5 教改班呼吸系统the lung(一)
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Transcript 5 教改班呼吸系统the lung(一)
Middle Examination
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Multiple choice 50%
Short answers 25%
Long answers
10%
Case analysis
15%
The weekend of 10th week, 150 min
总论+心血管系统疾病
Chapter 9
Diseases of the Respiratory System
Department Of Pathology
Guangxi Medical University
Zili Lv 吕自力
[email protected]
Anatomic Structures and Functions
Bronchi
Bronchioles
Alveolar ducts
Alveoli
Clinical features of respiratory
diseases
1. Cough
2. Sputum Production咳痰
3. Hemoptysis 咯血
4. Dyspnoea呼吸困难
5. Cyanosis紫绀
6. Chest pain
Contents (6 hrs)
1. Pulmonary infections
2. Chronic obstructive pulmonary
diseases & chronic cor pulmonale
3. Chronic diffuse interstitial lung disease,
carcinoma of nasopharynx and lung.
Pulmonary infections
Acute Pneumonia
Chronic Pneumonia
Classification of pneumonia
Clinical circumstance
Primary and Secondary
Etiological agent
Bacterial, Virus, Fungal
Host reaction
Fibrinous & Suppurative
Anatomical pattern
Lobar & Lobular
Case 1 analysis
History: Male, 20, after suffering from cold
and drunk, got high fever, chill, rapid
breathing and chest pain. After 2 days, he
coughed with “rusty” sputum.
T: 40℃, R: 32 times/min.
Chest x-ray: show large-area uniform
dense well-delimited shadow in his left
upper lobe.
Blood examination: WBC: 13.5x 109/ L
BACTERIUM PNEUMONIA
Lobar pneumonia
Lobular pneumonia
Legionella pneumonia
Lobar pneumonia
Affects a large part, or the entirety of a lobe
Relatively uncommon in infancy and old age
Affects males more than females
90% due to pneumococcus (肺炎球菌)
Cough and fever with purulent or
Rusty Sputum铁锈色痰
A. Etiology
Pathogen:
Streptococcus pneumonia
肺炎球菌 III型
Infective Route:
Inhalation, Aspiration 吸入
Risk Factors:
Cold, drunk, tired, diabetes
B. Pathology*
Acute exudative fibrinous inflammation
(急性纤维素性炎)
Involves one whole lobe or several lobes
The bronchi are not involved
Pathologic Features
Acute congestion 充血水肿期
Red hepatization 红色肝样变期
Gray hepatization 灰色肝样变期
Resolution 溶解消散期
1. Stage of acute congestion
1st-2nd day
(1)Gross changes:
Heavy, dark red and firm
(2)Microscopic change
Fluid, RBC, WBC in the air space
(3)Clinical features:
Stage of acute congestion
Alveolar capillaries: Dilated
Air space: Fluid, RBC, WBC
Stage of acute congestion
Clinical Features
Fever, cough, cyanopathy (发绀)
Chest pain
Bacteremia
Bacteria can be found in sputum
2. Stage of Red Hepatization:
2nd-4th day
(
)
1 Grossly
• Red and
consolidation,
just like liver
(2)Microscopic changes of red hepatization
A. Capillaries congestion
B. Exudation:
Fibrin, large number of RBC
C. Fibrinous pleurisy
Microscopical changes
(3)
Chest
x-ray
红色肝样变期X线特点
• The middle
segment of
right upper
lobe become
consolidated
and show
large-area
uniform
dense
shadow.
(4) Clinical features of red
hepatization
Fever, cough, chest pain
Rapid breathing, cyanopathy
Dullness浊音
Vocal fremitus enhancement 语颤增强
Rusty sputum 铁锈色痰
3. Stage of gray hepatization:
5th-6th day
(1)Gross changes of grey hepatization
Dry
Gray
Firm
Consolidation
(2)Histological changes
Capillary is
not dilated
anymore.
Alveolar
space is
filled with
neutrophil
and fibrin
Histological changes of grey hepatization
• (3)Chest x-ray: high dense shadow can
X-ray
features
gray hepatization
be
found
at theofright
upper lobe
(4)Clinical features of gray
hepatization
Consolidation: dullness, vocal fremitus
enhancement
Sputum: mucus purulent sputum
Dyspnoea(缺氧): is not obvious
4. Stage of Resolution, 7 days later
Gross changes: Friable and mottled
Microscope: The fibrin and cell debris are
digested by enzymatic, The exudation is
remove.
Chest X-ray
Pathologic Features (4 stages)
LOBULAR PNEMONIA
小叶性肺炎
(Bronchopneumonia)
(支气管肺炎)
Lobular pneumonia
Bronchopneumonia
Bronchi are infected
Patchy consolidation
Centred on inflamed bronchioles or bronchi
Secondary pneumonia
Less virulent agents, in infancy or old age
Suppurative inflammation化脓性炎
A. Etiology
Pathogen: many bacteria,
Infection via: Inhalation, Aspiration
Risk Factors: Secondary
B. Pathology
Gross:
Lower lobes, dorsal side
Multiple firm areas,
around inflamed
bronchioles.
