SouthernMedicalUniversity呼吸系統(tǒng)疾病病理學 Flusymptom Arewereadytomeetbirdfluchallenge?

Pneumonia-howcommonitis! SARS-themysteryillness

Pulmonarytuberculosis-olddiseaseContinuing

Wagingwaronlungcancer呼吸系統(tǒng)組成：下呼吸道:

鼻、咽、喉氣管、支氣管和肺肺小葉：3~5個終末細支氣管連同它的各級分支和肺泡組成，包括15~25個肺腺泡。肺小葉呼吸性細支氣管及其遠端所屬的肺組織；II型肺泡上皮、基底膜、毛細血管內(nèi)皮細胞共同組成肺泡毛細血管膜，組成氣血屏障，是肺進行氣血交換的場所；II型肺泡上皮：分泌肺表面活性物質(zhì)，降低肺泡表面張力，防止呼氣末肺萎陷，維持小氣道的通暢。Microscopicstructureofthealveolarwall.Notethatthebasementmembrane(yellow)isthinononesideandwidenedwhereitiscontinuouswiththeinterstitialspace.Portionsofinterstitialcellsareshown.肺臟是空氣可以進出體內(nèi)的唯一器官粉塵微粒、病原體黏附在氣道黏膜的黏液層上纖毛-黏液排送系統(tǒng)

肺泡腔吞噬、降解二肺組織學氣管和支氣管的組織結(jié)構(gòu)：分粘膜、粘膜下和外膜三層，粘膜上皮含三種細胞；粘膜上皮中含假復層或單層纖毛柱狀上皮，杯狀細胞、刷細胞、基細胞、Clara細胞和神經(jīng)內(nèi)分泌細胞。細支氣管：上皮成分，不含軟骨和腺體肺泡上皮：分I型和II型.粘膜層粘膜下層外膜層bronchiolepulmonaryalveoli呼吸系統(tǒng)疾?。焊腥拘约膊∽枞苑尾》伍g質(zhì)疾病腫瘤肺 炎pneumonia分類：感染性1、根據(jù)病因分類

