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  <head>
    <title>096-01 Cellular adaptation, injury patterns, haemodynamic disturbance, and tissue outcome</title>
    <ownerName>Integrated Medical Foundations</ownerName>
  </head>
  <body>
    <outline text="Adaptation, injury, haemodynamics, and tissue outcome">
      <outline text="Pathological reasoning">
        <outline text="Altered structure and function produce disease"/>
        <outline text="A pattern is not automatically a diagnosis">
          <outline text="One pattern, several causes"/>
          <outline text="One cause, patterns vary by dose and host"/>
        </outline>
        <outline text="Mechanism to morphology and back"/>
      </outline>
      <outline text="Cellular adaptation">
        <outline text="Hypertrophy enlarges cells">
          <outline text="Prominent where mature cells divide poorly"/>
          <outline text="Pressure overload raises oxygen demand and stiffness"/>
        </outline>
        <outline text="Hyperplasia adds cells in dividing tissue">
          <outline text="Hormonal, compensatory, or excessive stimulation"/>
        </outline>
        <outline text="Atrophy shrinks cells, sometimes numbers">
          <outline text="Less synthesis, more proteolysis, autophagy"/>
          <outline text="Prolonged loss reduces reserve"/>
        </outline>
        <outline text="Metaplasia swaps mature cell programmes">
          <outline text="Smoke: ciliated columnar to squamous"/>
          <outline text="Clearance and local defence decline"/>
        </outline>
      </outline>
      <outline text="Dysplasia and invasion">
        <outline text="Atypia, abnormal maturation, disordered architecture"/>
        <outline text="Mild dysplasia may regress when stimulus removed"/>
        <outline text="Severe dysplasia approaches carcinoma in situ"/>
        <outline text="Invasion crosses the basement membrane">
          <outline text="Access to lymphatics, vessels, nerves, stroma"/>
        </outline>
      </outline>
      <outline text="Reversible and irreversible injury">
        <outline text="Falling ATP weakens ion pumps">
          <outline text="Sodium and water enter, potassium lost"/>
          <outline text="Cells and organelles swell"/>
        </outline>
        <outline text="Anaerobic glycolysis lowers intracellular pH"/>
        <outline text="Lipid imbalance accumulates hepatic fat"/>
        <outline text="Irreversible: mitochondria fail, membranes break">
          <outline text="Calcium activates destructive enzymes"/>
          <outline text="Reactive oxygen species oxidise macromolecules"/>
        </outline>
        <outline text="Pyknosis, karyorrhexis, karyolysis"/>
        <outline text="Biomarkers need release, distribution, clearance"/>
      </outline>
      <outline text="Necrosis and regulated death">
        <outline text="Coagulative: ghost architecture in ischaemia"/>
        <outline text="Liquefactive: cerebral infarcts and abscesses"/>
        <outline text="Caseous: granular debris in granulomas"/>
        <outline text="Fat necrosis: fatty acids bind calcium"/>
        <outline text="Fibrinoid: vessel-wall immune pattern"/>
        <outline text="Gangrene is clinical, not a mechanism"/>
        <outline text="Apoptosis: caspases, contained fragments">
          <outline text="Less inflammation than necrosis"/>
          <outline text="Mitochondrial and death-receptor pathways"/>
        </outline>
        <outline text="Necroptosis, pyroptosis, ferroptosis"/>
      </outline>
      <outline text="Tissue outcome">
        <outline text="Dividing epithelia and marrow replace cells"/>
        <outline text="Stable cells re-enter the cycle"/>
        <outline text="Permanent cells: limited replacement"/>
        <outline text="Scar if injury extensive or matrix destroyed">
          <outline text="Fibrosis restores continuity, not architecture"/>
        </outline>
      </outline>
      <outline text="Congestion, oedema, and effusions">
        <outline text="Hyperaemia: active arteriolar inflow"/>
        <outline text="Congestion: passive impaired outflow">
          <outline text="Chronic lung: haemosiderin macrophages, fibrosis"/>
          <outline text="Chronic liver: centrilobular hypoxia"/>
        </outline>
        <outline text="Oedema: hydrostatic versus oncotic forces">
          <outline text="Heart failure raises venous pressure"/>
          <outline text="Protein loss lowers oncotic pressure"/>
          <outline text="Permeability and lymphatic obstruction"/>
        </outline>
        <outline text="Transudate protein-poor, exudate protein-rich">
          <outline text="Imperfect distinction, integrate context"/>
        </outline>
      </outline>
      <outline text="Haemorrhage, thrombosis, embolism">
        <outline text="Effect depends on rate, volume, site, reserve">
          <outline text="Skull makes small intracranial bleeds dangerous"/>
          <outline text="Repeated occult loss depletes iron"/>
        </outline>
        <outline text="Virchow&#x27;s triad">
          <outline text="Arterial: plaque, high shear, platelet rich"/>
          <outline text="Venous: stasis, fibrin and red cells"/>
        </outline>
        <outline text="Thrombus fates: propagate, organise, embolise"/>
        <outline text="Emboli: thrombus, fat, gas, amniotic, tumour">
          <outline text="Paradoxical embolism via venous-arterial link"/>
        </outline>
      </outline>
      <outline text="Infarction and shock">
        <outline text="White infarcts: end-arterial solid organs"/>
        <outline text="Red infarcts: venous, loose, dual, reperfused"/>
        <outline text="Occlusion does not always infarct"/>
        <outline text="Watershed injury without one thrombus"/>
        <outline text="Shock: inadequate perfusion and oxygen use">
          <outline text="Hypovolaemic, cardiogenic, distributive, obstructive"/>
          <outline text="Compensation maintains pressure"/>
          <outline text="Normal pressure does not prove perfusion"/>
        </outline>
      </outline>
      <outline text="Practical sequence">
        <outline text="Name pattern, distribution, and age"/>
        <outline text="Identify the threatened structure"/>
        <outline text="Focal or diffuse, acute or chronic"/>
        <outline text="Explain morphology, physiology, timing together"/>
      </outline>
    </outline>
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