ANATOMI VASKULARISASI
Transcript of ANATOMI VASKULARISASI
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PRINSIP ANATOMI VASKULER
• Arteri adalah pembuluh darah yang MENJAUHI jantung
• Vena adalah pembuluh darah yang MENUJU jantung
• Kapiler adalah pembuluh darah mikro PERALIHAN arteri dan vena
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PRINSIP ANATOMI VASKULER
• Arteri – Memiliki otot– Pompa (+)– Jaringan elastin (+) daya compliance
arteri– Kerusakan jaringan elastin ANEURYSMA– Makroskopik : locus minoris, penipisan, dan
pelebaran dinding arteri
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PRINSIP ANATOMI VASKULER
• Arteri • Kemampuan konstriksi & dilatasi• Daya compliance• Konstriksi obstruksi arteri
– Hipertensi– Atherosclerosis – Peningkatan aktifitas simpatik
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• Secara anatomis tekanan darah dipengaruhi– Volume darah– Kaliber pembuluh darah
• Volume darah meningkat BP meningkat
• Kaliber vaskuler mengecil BP meningkat
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• Hipertensi adalah bentuk KOMPENSASI tubuh
• Terjadi jika tubuh mengalami kekurangan suplai darah
• Tujuan peningkatan tensi MEMPERCEPAT aliran darah sampai pada tujuan
PRINSIP ANATOMI VASKULER
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• Hipertensi– Me kerja jantung sebagai pompa aktifitas
simpatis jantung meningkat– Me kerja ventrikel kiri
• Hipertrofi miocardium ventrikel sinistra• Peningkatan kebutuhan oksigenasi ventrikel sinistra
– Aneurysma bisa terjadi akibat hipertensi kronik– Resiko aneurysma lacerasi arteri
PRINSIP ANATOMI VASKULER
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• Tekanan vena lebih rendah dibanding arteri
• Dinding relatif lebih tipis• Memiliki katup flowback melawan
gravitasi• Dibantu oleh kontraksi musculi
extremitas
PRINSIP ANATOMI VASKULER
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imobilitas lama extremitas atrofi otot
flowback vena menuju jantung
pengisian jantung
Cardiac output
Tekanan darah
KLINIS
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• Hambatan flowback vena gangguan kerja katup– Obstruksi bagian distal vena– Stasis vena (terutama extremitas inferior)
• Pelebaran dinding vena varicose• Thrombosis vena obstruksi vena oleh jaringan
patologis• Emboli obstruksi vena oleh udara• Phlebitis inflamasi vena (steril/ nonsteril)
cardinal sign!!
PRINSIP ANATOMI VASKULER
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Varicose
Pori vena endothel berjauhan
Difusi cairan intravaskuler
Jaringan interstitial
OEDEMA EXTREMITAS
KLINIS
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• Kapiler ~ pembuluh darah mikro yang masuk ke dalam jaringan interstitial
• Sinusoid ~ kapiler yang membentuk jalinan/ rete/ anastomosis
• Sifat kapiler:– Tertutup end artery (sirkulasi coronaria dan ginjal)– Terbuka pada umumnya (regio facei A. carotis
externa ramus facialis beranastomosis dengan A. carotis interna foramen infra orbitale)
PRINSIP ANATOMI VASKULER
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PULSE SITES
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SIRKULASI PRENATAL
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SIRKULASI POSTNATAL
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Penekanan cavum thoracis melalui jalan lahir
Peningkatan tekanan intrathoracal
Cairan intrapulmonal terdorong secara mekanik keluar jaringan alveoli
Bayi menangis udara memasuki rima oris trachea bronchus mendorong sisa cairan intra alveoli paru-paru mengembang
Tekanan oksigen meningkat mendadak
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Tekanan oksigen meningkat mendadak,
temp meningkat
Obliterasi shunt arteriosus Bottali, AV. Umbilicales
Aliran extracorporal terhenti
Volume Flowback menuju VCI
Volume atrium kanan
Paru sudah mengembang
Aliran Vv. pulmonales (+)
Volume atrium kiri
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Volume atria sinistra et dextra meningkat
Mendorong septum secundum dan septum primum
Menutup foramen ovale secara mekanik
3 hari s/d 1 bulan secara organik