Microscope:
1. Multiple lesions
Purulent bronchitis and bronchiolitis
(化脓性细支气管炎)
2. Alveolar spaces surrounding the lesions are filled
with neutrophil
3. Compensatory emphysema
(代偿性肺气肿)
C. Clinical Features
The onset is insidious, nonspecific
Low-grade fever
Dyspnea is not prominent
The typical feature is
Purulent Sputum脓痰*
• Chest xray
• Several
scattered
patchy
shadows
evidently
in bilateral
lower
lobes
Legionella pneumonia,
军团菌肺炎
•嗜肺军团杆菌
•急性纤维素性化脓性
炎—典型病例,严重者
坏死—脓肿
•临床表现复杂:肺内\
外表现
Legionella pneumonia,
军团菌肺炎
急性纤维素性化脓性炎
acute fibrino-purulent
exudative pneumonia
军团菌病(legionaires disease)是由革
兰染色阴性的嗜肺军团杆菌
(legionella pneumophila)引起的一
种以肺炎为主的全身性疾病,1976
年被确认。
Resolution
Lobar
pneumonia
Air space
pneumonia
Lobular
pneumonia
Complications
Complications of acute air space
pneumonia
Pleura involvement
Bacteremia
Suppuration (Abscess Formation)
Necrotizing bacterial pneumonia
Pulmonay carnification肺肉质变
• Lung
abscess
• Pulmonary carnification
What are the differences?
Distribution
Number
Host
reaction
Clinical
Features
Acute interstitial pneumonia间质性肺炎
1. Agents: Virus (SARS, Avian influenza,
Swine Flu) and Mycoplasma or Pneumocystis
2. Interstitium
3. Atypical pneumonia
4. Infiltration with lymphocyte, monocyte
Pathologic Features of Viral
pneumonia
The alveolar septa are expanded
Cell infiltrate: lymphocyte, plasma cells
Air spaces are air filled
Epithelial necrosis
Inclusion bodies 病毒包涵体
Multinucleated giant cells 多核巨细胞
Hyaline membranes 透明膜
Viral Pneumonia
SARS
Severe Acute Respiratory Syndrom (SARS)
重症急性呼吸综合征
Atypical pneumonia(非典型肺炎)
Cornonavirus 变异的冠状病毒
Extensive consolidation, hyaline membrane,
necrosis, pulmonary fibrosis
Die in respiratory distress
Clinical features
Electro microscope
Avian Influenza
禽流感
H5N1
Interstitial
Atypical
人畜共患传染病
Bird flu
An infection disease of birds
1997, Hong Kong, outbreak
Vascular disturbances
Fever, cough
All the other organs can be affected, for
example, liver, heart and kidney.
H1N1, Swine influenza A
H1N1, Swine influenza A
临床表现
轻症:同普通流感;重症:肺炎,坏死性脑病
合并症:急性呼吸窘迫综合征
病理:肺部表现为支气管壁坏死、中性粒细胞
浸润、弥漫性肺泡损害伴肺透明膜病变。
发病机制:病毒损伤肺泡微血管导致肺出血与
血栓形成,体内免疫因子可对抗病毒感染并修
复损伤,但炎症反应过度、渗出液充满肺组织
又使肺瘢痕形成,进而限制肺功能。
H1N1 and H5N1
Mycoplasma pneumonia
支原体肺炎
Interstitial pneumonia
Atypical pneumonia
Congested, edematous,
mononuclear cells infiltration
Lobar pneumonia
Air space
pneumonia
Lobular pneumonia
Interstitial
Viral pneumonia
pneumonia
Mycoplasma pneumonia
ARDS
Acute Respiratory Distress Syndrome
An acute diffuse alveolar injury
Terminal events in many of the patients
Serious ill, the mortality rate > 50%
Results from ischemic, endotoxins, enzymes.
Case 1 analysis
History: Male, 20, after suffering from cold
and drunk, got high fever, chill, rapid
breathing and chest pain. After 2 days, he
coughed with “rusty” sputum.
T: 40℃, R: 32 times/min.
Chest x-ray: show large-area uniform
dense well-delimited shadow in his left
upper lobe.
Blood examination:
WBC: 13.5x 109/ L
Questions
What is the diagnosis?
Which type of inflammation?
Why does the patient cough with the
“rusty” sputum?
Half a year later, this student was enrolled to
the army.
The chest x-ray indicated there was a nodule in
his left lung.
The nodule was checked under microscope,
there was much granulation tissue in the
alveolar spaces.
WHY?
Case abstract 2
Male, 70-year-old, he had suffered
hypertensive heart disease and left heart
failure for half a year, and cough and
expectoration for 1 year. These symptoms
aggravated 4 days ago with fever and
purulent sputum.
T: 38℃, HR: 112 times/min, R: 35
times/min, BP: 22.6/13.5 kPa.
Blood WBC: 10.2 X 109/L
X-ray: Several scattered patchy shadows
evidently in bilateral lower lobes.
Questions
What is the diagnosis?
Which type of inflammation?
Why do patients cough with the purulent
sputum?
Summary
How to differentiate the lobar pneumonia
and the bronchopneumonia?
What is the “rusty sputum”?
See you next time!
2015/4/13
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