RADANG AKUT Dr. NK SUNGOWATI, SpPA

RADANG AKUTPerubahan vaskuler a. Perubahan aliran dan ukuran pembuluh darah b. Peningkatan permeabilitas vaskulerPeristiwa seluler: ekstravasasi leukosit dan fagositosis a. Adhesi dan transmigrasi b. Kemotaksis dan aktivasi leukosit Outline

c. Fagositosis (pengenalan, perlekatan, pelahapan dan degradasi)d. Pengeluaran produk leukosite. Defek fungsi leukosit

Jejas pada sel

RADANG AKUTMerupakan respon langsung dan dini terhadap jejasDitandai perubahan sirkulasi mikro, eksudasi cairan dan transmigrasi leukosit dari pembuluh darah ke tempat jejas

CARDINAL SIGNRuborCalorTumorDolorFunctio laesa

ISTILAH-ISTILAHEksudasiEksudatTransudatEdemaPus

PERUBAHAN VASKULERPerubahan kaliber pembuluh darah dan aliran darah a. Vasodilatasi b. Perlambatan sirkulasi c. StasisPeningkatan permiabilitas vaskuler (vascular leakage)

Mekanisme terjadinya vascular leakageKontraksi endotel (histamin,bradikinin, lekotrin)Reorganisasi sitoskeleton (sitokin)Jejas langsungLeakage diperantarai leukositLeakage dari endotel regeneratif

PERISTIWA SEL DARAH PUTIHMarginasi, rolling, adhesiTransmigrasi (diapedesis)Migrasi menuju stimulus kemotaktik

Peristiwa sel darah putih

Adhesi leukosit pada endotel

Interaksi endotel neutrofil

TRANSMIGRASITerjadi sepanjang interseluler junctionTergantung umur lesi dan tipe stimulusNeutrofil (6-24 jam)Monosit (24-48 jam)Pseudomonas (neutrofil ~ 2-4 hari)Virus ~ limfositHipersensitivitas ~ eosinofil

Reaksi radang akut

Peristiwa Sel Darah Putih

Ikatan ligan-reseptorIkatan ligan-reseptor

FAGOSITOSISPengenalan dan perlekatanPelahapanPembunuhan atau degradasi

FagositosisFcC3NADPHNADP+Oksidase aktifSITOPLASMAVAKUOLA FAGOSITIKOksidase sitoplasmikOksidase membranGranula spesifik

PENGELUARAN PRODUK LEUKOSITTerdiri dari : E. lisosom, metabolit aktif O2, prostalglandin dan lekotrin.

DEFEK FUNGSI LEUKOSITLebih rentan terhadap infeksiGenetik : 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 prostalglandinPerubahan hitung sel darah putih perifer - Neutrofil leukositosis - Neutropenia, limfositosisPerubahan protein plasma C-reactive protein, antitrypsin, fibrinogen, haptoglobin, ceruloplasmin

RINGKASANReaksi radang akut :Aliran darah meningkat (dilatasi arteriol)Permeabilitas meningkat (interendotel junction melebar, jejas langsung endotel)

Neutrofil (adhesi, transmigrasi, migrasi ke tempat jejas)FagositosisProduk 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.