组织损伤 病理学.ppt

1、第一章病 理 学 导 论,赵 国 强,病 理 学 导 论,病理学的定义 病理学发展简史 病理学的分支学科 病理学的研究方法,Definition of Pathology,The word “Pathology” is derived from two Greek word - pathos meaning suffering logos meaning study,Definition of Pathology,Pathology is scientific study of structure and function of the body in disease. It deals wi

2、th causes, effects, mechanisms and nature of disease.,The knowledge and understanding of pathology is essential for all would-be doctors as well as general practitioners and specialists since unless they know the causes and mechanisms of disease and understand the language spoken by the pathologist

3、in the form of laboratory reports, they would not be able to institute appropriate treatment or suggest preventive measures to the patient.,For the medical student, the discipline of pathology forms a vital bridge between initial learning phase of preclinical science and the final phase of clinical

4、subjects.,病理学发展简史,从宗教迷信走向理性探索(Antiquity to AD 1500) 大体病理学时期 (AD 1500 to 1800) 细胞病理学时期 (AD 1800 to 1950s) 现代病理学时期 (1950s to dawn of 21st century),从宗教迷信走向理性探索 (Antiquity to AD 1500),Hippocrates (Greece) 460-377 BC Permanently dissociated medicine from religious mysticism. Started study of patients sym

5、ptoms as method of diagnosis. Cornelius Celsus (Rome) 53 BC-7 AD Described 4 cardinal signs of inflammation (redness, heat, swelling, pain),Hippocrates (Greece) 460-377 BC,大体病理学时期 (AD 1500 to 1800),Giovanni B Morgagni (Italy) 1682-1771 Introduced clinicopathologic correlation (CPC) in the study of d

6、isease John Hunter (Scotland) 1728-1793 Introduced pathology museum in the study of disease. R.T.H. Laennec (France) 1781-1826 Described several lung diseases such as various tuberculous lesions of lungs, bronchiectasis. Described cirrhosis of liver (later called Laennecs cirrhosis). Invented stetho

7、scope.,John Hunter (Scotland) 1728-1793,R.T.H. Laennec (France) 1781-1826,细胞病理学时期 (AD 1800 to 1950s),Rudolf Virchow (Germany) 1821-1905 Father of cellular pathology Introduced histopathology as a diagnostic branch by his cellular theory George N. Papanicolaou (USA) 1883-1962 Father of exfoliative cy

8、tology Developed Pap smear for detection of cervical cancer in 1930s,Rudolf Virchow (Germany) 1821-1905,George N. Papanicolaou (USA) 1883-1962,现代病理学时期 (1950s to dawn of 21st century),Watson and Crick 1953 Described the structure of DNA Nowell and Hagerford 1960 Philadelphia chromosome in CML i.e. t(

9、9;22) Gall and Pardue 1969 In Situ Hybridization Kary Mullis 1983 Introduced polymerase chain reaction (PCR),著名病理学家 梁伯强教授 1899-1968,著名病理学家 秦光煜教授 1902-1969,病理学的分支学科,General Pathology - dealing with general principles of disease Systemic Pathology - includes study of diseases pertaining to the specifi

10、c organs and body systems,病理学的分支学科,Histo-Pathology Experimental Pathology Molecular Pathology Chemical Pathology Geographic Pathology Immunology Haematology Medical Genetics,病理学的研究方法,尸体剖验 Autopsy 活体组织检查 Biopsy 细胞学检查 Cytology,肖 萍 老师办公室：新教学楼4F电话：87330743,第二章细胞和组织的适应与损伤,细胞和组织的适应与损伤,细胞对环境刺激的应答反应 细胞的适应 细

11、胞损伤的原因 细胞损伤的机制 细胞损伤的形态学,细胞对环境刺激的应答反应,轻度的细胞损伤是可逆的，当刺激因子消除后，受损伤的细胞其形态结构和功能仍可恢复正常。 严重的损伤是不可逆的，最终导致细胞死亡。,适应 Adaptation, 可逆性损伤 Reversible injury, 细胞死亡Cell death -可被看作是细胞正常的结构和功能不断遭受损害的不同阶段。,细胞和组织的适应,萎缩Atrophy 肥大Hypertrophy 增生Hyperplasia 化生Metaplasia,萎缩Atrophy,发育正常的器官和组织，其实质细胞的体积变小或数量减少，而致器官或组织缩小称萎缩。 萎缩可分

