fis intra-ekstra uterine

1

PERUBAHAN LINGKUNGAN INTRA – EKSTRA UTERUS

TERHADAP FISIOLOGI

SISTEM TUBUH

Department of Physiology, Faculty of MedicineDepartment of Physiology, Faculty of MedicineUniversity of Sumatera Utara, MedanUniversity of Sumatera Utara, Medan

IndonesiaIndonesia

PROSES KELAHIRAN

(Perubahan Link. Intrauterine Link. Ekstrauterine)

“at term”“at term”KONTRAKSI uterus

(Frekuensi-Durasi-Intensitas)

KONTRAKSI uterus

(Frekuensi-Durasi-Intensitas)

Sirkulasi (PO2/PCO2) tergangguSirkulasi (PO2/PCO2) terganggu

Asphyxia (PO2 & PCO2 )

Heart Rate :

140x/mnt 160-180x/mnt bila O2 100-120x/mnt

Asphyxia (PO2 & PCO2 )

Heart Rate :

140x/mnt 160-180x/mnt bila O2 100-120x/mnt

3

Perubahan SIRKULASI segera setelah Lahir

Rangs. Dingin pd Kulit + AsphyxiaRangs. Dingin pd Kulit + Asphyxia

Bayi lahir (normal)Bayi lahir (normal)

Bayi MenangisBayi Menangis

PO2 70-80 mmHg

Saturasi Hb-O2 : 80-90%

PO2 70-80 mmHg

Saturasi Hb-O2 : 80-90%

at birth

potong Umbilical cord (tali pusat)

Tahanan peripher

TD. Aorta >> TD. Art.Pulmonal

Sirkulasi Plasenta (-)

Asphyxia (CO2 & O2 )

Menangis Tarik Napas

Paru mengembang

Tahanan paru

TD.Aorta TD. pulmonal

Rangs. Dingin

5

6

Bbrp. Jam postpartumBbrp. Jam postpartum

Aliran Atrium Kiri & Aliran Atrium Kanan

Aliran darah Aorta Arteri Pulmonalis

Konstriksi Duktus Arteriosus (Penutupan Fungsional)

1 - 4 Bulan

Fibrosis Occluded

Sirkulasi Dewasa

7

TD. Aorta >> TD. Art.PulmonalTD. Aorta >> TD. Art.Pulmonal

Aliran darah paru Aliran darah paru

Aliran Atrium Kiri & Aliran Atrium Kanan Aliran Atrium Kiri & Aliran Atrium Kanan

Tek. Atrium Kiri >>Tek. Atrium Kanan Tek. Atrium Kiri >>Tek. Atrium Kanan

Foramen Ovale TertutupForamen Ovale Tertutup

8

Circulation in Fetus and Newborn

9

PERUBAHAN SIRKULASI

PLASENTA

JARINGAN TUBUH

VENT Ki ATR Ki

PARU

VENT Ka ATR Ka

FETUS PERINATAL (0-1 Bln) BAYI (1-4 Bln) Dewasa

FO : Foramen Ovale

FO

DA

DA : Ductus Arteriosus

JARINGAN TUBUH

VENT Ki ATR Ki

PARU

VENT Ka ATR Ka

DA

PLASENTA

FO

PLASENTA

PARU

JARINGAN TUBUH

FO

VENT Ki ATR Ki

VENT Ka ATR Ka

PARU

JARINGAN TUBUH

DADA

10

MENARIK NAFAS PERTAMA (The First Breath)

Perubahan Respirasi Placenta Respirasi paru

Bayi LahirBayi Lahir

Rangsang sensorik : Kulit & OtotRangsang sensorik : Kulit & Otot Asidosis RinganAsidosis Ringan

Pusat PernapasanPusat Pernapasan

Kontraksi otot-otot PernapasanKontraksi otot-otot Pernapasan

Vol. Intra Thoraks & Tek. Intra Thoraks Vol. Intra Thoraks & Tek. Intra Thoraks

Udara Masuk ke ParuUdara Masuk ke Paru

11

REGULASI SUHU TUBUHREGULASI SUHU TUBUH

BayiBayi Iklim intrauterine (“tropis”) Iklim intrauterine (“tropis”) Iklim Ekstrauterine Iklim Ekstrauterine

STRESSSTRESS

Regulasi Suhu Regulasi Suhu BELUM STABILBELUM STABIL

Suhu Tubuh Suhu Tubuh

TDK STABILTDK STABIL

12

Regulasi Suhu Blm. Stabil

Thermogenesis (Heat Gain) Thermolysis (Heat Loss)

Tak dpt menggigil (respon dingin) Sistem syaraf blm. Sempurna.

