MODULE I : ALTERATIONS IN CELL FUNCTION AND GROWTH
Program Bachelor of Science in Nursing
Level/Placement 2nd year, 1st semester
Course Title Pathophysiology
Course code PATH 011
No. of Units 3 units
Pre-requisite None
Course Description The purpose of this course is to provide students with a basic
understanding of factors that contribute to the occurrence of various
diseases and how those diseases may be treated by clinical
professionals. Students will learn how to recognize the signs and
diseases.
Rationale Provide safe, appropriate and holistic care to individuals, families,
population group and community utilizing nursing process and apply
knowledge of evidenced based practices for care of clients with disease
process.
Focus Guide nursing students in applying guidelines and principles of evidence-
based practice in the delivery of care
Outcome At the end of the course and given actual situation, the student will be able
to:
Overview of cellular function and its parts
Understand the basic terminologies associated with the cellular
injury and adaptation
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Module Title Introduction to Cellular Adaptation and Injury
Module No. 1
Total study hours 4 HRS
Module writer/s: PROF. ENRIQUITO E. MAHINAY JR.
Introduction One of the most important function of the nurse in
order to fully comprehend the totality of the patient is
to first understand the basic pathophysiologic
mechanism and alterations in a disease process and
in order to apply appropriate nursing concepts and
interventions holistically and comprehensively.
This will result to providing safe, appropriate and
holistic nursing care to patients at risk and sick adult
clients.
Module Aims Introduce Concepts Cellular Injury and Adaptation
Module Learning Outcomes Upon completion of the module, the student should be able to
do the ff:
1. Understand the important concepts in Cellular
Injury and Adaption
2. Able to identify the different terminologies.
3. Comprehend the different mechanism adaptation of a
cell
4. Identify the different concepts in cellular function
Content Common Terminologies
Cellular Adaptation Mechanism
Overview of Cellular Function
Teaching/Learning Online, Synchronous
Activities
Assessment methods Pretest, Open discussion
References/Readings Recommended:
Pahtophysiology: Bullock: 2018: Eidtion
Brunner & Suddarth’s. (2016). Study guide for textbook of
medical-surgical nursing. Philippines:
Lippincott Williams & Wilkins
1. Cell injury and Cellular Adaptive Changes
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. Prevention
of disease by the body depends on the capacity of the affected cells to undergo self-repair and
regeneration i.e. adaptive-changes.
- When cells are confronted to one of the following stimuli, they may undergo adaptive changes. The
common stimuli are: -
a. Physical agents, Trauma, Burn, pressure, irradiation, etc.
b. Chemical agents, Poisons, drugs, simple compounds, etc.
c. Microorganisms- Bacteria, Virus, Fungus, Parasites
d. Hypoxia-Is the most common stimuli (cause); Is because of inadequate oxygen in the blood or
decreased tissue perfusion.
e. Genetic defects-can affect cellular metabolism through inborn errors of metabolism or gross
malformation
f. Nutritional imbalances-under nutrition or over nutrition causes cellular injury or changes.
g. Immunologic Reaction-E.g. - Hypersensitivity reaction.
2. Types of cellular Adaptive-changes
•When cells are exposed to one of the above noxious- stimulus they will undergo one or more of the
following types of adaptive changes: -
a. Increased concentrations of normal cellular constituents.
b. Accumulate abnormal substances
c. Change the cellular size or number or
undergo a lethal change.
3. Abnormal and normal accumulation of intracellular substances
Intracellular accumulations often result from environmental changes or an inability of the cell to process
materials (substances) that cannot be metabolized by the cells. These substances may accumulate in the
cytoplasm. As a result, common changes include: -
a. Cellular swelling
b. Lipid accumulation (Fatty change process in the cytoplasm of cells).
c. Glycogen depositions (Excess deposition of glycogen in organs).
d. Calcification (precipitation of calcium in dead or Chronic inflammation area)
e. Hyaline infiltration (characteristic alteration within cells or in the extra-cellular spaces that appear
as inclusion on stained histology).
4. Changes to cellular size or numbers
- Changes in size and numbers of the cells are usually as a result of response to adapt to harmful
agents.
The changes include: -
a.) Atrophy
-Atrophy refers to a decrease in cell size.
