八年制臨床醫(yī)學(xué)專業(yè)-模塊6-肝臟病理

1、八年制臨床醫(yī)學(xué)專業(yè)八年制臨床醫(yī)學(xué)專業(yè)八年制臨床醫(yī)學(xué)專業(yè)模塊模塊模塊666肝臟病理肝臟病理肝臟病理授課提綱授課提綱授課提綱授課提綱一、基本病理變化一、基本病理變化一、基本病理變化1.1.1.DegenerationDegenerationDegenerationintracellularintracellularintracellularaccumulation:accumulation:accumulation:CellCellCell

2、swellingswellingswellingballooningballooningballooningdegenerationdegenerationdegenerationfeatheryfeatheryfeatherydegenerationdegenerationdegenerationsteatosissteatosissteatosis2.2.2.NecrosisNecrosisNecrosisapoptosisapop

3、tosisapoptosis①點(diǎn)狀壞死（spottynecrosis）：肝小葉內(nèi)灶性肝細(xì)胞（數(shù)個(gè)肝細(xì)胞）溶解壞死，局部炎細(xì)胞浸潤(rùn)。②②碎片狀壞死（碎片狀壞死（碎片狀壞死（piecemealpiecemealpiecemealnecrosisnecrosisnecrosis）：指匯管區(qū)周圍的肝細(xì)胞（即肝小葉界板））：指匯管區(qū)周圍的肝細(xì)胞（即肝小葉界板））：指匯管區(qū)周圍的肝細(xì)胞（即肝小葉界板）變性壞死，使肝小葉界板呈蟲(chóng)蝕狀破壞。這種壞死常伴

4、有大量淋巴細(xì)胞及漿細(xì)胞浸變性壞死，使肝小葉界板呈蟲(chóng)蝕狀破壞。這種壞死常伴有大量淋巴細(xì)胞及漿細(xì)胞浸變性壞死，使肝小葉界板呈蟲(chóng)蝕狀破壞。這種壞死常伴有大量淋巴細(xì)胞及漿細(xì)胞浸潤(rùn)，形成匯管區(qū)周圍炎潤(rùn)，形成匯管區(qū)周圍炎潤(rùn)，形成匯管區(qū)周圍炎))。。PiecemealPiecemealPiecemealnecrosis:necrosis:necrosis:TheTheThenecrosisnecrosisnecrosisatatatthethethe

5、interfaceinterfaceinterfacebetweenbetweenbetweenthethetheperiptalperiptalperiptalparenchymaparenchymaparenchymainflamedinflamedinflamedptalptalptaltractstractstractsaccompaniedaccompaniedaccompaniedbybybylymphocyteslymph

6、ocyteslymphocytesinfiltrationinfiltrationinfiltration(Also(Also(Also“interface”“interface”“interface”hepatitis)hepatitis)hepatitis)③③橋接壞死（橋接壞死（橋接壞死（bridgingbridgingbridgingnecrosisnecrosisnecrosis）：表現(xiàn)為壞死區(qū)呈帶狀，連接中央靜脈與中央靜）：

7、表現(xiàn)為壞死區(qū)呈帶狀，連接中央靜脈與中央靜）：表現(xiàn)為壞死區(qū)呈帶狀，連接中央靜脈與中央靜脈、中央靜脈與匯管區(qū)以及匯管區(qū)與匯管區(qū)脈、中央靜脈與匯管區(qū)以及匯管區(qū)與匯管區(qū)脈、中央靜脈與匯管區(qū)以及匯管區(qū)與匯管區(qū)))。。BridgingBridgingBridgingnecrosis:necrosis:necrosis:InInInmememesevereseveresevereinflammatyinflammatyinflammatytoxict

8、oxictoxicinjuryinjuryinjurynecrosisnecrosisnecrosismaymaymayspanspanspanadjacentadjacentadjacentlobuleslobuleslobulesinininaaptaltoptaltoptaltoptalptalptalptaltocentralptaltocentralptaltocentral(vein)(vein)(vein)centralt

9、ocentralcentraltocentralcentraltocentralfashionfashionfashion④④亞大塊壞死（亞大塊壞死（亞大塊壞死（submassivesubmassivesubmassivenecrosisnecrosisnecrosis）和大塊壞死（）和大塊壞死（）和大塊壞死（massivemassivemassivenecrosisnecrosisnecrosis）：）：）：前者指累及數(shù)個(gè)肝小葉的融合

10、性壞死，小葉內(nèi)尚有前者指累及數(shù)個(gè)肝小葉的融合性壞死，小葉內(nèi)尚有前者指累及數(shù)個(gè)肝小葉的融合性壞死，小葉內(nèi)尚有131313～～232323殘存的肝細(xì)胞；殘存的肝細(xì)胞；殘存的肝細(xì)胞；SubmassiveSubmassiveSubmassivenecrosis:necrosis:necrosis:DestructionDestructionDestructionofofofentireentireentirelobuleslobuleslobu

11、lesleavingleavingleavingislsislsislsofofofhepatocyteshepatocyteshepatocytes后者指大部分或全部肝小葉發(fā)生大片壞死）；后者指大部分或全部肝小葉發(fā)生大片壞死）；后者指大部分或全部肝小葉發(fā)生大片壞死）；MassiveMassiveMassivenecrosis:necrosis:necrosis:necrosisnecrosisnecrosisinvolvinginvo

