病理學(xué)課件：呼吸系統(tǒng)疾病

呼吸系統(tǒng)疾病

Thelungandtheupperrespiratorytract病理學(xué)呼吸系統(tǒng)的組成正常結(jié)構(gòu)Conductiveregionandrespiratoryregionbasedontheirfunctions:TracheaandbronchiBronchiolesTerminalbronchiolesRespiratorybronchiolesAlveolarductsAlveolarsacAlveoliAcinusLobulecartilageChronicobstructivepulmonarydisease慢性阻塞性肺病Cor

pulmonale

肺源性心臟病Pneumonia肺炎Lungcancer肺癌一組由各種原因引起的，以肺實質(zhì)和小氣管受損后，導(dǎo)致慢性不可逆性氣道阻塞、呼氣阻力增加及肺功能不全為共同特征的肺疾病，主要包括慢支、肺氣腫、支氣管哮喘、支擴等疾病。慢性阻塞性肺?。–OPD），Chronicobstructivepulmonarydiseaseaffectsmorethan10%oftheUSadultpopulationandisthefourthleadingcauseofdeathinthiscountry.RobinBasicPathology9th慢性支氣管炎與細(xì)支氣管炎ChronicbronchitisandbronchiolitisDiagnosisofchronicbronchitis：

Apersistentproductivecoughforatleast3consecutivemonthsinatleast2consecutiveyearsPathogenesis：Cigarettesmoking：thesinglemostimportantcauseInfection:Airpollution：Allergicfactor:asthmaticbronchitisOthers:Pathologicchanges：

Beginningfromlargeairway,followedbysmallerbronchiandbronchioles

上皮的損傷與修復(fù)Epithelialinjuryandrepair腺體的增生、肥大與化生Enlargementofmucus-secretingglandsandgobletcellmetaplasia慢性非特異性炎InflammationandfibrosisinthewallsClinicalcourse：咳嗽、咳痰、喘息productionofsputum,Progression：肺氣腫emphysema肺氣腫肺氣腫(Emphysema)呼吸性細(xì)支氣管、肺泡管、肺泡因肺組織彈性減弱而過度充氣，呈永久性擴張，并伴肺泡間隔破壞，致使肺容積增大、肺功能降低的病理狀態(tài)。肺氣腫EmphysemaDefinition:

Permanentenlargementoftheairspacesdistaltotheterminalbronchiolesaccompaniedbydestructionoftheirwalls.RobinBasicPathology9thPathogenesis:支氣管阻塞性通氣功能障礙Partialobstruction：e.g.chronicbronchiolitis彈性蛋白酶及其及其抑制物失衡Protease-antiproteaseimbalance：e.g.

α1-antitrypsindeficiencySmoking:WBCactivationPathologicchanges：3types:腺泡中央型：Centriacinaremphysema全腺泡型：Panacinaremphysema腺泡周圍型：DistalacinaremphysemaCentriacinaremphysema:RespiratorybronchiolesaffectedDistalalveolisparedMorecommonintheupperlobeAconsequenceofsmokingPanacinaremphysema:ThewholeaciniuniformlyenlargedAconsequenceofα1-antitrypsindeficiencyDistalacinaremphysema:AdjacenttothepleuraMoresevereintheupperhalfofthelung大泡型肺氣腫Others:代償性肺氣腫Compensatoryemphysema老年性肺氣腫Senileemphysema阻塞性過度通氣Obstructiveoverinflation間質(zhì)性肺氣腫InterstitialemphysemaClinicalcourse:漸進(jìn)性呼氣性呼吸困難progressivedyspnea,pulmonaryfunctionreducedComplications：肺心病Corpulmonale自發(fā)性氣胸SpontaneouspneumothoraxInfection支氣管擴張癥BronchiectasisDefinition：以肺內(nèi)支氣管的持久性擴張為特征的慢性疾病ThepermanentdilationofbronchiandbronchiolescausedbydestructionofthemuscleandelasticsupportingtissuePathogenesis：Itisnotaprimarydisease，butrathersecondarytopersistinginfectionorobstructioncausedbyavarietyofconditions.RobinBasicPathology9th病因病機：支氣管壁的炎性損傷：嬰幼兒百日咳、麻疹后的支氣管肺炎、慢支、肺結(jié)核…

支氣管先天性發(fā)育缺陷和遺傳因素Pathologicchanges：Grossly：bronchialdilation,usuallyaffectthelowerlobes

moredistal,moreseverefullofpurulentexudateLM：chronicinflammationnecrosisandfibrosisinthewallClinicalcourse：慢性咳嗽Persistentcough，大量膿痰Mucopurulent,sometimesfetid,sputum咯血HemoptysisComplications：pneumonia,pulmonaryabscess,pulmonaryhypertensionandrarelycorpulmonalepulmonaryheartdisease慢性肺源性心臟病:由慢性肺疾病、肺血管疾病及胸廓運動障礙性疾病引起肺循環(huán)阻力增加、肺動脈壓力增高，以右心室肥厚、擴張為特征的心臟病，稱為pulmonaryheartdisease（colpulmonale），簡稱肺心病。Pathogenesis：肺部疾病Diseasesoflungs:e.g.COPD肺血管疾病Diseasesofpulmonaryvessels胸廓運動障礙DisordersaffectingchestmovementPathologicchanges：Pulmonarylesions：原有肺部病變肺小血管病變ThedecreaseintheamountofpulmonaryvascularbedIntimathickenedandSMChyperplasiaLesionsinheartTherightventricularhypertrophyanddilation

