Paramedic Care:Paramedic Care:Principles & Practice Principles & Practice

Volume 1Volume 1Introduction to Advanced Introduction to Advanced

Prehospital CarePrehospital Care

Chapter 8Chapter 8 General Principles of General Principles of

Physiology and Physiology and PathophysiologyPathophysiology

Chapter 8, Part 1Chapter 8, Part 1The Cell and the The Cell and the

Cellular EnvironmentCellular Environment

Part 1 TopicsPart 1 Topics The Normal CellThe Normal Cell How Cells Respond to Change and How Cells Respond to Change and

InjuryInjury The Cellular Environment: Fluids and The Cellular Environment: Fluids and

ElectrolytesElectrolytes Acid-Base BalanceAcid-Base Balance

CELL THEORYCELL THEORY All Living Things Are Composed of All Living Things Are Composed of

CellsCells Cells Are the Functional Unit of the Cells Are the Functional Unit of the

BodyBody Continuity of Life: Cells come from Continuity of Life: Cells come from

other cellsother cells

CELL DIVERSITYCELL DIVERSITY Human Body contains 50-106 trillion Human Body contains 50-106 trillion

cellscells 200 different cell types200 different cell types

Range from 2 micrometers to 1 Range from 2 micrometers to 1 meter in lengthmeter in length

The Normal CellThe Normal Cell

The Normal CellThe Normal Cell The cell is the The cell is the

fundamental unit fundamental unit of the human of the human body.body.

Three main Three main elements: elements: Cell membraneCell membrane Cytoplasm Cytoplasm Organelles Organelles

Cellular ComponentsCellular Components Membrane encircles and protects the cell.Membrane encircles and protects the cell.

The membrane is selectively permeable The membrane is selectively permeable Cytoplasm viscous fluid that fills and Cytoplasm viscous fluid that fills and

gives shape to the cellgives shape to the cell Electrolytes, proteins, glucose (sugar), and Electrolytes, proteins, glucose (sugar), and

lipids lipids OrganellesOrganelles

Structures that perform specific functions Structures that perform specific functions within the cellwithin the cell

The Cell MembraneThe Cell Membrane

OrganellesOrganelles NucleusNucleus Endoplasmic reticulumEndoplasmic reticulum Golgi apparatusGolgi apparatus MitochondriaMitochondria LysosomesLysosomes PeroxisomesPeroxisomes

NUCLEUSNUCLEUS Cell control center- directs activitiesCell control center- directs activities Bounded by a double membrane, the Bounded by a double membrane, the

nuclear envelopenuclear envelope Contains genetic information (DNA) in Contains genetic information (DNA) in

the form of genes the form of genes Nucleolus - site of ribosome assemblyNucleolus - site of ribosome assembly Multinucleate - many nucleiMultinucleate - many nuclei Anucleate - no nucleusAnucleate - no nucleus

CYTOPLASMCYTOPLASM Cell forming materialCell forming material

viscous transparent fluidviscous transparent fluid organelles - “little organs”organelles - “little organs” Inclusions - chemical substances that Inclusions - chemical substances that

may be stored in the cytoplasmmay be stored in the cytoplasm

ORGANELLESORGANELLES Endoplasmic reticulumEndoplasmic reticulum

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

detoxificationdetoxification Ribosome - synthesize proteinsRibosome - synthesize proteins Golgi apparatus - series of flattened Golgi apparatus - series of flattened

membrane sacs that process, sort and membrane sacs that process, sort and modify proteins and lipids for export or cell modify proteins and lipids for export or cell useuse

ORGANELLESORGANELLES Mitochondria - ATP formationMitochondria - ATP formation Lysosome - contain hydrolytic enzymes Lysosome - contain hydrolytic enzymes

that break down molecules, digest bacteria that break down molecules, digest bacteria Microtubules / Microfilaments - form part of Microtubules / Microfilaments - form part of

the cytoskeleton that serve as support the cytoskeleton that serve as support structures and assist with cell movement structures and assist with cell movement Cilia -numerous, short, transport substances Cilia -numerous, short, transport substances

across the membraneacross the membrane Flagella - often single, used to propel the cellFlagella - often single, used to propel the cell

ORGANELLESORGANELLES

Peroxisomes - contain enzymes that oxidize Peroxisomes - contain enzymes that oxidize toxic substances (neutralize free radicals)toxic substances (neutralize free radicals)

Centrosomes/centrioles - function in cell Centrosomes/centrioles - function in cell divisiondivision

Storage organelles - Vacuoles, Vesicles, Storage organelles - Vacuoles, Vesicles, may contain:may contain: fats, oils, melaninfats, oils, melanin

Size does matter!Size does matter! Cells range from Cells range from

1–200 1–200 mm Lower limit (0.2 Lower limit (0.2 m)m)

determined bydetermined byspace needed for space needed for ribosomes, DNA.ribosomes, DNA.

Upper limit determined Upper limit determined by need to transport by need to transport materials across surfacematerials across surface Large cells have lower Large cells have lower

surface to volume ratiosurface to volume ratio

Prokaryotic Cell StructureProkaryotic Cell Structure bacteria & archaeabacteria & archaea

very small 0.5 - 5 µm very small 0.5 - 5 µm no organelles, no organelles,

internal membranes rareinternal membranes rare DNA localized in nucleoid region, NO NUCLEUSDNA localized in nucleoid region, NO NUCLEUS growth due to increase in numbers rather than sizegrowth due to increase in numbers rather than size high surface to volume ratiohigh surface to volume ratio

Eukaryotic CellsEukaryotic Cells Internal Internal

membranes form membranes form different different compartments to compartments to carry out specific carry out specific activitiesactivities Energy metabolismEnergy metabolism Protein processingProtein processing RecyclingRecycling Information storageInformation storage

Essential ChemistryEssential Chemistry

Ions/Ionic bondsIons/Ionic bonds Some atoms can donate or Some atoms can donate or

accept electrons accept electrons # of protons (+ charge) and # of protons (+ charge) and

electronselectrons(- charge) become imbalanced. (- charge) become imbalanced.

Atom acquires a net charge.Atom acquires a net charge. A charged atom or group of A charged atom or group of

atoms is called an ion.atoms is called an ion. Oppositely charged atoms are Oppositely charged atoms are

attracted to each other, attracted to each other, forming an ionic bond.forming an ionic bond.

