Pembuluh darah & limfe, cvs
-
Upload
vrilisda-sitepu -
Category
Health & Medicine
-
view
1.853 -
download
12
Transcript of Pembuluh darah & limfe, cvs
![Page 1: Pembuluh darah & limfe, cvs](https://reader034.fdocument.pub/reader034/viewer/2022042511/559f3bd51a28ab63748b456b/html5/thumbnails/1.jpg)
KELAINAN PADA PEMBULUH DARAH
DAN LIMFE
Dr. FITRIANI LUMONGGA, SpPA
![Page 2: Pembuluh darah & limfe, cvs](https://reader034.fdocument.pub/reader034/viewer/2022042511/559f3bd51a28ab63748b456b/html5/thumbnails/2.jpg)
ARTERI
KELAINAN KONGENITAL
Terutama pada aorta dan arteri besar
Umumnya disertai dgn kelainan jtg bawaan,
1. Hipoplasia Aorta Ascendens
2. Anomali Lengkung Aorta
Coartatio aorta
Ductus arteriosus paten
A.Subclavia kanan posterior
Lengkung aorta di kanan
Lengkung aorta ganda
![Page 3: Pembuluh darah & limfe, cvs](https://reader034.fdocument.pub/reader034/viewer/2022042511/559f3bd51a28ab63748b456b/html5/thumbnails/3.jpg)
PENY. DEGENERATIVE PADA ARTERI
ATHEROMA
ARTERIOSCLEROSIS
![Page 4: Pembuluh darah & limfe, cvs](https://reader034.fdocument.pub/reader034/viewer/2022042511/559f3bd51a28ab63748b456b/html5/thumbnails/4.jpg)
PEMBULUH DARAH NORMAL
![Page 5: Pembuluh darah & limfe, cvs](https://reader034.fdocument.pub/reader034/viewer/2022042511/559f3bd51a28ab63748b456b/html5/thumbnails/5.jpg)
ATHEROMA
![Page 6: Pembuluh darah & limfe, cvs](https://reader034.fdocument.pub/reader034/viewer/2022042511/559f3bd51a28ab63748b456b/html5/thumbnails/6.jpg)
Pembuluh darah dengan atherosclerotic
![Page 7: Pembuluh darah & limfe, cvs](https://reader034.fdocument.pub/reader034/viewer/2022042511/559f3bd51a28ab63748b456b/html5/thumbnails/7.jpg)
![Page 8: Pembuluh darah & limfe, cvs](https://reader034.fdocument.pub/reader034/viewer/2022042511/559f3bd51a28ab63748b456b/html5/thumbnails/8.jpg)
Gambaran arteri coronaria yang
mengalami kalsifikasi yang berat
![Page 9: Pembuluh darah & limfe, cvs](https://reader034.fdocument.pub/reader034/viewer/2022042511/559f3bd51a28ab63748b456b/html5/thumbnails/9.jpg)
PENYAKIT DEGENERATIVE PD PEMBULUH
Gejala : gangguan fungsi
rasa sakit ok : infark
Ggn tropi
Ulcerasi kulit
Arteri iskhemia
Vena / lymph congestive edema
![Page 10: Pembuluh darah & limfe, cvs](https://reader034.fdocument.pub/reader034/viewer/2022042511/559f3bd51a28ab63748b456b/html5/thumbnails/10.jpg)
Arteriosclerosis (pengerasan arteri)
Atherosclerosis deposit lemak pd t. intima
Monckeberg sclerosis calcificasi pada t. media
Arteriolosclerosis arteri kecil
![Page 11: Pembuluh darah & limfe, cvs](https://reader034.fdocument.pub/reader034/viewer/2022042511/559f3bd51a28ab63748b456b/html5/thumbnails/11.jpg)
PATHOGENESIS ARTERIOSCLEROSIS
normal t. intima menghasilkan acid mucopolysacharida yg membantu anticoagulasi intima
adanya kelainan pada t.intima (infeksi,ggn trophidll) menyebabkan penimbunan lipid dlm sitoplasmaserabut otot polos intima menjadi lipofag berbuih(foamy) sehingga merusak lipo- protein pada t. intima.
