呼吸系统疾病-Diseases-of-the-Respiratory-System(病理)课件

1、Diseases of the Respiratory SystemPathology Department of SiChuan UniversitySu XueyingDiseases of the Respiratory SyNormal structure of the respiratory tractNormal structure of the respir呼吸系统疾病-Diseases-of-the-Respiratory-System(病理)课件Respiratory mucosaRespiratory mucosaThe respiratory system disease

2、s are very commonEnvironmental factors are important causesThe respiratory system diseaseAir pollutionsSO2NO2Air pollutionsSO2Cigarette smokingCigarette smokingMajor aetiological factors in respiratory diseaseEnvironmental Smoking Lung cancer Chronic bronchitis and emphysema Susceptibility to infect

3、ion Air pollution Lung cancer Chronic bronchitis and emphysema Susceptibility to infection Organism Influenza Pneumonia Tuberculosis Occupation silicosis MesotheliomaGenetic Cystic fibrosis Major aetiological factors in 呼吸系统疾病-Diseases-of-the-Respiratory-System(病理)课件Major aetiological factors in res

4、piratory diseaseEnvironmental Smoking Lung cancer Chronic bronchitis and emphysema Susceptibility to infection Air pollution Lung cancer Chronic bronchitis and emphysema Susceptibility to infection Organism Influenza Pneumonia Tuberculosis Occupation silicosis Mesothelioma（asbestos)Genetic Cystic fi

5、brosis Major aetiological factors in OUTLINE 1.Pulmonary Infections Community-Acquired Acute Pneumonia Community-Acquired Atypical Pneumonia Fungal infections 2.Chronic Obstructive Lung Diseases (COPD) Chronic Bronchitis Emphysema 3. Bronchiectasis 4. Asthma 5. Cor Pulmonale 6. Lung tumors OUTLINE 1

6、.Pulmonary InfectiOUTLINE 1.Pulmonary Infections Community-Acquired Acute Pneumonia Community-Acquired Atypical Pneumonia Fungal infections 2.Chronic Obstructive Lung Diseases (COPD) Chronic Bronchitis Emphysema 3. Bronchiectasis 4. Asthma 5. Cor Pulmonale 6. Lung tumors OUTLINE 1.Pulmonary InfectiC

7、hronic Obstructive Lung Diseases(COPD)10% US adults involvedThe 4th leading cause of death in USATwo common conditions- Chronic Bronchitis and Emphysema Persisting and irreversible airway obstructionChronic Obstructive Lung DiseChronic BronchitisDefinition (made on clinical ground) persistent produc

8、tive cough for at least 3 consecutive months in at least 2 consecutive years Chronic BronchitisDefinition Chronic BronchitisDefinition (made on clinical ground) persistent productive cough for at least 3 consecutive months in at least 2 consecutive years Chronic BronchitisDefinition It is often deve

9、loped in middle age to old men with cigarette smokingThe incidence is higher in urban dwellers than village residents It is often developed in middlCauses cigarette smoking air pollutions ( sulfur dioxide, nitrogen dioxide) CausesPathogical changesHypertrophy and hypersecretion of mucous gland, begi

10、nning in the large airwaysGoblet cell metaplastic formationInflammatory cells infiltration Epidermal growth factor receptorPathogical changesHypertrophy Marked thickening of the mucous gland layer Squamous metaplasia of the epithelium Marked thickening of the mucReid index (the ratio of the thicknes

11、s of the submucosal gland layer to that of the bronchial wall) 0.55 ）Reid index (the ratio of the Increased numbers of chronic inflammatory cells in the submucosa. Increased numbers of chroniChronic bronchiolitis goblet cell metaplasia smooth muscle hyperplasia fibrosis in the walls inflammatory cha

12、nges Luminal narrowingAirway obstructionChronic bronchiolitisLuminal nChronic bronchiolitisChronic bronchiolitisChronic bronchiolitisChronic bronchiolitisClinical course cough, mucus or mucopurulent sputum with/without asthma hypercapnia, hypoxemia, cyanosisClinical courseThe forms of chronic bronch

