中南大学想要在医学院病理课件局部血液循环障碍2010.ppt

1、 circulation volume abnormal materialemitHyperemia And Congestion A local increased volume of blood in a particular tissue充血和淤血充血和淤血 局部组织血管内血液含量增多局部组织血管内血液含量增多 Hyperemia Arterial hyperemia/Active hyperemia An active process resulting from augmented blood flow due to arteriolar dilation 充血充血 动脉性充血动脉性

2、充血/主动性充血主动性充血 动脉输入血量增多动脉输入血量增多原因：血管舒张神经兴奋性原因：血管舒张神经兴奋性 血管收缩神经兴奋性血管收缩神经兴奋性 舒张血管活性物质释放舒张血管活性物质释放 Causes:excitability of vasodilatator excitability of vasoconstrictor dilivery of relaxing vasoactive substance分类：分类：生理性充血生理性充血 病理性充血病理性充血 减压后充血减压后充血Classification:physiological pathological decompressionph

3、ysiological生理性充血生理性充血hyperemia of appendix阑尾充血阑尾充血pathological changesConsequence病变病变后果后果hyperemia Congestion Venous hyperemia/Passive hyperemia A passive process resulting from impaired venous return from a tissue 淤血淤血静脉性充血静脉性充血/被动性充血被动性充血静脉血流回流受阻静脉血流回流受阻Reasons:原因：原因：局部：局部：静脉受压血栓形成静脉受压血栓形成全身：心力衰竭全

4、身：心力衰竭FateLung congestion Lung brown induration Heart failure cells肺淤血肺淤血 肺褐色硬化肺褐色硬化 心衰细胞心衰细胞水肿出血水肿出血Lung brown indurationheart failure cellsHeart Failure cellsLung congestion Liver congestion 肝淤血肝淤血 Nutmeg liverNutmegNutmegNutmeg liverNutmeg liverCongestive liver cirrhosisThrombosis ThrombusThrombo

5、sis is the process of formation of a solid from the blood within living blood vessels or the heart,the resultant is termed a thrombus.血栓形成血栓形成/血栓血栓在在活体活体的心脏和血管内，血液发生凝固或血液的心脏和血管内，血液发生凝固或血液中某些有形成分凝集形成固体质块的过程中某些有形成分凝集形成固体质块的过程.Three primary influences predispose to thrombus formation:血栓形成的三个条件血栓形成的三个条件

6、:Endothelial injury 心血管内皮细胞的损伤心血管内皮细胞的损伤 Stasis or turbulence of blood flow血流状态的改变血流状态的改变(缓慢缓慢,涡流涡流)Blood hypercoagulability血液凝固性增高血液凝固性增高心血管内皮细胞的损伤心血管内皮细胞的损伤 抗凝抗凝Protective screenPGI2,NO,ADP酶酶ThrombomodulinMembrane-associated heparin-like moleculesProtein St-PA促凝促凝组织因子组织因子Von Willebrand factorPAIsO

7、n contact with extracellular matrix(ECM),platelets undergo three general reactions:(血小板的活化血小板的活化)Adhesion reaction(粘附反应粘附反应)Release reaction(释放反应释放反应)Aggregation reaction(粘集反应粘集反应)Ulcerative atherosclerosis(溃疡性的溃疡性的动脉粥样硬化动脉粥样硬化)Transmural myocardial infarction (透壁的透壁的心肌梗塞心肌梗塞)Vasculitis(脉管炎脉管炎,血管炎血管

8、炎)Trauma(创伤创伤,外伤外伤,损伤损伤)Radiation(辐射辐射,放射放射)Bacterial toxins(细菌毒素细菌毒素)Stasis or turbulence of blood flow（损伤）损伤）Process of thrombus formationTypes of thrombus（血栓的类型）（血栓的类型）Pale thrombus（白色血栓）白色血栓）Red thrombus（红色血栓）红色血栓）Mixed thrombus（混合血栓）混合血栓）Hyaline thrombus/microthrombus/fibrinous thrombus （透明血栓透明

9、血栓/微血栓微血栓/纤维素性血栓）纤维素性血栓）Downloaded from:Robbins&Cotran Pathologic Basis of Disease(on 28 August 2005 09:34 AM)2005 Elsevier Downloaded from:Robbins&Cotran Pathologic Basis of Disease(on 28 August 2005 09:34 AM)2005 Elsevier mixed thrombusmixed thrombuspale thrombushyaline thrombusFate of the Thrombu

10、s（血栓的结局）（血栓的结局）Dissolution（软化软化、溶解、吸收溶解、吸收 ）Organization/recanalization （机化机化/再通）再通）Calcification/phlebolith/arteriolith （钙化（钙化/静脉石静脉石/动脉石）动脉石）recanalization （影响：（影响：“弊大于利弊大于利”）阻塞血管局部缺血阻塞血管局部缺血栓塞）栓塞）心瓣膜变形）心瓣膜变形）广泛性出血）广泛性出血）Embolism（栓栓 塞）塞）Embolus（栓子）（栓子）An embolus is a detached intravascular solid,l

