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Patologi

vaskuler


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Spesialisasi vaskularisasi


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Sel endotel


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Pengaturan

tekanan darah


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5

Arteriosklerosis

1. Arteriosklerosis Monckeberg(medial calcific sclerosis)

2. Arteriolosklerosis

3. Aterosklerosis


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Response to injury hypothesis


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Penebalan tunika intima


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Plak aterom


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Interaksi sel pada aterosklerosis


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11/02/16 10

Klasifikasi Aterosklerosis: American Heart Association


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Fatty streakmakroskopis, pada aorta

mikroskopis


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Plak ibrous

Plak ruptur dengan trombosis


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Plak ateromatosa a! "oronaria

#asson $lastin %alsiikasi dan

rekanalisasi


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Plak aterosklerotikruptur

&isertai trombosis 'superimposed(

I# atal


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)terosklerosis dan komplikasi klinisnya


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16

The complications of atherosclerosis


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11/02/16 1*


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HYPERTENSION

+ ESSENTIAL 95%

+SECONARY 5%

+ 10/-0

BP = CO x PR


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SECONARY+ Re!al+ )"ute glomerulonephritis

+ .hroni" renal disease+ Poly"ysti" disease+ enal artery stenosis+ enal artery ibromus"ular dysplasia+ enal vas"ulitis+ eninprodu"ing tumors

+ E!"o#ri!e+ )dreno"orti"al hyperun"tion+ '.ushing syndrome, primary aldosteronism, "ongenital adrenal hyperplasia, li"ori"e

ingestion(+ $ogenous hormones 'glu"o"orti"oids, estrogen in"luding pregnan"yindu"ed and

oral "ontra"eptives3, sympathomimeti"s and tyramine"ontaining oods, monoamine

oidase inhibitors(+ Pheo"hromo"ytoma, )"romegaly, 4ypothyroidism 'myedema(, 4yperthyroidism+ Pregnan"yindu"ed+ Car"iovas#ular$ .oar"tation o aorta, Polyarteritis nodosa 'or other vas"ulitis(+ In"reased intravas"ular volume+ ISC$In"reased "ardia" output, igidity o the aorta, eurologi", Psy"hogeni",

In"reased intra"ranial pressure, Sleep apnea, )"ute stress, in"luding, surgery


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)rteriolosklerosis hialin

)rteriolosklerosis hiperplastik

onion skin'P)S(


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ANEURISMA

1. Aneurisma aterosklerotik

2. Aneurisma karena cystic

medial sclerosis3. Aneurisma Berry

4. Aneurisma sifilitik / luetik

5. issecting aneurisma

!. "istula arterio#enosa


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)neurisma


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&egenerasi tunika

media

ormal 'elasti"a verhoe(


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)neurisma aorta abdominalis

ruptur

&ibuka trombus

berlapis

lapis


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! Aneurisma Aterosklerotik

Paling sering di aorta desenden 'terutama

aorta abdominalis

"! Aneurisma karena cysticme#ial sclerosis

)neurisma paling sering pada

per"abangan aorta


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2*

$! Aneurisma %erry

+ 7esi ke"il dan sakular, paling sering di arteri ke"il otak

terutama sirkulus 8illisi+ 9imbul sesudah lahir di daerah kelemahan tunika media

arteri kongenital di biurkatio arteriae serebri

+ 9idak berhubungan dengan aterosklerosis

+ Sering berhubungan dengan penyakit gin:al polikistik+ $tiologi paling sering dari hemoragi subarakhnoid


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2;

&! Aneurisma Sifilitik'(uetik

+ Sebagai maniestasi lues std! I tra"t

Manifestasi klinis&

+ 4eno"hS"honlein purpura+ Serum si"kness

h S h5 l i


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11/02/16 *

Henoch3Sch5nlein purpura'Easkulitis hipersensiti leukositoklastik(

Lesio terutama padapantat dan siku trauma

Mikros: netrofl didalam & sekitarvenula karioreksisdebris inti

Lesi berat

degenerasi fbrinoiddinding vasa,nekrosis, trombus


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;

4askulitis (eukositoklastik

Biosi kulit& fragmentasi netrofil di dalam dansekitar dinding embulu' dara'


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-

Throm6oan+itis o6literans-%uer+er7s #isease.

