REVERSIBLE CELL INJURY AND

ADAPTATION
 Objectives

1. To define the different mechanisms of

cellular adaptation.

2. To define cell injury

3. To mention the causes of cell injury.

4. To explain the morphological changes

of reversible cell injury.
 Homeostasis

The normal cell is confined to a fairly

narrow range of function and
structure by its program of
metabolism, differentiation and
specialization. It is nevertheless able
to handle normal physiologic demand
maintaining a steady state called
homeostasis.
 Cellular Adaptation

More severe physiologic stresses and

some pathologic stimuli may bring
about a number of physiologic and
morphologic cellular adaptations,
during which new but altered steady
state are achieved, preserving the
viability of the cell and modulating
its function in respond to such
stimuli.
The cell can adapts to a physiologic stress
or pathologic stimuli by four different
mechanisms of cellular adaptation.

Cellular Adaptation

1. Hyperplasia
2. Hypertrophy
3. Atrophy
4. Metaplasia
 Hyperplasia
It is an increase in the number of cells in
an organ or tissue, usually resulting in
increased volume of the organ or tissue.
Hyperplasia takes place if the cellular
population is capable of synthesizing
DNA, thus permitting mitotic division.

Types of Hyperplasia
1. Physiologic Hyperplasia
2. Pathologic Hyperplasia
 Hormonal
Physiologic Hyperplasia
Compensatory
Hormonal Hyperplasia increases the functional
capacity of a tissue when needed.
1. Proliferation of the female breast at puberty.
2. Proliferation of the female breast during pregnancy.
3. Physiologic hyperplasia in the pregnant uterus.

Compensatory Hyperplasia increases tissue

mass after damage or partial resection.
Regeneration of the liver after hepatectomy.
 Pathologic Hyperplasia

Most of pathologic hyperplasia are caused by

excessive hormonal stimulation or growth factors
acting on target cells.

1. Endometrial Hyperplasia.

2. Benign prostatic Hyperplasia.

Pathologic hyperplasia constitutes a fertile soil in

which cancerous proliferation may eventually
arise.
 Hypertrophy
Hypertrophy refers to an increase in size
of cells, resulting in an increase in size of
the organ.

The increased size of the cells is due to the

synthesis of more structural components.

Type of Hypertrophy
1. Physiologic Hypertrophy
2. Pathologic Hypertrophy
Hypertrophy is caused by increased functional
demand or by specific hormonal stimulation.

Physiologic Hypertrophy Pathologic Hypertrophy

1. Hypertrophied skeletal 1. Ventricular hypertrophy of

muscles due to the heart due to chronic
increased workload hemodynamic overload.
♣Hypertension
♣Faulty valves

2. Growth of the uterus

during pregnancy due to
estrogen stimulation
 Atrophy
Atrophy is the shrinkage in the size of the cell
by loss of cell substance

When a sufficient number of cells are involved,

the entire tissue or organ diminish in size, or
become atrophic.

Types of Atrophy
1. Physiologic Atrophy
2. Pathologic Atrophy

Physiologic atrophy
is common during early
development.
Some embryonic
structure such as
the thyroglossal
duct, undergo
atrophy during
fetal development.

But also; The uterus decreases in size shortly

after parturition.
Pathologic atrophy depends on the underlying
cause and can be local or generalized.

Causes of Pathologic Atrophy

1. Decreased workload (atrophy of disuse)
2. Loss of innervation (denervation atrophy)
3. Diminished blood supply
4. Inadequate nutrition
5. Loss of endocrine stimulation
6. Aging
7. Pressure
 Metaplasia

Metaplasia is a reversible change in which one

adult cell type is replaced by another adult
cell type.

It represent and adaptive substitution of cells

that are sensitive to stress by cells type better
able to withstand the adverse environment.

Types of Metaplasia
1. Epithelia Metaplasia
2. Mesenchymal Metaplasia
 Columnar to squamous
Epithelial (Respiratory tract)
Metaplasia Squamous to columnar
(Barrett esophagus)

The influences that predispose to metaplasia, if

persist, may induce malignant transformation in
metaplastic epithelium.

Mesenchymal Metaplasia is the formation of

cartilage, bone, or adipose tissue (mesenchymal
tissue) in tissues that normally do not contain
these elements.
 Cell Injury

If the limits of adaptive capability are

exceeded, or when no adaptive response is
possible, a sequence of events follows, loosely
termed cell injury.

Type of cell
The cellular
Tissue involved
response to injury
varies according to: Extent and type of
injurious agent
 Etiology of cell injury

1.Hypoxia and ischemia

2.Physical agents
3.Chemical agents
4.Microbial agents
5.Immunologic agents
6.Nutritional derangements
7.Physiological factors
 Cellular responses to injury may be as
follows:

The injured cells may recover to its normal

state (reversible cell injury).

or

Die (irreversible cell injury).

 Reversible cell injury

Reversible cell injury denotes pathologic

changes that can be reversed when the
stimulus is removed or if the cause of injury is
mild.

Morphology of reversible cell injury

1.Cellular swelling
2.Fatty changes
 Cellular swelling

Cellular swelling appears whenever cells are

incapable of maintaining ionic and fluid
homeostasis.

It is the fist
manifestation of Macroscopically
almost all forms There is pallor, increased
of injury to cells. turgor, and increase in
weight of the organ.
Morphology:
Microscopically
Small clear vacuoles within
the cytoplasm
 Plasma membrane
alteration

Ultrastructural
Nuclear changes in Mitochondria
alterations reversible cell changes
injury

Dilatation of the
endoplasmic reticulum
Normal Cell Reversible cell injury

Swelling of
endoplasmic
reticulum
Myelin
figures

Clumping of
chromatin

Swelling of
mitochondria

Blebs

Ultrastructural changes
in reversible cell injury
 Fatty Changes.

The term fatty changes or steatosis describe

abnormal accumulations of triglycerides within
parenchymal cells.

Fatty changes occurs in Organs affected

hypoxic injury and various Liver
forms of toxic and metabolic Heart
injury. Muscles
Kidneys
 Morphology

Macroscopically
The liver enlarges and becomes increasingly
yellow until it weights 3 to 5 kg and
transforms into a bright yellow, soft, greasy
organ.

Microscopically
First there are small vacuoles in the
cytoplasm around the nucleus.
As the process progresses, the vacuoles
coalesce, creating clear spaces that displaces
the nucleus to the periphery of the cells.
Stages in the cellular response to stress and injurious stimuli

Normal Cell

Stress, Injurious
increased stimulus
demand

Adaptation Cell Injury

Inability to adapt

Reversible Irreversible