pertumbuhan focal fibrofatty merupakan plaque ygmenebal dr t. intima (disebut: atheroma)
![Page 12: Pembuluh darah & limfe, cvs](https://reader034.fdocument.pub/reader034/viewer/2022042511/559f3bd51a28ab63748b456b/html5/thumbnails/12.jpg)
selanjutnya mengalami penimbunan
lemak, cholesterol, calcium, fibrin, perdarahan, thromb
ocyt, sel radang menyebabkan intima rusak &
sclerotik
![Page 13: Pembuluh darah & limfe, cvs](https://reader034.fdocument.pub/reader034/viewer/2022042511/559f3bd51a28ab63748b456b/html5/thumbnails/13.jpg)
ATHEROMA ,dpt menyebabkan :
Coronary heart disease
Cerebrovascular accident
Gangren extremitas
Risk faktor
Serum lipoprotein LDL & HDL
Gula darah (DM)
Hipertensi
Merokok
Hypothyroid
![Page 14: Pembuluh darah & limfe, cvs](https://reader034.fdocument.pub/reader034/viewer/2022042511/559f3bd51a28ab63748b456b/html5/thumbnails/14.jpg)
FAKTOR PREDISPOSISI
1. Stress
2. Exercise Kurang
3. Soft Drink
4. Serum As.Urat
5. Byk Makan Lemak Jenuh
6. Kegemukan
![Page 15: Pembuluh darah & limfe, cvs](https://reader034.fdocument.pub/reader034/viewer/2022042511/559f3bd51a28ab63748b456b/html5/thumbnails/15.jpg)
KOMPLIKASI ARTERIOSCLEROSIS
1. Oklusi pembuluh darah
2. Ulcerasi kulit
3. Thrombosis
4. Emboli
![Page 16: Pembuluh darah & limfe, cvs](https://reader034.fdocument.pub/reader034/viewer/2022042511/559f3bd51a28ab63748b456b/html5/thumbnails/16.jpg)
MONCKEBERG SCLEROSIS
= MEDIAL CALCIFICATION
mengenai t. media + lamina elastica interna arteri
proses ketuaan
terdapat endapan kalsium berkelompok
![Page 17: Pembuluh darah & limfe, cvs](https://reader034.fdocument.pub/reader034/viewer/2022042511/559f3bd51a28ab63748b456b/html5/thumbnails/17.jpg)
ARTERIOLOSCLEROSIS
= SCLEROSIS ARTERIOL
endapan hialin subintimal
jar.elastik intima tersusun onion skin
appearence
![Page 18: Pembuluh darah & limfe, cvs](https://reader034.fdocument.pub/reader034/viewer/2022042511/559f3bd51a28ab63748b456b/html5/thumbnails/18.jpg)
RADANG ARTERI
1. ARTERITIS ACUTA INFECTIOSA
A. Etiologi:
Radang perivaskuler: meningitis acuta, cellulitis, pneumonia
Intravaskuler: septikemia, emboli septic
B. Efek terhadap arteri:
Infiltrat radang thrombosis
Kelemahan dinding arteri
Aneorysma erosif
Aneorysma mikotik
![Page 19: Pembuluh darah & limfe, cvs](https://reader034.fdocument.pub/reader034/viewer/2022042511/559f3bd51a28ab63748b456b/html5/thumbnails/19.jpg)
2. PERIARTHERITIS NODOSA
= POLYARTERITIS , PANARTERITIS
GEJALA KLINIK :
demam intermittemalaiselemahBB ↓neuritis perifermyalgiaarthralgia proliferasi
![Page 20: Pembuluh darah & limfe, cvs](https://reader034.fdocument.pub/reader034/viewer/2022042511/559f3bd51a28ab63748b456b/html5/thumbnails/20.jpg)
Cont’d….