理化性（放射性、吸入性和類脂性）變態(tài)反應性（過敏性和風濕）2、根據(jù)部位的不同分肺泡性和間質(zhì)性3、根據(jù)病變性質(zhì)引起肺炎的病原體有哪些？細菌：肺炎鏈球菌、肺炎桿菌、流感嗜血桿菌、溶血性球菌、葡萄球菌、結(jié)核桿菌、非典型分枝桿菌、綠膿桿菌、大腸桿菌、變形桿菌、軍團菌病毒：流感病毒、呼吸道合胞病毒、腺病毒、副流感病毒、麻疹病毒、單純皰疹病毒、巨細胞病毒、冠狀病毒、禽流感病毒支原體：肺炎支原體衣原體：沙眼認原體、鸚鵡熱衣原體真菌：新型隱球菌、曲霉菌、毛霉菌、念珠菌放線菌立克次體：伯納特立克次體→Qfever寄生蟲：弓形體、卡氏肺囊蟲、血吸蟲幼蟲、肺吸蟲大葉性肺炎lobarpneumonia主要由肺炎球菌引起的以肺泡內(nèi)彌漫性纖維素滲出為主的炎癥，常累及肺葉的大部或全部。IntroductionDiffusefibrinousinflammationinalveolitomiddleagedpersonsClinicalmanifestations:Rapid;chill,highfever,chestpain,cough,rustysputum,dyspnea;consolidationoflung;WBC↑Naturalcourseofdisease:5-10days肺炎鏈球菌（1,2,3,7型）肺炎鏈球菌（1,2,3,7型）病因和發(fā)病機制機體抵抗力↓呼吸道防御能力↓→細菌感染變態(tài)反應→血管擴張，通透性↑→漿液、纖維素滲出細菌在肺泡中繁殖 PathologicalchangesMostlylaterallung，inferiorlobeofleftorrightlungAlsomorethantwopulmonarylobesFourstages，5-10days(一)充血水腫期（1－2天）★肉眼：腫大 重量增加 暗紅鏡下：肺泡壁毛細血管擴張、充血肺泡腔大量漿液,少紅、中性粒、巨噬細胞,大量細菌高熱、咳嗽，毒血癥濕性啰音、淡薄陰影高熱、咳嗽，毒血癥濕性啰音、淡薄陰影GramStainofafilmofsputum(二)紅色肝樣變期（3－4天）★肉眼：大、質(zhì)實、灰紅鏡下：大量RBC滲出，少數(shù)WBC、纖維素發(fā)紺、咳嗽、鐵銹色痰、胸痛、支氣管呼吸音、濕性羅音、致密陰影(2)紅色肝樣變期(3-4天)(三)灰色肝樣變期(5-6天)★肉眼：大、重量↑、灰白、實鏡下：肺泡腔 纖維蛋白滲出↑中性粒細胞↑纖維素連成網(wǎng)、少細肺泡壁 毛細血管受壓發(fā)紺↓、咳膿痰、胸痛大片致密陰影TypicalappearanceofrightlobarPneumonia(3)灰色肝樣變期(5-6天)(四)溶解消散期（一周左右）★肉眼：質(zhì)軟鏡下：白細胞變性壞死→蛋白溶解酶→體溫降、痰多、捻發(fā)音陰影漸退→消失Fourstages(5-10days)現(xiàn)今，典型的大葉性肺炎的四期病變少見。臨床病理聯(lián)系X-rayX-ray、痰X-ray、痰溶解消散期 呼吸音、X-rayUpperrightlobepneumoniaOutcomeandcomplication多數(shù)可恢復正常多數(shù)可恢復正常肺肉質(zhì)變肺肉質(zhì)變金葡菌肺膿腫、膿胸細菌入血細菌入血敗血癥，感染性休克（休克/中毒型肺炎）(pulmonaryarnification)Earlyorganizationofintra-alveolarexudate,seeninareastobestreamingthroughtheporesofKohn(arrow).化膿性胸膜炎及膿胸(3)肺膿腫(4)敗血癥或膿毒敗血癥(5)感染性休克LungAbscesslungabscesscompletedestructionofunderlyingparenchymawithinthefocusofinvolvementAbscessformation小葉性肺炎lobularpneumonia以細支氣管為中心的化膿性炎癥。IntroductionAcutepurulentinflammation Oftenlocalizationtothebronchiolesandsurrounding,alsocalled Bronchopneumoniainfants,elderlyOftencomplicationofotherdiseasesEtiology:manykindsofbacteriamixedinfectionPathogenesis:Defenseofairway↓Inducedfactors→bodyresistance↓→bacteriaproliferationBronchitisLobularpneumoniaPathologicalchanges★肉眼：大小不等、0.5-1cm、不規(guī)則、灰黃；散布兩肺各葉，以下葉和背側(cè)多見；可融合（融合性支氣管肺炎）Confluentlobularpneumonia細支氣管粘膜充血、水腫，上皮壞死脫落，腔內(nèi)大量膿性滲出 周圍出，代償肺氣腫、肺不張LowpowerviewshowspatchyperibronchiolardistributionofpneumoniaNormalalveolarAcutepurulentexudatefillsbronchiolesandadjacentalveoli.--BacterialcenobiumWhitecell--ClinicalrelationsClinicalcharacters:Coughing,fever,sputum,chestpainNotobviousoflungconsolidationMoistralesXrayOutcomeandcomplicationRespiratoryfailureHeartfailureLungabscess,empyemaBronchiectasisSepticopyemia(膿毒血癥)病毒性肺炎Introduction Commonvirus:fluvirus,adenovirus,syncytialvirus,measlesvirus,cytomegalovirusClinicalcharacters:children,diversity,Toxicemia＋refractorycoughingorshortbreathPathologicalchanges肉眼：病變不明顯、輕度增大鏡下：間質(zhì)性肺炎充血、水腫間質(zhì) 淋巴細胞、單核細胞浸肺泡間隔明顯增寬肺泡腔 無或少量漿液支氣管上皮細胞或肺泡上皮內(nèi)包涵體Interstitialpneumonitiswithalveolarwallswidenedbymononuclearcells,butnointra-alveolarexudate透明膜：流感、麻疹、冠狀病毒、腺病毒肺炎多核巨細胞：麻疹病毒（支氣管、肺泡上皮增生SyncytialcellpneumoniaCytomegalovirusdistinctnuclearcytoplasmicinclusionsinthelungCellsfromtheblisterinshowingglassyintra-nuclearherpessimplexinclusionbodies比較大葉