1
PENGANTAR
Prodi Kesmas
FIKes URINDO
Oktober 2017
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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
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PATHOLOGY (PATOLOGI)
patho = penyakit ; logy = ilmu
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Penjelasan dalam patologi mencakup 4 aspek
yaitu:
1. Etiology,
2. Pathogenesis,
3. Morphologic changes
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Penjelasan dalam patologi mencakup 4 aspek
yaitu:
1. Etiology, Penyebab suatu penyakit.
Etiologi Primer : penyebab penyakit
diketahui
Idiopatik (idiopathic) : penyebab penyakit
tidak diketahui
Dengan diketahuinya penyebab primer suatu penyakit
maka pengobatan dapat dikembangkan
Etiologi penyakit dapat digolongkan dalam faktor
genetik dan didapat /acquired (infeksi; nutrisi; bahan
kimia dll)
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Penjelasan dalam patologi mencakup 4 aspek
yaitu:
1. Etiology,
2. Pathogenesis,
• Mekanisme terwujudnya keadaan patologis
dan gejala klinik
• Mekanisme tersebut mulai berlangsung
pada masa inkubasi
• Proses patogenesis dapat mengawali
perubahan morfologi
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Penjelasan dalam patologi mencakup 4 aspek
yaitu:
1. Etiology,
2. Pathogenesis,
3. Morphologic changes
• Perubahan struktur sel atau jaringan yang
terjadi mengikuti proses patogenesis
• Perubahan struktur dapat dilihat langsung
(perubahan makroskopik) atau dengan
mikroskop (perubahan mikroskopik)
• Perubahan struktur dapat digunakan untuk
membantu menegakkan diagnosis
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Penjelasan dalam patologi mencakup 4 aspek
yaitu:
1. Etiology,
2. Pathogenesis,
3. Morphologic changes
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Ringkasan proses patologik
Etiologi Patogenesis Perubahan Morfologik
Gambaran Klinik dan Prognosis penyakit
• Dengan memahami aspek inti dari suatu penyakit
(memahami patologinya) akan memahami bagaimana
gambaran klinik dari penyakit yang berbeda dan
bagaimana pengobatan serta prognosis penyakit
• Pemahaman tersebut akan membantu tenaga
kesehatan dalam menangani dan menolong pasien
dengan cara yang lebih baik dan ilmiah
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• Apa yang dipelajari tentang Patologi ?
• Mengapa Anda sebagai calon Sarjana
Kesehatan Masyarakat perlu mempelajari
Patologi?
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Cellular Injury
Definition:
These are the visible changes that occur in cells
as a result of exposure to causative agents of
disease, the degree of this changes are vary
according to the severity and duration of
damaging processes.
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Cells injury can be divided into:
Reversible cell injury:
Indicated that the changes will regress
and disappear when the injurious agent is
removed and the cell will return to the
normal morphologically and functionally.
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e.g. If the blood supply to a portion of the heart musculature is cut off for
few minutes and then restored, the muscles cells will sustain reversible
injury i.e. after restoration of blood supply, the cell injury will recover and
function normally as in angina pectoris .
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Factors influencing the severity
of cell injury:
1. Type, duration and severity of the injurious
agents.
2. Type of the affected cells: Cells differ in their
susceptibility to the effects of injurious agents.
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Susceptibility to Time for
Types of cells damage by ischemia damage
Myocard cells 30 – 60
Intermediate
Hepatocytes minutes
Skeletal muscles
Low Many hours
Epidermis of skin
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Cellular Adaptation
1. HYPERTROPHY
Hypertrophy is increase in the size of cells.
2. HYPERPLASIA
Hyperplasia is an increase in the number of
cells.
3. ATROPHY
Atrophy is a decrease in the size of a cell.
4. METAPLASIA.
Metaplasia is the replacement of one
differentiated tissue by another
differentiated tissue.
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Cellular Adaptation
1. HYPERTROPHY
Hypertrophy is increase in the size of cells.
Peningkatan pembebanan akan meningkatkan
sintesis protein sel , pembesaran ukuran sel dan
peningkatan jumlah organel intrasel .