Sering pd pria
Pd semua umur
Alat tubuh yg sering dikenai:
- Ren
- kulit
- paru
- otak
- cor
![Page 21: Pembuluh darah & limfe, cvs](https://reader034.fdocument.pub/reader034/viewer/2022042511/559f3bd51a28ab63748b456b/html5/thumbnails/21.jpg)
GAMBARAN MAKROSKOPIS
tonjolan ø 2-4 mm sepanjang arteri terutamaa.mesenteri,sal.cerna. pankreas,ginjal,otot seratlintang
GAMBARAN MIKROSKOPIS
Edema + eksudasi fibrinosa
Necrosis fibrinoid media
Lamina elstica interna rusak
Infiltrasi lekosit pada dinding pembuluh darah
Proliferasi fibroblast
![Page 22: Pembuluh darah & limfe, cvs](https://reader034.fdocument.pub/reader034/viewer/2022042511/559f3bd51a28ab63748b456b/html5/thumbnails/22.jpg)
AKIBATNYA : Obliterasi lumen
Infark
Thrombosis
Aneurysma
![Page 23: Pembuluh darah & limfe, cvs](https://reader034.fdocument.pub/reader034/viewer/2022042511/559f3bd51a28ab63748b456b/html5/thumbnails/23.jpg)
3. ARTERITIS KHAS = SPESIFIK
Arteritis sifilitika
Arteritis tuberkulosa
Khas adanya tuberkel yi: nekrosis sentral dikelilingi
sel limfosit,sel epitheloid, sel plasma & sel datia
langshans
Arteritis rhematoid
Necrosis fibrinoid
![Page 24: Pembuluh darah & limfe, cvs](https://reader034.fdocument.pub/reader034/viewer/2022042511/559f3bd51a28ab63748b456b/html5/thumbnails/24.jpg)
4. ARTERITIS SEL DATIA
= GIANT CELL ARTERITIS , ARTERITIS
TEMPORALIS
Gejala klinik :
demam
Terutama orang tua
Radang segmen a. Temporalis; a. Occipitalis
Lekositosis, LED
dpt menimbulkan kebutaan
![Page 25: Pembuluh darah & limfe, cvs](https://reader034.fdocument.pub/reader034/viewer/2022042511/559f3bd51a28ab63748b456b/html5/thumbnails/25.jpg)
Etiologi : tdk diketahui
Gambaran Mikroskopis :
Reaksi radang pembuluh darah pd lapisan
media & lamina elastika interna
Adanya sel datia
Fibrosis pada intima
Lapisan Adventitia menebal
![Page 26: Pembuluh darah & limfe, cvs](https://reader034.fdocument.pub/reader034/viewer/2022042511/559f3bd51a28ab63748b456b/html5/thumbnails/26.jpg)
5. TAKAYASU DISEASE = PULSELESS DISEASE
= AORTIC ARCH SYNDROME
Gejala klinik:
peny. tanpa nadi
Chronis & progresif
Terutama wanita muda
Ggn penglihatan
Paraestethesia lengan
Lemah & syncope
![Page 27: Pembuluh darah & limfe, cvs](https://reader034.fdocument.pub/reader034/viewer/2022042511/559f3bd51a28ab63748b456b/html5/thumbnails/27.jpg)
Gambaran mikroskopis :
panarteritis
Penebalan intima
Nekrosis coagulation
Infiltrasi sel plasma, limfosit, & Sel datia
Fibrosis
Infiltasi perivaskuler
![Page 28: Pembuluh darah & limfe, cvs](https://reader034.fdocument.pub/reader034/viewer/2022042511/559f3bd51a28ab63748b456b/html5/thumbnails/28.jpg)
PENYAKIT PEMBULUH DARAH TEPI
1. Arterioslerosis = arteriosclerosis obliterans
Klinis : Atropi iskhemia
Rasa dingin & nyeri
Cyanotic
Gangren jar.lunak extemitas dari
distal jari kaki menjalar ke proximal
Kejang otot
Cladicatio intermittens
Kaki pucat bila diangkat
![Page 29: Pembuluh darah & limfe, cvs](https://reader034.fdocument.pub/reader034/viewer/2022042511/559f3bd51a28ab63748b456b/html5/thumbnails/29.jpg)
PATOLOGI
Sering mengenai usia pertengahan
& lanjut
Penyempitan lumen
Obstruksi thrombotik
Arteri menebal tak merata, keras & rapuh
Terutama mengenai : a.Iliaca; a.femoralis, a.tibialis ;
a.Poplitea
