Download - 11. Inflamasi Akut & Kronik
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"Opportunities are usually"Opportunities are usuallydisguised by hard work, sodisguised by hard work, so
most people don't recognizemost people don't recognizethem."them."
- Ann Landers- Ann Landers
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INFLAMMATIONINFLAMMATIONdr. Al Munawir, M.Kes., Ph.D.
Laboratorium Patologi Anatomi
Fakultas Kedokteran
Universitas Jember
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Introdution!
"In#lame$ % to set #ire.
In#lammationis "d&nami res'onse o#
vasularised tissue to in(ur&.$
Is a 'rotetive res'onse.
)erves to bring de#ense * healingmehanisms to the site o# in(ur&.
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Lewis +ri'le es'onse!
FlushFlush::a'illar& dilatation.
FlareFlare::arteriolar dilatation.WealWeal::e-udation, edema.
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ed, arm * )wollen
/Flare, Flush * eal % Lewis0
+ri'le res'onse
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1astri Uler!
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Lar&ngitis!
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Mouth A'hthus uler
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Aute 2nteritis!
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Pneumonia
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3ardinal )igns o# In#lammation
RuborRubor:: edness % 4&'eraemia.
CalorCalor :: arm % 4&'eraemia.
DolorDolor ::Pain % 5erve, 3hemial med.
TumorTumor::)welling % 2-udation
LossLossofofFunctionFunction::
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In#lammation 6 Mehanism
1. Vaso dilatation
2. Exudation - Edema
3. Emigration of cells
4. Chemotaxis
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Mehanism o# In#lammation!
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5eutro'hil Margination
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7asular hanges
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Pneumonia 6 2-udation
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3hemial Mediators!
3hemial substanes s&nthesised orreleased whih mediate the hanges in
in#lammation.
4istamineb& mast ells 6 vasodilatation.Prostaglandins% 3ause 'ain * #ever.
8rad&kinin6 3auses 'ain.
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Mor'hologi t&'es
Aute!2-udative In#lammation! e-ess #luid. +8 lung.
)u''uration9Purulent % 8aterial 6 neutro'hils
Fibrinous % 'neumonia % #ibrin)erous % e-ess lear #luid % 4eart, lung
4aemorrhagi % b.v.damage 6 anthra-.
3hroni in#lammation! with healing.1rannulomatous % lusters o# e'itheloid: ells
eg. +8, Fungus, Foreign bod&.
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Never let the cometition define !ou.
Instead" !ou have to define !ourself
#ased on a oint of vie$ !ou care
deel! a#out.% om !happel
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In#lammation ;utome
&cuteInflammation
'esolution
ChronicInflammation
scess
(inus)istula
)i#rosis*(car
+lcer
In,ur!
)ungus
Virus
Cancers
.. etc.
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3hroni In#lammation!
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2dema
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)erous In#lammation 6 2##usion
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)erousIn#lammation
6 2##usion
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Fibrinous
In#lammation
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Purulent 6 In#lammation 6 PU)
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Purulent 6In#lammation 6
PU)
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Purulent 6In#lammation 6
PU)
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3hroni
In#lammation!
Lung Absess
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1ranuloma!
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Aute 7s 3hroni
Flush, Flare *eal
Aute
in#lammator& ells6 5eutro'hils
7asular damage
More e-udation
Little or no #ibrosis
Little signs 6Fibrosis,
3hroni
in#lammator& ells% L&m'ho&tes
5eo6vasularisation
5o9less e-udation
Prominent #ibrosis
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/0eole $ho soar" are those
$ho refuse to sit #ac and
$ish things $ould change./
Charles '. ($indoll
&uthor and 0astor
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eat 'edness ($elling 0ain oss f )unc.
+he < 3ardinal )igns o#
Inflammation 35
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4ealing * e'airdr. Al Munawir, M.Kes., Ph.D.
Laboratorium Patologi Anatomi
Fakultas Kedokteran
Universitas Jember
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)tages o# 4ealing!
4emorrhageIn#lammation
1ranulation tissue /so#t allus0)ar % Fibrosis /hard allus0
emodeling * ound strength
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e'air
egeneration o# in(ured tissue b&'arenh&mal ells o# the same t&'e
e'laement b& onnetive tissue
In other wordsegeneration
)ar
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Proli#erative Potential
Labile cells6 ontinuousl& dividing2'idermis, muosal e'ithelium, 1I trat
e'ithelium et
Stable cells6 low level o# re'liation4e'ato&tes, renal tubular e'ithelium,
'anreati aini
Permanent cells6 never divide5erve ells, ardia m&o&tes, skeletal mm
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Pol&'e'tide growth #ators
Most Important Mediators affecting CellGrowth
Present in serum or 'rodued loall&
2-ert 'leiotro'i e##ets= 'roli#eration, ellmigration, di##erentiation, tissue
remodeling
egulate growth o# ells b& ontrollinge-'ression o# genes that regulate ell
'roli#eration
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e'air b& onnetive tissue
;urs when re'air b& 'arenh&malregeneration alone annot be
aom'lished
Involves 'rodution o# Granulation Tissuere'laement o# 'arenh&mal ells with
'roli#erating #ibroblasts and vasular
endothelial ells
3 t # th
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Inflammation-413om'onents o# the 'roess
o# #ibrosis
Angiogenesis 6 5ew vessels budding
#rom old
Fibrosis, onsisting o# emigration and'roli#eration o# #ibroblasts and de'osition
o# 23M
)ar remodeling, tightl& regulated b&'roteases and 'rotease inhibitors
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ound healing
Indution o# aute in#lammator& res'onse
b& an initial in(ur&
Parenh&mal ell regeneration
Migration and 'roli#eration o#
'arenh&mal and onnetive tissue ells
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ound healing /ont>d0
)&nthesis o# 23M 'roteins
emodeling o# 'arenh&mal elements to
restore tissue #untion
emodeling o# onnetive tissue to
ahieve wound strength
I fl i 44
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4ealing b&
First IntentionFoal Disru'tion o#
8asement Membrane
and loss o# onl& a #ew
e'ithelial ells
e.g. )urgial Inision
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4ealing b&Secon Intention
Larger in(ur&, absess,
in#artionProess is similar but
esults in muh larger
)ar and then
3;5+A3+I;5
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ound )trength
A#ter sutures are removed at one week,wound strength is onl& ?@ o#
unwounded skin /alker> Law0
8& B6C months, wound strength is about@ o# unwounded skin /alker>s Law0
I fl ti 47
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1ranulation tissue
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4ealing)kin wound
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4ealing 6 )kin )ar
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Fators a##eting 4ealing!
S!stemicS!stemicAge
5utrition
7itamin de#.
Immune status
;ther diseases
LocalLocalIn#etion
)iEe or e-tent.
a''osition
8lood su''l&
Mobilit&
Foreign bod&
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)ummar&!
4ealing % Proli#eration * Di##erentiation.Labile, )tabe * Permanent ells
)tages o# 4ealing! ?66B6CG.
4ealing b& First or )eond intention.
)kin wound healing 6 bone healing.
Fators a##eting healing % Loal 9
)&stemi
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/Each time !ou are honest and conduct
!ourself $ith honest!" a success force $ill
drive !ou to$ard greater success. Each
time !ou lie" even $ith a little $hite lie"
there are strong forces ushing !ou
to$ard failure./
5oseh (ugarman
&uthor and 6areting (ecialist