呼吸系統(tǒng)教學(xué)資料-呼吸病理_zhou_中文版ppt課件

1、Pathology of Respiratory SystemMeiyi ZhouAssistant Professor, Department of PathophysiologySJTU, School of MedicineEtiology, Pathogenesis, Pathological changes, and Complications;Common Diseases in the pulmonary system COPD慢性支氣管炎、肺氣腫慢性支氣管炎、肺氣腫 Infection 肺炎肺炎 Silicosis硅肺硅肺 Chronic Cor Pulmonale肺心病肺心病

2、 Lung Cancer肺癌肺癌 Tuberculosis肺結(jié)核肺結(jié)核;Chronic Obstructive pulmonary Disease (COPD)DefinationCOPD, namely chronic bronchitis and emphysema, are diseases origination in the airways or notably affect in airway function. 慢性阻塞性肺病慢性阻塞性肺病COPD指由于氣道完全指由于氣道完全或不完全阻塞，導(dǎo)致通氣阻力添加及肺功能或不完全阻塞，導(dǎo)致通氣阻力添加及肺功能不全的慢性肺疾病。包括慢性支氣

3、管炎和肺不全的慢性肺疾病。包括慢性支氣管炎和肺氣腫。氣腫。;Chronic bronchitis is defined on clinical grounds alone, as the presence of chronic productive cough for 3 months in 2 successive years, in the absence of any other explanation for this symptom.指氣管、支氣管黏膜及其周?chē)M織的慢性炎癥。指氣管、支氣管黏膜及其周?chē)M織的慢性炎癥。臨床特征為反復(fù)發(fā)作的咳嗽、咳痰、喘息，病程臨床特征為反復(fù)發(fā)作的咳嗽、

4、咳痰、喘息，病程長(zhǎng)。如每年發(fā)作時(shí)間起過(guò)長(zhǎng)。如每年發(fā)作時(shí)間起過(guò)3個(gè)月延續(xù)兩年以上者，個(gè)月延續(xù)兩年以上者，可診斷為慢性支氣管炎。可診斷為慢性支氣管炎。Chronic bronchitis (慢性支氣管炎慢性支氣管炎);Chronic bronchitis (慢性支氣管炎慢性支氣管炎)Etiology病因?qū)W病因?qū)W 理化要素：理化要素： 長(zhǎng)期吸煙、空氣污染長(zhǎng)期吸煙、空氣污染 氣候要素氣候要素 過(guò)敏要素過(guò)敏要素 感染要素：感染要素： 病毒、細(xì)菌病毒、細(xì)菌;Chronic bronchitis (慢性支氣管炎慢性支氣管炎)Pathological Changes病理改動(dòng)病理改動(dòng)纖毛粘連、倒伏、脫失纖毛粘連

5、、倒伏、脫失粘膜上皮細(xì)胞變性壞死粘膜上皮細(xì)胞變性壞死柱狀上皮出現(xiàn)鱗狀上皮柱狀上皮出現(xiàn)鱗狀上皮化生化生 杯狀細(xì)胞增多杯狀細(xì)胞增多壁增厚壁增厚腺體增生、肥大、粘液化腺體增生、肥大、粘液化;Chapter : Chronic bronchitis (慢性支氣管炎慢性支氣管炎)1.1.粘膜上皮的損傷與修復(fù)粘膜上皮的損傷與修復(fù)2.2.腺體增生、肥大、粘液化腺體增生、肥大、粘液化3.3.管壁炎癥反響管壁炎癥反響 粘膜、粘膜下層充血、水腫粘膜、粘膜下層充血、水腫 淋巴、漿細(xì)胞等浸潤(rùn)淋巴、漿細(xì)胞等浸潤(rùn)4.4.管壁其他損害管壁其他損害 喘息型患者粘膜下層平滑肌增生、肥大，支氣喘息型患者粘膜下層平滑肌增生、肥大，

6、支氣管變窄，管壁軟骨變性、纖維化、鈣化或骨化管變窄，管壁軟骨變性、纖維化、鈣化或骨化Pathological Changes病理改動(dòng)病理改動(dòng);Squamous metaplasia of chronic bronchitis Chronic bronchitis (慢性支氣管炎慢性支氣管炎);粘液腺增生，漿液腺粘液化粘液腺增生，漿液腺粘液化Chronic bronchitis (慢性支氣管炎慢性支氣管炎);臨床病理聯(lián)絡(luò)臨床病理聯(lián)絡(luò)咳嗽：支氣管粘膜充血、水腫及粘液分泌物增多咳嗽：支氣管粘膜充血、水腫及粘液分泌物增多 刺激支氣管粘膜引起。刺激支氣管粘膜引起。咳痰咳痰: :咳大量白色粘痰或漿液泡沫狀

