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 Kontraksi endotel
terjadinya (histamin,bradikinin,
lekotrin)
vascular leakage
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
C3
Fc

SITOPLASMA VAKUOLA FAGOSITIK

Oksidase sitoplasmik

Granula spesifik
NADPH
Oksidase aktif
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.