DISEASES OF RESPIRATORY SYSTEM
description
Transcript of DISEASES OF RESPIRATORY SYSTEM
DISEASES OF DISEASES OF RESPIRATORY SYSTEM RESPIRATORY SYSTEM
The Department of Pathology The Department of Pathology Zili Lv Zili Lv
吕自力吕自力E-mail:[email protected]:[email protected]
Go overGo over PneumoniaPneumonia
Air space pneumonia
Interstitial pneumonia
lobar pneumonia
lobular pneumonia
viral pneumonia
mycoplasma pneumonia
Respiratory system diseases 2Respiratory system diseases 2
• Chronic (diffuse) obstructive passage disease
• Chronic cor pulmonale
|
CChronic hronic OObstructive bstructive PPulmonary ulmonary DDiseases, COPDiseases, COPD
• Chronic bronchitis 慢性支气管炎 *
• Pulmonary emphysema 肺气肿 *
• Bronchial asthma 支气管哮喘• Bronchiectasis 支气管扩张症
Chronic BronchitisChronic Bronchitis
Definition:
A persistent productive cough, sputum for at least 3 months in at least 2 consecutive years.
The most common disease in respiratory system. More common in old age (<40 )
Most cases caused by smoking
A. Etiology and Pathogenesis
Causes:
1. Cigarette smoking: 90%
2. Air pollution: sulfur dioxide and nitrogen dioxide, may contribute.
3. Microorganism infection is often present but plays a secondary role.
Etiology and PathogenesisEtiology and PathogenesisSmoking
Pollution
Infection
Destroy the defensive mechanisms
Hypertrophy of mucous glands
Metaplasia of squamous
Infiltration of inflammatory cells
B. Pathology*B. Pathology*
• The inflammation of trachea and larger bronchi
Grossly:
Hyperemia,
Edema,
Mucous or mucopurulent secretion
Histology Histology
• The injury and regeneration of epithelia.
• The hypertrophy, hyperplasia and metaplasia of mucus-secreting glands. (Reid I >0.5)
• Infiltration with chronic and acute inflammatory cells.
上皮损伤与修复上皮损伤与修复
Squamous metaplasiaSquamous metaplasia
An increase of goblet cellsAn increase of goblet cells
C. Clinical FeaturesC. Clinical Features
• Cough
• Sputum
• Puff
Secretion
D. Complications
BronchiectasisBronchopneumonia
Cor pulmonale
Chronic bronchitis
Pulmonary emphysema
Pulmonary EmphysemaPulmonary Emphysema肺气肿肺气肿
• Emphysema : Permanent enlargement of the
airspaces distal to the terminal bronchioles.
Accompanied by destruction of their walls.
A. Classification of emphysemaA. Classification of emphysema
Alveolar
Interstitial: The air comes into the septa of the lung.
Centriacinar (腺泡中央型)
Periacinar (腺泡周边型)
Panacinar (全腺泡型)
Others type
Centriacinar腺泡中央型
Heavy smokers
Panacinar 全腺泡型
A1-AT deficiency
Periacinar 腺泡周围型
B. Pathology*•Grossly: pale and voluminous lungs
Normal lungs emphysema
Bullous lung
肺大泡• Balloon-like
• >10 mm in diameter
are prone to rupture causing spontaneous pneumothorax
自发性气胸
HistologyHistology
1.Thinning and destruction of alveolar walls, septa broken, adjacent alveoli become confluent.2. Terminal and respiratory bronchioles may be deformed.3. The number of alveolar capillaries decreases.
Thinning and destruction of alveolar walls, large airspaces
C. Pathogenesis* C. Pathogenesis*
• Proteases
• Anti-proteases
• Leukocytes
• Smoking, Inflammation
• Alfa1-antitrypsin
• Inheritance
D. Clinical FeaturesD. Clinical Features
• Cough : dry or productive
• Dyspnea
• Mucoid sputum
• Type A: Pink puffers
• Type B: Blue bloaters
• Barrel chest
桶状胸
Relationship between chronic bronchitis and emphysema
chronic bronchitis and emphysema usually co-exist because the major pathogenic mechanism, cigarette smoking, is common to both.
Bronchial Asthma Bronchial Asthma 支气管哮喘支气管哮喘
• Increased responsiveness of tracheobronchial tree to a variety of stimuli.
• Bronchiolar smooth muscle contraction (bronchospasm 支气管痉挛 ).