7、，如伴細(xì)菌咳大量白色粘痰或漿液泡沫狀，如伴細(xì)菌 感染為膿性：粘液腺增生、肥大；部分感染為膿性：粘液腺增生、肥大；部分 漿液腺化生成粘液腺，粘液分泌增多而致漿液腺化生成粘液腺，粘液分泌增多而致氣喘：因支氣管炎癥，刺激支氣管痙攣或粘液阻氣喘：因支氣管炎癥，刺激支氣管痙攣或粘液阻 塞而致。塞而致。Chronic bronchitis (慢性支氣管炎慢性支氣管炎);并發(fā)癥并發(fā)癥 支氣管擴(kuò)張：長(zhǎng)期支氣管炎癥的破壞， 其彈力性和支撐力減弱，加之長(zhǎng) 期的咳嗽而致。 肺氣腫：管腔內(nèi)粘液潴留及粘液栓形 成，使末梢肺組織過(guò)度充氣而致。 肺心?。悍螝饽[引起肺間隔破壞，肺 動(dòng)脈高壓，右心室肥大、擴(kuò)張。 支氣管肺炎：支

8、氣管壁甚薄，炎癥易于 分散而累及肺泡。Chronic bronchitis (慢性支氣管炎慢性支氣管炎);Emphysema (肺氣腫肺氣腫)Defination指呼吸性細(xì)支氣管至肺泡的末梢肺組織因繼續(xù)性指呼吸性細(xì)支氣管至肺泡的末梢肺組織因繼續(xù)性含氣量添加而呈永久性過(guò)度膨脹，伴有肺泡壁彈含氣量添加而呈永久性過(guò)度膨脹，伴有肺泡壁彈力組織破壞，間隔斷裂致肺泡相互交融，肺容積力組織破壞，間隔斷裂致肺泡相互交融，肺容積增大的病理形狀。增大的病理形狀。病因和發(fā)病機(jī)理病因和發(fā)病機(jī)理阻塞性通氣妨礙阻塞性通氣妨礙1抗胰蛋白酶缺乏抗胰蛋白酶缺乏;Emphysema (肺氣腫肺氣腫)類(lèi)型類(lèi)型 肺泡性肺氣腫肺泡性肺

9、氣腫 (Alveolar emphysema) 腺泡中央型腺泡中央型 (Centriacinar emphysema), 吸煙相關(guān)吸煙相關(guān) 全腺泡型全腺泡型 (Panacinar emphysema), 1 - Antitrypsin 腺泡周?chē)拖倥葜車(chē)?(Periacinar emphysema), 青年人可見(jiàn)青年人可見(jiàn) 不規(guī)那么型不規(guī)那么型 (Irregular emphsema), 瘢痕旁肺氣腫瘢痕旁肺氣腫 肺氣腫樣病變：肺氣腫樣病變： 肺大泡肺大泡 間質(zhì)性肺氣腫間質(zhì)性肺氣腫 (Interstitial emphysema)類(lèi)型類(lèi)型; 煙民常見(jiàn)煙民常見(jiàn), 上中葉病變?yōu)樯现腥~病變?yōu)橹髦?

10、最嚴(yán)重最嚴(yán)重, 下葉病變?yōu)橹飨氯~病變?yōu)橹餍啬は虏∽優(yōu)橹餍啬は虏∽優(yōu)橹?部分片灶性病變部分片灶性病變 ;Emphysema (肺氣腫肺氣腫)大體：大體： 體積增大，邊緣鈍圓，灰白色，柔體積增大，邊緣鈍圓，灰白色，柔軟彈性差，切面海綿狀。外表?？梢?jiàn)肋軟彈性差，切面海綿狀。外表?？梢?jiàn)肋骨壓痕，壓痕不易衰退。觸之捻發(fā)音加骨壓痕，壓痕不易衰退。觸之捻發(fā)音加強(qiáng)。強(qiáng)。 ;擴(kuò)張的肺泡交融成較大的囊腔，間隔變窄，肺泡擴(kuò)張的肺泡交融成較大的囊腔，間隔變窄，肺泡孔擴(kuò)展，間隔斷裂孔擴(kuò)展，間隔斷裂Emphysema (肺氣腫肺氣腫);Localized Emphysema Irregular EmphysemaEmph

11、ysema (肺氣腫肺氣腫);Bullae ( 肺大泡肺大泡, 1cm )( 相關(guān)病變：腺泡周?chē)头螝饽[相關(guān)病變：腺泡周?chē)头螝饽[ )Emphysema (肺氣腫肺氣腫);Pneumonia (肺炎肺炎)DefinationPulmonary infections are in the form of pneumonia, which is common disease in respiratory system.指肺組織的急性滲出性炎癥，是呼吸系統(tǒng)的指肺組織的急性滲出性炎癥，是呼吸系統(tǒng)的常見(jiàn)病。常見(jiàn)病。;Pneumonia (肺炎肺炎)Classification Pathogen病因病因

