Pathology ofPneumonia课件

1、first step to make your dreams come true is to.wake up! paul valerypneumoniaintroduction:n5000 sq meters of area.! (olympic track)nfilters 10,000 l of air / day!nnormal lungs are sterile.ndelicate, thin resp. mem gas exch.nfilter, humidify, sterilize, highly sensitive.nrti resp. tract inf. commonest

2、 in medical practice.nenormous morbidity & mortality.npneumonia inflammation of alveoli.pneumonianormal lungpneumonianormal lungpneumoniaetiology:ndecreased resistance - general/immunenvirulent infection - lobar pneumoniandefective clearing mechanismncough/gag reflex coma, paralysis, sick.nmucos

3、al injury smoking, toxin aspirationnlow alveolar defense - immunodeficiencynpulmonary edema cardiac failure, embol.nobstructions foreign body, tumorspneumoniapatterns of lung disorders:nairway nbronchitis, bronchiectasis, bronchiolitis.ntumors / cancernparenchymanpneumonia.nlung abscess, tbnhyaline

4、membrane dis (hmd & ards)npneumoconiosisntumors / cancernpleura:npleural effusion (tb)ntumors / cancer* infectionspneumoniapathogenesis of pulmonary infectionsstep 1: entrynaspiration (ie pneumococcus)ninhalation (ie mtb and viral pathogens)ninoculation (contaminated equipment)ncolonization (in

5、patients with copd)nhematogenous spread (patients with sepsis)ndirect spread (adjacent abscess)pathogenesis:pathogenesis:pneumoniapneumonia types:etiologic types:ninfective nviralnbacterialnfungalntuberculosisnnon infectiventoxinsnchemicalnaspirationmorphologic types:nlobarnbronchoninterstitialdurat

6、ion:nacutenchronicclinical:nprimary / secondary.ntypical / atypicalncommunity a / hospital apneumonialobar pneumonia:nwhole lobe, exudation - consolidation n95% - strep pneum.(klebsiella in aged, dm, alcoholics)nhigh fever, rusty sputum, pleuritic chest pain.nfour stages: (*also in bronchopneumonia)

7、ncongestion 1d vasodilatation congestion.nred hepatization 2d exudation+rbcngray hepatizaiton 4d neutro & macrophages.nresolution 8d few macrophages, normal.congestionred hepatisationgrey hepatizationresolutionpathogenesis of pneumoniapneumonialobar pneumonia:pneumonialobar pneumonia:pneumonialo

8、bar pneumonia gray heppneumonialobar pneumonia:pneumonialobar pneumonia: congestionpneumonialobar pneumonia: red hepat.pneumonialobar pneumonia: grey hepat.pneumoniabroncho-pneumoniapneumoniabronchopneumonia (patchy)nextremes of age. (infancy and old age)nstaph, strep, pneumo & h. influenzanpatc

9、hy consolidation not limited to lobes.nsuppurative inflammationnusually bilateralnlower lobes commonpneumoniabroncho-pneumoniapneumoniabroncho-pneumoniapneumoniabronchopneumoniapneumoniabronchopneumonia:pneumoniabronchopneumonia - ctpneumoniabronchopneumoniapneumoniabroncho pneumonia - lobar nextrem

10、es of age.nsecondary.nboth genders.nstaph, strep, h.infl.npatchy consolidationnaround small airwaynnot limited by anatomic boundaries.nusually bilateral.nmiddle age 20-50nprimary in a healthy nmales common.n95% pneumoc (klebs.)nentire lobe consolidationndiffusenlimited by anatomic boundaries.nusuall

11、y unilateralbroncho pneumonia - lobar pneumoniainterstitial / atypical pneumonianprimary atypical pneumonia in the immunocompetant host (mycoplasma or chlamydia)ninterstitial pneumonitisnimmunocompromised host : pneumocystic carinii; cmvnimmunocompetant host: influenza angross features: nlungs are h

12、eavy but not firmly consolidatednmicroscopic features:nseptal mononuclear infiltratenalveolar air spaces either empty or filled with proteinaceous fluid with few or no inflammatory cellsinterstitial pneumonia:pneumoniainterstitial pneumonia:lymphocyte infiltrate in alveloar wallpneumoniachronic pneu

13、monianchronic, lymphoid infiltrate, nno classic stages.nlung destruction cavity, abscess etc.norganismsnmycobacterium tuberculosisnhistoplasma capsulatumnaspergillosisnactinomycespneumoniacomm pneumonia - nosoc nin healthy adultsngram positive.nstreptococcus pneumoniae (90%)nstrep. pyogenes, staph,

14、h. influenzae and klebsiella in elderly or with copd.nin *sick patients.ngram-negative bacilli npseudomonas aeruginosa, escherichia coli, enterobacter, proteus, and klebsiella.pneumoniapathogenesis of clinical features:*alveolar inflammation.ntachypnoea, dyspnoea, resp acidosis solid/airless lungs d

15、ecreased oxygenation.ndull percussion - consolidation exudationnrusty sputum - rbc & inflammatory cells. nfever inflammatory mediators.pneumoniacomplications of pneumonianabscessesnlocalized suppurative necrosis, right side often in aspiration.nstaphylococcus; klebsiella; pneudomonasnpleuritis / pleural effusion.ninflammation of the pleura ( streptococcu