病理学.ppt

Logo,Pathology,病理学,Logo,病理学系（病理生物学教育部重点实验室）,Logo,Logo,The main duty of medicine,diseases,prevention,diagnosis,treatment,What disease am I suffering from? How can you cure it? How could you prevent me from having the illness in the future?,Patients just want to know:,Logo,Definition of pathology,Evolution of pathology,introduction,Introduction to pathology,Logo,病理学是用自然科学的方法研究疾病的形态结构、代谢和功能等方面的改变，从而揭示疾病的病因、发病机制和转归的医学基础学科。,Pathology is scientific study of structure and function of the body in disease. It deals with causes, effects, mechanisms and nature of disease.,What is Pathology?,Pathos means suffering, disease logos means study, science,Logo,Pathologythe study of disease,Diseaseloss of ease to the body (dis-ease) An entity with a cause,Illnessis the reaction of the individual to disease in the form of symptoms and physical signs,What is Pathology?,The study of diseases is done in pathology while the learning of illness will be done in wards and clinics.,Logo,Patients is the person affected by disease,Lesionsare the characteristic changes in tissues and cells produces by disease,Pathological changes or morphology examination of diseased tissues,Etiologywhy of disease,Pathogenesishow of disease,Terminology in Pathology,Symptoms and physical signs,What is Pathology?,Logo,The position of pathology in medicine,Bridging Subject,Foundational medicine,Clinical medicine,Pathology forms a vital bridge between preclinical sciences and clinical medicine.,Logo,“基础医学课目中与临床最接近的当推病理学， 因为它是临床与基础之间的桥梁，要学好临床先要 学好病理学，我毕业后才认识这个道理。原想加学 一年病理学以资弥补，可是没能做到，至今引为遗憾。”,The position of pathology in medicine,张孝骞（18971987） 著名医学教育家、中国消化病学的奠基人,Logo,How to study Pathology,General Pathology Common changes in all tissues. E.g. Inflammation, cancer, Systemic Pathology Specific changes in organs. E.g. pneumonia, breast cancer.,The relationship between general pathology and Systemic Pathology,Logo,How to study pathology,I hear and I forget. I see and I remember. I do and I understand .,Where location,What change,Why cause,Logo,The history of pathology,器官病理学 Organ pathology,组织细胞病理学 cellular pathology,超微结构病理学 ultrastructural pathology,分子病理学 molecular pathology,Logo,Diagnosis and research methods,尸体剖检（autopsy） 活体组织检查（biopsy） 细胞学检查（ cytology ）,动物实验（animal experiment） 组织和细胞培养（tissue and cell culture）,Logo,Diagnosis and research methods,尸体解剖检查- 简称尸检，即对死者的遗体进行病理解剖和进行系统的形态学分析，是病理学的基本研究方法之一,Autopsy: An examination of a cadaver to determine the cause of death.,Significance:,Logo,Logo,Significance:,“盖棺定论”,Diagnosis and research methods,Autopsy:,1. Confirmation diagnosis and major cause of the death 2. Discover some new diseases. 3. Accumulation experience of clinical treatment 4. Accumulation specimens,The purposes of autopsy:,Logo,Diagnosis and research methods,Biopsy: a procedure where diseased tissue is removed from the alive body for laboratory examination to determine the diagnosis.,活体组织检查-简称活检，即用局部切取、钳取、细针穿刺、搔刮和切取病变器官等手术方法，从患者活体获取病变组织或病变器官进行病理诊断。 