12、为生理性和病理性两类。,生理性萎缩 Physiologic Atrophy,青春期后胸腺的萎缩 更年期后性腺的萎缩 老年人脑的萎缩,病理性萎缩 Pathologic Atrophy,营养不良性萎缩 Malnutrition atrophy 神经性萎缩 Denervation atrophy 废用性萎缩 Disuse atrophy 压迫性萎缩 Pressure atrophy 内分泌性萎缩 Endocrine atrophy 缺血性萎缩 Ischaemic atrophy,Atrophy of one kidney, gross,Atrophy, muscle fibers, microsco

13、pic,病理变化,萎缩的器官体积变小，质量减少，颜色变深或呈褐色。 实质细胞体积缩小或数目减少，但无死亡细胞。 萎缩的胞浆内可见脂褐素沉着。 脂褐素颗粒明显增多时，整个器官呈棕褐色，称褐色萎缩（brown atrophy)。,肥大 Hypertrophy,细胞、组织或器官体积的增大称为肥大。 生理性肥大 病理性肥大,生理性肥大 Physiologic Hpertrophy,病理性肥大 Pathologic Hpertrophy,Hypertrophy of cardiac muscle Hypertrophy of smooth muscle Hypertrophy of skeletal m

14、uscle Compensatory hypertrophy,代偿性肥大Hypertrophy, heart, gross,增生 Hyperplasia,由于实质细胞数量增多而引起的组织、器官体积增大称为增生。 增生可分为生理性增生和病理性增生。,病理性增生Hyperplasia, prostate, gross,化生 Metaplasia,为适应环境变化，一种已分化组织转变为另一种分化组织的过程称为化生。 这种转变过程并非由成熟的细胞直接转变，而是由未分化细胞向另一方向分化而成，一般只能转变为性质相似的细胞。,化生 Metaplasia,上皮组织化生 Epithelial metaplasi

15、a 1. Squamous metaplasia 2. Columnar metaplasia 间叶组织化生 Mesenchymal metaplasia 1. Osseous metaplasia 2. Cartilaginous metaplasia,Metaplasia, squamous, larynx, microscopic,Metaplasia, gastric columnar mucosa in esophagus, microscopic,细胞损伤的原因Causes of cell injury,缺氧和缺血 物理因素 化学因素 生物因素 免疫因素 遗传因素 营养失衡,细胞损

16、伤的机制 Mechanisms of cell injury,细胞损伤的形态学 Morphology of cell injury,变性 Degeneration/Intracellular Accumulations 细胞死亡 Cell death,变性 Degeneration,变性是指细胞或细胞间质内出现异常物质或正常物质的量显著增多，并伴有不同程度的功能障碍。 变性一般为可复性损伤，严重变性可发展为坏死。,变性 Degeneration,细胞肿胀Cellular swelling 脂肪变性Fatty change 玻璃样变性Hyaline change 黏液样变性Mucoid dege

17、neration 淀粉样变性Amyloidosis 病理性色素沉着Pigments 病理性钙化Pathologic calcification,细胞肿胀 Cellular Swelling,当缺氧或毒性物质损及线粒体内ATP产生时， 细胞膜上的钠泵功能降低，使更多的钠、钙离子和水进入细胞内，而细胞内钾离子外逸，导致细胞内水分增多，细胞肿胀，严重时称为细胞的水样变性（hydropic degeneration)。,病理变化,肉眼观，水样变性的器官体积肿大，包膜紧张，切面隆起，切缘外翻，颜色苍白，失去正常光泽。 镜下观，细胞体积增大，胞浆变得透明、淡染，可出现许多细小的淡红色颗粒。严重时，细胞膨大如气球，故有气球样变之称。,Viral hepatitis B, liver, high power microscopic,脂肪变性 Fatty change (Steatosis),由于细胞损伤导致脂肪代谢障碍而引起细胞内出现脂滴或脂滴明显增多。称脂肪变性。 脂肪变性常发生在肝、心、肾等器官。,Fatty metamorphosis of liver, gross,. Fatty metamorphosis of liver, microscopic,Fatty change, liver, microscopic,玻璃样变性 Hyaline Change,玻璃样变性又称透