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1、DiseasesofRespiratorySystem 呼吸系统疾病 授课教师 吴慧娟hjwu ANATOMYandFUNCTION Upperrespiratorytract nose pharynx larynx 鼻 咽 喉 Lowerrespiratorytract trachea气管bronchi支气管bronchiole细支气管 Lobar大叶 segmental lobular小叶Terminalairwaysandalveoli respiratorybronchiolealveolarsacalveolus Bronchialtree 通气 15000L d conductin
2、gportionFrommainbronchitoterminalbronchiolesTerminalairwaysandalveoli 气体交换 respiratoryportionFromrespiratorybronchioletoalveoli DefensesMechanismNasalhairandTurbinatesMucociliaryapparatusandcoughImmunoglobulin IgG IgM IgA ComplementproductionCytokines IL 1 TNF AlveolarmacrophagesPolymorphonuclearleu
3、kocytesCell mediatedimmunity Bronchialtree1 Mucosa pseudostratifiedciliatedcolumncell gobletcell producingmucus basalcell stemcell smallgranulescellhighlyspecializedbronchialliningcells containingneurosecretorygranules2 Submucosalgland serousandmucus3 Wall smoothmuscle contractile elasticfibers prov
4、ideflexibility cartilageplate forsupport Bronchioles细支气管 1mm1 Mucosa ciliatedepithelialcell Claracell non ciliatedsecretorycell 2 Wall smoothmuscle nogland nocartilage Terminalairwaysandalveoli Unitofgasexchange respiratorybronchioles alveolarducts alveoli AlveolitypeIcells 95 ofthesurface 40 ofthel
5、iningcells gaspermeable AlveolitypeIIcells 5 ofthesurface 60 oftheliningcells producingsurfactant loweringthesurfacetensionInvolvedintherepairofalveolarepithelium PulmonaryvasculatureDoublebloodsupply protectingfromischemia Pulmonarycirculation functional Bronchialsystem nutrientPulmonarylymphcircul
6、ationDeepandsuperficialnetwork drainingtothehilumlymphnodesNolymphaticsinmostalveolarwalls Rmunicatingwithexternalenviroment susceptibletothediseases2 bloodfrombody biologicalpathogens embolus3 relatedtoheart location pulmonarycirculation 4 specificdiseases damagetothewallofbronchialtree obstruction
7、ofbronchiolesdisintegrationofalveolar capillarymembrane AetiologicalfactorDiseaseGeneticCysticfibrosis 1 AntitrypsindeficiencySomeasthmaEnvironmentalSmokinglungcancerAirpollutionChronicbronchitisandemphysemaSusceptibilitytoinfectionOccupationSilicosisAsbestosis mesotheliomaandlungcancerInfectionInfl
8、uenzaMeaslesBacterialpneumoniasTuberculosis Atelectasis collapse ObstructivepulmonarydiseaseChronicbronchitisEmphysemaAsthmaBronchiectasisRestrictivepulmonaryAcuterespiratorydistresssyndrome ARDS DiffuseinterstitialpneumonaryfibrosisPneumoconioses 尘肺 PulmonaryinfectionPneumoniaAbscess TuberculosisTu
9、morCorpulmonale I Pneumonia肺炎Pneumoniacanbeverybroadlydefinedasanyinfectioninthelung Acute fulminantorchronic Histologicspectrum Fibrino purulentalveolarexudate acutebacterialpneumonias Mononuclearinterstitialinfiltrates viralandotheratypicalpneumonias Granulomas chronicpneumonias Acutebacterialpneu
10、monias LobarpneumoniaConsolidationofanentirelobe Lobularpneumonia Bronchopneumonia Scatteredsolidfociinthesameorseverallobes Lobarpneumonia大叶性肺炎 ConceptionContiguousairspacesofpartorallofalobearehomogeneouslyfilledwithanexudatethatcanbevisualizedonradiographsasalobarorsegmentalconsolidation Adisease
11、ofacuteexudativeinflammation急性渗出性炎症 Pathogenesis Healthyadult Hostdefensesdepressed NormalinhabitantsoftheoropharynxandnasopharynxPneumococcus I II III型 Pathologyandclinicalfeatures肺泡腔内急性渗出 纤维蛋白 中性粒细胞Aratherclearcut4stagedbattleintheaffectedlunginaperiodabout7 8daysFourstages CongestionRedhepatizati
12、onGrayhepatizationResolution Congestion 1 2d Gross Heavy red boggy LM Vascularcongestion Proteinaceousfluidcontainingnumerouspneumococcifillingthealveoli Scatteredneutrophils Clinicalfeature Abruptonsetofhighfever shakingchills pinkfrothysputum Moistrale Chestradiograph dim uniformshadow Redhepatiza
13、tion 3 4d Gross Aliver likeconsistency granular Afibrinousorfibrinopurulentexudateofpleura LM neutrophils redcells andfibrinpackingwithinalveolarspaces Numeruspneumococcidetected Clinicalfeature Rustysputum Dyspnea cyanosis chestpain Chestradiograph asolidappearanceextendingtoentirelobesorsegments P
14、ulmonaryconsolidation 实化 Redhepatization Grayhepatization 4 6d Aturningpoint Gross Dry gray firm granular LM Redcellslysed Fibrinousexudateandneutraphilewithinalveoli Nopneumococcidetected Clinicalfeaturesameasredhepatizationpurulentsputumhypoxiaimproved LobarpneumoniaGrayhepatization Greyhepatizati
15、on Resolution after1week Gross Pleuralresolvedororganizedfibrousthickeningorpermanentadhesions LM ExudateswithinalveolienzymaticallydigestedEitherresorbedorexpectorated ClinicalfeaturesRecovery ComplicationsNotcommon Carnification 肺肉化 organizingpneumonia Pulmonaryabscessandpyothorax Septicemia Toxic
16、pneumonia Carnification肺肉化 B Lobularpneumonia Bronchopneumonia initialinfectionofthebronchiandbronchioles adjacentalveoli Apurulentinflammation Apatchydistributionofinflammationthatgenerallyinvolvesmorethanonelobe Mostfrequentlybilateralandbasal Pathogenesis Organisms RelativelyavirulentPneumococcus staphylococcus andstreptococcus etc Opportunisticinfection Oftenasecondarydisease Terminallyillpatients infantsandtakingimmunosuppressivedrugs etc Aspirationpneumonia Acommoncauseofdeath terminalpneu