Covalent BondsCovalent Bonds Some atoms share electrons Some atoms share electrons

– forming covalent bonds– forming covalent bonds Shared electrons spend time Shared electrons spend time

orbiting both atomsorbiting both atoms Important elementsImportant elements

C – 4 bondsC – 4 bonds N – 3 bondsN – 3 bonds O, S – 2 bondsO, S – 2 bonds H – 1 bondH – 1 bond

Polar Covalent BondsPolar Covalent Bonds Some atoms such as O, N Some atoms such as O, N

attract electrons stronglyattract electrons strongly Unequal sharing of electrons Unequal sharing of electrons

creates partial charges at creates partial charges at ends (poles) of covalent bondends (poles) of covalent bond

Opposite partial chargesOpposite partial chargeson the same or separate on the same or separate molecules are attracted molecules are attracted to each other – forming to each other – forming hydrogen bonds hydrogen bonds (H-bonds)(H-bonds)

Why is water Why is water special?special?

Water is a polar molecule.Water is a polar molecule. Two ends of molecule have Two ends of molecule have

opposite charges.opposite charges. Water molecules stick to each Water molecules stick to each

other and to other things.other and to other things. Surface tensionSurface tension adhesion, capillary actionadhesion, capillary action

and redwood trees and redwood trees collapsed lungscollapsed lungs surfactantssurfactants cohesioncohesion

Water as a solventWater as a solvent Water can interact with Water can interact with

other polar substances, other polar substances, therefore they dissolve therefore they dissolve wellwell

Charged on ions areCharged on ions arestabilized by partial stabilized by partial charges in watercharges in water

Non- polar moleculesNon- polar moleculesdo not interact with do not interact with water.water.

Hydrophobic “interactions”Hydrophobic “interactions” Substances that do not interact with Substances that do not interact with

water referred to as hydrophobicwater referred to as hydrophobic hydrophobic molecules are aggregated to hydrophobic molecules are aggregated to

minimize disruption of water’s H-bonding minimize disruption of water’s H-bonding network.network.

Major Theme!!Major Theme!! Nature builds “big” things by Nature builds “big” things by organizingorganizing

and connecting “little” things.and connecting “little” things. The whole is greater than the sum of its parts.The whole is greater than the sum of its parts.

SocietiesSocieties FamiliesFamilies individuals/organismsindividuals/organisms organsorgans tissuestissues cellscells moleculesmolecules

Hydrated CarbonHydrated Carbon Carbohydrates have a base formula of (CHCarbohydrates have a base formula of (CH22O)O)nn names end with “ose”, e.g. - pentoses (n=5) – Ribose, names end with “ose”, e.g. - pentoses (n=5) – Ribose,

ribulose; hexoses – (n=6) - glucose, fructoseribulose; hexoses – (n=6) - glucose, fructose Monosaccharide = 1 sugarMonosaccharide = 1 sugar

Macromolecules Macromolecules

The most important chemical The most important chemical reactions in living organismsreactions in living organisms

Condensation - Removal of H and OH from two separate molecules forms water and Condensation - Removal of H and OH from two separate molecules forms water and connects the two molecules.connects the two molecules.

Hydrolysis - Water used to split a molecule Hydrolysis - Water used to split a molecule Can be continued Can be continued ad infinitum - monomers ad infinitum - monomers polymer polymer

DisaccharidesDisaccharides 2 monosaccharides can be 2 monosaccharides can be

linked to form a disaccharidelinked to form a disaccharide Oligosaccharides contain Oligosaccharides contain

several different sugars several different sugars linked inlinked indifferent types of different types of linkages. linkages. Present on cell surface Present on cell surface

proteins and lipids.proteins and lipids.

PolysaccharidesPolysaccharides Sugars (monosaccharides) can be connected to Sugars (monosaccharides) can be connected to

form polysaccharides – usually only 1 or 2 types form polysaccharides – usually only 1 or 2 types of linkage.of linkage.

Glucose is used to produce glycogen (animals), Glucose is used to produce glycogen (animals), starch (plants) and cellulose (plants).starch (plants) and cellulose (plants).

PolysaccharidesPolysaccharides Cellulose is also a polymer of glucose, but sugars are Cellulose is also a polymer of glucose, but sugars are

linked differently, difficult to breakdown.linked differently, difficult to breakdown. Fiber in the diet, paper, wood, Extra stomachs in ruminants Fiber in the diet, paper, wood, Extra stomachs in ruminants

(cows, sheep) with cellulose degrading bacteria(cows, sheep) with cellulose degrading bacteria Starch & Glycogen - branching creates more ends - Starch & Glycogen - branching creates more ends -

allows more rapid breakdown to individual sugarsallows more rapid breakdown to individual sugars

Nucleotides (nts)Nucleotides (nts) Sugar - ribose vs. deoxyriboseSugar - ribose vs. deoxyribose Base - A,C,G and T (DNA) or U Base - A,C,G and T (DNA) or U

(RNA)(RNA) Phosphates - 1 (mono), 2 (di) Phosphates - 1 (mono), 2 (di)

or 3 (tri)or 3 (tri) Important ntsImportant nts

ATP - energyATP - energy GTP - regulates GTP - regulates

protein activityprotein activity NAD, NADP carryNAD, NADP carry

electronselectrons

Nucleic AcidsNucleic Acids Nucleotides are linked Nucleotides are linked

together via together via dehydration synthesis dehydration synthesis reactionsreactions sugar phosphate sugar phosphate

backbonebackbone bases project to sidebases project to side

RNA has one strandRNA has one strand DNA is double strandedDNA is double stranded

Proteins are polymers Proteins are polymers of amino acidsof amino acids

Amino acidsAmino acids are connected together to form are connected together to form a chain linked by a chain linked by peptide bonds.peptide bonds.

Linkage by peptide bonds maintains amino Linkage by peptide bonds maintains amino and carboxyl termini, and carboxyl termini, directionalitydirectionality

20 different amino acids 20 different amino acids have “have “R groupsR groups” or ” or “side chains” with different “side chains” with different chemical properties.chemical properties.

