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1 Pathology of Respiratory System Etiology, Pathogenesis, Pathological changes, and Complications Meiyi Zhou Assistant Professor, Department of Pathophysiology SJTU, School of Medicine

2 Common Diseases in the pulmonary system COPD( 慢性支气管炎肺气肿 ) Infection ( 肺炎 ) Silicosis( 硅肺 ) Chronic Cor Pulmonale( 肺心病 ) Lung Cancer( 肺癌 ) Tuberculosis( 肺结核 )

3 Chronic Obstructive pulmonary Disease (COPD) Defination COPD, namely chronic bronchitis and emphysema, are diseases origination in the airways or notably affect in airway function. 慢性阻塞性肺病 (COPD) 指由于气道完全或不完全阻塞, 导致通气阻力增加及肺功能不全的慢性肺疾病包括慢性支气管炎和肺气肿

4 Chronic bronchitis ( 慢性支气管炎 ) 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. 指气管支气管黏膜及其周围组织的慢性炎症临床特征为反复发作的咳嗽咳痰喘息, 病程长如每年发作时间起过 3 个月连续两年以上者, 可诊断为慢性支气管炎

5 Chronic bronchitis ( 慢性支气管炎 ) Etiology( 病因学 ) 理化因素 : 长期吸烟空气污染气候因素过敏因素感染因素 : 病毒细菌

6 Chronic bronchitis ( 慢性支气管炎 ) Pathological Changes( 病理改变 ) 纤毛粘连倒伏脱失粘膜上皮细胞变性坏死柱状上皮出现鳞状上皮化生杯状细胞增多壁增厚腺体增生肥大粘液化

7 Chapter Ⅰ: Chronic bronchitis ( 慢性支气管炎 ) Pathological Changes( 病理改变 ) 1. 粘膜上皮的损伤与修复 2. 腺体增生肥大粘液化 3. 管壁炎症反应粘膜粘膜下层充血水肿淋巴浆细胞等浸润 4. 管壁其他损害喘息型患者粘膜下层平滑肌增生肥大, 支气管变窄, 管壁软骨变性纤维化钙化或骨化

8 Chronic bronchitis ( 慢性支气管炎 ) Squamous metaplasia of chronic bronchitis

9 Chronic bronchitis ( 慢性支气管炎 ) 粘液腺增生, 浆液腺粘液化

10 Chronic bronchitis ( 慢性支气管炎 ) 临床病理联系咳嗽 : 支气管粘膜充血水肿及粘液分泌物增多刺激支气管粘膜引起咳痰 :( 咳大量白色粘痰或浆液泡沫状, 如伴细菌感染为脓性 ): 粘液腺增生肥大 ; 部分浆液腺化生成粘液腺, 粘液分泌增多而致气喘 : 因支气管炎症, 刺激支气管痉挛或粘液阻塞而致

11 Chronic bronchitis ( 慢性支气管炎 ) 并发症支气管扩张 : 长期支气管炎症的破坏, 其弹力性和支撑力减弱, 加之长期的咳嗽而致肺气肿 : 管腔内粘液潴留及粘液栓形成, 使末梢肺组织过度充气而致肺心病 : 肺气肿引起肺间隔破坏, 肺动脉高压, 右心室肥大扩张支气管肺炎 : 支气管壁甚薄, 炎症易于扩散而累及肺泡

12 Emphysema ( 肺气肿 ) Defination 指呼吸性细支气管至肺泡的末梢肺组织因持续性含气量增加而呈永久性过度膨胀, 伴有肺泡壁弹力组织破坏, 间隔断裂致肺泡相互融合, 肺容积增大的病理状态病因和发病机理阻塞性通气障碍 α1 抗胰蛋白酶缺乏

13 类型 Emphysema ( 肺气肿 ) 肺泡性肺气肿 (Alveolar emphysema) 类型腺泡中央型 (Centriacinar emphysema), 吸烟相关全腺泡型 (Panacinar emphysema), α 1 - Antitrypsin 腺泡周围型 (Periacinar emphysema), 青年人可见不规则型 (Irregular emphsema), 瘢痕旁肺气肿肺气肿样病变 : 肺大泡间质性肺气肿 (Interstitial emphysema)