-Causes: - Decreased work load (Disuse atrophy)
-Loss of nerve supply
-Decreased blood supply
-Inadequate nutrition
-Loss of hormonal stimulation
Eg. - Uterine atrophy after menopause.
-Physiologic Atrophy
Eg. - Loss of muscle bulk with ageing.
b.) Dysplasia: -
-Dysplasia refers to the appearance of cells that have undergone some atypical changes in response to
chronic irritation.
-It is not a true adaptive process in that it serves no specific functions.
-It is controlled reproduction of cells, but closely related to malignancy in that it may transform into
uncontrolled, rapid reproduction.
-It is complete loss of normal architectural orientation of one cell with the next both in shape and size.
-Epithelial cells are common sites for dysplastic changes.
Eg: -Bronchial epithelium,
-Cervical epithelium, etc.
c.) Hyperplasia: -
-It is defined as increase of tissue mass due to an increase in the number of cells.
-It occurs in cells that are under increased physiologic workload or stimulations. I.e. the cells are capable
of dividing thus increasing their numbers.
Types of Hyperplasia
a. Physiologic Hyperplasia: occurs when their hormonal stimulation
-Occurs in puberty and pregnancy
b. Compensatory-Hyperplasia
-Occurs in organs that are capable of regenerating lost tissues.
Eg. When part of liver is destroyed.
c. Pathologic Hyperplasia
-Is seen in abnormal stimulation of organs with cells that are capable of regeneration.
E.g. Enlargement of Thyroid gland due to TSH from pituitary gland.
d.) Hypertrophy
-Is an increase in the size of individual cells, resulting in increased tissue mass without an increase in the
number of cells.
-It is usually response of a specific organ to an increased demand for work.
Example: - Enlargement of muscles in Athletes
e) Metaplasia
-Metaplasia is a reversible change in which one type of adult cell is replaced by another type.
-It is an adaptive substitution of one cell type more
suitable to the hostile environment for another.
Eg. - Replacement of the normal columnar, ciliated goblet cells of the bronchial mucosa by Stratified
squamous epithelial cells in chronic smokers.
FIGURE 1.1 TYPES OF CELLULAR ADAPTIVE CHANGES
5. CELLULAR INJURY AND LETHAL CHANGES
(Cell Death)
Cell injury can be sub lethal or lethal. Sub lethal injury alters functions without causing cell death. The
changes caused by this type of injury are potentially reversible if the injuring stimuli are removed.
Causes of cell injury: -
Causes of cell injury are the same causes of cellular adaptive changes as mentioned above.
Classification of cell injury: -
Cellular injury can be reversible or it may progress to irreversible change (Lethal change).
1.Reversible cell injury: -
Is cell injury which can be reversed when the stimulus or the cause of injury is removed.
Example
-Ischemia:
Ischemia refers to a critical lack of blood supply to a localized area.
It is reversible in that tissues are restored to normal function when oxygen is again supplied to them, but
if late progress to ischemic infraction
It usually occurs in the presence of atherosclerosis in the major arteries.
The classic conditions resulting from ischemia is Angina pectoris.
2.Irreversible Cell injury
It is cellular injury that cannot be corrected (reversed) after the stimulus or cause has been removed.
Example: -
a.Infarction: -
Is localized area of tissue death due to lack of blood supply.
It is also called Ischemic Necrosis.
It is due to occlusion of blood vessels by thrombus or embolus. Septic Infarction is added when there is
evidence of infection in the area.
It is irreversible cellular death due to lack of blood supply, when ischemia is persistent or late.
•Example: - Acute myocardial
infarction (AMI)
b. Necrosis: -
The term necrosis refers to cell or tissue death characterized by structural evidence of this death.
The structural changes are mitochondrial swelling, rupture of cell membrane, shrinking of nucleus or
fragmenting, and release of lysosomal- enzymes, etc.
Based on the structural changes, Necrosis is classified in to two main classes: -
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 (structureless necrosis)
•Caseouse Necrosis: - is a good
example of structureless 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, crumbly appearance.
2.Colliquative- Necrosis (liquefactive- Necrosis)
- It frequently occurs in brain tissues and results from break down of neurons by released lysosomal
enzymes resulting in formation of pockets of liquid, debris and cyst like structures in the brain tissue.
Example: - Wet gangrene.