Phospholipid structurePhospholipid structure Phospholipids - glycerol + 2 fatty acids + Phospholipids - glycerol + 2 fatty acids +

phosphate + something else.phosphate + something else. amphipathic amphipathic

hydrophobic tail +hydrophobic tail + hydrophilic head hydrophilic head

Lipid BilayersLipid Bilayers When mixed with water, phospholipids When mixed with water, phospholipids

spontaneously form a lipid bilayer.spontaneously form a lipid bilayer. Hydrophilic portion of phospholipid on surface, exposed to Hydrophilic portion of phospholipid on surface, exposed to

water.water. Hydrophobic portion in central region, away from water.Hydrophobic portion in central region, away from water.

Lipid bilayers formLipid bilayers formthe basis of membrane the basis of membrane structurestructure

Triglycerides = Fats/OilsTriglycerides = Fats/Oils Triglycerides = glycerol + 3 fatty acidsTriglycerides = glycerol + 3 fatty acids

Function as energy storage and insulationFunction as energy storage and insulation

Saturated vs. Unsaturated Saturated vs. Unsaturated FatsFats

SaturatedSaturated maximum number of hydrogensmaximum number of hydrogens no double bondsno double bonds more energy storage (more more energy storage (more

calories)calories) less fluid because straightless fluid because straight butter, lard, fatbutter, lard, fat

UnsaturatedUnsaturated less than maximum less than maximum

number of hydrogensnumber of hydrogens double bonds presentdouble bonds present less energy storageless energy storage more fluid because bentmore fluid because bent vegetable oilsvegetable oils

Other LipidsOther Lipids Isoprenoids - carotene, vitamin A, E, KIsoprenoids - carotene, vitamin A, E, K Sterols Sterols

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

cortisonecortisone

good cholesterol vs. bad good cholesterol vs. bad cholesterolcholesterol

Good cholesterolGood cholesterol bound to high density bound to high density

lipoprotein (HDL)lipoprotein (HDL) transports cholesterol transports cholesterol

to liverto liver blocks synthesis of blocks synthesis of

more cholesterolmore cholesterol

Bad cholesterolBad cholesterol bound to low bound to low

density lipoprotein density lipoprotein (LDL)(LDL)

transports transports cholesterol to cells cholesterol to cells of the bodyof the body

does not prevent does not prevent synthesis of more synthesis of more cholesterol by livercholesterol by liver

Other lipidsOther lipids Waxes - 1 fatty alcohol, very hydrophobicWaxes - 1 fatty alcohol, very hydrophobic

surface of leaves, ear waxsurface of leaves, ear wax detergents - fatty acid saltdetergents - fatty acid salt

amphipathic - hydrophobic part associates amphipathic - hydrophobic part associates with grease on your jeans,with grease on your jeans,hydrophilic part associates hydrophilic part associates with water to allow grease with water to allow grease to be washed awayto be washed away

emulsification - allows emulsification - allows oil and water to mixoil and water to mix

often forms micellesoften forms micelles

Fat substitutes - OlestraFat substitutes - Olestra Olestra = sucrose + 8 fatty acidsOlestra = sucrose + 8 fatty acids not absorbed by digestive tracknot absorbed by digestive track Advantage(s) Advantage(s)

can be used to fry foods can be used to fry foods without adding calorieswithout adding calories

DisadvantagesDisadvantages negative nutritional value - prevents negative nutritional value - prevents

absorption of many fat soluble absorption of many fat soluble vitamins that help prevent cancer vitamins that help prevent cancer

diarrheadiarrhea oily anal leakageoily anal leakage

Cell FunctionCell Function All human cells have the same general All human cells have the same general

structure and genetic material.structure and genetic material. Differentiation, or maturation, causes Differentiation, or maturation, causes

cells to become specialized.cells to become specialized. There are seven major functions of There are seven major functions of

cells.cells.

Major Functions of CellsMajor Functions of Cells MovementMovement ConductivityConductivity Metabolic absorptionMetabolic absorption SecretionSecretion ExcretionExcretion RespirationRespiration ReproductionReproduction

TissuesTissues Tissue refers to a group of cells that Tissue refers to a group of cells that

perform a similar function.perform a similar function. Four basic types of tissueFour basic types of tissue

EpithelialEpithelial Muscle Muscle ConnectiveConnective NerveNerve

TISSUE ORGANIZATIONTISSUE ORGANIZATION

Histology - is the study of Histology - is the study of tissuestissues

MAIN TISSUE TYPESMAIN TISSUE TYPES EpithelialEpithelial ConnectiveConnective MuscleMuscle NervousNervous

EPITHELIAL TISSUEEPITHELIAL TISSUE LocationLocation

sheets or layers lining body tubes, sheets or layers lining body tubes, cavities, or covering body surfacescavities, or covering body surfaces

Form many glandsForm many glands

GENERAL CHARACTERISTICSGENERAL CHARACTERISTICS Form sheets, layersForm sheets, layers Cells fit together tightlyCells fit together tightly One edge attached to basement One edge attached to basement

membranemembrane No blood supplyNo blood supply Regenerate quicklyRegenerate quickly Many are secretoryMany are secretory Supported by connective tissueSupported by connective tissue

FUNCTIONSFUNCTIONS ProtectionProtection AbsorptionAbsorption FiltrationFiltration SecretionSecretion Gas exchangeGas exchange

EPITHELIAL TISSUE TYPES EPITHELIAL TISSUE TYPES Number of layersNumber of layers

simple epitheliumsimple epithelium stratified epitheliumstratified epithelium pseudostratified epitheliumpseudostratified epithelium

Shape of cellsShape of cells squamous (flat)squamous (flat) cuboidal ( cubed)cuboidal ( cubed) columnar ( tall)columnar ( tall) transitional (varies)transitional (varies)

endocrine (ductless) - secrete hormones endocrine (ductless) - secrete hormones into bloodinto blood

exocrine- secrete through ducts to exocrine- secrete through ducts to specific locationsspecific locations

unicellular - “goblet cells”unicellular - “goblet cells” multicellularmulticellular

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

Glandular Epithelial Tissue Glandular Epithelial Tissue TypesTypes

CONNECTIVE TISSUECONNECTIVE TISSUE

Most abundant and Most abundant and widespread tissue found in widespread tissue found in

the bodythe body

GENERAL CHARACTERISTICS GENERAL CHARACTERISTICS Many types with great diversityMany types with great diversity Very good blood supplyVery good blood supply Cells usually spaced apart from each otherCells usually spaced apart from each other Intercellular material (matrix) separating Intercellular material (matrix) separating

cellscells No free surfaceNo free surface Derived from mesenchymeDerived from mesenchyme Consist of ground substance, fibers, cellsConsist of ground substance, fibers, cells

