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

Diseases of the Respiratory SystemPathology Department of SiChuan UniversitySu XueyingDiseases of the Respiratory Sy1Normal structure of the respiratory tractNormal structure of the respir2呼吸系统疾病-Diseases-of-the-Respiratory-System(病理)课件3Respiratory mucosaRespiratory mucosa4The respiratory system diseases are very commonEnvironmental factors are important causesThe respiratory system disease5Air pollutionsSO2NO2Air pollutionsSO26Cigarette smoking Cigarette smoking7Major aetiological factors in respiratory 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 MesotheliomaGenetic Cystic fibrosis Major aetiological factors in 8呼吸系统疾病-Diseases-of-the-Respiratory-System(病理)课件9Major aetiological factors in respiratory 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 fibrosis Major aetiological factors in 10OUTLINE 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 Infecti11OUTLINE 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 Infecti12Chronic 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 Dise13Chronic BronchitisDefinition(made on clinical ground)persistent productive cough for at least 3 consecutive months in at least 2 consecutive years Chronic BronchitisDefinition 14Chronic BronchitisDefinition(made on clinical ground)persistent productive cough for at least 3 consecutive months in at least 2 consecutive years Chronic BronchitisDefinition 15It is often developed in middle age to old men with cigarette smokingThe incidence is higher in urban dwellers than village residents It is often developed in middl16Causes cigarette smoking air pollutions (sulfur dioxide,nitrogen dioxide)Causes17Pathogical changesHypertrophy and hypersecretion of mucous gland,beginning in the large airwaysGoblet cell metaplastic formationInflammatory cells infiltration Epidermal growth factor receptorPathogical changesHypertrophy 18 Marked thickening of the mucous gland layer Squamous metaplasia of the epithelium Marked thickening of the muc19Reid index (the ratio of the thickness of the submucosal gland layer to that of the bronchial wall)0.55）Reid index (the ratio of the 20 Increased numbers of chronic inflammatory cells in the submucosa.Increased numbers of chroni21Chronic bronchiolitis goblet cell metaplasia smooth muscle hyperplasia fibrosis in the walls inflammatory changes Luminal narrowingAirway obstructionChronic bronchiolitisLuminal n22Chronic bronchiolitisChronic bronchiolitis23Chronic bronchiolitisChronic bronchiolitis24Clinical course cough,mucus or mucopurulent sputum with/without asthma hypercapnia,hypoxemia,cyanosisClinical course25The forms of chronic bronchitisSimple chronic bronchitisChronic mucopurulent bronchitisChronic asthma bronchitisChronic obstructive bronchitisThe forms of chronic bronchiti26Diagnosis&Therapy History and symptoms Alleviate the symptoms Diagnosis&Therapy Histo27 Prevention is the most important Prevention is the most imp28 Prevention is the most important Prevention is the most imp29EmphysemaDefinition Emphysema is characterized by permanent Enlargement of the air spaces distal to the terminal bronchioles accompanied by destruction of their walls EmphysemaDefinition30呼吸系统疾病-Diseases-of-the-Respiratory-System(病理)课件31Types of EmphysemaCentriacinarPanacinarDistal acinarTypes of EmphysemaCentriacinar32Centriacinar EmphysemaCigarette smokingThe upper lobe,apical segmentsCentriacinar EmphysemaCigaret33Periacinar EmphysemaIt is more striking adjacent to the pleura,fibrosis,scaring,at the margins of the lobulesUpper half of the lungsPeriacinar Emphysema34Panacinar Emphysema1-antitrypsin deficiencyThe lower lobePanacinar Emphysema1-antitry35Centriacinar vs Panacinar EmphysemaCentriacinar vs Panacinar36Periacinar EmphysemaPeriacinar Emphysema37BullaeBullae38呼吸系统疾病-Diseases-of-the-Respiratory-System(病理)课件39pathogenesisProtease-antiprotease imbalanceOxidant-antioxidant imbalance These two imbalances are almost always coexist,effects are additivepathogenesisProtease-antiprote40 Proteolytic activity Anti-Proteolytic activity TISSUE DAMAGE EMPHYSEMA Proteolytic activity An41Pathogenesis of emphysema Pathogenesis of