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KLINIS
• Atrial/ ventricular septal defect• Persisten Ductus Arteriosus• Persisten Foramen Ovale• Persisten Fetal Circulation• Tetralogy Of Fallot
– Riding aorta– PDA– Stenosis infundulum/ truncus pulmonalis– Transposisi aorta
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Left CoronaryLeft AnteriorDescending
1st Diagonal
1st SeptalPerforating
Circumflex
2nd SeptalPerforating
Ramus M
arginalis
AtrialCircumflex
1st Marginal
2nd Marginal
3rd Marginal
2nd Diagonal
3rd Diagonal
Left Posterior Descending
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Right Coronary
SA Node Artery
Conus Branch
Right Ventricular
A-V Nodal
Right Acute Marginal
3rd Inferior Ventricular
2nd Inferior Ventricular
1st Inferior VentricularRight Posterior Descending
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DOMINANSI A.CORONARIA
• A. coronaria end artery• Dominansi kiri >> ~ kerja ventrikel kiri• Dominansi kanan >• Non-dominansi >>>• Penelitian klinis arteriografi pasien
cardiovasculare dominansi kiri kekambuhan pasca tindakan operasi > dominansi kanan/ non dominansi
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KLINIS
• Obstruksi A. coronaria– Atherosclerosis– Emboli fatal– Vasokonstriksi (simpatik meningkat)
• End artery mudah terjadi infark fokal• Ischaemic hipoksia akibat terputusnya suplai
oksigen• Infark kematian jaringan akibat anoksia
daerah pucat
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KLINIS
• Angina pectoris ischaemic myocardium
• Infark myocard kerusakan jaringan permanen
• Infark mikro ~ makro• Angina stable ~ unstable
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KLINIS• Hipoksia myocard hipokinesia COP rendah
• COP rendah BP turun kadar O2 rendah
• Sinus caroticus terangsang (impuls diterima oleh N. IX) terjadi reflex cardiac (oleh N. X parasimpatis)
• Parasimpatis dilatasi pembuluh darah, menurunkan tekanan darah + pulse jantung Kolaps
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A. Cere
bri
A. vertebralis
A. basilaris
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KLINIS
• CVD = cerebrovasculare disorsers
• Nama lain STROKE– Stroke haemorrhagic aktivitas, kehilangan kesadaran– Stroke thrombosis istirahat, bangun tidur, tanpa
kehilangan kesadaran
• Cabang dari A. vertebralis atau A. cerebralis mengalami ruptur atau sumbatan
• Khas pada stroke haemorrhagic Blood Pressure turun spontan
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CEPHALHEMATOME
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• Akibat pecahnya pembuluh darah subkutan
• Biasanya akibat proses persalinan atau tindakan vacuum
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EPIDURAL HEMATOME
Pecahnya V. emissaria atau V. diploicaCephalomegali, sepertiHydrocephalusPelebaran pupilKesadaran baik
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SUBDURAL HEMATOME
• Pecahnya AV. meningealis
• Penurunan kesadaran (+)
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PIAL HEMATOM
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• Pecahnya sinus sagitalis atau Vv. cerebrales profundae
• Penurunan kesadaran (+)• Kelumpuhan tipe sentral (spastik)
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DEFINISI
• Sistem portal adalah suatu sistem yang merupakan muara beberapa vena abdomen
• Masuk ke dalam hilus hepatis (area H)
• Dilapisi peritoneum dan omentum minus
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VENA YANG BERMUARA
• V. gastrica sinistra• V. gastrica dextra• V. mesenterica superior• V. splenica• V. pancreaticoduodenale posterior superior• Tributary oesophagus• V. colica media
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KLINIS
• Pengerasan hati (kasus cirhhosis hepatis) obstruksi sistem portal hepatis
• Obstruksi aliran balik pelebaran vena • Varicose/ varices dinding tipis mudah ruptur• Sehingga pada cirrhosis hepatis didapatkan
gambaran:– Caput medusae– Spider naevi– Varices oesophagus hematemesis
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TUGAS!!HAEMORRHOID
• Dibagi menjadi 5 kelompok• Bahas haemorrhoid dari segi
vaskularisasinya