病理学英文课件：肝脏胰腺

1、单击此处编辑母版标题样式,单击此处编辑母版文本样式 第二级 第三级 第四级 第五级,2020/12/8,1,Diseases of the Digestive System,Department of Pathology Peking University Health Science Center,单击此处编辑母版标题样式,单击此处编辑母版文本样式 第二级 第三级 第四级 第五级,2020/12/8,2,The digestive system,The gastrointestinal tract The liver and the biliary tract The pancreas,单击

2、此处编辑母版标题样式,单击此处编辑母版文本样式 第二级 第三级 第四级 第五级,2020/12/8,3,The liver and the biliary tract,Viral hepatitis Alcoholic liver disease Cirrhosis Primary carcinoma of the liver Cholecystitis Cholelithiasis (gallstones,4,The largest parenchymal organ in the body Processes dietary nutrients Synthesis of serum pro

3、teins Detoxification spider nevi; testicular atrophy and gynecomastia Hepatic encephalopathy,2020/12/8,47,单击此处编辑母版标题样式,单击此处编辑母版文本样式 第二级 第三级 第四级 第五级,2020/12/8,48,Portal hypertension,Increased resistance to portal blood flow Classified by the site of portal venous obstruction Prehepatic: portal and sp

4、lenic vein obstruction Intraheptic: intrahepatic vascular obstruction, most often by cirrhosis, metastatic tumor or schistosomiasis Posthepatic: venous congestion in the distal hepatic venous circulation, most often as a result of constrictive pericarditis, tricuspid insufficiency, congestive heart

5、failure, or hepatic vein occlusion,单击此处编辑母版标题样式,单击此处编辑母版文本样式 第二级 第三级 第四级 第五级,2020/12/8,49,Main manifestations Ascites Splenomegaly Portosystemic shunts Esophageal varices Rectal hemorrhoids Periumbilical venous collaterals (caput medusae,单击此处编辑母版标题样式,单击此处编辑母版文本样式 第二级 第三级 第四级 第五级,2020/12/8,50,caput m

6、edusae,Esophageal varices,单击此处编辑母版标题样式,单击此处编辑母版文本样式 第二级 第三级 第四级 第五级,2020/12/8,51,单击此处编辑母版标题样式,单击此处编辑母版文本样式 第二级 第三级 第四级 第五级,2020/12/8,52,Hepatic tumors,Benign tumors Hemangioma: the most common benign tumors of the liver Adenoma: related to use of oral contraceptives,单击此处编辑母版标题样式,单击此处编辑母版文本样式 第二级 第三级

7、 第四级 第五级,2020/12/8,53,Malignant tumors Metastatic tumors: account for the majority of hepatic malignancies-colon, lung and breast Primary carcinomas of the liver Hepatocellular carcinomas (HCC): 70% Cholangiocarcinomas (ICC): 15% Combined hepatocellular and cholangiocarcinoma: have a worse prognosis

8、 as compared with patients with HCC,单击此处编辑母版标题样式,单击此处编辑母版文本样式 第二级 第三级 第四级 第五级,2020/12/8,54,Hepatocellular carcinoma (HCC,Frequently marked by increased serum concentration of alpha-feto-protein (AFP) Has a propensity for invasion of vascular channels with hematogenous dissemination,单击此处编辑母版标题样式,单击此处

9、编辑母版文本样式 第二级 第三级 第四级 第五级,2020/12/8,55,Hepatocellular carcinoma (HCC,A malignant tumor derives from hepatocytes Most common primary malignancy of the liver Most common etiological factors Viral infections (HBV, HCV) Dietary aflatoxin B1 ingestion Chronic alcohol abuse,单击此处编辑母版标题样式,单击此处编辑母版文本样式 第二级 第三

10、级 第四级 第五级,2020/12/8,56,Macroscopic appearance Unifocal: massive tumor Multifocal: widely distributed nodules of variable size Diffusely infiltrative,From WHO, 4th edition,单击此处编辑母版标题样式,单击此处编辑母版文本样式 第二级 第三级 第四级 第五级,2020/12/8,57,Microscopy Ranging from well-differentiated to poorly differentiated lesio

11、ns Bile products or hyaline bodies (-1-antitrypsin) may be found,单击此处编辑母版标题样式,单击此处编辑母版文本样式 第二级 第三级 第四级 第五级,2020/12/8,58,Prognosis Five-year survival rate: 5% Largely resistant to radio- or chemotherapy Long-term survival is likely only in patients with small (2cm) , HCC that can be treated by Surgic

12、al resection Liver transplantation Percutaneous ethanol or acetic acid injection Percutaneous radiofrequency thermal ablation,单击此处编辑母版标题样式,单击此处编辑母版文本样式 第二级 第三级 第四级 第五级,2020/12/8,59,Cholangiocarcinoma(CC,An intrahepatic malignant tumor composed of cells resembling those of bile ducts Less common than

