2112 K 08 Hemodinamik Lengkap

PATOLOGI UMUM
8
Gangguan HEMODINAMIK
Prodi Kesmas
FIKes
URINDO
2021
sasinggih/Kesmas/pato umum/2112 1
Jimma University,
Gondar University
Haramaya University,
Dedub University
In collaboration with the Ethiopia Public Health Training Initiative, The Carter Center,
the Ethiopia Ministry of Health, and the Ethiopia Ministry of Education
2004
Gangguan HEMODINAMIK
Sel dan jaringan yang sehat dan berfungsi baik tidak hanya
bergantung kepada sirkulasi yang baik dalam pemberian
nutrisi dan oxygen, tetapi juga bergantung kepada
hemostasis yang normal
Gangguan hemodinamik berupa:
A. Edema (increased fluid in the ECF)
B. Hyperaemia and Congestion
(INCREASED flow) (INCREASED backup)
C. Haemorrhage (extravasation)
D. Hemostasis and Blood Coagulation
E. Thrombosis (clotting blood)
F. Embolism (downstream travel of a clot)
G. Infarction (death of tissues w/o blood)
H. Disseminated Intravascular Coagulation (DIC)
I. Shock (circulatory failure/collapse) 3
sasinggih/Kesmas/pato umum/2112
A. Udem (Edema)
Udem adalah peningkatan cairan dalam
rongga interstitial atau penumpukan
(akumulasi) cairan yang berlebihan dalam
rongga tubuh
(EDEMA is SHIFT to the INTERSTITIAL SPACE)
Pemberian nama bergantung pada tempat akumulasi
cairan dalam rongga tubuh,
a) Hydrothorax – fluid accumulation in pleural cavity
in a pathologic amount.
b) Hydropericardium – pathologic amount of fluid
accumulated in the pericardial cavity.
c) Hydroperitoneum (ascites) – fluid accumulation in
peritoneal cavity
d) Anasarca – is a severe & generalized edema of the
body with profound subcutaneous
swelling.
Mekanisme pembentukan udem
Sekitar 60% dari berat badan berupa air.
Duapertiganya terdapat dalam sel (intrasel)
sedangkan sisanya terdapat di ekstrasel
Sel endotel dinding kapiler berfungsi sebagai
membran semipermiabel yang mudah ditembus
air dan bahan terlarut dalam plasma, kecuali
protein.
Protein dalam plasma dan cairan interstisiel,
penting untuk mengendali volume plasma dan
cairan interstisiel
Normally, any outflow of fluid into the interstitium from the
arteriolar end of the microcirculation is nearly balanced
by inflow at the venular end. Therefore, normally, there
is very little fluid in the interstitium.
Pembentukan udem ditentukan oleh faktor:
1) Tekanan hidrostatik (Hydrostatic pressure)
2) Tekanan onkotik (Oncotic pressure)
3) Permiabilitas vaskular (Vascular permeability)
4) Saluran limfe (Lymphatic channels)
5) Retensi natrium dan air (Sodium and water
retention)
Aliran cairan yang keluar menembus dinding pembuluh kapiler
ditentukan oleh kesetimbangan antara tekanan hidrostatik dengan
tekanan onkotik
PHk POk
PHit POit
PHk: tekanan hidrostatik kapiler
PHit: tekanan hidrostatik interstitiel
POk: tekanan onkotik kapiler
POit: tekanan osmotik interstitiel
A. Edema due to decreased plasma oncotic pressure.
1. Protein loosing glomerulopathies like nephroticsyndrome
with leaky glomerulus.
2. Liver cirrhosis which leads to decreased protein synthesis
by the damaged liver.
3. Malnutrition
4. Protein loosing enteropathy.
B. Edema resulting from increased capillary hydrostatic

pressure
1. Deep venous thrombosis resulting in impaired venous return.
2. Pulmonary oedema
3. Cerebral oedema
4. Congestive heart failure
Peningkatan permiabilitas dinding pembuluh darah (vaskular)
biasanya karena inflamasi akut dengan produksi mediator kimia
a) Inflammatory edema  exudate

