Disease of respiratory system

Transcription

1 基础医学各论 II Disease of respiratory system Pathology Department, Zhejiang University School of Medicine,

2 五大慢性病 世界经济论坛 9 月 18 日发布评估报告, 称人类五大慢性病在未来 20 年将给全球经济造成 47 万亿美元损失, 相当于全球国内生产总值的 4% 五大慢性病分别是癌症 糖尿病 精神类疾病 心血管疾病和呼吸系统疾病 ( 比如慢性阻塞性肺部疾病和哮喘 ) 这份报告显示, 非传染性疾病是世界上最大的疾病死因, 在 2008 年使 3600 多万人失去生命, 占当年全世界总死亡人数的 63% 在这 3600 多万死亡人数中, 心血管疾病占 48%, 癌症占 21%, 慢性呼吸系统疾病占 12%, 糖尿病占 3%

3 人类健康的 头号杀手 非传染性疾病 报告将中国划为中低收入国家, 指出在中国, 由非传染性疾病造成的死亡占总死亡人数的 83% 其中, 心血管疾病占 38%, 癌症占 21%, 呼吸系统疾病占 15%, 糖尿病占 2% 经常吸烟和缺乏运动是导致非传染性疾病的主要行为危险因素, 而血压升高 血糖升高 超重 肥胖和胆固醇升高是导致疾病的代谢性危险因素 报告还指出, 中国人口的平均血压 体重 血糖和总胆固醇都有逐年升高的趋势

4 Histologic structure

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8 Disease Pneumonia COPD Pneumoconiosis Chronic cor pulmonale Lung cancer Tuberculosis

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10 Pneumonia

11 Type of pneumonia Exudative inflammation Lobar pneumonia Lobular pneumonia interstitial pneumonia

12 Lobar pneumonia 1. Concept 2. Etiopathogenisis and pathogenesy 3. Pathological changes and Complications

13 Lobar pneumonia Concept :Lobar pneumonia is an acute bacterial infection resulting in fibrinosuppurative consolidation of a large portion of a lobe or of an entire lobe. Moreover, the same organisms may produce bronchopneumonia in one patient, whereas in the more vulnerable individual, a full-blown lobar involvement develops.

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15 Pathological changes Congestion( 充血水肿期,1-2 day): heavy, boggy, and red vascular engorgement, intra-alveolar fluid with few neutrophils, numerous bacteria Red hepatization ( 红色肝变期,3-4 day) : red, firm, airless, a liver-like consistency, massive confluent exudation with red cells (congestion), fibrin, bacteria, rusty sputum( 铁锈色痰 ) Gray hepatization ( 灰色肝变期,5-6day) : grayish brown, dry, a liver-like consistency, progressive disintegration of red cells, the persistence of a fibrinosuppurative exudate, mucoid sputum ( 粘液脓痰 ) Resolution ( 溶解消散期,7-) : the consolidated exudate within the alveolar spaces undergoes progressive enzymatic digestion to produce a granular, debris that is resorbed, ingested by macrophages, coughed up, or organized by fibroblasts growing into it.

16 ( 充血水肿期,1-2 day): heavy, boggy, and red vascular engorgement, intraalveolar fluid with few neutrophils, numerous bacteria Congestion

17 Red hepatization ( 红色肝变期,3-4 day) : red, firm, airless, a liver-like consistency, massive exudation with red cells, fibrin, bacteria, rusty sputum

18 Red hepatization

19 Gray hepatization ( 灰色肝变期,5-6day) : grayish brown, dry, a liver-like consistency,

20 disintegration of red cells, the persistence of a fibrinosuppurative exudate Gray hepatization

21 Resolution ( 溶解消散期,7-) : the consolidated exudate within the alveolar spaces undergoes progressive enzymatic digestion to produce a granular, debris that is resorbed, ingested by macrophages, coughed up, or organized by fibroblasts growing into it.

22 Complications (1) Pulmonary abscess( 肺脓肿 ):tissue destruction and necrosis, causing abscess formation ; (2) Empyema ( 脓胸 ):spread of infection to the pleural cavity, causing the intrapleural fibrinosuppurative reaction; (3) Pulmonary carnification ( 肺肉质变 ): organization of the exudate, which may convert a portion of the lung into solid tissue; brown, meat-like fibrous tissue; function of lung lost (4) Septic shock( 感染性休克 ): bacteremic dissemination to organs, causing metastatic abscesses, such as endocarditis, meningitis, or suppurative arthritis; to blood causing septicaemia, septicopyemia.

23 organization of the exudate Pulmonary carnification

24 Pulmonary carnification

25 Lobular pneumonia (Bronchopneumonia)

26 Lobular pneumonia 1. Concept 2. Etiopathogenisis and pathogenesy 3.Pathological changes and Complications

27 Foci of bronchopneumonia are consolidated areas of acute suppurative inflammation involved the pulmonary lobulus. Well-developed lesions are usually 3 to 4 cm in diameter, slightly elevated, dry, granular, gray-red to yellow, and poorly delimited at their margins. Histologically, the reaction usually elicits a suppurative, neutrophil-rich exudate that fills the bronchi, bronchioles, and adjacent alveolar spaces.

28 Lobular pneumonia

29 Pathological changes Gross appearance Well-developed lesions are usually 3 to 4 cm in diameter, slightly elevated, dry, granular, gray-red to yellow, and poorly delimited at their margins.

30 Histologically the reaction usually elicits a suppurative, neutrophil-rich exudate that fills the bronchi, bronchioles, and adjacent alveolar spaces.

