Download - Vasku Ler
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SUMBATAN ARTERI AKUT
Causal ?
emboli (biasanya) trauma kelainan degeneratif
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emboli
udara tumor kista echinococcus
FAKTOR: T.u kelainan jantung (irama) aneurysma aorta
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trombosis
(Setiap kelainan degeneratif dinding arteri yang menyebabkan
sumbatan arteri akut)
FAKTOR:1.Aliran laminer turbulen2.Perubahan unsur darah3.Kerusakan dinding pembuluh darah4.Lain-lain: Rokok
LipidaemiaDM
stress radiasiendotoksin
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Klinis:1.Nyeri akut – lokal/distal
2.Mati rasa dingin triad rasa ditusuk-tusuk
3.Seterusnya lumpuh otot
4.Vena kosong
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TRIAD hilang sembuhsementar
a
Dingin hipertensi
Claudicatio
intermitten
(kronis)gangraen
Diff. diagnosa: sumbatan vena dalam
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RinganDistal
+/-
-
o.k iskemia
Sumbatan arteri
Hebat s/d shockSeluruh tungkai
+++
+
o.k nyeri
Sumbatan venadalam
Sakit
Edema
Nadi
Gerakan
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Sikap ?1.Diagnosa dini + tindakan emergensi2.Istirahat +analgetika kuat3.Vasodilatan
4.Anti coagulantia
5.Bedah embolektomi6.fasciotomi
Romcoldufadilan
trentalpraxilene
Heparin ( I.V )Coumarin ( oral ) sintrom
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Trombektomi / embolektomi= mengeluarkan
trombus/emboli dari arteri/vena
Alatnya : fogarthy catheter
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+ arteriografi+ doppler (echocardiografi)
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SUMBATAN KRONIK PEMBULUH DARAH ARTERI
PERIFERPENYAKITBUERGER
DIABETIC ANGIOPATI
RokokUsia mudaUnilateralFlebitis berpindahBatas tegas pada ujung jari
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patofisiologiFatty streaktrauma
kalsifikasi
Fibrous plaque
exogen
endogen
sklerotik
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DIABETIC
Neuropati otonom
Blood flowend organ Injury endothel
Bahan aterogenikViskositas darah
Faktor pembekuan
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ANGIOPATINEUROPATI
MotorikSensorikotonom
Trauma tumpul
Trama kebalKulit kering
Ulkus/luka
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klinis
CrampKlaudikasioNyeri istirahatGangguan nutrisi kulit
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khas
Gangguan aktifitasPsikologisKecacatan nyeri
masalah
Posisi tertentuWaktu tertentu seranganmetabolisme
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diagnosa
Klinis kulit nadi exercise pengisian kapiler
Doppler AB indexAngiografi
Lain-lain laser doppler radioisotop
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penanganan lokasi jelas koreksi pertahankan kolateral Vasodilator, simpatektomi Cegah sumbatan baru
anti platelet Exercise debridement ulkus amputasi kalau perlu
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nasehatJauhi rokokHindari trauma sepatu, kaus kaki, air panas, dllRawat jari & sela jariJari lembab – sela jari keringHati-hati potong kukuJangan lupa ke dokter anda
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TROMBOANGITIS OBLITERAN
( TAO )=BUERGER’S
DISEASE
CAUSA: ?Insiden: tangan 2 % tungkai 60% gabungan 38%
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klinis1.NYERI
2.PULSASI
3.PERUBAHAN WARNA KULIT tergantung posisi kaki4.SUHU LOKAL dingin5.GANGREN unilateral6.TROMBOPHLEBITIS BERPINDAH7.GANGGUAN TROPIK
a.Claudicatio intermittenb.Spontanc.osteoporosis
A.Dorsalis pedisB.Tibialis post.
Kulit, bulu kaki pirang, jarang, kuku tebal
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Faktor : diagnosa muda usia rokok gangraen menetap ekstremitas bawah unilateral
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Pemeriksaan tambahan
DOPPLER aliran ARTERIOGRAFI segmental
Pengobatan cegah progresifitas vasodilatant atasi nyeri rawat ulkus/gangren stop rokok bedah - lumbal simpatektomi