RADANG AKUT

Dr. NK SUNGOWATI, SpPA

RADANG AKUT• Perubahan vaskuler a. Perubahan aliran dan ukuran pembuluh

darah b. Peningkatan permeabilitas vaskuler• Peristiwa 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 AKUT

• Merupakan respon langsung dan dini terhadap jejas

• Ditandai perubahan sirkulasi mikro, eksudasi cairan dan transmigrasi leukosit dari pembuluh darah ke tempat jejas

CARDINAL SIGN

• Rubor• Calor• Tumor• Dolor• Functio

laesa

ISTILAH-ISTILAH

• Eksudasi• Eksudat• Transudat• Edema• Pus

PERUBAHAN VASKULER

• Perubahan kaliber pembuluh darah dan aliran darah

a. Vasodilatasi b. Perlambatan sirkulasi c. Stasis• Peningkatan permiabilitas vaskuler

(vascular leakage)

Mekanisme terjadinya vascular leakage

Kontraksi endotel (histamin,bradikinin, lekotrin)

Reorganisasi sitoskeleton (sitokin)

Jejas langsung

Leakage diperantarai leukosit

Leakage dari endotel regeneratif

PERISTIWA SEL DARAH PUTIH

• Marginasi, rolling, adhesi• Transmigrasi (diapedesis)• Migrasi menuju stimulus

kemotaktik

Peristiwa sel darah putih

Adhesi leukosit pada endotel

Interaksi endotel neutrofil

TRANSMIGRASI• Terjadi sepanjang interseluler junction• Tergantung umur lesi dan tipe stimulus• Neutrofil (6-24 jam)• Monosit (24-48 jam)• Pseudomonas (neutrofil ~ 2-4 hari)• Virus ~ limfosit• Hipersensitivitas ~ eosinofil

Reaksi radang akut

Peristiwa Sel Darah Putih

Ikatan ligan-reseptor

Ikatan ligan-reseptor

FAGOSITOSIS

• Pengenalan dan perlekatan• Pelahapan• Pembunuhan atau degradasi

FagositosisFc

C3

NADPH

NADP+Oksidase aktif

SITOPLASMA VAKUOLA FAGOSITIKOksidase sitoplasmik

Oksidase membran

Granula spesifik

PENGELUARAN PRODUK LEUKOSIT

• Terdiri dari : E. lisosom, metabolit aktif O2, prostalglandin dan lekotrin.

DEFEK FUNGSI LEUKOSIT• Lebih rentan terhadap infeksi• Genetik : 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 prostalglandin• Perubahan hitung sel darah putih perifer - Neutrofil leukositosis - Neutropenia, limfositosis• Perubahan protein plasma C-reactive protein, antitrypsin, fibrinogen, haptoglobin, ceruloplasmin

RINGKASAN

Reaksi radang akut :• Aliran darah meningkat (dilatasi

arteriol)• Permeabilitas meningkat

(interendotel junction melebar, jejas langsung endotel)

• Neutrofil (adhesi, transmigrasi, migrasi ke tempat jejas)

• Fagositosis• Produk 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.