RADANG AKUT

Dr. NK SUNGOWATI, SpPA

Outline

RADANG AKUT

Perubahan vaskuler a. Perubahan aliran dan ukuran pembuluh darah b. Peningkatan permeabilitas vaskuler Peristiwa seluler: ekstravasasi leukosit dan fagositosis a. Adhesi dan transmigrasi b. Kemotaksis dan aktivasi leukosit

c. Fagositosis (pengenalan, perlekatan, pelahapan dan degradasi) d. Pengeluaran produk leukosit e. Defek fungsi leukosit

Jejas pada sel

RADANG AKUT
Merupakan respon langsung dan dini terhadap jejas Ditandai perubahan sirkulasi mikro, eksudasi cairan dan transmigrasi leukosit dari pembuluh darah ke tempat jejas

CARDINAL SIGN
Rubor Calor Tumor Dolor Functio laesa

ISTILAH-ISTILAH
Eksudasi Eksudat Transudat Edema Pus

PERUBAHAN VASKULER
Perubahan kaliber pembuluh darah dan aliran darah a. Vasodilatasi b. Perlambatan sirkulasi c. Stasis Peningkatan permiabilitas vaskuler (vascular leakage)

Mekanisme terjadinya vascular leakage

Kontraksi endotel (histamin,bradikinin, lekotrin) Reorganisasi sitoskeleton (sitokin) Jejas langsung

Leakage diperantarai leukosit Leakage dari endotel regeneratif

PERISTIWA SEL DARAH PUTIH

Marginasi, rolling, adhesi Transmigrasi (diapedesis) Migrasi menuju stimulus kemotaktik

Peristiwa sel darah putih

Adhesi leukosit pada endotel

Interaksi endotel neutrofil

TRANSMIGRASI
Terjadi sepanjang interseluler junction Tergantung umur lesi dan tipe stimulus Neutrofil (6-24 jam) Monosit (24-48 jam) Pseudomonas (neutrofil ~ 2-4 hari) Virus ~ limfosit Hipersensitivitas ~ eosinofil

Reaksi radang akut

Peristiwa Sel Darah Putih

Ikatan ligan-reseptor Ikatan ligan-reseptor

FAGOSITOSIS
Pengenalan dan perlekatan Pelahapan Pembunuhan atau degradasi

Fagositosis
Fc C3

SITOPLASMA

VAKUOLA FAGOSITIK
Oksidase sitoplasmik

NADPH
Oksidase aktif

Granula spesifik

NADP+ Oksidase membran

PENGELUARAN PRODUK LEUKOSIT

Terdiri dari : E. lisosom, metabolit aktif O2, prostalglandin dan lekotrin.

DEFEK FUNGSI LEUKOSIT

Lebih rentan terhadap infeksi Genetik : a. LAD tipe1,2 (defisiensi molekul adhesi) b. CGD (defisiensi NADPH oksidase) c. Chediak-Higashi S. (neutrofenia, defektif degranulasi, perlambatan pembunuhan bakteri)

 Didapat : a. Kemotaksis : febris, diabetes , sepsis, immunodefisiensi b. Adhesi : hemodialisis, DM c. Fagositosis, aktivitas mikrobisidal : leukemia, anemia, sepsis, diabetes, neonatus, malnutrisi

MANIFESTASI KLINIK (SISTEMIK)

Febris : pirogen dan prostalglandin Perubahan hitung sel darah putih perifer - Neutrofil leukositosis

- Neutropenia, limfositosis Perubahan protein plasma C-reactive protein, antitrypsin, fibrinogen, haptoglobin, ceruloplasmin

RINGKASAN
Reaksi radang akut : Aliran darah meningkat (dilatasi arteriol) Permeabilitas meningkat (interendotel junction melebar, jejas langsung endotel)

 Neutrofil (adhesi, transmigrasi, migrasi ke tempat jejas) Fagositosis Produk leukosit

Dr.NK Sungowati

Acute Inflammation. A capillary surrounded by PMN leucocyte in are of inflammation.

Purulent exudate in some alveoli of the lung (left). Alveoli to the right are dilated as compensatory measure for the obstruction of alveoli on the left.

Alveolar exudate. Leucocytes in the alveoli together with strands of fibrin. Venules in the alveolar walls are dilated as part of the inflammatory response.

Fibrinous exudate. Pink staining threads of fibrin with leucocytes in alveoli. The vessels are dilated.

Pus. Section of skin showing an accumulation of the pus (pustule) in the epidermis. This is often seen in impetigo which superficial infection caused by coccal bacteria.

Purulent exudate. The edge of an ulcer in the colon. Damaged colonic epithelium is seen on the left and purulent exudate in the base of the ulcer on the right.

Fibrinopurulent exudate. The wall of an ulcer showing fibrinopurulent exudate on the surface (top) and newly formed vessels (granulation tissue) deeper down.

Acute inflammation. Section of heart muscle an visceral pericardium showing pink layer of fibrin on the surface. Inflammatory cells and dilated vessels are present in the underlying connective tissue.

Acute inflammation. Visceral pericardium. Movement of the heart in pericardial sac causes strands of fibrin to project into the lumen of the pericardial sac.

Plasma cells and mast cells

Mast cells with fibroblast on the right. The mast cell granules have stain bright red with solachrome cyanin.

Mast cell granules also stain bright blue with toluidine blue.

Eosinofil leucocyte.