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3/28/2011

PROSES RADANG, INFEKSI, PEMULIHAN JARINGAN DAN DEGENERASI


DEPARTEMEN PATOLOGI ANATOMI FK - USU Medan 2008

DEGENERASI
Terjadi perubahan morfologik (dalam sel / dalam zat antar sel) akibat gangguan metabolisme pada sel

Penyebab : jejas non-fatal

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Sifat degenerasi :
Ringan (reversibel) Berat (irreversibel) Nekrosis

The sequential ultrastructural changes seen in necrosis (left) & apoptosis (right).

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Degenerasi

Infiltrasi

Perubahan metabolisme

Jejas pada sel

Adanya jejas pada sel

Adanya perubahan metabolisme

Degenerasi & infiltrasi


Dapat terjadi gangguan yang bersifat biokimia/ biomolekuler

DEGENERASI
Sering disertai pengendapan zat-zat :
Lemak Amiloid Lipoid (zat yang menyerupai lemak)

Degenerasi : D. Albumin D. Hidropik (D.vakuoler) D. Hyalin D. zenker/ waxy deg. Deg / infiltrasi glikogen

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DEGENERASI HIDROPIK
(Degenerasi vakuoler)
Edema intraseluler menonjol (> deg. bengkak keruh) Kerusakan tampak lebih berat Sediaan :

Kuretage cavum uteri ( abortus imminens) perdarahan hebat Hasil Kuretage (makroskopis):
Gelembung jernih bervariasi

Diagnosa : Mola hidatidosa

Macroscopis (Hydatidiform Mole)


a mass of tissue with grape-like swollen villi

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Complete mole. All villi are markedly swollen.

Macroscopis (Hydatidiform Mole)

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Normal Villi
The 1st trimester (7-8 weeks)(20X)

Microscopis (Hydatidiform Mole)


Avascular

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Complete mole showing large villi with stromal edema & marked trophoblastic proliferation.

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Radang : reaksi jaringan hidup terhadap semua bentuk jejas (injury)

Rubor Calor

Mikroskopis: Infiltrasi sel-sel radang akut (PMN) Vasodilatasi Oedema

Akut

Tumor Dolor Functio laesa

Mikroskopis:

Kronik

Infiltrasi sel-sel radang kronik (MN) Proliferasi jaringan fibroblast Neovaskularisasi

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ACUTE INFLAMATION
REDNESS (RUBOR)

HEAT (CALOR)

GROSS :

SWELLING (TUMOR)

PAIN (DOLOR) LOSS OF FUNCTION (FUNCTIO LAESA)

ACUTE INFLAMATION
MICROSCOPIC :
Hyperaemia

Exudation

Emigration of Leucocytes

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Hyperaemia

Micro-vascular changes (Lewiss Triple Response) : Flush Dull red line (capilar dilatation) Flare Bright red (artery dilatation) Wheal

Exudation
Protein fluid interstitial (wheal) Fluid dilution of toxin Protein : - Globulin antibodies - Fibrin to limit spread bacterial Wound healing

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Exudation (Mechanism)
Protein Passage : - Chemical Mediator Endothelial Damage

Permeabilitas

Emigration of leucocytes

PMN & MN Pass (amoeboid)

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Gambaran Histologis Bentuk-Bentuk Makroskopik Peradangan :


1.

Peradangan serosa Ditandai : extravasasi cairan protein sel Sebagian besar peradangan akut bermula sebagai bentuk serosa Peradangan fibrinosa Ditandai : eksudasi plasma fibrinogen Peradangan purulen Ditandai : keluarnya neutrofil & pembentukan pus. Peradangan pseudomembranosa

2.

3.

4.

Hyperemia (serosa)

Purulent

Fig. 11.127. Outer aspect of appendix involved by acute inflammation. A thick purulent coating is seen together with marked hyperemia of the serosa.

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Acute appendicitis with massive inflammatory infiltrate, extensive ulceration, and hemorrhage. An island of heavily inflamed residual mucosa is seen in the center.

Radang Kronik

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HEALING
WOUND HEALING COMPLICATIONS : - CONTRACTURE - GRANULATION - KELOID - FIBROSIS REGENERATION SPECIAL SITUATION.

WOUND HEALING
PRIMARY HEALING : - CLEAN EXISED WOUND - GOOD POSITION (PALNED SURG.INCIS) IMMEDIATELY: - BLOOD CLOT 2-3 HOURS : - INFLAMATION (+) - MILD HYPERAEMIA - FEW POLYMORPHS

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WOUND HEALING
2-3 DAYS : - MACROPHAGE REMOVING CLOT - FIBROBLASTIC 10-14 DAYS : - SCAB LOOSE - EPITHELIAL COVERING. - FIROUS UNION

WOUND HEALING
WEEKS : - SCAR TISSUE SLIGHLY HYPERAEMIA - GOOD FIBROUS UNION MONTHS YEAR: - DEVASCULARISATION - COLLAGEN(-) ENZYME - SCAR MINIMAL.

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SECONDARY HEALING
LOSS OF TISSUE >> NECROSIS (+) INFECTION (+) EARLY : BLOOD & FIBRIN CLOT (+) ACUTE INFL. CELLS (+) FEW DAYS : - EPITH.PROLIFERATION - NEW CAPILARY - MACROPHAGE - PMN, FIBROBLAST

SECONDARY HEALING
1 WEEK : - SURFACE DEBRIS (-) - FIBROBLASTS >> - EPITH.PROLIFTION - CAPILARY >> - GRANULATION

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SECONDARY HEALING
2 WEEKS : - EPITH.COVERING COMPL - TRANSVERS COLLAGEN - DECREASED CAPILARY - FEW CELLS MONTH : - FULL EPITH.COVERING - SURFACE DEPRETION (< ) - THICK COLLAGEN SCAR - VASCULAR ( < )

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