Connective Tissue FunctionsConnective Tissue Functions Physical protectionPhysical protection SupportSupport BindingBinding Absorb shockAbsorb shock InsulationInsulation Stores energyStores energy Blood productionBlood production ImmunityImmunity

Types of FibersTypes of Fibers Collagen - very tough and strong Collagen - very tough and strong

contains collagen proteincontains collagen protein Elastic - very flexible and stretchableElastic - very flexible and stretchable

contains elastin proteincontains elastin protein Reticular - forms network meshReticular - forms network mesh

contains collagen & glycoprotein contains collagen & glycoprotein

Connective Tissue ProperConnective Tissue Proper

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

Adipose - energy storage; insulationAdipose - energy storage; insulation

Reticular - binds smooth muscles Reticular - binds smooth muscles togethertogether

Regular dense connective Regular dense connective tissue(fibrous)tissue(fibrous) tendon; ligamentstendon; ligaments

Irregular denseIrregular dense fascia, periosteumfascia, periosteum

Elastic connectiveElastic connective blood vessels, lung tissue blood vessels, lung tissue

CartilageCartilage

Hyaline cartilage (gristle)Hyaline cartilage (gristle) ends of long bone, nose tip, connects ends of long bone, nose tip, connects

ribs to sternumribs to sternum Elastic cartilageElastic cartilage

external earexternal ear FibrocartilageFibrocartilage

between pubic symphysisbetween pubic symphysis discs between vertebraediscs between vertebrae

OSSEOUS TISSUE - BONEOSSEOUS TISSUE - BONE

MATRIXMATRIX30% collagen fibers30% collagen fibers70% mineral salts70% mineral salts

Osseous TissueOsseous Tissue Types of CellsTypes of Cells

osteocytesosteocytes osteoblastsosteoblasts osteoclastsosteoclasts

Types of BoneTypes of Bone Cancellous (Spongy) Bone - trabeculaeCancellous (Spongy) Bone - trabeculae Compact Bone - Haversian Canal System Compact Bone - Haversian Canal System

Blood Tissue (Vascular)Blood Tissue (Vascular) Hemopoietic Tissue (blood forming Hemopoietic Tissue (blood forming

tissue)tissue) Types of Cells: Types of Cells:

erythrocytes (RBC’s)erythrocytes (RBC’s) leukocytes (WBC’s)leukocytes (WBC’s) platelets (thrombocytes) platelets (thrombocytes)

MUSCLE TISSUEMUSCLE TISSUE

Contractile tissue Contractile tissue Responsible for movementResponsible for movement

Skeletal Muscle - VoluntarySkeletal Muscle - Voluntary Long, threadlike cells with parallel Long, threadlike cells with parallel

fibersfibers

Cells are multinucleate with nuclei Cells are multinucleate with nuclei located peripherally; striatedlocated peripherally; striated

Usually attached to long bonesUsually attached to long bones

Smooth Muscle - Smooth Muscle - InvoluntaryInvoluntary

Spindle shaped cells with single Spindle shaped cells with single nucleus per cellnucleus per cell

No striationsNo striations Located in blood vessels, walls of Located in blood vessels, walls of

hollow organs, and the hollow organs, and the gastrointestinal tractgastrointestinal tract

Cardiac Muscle - InvoluntaryCardiac Muscle - Involuntary Branched cells with striated fibersBranched cells with striated fibers Intercalated discsIntercalated discs Only a single nucleus per cellOnly a single nucleus per cell Only found in the heart Only found in the heart

NERVE TISSUENERVE TISSUE

Characterized by the ability to Characterized by the ability to conduct electrical signals conduct electrical signals

Nervous TissueNervous Tissue Located in the brain and spinal cord Located in the brain and spinal cord

(CNS) and in the nerves (PNS)(CNS) and in the nerves (PNS) Sensitive to changes in the internal Sensitive to changes in the internal

and external environmentand external environment Conducts nerve impulses to other Conducts nerve impulses to other

neurons/body partsneurons/body parts

NERVE TISSUENERVE TISSUE Functions in coordinating, regulating, Functions in coordinating, regulating,

and integrating body activitiesand integrating body activities Types of Cells: Types of Cells:

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

MEMBRANESMEMBRANES

Thin sheet or layer of tissue Thin sheet or layer of tissue that covers a structure or that covers a structure or

lines a cavitylines a cavity

Epithelial MembranesEpithelial Membranes Cutaneous membrane - skinCutaneous membrane - skin Serous membrane - (serosa)Serous membrane - (serosa)

found in closed cavitiesfound in closed cavities parietal membrane - lines inside of cavitiesparietal membrane - lines inside of cavities visceral membrane - covers organsvisceral membrane - covers organs

Mucous membrane - mucosa Mucous membrane - mucosa line cavities that open to the exteriorline cavities that open to the exterior

Connective Tissue Connective Tissue MembranesMembranes

Synovial MembraneSynovial Membrane line spaces between bones in jointsline spaces between bones in joints secrete synovial fluidsecrete synovial fluid

Organs, Organ Systems, Organs, Organ Systems, and the Organismand the Organism

An organ is a group of tissues An organ is a group of tissues functioning together.functioning together.

A group of organs working together is A group of organs working together is an organ system.an organ system.

The sum of all cells, tissues, organs, The sum of all cells, tissues, organs, and organ systems makes up an and organ systems makes up an organism.organism.

Organ SystemsOrgan Systems CardiovascularCardiovascular RespiratoryRespiratory GastrointestinalGastrointestinal GenitourinaryGenitourinary ReproductiveReproductive

NervousNervous EndocrineEndocrine LymphaticLymphatic MuscularMuscular SkeletalSkeletal

System IntegrationSystem Integration Homeostasis is the body’s natural Homeostasis is the body’s natural

tendency to keep the internal tendency to keep the internal environment and metabolism steady environment and metabolism steady and normal.and normal. Cells do not tolerate extreme Cells do not tolerate extreme

environmental fluctuations. environmental fluctuations.

