中國(guó)醫(yī)科大學(xué)病理學(xué)英文課件5

1、 chapter hemodynamic disorder section 1. hyperemia and congestionl heart l a vl n-humortypesllocal：coronary aslsystemic：heart failurelrelationshipl(一一) change of blood: 1. volume: increasehyperemia decreaseischemia l2. nature: l high coagultionthrombosisl foreign bodythrombusl embolisminfarctionl(二二

2、) vessel: l 1. high permeabilityl 2. rupturea. v. (congestion)edema hemorrhage一一. arterial hyperemia1. definition: increased volume of arterial inflow in an organ or tissue (hyperemia)2. common types:(1) physiologic: exercise skeletal muscle (2) pathologic: at the foci of inflammation(3) hyperemia a

3、fter reducing pressure(1) restore: if causes abated(2) hemorrhage: hypertension , as二、二、congestionresulting from an isolate venous obstructionaccumulation of blood in veinlet and capillary1. veins being pressed: tumor press local vein2. venous obstruction: thrombosis3. heart failure: left pulmonary

4、congestion right hepatic congestion1. hydrostatic pressure congestive edema, hemorrhage 2. chronic hypoxia atrophy or degeneration fibrosis, sclerosis1. pulmonary congestion(acute,chronic):(1) cause: left heart failure(2) morphology: gross: volume weight dark red cut surface consolidated aalveolar s

5、epta capillary engorged with blood become thickened fibrosis alveolar spaces edema fluid heart failure cells hemorrhagebrown induration: long period congestion, texture become solid and show brown appearance.chronic pulmonary congestion慢性肺淤血慢性肺淤血heart failure cells: hemosiderin- laden m(1) cause: ri

6、ght heart failure(2) morphology:acute hepatic congestion: 1) gross: enlarged, dark red2) lm the central vein and sinusoids are engorged with blood central hepatocyte: necrosis peripheral hepatocyte: fatty change 1) gross: nutmeg liver cut surface shows zones of yellow alternating with zones of red ,

7、 like nutmeg.the central v , sinusoids :distended with bloodcentral hepatocyte: atrophy or necrosis peripheral hepatocyte: fatty changecongestive bands among central v2) lm: definition: within living heart or blood vessel blood coagulated (clotting) or some components clump form solid mass(thrombus)

8、three primary influences predispose to thrombus formation: (1) endothelial injury(2) alteration in normal blood flow stasis or turbulence of blood flow(3) blood hypercoagulability(一一) endothelial injurynormal condition: intact ec inhibit platelet adherence blood clotting.injury or activated ec augme

9、nts local blood clotting.1. functions of endothelium(1). antithrombotic properties screen function of intact endothelium antiplatelet adhering anticoagulants fibrinolytic內(nèi)皮細(xì)胞抑制血栓形成作用示意圖內(nèi)皮細(xì)胞抑制血栓形成作用示意圖 activate exogenous coagulation process promoting adhesion of platelet inhibiting fibrinolysis2. fun

10、ctions of platelets: adhesion and shape change secretion (release reaction) aggregation(2). prothrombotic properties(1) endocardial injury: myocardial infarction, valvulitis(2) vascular injury: traumatic, as ulcerated plaques inflammatory injury (vasculitis), (3) hypoxia, shock, bacterial endotoxin

11、dic microthrombus 1. refer to stasis or turbulence(1) disrupt laminar flow and bring platelets into contact with ec . (2) prevent dilution by fresh flowing blood of activated clotting factors(3) promote ec activation, predisposing to local thrombosis, leukocyte adhesion.1) venous valves slow, turbul

12、ence2) fugacious stasis3) thinner wall pressed easily4) adherence increased (blood from capillary vein)1. inherited causes of hypercoagulability: (1) the most common cause: mutations in the factor v gene prothrombin gene (2) inherited lack of the anticoagulants: anti-thrombin protein c, protein s1)

13、widely metastasis of malignant tumor 2) severe trauma large area burn operation of3) hyperlipemia, as, smoking, obesityloss of blood(一一) the process of thrombosis: platelets adhere to extracellular matrix at sites of endothelial injury and become activated. secrete granule products ( adp, txa2 ) pla

14、telets aggregating the intrinsic and extrinsic pathway activate fibrinogen fibrinthe process of vein thrombosis1. artery thrombi (pale thrombus ):(1) the common sites: arterial lumen:coronary a cardiac valves and chambers injured site of bv(2) gross pale nodule or vegetation rough surface,friable firmly adherent to arterial wall(1) sites heart chamber aneurysm, as(2) gross : gray-white alternating with brown dry, adherent to vascular wall mural thrombus(3) lm: platelet , fibrin , erythrocytes(1) sites vein