14 烟民常见, 上中叶病变为主胸膜下病变为主最严重, 下叶病变为主局部片灶性病变

15 Emphysema ( 肺气肿 ) 大体 : 体积增大, 边缘钝圆, 灰白色, 柔软弹性差, 切面海绵状表面常可见肋骨压痕, 压痕不易消退触之捻发音增强

16 Emphysema ( 肺气肿 ) 扩张的肺泡融合成较大的囊腔, 间隔变窄, 肺泡孔扩大, 间隔断裂

17 Emphysema ( 肺气肿 ) Localized Emphysema Irregular Emphysema

18 Emphysema ( 肺气肿 ) Bullae ( 肺大泡, >1cm ) ( 相关病变 : 腺泡周围型肺气肿 )

19 Pneumonia ( 肺炎 ) Defination Pulmonary infections are in the form of pneumonia, which is common disease in respiratory system. 指肺组织的急性渗出性炎症, 是呼吸系统的常见病

20 Pneumonia ( 肺炎 ) Classification Pathogen( 病因 ) Infection bacteria, virus, fungal, mycoplasmal Physics & chemistry radio, inhaling materials Allergy hypersusceptibility, rheumatism Lesion position and range( 累及部位 ) lobar, lobular, interstitial Type of inflammation( 感染类型 ) serous, fibrinous, hemorrhagic, caseous, granulomatous

21 Lobar Pneumonia ( 大叶性肺炎 ) Defination Lobar 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. 指肺泡内以纤维素渗出为主的急性炎症, 病变始于肺泡, 迅速波及一个肺段或整个大叶, 多见于青壮年

22 Lobar Pneumonia ( 大叶性肺炎 ) Symptoms high fever, shaking chills cough rusty sputum( 铁锈色痰 ) chest pain dyspnea, cyanosis rales with consolidation presentations

23 Lobar Pneumonia ( 大叶性肺炎 ) Etiolgoy pathogen - streptococcus pneumoiae ( 肺炎链球菌 ) - staphylococcus ( 葡萄球菌 ) - hemophilus influenzae ( 流感嗜血杆菌 ) inducing factors - cold - excessive tired - anesthesia

24 Lobar Pneumonia ( 大叶性肺炎 ) Pathogenesis( 发病机制 ) Permeability of cap. Serous and fibrinous exudation Proliferation of bacteria Lobar pneumonia (7-10 days)

25 Lobar Pneumonia ( 大叶性肺炎 ) Morphology ---- Gross View Cited from Robbins Basic Pathology (9 th Edition) Page 489

26 Lobar Pneumonia ( 大叶性肺炎 ) Phase Ⅰ: Congestion and Edema( 充血水肿 ) 1-2 days 肺泡壁血管充血, 肺泡腔浆液渗出临床可出现湿性罗音,X 线呈浅薄均匀的阴影

27 Lobar Pneumonia ( 大叶性肺炎 ) Phase Ⅰ: Congestion and Edema( 充血水肿 ) 1-2 days 暗红肿大切面能挤出淡红色泡沫状液体

28 Lobar Pneumonia ( 大叶性肺炎 ) Phase Ⅱ : Red Hepatization ( 红色肝变期 ) 3-4 days 肺泡壁血管显著充血, 肺泡腔充满大量纤维蛋白和红细胞, 肺组织实变色暗红如肝病人开始咳铁锈色痰, 常伴胸痛呼吸困难等有肺实变征 X 线见大片均匀致密阴影

29 Lobar Pneumonia ( 大叶性肺炎 ) Phase Ⅱ : Red Hepatization ( 红色肝变期 ) 3-4 days 暗红色肿大质地变实像肝脏切面粗糙呈颗粒状

30 Lobar Pneumonia ( 大叶性肺炎 ) Phase Ⅲ : Gray Hepatization ( 灰色肝变期 ) 5-6 days 肺泡壁血管受压迫, 肺泡腔内充满大量纤维蛋白网, 中性白细胞肺叶灰白, 实变如肝病人仍有肺实变体征

31 Lobar Pneumonia ( 大叶性肺炎 ) Phase Ⅲ : Gray Hepatization ( 灰色肝变期 ) 5-6 days 肿大灰白切面干燥

32 Lobar Pneumonia ( 大叶性肺炎 ) Phase Ⅳ : Resolution( 溶解消散期 ) 7-10 days 中性白细胞崩解, 放出蛋白酶, 溶解纤维蛋白 ; 巨噬细胞增多, 吞噬活跃, 渗出物逐渐吸收, 肺组织复原

