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EMSON UA Nursing

Stages in the Cellular Response to Stress and Injurious Stimuli

homeostasis, adaptation, cell injury/death

Normal Cell (Homeostasis) (change to next stage)

Stress, increased demand

Adaptation (change to next stage)

hypertrophy, hyperplasia, atrophy →Injurious stimulus/Inability to adapt

Cell injury/cell death: (change to next stage)

necrosis, apoptosis, pathologic calcification (calcium deposited at site of cell death)

Atrophy is a decrease in cell size due to:

Disuse/decrease workload, Denervation/loss of innervations (ex. Paralysis), Lack of endocrine stimulation (ex. Menopause results in a decrease in breast size), Decreased nutrition, Ischemia or decreased blood flow

Hypertrophy is an Increase in functional cell/tissue size due to

Physiologic hypertrophy, Adaptive hypertrophy, Compensatory hypertrophy

Physiologic hypertrophy,

ex. Hormone induced hypertrophy (uterus during pregnancy)

Adaptive hypertrophy

increase in cell size to accommodate changes

Compensatory hypertrophy

increase in size to compensate for loss (ex. Kidney will hypertrophy if the other one is removed)


Increase in cell number

The 3 types of hyperplasia:

Hormonal, Compensatory, Pathologic

Hormonal hyperplasia

ex. Breast growth during puberty

Compensatory hyperplasia

ex. Increase in red blood cells in response to high altitudes

Pathologic hyperplasia

ex. Increase in liver cells in response to alcoholism

Metaplasia is the...

Reversible replacement of one mature cell type by another (sometimes less differentiated)

Metaplasia maintains

cell lives

Metaplasia is survival...

of the fittest

Metaplasia can be...

good or bad

Metaplasia: Ex. Acid can change esophageal squamous cells to

glandular cells


Deranged cell growth

Dysplasia is abnormal changes in the

size, shape, and organization of mature cells

Dysplasia leads

to cancer

Dysplasia leads to Cellular

Injury and Death


programmed cell death

6 types of apoptosis:

Embryogenesis, involution, cell deletion, death of host cells, elimination of lymphocytes, cytotoxic T cells

Pathologic Apoptosis

apoptosis at wrong time


Cell death in an organ or tissue that is still a part of a living person

Pathologic conditions of necrosis

Cell death, cell injury, pathologic atrophy, tumors

4 Types of necrosis

Liquificative, infarction, coagulative, caseous

Liquificative necrosis-

brain and spinal cord

Infarction necrosis-

lack of blood supply

Coagulative necrosis -

common in kidneys

Caseous necrosis-

"cheesy-like" substance, associated with TB, decreased function

Common Causes of Injury and Death

toxin, infection, physical injury, serum deficit

3 types of Physical Injury

mechanical, chemical, thermal

3 causes of Serum deficit

nutrition, hydration, oxygenation

3 causes of Cell Injury and Death

Hypoxia, cell injury, anoxia


decreased oxygen


no oxygen


decreased blood flow

Chemical injury

A biochemical reaction between a toxic substance and the cell membrane leading to increased permeability

Effects of Hypoxia: Reduction in...

Na+ - K+ pump

Effects of Hypoxia: Na+ - Ca++

exchange fails

Effects of Hypoxia: Reduced ATP production leading to

cellular swelling as Na-K pump fails

Effects of Hypoxia:: Injury to lysosomal membranes results in

leakage of enzymes and self destruction

Poisons -

highly toxic chemical substances

3 popular poisons

Arsenic, Cyanide (naturally occurring in plants), Lead

Constitutes a high percentage of childhood poisonings


Malnutrition enhances

lead uptake

Lead causes

hyper activity in children, convulsion, delirium, peripheral nerve damage and paralysis, anemia (lysis of red blood cells)

Organs effected by lead poisoning: :

CNS, hematopoietic system, renal system, GI system

Renal lesion can cause

nausea, loss of appetite, weight loss, abdominal cramping

Carbon Monoxide:

Produces hypoxia

CO Takes over

respiratory system and hemoglobin\

CO Causes

giddiness, headache, hyperactivity, red skin

CO's Half life

3-4 hours

CO's Affinity for hemoglobin is

300x higher than oxygen

Ethanol consumption by pregnant women causes_________

Fetal Alcohol Syndrome

Fetal Alcohol Syndrome results in

Mental retardation, malformation, disfiguration

FAS can lead to

Microcephaly (small brain)

Unintentional/Intentional Injuries:

Blunt force injuries, contusion, Abrasion, Laceration, sharp force injuries, gunshot wounds, aspyxia, drowning

Blunt force injuries include

Tearing, shearing, crushing of tissues, Subdural (dura mater) hematoma (collection of fluid around brain)

A contusion is bleeding...

into skin or underlying tissues

Contusions are caused by...

Blows to head, fall, or impact

Contusions Cause __________ (collection of blood in tissues)


Epidural hematoma, caused by torn artery, associated with _____________

skull fracture




Tear or rip

Sharp force injuries

Incised, stab, puncture, chopping

Incised wounds

(length of cut greater than depth)

Stab wounds

(depth of cut is greater than length)


(made with blunt or dull object)

Chopping wounds

(blunt and sharp force)

Gunshot wounds (2 types)

Penetrate & perforate


(bullet gets stuck in body)


(bullet exits body)

Asphyxia (2 types)

Suffocation & strangulation


anything that blocks oxygen from blood


caused by compression of blood/airways

It takes __________ to close jugular vein

4.5 lb

It takes 11 lb to close ___________

carotid artery

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