System IntegrationSystem Integration Two systems work together to maintain Two systems work together to maintain

homeostasis:homeostasis: Nervous systemNervous system Endocrine systemEndocrine system

Nervous system response is fastNervous system response is fast Endocrine response is longer lastingEndocrine response is longer lasting Responses are stimulated by Responses are stimulated by

pathological alterations pathological alterations

System IntegrationSystem Integration Chemical signals are received by Chemical signals are received by

various types of receptorsvarious types of receptors Interact with, and then respond to, the Interact with, and then respond to, the

chemical signals and other stimuli chemical signals and other stimuli ChemoreceptorsChemoreceptors BaroreceptorsBaroreceptors Alpha and Beta ReceptorsAlpha and Beta Receptors

System IntegrationSystem Integration Endocrine GlandsEndocrine Glands

Secrete hormones directly into the Secrete hormones directly into the circulatory systemcirculatory system

Exocrine GlandsExocrine Glands Secrete hormones directly onto surfaceSecrete hormones directly onto surface

Some glands are “mixed”Some glands are “mixed” Endocrine and exocrine functionEndocrine and exocrine function

Intercellular CommunicationIntercellular Communication Endocrine signalingEndocrine signaling

Hormones distributed throughout the bodyHormones distributed throughout the body Paracrine signalingParacrine signaling

Secretion of chemical mediators by certain Secretion of chemical mediators by certain cells that act only upon nearby cellscells that act only upon nearby cells

Autocrine signalingAutocrine signaling Cells secrete substances that act upon Cells secrete substances that act upon

themselvesthemselves Synaptic signalingSynaptic signaling

Cells secrete neurotransmitters that Cells secrete neurotransmitters that transmit signals across synapsestransmit signals across synapses

System IntegrationSystem Integration Stressors on a body system are inputs.Stressors on a body system are inputs. A system receiving input creates A system receiving input creates

feedback.feedback. A negative feedback loop exists when A negative feedback loop exists when

body mechanisms work to reverse the body mechanisms work to reverse the input.input.

Biological systems generally employ Biological systems generally employ negative feedback loops to maintain negative feedback loops to maintain stability. stability.

PathophysiologyPathophysiology ““The physiology of disordered The physiology of disordered

function” function” Our understanding is constantly Our understanding is constantly

expanding expanding During your career you will encounter During your career you will encounter

patient conditions or diseases that patient conditions or diseases that were not addressed in your initial were not addressed in your initial paramedic education. paramedic education.

How Cells Respond How Cells Respond To Change and InjuryTo Change and Injury

Cell ReproductionCell Reproduction Human cells (except sex cells) reproduce by Human cells (except sex cells) reproduce by

mitosis mitosis Most undergo division throughout the life of Most undergo division throughout the life of

the individualthe individual Epithelial cellsEpithelial cells Liver cellsLiver cells Bone marrow cellsBone marrow cells

Some divide until near time of birthSome divide until near time of birth Nerve cellsNerve cells Skeletal muscle cellsSkeletal muscle cells

Copyright © 2006, 2001, 1994 by Mosby, Inc. All rights reserved.

CELL DIVISIONCELL DIVISION Process by which a cell reproduces itselfProcess by which a cell reproduces itself Involves nuclear division - mitosis, meiosisInvolves nuclear division - mitosis, meiosis Involves cytoplasmic division - cytokinesisInvolves cytoplasmic division - cytokinesis Mitosis - somatic cell division in which the Mitosis - somatic cell division in which the

cell retains the same number of cell retains the same number of chromosomeschromosomes

Meiosis - reductional division in which the Meiosis - reductional division in which the chromosome number is reducedchromosome number is reduced

CELL CYCLE CELL CYCLE Growth Phase 1 - synthesis of lipids, Growth Phase 1 - synthesis of lipids,

proteins and carbohydratesproteins and carbohydrates S Phase - DNA synthesisS Phase - DNA synthesis Growth Phase 2 - formation of spindle Growth Phase 2 - formation of spindle

fibers for cell division, centrioles dividefibers for cell division, centrioles divide Mitosis / MeiosisMitosis / Meiosis INTERPHASEINTERPHASE

•STAGES OF MITOSISSTAGES OF MITOSISPROPHASEPROPHASE

METAPHASEMETAPHASEANAPHASEANAPHASETELOPHASETELOPHASE

PROPHASEPROPHASE Chromatin condenses into chromosomesChromatin condenses into chromosomes Spindle Fibers appearSpindle Fibers appear Nuclear membrane disappearsNuclear membrane disappears Nucleolus disappearsNucleolus disappears Centrioles move to opposite polesCentrioles move to opposite poles Chromosomes begins to migrate toward Chromosomes begins to migrate toward

equatorequator

METAPHASE / ANAPHASEMETAPHASE / ANAPHASE Chromosomes line Chromosomes line

up along equatorup along equator centromere of each centromere of each

pair attached to a pair attached to a spindle fiberspindle fiber

Centromeres split; Centromeres split; sister chromatids sister chromatids separateseparate

Chromatids Chromatids migrate to opposite migrate to opposite polespoles

TELOPHASE & CYTOKINESISTELOPHASE & CYTOKINESIS Opposite of ProphaseOpposite of Prophase Chromosomes elongate forming Chromosomes elongate forming

indistinct chromatinindistinct chromatin Nuclear membrane reappearsNuclear membrane reappears Nuclear reorganization occursNuclear reorganization occurs Two new daughter cells formedTwo new daughter cells formed

NUCLEIC ACID STRUCTURENUCLEIC ACID STRUCTURE DNA - forms genetic codeDNA - forms genetic code RNA - functions in the process of RNA - functions in the process of

protein synthesisprotein synthesis

DNA DNA DEOXYRIBONUCLEIC ACID DEOXYRIBONUCLEIC ACID

Double stranded helix; nucleusDouble stranded helix; nucleus Contains: 5 carbon sugar, phosphate Contains: 5 carbon sugar, phosphate

group, nitrogenous basegroup, nitrogenous base Nitrogenous basesNitrogenous bases

adenine-thymineadenine-thymine cytosine- guaninecytosine- guanine

Base pairing occursBase pairing occurs

DNA RELICATIONDNA RELICATION DNA makes an exact duplicate of itselfDNA makes an exact duplicate of itself DNA strands separate into separate DNA strands separate into separate

strands and each one is used as a strands and each one is used as a template for a new strand of nucleotidestemplate for a new strand of nucleotides

Two double- helix molecules are formed, Two double- helix molecules are formed, each contains an original strand and a each contains an original strand and a newly synthesized strand newly synthesized strand