12、Infection bacteria, virus, fungal, mycoplasmal Physics & chemistry radio, inhaling materials Allergy hypersusceptibility, rheumatism Lesion position and range累及部位累及部位 lobar, lobular, interstitial Type of inflammation感染類(lèi)型感染類(lèi)型 serous, fibrinous, hemorrhagic, caseous, granulomatous ;Lobar Pneumonia

13、 (大葉性肺炎大葉性肺炎)DefinationLobar pneumonia is an acute fibrinous inflammation in alveoli. Although originally occurred in alveoli, it would spread into a whole lobe or more lobes rapidly. In general, young adults are involved in this type of pneumonia.指肺泡內(nèi)以纖維素滲出為主的急性炎癥，病指肺泡內(nèi)以纖維素滲出為主的急性炎癥，病變始于肺泡，迅速涉及一個(gè)肺段

14、或整個(gè)大葉，變始于肺泡，迅速涉及一個(gè)肺段或整個(gè)大葉，多見(jiàn)于青壯年。多見(jiàn)于青壯年。;Lobar Pneumonia (大葉性肺炎大葉性肺炎)Symptoms high fever, shaking chills cough rusty sputum鐵銹色痰鐵銹色痰 chest pain dyspnea, cyanosis rales with consolidation presentations;Lobar Pneumonia (大葉性肺炎大葉性肺炎)Etiolgoy pathogen - s t r e p t o c o c c u s pneumoiae (肺炎鏈球菌肺炎鏈球菌) - s

15、taphylococcus (葡萄葡萄球菌球菌) - h e m o p h i l u s influenzae (流感嗜血桿菌流感嗜血桿菌) inducing factors - cold - excessive tired - anesthesia;Lobar Pneumonia (大葉性肺炎大葉性肺炎)Pathogenesis發(fā)病機(jī)制發(fā)病機(jī)制Permeability of cap.Serous and fibrinous exudationProliferation of bacteriaLobar pneumonia (7-10 days);Lobar Pneumonia (大葉性肺

16、炎大葉性肺炎)Morphology - Gross ViewCited from Robbins Basic Pathology (9th Edition) Page 489;Lobar Pneumonia (大葉性肺炎大葉性肺炎) 肺泡壁血管充血，肺泡壁血管充血，肺泡腔漿液滲出。肺泡腔漿液滲出。臨床可出現(xiàn)濕性臨床可出現(xiàn)濕性羅音，線呈淺羅音，線呈淺薄均勻的陰影。薄均勻的陰影。Phase : Congestion and Edema充血水腫充血水腫 1-2 days;暗紅、腫大、切面能擠出淡紅色泡沫狀液體暗紅、腫大、切面能擠出淡紅色泡沫狀液體Lobar Pneumonia (大葉性肺炎大葉性肺炎

17、)Phase : Congestion and Edema充血水腫充血水腫 1-2 days; 肺泡壁血管顯著充血，肺泡壁血管顯著充血，肺泡腔充溢大量纖維蛋白肺泡腔充溢大量纖維蛋白和紅細(xì)胞，肺組織實(shí)變、和紅細(xì)胞，肺組織實(shí)變、色暗紅如肝。色暗紅如肝。 病人開(kāi)場(chǎng)咳鐵銹色痰，病人開(kāi)場(chǎng)咳鐵銹色痰，常伴胸痛、呼吸困難等。常伴胸痛、呼吸困難等。有肺實(shí)變征。線見(jiàn)大片有肺實(shí)變征。線見(jiàn)大片均勻致密陰影。均勻致密陰影。Phase : Red Hepatization (紅色肝變期紅色肝變期) 3-4 daysLobar Pneumonia (大葉性肺炎大葉性肺炎);暗紅色、腫大暗紅色、腫大質(zhì)地變實(shí)像肝臟質(zhì)地變實(shí)像

18、肝臟切面粗糙呈顆粒狀切面粗糙呈顆粒狀Lobar Pneumonia (大葉性肺炎大葉性肺炎)Phase : Red Hepatization (紅色肝變期紅色肝變期) 3-4 days;Phase : Gray Hepatization (灰色肝變期灰色肝變期) 5-6 days 肺泡壁血管肺泡壁血管受壓迫，肺泡腔受壓迫，肺泡腔內(nèi)充溢大量纖維內(nèi)充溢大量纖維蛋白網(wǎng)，中性白蛋白網(wǎng)，中性白細(xì)胞。肺葉灰白，細(xì)胞。肺葉灰白，實(shí)變?nèi)绺?。病人?shí)變?nèi)绺?。病人仍有肺?shí)變體征。仍有肺實(shí)變體征。Lobar Pneumonia (大葉性肺炎大葉性肺炎);腫大、灰白、切面枯燥腫大、灰白、切面枯燥L(fēng)obar Pneumo