$ umen tersumbat trombus dengan 2 abses (ana')

$ inding arteri dengan infiltratleukosit

$ angren 0ari0ari kaki

/enyakit 4askular 8un+sional


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/enyakit 4askular 8un+sional

$ Raynau#7s #isease

Sianosis paroksismal u:ung ekstrimitas ':ari tangan,

kaki, u:ung hidung,telinga( disertai rasa tebal dan

panas

%arena vasospasme arteri ke"il / arteriolae

Idiopatik keadaan dingin dan stimulus emosional

dapat mendahului serangan

$ Raynau#7s phenomenon

Seperti aynaudHs disease,

&isebabkan penyakit lain Peny! @uerger, arterios"le

rosis oblit!, trauma 'tukang ketik, pianis(, S7$, poliar

teritis nodosa


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Fenomena aynaud

Pu"at berbatas tegas Sianosis u:ung :ari


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Penyakit Venosa

$ /hle6otrom6osis$ 4arikosis 9ena

-9arises.


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5anas hemangioendotelioma,

angiosarkoma, hemangioperisitoma,

%aposi sar"oma


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HEAN0IOA+ O1te! a ge!eri# ter' 1or ANY *e!ig! *loo"

vessel tu'or

+ CAPILLARY,s'all vas#ular s(a#es/A Also #alle" 2uve!ile3 o1te! #alle" *irt) 'arksA 4suall& regress it) age

+ CA6ERNO4S,LAR0E vas#ular

s(a#es/A Also #alle" a"ultA 4suall& "o NOT regress


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) hemangioma lidah, @ hemangioma kapilare, . hemangioma kavernosa,

& granuloma piogenikum


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LYPHAN0IOA

+ S'all 7.8 ''

+ 9% Hea" a!" !e#k regio! i! ki"s :8

+ 0e!erall&;;RARE+


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0LO4S T4OR


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0LO4S T4OR

0LOAN0IOA

+ 7 #'

+ ost #o''o!l& u!"er !ail

+ Pai!1ul


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)ngiomatosis basiler


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)ngiosarkoma

.&


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Sarkoma %aposi


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Sarkoma Kaposi

*1


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9erapi/intervensi Easkuler

+)ngioplasty

+Stent+>rat )utolog 'v! saphena, a! mammaria int(

Sintetik 'telon(


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AN0IOPLASTI+ Fraktur plak '"ra"kling sound(

+ &isse"tion

+ )rterial dilatation initially+ estenosis K 6 months

STENTS


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STENTS+ etalli# 'es)+ Per'a!e!tl& (la#e"

+ Sta&s (ate!t lo!ger t)a!

a!gio(last&+ O+TEN R40 COATE

+ 0oals$

A Preve!t t)ro'*osisA Preve!t s(as'

A ela& RE.ste!osis

)ngioplasti LballoonH


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)ngioplasti balloon

dan stent endovaskuler

0RA+TS


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0RA+TS+ ?3 CA@0 gra1ts (er &ear i! 4SA

+ Sa()e!ous v vs I!ter!al 'a''ar& a ,i!ter!al

t)ora#i# a/

+ 5% (ate!t a1ter 7 &ears3 1or sa()e!ous v+ 9% (ate!t a1ter 7 &ears3 1or 'a''ar& a

+ E!"ot)elial a!" s'oot) 'us#le 'igratio! a!"(roli1eratio! ke& 1a#tors 1or su##ess


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)nastomosis

)ngiogram

penyempitan di distal

Prolierasi t! intima dan

penyempitan lumen

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