肺動脈瓣下2㎝處右心室肌壁厚≥5mmClinicalcourse：原有肺部疾病或胸廓疾病的癥狀與體征respiratoryinsufficiency呼吸性酸中毒與肺性腦病

respiratoryacidosisandcoma右心衰Right-sidedheartfailure肺炎PneumoniaClassification:Lobarpneumonia/bronchopneumonia/interstitialpneuomoniaBacterial/viralpneuomiaOthers:大葉性肺炎Lobarpneumonia：急性炎癥Acuteinfection肺炎雙球菌感染PneumococcallunginfectionLowerlobesortherightmiddlelobe變態(tài)反應(yīng)性炎，彌漫性纖維素性炎DiffusedfibrinousinflammationFourstages:

充血消腫期Congestion

紅色肝變期Redhepatization

灰色肝變期Greyhepatization

溶解消散期ResolutionCongestion:1-2nddaysGrossly:theaffectedlobe(s):heavy,red,andboggyLM:充血水腫vascularcongestion

漿液性滲出pinkexudatewithbacteriainthealveoliRedhepatization:3–4thdaysGrossly:redandenlarged,aliver-likeconsistency

Redhepatization:LM:滲出物含大量紅細(xì)胞與纖維素thealveoliarefilledwithRBCandfibrin,Greyhepatization:5-6thdaysGrossly:thelungisdry,greyandfirmLM:滲出物含大量纖維素與白細(xì)胞alveoliarefilledwithfibrinousexudateandWBCbacteriaarekilledanddegraded

Resolution:the2ndweek炎性滲出物溶解消散，肺組織結(jié)構(gòu)完整TheexudatesaredigestedbyWBC,leavingthebasicarchitectureintact.Complications：并發(fā)癥少見Rarely,lungabscess,empyema,

septemia,septicshock…纖維素性胸膜炎肺肉質(zhì)變Pulmonarycarnification小葉性肺炎Lobularpneumonia（bronchopneumonia）：混合感染Multiplebacteriainfection肺小葉為單位Extensionintothewholelobules局灶性化膿性炎FocalPurulentinflammationPathologicchanges:

Thelesionsaredistributedinpatchesthroughoutoneorseverallobes,mostfrequentlybilateralandbasal.ConfluencemayoccurinseverecasesLM：細(xì)支氣管與周圍組織大量中性粒細(xì)胞滲出Thebronchiolesandadjacentalveoliarefullofpurulentexudates.病灶間組織結(jié)構(gòu)完整Theinterveningareasarenormal支氣管及肺泡壁遭破壞Thebasicarchitecturesareofteninjured.

Clinicalcourse:

fever,cough,purulentsputum…Complications：并發(fā)癥多見，且預(yù)后較差

Lungabscess,empyema,

septemia,septicshock…病毒性肺炎Viralpneumonia:ViralinfectionMorefrequentinchildren急性間質(zhì)性肺炎InterstitialpneumoniaClinicalcourse：

Fever,headache,干咳Nonproductivecough,Hypoxia,dyspnea肺硅沉著癥SilicosisSiO2粉塵吸入我國最常見的職業(yè)病之一OccupationaldiseasePathologicchanges：硅結(jié)節(jié)的形成Silicoticnodulesformation彌漫性纖維化DiffusedfibrosisThreestages：StageⅠ：silicoticnoduleslocatedinhilarlymphnodesStageⅡ：silicoticnoduleslimitedin1/3oflungs.Thelungsgetenlargedandconsolidated.

StageⅢ：silicoticnodulesgetincreasedinsizeandquantity.Thelungsgetheavierandfirm.Thepleuragetthickened.Complications：結(jié)核Tuberculosis肺心病Colpulmonale感染PulmonaryinfectionOthers…LungandbronchuscancerRoughly95%ofprimarylungtumorsarecarcinomas;…..Carcinomaofthelung(alsoknownas“l(fā)ungcancer”)iswithoutdoubtthesinglemostimportantcauseofcancerrelateddeathsinindustrializedcountries.

RobinBasicPathology9thWorldCancerReport2014CancerStatistics,2013CACANCERJCLIN2013;00:000–0002013中國腫瘤登記年報Causes：Smoking:About90%oflungcancersoccurinactivesmokersorthosewhostoppedrecently.RobinBasicPathology9thAirpollution:Geneticfactor:p53,K-ras,…Pathologicchanges：

Grossly：中央型：Centralhilarmasses周圍型：Peripheralnodules彌漫型：MultiplediffusednodulesHistologicclassification:鱗狀細(xì)胞癌Squamouscellcarcinoma小細(xì)胞癌Smallcelllungcarcinoma腺癌Adenocarcinoma大細(xì)胞未分化癌LargecellcarcinomaSquamouscellcarcinoma:MorefrequentinmalesStrongassociationwithcigarettesmokingPrecededbysquamousmetaplasiaanddysplasiainbronchi