病理学 绪论(英文)

IntroductionofPathology

（病理学绪论)

1,

WhatisPathology2,

Thehistoryofpathologyandthe positioninmedicine3,Howtostudypathology

一、Whatispathologypathology, studyofsufferring(Logos)(pathos)

1，Thebranchofpathology

总论（generalpathology)（1）基础病理学

(Basicpathology)各论(systemicpathology)（2）临床病理学(clinicalpathology)Basicpathology1，AbridgewhichcanhelpmedicalstudentstoacrosstheriverbetweenbasicmedicalscienceandclinicalsubjectsThetaskofbasicpathology2，基础病理学的内容： （1）etiology(病因学)

（2）pathogenesis(发病机制)

（3）Morphology(病理变化)

（4）consequence(结局)ExamsofPathology11,paperexams.80%2,practiceexams.10%3,classes:10%ExamsofPathology1,paperexams.70%2,practiceexams.20%3,classes:10%Thehistoryofpathology3stepsThefirststeporganpathology

Visalius–humananatomystartedin1600s.It isthebeginningofmodernmedicine.Morgagni–Heisthefounderoforgan pathology,whoreportedmorethan 700casesaboutlocationsandreasonsofthediseasesin1761.

Rokitansky-reportedmorethan30,000 pathologyanatomy.Dehumanicorporisfabrica

OntheFabricoftheHumanBodyAndreasVesalius(1514–1564)founderofmodernhumananatomy15431761“theseatsandcausesofdiseasesinvestigatedbyanatomy”《论疾病的位置和原因》一切疾病的发生都有一定的位置。只有脏器变化才是疾病的真正原因。把“病灶”和临床症状联系起来，西医诊断学才开始找病灶，这种思想影响至今。

在解剖大量尸体的基础上，解剖学家和外科医生就有机会认识到器官异常，因此病理解剖开始出现了。GiovanniBattistaMorgagni1682-1771人物介绍Full-timeprofessorofpathologyHandbookofpathologicalAnatomy“First…sortingoutthefactsscientificallyonapureanatomicbasis,andtherebycreatingthesubjectofgeneralpathologicalanatomy”KarlRokitansky（1804-1878）人物介绍

细胞病理学（cellularpathology）

Schleiden&Schwan–Thefounderofcellbiology.Theirconclusionis“allthelivingbodywasorganizedwithcells.”

Virchow-Thefounderofcellularpathology.Thefamousbook“cellularpathology”waspublishedin1858RudolfVirchow（1821-1902）人物介绍Founderofmodernpathology“Cellularpathologyasbaseduponphysiologicalandpathologicalhistology”(1858)EMandmolecularpathology

EM–in1930s

Molecularpathology–in1970s

Thepositioninmedicine 1，thebridgesubjectinmedical education2，thefinaldiagnosisintheclinic3，thegoldstandardinthe medicallegalcases4，thegoldstandardofstandardmedicalqualitycontrol5，thegoldstandardinthemedical research3,HowtoStudyPathologyPracticeTheRelationshipofClinicalandPathologyTheKeysinthePathologicStudy1thebasicessentialwordsinthegeneralpathology(总论中的基本概念)2thebasicpathologicchangesintheorganpathology(各论中的基本病理变化)3Tousetheknowledgeinthegenealpathologytotheorganpathology(总论各论的融会贯通)Thefirstchapteradaptationandinjury

(组织、细胞的适应和损伤)Injuryfactors1Oxygendeprivation2Chemicalagents3Infectiousagents4Immunologicreactions5Geneticdefects6Nutritionalimbalances7Physicalagents8AgingCellinjury,adaptation

anddeathOxygendeprivation

normalcells

(adaptation)(reversibleinjury)(irreversibleinjury)

Themostimportantreasonsfortheinjury：Thepoweroftheinjuryfactors(损伤因子的作用强度)Thecharactersandfunctionalstatusofthecellandtissue.

组织、细胞的特性及功能状态1cellularadaptation,

（细胞适应）Adaptation

ofcellularandtissue

themorphologicandfunctionalchangesofthecellandtissuetotheenvironmentalchanges.(机体组织、细胞对内、外环境的变化所发生的形态结构和功能代谢的改变)Classification：

atrophy

（萎缩）hypertrophy

（肥大）hyperplasia

（增生）metaplasia（化生)（一）

atrophy(萎缩)Shrinkageinthesizeofthecellbythelossofcellsubstanceinthenormaldevelopedorgans

(发育正常的器官、组织和细胞体积的缩小)

morphologyGross:

SmallerinsizeBrownincolorBrownatrophy(褐色萎缩)microscope:

Cellbecacomesmaller,lipofuscinincreased.（lipofuscin）

EM:increasedautophage

Results:reversible,decreasedfunction

Atrophyofthebrain

—

agingidiot

Atrophyoftheadrenal—Addison’sdisease

Atrophyoftheislet—DiabetesTheclassificationoftheatrophy1,physiologicatrophy: a,adolescentstage:thymus b,aging:uterus,beast,brain2,pathologicatrophy:

a,inadequatenutrition b,decreasedworkload c,lossofinnervation d,pressure(hydronephrosis) e,lossofendocrinestimulationHypertrophy（肥大)Hypertrophyisanincreaseinthesizeofcellresultinginincreaseinthesizeoftheorgan.MorphologyGross：(heart)increasedsizeinheartwall.LM：Increasedsizeinthecardiomyocyte,andthenuclearstronglystained.classificationPhysiologichypertrophy: theuterusandthebreastinpregnancyPathologichepertrophy: adaptation(heartinhypertension)compensation(kidneyafter removedone)

resultsofthehepertrophyReversibleIncreasedfunction,butmaycausethecompensationabilitylossed.hyperplasia

（增生）Hyperplasiaisanincreaseinthenumberofcellsinanorganortissue.Itoftenoccurswiththehypertrophyatthesametime.