13、itisSimple chronic bronchitisChronic mucopurulent bronchitisChronic asthma bronchitisChronic obstructive bronchitisThe forms of chronic bronchitiDiagnosis & Therapy History and symptoms Alleviate the symptoms Diagnosis & Therapy Histo Prevention is the most important Prevention is the most imp Preve

14、ntion is the most important Prevention is the most impEmphysemaDefinition Emphysema is characterized by permanent Enlargement of the air spaces distal to the terminal bronchioles accompanied by destruction of their walls EmphysemaDefinition呼吸系统疾病-Diseases-of-the-Respiratory-System(病理)课件Types of Emph

15、ysemaCentriacinarPanacinarDistal acinarTypes of EmphysemaCentriacinarCentriacinar EmphysemaCigarette smokingThe upper lobe, apical segmentsCentriacinar EmphysemaCigaretPeriacinar EmphysemaIt is more striking adjacent to the pleura, fibrosis, scaring , at the margins of the lobulesUpper half of the l

16、ungsPeriacinar EmphysemaPanacinar Emphysema1- antitrypsin deficiencyThe lower lobePanacinar Emphysema1- antitryCentriacinar vs Panacinar EmphysemaCentriacinar vs PanacinarPeriacinar EmphysemaPeriacinar EmphysemaBullaeBullae呼吸系统疾病-Diseases-of-the-Respiratory-System(病理)课件pathogenesisProtease-antiprote

17、ase imbalanceOxidant-antioxidant imbalance These two imbalances are almost always coexist, effects are additivepathogenesisProtease-antiprote Proteolytic activity Anti- Proteolytic activity TISSUE DAMAGE EMPHYSEMA Proteolytic activity AnPathogenesis of emphysema Pathogenesis of emphysemaSmall airway

18、s tend to collapse during expiration-an important cause of chronic airflow obstruction Small airways tend to collapseEmphysema vs OverinflationWith destruction without destructionComplicated reasons compensatory obstructive Emphysema vs Clinical course no symptom Dyspnea Cough, mucus or mucopurulent

19、 sputum, wheezing(with bronchitis) FEV1 (Forced Expiratory Volume at one second ) Clinical course no symptomExpiration stage prolongedSitting forward in a hunched-over positionBarrel-chestExpiration stage prolongedBarrel-chest呼吸系统疾病-Diseases-of-the-Respiratory-System(病理)课件Expiration stage prolongedS

20、itting forward in a hunched-over positionBarrel-chestHypoxic, cyanosisExpiration stage prolonged Emphysema vs Chronic bronchitis The two diseases usually coexistmorphologic feature clinical featurerestricted to acinus large and small airways Emphysema vs Chronic b呼吸系统疾病-Diseases-of-the-Respiratory-S

21、ystem(病理)课件OUTLINE 1.Pulmonary Infections Community-Acquired Acute Pneumonia Community-Acquired Atypical Pneumonia Fungal infections 2.Chronic Obstructive Lung Diseases (COPD) Chronic Bronchitis Emphysema 3. Bronchiectasis 4. Asthma 5. Cor Pulmonale 6. Lung tumors OUTLINE 1.Pulmonary InfectiDefiniti

22、on Bronchiectasis is the permanent dilation of bronchi and bronchioles caused by destruction of the muscle and elastic supporting tissue. It is not a primary disease but rather is secondary to persisting infection or obstruction caused by variety of conditions BronchiectasisDefinitionBronchiectasisC

23、onditions that predispose to bronchiecctasisBronchial obstructionBacteria pneumoniaCongenital conditions: cystic fibrosis kartagener syndromeConditions that predispose to pathogenesis Obstruction Chronic infection Bronchial walls damage irreversible dilationpathogenesis Obstruction 呼吸系统疾病-Diseases-o

24、f-the-Respiratory-System(病理)课件bronchiectasis 呼吸系统疾病-Diseases-of-the-Respiratory-System(病理)课件 Cross-section of lung demonstrating dilated bronchi extending almost to the pleura Cross-section of lung demon Dilated bronchus in which the mucosa and wall is not clearly seen because of the necrotizing inf

