八制临床医学专业模块肝脏病理.docVIP

八年制临床医学专业-模块6-肝脏病理 授课提纲 一、基本病理变化 1. Degeneration and intracellular accumulation: Cell swelling; ballooning degeneration; feathery degeneration; steatosis 2. Necrosis and apoptosis ①点状坏死（spotty necrosis）：肝小叶内灶性肝细胞（数个肝细胞）溶解坏死，局部炎细胞浸润。 ②碎片状坏死（piecemeal necrosis）：指汇管区周围的肝细胞（即肝小叶界板）变性坏死，使肝小叶界板呈虫蚀状破坏。这种坏死常伴有大量淋巴细胞及浆细胞浸润，形成汇管区周围炎)。 Piecemeal necrosis: The necrosis at the interface between the periportal parenchyma and inflamed portal tracts and accompanied by lymphocytes infiltration (Also “interface” hepatitis) ③桥接坏死（bridging necrosis）：表现为坏死区呈带状，连接中央静脉与中央静脉、中央静脉与汇管区以及汇管区与汇管区)。 Bridging necrosis: In more severe inflammatory or toxic injury, necrosis may span adjacent lobules in a portal-to-portal, portal-to-central (vein), central-to-central fashion ④亚大块坏死（submassive necrosis）和大块坏死（massive necrosis）： 前者指累及数个肝小叶的融合性坏死，小叶内尚有1/3～2/3残存的肝细胞；Submassive necrosis: Destruction of entire lobules, leaving islands of hepatocytes 后者指大部分或全部肝小叶发生大片坏死）；Massive necrosis: necrosis involving most of the liver parenchyma, the lobules are destroyed, collapse and disappear, and is usually accompanied by hepatic failure 3. 汇管区和坏死灶内炎细胞浸润。Inflammation: portal or entire parenchyma inflammation 4. Regeneration: hepatocyte regeneration is recognized by the presence of mitoses Fibrosis and cirrhosis: Deposition of collagen; portal or periportal fibrosis; bridging fibrosis; regeneration nodule formation (pseudolobule) and surrounding by fibrous septa (cirrhosis) 二、病毒性肝炎　Viral hepatitis 病因和发病　Etiology and pathogenesis 临床病理类型 1. Acute hepatitis Enlarged, reddened liver, greenish if cholestatic Cell swelling Apoptosis and necrosis Inflammation Kupffer cells hypertrophy and hyperplasia Cholestatic 2. Fulminant hepatitis 急性重型肝炎 肉眼①肝体积↓（左叶），重量↓ ②被膜皱缩，质地柔软，可折叠③切面呈黄色或红褐色（急性黄色肝萎缩或急性红色肝萎缩） 镜下特点①弥漫性大片融合性坏死（大块坏死）②无明显肝细胞再生现象 亚急性重型肝炎：与急性重型肝炎主要不同在于有肝细胞再生结节（大体呈岛屿状） 3. 慢性肝炎（chronic hepatitis） 　　病程持续半年以上者。根据炎症、坏死及纤维化程度分为轻、中、重度三类。1、轻度慢性肝炎（1）点（灶）状坏死，偶见轻度碎片状坏死；（2）汇管区周围纤维增生；（3）肝小叶结构完整。 2、中度慢性肝炎（1） 坏死明显，除灶