chapter 7 diseases of the respiratory system department of pathology guangxi medical university zili...
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Chapter 7Chapter 7Diseases of the Diseases of the
Respiratory SystemRespiratory System
Department Of PathologyDepartment Of PathologyGuangxi Medical UniversityGuangxi Medical University
Zili LvZili Lv吕自力吕自力
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Anatomic Structures and Anatomic Structures and FunctionsFunctions
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Bronchi
Bronchioles
Alveolar ducts
Alveoli
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Clinical features of Clinical features of respiratory diseasesrespiratory diseases
•1. Cough:•2. Sputum Production 痰 : •3. Hemoptysis 咯血•4. Dyspnoea 呼吸困难 :•5. Cyanosis 苍白 :•6. Chest pain:
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Contents Contents
•1. Acute infection of the lung •2. Chronic obstructive
pulmonary diseases & chronic cor pulmonale
•3. Chronic diffuse interstitial lung disease, carcinoma of nasopharynx and lung.
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Acute infection
of the lung
Pneumonia
p185
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Case 1 analysisCase 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.
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• 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
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Classification of pneumoniaClassification of pneumonia•Clinical circumstance Primary and Secondary•Etiological agent: Bacterial, Virus, Fungal•Host reaction Fibrinous & Suppurative•Anatomical pattern Lobar & Lobular
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LOBAR PNEUMONIALOBAR PNEUMONIA
(( 一一 )) 大叶性肺炎大叶性肺炎p187p187
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Lobar pneumoniaLobar 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• Cough and fever with purulent or
Rusty Sputum 铁锈色痰
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A. EtiologyA. Etiology
Pathogen: Streptococcus pneumonia
肺炎球菌 III 型Infective Route: Inhalation, Aspiration 吸入 Risk Factors : Cold, drunk, tired, diabetes
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B. Pathology*B. Pathology*
• Acute exudative fibrinous inflammation
• Involves one whole lobe or
several lobes
• The bronchi are not involved
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Pathologic FeaturesPathologic 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
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1. Stage of acute congestion1. Stage of acute congestion 1st-2nd day 1st-2nd day
•(1)Gross changes: Heavy, dark red and firm•(2)Microscopic changes:
•(3)Clinical features:
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Stage of acute congestionStage of acute congestion
Alveolar capillaries: Dilated
Air space: fluid, RBC, WBC
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•Fever, cough, cyanopathy ( 发绀 )
•Chest pain•Bacteremia •Bacteria can be found in sputum
Stage of acute congestionStage of acute congestionclinical featuresclinical features
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2. Stage of Red Hepatization: 2. Stage of Red Hepatization:
2nd-4th day 2nd-4th day
• (1)Gross changes:
• (2)Microscopic changes:
• (3)X-ray
(4)Clinical features:
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(1)Gross changes of red (1)Gross changes of red hepatizationhepatization
• Red and consolidation, just like liver
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(2)Microscopic changes of (2)Microscopic changes of red hepatization red hepatization
•A. Capillaries congestion
•B. Exudation: Fibrin, large number of RBC •C. Fibrinous pleurisy
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Microscopical changesMicroscopical changes
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红色肝样变期红色肝样变期 XX 线特点线特点(3)
Chest x-ray
• The middle segment of right upper lobe become consolidated and show large-area uniform dense shadow.
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(4) Clinical features of red (4) Clinical features of red hepatizationhepatization
•Fever, cough, chest pain•Rapid breathing, cyanopathy•Dullness 浊音 , vocal fremitus
enhancement 语颤增强•Rusty sputum 铁锈色痰
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3. Stage of 3. Stage of graygray hepatization: hepatization: 5th-6th day 5th-6th day
• Gross changes:
• Microscopic changes:
• X-ray
Clinical features:
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(1)Gross changes of (1)Gross changes of grey hepatization grey hepatization
•Dry •Gray •Firm •Consolidation
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(2)Histological changes(2)Histological changes
• Capillary is not dilated anymore.