25、lammation Dilated bronchus in whichClinical Course Severe, persistent cough Copious amount of mucopurulent, fetid sputum Hemoptysis Symptoms are episodic and are precipitated by upper respiratory tract infection Clinical CourseOUTLINE 1.Pulmonary Infections Community-Acquired Acute Pneumonia Communi

26、ty-Acquired Atypical Pneumonia Fungal infections 2.Chronic Obstructive Lung Diseases (COPD) Chronic Bronchitis Emphysema 3. Bronchiectasis 4. Asthma 5. Cor Pulmonale 6. Lung tumors OUTLINE 1.Pulmonary Infectibronchial asthmaAsthma is characterized by episodic, reversible bronchospasm resulting from

27、an exaggerated bronchoconstrictor response to varous stimulibronchial asthmaAsthma is charAllergic substances：pollen、food、petsMedicine: asprinVirus and bacteriaExerciseweathermoodAllergic substances：pollen、fooClinically, asthma is manifested by episodic dyspnea, cough and wheezing (a soft whistling

28、sound during expiration)Clinically, asthma is manifestpathogenesisAir way hyperresponsiveness Bronchial inflammation is the basis for hyperresponsiveness histamine or methacholinepathogenesisAir way hyperrespoPathological changesEosinophils, lymphocytes, mast cells infiltration Mucus gland hypersecr

29、etion and damage of bronchial wallsPathological changesEosinophil呼吸系统疾病-Diseases-of-the-Respiratory-System(病理)课件呼吸系统疾病-Diseases-of-the-Respiratory-System(病理)课件The type of asthmaExtrinsic asthma Intrinsic asthmaThe type of asthmaExtrinsic asOUTLINE 1.Pulmonary Infections Community-Acquired Acute Pneu

30、monia Community-Acquired Atypical Pneumonia Fungal infections 2.Chronic Obstructive Lung Diseases (COPD) Chronic Bronchitis Emphysema 3. Bronchiectasis 4. Asthma 5. Cor Pulmonale 6. Lung tumors OUTLINE 1.Pulmonary InfectiCor pulmonaleDefinition It also called pulmonary heart disease, is used to desc

31、ribe disease of the right-side cardiac chambers caused by pulmonary hypertension resulting from pulmonary parenchymal or pulmonary vascular diseases Cor pulmonaleDefinitionDisorders that predispose to cor pulmonale Diseases of the lungs Chronic obstructive lung disease Diffuse pulmonary interstitial

32、 fibrosis Extensive, persistent atelectasis Cystic fibrosis Diseases of pulmonary vessels Pulmonary embolism Primary pulmonary vascular sclerosis Extensive pulmonary arteritis Drug-, toxin-, or radiation-induced vascular sclerosis Disorders affecting chest movement Disorders inducing pulmonary arter

33、iolar constrictionDisorders that predispose to c呼吸系统疾病-Diseases-of-the-Respiratory-System(病理)课件Heart changesright ventricular, and often right atria hypertrophy. It may be dilated when ventricular failure develops. Heart changesright ventricular2cm below the valves of the pulmonary artery the thickn

34、ess of ventricle5mm2cm below the valves of the pu Clinical courseSymptoms of primary pulmonary diseaseProgressive right cardiac failure and respiratory failure Clinical courseOUTLINE 1.Pulmonary Infections Community-Acquired Acute Pneumonia Community-Acquired Atypical Pneumonia Fungal infections 2.C

35、hronic Obstractive Lung Diseases (COPD) Chronic Bronchitis Emphysem 3. Bronchiectasis 4. Asthma 5. Cor Pulmonale 6. Lung tumors OUTLINE 1.Pulmonary InfectiLung tumorsBronchogenic carcinoma:95%Miscellaneous group:5% bronchial carcinoid tumor sarcoma melanoma lymphoma Lung tumorsBronchogenic carcinBro

36、nchogenic carcinomaNo.1 cause of cancer-related deaths in industrialized countries.Cigarette smoking is a important causeThe peak incidence occurs between ages 55 and 65 years.The male to female ratio is 2:1The prognosis of lung cancer is dismalBronchogenic carcinomaNo.1 cauMalignant neoplasm of the