emphysema42Small airways tend to collapse during expiration-an important cause of chronic airflow obstruction Small airways tend to collapse43Emphysema vs OverinflationWith destruction without destructionComplicated reasons compensatory obstructive Emphysema vs 44Clinical course no symptom Dyspnea Cough,mucus or mucopurulent sputum,wheezing(with bronchitis)FEV1 (Forced Expiratory Volume at one second)Clinical course no symptom45Expiration stage prolongedSitting forward in a hunched-over positionBarrel-chestExpiration stage prolonged46Barrel-chest呼吸系统疾病-Diseases-of-the-Respiratory-System(病理)课件47Expiration stage prolongedSitting forward in a hunched-over positionBarrel-chestHypoxic,cyanosisExpiration stage prolonged48 Emphysema vs Chronic bronchitis The two diseases usually coexistmorphologic feature clinical featurerestricted to acinus large and small airways Emphysema vs Chronic b49呼吸系统疾病-Diseases-of-the-Respiratory-System(病理)课件50OUTLINE 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 Infecti51Definition 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 BronchiectasisDefinitionBronchiectasis52Conditions that predispose to bronchiecctasisBronchial obstructionBacteria pneumoniaCongenital conditions:cystic fibrosis kartagener syndromeConditions that predispose to 53pathogenesis Obstruction Chronic infection Bronchial walls damage irreversible dilationpathogenesis Obstruction 54呼吸系统疾病-Diseases-of-the-Respiratory-System(病理)课件55bronchiectasis 呼吸系统疾病-Diseases-of-the-Respiratory-System(病理)课件56 Cross-section of lung demonstrating dilated bronchi extending almost to the pleura Cross-section of lung demon57 Dilated bronchus in which the mucosa and wall is not clearly seen because of the necrotizing inflammation Dilated bronchus in which58Clinical Course Severe,persistent cough Copious amount of mucopurulent,fetid sputum Hemoptysis Symptoms are episodic and are precipitated by upper respiratory tract infection Clinical Course59OUTLINE 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 Infecti60bronchial asthmaAsthma is characterized by episodic,reversible bronchospasm resulting from an exaggerated bronchoconstrictor response to varous stimulibronchial asthmaAsthma is char61Allergic substances：pollen、food、petsMedicine:asprinVirus and bacteriaExerciseweathermoodAllergic substances：pollen、foo62Clinically,asthma is manifested by episodic dyspnea,cough and wheezing(a soft whistling sound during expiration)Clinically,asthma is manifest63pathogenesisAir way hyperresponsiveness Bronchial inflammation is the basis for hyperresponsiveness histamine or methacholinepathogenesisAir way hyperrespo64Pathological changesEosinophils,lymphocytes,mast cells infiltration Mucus gland hypersecretion and damage of bronchial wallsPathological changesEosinophil65呼吸系统疾病-Diseases-of-the-Respiratory-System(病理)课件66呼吸系统疾病-Diseases-of-the-Respiratory-System(病理)课件67The type of asthmaExtrinsic asthma Intrinsic asthmaThe type of asthmaExtrinsic as68OUTLINE 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 Infecti69Cor pulmonaleDefinition It also called pulmonary heart disease,is used to describe disease of the right-side cardiac chambers caused by pulmonary hypertension resulting from pulmonary parenchymal or pulmonary vascular diseases Cor pulmonaleDefinition70Disorders that predispose to cor pulmonale Diseases of the lungs Chronic obstructive lung disease Diffuse pulmonary interstitial 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 arteriolar constrictionDisorders that predispose to c71呼吸系统疾病-Diseases-of-the-Respiratory-System(病理)课件72Heart changesright ventricular,and often right atria hypertrophy.It may be dilated when ventricular failure develops.Heart changesright ventricular732cm below the valves of the pulmonary artery the thickness of ventricle5mm2cm below the valves of the pu74 Clinical courseSymptoms of primary pulmonary diseaseProgressive right cardiac failure and respiratory failure Clinical course75OUTLINE 1.Pulmonary Infections Community-Acquired Acute Pneumonia Community-Acquired Atypical Pneumonia Fungal infections 2.Chronic Obstractive Lung Diseases(COPD)Chronic Bronchitis Emphysem 3.Bronchiectasis 