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Cell Injury

Reversible Injury:

1. Decreased synthesis of ATP by oxidative phosphorylation.
2. Decrease function of Na-K ATPase pump-
  • Influx of sodium and efflux of potassium
  • Swelling of cell and endoplasmic reticulum.
3. Glycolysis-
  • Depletion of cytoplasmic glycogen,
  • Increased lactic acid production
  • Decreased PH of the cell
4. Decreased protein synthesis and detachment of ribosomes from rough endoplasmic reticulum. 5. Plasma membrane blebs and myelin figures Irreversible Injury: 1. Severe membrane damage-
  • Massive influx of calcium into the cell- Large flocculant densities in the matrix.
  • Efflux of intra cellular enzymes into circulation.
2. Mitochondrial dysfunction-
  • Mitochondrial swelling
  • Large densities in mitochondrial matrix
  • Irreparable damage of oxidative phosphorylation
  • Inability to produce ATP
3. Rupture of lysosomes-
  • Release of lysosomal digestive enzymes into cytosol
  • Activation of acid hydrolases followed by autolysis
4. Nuclear changes-
  • Pyknosis- degeneration and condensation of nuclear chromatin
  • Karyorrhexis- Nuclear fragmentation
  • Karyolysis- dissolution of nucleus.
Clinically important examples of intracellular enzymes (and proteins) found in circulation due to membrane damage- 1. Myocardial injury- CK MB, Troponin, Lactate dehydrogenase. 2. Biliary tract obstruction- Alkaline phosphatase. 3. Pancreatitis- Amylase, lipase. 4. Hepatitis- Transaminases.


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