37、 epithelium of bronchusDefinition Malignant neoplasm of the epitTrends in bronchogenic carcinoma incidence and mortality. From the WHO Classification of TumorsIncidence and death rate, age standardised(x103)Trends in bronchogenic carcinoCauses: cigarette smoking air pollutions occupational factors g

38、enetic reasonsCauses: HEAVY SMOKERS(1 pack/day)SMOKERSNEVER SMOKERDAge(103) Cigarette consumption and the mortality of bronchogenic carcinoma . From the General and Systematic PathologyAnnualdeath rate ofbronchogenic carcinomaHEAVY SMOKERSSMOKERSNEVER SMOKCauses: cigarette smoking air pollutions occ

39、upational factors genetic reasonsCauses: The types of bronchogenic carcinoma Central type Peripheral type Diffuse typeThe types of bronchogenic carcCentral typeCentral typePeripheral typePeripheral typeDiffuse typeDiffuse typeHistological classification of bronchogenic carcinoma Non-small cell lung

40、carcinoma (NSCLC) Small cell lung carcinoma (SCLC) Histological classification ofNon-small cell lung carcinoma Squamous cell carcinoma AdenocarcinomaLarge cell carcinoma Non-small cell lung carcinoma Histological classification of bronchogenic carcinoma Form the Robbins pathologyHistological classif

41、ication ofAdenocarcinoma Bronchioloalveolar carcinomaAdenocarcinoma Bronchioloa Squamous cell carcinoma Squamous cell caLarge cell carcinomaLarge cell carcinomaSmall cell carcinomaSmall cell carcinomaClinical courseSilent,insidious lesionChronic cough and expectorationHoarseness, chest pain, pleural

42、 or pericardial effusionSymptoms emanating from metastatic spread to the brain, liver,or boneNSCLCs have a better prognosis than SCLCsClinical courseSilent,insidiouClinical courseFrom the General and Systematic PathologyParaneoplastic syndromeClinical courseFrom the Gener How can we find the tumor?

43、Methods to diagnose bronchogenic carcinoma CT scanX-rayFine needle aspiration Methods to diagnose bronchogenBiopsy from bronchus by endoscopeCytological smear of sputumMethods to diagnose bronchogenic carcinoma Biopsy from bronchus CytologicTherapyTherapyPrognosis of bronchogenic carcinoma NSCLCSCLC

44、NSCLCSCLCMonths after treatmentForm the Diagnostic OncologySurvivalPrognosis of bronchogenic carcTHANK YOU FOR YOUR ATTENTION!THANK YOU FOR YOUR ATTENTION!OUTLINE 1.Pulmonary Infections Community-Acquired Acute Pneumonia Community-Acquired Atypical Pneumonia Tuberculosis Fungal infections 2.Chronic

45、Obstructive Lung Diseases (COPD) Chronic Bronchitis Emphysema 3. Bronchiectasis 4. Asthma 5. Cor Pulmonale 6. Lung tumors OUTLINE 1.Pulmonary InfectiSwine flu in MexicoSwine flu in Mexico呼吸系统疾病-Diseases-of-the-Respiratory-System(病理)课件Pulmonary Infections in the form of pneumonia is very commonPneumo

46、nia can be very broadly defined as any infection in the lungPulmonary Infections in the foPneumonia bacteria pneumonia viral pneumonia mycoplasmal pneumonia chlamydia pneumonia fungus pneumonia PneumoniaPneumonia lobar pneumonia lobular pneumonia interstitial pneumonia Pneumonia Lobar pneumonia Lobu

47、lar pneumonia Lobar pneumoniaLobular The anatomic distinction between lobar pneumonia and bronchopneumonia can often become blurry (1) many organisms present with either two patents (2) confluent bronchopneumonia can hard to distinguish radiologically from lobar pneumoniaThe anatomic distinction bet

48、weIt is best to classify either by etiology agent and clinical setting in which infection occursIt is best to classify either 呼吸系统疾病-Diseases-of-the-Respiratory-System(病理)课件OUTLINE 1.Pulmonary Infections Community-Acquired Acute Pneumonia Community-Acquired Atypical Pneumonia Fungal infections 2.Chr