Respon dingin :

Metabolisme “brown fat”

Trigliserida

Free fatty acid

Luas permukaan bayi >> Dewasa

Kulit & Jar. Subcutan tipis High Conductance Panas hilang >>

Cairan Tubuh

BB (5-10%) 2-3 Hr pertama

1313

FUNGSI LIVER

Bayi baru lahir Sumber Energi

GLIKOGEN

LIVER, OTOT, JANTUNG, dll

GLIKOGEN

LIVER, OTOT, JANTUNG, dll

Beberapa jam postpartum GLIKOGEN GLIKOGEN

14

REGULASI GLUKOSAREGULASI GLUKOSA

Segera setelah lahir KGD 30-40mg/100mLSegera setelah lahir KGD 30-40mg/100mL

Bbrp. jamBbrp. jam

Glikogen Glikogen

KGD <20mg/100mLKGD <20mg/100mL

GLUKONEOGENESISGLUKONEOGENESIS

Gangguan/gagalGangguan/gagal

Ggn. Syaraf & KomaGgn. Syaraf & Koma

Apnoe + CyanosisApnoe + Cyanosis

Pemberian Glukosa

Pemberian Glukosa

15

METABOLISME PROTEIN & LEMAK

Fetus

Melawati “Barrier Placenta”

- Immunoglobulin

Melawati “Barrier Placenta”

- Immunoglobulin

Tak Melawati “Barrier Placenta”

- Plasma Protein

- Lemak

Tak Melawati “Barrier Placenta”

- Plasma Protein

- Lemak

Sintesa di Hati :

Albumin & Lemak

Sintesa di Hati :

Albumin & Lemak

Aktivasi Met. As.Nukleat & sintesa Protein

Aktivasi Met. As.Nukleat & sintesa Protein

Segera Setelah Lahir

16

BILIRUBIN & FUNGSI DETOXIFIKASI

Fungsi Ekskresi Bilirubin (Hati) & Detoxifikasi Obat-obatan

Fungsi Ekskresi Bilirubin (Hati) & Detoxifikasi Obat-obatan

Physiological Joundice (3-7

Hari)

Physiological Joundice (3-7

Hari)

Blm. SempurnaBlm. Sempurna

1717

TRACT. GASTROINTESTINALIS

“Rute PLACENTA” “Rute INTESTINAL”

Gastric Emptying Time : 3-4 jamGastric Emptying Time : 3-4 jam

Enzym Lambung & HCl, pH : <3

(pencernaan Susu)

Enzym Intestinal, dan Empedu CUKUP

Amilase Pankreas <<<

Enzym Lambung & HCl, pH : <3

(pencernaan Susu)

Enzym Intestinal, dan Empedu CUKUP

Amilase Pankreas <<<

MOTILITAS

MOTILITAS

SEKRESI

SEKRESI

ABSORPSIABSORPSIZat Nutrisi BAIK

Kecuali LEMAK

Zat Nutrisi BAIK

Kecuali LEMAK

18

PENGATURAN ENDOKRIN

PERTUMBUHAN

Foetus Growth Foetus Growth dipengaruhi dipengaruhi ::

““Maternal Nourishment”Maternal Nourishment”

Estrogen & ProgesteronEstrogen & Progesteron

Fetus Growth Fetus Growth Tdk.dipengaruhiTdk.dipengaruhi ::

Growth Hormon FoetusGrowth Hormon Foetus

Thyroxine FoetusThyroxine Foetus

19

Thyroid Gland

IBU

(HYPOTHYROIDISM)

Lahir Bayi

(HYPOTHYROIDISM)

PERKEMBANGANAKTIF segera Stlh Lahir

(respon thd dingin)

2020

Adrenal Korteks

Kortikosteroid (+)

Respon kelenjar (+)

Pada urinePada urine

Keadaan stressKeadaan stress

Adrenal Medula

Saat LahirSaat Lahir

Mempertahankan Sirkulasi Darah Otak

PO2 PO2

ASPHYXIAASPHYXIA

Epinephrin/NEEpinephrin/NE

VASOKONSTRIKSIVASOKONSTRIKSI

Respon Metabolik Thd DINGIN

21

SISTEM SYARAF

Sist. Syaraf Pusat

Pertumbuhan :

- me pd Trimester II & III (maks)

-Berat : ¼ berat Otak Dewasa

Sifat Refleks

Flexion Reflex,menangis wkt. Lapar, memutar Kepala, dll.

Buka mata (respon Cahaya & Suara)

Tidur barbagai posisi

22

PERAN HORMON DALAM PROSES TUMBUH DAN

KEMBANG

23

Multiple hormones, including growth hormone (GH), insulin-like growth factors (IGF-I and -II), insulin, thyroid hormones, glucocorticoids, androgens, and estrogens contribute to the growth process in humans.

Among these, GH and IGF-I have been implicated as the major determinants of growth in normal postuterine life. However, deficiencies (or excesses) of each of the other hormones can seriously affect the normal growth of the musculoskeletal system as well as the growth and maturation of other tissues.

24

25

26

27

Pancreas: Insulin• actions: hypoglycemic (lowers blood

glucose)– increases transport of glucose into muscle and fat

cells (NOTE: does not increase uptake by brain, liver, or kidney)

– inhibits breakdown of glycogen and formation of glucose from amino acids or fatty acids (inhibits glycogenolysis and gluconeogenesis)

– promotes formation of glycogen (liver, skeletal muscles), protein synthesis (muscle), and fat synthesis and storage (adipose)

28

5. Pancreas: Insulin (Control)• stimulated by:

– increased blood glucose

– increased blood amino acid and fatty acid levels

– parasympathetic impulses

– hyperglycemic hormones (GH, glucagon, epinephrine, thyroxine, glucocorticoids) indirectly result in insulin secretion by increasing blood glucose levels

• inhibited by: – low blood glucose and by

somatostatin

– sympathetic impulses

29

30

31