4.Asthma 5.Cor Pulmonale 6.Lung tumors OUTLINE 1.Pulmonary Infecti76Lung tumorsBronchogenic carcinoma:95%Miscellaneous group:5%bronchial carcinoid tumor sarcoma melanoma lymphoma Lung tumorsBronchogenic carcin77Bronchogenic 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 cau78Malignant neoplasm of the epithelium of bronchusDefinition Malignant neoplasm of the epit79Trends in bronchogenic carcinoma incidence and mortality.From the WHO Classification of TumorsIncidence and death rate,age standardised(x103)Trends in bronchogenic carcino80Causes:cigarette smoking air pollutions occupational factors genetic reasonsCauses:81HEAVY 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 SMOK82Causes:cigarette smoking air pollutions occupational factors genetic reasonsCauses:83The types of bronchogenic carcinoma Central type Peripheral type Diffuse typeThe types of bronchogenic carc84Central typeCentral type85Peripheral typePeripheral type86Diffuse typeDiffuse type87Histological classification of bronchogenic carcinoma Non-small cell lung carcinoma(NSCLC)Small cell lung carcinoma(SCLC)Histological classification of88Non-small cell lung carcinoma Squamous cell carcinoma AdenocarcinomaLarge cell carcinoma Non-small cell lung carcinoma 89Histological classification of bronchogenic carcinoma Form the Robbins pathologyHistological classification of90Adenocarcinoma Bronchioloalveolar carcinomaAdenocarcinoma Bronchioloa91 Squamous cell carcinoma Squamous cell ca92Large cell carcinomaLarge cell carcinoma93Small cell carcinomaSmall cell carcinoma94Clinical courseSilent,insidious lesionChronic cough and expectorationHoarseness,chest pain,pleural or pericardial effusionSymptoms emanating from metastatic spread to the brain,liver,or boneNSCLCs have a better prognosis than SCLCsClinical courseSilent,insidiou95Clinical courseFrom the General and Systematic PathologyParaneoplastic syndromeClinical courseFrom the Gener96 How can we find the tumor?97Methods to diagnose bronchogenic carcinoma CT scanX-rayFine needle aspiration Methods to diagnose bronchogen98Biopsy from bronchus by endoscopeCytological smear of sputumMethods to diagnose bronchogenic carcinoma Biopsy from bronchus Cytologic99TherapyTherapy100Prognosis of bronchogenic carcinoma NSCLCSCLCNSCLCSCLCMonths after treatmentForm the Diagnostic OncologySurvivalPrognosis of bronchogenic carc101THANK YOU FOR YOUR ATTENTION!102OUTLINE 1.Pulmonary Infections Community-Acquired Acute Pneumonia Community-Acquired Atypical Pneumonia Tuberculosis Fungal infections 2.Chronic Obstructive Lung Diseases(COPD)Chronic Bronchitis Emphysema 3.Bronchiectasis 4.Asthma 5.Cor Pulmonale 6.Lung tumors OUTLINE 1.Pulmonary Infecti103Swine flu in MexicoSwine flu in Mexico104呼吸系统疾病-Diseases-of-the-Respiratory-System(病理)课件105Pulmonary Infections in the form of pneumonia is very commonPneumonia can be very broadly defined as any infection in the lungPulmonary Infections in the fo106Pneumonia bacteria pneumonia viral pneumonia mycoplasmal pneumonia chlamydia pneumonia fungus pneumonia Pneumonia107Pneumonia lobar pneumonia lobular pneumonia interstitial pneumonia Pneumonia108 Lobar pneumonia Lobular pneumonia Lobar pneumoniaLobular 109The 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 betwe110It is best to classify either by etiology agent and clinical setting in which infection occursIt is best to classify either 111呼吸系统疾病-Diseases-of-the-Respiratory-System(病理)课件112OUTLINE 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 Infecti113Community-Acquired Acute Pneumonia is due to bacteria infection affecting distal airways,especially alveoli,with formation of an inflammatory exudate.often follows a viral upper respiratory tract infectionCommunity-Acquired Acute Pneum114Streptococcus pneumoniae (pneumococcus)StaphylococcusHaemophilus influenzaeKlebsiella pneumoniaeMoraxella catarrhalisStreptococcus pneumoniae 115 Lobar pneumonia Lobular pneumonia Lobar pneumoniaLobular 116Lobar pneumoniaAffects 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 large117呼吸系统疾病-Diseases-of-the-Respiratory-System(病理)课件118 Lobar pneumonia congestion stage red hepatization gray hepatization