33 Lobar Pneumonia ( 大叶性肺炎 ) Complications( 并发症 ) Carnification ( 肺肉质变 ) Fibrinous exudations from lobar pneumonia converted into granulation tissues because of the deficiency of proteases, which is normally secreted by neutrophils. Abscess( 脓肿 ) empyema ( 化脓性胸膜炎 ) fibrinous pleurisy ( 纤维素性胸膜炎 ) septicemia ( 败血症 ) or pyosepticemia ( 脓毒败血症 ) infectious shock

34 Lobar Pneumonia ( 大叶性肺炎 ) 肺肉质变肺脓肿脓胸

35 Lobular Pneumonia ( 小叶性肺炎 ) Defination This 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 age. 常作为一种并发症出现, 多见于小儿老人与体弱者病变起始于细支气管, 以肺小叶为单位, 以支气管为中凡的肺组织化脓性炎症

36 Lobular Pneumonia ( 小叶性肺炎 ) Pathology and Pathogenesis Mixed infection by many weak bacteria, such as staphylococus and pseudomonas aeruginosa 由多种细菌混合感染引起 symptoms Fever, cough, mucopurulent sputum, dyspnea, cyanosis

37 Lobular Pneumonia ( 小叶性肺炎 ) Morphology ---- Gross View Cited from Wikicommon Media

38 Lobular Pneumonia ( 小叶性肺炎 ) Morphology ---- Microscopical structure 细支气管粘膜充血, 上皮坏死脱落, 管腔内充满嗜中性粒细胞崩解的上皮细胞及渗出液病灶周围肺组织充血水肿代偿性肺气肿

39 Lobular Pneumonia ( 小叶性肺炎 )

40 Lobular Pneumonia ( 小叶性肺炎 )

41 Lobular Pneumonia ( 小叶性肺炎 )

42 Lobular Pneumonia ( 小叶性肺炎 ) Complications Respiratory failure Heart failure Abscess ( 脓肿 ) Empyema ( 脓胸 ) Pyosepticemia ( 脓毒血症 ) Bronchiectasis

43 Difference between Lobar pneumonia and bronchopneumonia

44 Lobar Pneumonia Lobular Pneumonia Pathogen streptococcus pneumoiae mixed bacteria Age young adult infancies, oldes, patients Position single lobe bilateral and basal Complication cartification pulmonary failure, Gross View Microscopy Structure whole lobe,hepatization fibrous heart failure scattered, small, red or yellow purulent

45 Interstitial Pneumonia ( 间质性肺炎 ) Defination The 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 viruses - influenza types A and B - syncytial viruses - human metapneumovirus - adenovirus

46 Interstitial Pneumonia ( 间质性肺炎 ) Alveolar septum thickened with congestion, edema and mononuclear cell infiltration.

Interstitial Pneumonia ( 间质性肺炎 ) Morphology involve whole lobes bilaterally or

largely confined within the walls of the alveoli mononuclear inflammatory

structure Hyaline membrane Giant cell Viral inclusion Cited from Wikipedia

47 Interstitial Pneumonia ( 间质性肺炎 ) Morphology involve whole lobes bilaterally or unilaterally red-blue, congested, and subcrepitant inflammatory reaction is largely confined within the walls of the alveoli mononuclear inflammatory infiltrate in the septa free of cellular exudate in alveolar spaces Special structure Hyaline membrane Giant cell Viral inclusion Cited from Wikipedia Indian J Pathol Microbiol Apr-Jun;54(2): Cited from

49 Pneumonia ( 肺炎 ) Self Assesment 灰色肝样变 Gray hepatizatin 肺肉质变 Pulmonary carnification 比较小叶性肺炎大叶性肺炎的不同点 Cited from Biology-Forums.com

50 WE ARE JUST ON THE WAY THANK YOU.

PowerPoint 演示文稿

PowerPoint 演示文稿 Disease of respiratory system Wang Lin Department of Pathology Norman Bethune College of Medicine Section one Pneumonia 肺炎 Review-1 呼吸系统的解剖学呼吸道分上下两部分 Anatomy of respiratory system 支气管 ---nose ---pharynx