Due to inflammation-induced increased permeability
and leakage of plasma proteins.
b) Non-inflammatory edema  transudate
increased plasma hydrostatic pressure & decreased
plasma oncotic pressure.
Penyumbatan pembuluh limf oleh bermacam penyebab dapat
menimbulkan akumulasi (penumpukan) protein di interstitium
(ekstrasel) - disebut udem limfatik
Udem limfatik dapat terjadi pada:
1) Parasitic infection. E.g filariasis which causes massive lymphatic and inguinal
fibrosis ; Kaki gajah
2) Lymphatic obstruction secondary to neoplastic infiltration. E.g. breast cancer
3) post surgical or post irradiation, i.e surgical resection of lymphatic channels
or scarring after irradiation
Lymphatic Vessels and Valves
Kapiler Limfatik (Lymphatic Capillaries)
• Net filtration – net absorption = net out flow
• About 2 L/day collected by lymph vessels
Air yang berlebihan dan

bahan terlarut yang
keluar dari kapiler darah,
akan masuk ke
pembuluh limf dan
kembali ke sirkulasi
darah
Figure 15-18b: Fluid exchange at the capillary
5) Retensi natrium dan air (Sodium and water
retention)
Retensi Natrium dan air terjadi pada beberapa kasus klinik mis,
gagal jantung ; gagal ginjal.
Pada kasus tersebut, retensi Natrium dan air sebagai akibat
peningkatan tekanan hidrostatik kapiler
Clinical classification of edema
A) Localized
a. Edema of the brain
b. Pulmonary edema
B) Generalized (anasarca)
a. Reduction of albumin due to excessive loss

b. Increased volume of blood secondary to
sodium retention caused by congestive heart
failure
B. Hyperaemia and Congestion
Definition: Both of them

can be defined as a local
increase in volume of
blood in a particular tissue.
HYPEREMIA
Active Process
- is an active process resulting from an increased inflow of blood
into a tissue because of arteriolar vasodilation.

-commonly occurs in exercising skeletal muscle or acute
inflammation.
-Affected tissue becomes red as there is engorgement with
oxygenated blood.
CONGESTION
Passive Process
Acute or Chronic
- is a passive process resulting from impaired outflow of blood
from a tissue.
- occurs systemically as in cardiac failure or locally as in isolated
venous obstruction.
- sasinggih/Kesmas/pato
Affected tissueumum/2112
appears blue-red due to accumulation of 18
deoxygenated blood.
C. Haemorrhage
(HEMORAGI)
Hemorrhage is extravasation of blood outside the
blood vessel
PENYEBAB:
1. Trauma fisik
2. Gangguan pada faktor pembekuan darah: a. l. karena
2. 1. Kuantitas dan kualitas trombosit (platelet) yang
rendah
2. 2. Rendahnya atau hilangnya faktor pembeku darah,
mis, protrombin, fibrinogen, vitamin K
C. Haemorrhage
(HEMORAGI)
blood vessel
ISTILAH dalam hemoragi:
1) Haemorrhage enclosed within a tissue or a cavity is known as
hematoma
2) Minute 1-2 mm hemorrhages occurring in the skin, mucosal
membrane, or serosal surface are called petechiae.
3) Slightly > 3mm hemorrhage occurring in the skin is referred to
as purpura.
4) Larger than 1-2cm subcutaneous hematoma is called
eccymosis (bruises). It is typical after trauma.
C. Haemorrhage
(HEMORAGI)
blood vessel
Akibat hemoragi bergantung kepada
kecepatan dan jumlah darah yang hilang
Bila kehilangan darah secara cepat lebih dari 20%
jumlah darah dalam tubuh, maka dapat menyebabkan
syok hipovolemik atau kematian
Perdarahan sedikit dan kronik menyebabkan anemia
D. Hemostasis and Blood Coagulation
Definition: Hemostasis is the maintainence of the
clot-free state of blood & the prevention of
blood loss via the formation of hemostatic plug.
Keadaan mempertahankan darah tanpa bekuan darah