Hal tersebut akan menyebabkan pembesarabn
ukuran sel
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Cellular Adaptation
1. HYPERTROPHY
2. HYPERPLASIA
Hyperplasia is an increase in the number of
cells.
Dapat menyebabkan pembesaran organ. Biasanya
karena rangsangan hormon. Sebagai contoh:
keadaan fisiologi: pembesaran payu dara pada
waktu hamil,
keadaan patologi: hiperplasia endometrium
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Cellular Adaptation
1. HYPERTROPHY
2. HYPERPLASIA
3. ATROPHY
Atrophy is a decrease in the size of a cell.
Menyebabkan penyusutan ukuran organ.
Dapat disebabkan oleh:
1. Disuse
2. Undernutrition
3. Decreased endocrine stimulation
4. Denervation
5. Old age
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Cellular Adaptation
1. HYPERTROPHY
2. HYPERPLASIA
3. ATROPHY
4. METAPLASIA.
Metaplasia is the replacement of one differentiated tissue
by another differentiated tissue.
CONTOH:
1. Squamous metaplasia : perubahan sel bronkus
paru perokok dari jenis sel epitel kolumnar
menjadi sel epitel skuamus
2. Osseous metaplasia : perubahan jaringan ikat
menjadi tulang
21
Sampai Jumpa
minggu depan
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Penjelasan dalam patologi mencakup 4 aspek
yaitu:
1. Etiology,
2. Pathogenesis,
3. Morphologic changes
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The causes of disease
A. Environmental factors
1. Physical agents
2. Chemicals
3. Nutritional deficiencies & excesses
4. Infections & infestations
5. Psychogenic factors
6. Immunology factors
B. Geneticl factors
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The causes of disease
A. Environmental factors
1. Physical agents
termasuk trauma, suhu ekstrem (dingin/panas), listrik
Agen tersebut memberikan energi fisik yang berlebihan pada tubuh
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The causes of disease
A. Environmental factors
1. Physical agents
2. Chemicals
Semakin banyak kerusakan (injury) oleh bahan kimia
Penggunaan obat yang berlebihan; proses industri dan di rumah
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The causes of disease
A. Environmental factors
1. Physical agents
2. Chemicals
3. Nutritional deficiencies & excesses
4. Infections & infestations
Virus, bakteri, jamur (fungi) dan protozoa dapat merusak sel
Virus poliomielitis. Protozoa malaria
Kerusakan dapat disebabkan oleh toksin yang diproduksi agen
misalnya: diphtheri dan tetanus
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The causes of disease
A. Environmental factors
1. Physical agents
2. Chemicals
3. Nutritional deficiencies & excesses
4. Infections & infestations
5. Immunological factors
a. Hipersensitif (hypersensitive reaction)
asthma
b. Immunodeficiency
AIDS
c. Autoimmunity
diabetes mellitus tipe 1 disebabkan oleh kerusakan
autoimmune dari sel beta Langerhans pankreas
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The causes of disease
A. Environmental factors
1. Physical agents
2. Chemicals
3. Nutritional deficiencies & excesses
4. Infections & infestations
5. Immunological factors
6. Psychogenic factors
mental stress gangguan fungsi organ
penyakit
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The causes of disease
A. Environmental factors
1. Physical agents
2. Chemicals
3. Nutritional deficiencies & excesses
4. Infections & infestations
5. Immunological factors
6. Psychogenic factors
The mental stresses imposed by conditions of life,
particularly in technologically advanced communities,
are probably contributory factors in some groups of
diseases
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The Biology of Feelings and
Emotions
• Thoughts, feelings, emotions, and
desires affect the functioning of our
organ systems
• This is mediated through the endocrine
and nervous systems
• Integrated studies of physiology and
psychology demonstrate the links
between the affect and the body
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Findings of Dr. Selye
• Stress is the response to pressure
• Pressure comes from conflicts, overwork,
anxiety, confusion, trauma, etc.
