A nurse is assessing a client who has liver cirrhosis. The nurse notices that the client has yellowish discoloration of the skin and sclera. The nurse recognizes that this is an example of what type of cellular accumulation?

Choice A reason: "An unregulated and passive process of cell death that causes inflammation and tissue damage." This is a description of necrosis, not apoptosis. Necrosis is an abnormal and harmful process that occurs when the cells are exposed to severe or persistent stressors that overwhelm their adaptive capacity. It involves the loss of cell membrane integrity, the release of cellular contents into the extracellular space, and the initiation of an inflammatory response that can damage the surrounding tissues.

Choice B reason: Apoptosis is also known as programmed cell death or cell suicide. It is a normal and beneficial process that maintains the balance between cell proliferation and cell death. It involves a series of biochemical events that lead to the activation of enzymes called caspases, which degrade the cell's DNA, proteins, and organelles. The cell then shrinks and forms membrane-bound fragments called apoptotic bodies, which are phagocytosed by macrophages or neighboring cells without causing inflammation or tissue damage.

Choice C reason: "A reversible process of cell injury that occurs when the stressor is mild or removed." This is a description of reversible cell injury, not apoptosis. Reversible cell injury is a process that occurs when the cells are exposed to mild or transient stressors that do not exceed their adaptive capacity. It involves changes in cell metabolism, function, and structure that can be restored if the stressor is removed or the cells are able to adapt.

Choice D reason: "An irreversible process of cell injury that occurs when the stressor is severe or persistent." This is a description of irreversible cell injury, not apoptosis. Irreversible cell injury is a process that occurs when the cells are exposed to severe or persistent stressors that exceed their adaptive capacity. It involves changes in cell metabolism, function, and structure that cannot be restored and lead to cell death by necrosis or apoptosis.

Choice A reason: Bilirubin is a yellow pigment that is produced from the breakdown of hemoglobin in red blood cells. It is normally excreted by the liver into bile and then eliminated by the intestines. However, when there is an obstruction of bile flow in the liver due to cirrhosis, bilirubin accumulates in the blood and tissues, causing jaundice.

Choice B reason: Lipofuscin is a brown pigment that is derived from the oxidation of lipids and proteins in the cells. It is also known as "wear and tear" pigment because it accumulates with aging and reflects the cumulative damage to the cells.

Choice C reason: Steatosis is a condition where fat accumulates in the cytoplasm of hepatocytes (liver cells). It can be caused by various factors, such as alcohol abuse, obesity, diabetes, or malnutrition.

Choice D reason: Phenylketonuria is a genetic disorder where phenylalanine, an amino acid, cannot be converted into tyrosine, another amino acid, due to a deficiency of an enzyme called phenylalanine hydroxylase. This leads to a buildup of phenylalanine and its metabolites in the blood and tissues, causing brain damage and mental retardation.