochondrial swelling, rupture of cell membrane,
shrinking of nucleus and releasing of lysosomal
enzyme etc.
Is a pathologic death of cell / crippled cells (damaged
cells)

-
 B) Necrosis:-

Is death of a cell, organ or tissue that is still a

part of the body.
-Is not programmed.
-Occurs when adaptive change fails.
Based on structural change it can be classified in
to two categories.
 Coagulative Necrosis
 Liquefactive necrosis
1). Coagulative Necrosis
 Usually results from lack of blood supply to an
area.
 The cell structure and its architectural outline is
preserved, but the nucleus is lost (structure less
necrosis)
 Caseous Necrosis: - is a good example of
structure less necrosis.
 It is common in tuberculosis and is
characterized by central area of necrosis which
is soft, friable and surrounded by an area with a
cheesy,
2). Liquefactive necrosis (Colliquative- necrosis)

Usually occurs in brain tissue as a result of

hypoxic condition which, finally bring
breakdown of neurons by lysosmal enzyme and
formation of pockets of liquid , debris and cyst
like structure in the brain tissue.
Example – Wet gangrene
 Apoptosis
 Apoptosis is the death of single cells within
clusters of other cells.
 Is an internally programmed cell death
 Is designed to eliminate unwanted cells
 Can be physiologic(E.g. embryogenesis,
menstruation) or pathologic(E.g injury)
 Serves in many normal function
 Is not necessarily associated with cell injury

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 Cellular Adaptive disorder/change

The life cycle of a cell exists on continuum that

includes normal activities and adaptation, injury or
lethal changes.
Adaptation is a normal life cycle adjustment like in
growth during puberty; changes during pregnancy or
aging and stressful life style produce physiologic
changes that may lead to adaptation or disease.
The cell constantly makes adjustments to a changing,
hostile environment to keep the organism functioning
in normal steady state which is necessary to ensure the
survival of the organism.
Types of cellular Adaptive-changes

When cells are exposed to noxious stimulus they will undergo

one or more of the following types of adaptive changes:-
◦ i. Increased concentrations of normal cellular
constituents.
◦ ii. Accumulate abnormal substances
◦ iii. Change the cellular size or number or
◦ iv. Undergo a lethal change.
◦ Cellular change in No & size: It is the commenest
adaptation
Changes In Cellular Size And Number

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 Atrophy
- Decrease or Shrinkage in the size of the cell by
the loss of cell substance.
- When a sufficient number of cells are involved
entire tissue or organ diminishes in size.
- Ultimately affect the balance between synthesis
and degradation. (Decreased synthesis, increased
catabolism or both)
 Atrophy
Causes: - Decrease workload (Disuse atrophy
due to immobilization)
- Loss of innervations
- Diminished blood supply
- Inadequate nutrition
- Loss of endocrine stimulation
-Aging (Uterine atrophy after menopause)
 Hypertrophy
• It is an increase in the tissue mass of an organ
due to increase in cell size without an increase
in number of cell.
• Result from increased work demand or specific
hormonal stimulation.
E.G. Athletics!
• It can be either physiologic or pathologic
response.
E.G. pathologic for cardiac hyper trophy!
 Hyperplasia
It is an increase in tissue mass because of increase in
cellular number
 It occurs with the tissue that has mitotic division
character.
 It has a potential for proliferation.
 It always needs stimuli.
 It stops when the stimuli is removed
 It is controlled cell reproduction unlike cancer &
malignancy.
 It occurs in; tests, ovaries, kidney & liver
 Metaplasia:
Is a reversible change in which one adult cell type
is replaced by another cell type
- It is substitution of a cell by other that can with
stand the irritation.
- It is the conversion from adult cell to other adult
cell.
E.G. Stratified squamous epithelium cells
substituted for the columnar epithelial Cells in
trachea.
-Occurs due to stimulus & usually reversible
 Dysplasia
It is abnormal changes in shape & size to give
abnormal Architecture
 It is characterized by cellular atypical.
 It is controlled multiplication of cell manner but
have high chance to get Uncontrolled
multiplication. i.e. CANCER!
 It is called precancer condition.
 It occurs because of chronic irritation.

 Seen in: trachea, bronchus, esophagus & cervix

 Neoplasm
• NEOPLASM = “New growth”
• Synonym: TUMOR = “swelling”
• Oncology = the study of tumors
Definition: an abnormal mass of tissue growth
which exceeds and uncoordinated with that of
the normal tissues and persists in the same
excessive manner after the cessation of the
stimuli which initiates the change
 Types
Benign And Malignant

Benign Neoplasm: -Is abnormal growth of cells

& localized to one site which is non
disseminating & non recurrent.
-Not locally invasive.

-Is slowly growing.

-Do not under go degenerative change.
-Do not cause death unless by their location.
 Malignant Neoplasm
Is abnormal division of the cells characterized by the; -
Local invasion.
-Distant dissemination.
-Rapid growth.
-Is there fore called precancer.
-Cause death with out location
Metastasis: Is dissemination of cells to other site other
than the primary site.
Growth of the secondary tumor in distant site.
Is also a typical feature of malignant tumor
 Comparison Of Benign And Malignant Tumor
Benign Malignant
- Similar to cell origin - Dissimilar from cell origin
- Contain differentiated cell - Contain anaplastic cell beside
with differentiated cell
- Edges moves outward - Edges moves outward
smoothly irregularly
- Has slow growth rate - Rapid to very rapid growth rate
- Compress locally - Invade locally
- Seldom recur after removal by - Frequently recur after removal
surgery
- Necrosis and ulceration are not - Necrosis and ulceration are
common common
- Systemic effect is uncommon - Systemic effect is common
11/08/2023 Pathophysiology for Bsc in Nursing students 32
 Nomenclature of Neoplasms
A) Based on its Behavior of growth:-
i) Benign: - Add “oma” at the end for connective tissue
origin tumors.
- Add “papiloma” for epithelial origin.
- Add “adenoma” for glandular origin.
ii) Malignant: – Add: - “sarcoma” at the end for malignant
tumors of Connective tissues origin.
- Add “carcinoma” at the end for malignant tumors of
epithelial origin.
- Add “adenocarcinoma” at the end for malignant tumors of
glandular origin.
 B) Based on cells of origin
Example: - Behavior of growth
Cells of origin: Benign Malignant
- Fatty cells - Lipoma - Liposarcoma
- Bone cells - Osteoma - Osteosarcoma
- Blood vessels - Hemangioma -
Hemangiosarcoma
- Fibrous tissues - Fibroma - Fibrosarcoma
Exceptional Naming (Malignant
Misnomers)
• Hepatoma: - Malignant tumor of the liver
cells.
• Hodgkin’s disease: Malignant tumor of the
lymphoid tissue.
• Multiple Myeloma:- Malignant tumor of the
plasma cell.
• Leukemia: - Malignant tumor of WBC
 CARCINOGENESIS:
-Is the process through which the malignance
come / originated
-A normal tissue changed to a cancerous
tissue. -There is equal chance for all cells to
multiply mitotically abnormally.
but controlled / suppressed by gene.
-So it originated from genetic mutation.
-The process is under direct suppression of
D.N.A
 Carcinogenic Agents:-
Is some thing which causes /initiates cancer growth.
1. Genetic mutation.-inherited
2. Chemicals .Like some drugs, Aromatic
hydrocarbon & Aflatoxin.
3. Physical agents. Like radiation injury & nuclear
bomb attack.
4. Viral carcinogenic. Like carcinogenic viruses/
human pappiloma virus.