又称为外科病理学，诊断病理学,病理学诊断“金标准”,Logo,Therapeutic resection Resected tissue for diagnostic purpose Endoscopic biopsies Shave biopsies Core biopsies Naturally discharged tissues,The origin of routine biopsy materials,biopsy,Logo,biopsy,An examination of pathologic samples from living body to set up diagnosis,Frozen Section Examination,Logo,Diagnosis and research methods,cytopathology: cytology is the diagnosis of disease from individual cells, such as cervical smears or fluid from cysts.,细胞学检查 -通过采集病变处的细胞，涂片染色后进行诊断,脱落细胞 自然分泌物 体液 排泄物 细针穿刺吸取,Logo,Diagnosis and research methods,Logo,Diagnosis and research methods,动物实验（animal experiment） 组织和细胞培养（tissue and cell culture）,Logo,Diagnosis and research methods,动物实验（animal experiment） 组织和细胞培养（tissue and cell culture）,Logo,Gross observation (大体）,1,HistopathologyMicroscope observation （镜下）,2,Immunohistochemistry (IHC)：免疫组织化学,3,electron microscope （用扫描、透射电镜观察病变亚微病）,4,flow cytometry（流式细胞学）：测定细胞DNA变化来研究诊断疾病,5,image analysis （图像分析技术 ）：定量法分析、诊断疾病,8,Laser Scanning Confocal microscope（激光扫描共聚焦显微镜）,6,Microdissection(激光显微切割）,7,Biological techniques 分子生物学技术,9,Basic techniques in the study and diagnosis of pathology,Logo,size weight shape color consistency surface edge section,Gross appearance:,Basic techniques in the study and diagnosis of pathology,Logo,Basic techniques in the study and diagnosis of pathology,HistopathologyMicroscope observation （镜下）,HE staining,Specific staining,HE,HE,Periodic acid schiff(PAS PAS,Logo,Basic techniques in the study and diagnosis of pathology,Immunohistochemistry (IHC) & immunofluorescence (IF),IHC,IF,Logo,Electron microscope,Basic techniques in the study and diagnosis of pathology,Logo,Laser Scanning Confocal microscope,Basic techniques in the study and diagnosis of pathology,Logo,flow cytometry,Basic techniques in the study and diagnosis of pathology,Logo,Microdissection pick up target cells (e.g.tumor cells) from HE slides for DNA extraction,Basic techniques in the study and diagnosis of pathology,By Manual,By laser,Logo,Biochip technique,Gene chip: Protein chip: Tissue array:,Basic techniques in the study and diagnosis of pathology,Logo,大体 组织和细胞学 组织和细胞化学 免疫组织化学 超微结构 流式细胞术 图像分析技术 分子生物学技术 激光扫描共聚焦显微术,Logo,第一章,Chapter one Tissue and Cellular adaptation and Injury,Logo,Diagram 2,Cell and tissue adaptation and injury,Logo,指细胞、组织、器官和机体对于持续性的内外刺激作出的非损伤性的应答反应。通过适应性反应，细胞、组织和器官改变其自身的代谢、功能和结构以达到新的平衡、耐受各种刺激而得以存活，避免损伤。,Adaptation 适应,Cellular adaptation occurs when excessive physiologic stresses, or some pathologic stimuli, result in a new but altered state that preserves the viability of the cell.,Logo,Hyperplasia 增生,Metaplasia 化生,Adaptation 适应,Adaptation,Cell size & number,differentiation,Cell number,Cell size,Logo,An increase in the size of cells and consequently an increase in the size of the organ.,hypertrophy-肥大,肥大：细胞体积的增大 组织和器官的肥大通常是由于实质细胞的体积增大所致，但也可伴有实质细胞数量的增加。,Definition:,Logo,athletic musculature the uterus during pregnancy lactating breast,Hypertrophy-types,Compensatory hypertrophy-caused by increased functional demand Endocrine hypertrophy caused by specific hormonal stimulation,hypertensive myocardial hypertrophy residual nephron hypertrophy hepatic cells hypertrophy (hyperplasia),Physiologic,Pathologic,Logo,Physiologic hypertrophy of uterus,Hypertrophy-types,Logo,Hypertrophy-morphology,Hypertrophy of cardiac muscle,Normal heart,concentric hypertrophy（compensatory),eccentric hypertrophy（decompensate）,Normal heart,hypertrophy,Logo,Hypertrophy-morphology,Logo,chronic glomerulonephritis,Hypertrophy-morphology,Compensatory hypertrophy,Atrophic glomeruli,Logo,An increase in the number of cells in an organ or tissue, which may then have increased volume.,Hyperplasia 增生,器官或组织的实质细胞数目增多。 