![Page 30: Pembuluh darah & limfe, cvs](https://reader034.fdocument.pub/reader034/viewer/2022042511/559f3bd51a28ab63748b456b/html5/thumbnails/30.jpg)
2. RAYNAUD DISEASE
Sindrom vasospastik ok kedinginan
& terbatas pd jari terutama pd
Etiologi : spasme pembuluh darah
Gejala Klinis : ujung jari tangan pucat
Rasa kebas & panas
Cyanotic & kemudian merah
Bisa nekrosis iskhemik pd ujung jari
![Page 31: Pembuluh darah & limfe, cvs](https://reader034.fdocument.pub/reader034/viewer/2022042511/559f3bd51a28ab63748b456b/html5/thumbnails/31.jpg)
3. SCLERODERMA
= PROGRESIVE SYSTEMIK SCLEROSIS
Merupakan penyakit systemik
Kelainan terutama : kulit & organ dalam
mengalami fibrosis
Mengenai umur 30 – 50 tahun
Wanita lebih sering
![Page 32: Pembuluh darah & limfe, cvs](https://reader034.fdocument.pub/reader034/viewer/2022042511/559f3bd51a28ab63748b456b/html5/thumbnails/32.jpg)
4. BURGER DISEASE = WINI WARTER
= THROMBOANGITIS OBLITERANS
Terutama : mengenai muda & perokok berat
Gejala Klinis :
- nyeri persisten pd kaki ok obstruksi & oklusisegmen arteri distal
- Iskhemia persisten 1 atau > jari kaki
- Trombophlebitis supeficial
![Page 33: Pembuluh darah & limfe, cvs](https://reader034.fdocument.pub/reader034/viewer/2022042511/559f3bd51a28ab63748b456b/html5/thumbnails/33.jpg)
Gambaran Makroskopis
Pemblh drh keras spt lidi
Pemblh drh tersumbat ok massa kuningkelabu/tengguli trombosis
Mikroskopis
Lumen terisi thrombus
Elastika tetap utuh
Media & adventitia dgn sebukan limfosit
Adventitia fibrosis
Fokus granulomatus dgn sel datia/
fokus miler supurative
![Page 34: Pembuluh darah & limfe, cvs](https://reader034.fdocument.pub/reader034/viewer/2022042511/559f3bd51a28ab63748b456b/html5/thumbnails/34.jpg)
![Page 35: Pembuluh darah & limfe, cvs](https://reader034.fdocument.pub/reader034/viewer/2022042511/559f3bd51a28ab63748b456b/html5/thumbnails/35.jpg)
5. ANEURISMA
Dilatasi abnormal setempat pd arteri ok lemahnyadinding pembuluh darah
Etiologi : - arteriosklerosis
- Infeksi sifilis, bakteri & jamur
- Congenital
- Trauma
Bentuk : - sacculer/ - dissecans
Kantong
- fusiform - cirsoid/
- silindris racemosus
![Page 36: Pembuluh darah & limfe, cvs](https://reader034.fdocument.pub/reader034/viewer/2022042511/559f3bd51a28ab63748b456b/html5/thumbnails/36.jpg)
lokasi sering pada :
Lengkung aorta
Aorta abdominalis
A. Poplitea
A. Femoralis
A. Carotis/ subclavia
komplikasi :
Ruptura kompresi ke alat lain
Perdarahan erosi
![Page 37: Pembuluh darah & limfe, cvs](https://reader034.fdocument.pub/reader034/viewer/2022042511/559f3bd51a28ab63748b456b/html5/thumbnails/37.jpg)
VENA
RADANG
Phlebitis Acute
Phlebitis purulenta : meningitis, Abses & pneumoni
Phlebitis Non Purulenta :
- Dermatitis - demam rematik
- Allergi obat - arthritis rheumatica
![Page 38: Pembuluh darah & limfe, cvs](https://reader034.fdocument.pub/reader034/viewer/2022042511/559f3bd51a28ab63748b456b/html5/thumbnails/38.jpg)
Gambaran Mikroskopis
Infiltrasi radang
Edema
Hiperemia
Destruksi dinding pemblh drh
![Page 39: Pembuluh darah & limfe, cvs](https://reader034.fdocument.pub/reader034/viewer/2022042511/559f3bd51a28ab63748b456b/html5/thumbnails/39.jpg)
KELAINAN OBSTRUKSI VENA
1. Phlebothrombosis : thrombosis vena tanpa kerusakan
p.drh setempat
2. Thrombophlebitis : thrombosis (+) & menyebabkan
kerusakan ddg p.drh.