• Stress stimulates the production of certain
hormones – adrenaline and cortisol, the
inflammatory hormone
• This is a protective response for our benefit
to prepare our organs for defense and action
• But over time the effects of chronic stress
can cause damage to organs and subsequent
illness
• Heart and vessels, GI tract, bones and joints,
collagen tissues, and so forth
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PSYCHONEUROIMMUNOLOGY (PNI)
• Psycho – thoughts, feelings, emotions that
influence
• The brain – Neurons in the brain that
produce chemicals that act on
• The Immune system – white blood cells
and antibodies
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Neurochemistry
• Brain cells make chemicals in response to emotions
and feelings
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Physical changes of acute stress
• Heart rate accelerates and the force of
contractions increases
• Arteries contract and blood pressure increases
• Shallow breathing as bronchioles dilate
• Muscles are tense to prepare for action
• More blood flows to the muscles
• Digestion slows
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What produces these changes?
• Adrenalin and cortisol from the adrenal glands
• Neurochemicals from the brain
• These are produced instantly and act
immediately
• This is to protect us
• Strong emotions produce physical changes
immediately
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Positive feelings
• Joy, happiness, peace, laughter, sense of
security stimulate production of “happy” NCs
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Negative feelings lead to chronic
internal stress
• Fear – of death, disease, disaster, sorcery
• Conflicts with other people
• Too many demands made on us
• Anger, bitterness, hatred
• Uncontrolled desires, passions, addictions
• Guilt, shame, sense of rejection
• Depression
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ESSENCE model
• E • Education
• S • Stress management
• S • Spirituality
• E • Exercise
• N • Nutrition
• C • Connectedness
• E • Environment
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Penjelasan dalam patologi mencakup 4 aspek
yaitu:
1. Etiology,
2. Pathogenesis,
3. Morphologic changes
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COURSE of disease
(PERJALANAN PENYAKIT)
Secara ringkas dapat digambarkan sebagai
bagan berikut:
Exposure Biological onset Clinical onset Permanent damage Death
Latency period
penyebab penyakit
Latency period : masa antara pajanan pada
penyebab penyakit hingga
mulai proses biologi penyakit
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COURSE of disease
(PERJALANAN PENYAKIT)
Secara ringkas dapat digambarkan sebagai
bagan berikut:
Exposure Biological onset Clinical onset Permanent damage Death
Latency period
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COURSE of disease
(PERJALANAN PENYAKIT)
Secara ringkas dapat digambarkan sebagai
bagan berikut:
Exposure Biological onset Clinical onset Permanent damage Death
Latency period
Clinical onset : tanda dan gejala klinik mulai
C. Meninggal
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CLINICAL and biological death
Clinical death
the period of respiratory, circulatory and brain
arrest during which initiation of resuscitation
can lead to recovery.
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CLINICAL and biological death
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CELL death (KEMATIAN SEL)
Dapat melalui proses:
1. NEKROSIS
Cairan tubuh berlebihan masuk sel sel membengkak
merusak membran sel . Setelah sel mati, terjadi reaksi degradasi
intrasel di antara sel yang masih berfungsi.pada mahluk hidup.
Nekrosis tidak terjadi pada orang yang telah meninggal. Pada
orang yang telah meninggal terjadi autolysis dan heterolysis
2. APOPTOSIS
Kematian sel secara terprogram
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CELL death (KEMATIAN SEL)
Dapat melalui proses:
1. NEKROSIS
Terjadi melalui mekanisme berikut::
A. Hypoxia
B. Free radical-induced cell injury
C. Cell membrane damage
D. Increased intracellular calcium level
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CELL death (KEMATIAN SEL)
Dapat melalui proses:
1. NEKROSIS
Terjadi melalui mekanisme berikut::
A. Hypoxia = berkurangnya pasokan oksigen ke jaringan
1. Ischemia
2. Anemia
3. Carbon monoxide poisoning
4. Poor oxygenation of blood due to
pulmonary
disease.
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CELL death (KEMATIAN SEL)
Dapat melalui proses:
1. NEKROSIS
Terjadi melalui mekanisme berikut::
A. Hypoxia
B. Free radical-induced cell injury
Free radical is any molecule with a single unpaired electron in the
outer orbital. Examples include superoxide & the hydroxyl radicals.