dan pencegahan kehilangan darah dengan membentuk
sumbatan hemostatik
Hemostasis bergantung pada 3 komponen yaitu: :

a) Dinding pembuluh darah (Vascular wall)
b) Trombosit (Platelets)
c) Mekanisme pembekuan darah (Coagulation pathways)
RINGKASAN UNTUK MELAWAN LUPA
• Darah terdiri dari sekitar 50% plasma, air dan bahan
terlarut berupa ion , element, gas, protein,
nutrient & sampah metabolisme (tidak pernah
menggumpal/membeku dalam pembuluh darah
normal)
• Fungsi darah putih sebagai pertahanan dalam
tubuh
• Besi (Fe) dalam hemoglobin merupakan unsur
utama bagi sel darah merah untuk transpor O 2
• Pengaktifan trombosit (platelet) mengawali
pembentukan bekuan darah
• Bekuan darah mencegah hilangnya darah karena
perdarahan, tetapi dapat menimbulkan masalah
sebagai penyakit
sasinggih/Kesmas/pato umum/2112 kardiovaskular 23
RINGKASAN UNTUK MELAWAN LUPA
Bila terjadi kerusakan dinding pembuluh darah, akan terjadi
hemostasis melalui beberapa mekanisme
A. Vascular spasm
B. Formation of platelet plug
C. Formation blood clot as a result of blood coagulation
D. Eventual growth of fibrous tissue in to the blood clot
to close the hole in the vessel permanently.
Hemostasis: Vasokonstriksi
Hemostasis: & Pembentukan
Vasoconstriction sumbatan
& Plug Formation
(1) Kolagen yang terluka
mengikat dan
mengaktifkan trombosit
(2) Penglepasan faktor

trombosit
(3) Pengumpulan lebih

banyak trombosit
(4) Penggumpalan
trombosit membentuk
sumbatan
E. Thrombosis
Definition: Thrombosis is defined as the formation of a
solid or semisolid mass from the constituents of the blood
within the vascular system during life.
Thrombosis adalah pembentukan bahan padat

(solid) atau agak padat (semisolid) yang berasal
dari berbagai unsur darah, yang terjadi dalam
sistem vaskular orang hidup
Pathogenesis:
There are three factors that predispose to thrombus formation.
These factors are called Virchow’s triad:
A: Endothelial injury
B: Stasis or turbulence of blood flow
C: Blood hypercoagulability
F. Embolism
Definition:-
An embolus is a detached intravascular solid, liquid
or gaseous mass that is carried by blood to sites
distant from its point of origin. After traveling via
the blood, the embolus can obstruct a vessel.
An embolus can arise from:
o Thrombus (99% of emboli arise from a thrombus. Such an
embolus is called thromboembolus)
o Platelets aggregates
o Fragment of material from ulcerating atheromatous plaque
o Fragment of a tumour
o Fat globules
o Bubbles of air
o Amniotic fluid
o Infected foreign material
o Bits of bone marrow
o Others.
G. Infarction
Definition: An infract is an area of ischemic
necrosis caused by occlusion of either the
arterial supply or venous drainage in a particular
tissue.
Nearly 99% of all infarcts result from thrombotic or embolic events.
Other mechanisms include [almost all of them are arterial in origin]:
• Local vasospasm
• Expansion of atheroma due to hemorrage in to athermotous
plaque.
• External compression of the vessels. e.g trauma
• Entrapment of vessels at hernial sacks etc.
H. Disseminated Intravascular Coagulation (DIC)
Definition: -DIC is an acute, or chronic

thrombohemorrhagic disorder occurring as a
result of progressive activation of coagulation
pathway beyond physiologic set point secondary
to a variety of diseases resulting in failure of all
components of hemostasis. Hence the other
term for DIC is consumption coagoulopathy.
I. Shock
Definition: Shock is a state in which there is
failure of the circulatory system to maintain
adequate cellular perfusion resulting in widespread
reduction in delivery of oxygen & other nutrients
to tissues. In shock, the mean arterial pressure is
less than 60 mmHg or the systolic blood pressure
is less than 90 mmHg.
Shock can be divided into:

