1. Introduction of Pathology （病理学绪论 ) 复旦大学上海医学院病理学系 朱虹光

2. 1, What is Pathology 2, The history of pathology and the position in medicine 3, How to study pathology

3. 一、 What is pathology  pathology, study of sufferring (Logos) (pathos)

4. 1 ， The branch of pathology 总论（ general pathology) （ 1 ）基础病理学 ( Basic pathology) 各论 (systemic pathology) （ 2 ）临床病理学 (clinical pathology)

5. Basic pathology 1 ， A bridge which can help medical students to across the river between basic medical science and clinical subjects

6. The task of basic pathology 2 ，基础病理学的内容： （ 1 ） etiology( 病因学 ) （ 2 ） pathogenesis( 发病机制 ) （ 3 ） Morphology( 病理变化 ) （ 4 ） consequence( 结局 )

7. Exams of Pathology 1, paper exams. 70% 2, practice exams. 20% 3, classes: 10%

8. The history of pathology 3 steps

9. The first step organ pathology Visalius – human anatomy started in 1600s. It is the beginning of modern medicine. Morgagni – He is the founder of organ pathology, who reported more than 700 cases about locations and reasons of the diseases in 1761. Rokitansky - reported more than 30,000 pathology anatomy.

10. 细胞病理学（ cellular pathology ） Schleiden & Schwan – The founder of cell biology. Their conclusion is “ all the living body was organized with cells. ” Virchow-The founder of cellular pathology. The famous book “ cellular pathology ” was published in 1858

11. EM and molecular pathology EM – in 1930s Molecular pathology – in 1970s

12. The position in medicine 1 ， the bridge subject in medical education 2 ， the final diagnosis in the clinic 3 ， the gold standard in the medical legal cases 4 ， the gold standard of standard medical quality control 5 ， the gold standard in the medical research

13. 3, How to Study Pathology Practice The Relationship of Clinical and Pathology

14. The Keys in the Pathologic Study 1 the basic essential words in the general pathology( 总论中的基本概念 ) 2 the basic pathologic changes in the organ pathology( 各论中的基本病理变 化 ) 3 To use the knowledge in the geneal pathology to the organ pathology( 总论各论的融会贯通 )

15. The first chapter adaptation and injury ( 组织、细胞的适应和损伤 )

16. Injury factors 1 Oxygen deprivation 2 Chemical agents 3 Infectious agents 4 Immunologic reactions 5 Genetic defects 6 Nutritional imbalances 7 Physical agents 8 Aging

17. Cell injury, adaptation and death Oxygen deprivation normal cells (adaptation) (reversible injury) (irreversible injury)

18. The most important reasons for the injury ： The power of the injury factors ( 损伤因子的作用强度 ) The characters and functional status of the cell and tissue. 组织、细胞的特性及功能状态

19. 1 cellular adaptation, （细胞适应）

20. Adaptation of cellular and tissue the morphologic and functional changes of the cell and tissue to the environmental changes. ( 机体组织、细胞对内、外环境的变 化所发生的形态结构和功能代谢的 改变 )

21. Classification ： atrophy （萎缩） hypertrophy （肥大） hyperplasia （增生） metaplasia （化生 )

22. （一） atrophy( 萎缩 ) Shrinkage in the size of the cell by the loss of cell substance in the normal developed organs ( 发育正常的器官、组织和细胞体积的 缩小 )

23. morphology Gross: Smaller in size Brown in color Brown atrophy ( 褐色萎缩 )

24. microscope: Cell becacome smaller, lipofuscin increased. （ lipofuscin ） EM: increased autophage

26. Results: reversible, decreased function Atrophy of the brain — aging idiot Atrophy of the adrenal — Addison ’ s disease Atrophy of the islet — Diabetes

27. The classification of the atrophy 1, physiologic atrophy: a, adolescent stage: thymus b, aging: uterus, beast, brain 2, pathologic atrophy: a, inadequate nutrition b, decreased workload c, loss of innervation d, pressure (hydronephrosis) e, loss of endocrine stimulation

28. Hypertrophy （肥大 ) Hypertrophy is an increase in the size of cell resulting in in crease in the size of the organ.

29. Morphology Gross ： (heart) increased size in heart wall. LM ： Increased size in the cardiomyocyte, and the nuclear strongly stained.

30. classification Physiologic hypertrophy: the uterus and the breast in pregnancy Pathologic hepertrophy: adaptation (heart in hypertension) compensation (kidney after removed one )

31. results of the hepertrophy Reversible Increased function, but may cause the compensation ability lossed.

32. hyperplasia （增生） Hyperplasia is an increase in the number of cell s in an organ or tissue. It often occurs with the hypertrophy at the same time.

33. Classification Physiologic hypertrophy: the uterus and the breast in pregnancy Pathologic hypertrophy adenosis of the breast healing granulation tissue

34. Morphyology The number of cells increased

35. Results: 1, make the organ adapt to the demands of function 2, hyperplasia can cause dysplasia and even cancer

36. metaplasia （化生） One adult cell type is replaced by another adult cell type. Epithelial become another type epithelial Mesenchymal become another type mesenchymal Reversible change

37. classification Metaplasia of normal ciliated columnar to squamous epithlium

38. Fibro-tissue to chondro-tissue

39. squamous to epithlium columnar

40. The significance of metaplasia Suit to the environmental change Loss the original function

41. cellular degeneration （细胞变性） The normal or abnormal substances accumulated in the cells caused by the injury factor. reversible injury

42. cellular swelling （细胞肿胀） The degeneration is a slight lesion, and often occurs in the highly metabolic organs. Gross: pallor, increased in turgor and weight of the organ. Microscope: the cytoplasm become clear, and a lot of particles in it. So, it is also called as hydropic change or vacuolar degeneration.