13、 hepatocellular carcinoma Etiology Parasites: Opisthorchis viverrini, Clonorchis sinensis Hepatolithiasis Not associated with HBV infection or cirrhosis Occurs at ages older than HCC Has a propensity for early invasion of vascular channels,单击此处编辑母版标题样式,单击此处编辑母版文本样式 第二级 第三级 第四级 第五级,2020/12/8,60,Macro

14、scopic appearance Usually consist of variably sized nodules with coalescence,From WHO, 4th edition,单击此处编辑母版标题样式,单击此处编辑母版文本样式 第二级 第三级 第四级 第五级,2020/12/8,61,Microscopy Most are well to moderately differentiated sclerosing adenocacinoma Bile pigment and hyaline inclusions are not found within the cells,

15、单击此处编辑母版标题样式,单击此处编辑母版文本样式 第二级 第三级 第四级 第五级,2020/12/8,62,Prognosis: 5-year survival rate 39% with mass-forming tumors 69% for intraductal tumours no patients with mass-forming plus periductal-infiltrating tumours survived 5 years,单击此处编辑母版标题样式,单击此处编辑母版文本样式 第二级 第三级 第四级 第五级,2020/12/8,63,Cholecystitis,Acu

16、te cholecystitis An acute inflammation of the gallbladder, precipitated 90% of the time by obstruction of the neck or cystic duct Usually occur in the absence of bacterial infection Leukocytes infiltration, empyema, gangrenous cholecystitis Manifestation: nausea, vomiting, fever and leukocytosis ass

17、ociated with right upper quadrant and epigastric pain,单击此处编辑母版标题样式,单击此处编辑母版文本样式 第二级 第三级 第四级 第五级,2020/12/8,64,Chronic cholecystitis Frequently complicated by gallstones Morphology Thickening of the gallbladder wall Varies degree of the inflammation Rokitansky-Aschoff sinuses: outpouchings of the muco

18、sal epithelium into the wall,From Ackerman, 9th edition,单击此处编辑母版标题样式,单击此处编辑母版文本样式 第二级 第三级 第四级 第五级,2020/12/8,65,Cholelithiasis (gallstones,Has a higher incidence in women Often associated with obesity and multiple pregnancies Pathogenesis Supersaturatd with cholesterol Gallbladder hypomotility Crysta

19、l nucleation Accretion within the GB mucous layer Types of stone : Cholesterol stones, Pigment stones,From WHO, 4th edition,单击此处编辑母版标题样式,单击此处编辑母版文本样式 第二级 第三级 第四级 第五级,2020/12/8,66,Often silent, sometimes fatty food intolerance Biliary colic Obstructive jaundice Perforation Secondary bacterial infecti

20、on facilitated by obstructed bile flow -ascending cholangitis,Manifestations and Complications of Cholelithiasis,单击此处编辑母版标题样式,单击此处编辑母版文本样式 第二级 第三级 第四级 第五级,2020/12/8,67,Exocrine pancreas,Acute pancreatitis Chronic pancreatitis Carcinoma of the pancreas,单击此处编辑母版标题样式,单击此处编辑母版文本样式 第二级 第三级 第四级 第五级,2020/1

21、2/8,68,单击此处编辑母版标题样式,单击此处编辑母版文本样式 第二级 第三级 第四级 第五级,2020/12/8,69,单击此处编辑母版标题样式,单击此处编辑母版文本样式 第二级 第三级 第四级 第五级,2020/12/8,70,Acute pancreatitis,Autodigestion of the organ caused by activation of pancreatic enzymes with hemorrhagic fat necrosis and deposition of calcium soaps,单击此处编辑母版标题样式,单击此处编辑母版文本样式 第二级 第三

22、级 第四级 第五级,2020/12/8,71,Predisposition Gallstones Excessive alcohol intake Clinical features Severe abdominal pain, radiation to the back Increased levels of serum amylase and lipase Hypocalcemia Mortality rate: 20%-40% in severe,单击此处编辑母版标题样式,单击此处编辑母版文本样式 第二级 第三级 第四级 第五级,2020/12/8,72,From Robbins,Bas

23、ic Pathology, 7th edition,单击此处编辑母版标题样式,单击此处编辑母版文本样式 第二级 第三级 第四级 第五级,2020/12/8,73,From Robbins,Basic Pathology, 7th edition,单击此处编辑母版标题样式,单击此处编辑母版文本样式 第二级 第三级 第四级 第五级,2020/12/8,74,Chronic pancreatitis,Bouts of mild to moderate pancreatic inflammation with continued loss of pancreatic parenchyma and re

24、placement by fibrous tissue Pathogenesis: obscure Clinical features Repeated attacks of various degrees of abdominal pain Mild elevations of serum amylase and lipase levels X-ray reveals calcifications within the pancreas,单击此处编辑母版标题样式,单击此处编辑母版文本样式 第二级 第三级 第四级 第五级,2020/12/8,75,Morphology Fibrosis with chronic inflammatory infiltrate Extensive atrophy of the exo