resolution Lobar pneumonia119Stage of congestionStage of congestion120Stage of congestion Red,edematousStage of congestion 121Red hepatizationRed hepatization122Red hepatizationRedSolidConsistency resembling fresh liverRed hepatizationRed123Gray hepatizationGray hepatization124Gray hepatizationDryFirmPaleGray hepatizationDry125Resolution stageResolution stage126SymptomsFever,chillsCoughRusty sputumChest painDyspnea,cyanosisSymptomsFever,chills127Fibrinous pleuralitisFibrinous pleuralitis128Physical examinationRales Consolidation presentationsPhysical examinationRales 129Laboratory ExaminationWBC X-Ray examinationSputum examinationBlood cultureLaboratory ExaminationWBC 130Bronchopneumonia(Lobular pneumonia)Patchy consolidation,centred on bronchioles or bronchiUsually in infancy or old age,or secondary to pre-existing diseaseRelated to some low virulent bacteriaBronchopneumonia(Lobular pneu131BronchopneumoniaBronchopneumonia132BronchopneumoniaBronchopneumonia133呼吸系统疾病-Diseases-of-the-Respiratory-System(病理)课件134SymptomsFeverCoughMucopurulent sputumDyspnea,cyanosisSymptomsFever135Physical examinationRales With/without consolidation presentaionsPhysical examinationRales 136WBC X-Ray examinationSputum examinationBlood cultureLaboratory ExaminationWBC Laboratory Examination137Therapy Penicillin or other sensitive antibiotic treatment,such as cephalosporinTherapy138Outcomesof PneumoniaComplete recoveryComplications developed Abscess formation Empyema Bacteremic dissemination OrganizationDeath Outcomesof PneumoniaComplete 139Abscess formationAbscess formation140 Abscess formation Abscess formation141Outcomesof PneumoniaComplete recoveryComplications developed Abscess formation Empyema Bacteremic dissemination OrganizationDeath Outcomesof PneumoniaComplete 142EmpyemaEmpyema143Outcomesof PneumoniaComplete recoveryComplications developed Abscess formation Empyema Bacteremic dissemination OrganizationDeath Outcomesof PneumoniaComplete 144Outcomesof PneumoniaComplete recoveryComplications developed Abscess formation Empyema Bacteremic dissemination OrganizationDeath Outcomesof PneumoniaComplete 145OrganizationOrganization146Outcomesof PneumoniaComplete recoveryComplications developed Abscess formation Empyema Bacteremic dissemination OrganizationDeath Outcomesof PneumoniaComplete 147Pneumococcus vaccinePneumococcus vaccine148OUTLINE 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 Infecti149Atypical pneumoniaThe concept was set forth in 1938 by ReimannThe clinical course is unlike the“typical”bacteria pneumonia sputum was modest no bacteria was isolated leukocytosis was modest no physical findings of consolidationAtypical pneumoniaThe concept 150Causes Mycoplasma pneumoniae(children and young adults)Virus influzenza A and B (adult)parainfluzenza virus (children)respiratory syncytial virus(infant,children)Chlamydia pneumoniae Rickettsiae Causes151Microscopic characteristic the inflammatory reaction is largely confined within the walls of the alveoli,the septa are widened and edematous with mononuclear cells infiltration-interstitial pneumoniaMicroscopic characteristic152interstitial pneumoniainterstitial pneumonia153 Viral inclusion body Viral inclusion body154 Viral inclusion body Viral inclusion body155Hyaline membraneHyaline membrane156Gross morphology Red,congested Patchy or whole lobes Gross morphology157 Clinical course Cough,fever,headache,malaise Sputum is modest No bacteria is isolated Leukocytosis is modest Physical findings of consolidation is varied Clinical course158 PrognosisGood in most uncomplicated casesBad in complicated bacterial superinfection cases Prognosis159severe acute respiratory syndrome,(SARS)Caused by a variant of coronavirus Sever clinical manifestationsStrong infectiousnessHigh mortalityPathological change:acute diffuse alveolar damagesevere acute respiratory syndr160coronaviruscoronavirus161severe acute respiratory syndrome,(SARS)Caused by a variant of coronavirus Sever clinical manifestationsStrong infectiousnessHigh mortalityPathological change:acute diffuse alveolar damagesevere acute respiratory syndr162OUTLINE 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 OUT