組織損傷 病理學(xué).ppt

1、第一章病 理 學(xué) 導(dǎo) 論,趙 國 強(qiáng),病 理 學(xué) 導(dǎo) 論,病理學(xué)的定義 病理學(xué)發(fā)展簡史 病理學(xué)的分支學(xué)科 病理學(xué)的研究方法,Definition of Pathology,The word “Pathology” is derived from two Greek word - pathos meaning suffering logos meaning study,Definition of Pathology,Pathology is scientific study of structure and function of the body in disease. It deals wi

2、th causes, effects, mechanisms and nature of disease.,The knowledge and understanding of pathology is essential for all would-be doctors as well as general practitioners and specialists since unless they know the causes and mechanisms of disease and understand the language spoken by the pathologist

3、in the form of laboratory reports, they would not be able to institute appropriate treatment or suggest preventive measures to the patient.,For the medical student, the discipline of pathology forms a vital bridge between initial learning phase of preclinical science and the final phase of clinical

4、subjects.,病理學(xué)發(fā)展簡史,從宗教迷信走向理性探索(Antiquity to AD 1500) 大體病理學(xué)時(shí)期 (AD 1500 to 1800) 細(xì)胞病理學(xué)時(shí)期 (AD 1800 to 1950s) 現(xiàn)代病理學(xué)時(shí)期 (1950s to dawn of 21st century),從宗教迷信走向理性探索 (Antiquity to AD 1500),Hippocrates (Greece) 460-377 BC Permanently dissociated medicine from religious mysticism. Started study of patients sym

5、ptoms as method of diagnosis. Cornelius Celsus (Rome) 53 BC-7 AD Described 4 cardinal signs of inflammation (redness, heat, swelling, pain),Hippocrates (Greece) 460-377 BC,大體病理學(xué)時(shí)期 (AD 1500 to 1800),Giovanni B Morgagni (Italy) 1682-1771 Introduced clinicopathologic correlation (CPC) in the study of d

6、isease John Hunter (Scotland) 1728-1793 Introduced pathology museum in the study of disease. R.T.H. Laennec (France) 1781-1826 Described several lung diseases such as various tuberculous lesions of lungs, bronchiectasis. Described cirrhosis of liver (later called Laennecs cirrhosis). Invented stetho

7、scope.,John Hunter (Scotland) 1728-1793,R.T.H. Laennec (France) 1781-1826,細(xì)胞病理學(xué)時(shí)期 (AD 1800 to 1950s),Rudolf Virchow (Germany) 1821-1905 Father of cellular pathology Introduced histopathology as a diagnostic branch by his cellular theory George N. Papanicolaou (USA) 1883-1962 Father of exfoliative cy

8、tology Developed Pap smear for detection of cervical cancer in 1930s,Rudolf Virchow (Germany) 1821-1905,George N. Papanicolaou (USA) 1883-1962,現(xiàn)代病理學(xué)時(shí)期 (1950s to dawn of 21st century),Watson and Crick 1953 Described the structure of DNA Nowell and Hagerford 1960 Philadelphia chromosome in CML i.e. t(

9、9;22) Gall and Pardue 1969 In Situ Hybridization Kary Mullis 1983 Introduced polymerase chain reaction (PCR),著名病理學(xué)家 梁伯強(qiáng)教授 1899-1968,著名病理學(xué)家 秦光煜教授 1902-1969,病理學(xué)的分支學(xué)科,General Pathology - dealing with general principles of disease Systemic Pathology - includes study of diseases pertaining to the specifi

10、c organs and body systems,病理學(xué)的分支學(xué)科,Histo-Pathology Experimental Pathology Molecular Pathology Chemical Pathology Geographic Pathology Immunology Haematology Medical Genetics,病理學(xué)的研究方法,尸體剖驗(yàn) Autopsy 活體組織檢查 Biopsy 細(xì)胞學(xué)檢查 Cytology,肖 萍 老師辦公室：新教學(xué)樓4F電話：87330743,第二章細(xì)胞和組織的適應(yīng)與損傷,細(xì)胞和組織的適應(yīng)與損傷,細(xì)胞對環(huán)境刺激的應(yīng)答反應(yīng) 細(xì)胞的適應(yīng) 細(xì)

11、胞損傷的原因 細(xì)胞損傷的機(jī)制 細(xì)胞損傷的形態(tài)學(xué),細(xì)胞對環(huán)境刺激的應(yīng)答反應(yīng),輕度的細(xì)胞損傷是可逆的，當(dāng)刺激因子消除后，受損傷的細(xì)胞其形態(tài)結(jié)構(gòu)和功能仍可恢復(fù)正常。 嚴(yán)重的損傷是不可逆的，最終導(dǎo)致細(xì)胞死亡。,適應(yīng) Adaptation, 可逆性損傷 Reversible injury, 細(xì)胞死亡Cell death -可被看作是細(xì)胞正常的結(jié)構(gòu)和功能不斷遭受損害的不同階段。,細(xì)胞和組織的適應(yīng),萎縮Atrophy 肥大Hypertrophy 增生Hyperplasia 化生Metaplasia,萎縮Atrophy,發(fā)育正常的器官和組織，其實(shí)質(zhì)細(xì)胞的體積變小或數(shù)量減少，而致器官或組織縮小稱萎縮。 萎縮可分

