DISEASES OF RESPIRATORY SYSTEM

1. DISEASES OF RESPIRATORY SYSTEM The Department of Pathology Zili Lv 吕自力 15907817634 E-mail:lvzili@yahoo.com.cn

2. Air space pneumonia Interstitial pneumonia lobar pneumonia lobular pneumonia Go overPneumonia viral pneumonia mycoplasma pneumonia

3. Respiratory system diseases 2 • Chronic (diffuse) obstructive passage disease 慢性阻塞性肺病 • Chronic cor pulmonale 慢性肺心病

4. Chronic Obstructive Pulmonary Diseases, COPD • Chronic bronchitis 慢性支气管炎 • Pulmonary emphysema 肺气肿 • Bronchial asthma 支气管哮喘 • Bronchiectasis 支气管扩张症

5. Section 1: Chronic Bronchitis p194 Definition: A persistent productive cough, sputum for at least 3 months in at least 2 consecutive years. The most common disease in respiratory system. More common in old age (<40 ) Most cases caused by smoking

6. A. Etiology and Pathogenesis Causes: • Cigarette smoking: 90% • Air pollution: sulfur dioxide and nitrogen dioxide, may contribute. 3. Microorganism infection is often present but plays a secondary role.

7. Etiology and Pathogenesis Smoking Pollution Infection Destroy the defensive mechanisms Hypertrophy of mucous glands Metaplasia of squamous Infiltration of inflammatory cells

8. B. Pathology • The inflammation of trachea and larger bronchi Grossly: Hyperemia, Edema, Mucous or mucopurulent secretion

9. Histology • The injury and regeneration of epithelia. • The hypertrophy, hyperplasia and metaplasia of mucus-secreting glands. (Reid I >0.5) • Infiltration with chronic and acute inflammatorycells.

10. Chronic bronchitis

11. Squamous metaplasia

12. An increase of goblet cells

14. C. Clinical Features • Cough • Sputum • Puff Secretion

15. D. Complications Bronchopneumonia Bronchiectasis Chronic bronchitis Cor pulmonale Pulmonary emphysema

16. Section 2 Pulmonary Emphysema肺气肿p194 • Emphysema : permanentenlargement of the airspaces distal to the terminal bronchioles. Accompanied by destruction of their walls.

18. A. Classification of emphysema Centriacinar Alveolar Periacinar Panacinar Interstitial: The air comes into the septa of the lung. Others type

20. Centriacinar腺泡中央型 Heavy smokers

21. Panacinar 全腺泡型 A1-AT deficiency

22. Periacinar 腺泡周围型

23. emphysema Normal lungs B. Pathology • Grossly: pale and voluminous lungs

25. Bullous lung • Balloon-like • >10 mm in diameter • are prone to rupture causing spontaneous pneumothorax自发性气胸

26. Histology 1.Thinning and destruction of alveolar walls, septa broken, adjacent alveoli become confluent.2. Terminal and respiratory bronchioles may be deformed.3. The number of alveolar capillaries decreases.

27. Thinning and destruction of alveolar walls, large airspaces

28. C. Pathogenesis • Proteases • Anti-proteases • Leukocytes • Alfa1-antitrypsin • Smoking, Inflammation • Inheritance

29. D. Clinical Features • Cough : dry or productive • Dyspnea • Mucoid sputum • Type A: Pink puffers • Type B: Blue bloaters

30. Barrel chest

31. Relationship between chronic bronchitis and emphysema chronic bronchitis and emphysema usually co-exist because the major pathogenic mechanism, cigarette smoking, is common to both.

32. (3)Bronchial Asthma 支气管哮喘P197 • Increased responsiveness of tracheobronchial tree to a variety of stimuli. • Bronchiolar smooth muscle contraction (bronchospasm支气管痉挛). • Paroxysmal attacks阵发性 • Mucus plugs in bronchi

33. A. Etiology and pathogenesis Hyper-reactive airways Hypersensitivity Bronchial smooth muscle spasm Hypersecretion—mucus plugs Increased vascular permeability Inflammation Nerve system

34. B. Clinical Features—episodic attacks • Dyspnea • Wheezing • Dry cough

35. 4. BRONCHIECTASIS支气管扩张症 • Permanent dilation of bronchi and bronchioles • Results from bronchial obstruction with distal infection and scarring • Destruction of alveolar walls, especially interstitial elastin, and fibrosis of lung parenchyma

36. Chronic inflammation Congenital, hereditary The destruction of the wall Dilation Fibrosis Fibrosis Obstruction

37. Pathology, Gross 1) Lower lobes of bilateral lungs are more common, particularly left side2) The airways may be dilated to as much as four times their usual diameter3) The dilated bronchioles can be seen almost to the pleura.

39. Morphology • Histological • Destruction of the bronchial or bronchiolar walls • Acute and chronic inflammatory exudate within the walls of the bronchi and bronchioles • Ulceration formation: the desquamation of lining epithelium cause extensive areas of ulceration. • Fibrosis of the bronchial and bronchiolar walls (in chronic cases). • Lung abscess.

42. Clinical Features • Cough • Mucopurulent sputum • Hemoptysis • Finger-clubbing • Dyspnoea • Clubbing

43. Clubbing • Normal

44. Complications • Pneumonia, lung abscess • Emphysema • Remote abscesses • Pulmonary hypertension • Chronic cor pulmonale

45. Chronic cor pulmonale 慢性肺源性心脏病 • A heart disease results from chronic lung diseases, chest or pulmonary vascular diseases. • Pulmonary hypertension(肺动脉高压). • Thickened right ventricle(右心室肥厚).

46. A. Etiology and pathogenesis • Recurrent pulmonary emboli • Heart disease: • Chronic obstructive or interstitial lung disease:

47. Chronic obstuctive pulmonary disease Disorders affecting chest movement Abnormalities of the pulmonary vasculature Pulmonary arteriolar constriction Pulmonary vascular bed • Key • Key Pulmonary hypertension Right ventricle hypertrophy

48. B. Pathology • Lung • Existed lung diseases: • Medium-sized muscular arteries: proliferation of myo-intimal cells and smooth muscle cells, causing thickening of the intima and media with narrowing of the lumina • Smaller arteries and arterioles: thickening, medial hypertrophy, and reduplication of the internal and external elastic membranes.