11、iquid,or gaseous mass that is carried by the blood to a site distant from its point of origin。(在循环血液中出现的不溶于血液的异常物在循环血液中出现的不溶于血液的异常物质，随血流运行阻塞血管腔的现象称为栓塞。质，随血流运行阻塞血管腔的现象称为栓塞。)Thromboembolism（血栓栓塞）（血栓栓塞）Pulmonary thromboembolism （肺动脉栓塞）（肺动脉栓塞）Systemic thromboembolism （体循环动脉栓塞）（体循环动脉栓塞）pulmonary embolism

12、 这里是位于通向这里是位于通向左肺的肺动脉内左肺的肺动脉内一个大的肺栓。一个大的肺栓。这类血栓发源于这类血栓发源于不能走动的病人不能走动的病人的大腿静脉或骨的大腿静脉或骨盆静脉。盆静脉。Large embolus derived from a lower extremity deep venous thrombosis and now impacted in a pulmonary artery branch.血栓栓子停留在脑动脉，发源于左心房的一个附壁血栓。血栓栓子停留在脑动脉，发源于左心房的一个附壁血栓。心脏是这种拴子的常见来源。心脏是这种拴子的常见来源。Fat embolism(脂肪栓塞

13、脂肪栓塞)Gas embolism（气体栓塞）（气体栓塞）Air embolism （空气栓塞）空气栓塞）Decompression sickness （减减 压压 病）病）图图a a为锁骨下静脉栓塞。为锁骨下静脉栓塞。图图b b为上腔静脉和左心为上腔静脉和左心室气体栓塞。室气体栓塞。图图c c为肺动脉干气栓。为肺动脉干气栓。角化上皮其他栓塞其他栓塞:胆固醇栓子胆固醇栓子癌栓癌栓Infarction（梗死）（梗死）An infarction is an area of ischemic necrosis caused by occlusion of either the arterial su

14、pply or the venous drainage in a particular tissue。（器官或局部组织由于血管阻塞，动脉多见、（器官或局部组织由于血管阻塞，动脉多见、血流停止导致缺氧而发生的坏死。）血流停止导致缺氧而发生的坏死。）血栓形成）血栓形成）Factors that influence development of an infarct （影响梗死的因素）（影响梗死的因素）Nature of the vascular supply （血管类型）（血管类型）Vulnerability to hypoxia （对缺血的敏感性）（对缺血的敏感性）texture color C

15、lassification（分类）（分类）Anemic infarcts/White infarcts （贫血性梗死（贫血性梗死/白色梗死）白色梗死）:心心,肾肾,脾脾 Hemorrhagic infarcts/Red infarcts （出血性梗死（出血性梗死/红色梗死）红色梗死）:肺、肠肺、肠 Septic infarcts （败血性梗死）（败血性梗死）Hemorrhagic infarcts/Spleen infarctLung infarct梗死区梗死区肠梗死肠梗死正常肠正常肠Intestine infarct Clinical Effects 决定于梗死的器官、决定于梗死的器官、梗死

16、灶的大小和部位、梗死灶的大小和部位、以及有无细菌感染以及有无细菌感染一、名词解释：一、名词解释：congestion Brown induration of lung Thrombosis Decompression sickness 二、问答题：二、问答题：1 1、慢性肝淤血时，肝切面为什么慢性肝淤血时，肝切面为什么会出现槟榔状花纹？会出现槟榔状花纹？2 2、栓子是如何运行的？、栓子是如何运行的？3 3、羊水栓塞的病理特征是什么？、羊水栓塞的病理特征是什么？4 4、静脉淤血、血栓形成、栓塞及、静脉淤血、血栓形成、栓塞及梗死之间有何联系？梗死之间有何联系？Case discussion Cas

17、e abstract.Female,30-year-old,farmer.Chief complaint.Intermittent palpitation(心悸）心悸）and short breathe for 1 years;lower extrem-ities edema and oligouria for 1 month.Current medical history.Since last year,she felt palpitation and short breath after laboring,and these symptoms were relieved when rela

18、xation.She caught a cold,and presented fever,worsen palpitation and short breath one month before.Simultaneously,Lower extremities edema,oligouria,and right-upper abdominal turgor(膨隆）膨隆）began and appetite decreased,Especially she was unable to lie horizontally.She was admitted to hospital because th

19、e General medical treatment was ineffective to her.Past medical history:frequent pharyngodynia(咽痛）咽痛）and arthralgia（关节痛）（关节痛）10 years before was mentioned.Physical examination.She was semireclin-Ing position,chronic sickly complexion with terminal and lips cyanosis.Jugular vein dilated,and mild-mode

20、rate rales in the dorsal of both lungs Were noticed.The cardiac border was enlarged bilaterally.HR 110/min,BP:110/70mmHg,thunder-like murmur during diastolic(舒张）舒张）phase was palpated in precordium region.And blowing murmur during systolic phase was ausculated(听诊听诊).The liver was 3 cm beneath the rib and 5 cm beneath the xiphoid process,tough and mild tenderness（触痛）（触痛）.勤奋、严谨、团结、进取勤奋、严谨、团结、进取 Diligent,rigorous,solidification,enterprising Thanks!