病理学ppt课件-局部血液循环障碍 .ppt
Local Hemodynamic Disorders局部血液循环障碍,病理学系彭劲武,Contents,循环血量的异常(充血、缺血)血液内出现异常物质(血栓、空气、脂滴、羊水等)血管内成分逸出血管外（水肿、出血）,Hyperemia And Congestion A local increased volume of blood in a particular tissue充血和淤血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 主动性充血/动脉性充血 动脉输入血量增多,原因：血管舒张神经兴奋性 血管收缩神经兴奋性 舒张血管活性物质释放 分类：生理性充血 病理性充血 减压后充血,Causes:excitability of vasodilatator excitability of vasoconstrictor dilivery of relaxing vasoactive substanceClassification:physiologic congestion pathological congestion congestion after decompression,hyperemia of appendix阑尾充血,pathological changes:Consequence:病变：后果：,hyperemia,Congestion Venous hyperemia/Passive hyperemia A passive process resulting from impaired venous return from a tissue 淤血静脉性充血/被动性充血静脉血流回流受阻,Reasons:Local congestion：External pressureThrombosisVenous valvesSystemic congestion：Heart failures原因：局部：静脉受压静脉腔阻塞全身：心力衰竭,Pathological changes：cyanosis-a blue-red color病变：发绀,Fate Atrophy/Degeneration/NecrosisCongestive edemaCongestive hemorrhageCongestive sclerosis萎缩/变性/坏死淤血性水肿淤血性出血淤血性硬化,Lung congestion,Lung congestion Lung brown induration Heart failure cells肺淤血 肺褐色硬化 心衰细胞,Lung brown induration,heart failure cells,Heart Failure cells,Liver congestion Nutmeg liver Congestive liver cirrhosis 肝淤血 槟榔肝 淤血性肝硬化,Nutmeg liver,Nutmeg,Nutmeg liver,Nutmeg liver,Congestive liver cirrhosis,Thrombosis ThrombusThrombosis 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/血栓在活体的心脏和血管内，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.,Three primary influences predispose to thrombus formation:Endothelial injury(most important)Alone can induce thrombosis Stasis or turbulence of blood flow Blood hypercoagulability血栓形成的三个条件:心血管内皮细胞的损伤 血流状态的改变(缓慢,涡流)血液凝固性增高,抗凝,Protective screen,PGI2,NO,ADP酶,ThrombomodulinMembrane-associated heparin-like moleculesProtein S,t-PA,促凝,组织因子,Von Willebrand factor,PAIs,On contact with extracellular matrix(ECM),platelets undergo three general reactions:Adhesion reaction Release reaction Aggregation reaction血小板的活化 粘附反应 释放反应 粘集反应,Ulcerative atherosclerosis(溃疡性的动脉粥样硬化)Transmural myocardial infarction(透壁的心肌梗塞)Vasculitis(脉管炎,血管炎)Trauma(创伤,外伤,损伤)Radiation(辐射,放射)Bacterial toxins(细菌毒素),血流状态的改变(缓慢,涡流)Platelets activated by contact with endothelium.Slowed flow retards dilution of activated clotting factors and hepatic clearance.Turbulence may induce endothelial injury,血液凝固性增高:Primary(genetic):Antithrombin(抗凝血酶)III deficiency Protein C deficiency Protein S deficiencySecondary(acquired):Prolonged bed rest(长期卧床休息)Myocardial infarction(心肌梗塞)Tissue damage(surgery,fractures,burns)Cardiac failure(心力衰竭).Cancer.Acute leukemia(急性白血病).DIC.,Process of thrombus formation,Types of thrombus Pale thrombus Mixed thrombus Red thrombus Hyaline thrombus/microthrombus/fibrinous thrombus血栓的类型 白色血栓 混合血栓 红色血栓 透明血栓/微血栓/纤维素性血栓,白色血栓,pale thrombus,门静脉内血栓形成,肾静脉内血栓形成,左心室附壁血栓,左心房内球形附壁血栓,mixed thrombus,红色血栓,hyaline thrombus,Fate of the Thrombus Dissolution Organization/recanalization Calcification/phlebolith/arteriolith血栓的结局 软化、溶解、吸收 机化/再通 钙化/静脉石/动脉石,recanalization,影响：“弊大于利”1.阻塞血管 2.栓塞 3.心瓣膜变形4.广泛性出血:DIC,Effects of thrombosis：Ischemia(局部缺血)CongestionEmbolismHeart valve diseaseDIC,EmbolismEmbolusAn embolus is a detached intravascular solid,liquid,or gaseous mass that is carried by the blood to a site distant from its point of origin,栓 塞栓子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。,Motional pathway of embolus:Embolus from left heart cavity or arterial system Embolus from right heart cavity or venous system Embolus from portal veins Paradoxical embolism Retrograde ethrombus,栓子运行的途径：动脉系统及左心栓子静脉系统及右心栓子门静脉系统栓子交叉性栓塞逆行性栓塞,运行途径,Thromboembolism Pulmonary thromboembolism Systemic thromboembolism血栓栓塞 肺动脉栓塞 体循环动脉栓塞:下肢.脑.肠.肾,pulmonary embolism,肺动脉主干及分支血栓栓塞,这里是位于通向左肺的肺动脉内一个大的肺血栓。这类血栓发源于不能走动的病人的大腿静脉或骨盆静脉。,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。,Etiology:Fractures of long bonesSoft tissue trauma(创伤)Burns,脂肪栓塞,Fat embolism(脂肪栓塞),Gas embolism Air embolism Decompression sickness Amniotic fluid embolism气体栓塞 空气栓塞 减 压 病,羊水栓塞,Incidence:1/50 000 deliveriesMortality rate:20-80%Clinical onset:Sudden severe dyspnea,cyanosis,hypotensive shock,seisuresand coma.,角化上皮,其他栓塞:胆固醇栓子,癌栓,InfarctionAn infarction is an area of ischemic necrosis caused by occlusion of either the arterial supply or the venous drainage in a particular tissue梗死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坏死的过程，称为梗死形成，所形成的局部坏死称为梗死,Causes,血栓形成:心,脑,肢体 动脉栓塞:肾,脾,肺,脑 动脉痉挛 血管受压闭塞,Characteristics Shape:Wedge-shaped(楔形)Segmental(节段性)Irregular(不规则形)color:Red and white infarcts,Classification Anemic infarcts/White infarcts Hemorrhagic infarcts/Red infarcts Septic infarcts分类 贫血性梗死/白色梗死:心,肾,脾 出血性梗死/红色梗死:肺、肠 败血性梗死,Renal infarct,Spleen infarct,Lung infarct,梗死区,Intestine infarct,细菌栓子,THANKS,提问,一、名词解释：Congestion/Heart failure cellsBrown induration of lung/Nutmeg liver Thrombosis/Mixed thrombus Hyaline thrombus/RecanalizationCrossed embolism/Retrograde embolismAmniotic fluid embolism/Infarction Anemic infarcts/Hemorrhagic infartsDecompression sickness,二、问答题：1、慢性肝淤血时，肝切面为什么会出 现槟榔状花纹？2、栓子是如何运行的？3、羊水栓塞的病理特征是什么？4、静脉淤血、血栓形成、栓塞及梗死之间有何联系？,