• Alveolar space is filled with neutrophil and fibrin
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Histological changes of Histological changes of grey hepatizationgrey hepatization
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X-ray features of gray X-ray features of gray hepatizationhepatization
• (3)Chest x-ray: high dense shadow can be found at the right upper lobe
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(4)Clinical features of gray (4)Clinical features of gray hepatizationhepatization
• Consolidation: dullness, vocal fremitus enhancement
•Sputum: mucus purulent sputum
•Dyspnoea( 缺氧) : is not obvious
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4. Stage of 4. Stage of ResolutionResolution 7 days later 7 days later
• Gross changes: Friable and mottled• Microscopic changes:• X-ray• Clinical features:
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Microscope changes of Microscope changes of resolutionresolution
• The fibrin and cell debris are digested by enzymatic
• The exudation is remove
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Pathologic FeaturesPathologic Features
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LOBULAR PNEMONIALOBULAR PNEMONIA
(( 二二 )) 小叶性肺炎小叶性肺炎 (Bronchopneumonia)(Bronchopneumonia)
(( 支气管肺炎支气管肺炎 ))
p189p189
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Lobular pneumoniaLobular pneumoniaBronchopneumoniaBronchopneumonia
• 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
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•Pathogen: many bacteria, • Infection via: Inhalation, Aspiration•Risk Factors: secondary
A. Etiology
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B. PathologyBronchopneumonia , Gross
Lower lobes, dorsal side
双肺下叶 , 背侧
Multiple firm areas, around inflamed bronchioles.多个实变病灶 , 围绕细支气管
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B. Pathology B. Pathology Bronchoneumonia, Bronchoneumonia,
Microscope:Microscope:
1. Multiple lesionsPurulent 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 )
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C. Clinical FeaturesC. Clinical Features
•The onset is insidious, nonspecific
• low-grade fever•Dyspnea is not prominent•The typical feature is Purulent Sputum 脓痰
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• Chest x-ray
• Several scattered patchy shadows evidently in bilateral lower lobes
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Lobar pneumonia
Lobular pneumonia
Air space pneumonia
Complications
Resolution
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Complications of acute air Complications of acute air space pneumoniaspace pneumonia
• Pleura involvement• Bacteremia• Suppuration (Abscess Formation)• Necrotizing bacterial pneumonia• Pulmonay carnification 肺肉质变
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• Lung abscess
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• Pulmonary carnification
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Distribution
Number
Host reaction
Clinical features
What are the What are the differences?differences?
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Acute interstitial pneumoniaAcute interstitial pneumonia间质性肺炎间质性肺炎
• 1. Agents: Virus (SARS, Avian influenza) Mycoplasma or Pneumocystis• 2. Interstitium• 3. Atypical pneumonia• 4. Infiltration with lymphocyte,
monocyte
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Viral pneumoniaViral pneumoniapathologic featurespathologic features
• 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
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Viral Pneumonia
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• 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
SARSSARS
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Clinical featuresClinical features
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Electro microscopeElectro microscope
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Avian Influenza 禽流感
人畜共患传染病
H5N1
Interstitial
Atypical
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Bird fluBird 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.
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Interstitial pneumonia•Atypical pneumonia •Congested, edematous, mononuclear cells infiltration
Mycoplasma pneumonia 支原体肺炎
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Air space
pneumonia
Lobar pneumonia
Lobular pneumonia
Interstitial
pneumonia
Viral pneumonia
Mycoplasma pneumonia
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ARDSARDSAcute Respiratory Acute Respiratory Distress SyndromeDistress Syndrome
• An acute diffuse alveolar injury• Terminal events in many of the
patients• Serious ill, the mortality rate > 50%• Results from ischemic, endotoxins,
enzymes.
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Case 1 analysisCase 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.
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• 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
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Questions Questions
•What does this patient should be diagnosed as?
•Which type of inflammation?•Why does the patient cough
with the “rusty” sputum?
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• 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?
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Case abstract 2Case 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.
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•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.
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Questions Questions
•What does this patient will be diagnosed as?
•Which type of inflammation?•Why do patients cough with
the purulent sputum?
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Summary Summary
•How to differentiate the lobar pneumonia and the bronchopneumonia?
•What is the “rusty sputum”?