Free radicals are formed by normal metabolism, oxygen toxicity,
ionizing radiation, & drugs & chemicals, & reperfusion injury.
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CELL death (KEMATIAN SEL)
Dapat melalui proses:
1. NEKROSIS
Terjadi melalui mekanisme berikut::
A. Hypoxia
B. Free radical-induced cell injury
C. Cell membrane damage
Direct cell membrane damage as in extremes of temprature, toxins,
or viruses, or indirect cell membrane damage as in the case of
hypoxia can lead to cell death by disrupting the homeostasis of the
cell.
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CELL death (KEMATIAN SEL)
Dapat melalui proses:
1. NEKROSIS
Terjadi melalui mekanisme berikut::
A. Hypoxia
B. Free radical-induced cell injury
C. Cell membrane damage
D. Increased intracellular calcium level
The cell membrane damage leads to increased
intracellular calcium level. The increased cytosolic
calcium, in turn, activates enzymes in the presence of low
pH. The activated enzymes will
degrade the cellular organelles.
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CELL death (KEMATIAN SEL)
Dapat melalui proses:
1. NEKROSIS
Terjadi melalui mekanisme berikut::
A. Hypoxia
B. Free radical-induced cell injury
C. Cell membrane damage
D. Increased intracellular calcium level
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Sampai Jumpa
minggu depan
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INFLAMMATIO
N
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INFLAMMATION
(PERADANGAN)
Definisi: repons (reaksi) lokal jaringan hidup yang
bervaskularisasi, terhadap rangsang dari luar (exogen) atau
dalam tubuh (endogen)
“Inflammare” = terbakar
Pada dasarnya merupakan reaksi tubuh untuk melokalisasi dan
menghilangkan penyebab, serta membatasi kerusakan jaringan
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KLASIFIKASI INFLAMASI
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Radang akut
(Acute inflammation )
Radang akut merupakan respons yang cepat timbul
terhadap agent injuri dan berlangsung dalam waktu
singkat, beberapa menit hingga beberapa hari.
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Radang akut
(Acute inflammation )
Tanda utama (5):
1.RUBOR (redness) – disebabkan oleh dilatasi pembuluh
darah pada jaringan yang rusak (cellulitis)
2. CALOR (heat) – aliran darah yang meningkat (hiperemia)
karena dilatasi pembuluh darah
3. TUMOR (swelling) – penumpukan cairan di luar pembuluh
darah (extravascular) karena peningkatan permiabilitas dinding
vaskular
4. DOLOR (pain) – bradykinin, prostaglandin dan serotonin ,
selain tekana pada saraf
5. Functio laesa (loss of function) – oleh rasa nyeri
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Radang akut
(Acute inflammation )
Tahap proses radang akut berupa respons vaskular
dan repons seluler
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Radang akut
(Acute inflammation )
Morfologi radang akut
An exudate is an edema fluid with high protein concentration, which
frequently contains inflammatory cells.
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Radang akut
(Acute inflammation )
Effects of acute inflammation:
A. Beneficial effects
B. Harmful effects
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Radang akut
(Acute inflammation )
Effects of acute inflammation:
A. Beneficial effects
Dilution of toxins
Protective antibodies:
Fibrin formation:
Plasma mediator systems provisions
Cell nutrition:
Promotion of immunity
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Radang akut
(Acute inflammation )
Effects of acute inflammation:
A. Beneficial effects
B. Harmful effects
Tissue destruction
Swelling:
Inappropriate response:
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Radang KRONIS
(CHRONIC inflammation )
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Radang kronis
(CHRONIC inflammation )
Radang kronis merupakan proses inflamasi yang
berkelanjutan (beberapa minggu atau bulan).
Kerusakan jaringan dan penyembuhan berjalan
secara bersamaan dalam waktu lama.
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Radang kronis
(CHRONIC inflammation )
PEnYEBAB INFLAMASI
KRONIS
1. Persistent infections
Certain microorganisms associated with intracellular
infection
such as tuberculosis, leprosy, certain fungi etc
characteristically cause chronic inflammation.