12、為生理性和病理性兩類。,生理性萎縮 Physiologic Atrophy,青春期后胸腺的萎縮 更年期后性腺的萎縮 老年人腦的萎縮,病理性萎縮 Pathologic Atrophy,營養(yǎng)不良性萎縮 Malnutrition atrophy 神經(jīng)性萎縮 Denervation atrophy 廢用性萎縮 Disuse atrophy 壓迫性萎縮 Pressure atrophy 內(nèi)分泌性萎縮 Endocrine atrophy 缺血性萎縮 Ischaemic atrophy,Atrophy of one kidney, gross,Atrophy, muscle fibers, microsco

13、pic,病理變化,萎縮的器官體積變小，質(zhì)量減少，顏色變深或呈褐色。 實(shí)質(zhì)細(xì)胞體積縮小或數(shù)目減少，但無死亡細(xì)胞。 萎縮的胞漿內(nèi)可見脂褐素沉著。 脂褐素顆粒明顯增多時(shí)，整個(gè)器官呈棕褐色，稱褐色萎縮（brown atrophy)。,肥大 Hypertrophy,細(xì)胞、組織或器官體積的增大稱為肥大。 生理性肥大 病理性肥大,生理性肥大 Physiologic Hpertrophy,病理性肥大 Pathologic Hpertrophy,Hypertrophy of cardiac muscle Hypertrophy of smooth muscle Hypertrophy of skeletal m

14、uscle Compensatory hypertrophy,代償性肥大Hypertrophy, heart, gross,增生 Hyperplasia,由于實(shí)質(zhì)細(xì)胞數(shù)量增多而引起的組織、器官體積增大稱為增生。 增生可分為生理性增生和病理性增生。,病理性增生Hyperplasia, prostate, gross,化生 Metaplasia,為適應(yīng)環(huán)境變化，一種已分化組織轉(zhuǎn)變?yōu)榱硪环N分化組織的過程稱為化生。 這種轉(zhuǎn)變過程并非由成熟的細(xì)胞直接轉(zhuǎn)變，而是由未分化細(xì)胞向另一方向分化而成，一般只能轉(zhuǎn)變?yōu)樾再|(zhì)相似的細(xì)胞。,化生 Metaplasia,上皮組織化生 Epithelial metaplasi

15、a 1. Squamous metaplasia 2. Columnar metaplasia 間葉組織化生 Mesenchymal metaplasia 1. Osseous metaplasia 2. Cartilaginous metaplasia,Metaplasia, squamous, larynx, microscopic,Metaplasia, gastric columnar mucosa in esophagus, microscopic,細(xì)胞損傷的原因Causes of cell injury,缺氧和缺血 物理因素 化學(xué)因素 生物因素 免疫因素 遺傳因素 營養(yǎng)失衡,細(xì)胞損

16、傷的機(jī)制 Mechanisms of cell injury,細(xì)胞損傷的形態(tài)學(xué) Morphology of cell injury,變性 Degeneration/Intracellular Accumulations 細(xì)胞死亡 Cell death,變性 Degeneration,變性是指細(xì)胞或細(xì)胞間質(zhì)內(nèi)出現(xiàn)異常物質(zhì)或正常物質(zhì)的量顯著增多，并伴有不同程度的功能障礙。 變性一般為可復(fù)性損傷，嚴(yán)重變性可發(fā)展為壞死。,變性 Degeneration,細(xì)胞腫脹Cellular swelling 脂肪變性Fatty change 玻璃樣變性Hyaline change 黏液樣變性Mucoid dege

17、neration 淀粉樣變性Amyloidosis 病理性色素沉著Pigments 病理性鈣化Pathologic calcification,細(xì)胞腫脹 Cellular Swelling,當(dāng)缺氧或毒性物質(zhì)損及線粒體內(nèi)ATP產(chǎn)生時(shí)， 細(xì)胞膜上的鈉泵功能降低，使更多的鈉、鈣離子和水進(jìn)入細(xì)胞內(nèi)，而細(xì)胞內(nèi)鉀離子外逸，導(dǎo)致細(xì)胞內(nèi)水分增多，細(xì)胞腫脹，嚴(yán)重時(shí)稱為細(xì)胞的水樣變性（hydropic degeneration)。,病理變化,肉眼觀，水樣變性的器官體積腫大，包膜緊張，切面隆起，切緣外翻，顏色蒼白，失去正常光澤。 鏡下觀，細(xì)胞體積增大，胞漿變得透明、淡染，可出現(xiàn)許多細(xì)小的淡紅色顆粒。嚴(yán)重時(shí)，細(xì)胞膨大如氣球，故有氣球樣變之稱。,Viral hepatitis B, liver, high power microscopic,脂肪變性 Fatty change (Steatosis),由于細(xì)胞損傷導(dǎo)致脂肪代謝障礙而引起細(xì)胞內(nèi)出現(xiàn)脂滴或脂滴明顯增多。稱脂肪變性。 脂肪變性常發(fā)生在肝、心、腎等器官。,Fatty metamorphosis of liver, gross,. Fatty metamorphosis of liver, microscopic,Fatty change, liver, microscopic,玻璃樣變性 Hyaline Change,玻璃樣變性又稱透