3. Obstruksi vena cava superior ,
ok: - Bronchogenic carcinoma
- mediastinal lymphoma
- Aortic aneurysma
menimbulkancyanosis & bendungan vena
kepala, leher & extremitas atas.
![Page 40: Pembuluh darah & limfe, cvs](https://reader034.fdocument.pub/reader034/viewer/2022042511/559f3bd51a28ab63748b456b/html5/thumbnails/40.jpg)
4. OBSTRUKSI VENA CAVA INFERIOR
Ok: - tumor hati - renal cell ca
- Aneurisma - ascites
- Radang
5. OBSTRUKSI VENA PORTAE
Ok: -thrombosis
- Peny. Intrahepatik
- Splenectomy
- policytemia vera
![Page 41: Pembuluh darah & limfe, cvs](https://reader034.fdocument.pub/reader034/viewer/2022042511/559f3bd51a28ab63748b456b/html5/thumbnails/41.jpg)
6. VENA VARICOSUS= VARIX=VARICOSE VEIN
pelebaran abnormal vena yg terbts tekanan intraluminaldan kehilangan suport dr jar. sekitar.
ETIOLOGI :
* Kelemahan herediter
* Obstruksi vena
* Tekanan intraabdominal
* usia lanjut
* Berdiri lama, kerja berat
* Radang vena
* Konstipasi kronis
Hipertensi portal hemorrhoid , Varises oesoph.
Tersering Vena Superficial Tungkai Bawah
![Page 42: Pembuluh darah & limfe, cvs](https://reader034.fdocument.pub/reader034/viewer/2022042511/559f3bd51a28ab63748b456b/html5/thumbnails/42.jpg)
Morphologi
- vena memanjang & berkelok
- dilatasi & ektasi yg irreguler
- perubahan katup
- penebalan dinding berbeda
- jar.elastik diganti fibrosis
Gejala Klinis
rasa nyeri
kongesti & odema
dermatitis ok stasis
cellulitis
ulcerasi khronis
![Page 43: Pembuluh darah & limfe, cvs](https://reader034.fdocument.pub/reader034/viewer/2022042511/559f3bd51a28ab63748b456b/html5/thumbnails/43.jpg)
Komplikasi
* peradangan
* Perporasi vena
* Thrombosis
* Ulcerasi + dermatitis
PEMBULUH LIMFE
1. Lymphangitis acuta ok proses pyogen
2. Lymphangitis khronik ok filariasis
3. Non inflamatory lymphedema ok Neoplasma & operative
![Page 44: Pembuluh darah & limfe, cvs](https://reader034.fdocument.pub/reader034/viewer/2022042511/559f3bd51a28ab63748b456b/html5/thumbnails/44.jpg)
TUMOR PEMBULUH DARAH & LIMFE
Jinak
1.Hemangioma capillare
Tumor tanpa kapsul tdd proliferasi pemb.drh
& dipisahkan oleh sedikit jar.Ikat.
Sering pada : kulit & mukosa
2. Hemangioma cavernosum = cystic
hygroma
Lumen pemblh drh besar sampai kistik
![Page 45: Pembuluh darah & limfe, cvs](https://reader034.fdocument.pub/reader034/viewer/2022042511/559f3bd51a28ab63748b456b/html5/thumbnails/45.jpg)
3. Hemangioma endothelioma
Bila endothel yg berproliferative
4. Hemangioma pericytoma
Bl suportive tissue proliferative
5. Glomangioma = glomus tumor
Kecil di bawah kulit / kuku
![Page 46: Pembuluh darah & limfe, cvs](https://reader034.fdocument.pub/reader034/viewer/2022042511/559f3bd51a28ab63748b456b/html5/thumbnails/46.jpg)
GANAS:
ANGIOSARCOMA , KAPOSI’S SARCOMA
Biasa merupakan subcutaneus plaque atau verucosus
Tdd :- Proliferasi Sel Endothelial
- Perdarahan Extravascular
- Proliferasi AnaplastikFibroblast
- Granulation Like Inflamatory reaction
- Merupakan tumor yg sgt nyeri