A. Hypovolemic shock
B. Cardiogenic shock
C. Distributive shock
Definition of shock
A clinical state in which tissues do not receive
adequate blood flow and O2 to meet their metabolic
needs.
Supply v demand
• O2 supply = CO x (arterial O2 content)
• O2 demand is dependent upon temperature,

metabolic status and hormonal status
PENTING !!
Pathophysiology of shock
Inadequate tissue perfusion
Decreased oxygen supply
Anaerobic metabolism
Accumulation metabolic waste
Cellular failure
PENTING !!
Classification of shock
• Hypovolaemic Shock
• Cardiogenic shock
• Distributive shock
PENTING !!
A. Hypovolemic shock
This is shock caused by reduced blood volume.
Reduction in circulating blood volume results in the reduction of the
preload which leads to inadequate left ventricular filling, reflected as
decreased left & right ventricular end diastolic volume and pressure.
The reduced preload culminates in decreased cardiac out put which
leads to widespread tissue
perfusion (shock).
Causes of hypovolumic shock include:

a) Haemorrhage
b) Diarrhoea & vomiting
c) Burns
d) Trauma
e) etc
This is shock that results from severe depression of cardiac
performance. It primarily results from pump failure [myocardial
failure].
Causes of cardiogenic shock can be divided into :
A. Myopathic
B. Mechanical
LENGKAPI URAIAN
A.Hypovolemic shock dan
B.Cardiogenic shock
dalam bahasa Indonesia
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seperti biasanya
failure].
A. Myopathic
causes of cardiogenic shock include:
1.Acute myocardial infarction. Usually shock occurs in this
conditioin if ≥ 40% of the left ventricular mass & more on the
right ventricle is involved by infarction.
2. Mycocarditis
3. Dilated cardiomyopathy / hypertrophic cardiomyopathy
4. Myocardial depression in septic shock
failure].
A. Myopathic
B. Mechanical
i) Intracardiac
ii) Extracardiac
failure].
A. Myopathic
B. Mechanical
i) Intracardiac
a) Left ventricle outflow obstruction E.g.Aortic
stenosis, hypertrophic cardiomyopathy
b) Reduction in forward cardiac output E.g. Aortic
or mitral regurgitation
c) Arrhythmia
failure].
A. Myopathic
B. Mechanical
i) Intracardiac
ii) Extracardiac This can be called obstructive shock.
a) Pericardial tamponade (gross fluid accumulation in the pericardial space) results in a
decreased ventricular diastolic filling → ↓CO
b) Tension pneumothorax (gas accumulation in pleural space)
This decreases the venous return by creating a positive pressure.
c) Acute massive pulumonary embolism occupying 50-60% of pulmonary vascular
bed.
d) Severe pulumonary hypertension .
C. Distributive shock
Distributive shock refers to a group of shock subtypes caused by
profound peripheral vasodilatation despite normal or high
cardiac output
Causes of distributive shock
1) Septic shock
2) Neurogenic shock
3) Anaphylactic shock
4) Endocrine shock
LENGKAPI URAIAN 1) sd 4)
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PATOLOGI UMUM

B. Edema resulting from increased capillary hydrostatic

a) Inflammatory edema  exudate

Air yang berlebihan dan

a. Reduction of albumin due to excessive loss

Definition: Both of them

into a tissue because of arteriolar vasodilation.

Keadaan mempertahankan darah tanpa bekuan darah

Hemostasis bergantung pada 3 komponen yaitu: :

(2) Penglepasan faktor

(3) Pengumpulan lebih

Thrombosis adalah pembentukan bahan padat

Definition: -DIC is an acute, or chronic

Shock can be divided into:

• O2 demand is dependent upon temperature,

Causes of hypovolumic shock include:

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