资源简介

(共27张PPT)
第二章 局部血液循环障碍
5出血 Hemorrhage
血液由心腔或血管内逸出，称为出血
机制分类
破裂性出血：外伤或病变破坏血管
漏出性出血
血管壁损害
血小板减少或功能障碍
凝血因子缺乏
Intracerebral hemorrhage
Petechiae- pericardium ( thrombocytopenia)
Petechiae 瘀点- white matter
( fat embolism due to trauma)
Term Description Main Cause(s)
血肿 组织内出血 创伤
心包积血 心包腔 主动脉,心脏
胸腔积血 胸腔 创伤,主动脉破裂
腹腔积血 腹腔 主动脉破裂,脾,肝破裂
关节腔积血 关节腔 创伤,出血疾病
Post-Anesthetic Hematoma
Hemopericardium
Subcapsular hematoma - liver
Hematom 血肿
Apoplexia cerebri 脑卒中- hypertension
Thalamus 丘脑 -hemorrhage- hypertension
Photo: Kumar, Cotran, Robbins. Robbins Basic pathology, 7th ed., Saunders, Philadelphia, 2003.
病例一
某男，58岁,患高血压已十余年。近年常有便秘，五日前大便时突然昏倒，并伴大小便失禁和右侧上、下肢麻痹。
脑出血
病例二
某女，60岁，5年前已确诊为脑动脉粥样硬化(血管内膜受损害)，四天前早晨醒来自觉头晕并发现右侧上、下肢不能自如活动，且病情逐渐加重，至次日上午右侧上、下肢麻痹。
贫血性梗死
病例三
某女，27岁，患风湿性心脏病伴亚急性细菌性心内膜炎(二尖瓣有赘生物形成)。起床下地活动时，突然感觉头晕。当即卧床，二天后发现右上、下肢麻痹。
结合局部血液循环障碍一章的学习，考虑:上述三位患者的病变性质是否相同？根据已提供的简要病史，初步考虑三位患者的诊断分别是 什么，并提出诊断的根据。
病例分析
患者，男性，56岁，因患支气管癌入院，住院近半月，安静卧床休息，行各种化验及各项术前准备，一日去厕所，突然晕倒，经多方抢救无效死亡。
尸体解剖所见：营养状况良好，冠状动脉未见动脉粥样硬化，未见心肌梗死，未见心腔破裂；肺脏：左肺上叶近肺膜处可见一6cm x 5cm肿物，切面灰白色，干燥，有轻度出血坏死，肺膜与胸壁明显粘连；剖开肺动脉系统，可见一大的血栓阻塞于肺动脉主干。
患者死亡原因？并对其分析？
Case history
55 year old female complains of swelling and painfulness of the left leg for 6 months.
“Thromboangitis obliterans” was diagnosed before.
Question:
Descript the morphologic changes you found from the photo and try to explain the phenomena you found
Questions:
What is inside the opened femoral vein股静脉
How to distinguish thrombus, thromboembolus and postmortem clot of blood in autopsy
Question:
What is it How it is formed
Is it possible or not to distinguish thrombus from thromboembolus under microscope
Questions:
What pathologic changes it is on the overlying skin How it is happened And What consequences may develop
Discussion
Based on the knowledge of anatomy and histology you have learned before, try to explain why thrombosis of the lower extremities is more commonly seen than that of other parts of the bodies

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