• Paroxysmal attacks 阵发性• Mucus plugs in bronchi
A. Etiology and pathogenesisA. Etiology and pathogenesis Hypersensitivity
Inflammation
Hyper-reactive airways
Nerve system
Bronchial smooth muscle spasm
Hypersecretion—mucus plugs
Increased vascular permeability
B. Clinical FeaturesB. Clinical Features——episodic attacksepisodic attacks
• Dyspnea (呼吸困难)• Wheezing (喘)• Dry cough
4. BRONCHIECTASIS4. BRONCHIECTASIS支气管扩张症支气管扩张症
• Permanent dilation of bronchi and bronchioles
• Results from bronchial obstruction with distal infection and scarring
• Destruction of alveolar walls, especially interstitial elastin, and fibrosis of lung parenchyma
Chronic inflammation
The destruction of the wall
Dilation
Congenital, hereditary
Obstruction
Fibrosis Fibrosis
Pathology, GrossPathology, Gross
1) Lower lobes of bilateral lungs are 1) Lower lobes of bilateral lungs are more common, particularly left side more common, particularly left side
2) The airways may be dilated to as 2) The airways may be dilated to as much as much as four timesfour times their usual their usual diameter diameter
3) The dilated bronchioles can be seen almost to 3) The dilated bronchioles can be seen almost to the pleura.the pleura.
PathologyHistological
•Destruction of the bronchial or bronchiolar walls
•Acute and chronic inflammatory exudate within the walls of the bronchi and bronchioles
•Ulceration formation: the desquamation of lining epithelium cause extensive areas of ulceration.
•Fibrosis of the bronchial and bronchiolar walls (in chronic cases).
•Lung abscess.
Clinical FeaturesClinical Features• Cough
• Mucopurulent sputum
• Hemoptysis (咯血)• Finger-clubbing
• Dyspnoea
• Clubbing: 杵状指
• Normal • Clubbing
ComplicationsComplications
• Pneumonia, lung abscess
• Emphysema
• Remote abscesses
• Pulmonary hypertension
• Chronic cor pulmonale
Chronic cor pulmonale Chronic cor pulmonale 慢性肺源性心脏病慢性肺源性心脏病
• A heart disease results from chronic lung diseases, chest or pulmonary vascular diseases.
• Pulmonary hypertension( 肺动脉高压 ).
• Thickened right ventricle( 右心室肥厚 ).
A. Etiology and pathogenesis
1) Recurrent pulmonary emboli
2) Heart disease:
3) Chronic obstructive or interstitial lung disease:
Chronic obstuctive pulmonary disease
Abnormalities of the pulmonary vasculature
Pulmonary arteriolar constriction
Disorders affecting chest movement
Pulmonary vascular bed
Pulmonary hypertension*
Right ventricle hypertrophy
• Key • Key
B. Pathology
Lung
•Existed lung diseases:
•Medium-sized muscular arteries: proliferation of myo-intimal cells and smooth muscle cells, causing thickening of the intima and media with narrowing of the lumina
•Smaller arteries and arterioles: thickening, medial hypertrophy, and reduplication of the internal and external elastic membranes.
B. Pathology
Heart*
•Right ventricle hypertrophy:
•More than 1 cm in thickness (normal 0.3-0.4cm)
•More than 500—700 gm
•The right ventricle and atrium may be dilated when failure occurs
Clinical featuresClinical features
• Cyanosis: hypoxemia
• Pulmonary encephalopathy (肺性脑病)
• Right-sided congestive heart failure--- congestion, edema of lower extremities, palpitation, ascites
SUMMARYSUMMARY • COPD: Chronic bronchitis* Asthma Pulmonary emphysema* Bronchiectasis
• Pulmonary hypertension
• Chronic cor pulmonale*
• 65, woman, cough with purulent sputum after
catching cold 15 years ago.
• She developed cough and expectoration of
white spumy sputum every winter and spring.
•
• Since 3 years ago, she felt breath shortness and
palpitation (心悸) after physical labor.
•Pitting edema (水肿) occurred
repeatedly on her lower limbs for 2 years.
•Two months ago after catching cold, she
developed fever, cough with purulent
sputum, palpitation, breath shortness, and
abdominal distension (膨隆) , and could
not lie down.
Physical examination:
• T: 37.6 , HR:102 times/min, R: 30 ℃times/min.
•
• Chronic sickness appearance, up-straight sit breathing (端坐呼吸) , sleepiness, dark purple lip and skin, cervix venous engorgement (颈静脉怒张)
Chest: Barrel-shape chest, hyper-resonance(过清音) to percussion (叩诊) , scattered dry and moist rales (啰音) .
Abdomen: Abdominal bulge, a large amount of ascites (腹水) , the liver is hard with the rim under the rib 7.8 cm, lower limbs show pitting edema.
QuestionsQuestions
• 1. what is the pathological diagnosis of the patient?
• 2. how to explain the process of the development of the diseases about the patient.
Pathological diagnosisPathological diagnosis
• Chronic bronchitis
• Emphysema
• Chronic cor pulmonale
complicated with:
(1) right heart failure---- liver congestion, lower limbs edema, ascites
(2) pulmonary encephalopathy
The relationshipThe relationship
• Chronic bronchitis---- emphysema----
chronic cor pulmonale----
right heart failure and pulmonary encephalopathy.
See you next time!