12、lvinginvolvingmostmostmostofofofthethetheliverliverliverparenchymaparenchymaparenchymathethethelobuleslobuleslobulesarearearedestroyeddestroyeddestroyedcollapsecollapsecollapsedisappeardisappeardisappearisisisusuallyusua

13、llyusuallyaccompaniedaccompaniedaccompaniedbybybyhepatichepatichepaticfailurefailurefailure3.匯管區(qū)和壞死灶內(nèi)炎細(xì)胞浸潤(rùn)。Inflammation:ptalentireparenchymainflammation4.4.4.Regeneration:Regeneration:Regeneration:hepatocytehepatocytehep

14、atocyteregenerationregenerationregenerationisisisrecognizedrecognizedrecognizedbybybythethethepresencepresencepresenceofofofmitosesmitosesmitosesFibrosisFibrosisFibrosiscirrhosis:cirrhosis:cirrhosis:DepositionDepositionD

15、epositionofofofcollagencollagencollagenptalptalptalperiptalperiptalperiptalfibrosisfibrosisfibrosisbridgingbridgingbridgingfibrosisfibrosisfibrosisregenerationregenerationregenerationnodulenodulenodulefmationfmationfmati

16、on(pseudolobule)(pseudolobule)(pseudolobule)surroundingsurroundingsurroundingbybybyfibrousfibrousfibrousseptaseptasepta(cirrhosis)(cirrhosis)(cirrhosis)三、酒精性肝病三、酒精性肝病三、酒精性肝病AlcoholicAlcoholicAlcoholicliverliverliverdisea

17、sesdiseasesdiseases病理變化：FattyFattyFattyliverliverliverAlcoholicAlcoholicAlcoholichepatitishepatitishepatitisHepatocyteHepatocyteHepatocyteswellingswellingswellingnecrosisnecrosisnecrosisMallyMallyMallybodiesbodiesbodiesN

18、eutrophilicNeutrophilicNeutrophilicreactionreactionreactionFibrosisFibrosisFibrosisAlcoholicAlcoholicAlcoholiccirrhosiscirrhosiscirrhosis四、肝硬變四、肝硬變四、肝硬變CirrhosisCirrhosisCirrhosis各種原因各種原因各種原因→→肝細(xì)胞彌漫變性壞死、纖維組織增生、肝細(xì)胞結(jié)節(jié)狀再生肝細(xì)

19、胞彌漫變性壞死、纖維組織增生、肝細(xì)胞結(jié)節(jié)狀再生肝細(xì)胞彌漫變性壞死、纖維組織增生、肝細(xì)胞結(jié)節(jié)狀再生→→損傷與損傷與損傷與修復(fù)反復(fù)交替修復(fù)反復(fù)交替修復(fù)反復(fù)交替→→肝小葉結(jié)構(gòu)改建、肝血液循環(huán)途徑改建肝小葉結(jié)構(gòu)改建、肝血液循環(huán)途徑改建肝小葉結(jié)構(gòu)改建、肝血液循環(huán)途徑改建肝變形、變硬肝變形、變硬肝變形、變硬→→門(mén)靜脈高門(mén)靜脈高門(mén)靜脈高壓癥、肝功能不全壓癥、肝功能不全壓癥、肝功能不全11、病因與發(fā)病機(jī)理、病因與發(fā)病機(jī)理、病因與發(fā)病機(jī)理（（11））Vi

20、ralViralViralhepatitishepatitishepatitis病毒性肝炎病毒性肝炎病毒性肝炎——乙型及丙型乙型及丙型乙型及丙型（（22）慢性酒精中毒）慢性酒精中毒）慢性酒精中毒AlcoholicAlcoholicAlcoholicliverliverliverdiseasediseasedisease（（33））BiliaryBiliaryBiliarydiseasesdiseasesdiseases（（44））Met

21、abolicMetabolicMetabolicdiseasesdiseasesdiseases分類按病因分類：病毒性肝炎性、酒精性、膽汁性、淤血性、寄生蟲(chóng)性、隱源性按形態(tài)分類：小結(jié)節(jié)型（φ＜3mm＝）；大結(jié)節(jié)型（φ＞3mm）；大小結(jié)節(jié)混合型；不全分隔型（早期肝硬化）結(jié)合病因及病變分類：門(mén)脈性、壞死后性、膽汁性、淤血性、寄生蟲(chóng)性、色素性門(mén)脈性肝硬化（門(mén)脈性肝硬化（門(mén)脈性肝硬化（PtalPtalPtalcirrhosiscirrhosis

22、cirrhosisAlcoholicAlcoholicAlcoholiccirrhosiscirrhosiscirrhosisLaennec’sLaennec’sLaennec’scirrhosis)cirrhosis)cirrhosis)（1）肉眼:micronodularcirrhosis；肝體積↓、重量↓、變硬表面—顆粒狀結(jié)節(jié)，大多φ0.15～0.3cm；切面—結(jié)節(jié)大小相近，呈黃褐色（脂變）或黃綠色（淤膽）；纖維間隔薄，厚薄均勻（