44. Mechanism Na + --K + ATP as difunction

45. fatty degeneration ( 脂肪变性 ) Fatty change refers as to any abnormal accumulation of triglycerides with parenchymal cells except fat cells.

46. Hepatic steatosis Gross: increased in size. The cutting surface became yullow. LM: clear vacuoles without any substance. the well-preverved nuleus is aqueezed into the displaced rim of cytoplasm about the fat vacuole.

47. fatty change in cardiomyocyte

48. Fatty change in kidney

49. Mechanism Starving, over-nutrition, toxic, hypoxia,

50. cell death （细胞死亡 ), irreversible injury ） necrosis （ pathologic Two types apoptosis （ physiologic or pathologic ）

51. necrosis （坏死） Local cells or tissue died in the living body.

52. Morphology 1. Nuclear changes The most important marker of cell death. a. pyknosis （核固缩） —the nucleus shrinkage and increased basophilia. b. karyorrhexis （核碎裂） —the nucleus broken and basophilia of the chromatin fade. c. karyolysis （核溶解） —the nucleus compeletely disappeared

53. Morphology 2. Cytoplasmic changes increased iosinophilic and hogeneous of cytoplasm Degradation of protein and RNA

54. Morphology 3. interstitial tissue changes Degradation of matrix structureless eosinophilic material Inflammation cells infiltration

55. Mechanism of the nocrostic morphology Degradation by the enzymes from broken lysosomes Autolysis: degradation from the died cell’s lysosomes. Heterolysis: degradation from the infiltrated inflammation cells.

56. Types of necrosis 1. coagulation necrosis （ 凝固性坏死） character ： the basic structure outline of the cell or tissue was kept for a span of days. location ： heart, kidney, liver, spleen, arms, center of the cancer

58. 2. liquefaction necrosis （液化性坏死） Characters: The structure outline was not kept, but left the liquefaction space. Location ： Brain, 、 spine

59. 3. Special type of necrosis A, caseous necrosis （干酪样坏死） The special marker for tuberculosis and some fungi infection. Gross ： yellow, and looks like cheese. LM ： complete necrosis without structure outline, and amorphous granular appearance.

62. b, fat necrosis （脂肪坏死） The character of acute bleeding necrotic pancreatitis. Gross ： the areas of white chalky deposits represent foci of calcium soap formation. LM ： necrosis contain shadowy outlines of necrotci fat cells with basophilic calcium deposit.

65. C, fibrinoid necrosis （纤维蛋白样坏死） The character of immune reactions involving blood vessles.

66. Morphology ： The immune complexes together sith fibrin result in a bright pink and amorphous appearance.

67. d. gangrene （坏疽） Classification: 1, dry gangrene 2, wet gangrene 3, gas gangrene

68. Dry gangrene Usually occurs in a limb that lost its blood supply and has undergone coagulative necrosis involving multiple tissue layers. It appears black, dry, and shriveled

69. Wet gangrene Swollen and reddish-black. Occurs in the case of both artery and vein blocked.

70. Gas gangrene The gross appearance is similar to that of wet gangrene, with the additional presence of gas in the tissues.

71. The results of necrosis 1, resolved and absorbed. No scar formed. 2, separated and excluded. Ulcer, cavity and capsulated. 3. organization （机化） scar formed 4. calcification （钙化） calcium accumulated

72. Apoptosis （细胞凋亡） Apoptosis is induced by a suicide program in the cells. It appears in the many physilogic programm.

73. Morphology LM ： simgle cell may appear as round or oval masses with intensely eosinophilic cytoplasm. The muclei show pyknosis, karyorrhexis, karyolysis. One of the apoptotic characters is no inflammative reaction.

74. hyaline degeneration （玻璃样变性） A amorphous and pink material accumulated in the cells, vessle wall or connective tissue ：

75. Types Hyaline degeneration in the cells. Viral particles 病毒或病毒颗粒 Negri body —— 狂犬病病毒 CMV inclusion body —— 巨细胞病毒

76. 2. Reabsorbed protein Rusell body —— 浆细胞浸润 3. Aggregated intermediate filaments Mallory body —— pro-keratin 4. Apoptosis body Councilman body

77. Protein accumulations in the epithelium of the tubules if theminimal change gomerulonephropathy

78. Mallory body (Prekeratin in liver cells)

79. Hyaline degeneration in vessles wall Hyaline degeneration in kidney arterioles

80. Hyaline degeneration in connective tissues Hyaline degeneration in the scar

81. A myloidosis （淀粉样变） Amyloid protein accumulated in the interstitial tissue or vessles wass. 。

82. Chemical nature of amyloid （一） amyloid light chain ( 免疫球蛋白 轻链） mainly λchain so called primary amyloidodosis （二） amyloid associated protein It is called secondary amyloidosis

85. Under the polarized light microscope

86. pathologic calcification （病理性钙化） The calcium deposited in the any tissues except bone and teeth.

87. 类型 （一） dystrophic calcification （营养不良性钙 化） Occurs in the pathologic tissues.

89. metastatic calcification （转移性钙化） Occurs in the normal tissues with the hypercalcemia.