ClassificationPhysiologichypertrophy: theuterusandthebreastin pregnancyPathologichypertrophy adenosisofthebreast

healinggranulationtissue

Morphyology

ThenumberofcellsincreasedResults:1,maketheorganadapttothedemandsoffunction2,hyperplasiacancausedysplasiaandevencancermetaplasia

（化生）Oneadultcelltypeisreplacedbyanotheradultcelltype.EpithelialbecomeanothertypeepithelialMesenchymalbecomeanothertypemesenchymalReversiblechangeclassificationMetaplasiaofnormalciliatedcolumnartosquamousepithlium

Fibro-tissueto

chondro-tissue

squamoustoepithliumcolumnarThesignificanceofmetaplasiaSuittotheenvironmentalchangeLosstheoriginalfunction

cellulardegeneration

（细胞变性）Thenormalorabnormalsubstancesaccumulatedinthecellscausedbytheinjuryfactor.reversibleinjury

cellularswelling

（细胞肿胀）Thedegenerationisaslightlesion,andoftenoccursinthehighlymetabolicorgans.Gross:pallor,increasedinturgorandweightoftheorgan.Microscope:thecytoplasmbecomeclear,andalotofparticlesinit.So,itisalsocalledashydropicchangeorvacuolardegeneration.Mechanism

Na+--K+ATPasdisfunction

fattydegeneration

(脂肪变性)

Fattychangerefersastoanyabnormalaccumulationoftriglycerideswithparenchymalcellsexceptfatcells.Hepaticsteatosis

Gross:increasedinsize.The cuttingsurfacebecameyullow.

LM:clearvacuoleswithoutanysubstance. thewell-prevervednuleusisaqueezedintothedisplacedrimofcytoplasmaboutthefatvacuole.

fattychangeincardiomyocyte

FattychangeinkidneyMechanismStarving,over-nutrition,toxic,hypoxia,

celldeath（细胞死亡),

irreversibleinjury）

necrosis（pathologic

Twotypes

apoptosis（physiologic orpathologic）

necrosis（坏死）Localcellsortissuediedinthelivingbody.Morphology

1.NuclearchangesThemostimportantmarkerofcelldeath.a.

pyknosis（核固缩）—thenucleus shrinkageandincreasedbasophilia.b.

karyorrhexis（核碎裂）—thenucleus brokenandbasophiliaofthe chromatinfade.c.

karyolysis（核溶解）—thenucleus compeletelydisappearedMorphology

2.CytoplasmicchangesincreasediosinophilicandhogeneousofcytoplasmDegradationofproteinandRNAMorphology

3.interstitialtissuechangesDegradationofmatrix structurelesseosinophilic materialInflammationcellsinfiltrationMechanismofthenocrosticmorphologyDegradationbytheenzymesfrombrokenlysosomes Autolysis:degradationfromthediedcell’slysosomes. Heterolysis:degradationfromtheinfiltratedinflammationcells.

Typesofnecrosis1.

coagulationnecrosis

（

凝固性坏死）

character：thebasicstructureoutlineofthecellortissuewaskeptforaspanofdays.

location：heart,kidney,liver,spleen,arms,centerofthecancer2.

liquefactionnecrosis

（液化性坏死）

Characters:Thestructureoutlinewasnotkept,butlefttheliquefactionspace.

Location：Brain,、spine3.SpecialtypeofnecrosisA,caseousnecrosis

（干酪样坏死）

Thespecialmarkerfortuberculosisandsomefungiinfection.Gross：yellow,andlookslikecheese.LM：completenecrosiswithoutstructureoutline,andamorphousgranularappearance.b,fatnecrosis（脂肪坏死）Thecharacterofacutebleedingnecroticpancreatitis.Gross：theareasofwhitechalkydepositsrepresentfociofcalciumsoapformation.

LM：necrosiscontainshadowyoutlinesofnecrotcifatcellswithbasophiliccalciumdeposit.

C,fibrinoidnecrosis

（纤维蛋白样坏死）Thecharacterofimmunereactionsinvolvingbloodvessles.Morphology：Theimmunecomplexestogethersithfibrinresultinabrightpinkandamorphousappearance.

d.

gangrene

（坏疽）Classification:1,drygangrene2,wetgangrene3,gasgangreneDrygangreneUsuallyoccursinalimbthatlostitsbloodsupplyandhasundergonecoagulativenecrosisinvolvingmultipletissuelayers.Itappearsblack,dry,andshriveledWetgangreneSwollenandreddish-black.Occursinthecaseofbotharteryandveinblocked.GasgangreneThegrossappearanceissimilartothatofwetgangrene,withtheadditionalpresenceofgasinthetissues.Theresultsofnecrosis1,resolvedandabsorbed.Noscarformed.2,separatedandexcluded.Ulcer,cavityandcapsulated.3.

organization

（机化）scarformed

4.calcification

（钙化）calciumaccumulatedApoptosis

（细胞凋亡）Apoptosisisinducedbyasuicideprograminthecells.Itappearsinthemanyphysilogicprogramm.MorphologyLM：

simglecellmayappearasroundorovalmasseswithintenselyeosinophiliccytoplasm.Themucleishowpyknosis,karyorrhexis,karyolysis.Oneoftheapoptoticcharactersisnoinflammativereaction.

hyalinedegeneration

（玻璃样变性）Aamorphousandpinkmaterialaccumulatedinthecells,vesslewallorconnectivetissue：

TypesHyalinedegenerationinthecells.Viralparticles