31 Confluent bronchopneumonia ( 融合性支气管肺炎 )

32 Complications Respiratory failure Cardiac failure Pulmonar abscess empyema Septicopyemia

33 Distinguish between lobar pneumonia and lobular pneumonia

34 Interstitial pneumonia 1. Concept 2. Etiopathogenisis and pathogenesy 3. Pathological changes and Complications

35 Computerized scanning,ct tomographic X-ray

36 Interstitial pneumonia

37 Interstitial pneumonia

38 viral inclusion bodies

39 Chronic obstructive pulmonary disease (COPD, 慢性阻塞性肺病 ) Chronic bronchitis Pulmonary emphysema Bronchiectasis

40 Chronic bronchitis Bronchus Mucous gland hyperplasia, hypersecretion Tobacco smoke, air pollutants Cough, sputum production Bronchiectasis Bronchus Airway dilation and scarring Persistent or severe infections Cough, purulent sputum, fever Emphysema Acinus Airspace enlargement; wall destruction Tobacco smoke Dyspnea

41 Chronic bronchitis ( 慢性支气管炎 ) Conception: chronic nonspecific inflammation involving tunicamucosa bronchiorum and its surrounding tissue

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43 Normal tissue

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45 Pathological change Epithelium Mucous gland, goblet cell Cartilage,smooth muscle, elastic fibers Inflammatory cell infiltration Other tissues

46 Chronic bronchitis

47 Clinical Features A persistent cough productive of sputum For many years, dyspnea on exertion develops Continued smoking, other elements of COPD may appear, including hypercapnia( 高碳酸血症 ), hypoxemia, and mild cyanosis( 发绀 ). Long-standing severe chronic bronchitis commonly leads to cor pulmonale with cardiac failure.

48 Pulmonary emphysema Conception: Emphysema is a condition of the lung characterized by abnormal permanent enlargement of the airspaces distal to the terminal bronchiole, accompanied by destruction of their walls, termed "overinflation,".

49 Etiopathogenisis and pathogenesy 1. mostly, chronic bronchitis, 2. Obstructive ventilatory disorder 3. Elastase( 弹性蛋白酶 ) increasing 4. Smoking 5. Lacking of α1 antitrypsin

50 Pathological change Enlarged, Inflammation Airway dilation and scarring Broken of alveolar septum

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53 Type Alveolar emphysema( 肺泡性肺气肿 ) 1 中央型 (centriacinar emphysema) 2 全腺泡型 (panacinar emphysema) 大泡性肺气肿 (bullous emphysema) 3 周围型 (periacinar emphysema)

54 Interstitial emphysema Others 1 Senile emphysema ( 老年性肺气肿 ) 2 Compensatory emphysema ( 代偿性肺气肿 )

55 Interstitial emphysema

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57 Clinical manifestation expiratory dyspnea( 呼气性呼吸困难 ) barrel-shaped thorax( 桶状胸 ) pneumocardial disease (PHD, 肺心病 ) spontaneous pneumothorax ( 自发性气胸 ) respiratory failure pulmonary encephalopathy( 肺性脑病 )

58 Bronchiectasis Bronchiectasis is a disease characterized by permanent dilation of bronchi and bronchioles caused by destruction of the muscle and elastic tissue, resulting from or associated with chronic necrotizing infections. To be considered bronchiectasis, the dilation should be permanent; often accompanies viral and bacterial pneumonia.

59 Normal lung Bronchiectasis

60 Bronchiectasis

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64 Clinical manifestation Airway dilation and scarring Persistent or severe infections Cough, hemoptysis, purulent sputum, fever chest pain, pneumonia, lung abscess, emphysema, pneumocardial disease,

65 Acute respiratory distress syndrome (ARDS) Self-study

66 Pulmonary interstitial diseases

67 Pneumoconiosis ( 尘肺 )

68 Silicosis ( 硅肺 )

69 Silicosis ( 硅肺 )

70 Silicosis is characterized grossly in its early stages by tiny, barely palpable, discrete pale to blackened (if coal dust is also present) nodules in the upper zones of the lungs. As the disease progresses, these nodules may coalesce into hard, collagenous scars----siliconic nodule. Histologically, the nodular lesions consist of concentric layers of hyalinized collagen surrounded by a dense capsule of more condensed collagen. interstitial fibrosis

71 Silicosis ( 硅肺 )

72 Complication Silicotuberculosis, cor pulmonale, chronic bronchitis, obstructive emphysema, spontaneous pneumothorax

73 Chronic cor pulmonale

74 1. Concept 2. Etiopathogenisis and pathogenesy 3. Pathological changes

75 Concept Cor pulmonale, consists of right ventricular hypertrophy, dilation, and right heart failure secondary to pulmonary hypertension caused by disorders of the lungs, pulmonary vasculature, thoracal disease.

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77 Right atrium Right ventricle

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81 Tumor nasopharyngeal carcinoma pulmonary carcinoma

82 adenocarcinoma

83 Squamous carcinoma

84 Pulmonary carcinoma Etiopathogenisis Smoking Air pollution vocational factor Genic change

85 Morphology Gross: 1.central carcinoma of the lungs 2.peripheral carcinoma of the lungs 3.diffuse carcinoma of the lungs

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92 Histological : Adenocarcinoma, squamous carcinoma, large cell carcinoma, small cell carcinoma, mucinous carcinoma, carcinoma sarcomatodes, et al.

93 squamous carcinoma

94 adenocarcinoma

95 mucinous carcinoma

96 mucinous carcinoma

97 bronchioalvolar carcinoma

98 small cell carcinoma

99 small cell carcinoma

100 large cell carcinoma

101 large cell carcinoma

102 Sarcomatodes carcinoma

103 Prognosis Clinical manifestation Therapeutics Differential diagnosis

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