RNARNARIBONUCLEIC ACIDRIBONUCLEIC ACID

Single strandedSingle stranded Uracil substitutes for thymineUracil substitutes for thymine consists of 5 carbon sugar ribose, consists of 5 carbon sugar ribose,

phosphate group, nitrogenous basephosphate group, nitrogenous base Bases: adenine, guanine, cytosine, Bases: adenine, guanine, cytosine,

uraciluracil RNA types: mRNA, tRNA, rRNARNA types: mRNA, tRNA, rRNA

TRANSCRIPTIONTRANSCRIPTIONRNA SYNTHESISRNA SYNTHESIS

mRNA is synthesized using a DNA mRNA is synthesized using a DNA molecule as a templatemolecule as a template

mRNA carries MESSAGE out of the mRNA carries MESSAGE out of the nucleus to the ribsome in the nucleus to the ribsome in the cytoplasmcytoplasm

TRANSLATIONTRANSLATIONPROTEIN SYNTHESISPROTEIN SYNTHESIS

Genetic code is translated forming a Genetic code is translated forming a specific sequence of amino acidsspecific sequence of amino acids

mRNA attaches to the ribosomes in the mRNA attaches to the ribosomes in the cytoplasmcytoplasm

tRNA molecules bring specific A.A. to tRNA molecules bring specific A.A. to the ribosome for placement in the the ribosome for placement in the dictated sequencedictated sequence

Ribosome bonds amino acids together Ribosome bonds amino acids together to form proteins / polypeptidesto form proteins / polypeptides

Protein is releasedProtein is released

Loose end - membranesLoose end - membranes Lipid bilayer closes to Lipid bilayer closes to

form a sphere (vesicle)form a sphere (vesicle) Inside of vesicle is a Inside of vesicle is a

separate compartmentseparate compartment Bilayer is Bilayer is

“semipermeable”“semipermeable” Small, uncharged Small, uncharged

molecules pass throughmolecules pass through Large or charged Large or charged

molecules cannot pass molecules cannot pass through hydrophobic part through hydrophobic part of bilayerof bilayer

Proteins are incredibly diverse – 20Proteins are incredibly diverse – 20(# of amino acids)(# of amino acids) possible possible combinations (3,200,000 combinations for a 5 aa protein).combinations (3,200,000 combinations for a 5 aa protein).

Different amino acids have different chemical properties, Different amino acids have different chemical properties, causing polypeptide chain to fold up on itself.causing polypeptide chain to fold up on itself. Hydrophobic amino acids are buried in the centerHydrophobic amino acids are buried in the center Hydrophilic are on the Hydrophilic are on the

surfacesurface Ionic and H-bonds can Ionic and H-bonds can

form between amino acidsform between amino acids Function is dependent onFunction is dependent on

folded structure, which isfolded structure, which isdependent on sequence dependent on sequence of amino acids.*******of amino acids.*******

Loose end– protein foldingLoose end– protein folding

Enzymes are proteins that catalyze Enzymes are proteins that catalyze (stimulate/ accelerate) chemical reactions(stimulate/ accelerate) chemical reactions

Names end in -aseNames end in -ase ExamplesExamples

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

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

Loose end– enzymesLoose end– enzymes

Info Flow - What Info Flow - What Information?Information?

What is information?What is information? Representation of knowledge, Representation of knowledge,

thoughts; series of symbols that thoughts; series of symbols that have meaning.have meaning.

Digital – 1’s and 0’sDigital – 1’s and 0’s Alphanumeric – letters and Alphanumeric – letters and

numbersnumbers Graphic – illustrationGraphic – illustration Genetic – chemical – order of Genetic – chemical – order of

bases (ACGTU) in a nucleic acid bases (ACGTU) in a nucleic acid tells a cell how and when to make tells a cell how and when to make specific proteins – which then specific proteins – which then perform some function for the cell.perform some function for the cell.

Storage of InformationStorage of Information Information is stored in the sequence of Information is stored in the sequence of

bases in DNA.bases in DNA. What Information?What Information?

Genes - instructions on how to make proteinsGenes - instructions on how to make proteins hemoglobin gene contains the information on the hemoglobin gene contains the information on the

order of amino acids that are linked together to order of amino acids that are linked together to make hemoglobinmake hemoglobin

Regulation - when and where to make proteinsRegulation - when and where to make proteins only bone marrow cells make hemoglobin only bone marrow cells make hemoglobin

DNADNA DNA = deoxyribonucleic acidDNA = deoxyribonucleic acid

Sugar = deoxyriboseSugar = deoxyribose Base –Base –

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

Phosphate – negative charge Phosphate – negative charge – gives DNA a negative – gives DNA a negative chargecharge

Nucleic AcidsNucleic Acids Nucleotides are Nucleotides are

linked together via linked together via dehydration dehydration synthesis reactionssynthesis reactions sugar phosphate sugar phosphate

backbonebackbone bases project to sidebases project to side

DNA structureDNA structure Bases can form H-bondsBases can form H-bonds C’s and G’s pairC’s and G’s pair A pairs with T or UA pairs with T or U

Two strands of DNA are Two strands of DNA are said to be said to be complementarycomplementary

Strands are antiparallel, Strands are antiparallel, have 5’ phosphate & 3’ OHhave 5’ phosphate & 3’ OH

5’-GCTAGGTAGTCCT-3’5’-GCTAGGTAGTCCT-3’3’-CGATCCATCAGGA-5’3’-CGATCCATCAGGA-5’

The Central DogmaThe Central Dogma Information Flow within OrganismsInformation Flow within Organisms

What Information?What Information? Replication: DNA Replication: DNA DNA DNA

exact copy - photocopyexact copy - photocopy Transcription: DNA Transcription: DNA RNA RNA

still a sequence of nucleotidesstill a sequence of nucleotides writing notes from screen - still writing notes from screen - still

same letters, different form (cursive)same letters, different form (cursive) Translation: RNA Translation: RNA protein protein

nucleotide seq. nucleotide seq. amino acid seq. amino acid seq. english english russian russian

TranscriptioTranscriptionn

Messenger RNA (mRNA) functions Messenger RNA (mRNA) functions as a “working copy” of the as a “working copy” of the information on DNA.information on DNA.