增生可导致组织、器官的体积增大 增生是细胞有丝分裂活跃的结果，也与细胞凋亡受到抑制有关，通常受到增殖基因、凋亡基因、激素和各种肽类生长因子及其受体的精细调控。,Definition:,Logo,Hyperplasia-Types,Pathologic,Physiologic,Hormonal hyperplasia: female breast epithelium at puberty or during pregnancy Compensatory hyperplasia: a portion of the tissue is removed or diseased-a liver is partially resected,Excessive hormonal or growth factor stimulation: endometrial hyperplasia Hyperplasia of prostate gland would healingfibroblasts and blood vessels proliferate.,Logo,Hyperplasia-Types,Physiologic breast hyperplasia,Logo,Proliferated endometrium,Complex hyperplasia,Hyperplasia-Types,Logo,hyperplasia of prostate gland,Hyperplasia-Types,Hyperplasia Diffusetissue and organ diffusely enlarged Nodularsingle or multiple nodules,Logo,hyperplasia and hypertrophy,Although hypertrophy and hyperplasia are two distinct processes, frequently both occur together, and they will be triggered by the same mechanism. The hyperplasia process remains controlled (reversible) Pathological hyperplasia constitutes a fertile soil in which cancerous proliferation may arise.,Logo,Atrophy is Shrinkage in the size of the cell due to loss of cell substance.,Atrophy-萎缩,发育正常的实质细胞因细胞物质的丢失而体积变小称为萎缩。 细胞萎缩可导致组织、器官的体积缩小。常伴有细胞数目的减少,Definition,When a sufficient number of cells is involved, the entire tissue or organ diminishes in size, becoming atrophic.,Although atrophic cells may have diminished function, they are not dead.,Logo,Inadequate nutrition Decreased workload Denervation Pressure Loss of endocrine stimulation,Aging Endocrine,Physiologic,Atrophy- Types,Logo,大体：萎缩的器官体积缩小，重量减轻，色泽变深（褐色萎缩）；被膜皱缩，边缘变锐 镜下：实质细胞体积变小，可伴细胞数目的减少。心肌细胞和肝细胞等萎缩细胞胞质内可出现脂褐素颗粒 (lipofuscin) 电镜：线粒体、内质网等减少，自噬泡（autophagy vacuoles）显著增多，自噬泡内的细胞碎片不能被消化而以膜包绕的形式存在于细胞质，即脂褐素 可伴间质的增生假性肥大,Atrophy- Morphology,Logo,Chachexia 恶病质 is a sign of late-stage disease Marked weight loss Loss of muscle mass,Atrophy due to inadequate nutrition,Atrophy- Types,Logo,Atrophy- Morphology,Physiologic atrophy of brain,82 year-old male,Normal brain of a 25-year-old male,Logo,Atrophy- Morphology,Pathological atrophy of brain,Brain of Alzheimers disease,Brain atrophy caused by diminished blood supply,Logo,Atrophy- Morphology,Atrophy of heart,Logo,Atrophy- Morphology,Atrophy of heart,Tortuous of arteries,Brown atrophy of heart,Logo,normal heart atrophic heart,Atrophy- Morphology,Atrophy of heart,Logo,Atrophy- Morphology,Atrophy of heart,Normal cardiac muscle Atrophic cardiac muscle,Logo,Atrophy- Morphology,Atrophy of heart,Logo,Atrophy- Morphology,Logo,Atrophy- Morphology,Logo,Atrophy- Morphology,Pressure atrophy of brain,Logo,Atrophy- Morphology,Pressure atrophy of kidney,Logo,Normal liver Pressure atrophy ( liver carcinoma),Atrophy- Morphology,Pressure atrophy of liver,Logo,Atrophy represents a retreat by the cell to a smaller size at which survival is still possible; A new equilibrium is achieved between cell size and diminished blood supply, nutrition, or other stimulation. Mild-recover Severe and durative-to death,Atrophy,Logo,Metaplasia is a reversible change in which