These organisms are of low toxicity and evoke delayed
hypersensitivity reactions.
PEnYEBAB INFLAMASI
3. Progression from acute inflammation: Acute
inflammation
almost always progresses to chronic inflammation
following:
Persistent suppuration as a result of uncollapsed
abscess
cavities, foreign body materials (dirt, cloth, wool, etc),
sequesterum in osteomylitis, or a sinus/fistula from
chronic
abscesses.
4. Autoimmuniy. Autoimmune diseases such as rheumatoid
arthritis and systemic
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Characteristics Acute inflammation Chronic
inflammation
Duration Short
Relatively long
Pattern Stereotyped Varied
Predominant cell Neutrophils
Macrophages,
Lymphocytes
Tissue destruction
plasma cells Mild to moderate Marked
Fibrosis Absent
Present
Inflammatory Exudative
Productive
reaction
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Efek sistemik peRadangan
(SYSTEMIC EFFECTS OF INFLAMMATIONS)
a. Fever
b. Endocrine & metabolic responses
c. Autonomic responses
d. Behavioral responses
e. Leukocytosis
f. Leukopenia
g. Weight loss
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Efek sistemik peRadangan
(SYSTEMIC EFFECTS OF INFLAMMATIONS)
a. Fever
Merupakan manifestasi sistemik yang
utama adanya inflamasi.
Dikendalikan oleh hipotalamus dan
sitokin (IL -1, IL-6, TNF-α)
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Efek sistemik peRadangan
(SYSTEMIC EFFECTS OF INFLAMMATIONS)
a. Fever
b. Endocrine & metabolic responses
- The liver secrets acute phase proteins
such as:
C-reactive proteins
Serum Amyloid A
Complement and coagulation proteins
- Glucocorticoids (increased)
- Vasopressin (decreased)
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Efek sistemik peRadangan
(SYSTEMIC EFFECTS OF INFLAMMATIONS)
a. Fever
b. Endocrine & metabolic responses
c. Autonomic responses
- Pergeseran aliran darah dari daerah permukaan
(kulit) ke
organ yang lebih dalam
- Peningkatan frekuensi denyut nadi dan tekanan
darah
- Penurunan volume keringat
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Efek sistemik peRadangan
(SYSTEMIC EFFECTS OF INFLAMMATIONS)
a. Fever
b. Endocrine & metabolic responses
c. Autonomic responses
d. Behavioral responses
- Kaku (rigor), menggigil (chills), selera
makan
menurun (anorexia), somnolence, and
malaise.
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Efek sistemik peRadangan
(SYSTEMIC EFFECTS OF INFLAMMATIONS)
a. Fever
b. Endocrine & metabolic responses
c. Autonomic responses
d. Behavioral responses
e. Leukocytosis (peningkatan jumlah
lekosit)Peningkatan jumlah lekosit merupakan
gambaran adanya inflamasi, terutama infeksi
oleh bakteri (dapat mencapai 15,000 to 20,000
cells/mm3) biasanya jenis netrofil. Beberapa
infeksi virus, mis. campak (mumps)
meningkatkan sel limfosit ( lymphocytosis).
Infestasi parasit atau alergi (asthma)
meningkatkan
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Efek sistemik peRadangan
(SYSTEMIC EFFECTS OF INFLAMMATIONS)
a. Fever
b. Endocrine & metabolic responses
c. Autonomic responses
d. Behavioral responses
e. Leukocytosis
f. Leukopenia (penurunan jumlah lekosit)
dapat terjadi pada beberapa penyakit
misal typhus abdominalis , infeksi
parasit
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Efek sistemik peRadangan
(SYSTEMIC EFFECTS OF INFLAMMATIONS)
a. Fever
b. Endocrine & metabolic responses
c. Autonomic responses
d. Behavioral responses
e. Leukocytosis
f. Leukopenia
g. Weight loss
Diduga disebakan oleh IL-1 and TNF-α yang
menimbulkan peningkatan katabolisme pada otot
rangka, jaringan adiposa dan hepar.
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