RNA polymerase uses 1 strand of RNA polymerase uses 1 strand of DNA as a template to make mRNA.DNA as a template to make mRNA. Starting position determined by Starting position determined by

RNA polymerase binding to RNA polymerase binding to PROMOTERPROMOTER

RNA polymerase moves down RNA polymerase moves down DNA and connects nucleotides to DNA and connects nucleotides to make RNAmake RNA

bases - A,C,G in both RNA and bases - A,C,G in both RNA and DNA, T in DNA, U in RNADNA, T in DNA, U in RNA

TranscriptioTranscriptionn

After RNA is made, the 2 DNA After RNA is made, the 2 DNA strands come back together, strands come back together, RNA molecule is releasedRNA molecule is released in eukaryotes - each RNA in eukaryotes - each RNA

contains the info from 1 contains the info from 1 gene – produces 1 proteingene – produces 1 protein

in prokaryotes - RNAs may in prokaryotes - RNAs may contain info from multiple contain info from multiple gene – produce multiple gene – produce multiple proteinsproteins

RNA processingRNA processing

Once transcription does Once transcription does occur, RNA produced occur, RNA produced referred to as “primary referred to as “primary transcript”transcript”

In Eukaryotes, RNA is In Eukaryotes, RNA is processed to form mRNA processed to form mRNA before export from before export from nucleus to cytoplasmnucleus to cytoplasm

RNA splicingRNA splicing Eukaryotic genes are interrupted by DNA sequences called introns or Eukaryotic genes are interrupted by DNA sequences called introns or

intervening sequences, parts that will be used to make protein are intervening sequences, parts that will be used to make protein are exons.exons.

Introns are cut from primary RNA transcript, exons are spliced together.Introns are cut from primary RNA transcript, exons are spliced together.

RNA ProcessingRNA Processing Poly-A tail added to 3’ end to enhance Poly-A tail added to 3’ end to enhance

stability of mRNAstability of mRNA 7-methyl-guanine “cap” added to 5’ end – 7-methyl-guanine “cap” added to 5’ end –

required for export from nucleusrequired for export from nucleus

The Genetic CodeThe Genetic Code What is a code?What is a code? Morse CodeMorse Code The genetic code The genetic code

translates nucleotide translates nucleotide sequence into amino sequence into amino acid sequenceacid sequence codoncodon - sequence of 3 - sequence of 3

nucleotides that nucleotides that specifies 1 amino acid.specifies 1 amino acid.

AUG=start codonAUG=start codon UAA, UGA, UAG are UAA, UGA, UAG are

stop codons.stop codons.

The Genetic CodeThe Genetic Code Genetic code is Genetic code is

degenerate - 64 degenerate - 64 possible combinations, possible combinations, but only 20 amino but only 20 amino acids.acids.

Most amino acids are Most amino acids are encoded by multiple encoded by multiple codonscodons

The Genetic Code is The Genetic Code is Universal - same for all Universal - same for all organismsorganisms

The Genetic CodeThe Genetic Code Codons are read sequentially, not-Codons are read sequentially, not-

overlapped.overlapped. 3 Possible Reading Frames3 Possible Reading Frames

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

The Big PictureThe Big Picture

RibosomesRibosomes Translation occurs on ribosomesTranslation occurs on ribosomes Ribosomes are ribonucleoproteins Ribosomes are ribonucleoproteins

(RNA and protein components)(RNA and protein components) Small subunit contains Small subunit contains

16S rRNA and 33 proteins16S rRNA and 33 proteins Large subunit contains Large subunit contains

23S rRNA, 5S rRNA and 23S rRNA, 5S rRNA and 45 proteins45 proteins

rRNAs are functional components, rRNAs are functional components, proteins proteins provide scaffoldingprovide scaffolding

““Functional” Functional” RNAsRNAs

mRNA function is mRNA function is information transfer – information transfer – info is used to make info is used to make proteinprotein

Some RNAs are not Some RNAs are not translated – tRNA, rRNAtranslated – tRNA, rRNA

Intramolecular base Intramolecular base pairing causes RNA to pairing causes RNA to fold into a specific fold into a specific shape (like a protein)shape (like a protein)

Paired regions twist to Paired regions twist to form helixform helix

tRNA structuretRNA structure Transfer RNA (tRNAs) are the adaptors that Transfer RNA (tRNAs) are the adaptors that

associate RNA codons with amino acidsassociate RNA codons with amino acids anticodon at one end base pairs with codons on anticodon at one end base pairs with codons on

mRNA. mRNA. amino acid at other end amino acid at other end

attached by amino acyl-attached by amino acyl-tRNA synthetasestRNA synthetases

Each amino acid has Each amino acid has 1-2 tRNAs1-2 tRNAs

TranslationTranslation 1. Ribosomes bind mRNA, position start codon.1. Ribosomes bind mRNA, position start codon. 2. Initiator tRNA base pairs with AUG codon.2. Initiator tRNA base pairs with AUG codon. 3. tRNA that base pairs with next codon is lined up.3. tRNA that base pairs with next codon is lined up. 4. Two amino acids are connected.4. Two amino acids are connected.

TranslationTranslation 4. Two amino acids are connected.4. Two amino acids are connected. 5. Ribosome moves down mRNA to next codon.5. Ribosome moves down mRNA to next codon. 6. New tRNA pairs with next codon.6. New tRNA pairs with next codon. 7. Return to step 47. Return to step 4

TranslationTranslation When ribosome reaches a stop codon - When ribosome reaches a stop codon -

no tRNAs can pair with it. no tRNAs can pair with it. Polypeptide is released, folds into a Polypeptide is released, folds into a

functional protein.functional protein. See animationSee animation

The Big PictureThe Big Picture DNA is transcribed DNA is transcribed

to mRNA.to mRNA. Ribosome binds Ribosome binds

mRNA.mRNA. tRNAs with amino tRNAs with amino

acids pair up with acids pair up with codons on mRNA.codons on mRNA.

Amino acids Amino acids connected to connected to produce proteinproduce protein

Questions?Questions?

How Cells Respond How Cells Respond To Change and InjuryTo Change and Injury

Cellular AdaptationCellular Adaptation Cellular InjuryCellular Injury Cellular DeathCellular Death

Cellular AdaptationCellular Adaptation Cells, tissues, organs, and organ Cells, tissues, organs, and organ

systems can adapt to both normal and systems can adapt to both normal and injurious conditions.injurious conditions.