49、onic Obstructive Lung Diseases (COPD) Chronic Bronchitis Emphysema 3. Bronchiectasis 4. Asthma 5. Cor Pulmonale 6. Lung tumors OUTLINE 1.Pulmonary InfectiCommunity-Acquired Acute Pneumonia is due to bacteria infection affecting distal airways, especially alveoli, with formation of an inflammatory ex

50、udate. often follows a viral upper respiratory tract infectionCommunity-Acquired Acute PneumStreptococcus pneumoniae (pneumococcus)StaphylococcusHaemophilus influenzaeKlebsiella pneumoniaeMoraxella catarrhalisStreptococcus pneumoniae Lobar pneumonia Lobular pneumonia Lobar pneumoniaLobular Lobar pne

51、umoniaAffects a large part, or the entirety of a lobe, frequently unilateralAffects otherwise healthy adults between 20 and 50 years of age, males more than females90% due to Streptococcus pneumoniae Lobar pneumoniaAffects a large呼吸系统疾病-Diseases-of-the-Respiratory-System(病理)课件 Lobar pneumonia conges

52、tion stage red hepatization gray hepatization resolution Lobar pneumoniaStage of congestionStage of congestionStage of congestion Red, edematousStage of congestion Red hepatizationRed hepatizationRed hepatizationRedSolidConsistency resembling fresh liverRed hepatizationRedGray hepatizationGray hepat

53、izationGray hepatizationDryFirmPaleGray hepatizationDryResolution stageResolution stageSymptomsFever, chillsCoughRusty sputumChest painDyspnea, cyanosisSymptomsFever, chillsFibrinous pleuralitisFibrinous pleuralitisPhysical examinationRales Consolidation presentationsPhysical examinationRales Labora

54、tory ExaminationWBC X-Ray examinationSputum examinationBlood cultureLaboratory ExaminationWBC Bronchopneumonia(Lobular pneumonia)Patchy consolidation, centred on bronchioles or bronchiUsually in infancy or old age, or secondary to pre-existing diseaseRelated to some low virulent bacteriaBronchopneum

55、onia(Lobular pneuBronchopneumoniaBronchopneumoniaBronchopneumoniaBronchopneumonia呼吸系统疾病-Diseases-of-the-Respiratory-System(病理)课件SymptomsFeverCoughMucopurulent sputumDyspnea, cyanosisSymptomsFeverPhysical examinationRales With/without consolidation presentaionsPhysical examinationRales WBC X-Ray exam

56、inationSputum examinationBlood cultureLaboratory ExaminationWBC Laboratory ExaminationTherapy Penicillin or other sensitive antibiotic treatment, such as cephalosporinTherapyOutcomesof PneumoniaComplete recoveryComplications developed Abscess formation Empyema Bacteremic dissemination OrganizationDe

57、ath Outcomesof PneumoniaComplete Abscess formationAbscess formation Abscess formation Abscess formationOutcomesof PneumoniaComplete recoveryComplications developed Abscess formation Empyema Bacteremic dissemination OrganizationDeath Outcomesof PneumoniaComplete EmpyemaEmpyemaOutcomesof PneumoniaComp

58、lete recoveryComplications developed Abscess formation Empyema Bacteremic dissemination OrganizationDeath Outcomesof PneumoniaComplete Outcomesof PneumoniaComplete recoveryComplications developed Abscess formation Empyema Bacteremic dissemination OrganizationDeath Outcomesof PneumoniaComplete Organi

59、zationOrganizationOutcomesof PneumoniaComplete recoveryComplications developed Abscess formation Empyema Bacteremic dissemination OrganizationDeath Outcomesof PneumoniaComplete Pneumococcus vaccinePneumococcus vaccineOUTLINE 1.Pulmonary Infections Community-Acquired Acute Pneumonia Community-Acquire

60、d Atypical Pneumonia Fungal infections 2.Chronic Obstructive Lung Diseases (COPD) Chronic Bronchitis Emphysema 3. Bronchiectasis 4. Asthma 5. Cor Pulmonale 6. Lung tumors OUTLINE 1.Pulmonary InfectiAtypical pneumoniaThe concept was set forth in 1938 by ReimannThe clinical course is unlike the “typic