19、nia (大葉性肺炎大葉性肺炎)Phase : Gray Hepatization (灰色肝變期灰色肝變期) 5-6 days;Phase : Resolution溶解散失期溶解散失期 7-10 days 中性白細(xì)胞崩解，中性白細(xì)胞崩解，放出蛋白酶，溶放出蛋白酶，溶解纖維蛋白；巨解纖維蛋白；巨噬細(xì)胞增多，吞噬細(xì)胞增多，吞噬活潑，滲出物噬活潑，滲出物逐漸吸收，肺組逐漸吸收，肺組織復(fù)原?？棌?fù)原。Lobar Pneumonia (大葉性肺炎大葉性肺炎);Lobar Pneumonia (大葉性肺炎大葉性肺炎)Complications并發(fā)癥并發(fā)癥Carnification (肺肉量變肺肉量變) Fi

20、brinous exudations from lobar pneumonia converted into granulation tissues because of the deficiency of proteases , which is normally secreted by neutrophils.Abscess(膿腫膿腫)、empyema (化膿性胸膜炎化膿性胸膜炎)fibrinous pleurisy (纖維素性胸膜炎纖維素性胸膜炎)septicemia (敗血癥敗血癥) or pyosepticemia (膿毒敗血癥膿毒敗血癥)infectious shock;Lobar

21、 Pneumonia (大葉性肺炎大葉性肺炎)肺肉量變肺肉量變肺膿腫肺膿腫膿胸膿胸;Lobular Pneumonia (小葉性肺炎小葉性肺炎)DefinationThis type of pulmonary infection can induce purulent exudation mainly occurred in lobule arounding the bronchiole. So it is also defined as bronchopneumonia. It is much more prevalent at the infancies, the extremes of

22、age.常作為一種并發(fā)癥出現(xiàn)，多見(jiàn)于小兒、老人常作為一種并發(fā)癥出現(xiàn)，多見(jiàn)于小兒、老人與體弱者。病變起始于細(xì)支氣管，以肺小葉與體弱者。病變起始于細(xì)支氣管，以肺小葉為單位，以支氣管為中凡的肺組織化膿性炎為單位，以支氣管為中凡的肺組織化膿性炎癥。癥。 ;Lobular Pneumonia (小葉性肺炎小葉性肺炎)Pathology and PathogenesisMixed infection by many weak bacteria, such as staphylococus and pseudomonas aeruginosa由多種細(xì)菌混合感染引起。由多種細(xì)菌混合感染引起。symptomsF

23、ever, cough, mucopurulent sputum, dyspnea, cyanosis ;Lobular Pneumonia (小葉性肺炎小葉性肺炎)Morphology - Gross ViewCited from Wikicommon Media;Lobular Pneumonia (小葉性肺炎小葉性肺炎)Morphology - Microscopical structure細(xì)支氣管粘膜充血，上皮細(xì)支氣管粘膜充血，上皮 壞死、零落，管腔內(nèi)充溢壞死、零落，管腔內(nèi)充溢嗜中性粒細(xì)胞、崩解的上嗜中性粒細(xì)胞、崩解的上皮細(xì)胞及滲出液皮細(xì)胞及滲出液病灶周?chē)谓M織充血、水病灶周?chē)谓M織充

24、血、水腫腫代償性肺氣腫代償性肺氣腫;Lobular Pneumonia (小葉性肺炎小葉性肺炎);Lobular Pneumonia (小葉性肺炎小葉性肺炎);Lobular Pneumonia (小葉性肺炎小葉性肺炎);Complications Respiratory failure Heart failure Abscess (膿腫膿腫) Empyema (膿胸膿胸) Pyosepticemia (膿毒血癥膿毒血癥) BronchiectasisLobular Pneumonia (小葉性肺炎小葉性肺炎);Difference between Lobar pneumonia and br

25、onchopneumonia;Lobar PneumoniaLobular PneumoniaPathogenstreptococcus pneumoiae mixed bacteriaAgeyoung adultinfancies, oldes, patientsPositionsingle lobebilateral and basalComplicationcartificationpulmonary failure, heart failureGross Viewwhole lobe,hepatizationscattered, small, red or yellowMicrosco

26、py Structurefibrouspurulent;Interstitial Pneumonia (間質(zhì)性肺炎間質(zhì)性肺炎)DefinationThe interstitial pneumonia was an acute respiratory disease characterized by patchy inflammatory changes in the alveolar septa and pulmonary interstitium. Pathogens mycoplasma pneumoniae are the most common children and young adults were usually involved vi