Adaptation results in alteration of Adaptation results in alteration of structure and function.structure and function.

Many of these cellular adaptations are Many of these cellular adaptations are successful.successful. May also be part of the process of a May also be part of the process of a

disease disease

Types of Cellular Types of Cellular AdaptationsAdaptations

AtrophyAtrophy Decreased size resulting from a decreased Decreased size resulting from a decreased

workloadworkload HypertrophyHypertrophy

An increase in cell size resulting from an An increase in cell size resulting from an increased workloadincreased workload

HyperplasiaHyperplasia An increase in the number of cells resulting An increase in the number of cells resulting

from an increased workloadfrom an increased workload

Types of Cellular Types of Cellular AdaptationsAdaptations

MetaplasiaMetaplasia Replacement of one type of cell by another Replacement of one type of cell by another

type of cell that is not normal for that type of cell that is not normal for that tissuetissue

DysplasiaDysplasia A change in cell size, shape, or appearance A change in cell size, shape, or appearance

caused by an external stressorcaused by an external stressor

Cellular InjuryCellular Injury HypoxicHypoxic ChemicalChemical InfectiousInfectious Immunologic or Immunologic or

Inflammatory Inflammatory

Physical agentsPhysical agents Nutritional Nutritional

balancesbalances Genetic factors Genetic factors

Cellular InjuryCellular Injury Hypoxic InjuryHypoxic Injury

Usually a deficit in the respiratory or Usually a deficit in the respiratory or cardiovascular system cardiovascular system

Blockage or reduction of blood flow to a Blockage or reduction of blood flow to a cell may result in ischemia.cell may result in ischemia.

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

swell swell Reversible if intervention is earlyReversible if intervention is early

Infarction occurs if no intervention Infarction occurs if no intervention

Cellular InjuryCellular Injury Chemical InjuryChemical Injury

Cellular injury due to chemical products is Cellular injury due to chemical products is very common. very common.

Heavy metals, carbon monoxide, ethanol, drugs, Heavy metals, carbon monoxide, ethanol, drugs, and insecticides are examplesand insecticides are examples

Injuries include:Injuries include: Disruption of the cellular membrane Disruption of the cellular membrane Alteration of coagulation Alteration of coagulation Death of the cell Death of the cell

Cellular InjuryCellular Injury Infectious InjuryInfectious Injury

Caused by bacteria, viruses, prions, fungi, Caused by bacteria, viruses, prions, fungi, and parasites and parasites

Majority are harmlessMajority are harmless Pathogens cause diseasePathogens cause disease

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

Cellular InjuryCellular Injury Immunologic/Inflammatory InjuryImmunologic/Inflammatory Injury

Protective responses of the body can cause Protective responses of the body can cause cell injury and even death. cell injury and even death.

HypersensitivityHypersensitivity AnaphylaxisAnaphylaxis An immune response may harm healthy An immune response may harm healthy

cells as well as damaged cells.cells as well as damaged cells.

Cellular InjuryCellular Injury Injurious Physical AgentsInjurious Physical Agents

Extreme variances in temperature Extreme variances in temperature Atmospheric pressure changesAtmospheric pressure changes Exposure to ionizing radiationExposure to ionizing radiation Illumination Illumination NoiseNoise Mechanical stresses Mechanical stresses

Cellular InjuryCellular Injury Injurious Nutritional ImbalancesInjurious Nutritional Imbalances

Excessive intake of saturated fats and Excessive intake of saturated fats and cholesterolcholesterol

Excessive carbohydrate (glucose) intake Excessive carbohydrate (glucose) intake Insufficient intake of nutrients Insufficient intake of nutrients

Cellular InjuryCellular Injury Injurious Genetic FactorsInjurious Genetic Factors

Some cellular dysfunctions are caused by Some cellular dysfunctions are caused by genetic predisposition. genetic predisposition.

This can involve alterations to the nucleus or This can involve alterations to the nucleus or the cell membrane, the shape of the cell, the the cell membrane, the shape of the cell, the receptors on the cell membrane, or the receptors on the cell membrane, or the transport mechanisms that carry substances transport mechanisms that carry substances across the cell membrane. across the cell membrane.

The interaction of genes and environmental The interaction of genes and environmental factors determine that person’s development. factors determine that person’s development.

Manifestations of Cellular Manifestations of Cellular InjuryInjury

When cells are injured metabolism is When cells are injured metabolism is changed, causing substances to changed, causing substances to infiltrate or accumulate to an abnormal infiltrate or accumulate to an abnormal degree in cells and tissues.degree in cells and tissues.

The most commonly seen effects of cell The most commonly seen effects of cell injury and accumulation are cellular injury and accumulation are cellular swelling and fatty change.swelling and fatty change.

Manifestations of Cellular Manifestations of Cellular InjuryInjury

Cellular SwellingCellular Swelling Results from a permeable or damaged Results from a permeable or damaged

cellular membranecellular membrane Caused by an inability to maintain stable Caused by an inability to maintain stable

intra- and extra-cellular fluid andintra- and extra-cellular fluid andelectrolyte levelselectrolyte levels

Fatty ChangeFatty Change Lipids invade site of injuryLipids invade site of injury Ominous sign of impending cellular Ominous sign of impending cellular

destruction destruction

Manifestations of Cellular Manifestations of Cellular InjuryInjury

Systemic Signs and Symptoms of Systemic Signs and Symptoms of Cellular Change Cellular Change Fatigue and malaiseFatigue and malaise Altered appetiteAltered appetite FeverFever Increased heart rate associated with feverIncreased heart rate associated with fever PainPain

Cellular DeathCellular Death ApoptosisApoptosis

The body’s way of ridding itself of The body’s way of ridding itself of destroyed or nonfunctional cells destroyed or nonfunctional cells

Result of both normal and pathological Result of both normal and pathological tissue changes tissue changes

In apoptosis, cells shrink In apoptosis, cells shrink Apoptosis has specificityApoptosis has specificity

Contained to specific cells or areas Contained to specific cells or areas

Cellular DeathCellular Death NecrosisNecrosis

A pathological processA pathological process Cells swell and ruptureCells swell and rupture Necrotic tissue changesNecrotic tissue changes

Coagulative, liquefactive, caseous, and fattyCoagulative, liquefactive, caseous, and fatty Gangrenous necrosisGangrenous necrosis