10. sistem limfatik dan imunitas

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  • Sistem Limfatik dan Sistem ImunitasPurwo Sri Rejeki

  • *Sistem LimfatikSistem Satu Arah: menuju jantungMengembalikan cairan jaringan berlebihMengembalikan protein yang bocorLymph = cairanBila buntu Edema

  • *Kapiler LimfatikPunya katup mini cairan masuk tidak bisa keluar Menangkap Bakteri dan Virus dihancurkan Menyerap protein, elektrolit dan cairan

  • *

  • *Kapiler LimfatikTidak didapatkan di tulang, sumsum tulang, gigi dan SSPMasuk ke lymphatic collecting vesselsLymphatic collecting vesselsMempunyai lapisan seperti pembuluh vaskuler (3 lapis), tapi tipis dan lenturYang superfisial tdp di kulit: bersama vena superfisialYang dalam: di badan dan organ visera, berjalan bersama arteriTekanannya sangat rendahMemberikan gambaran khusus pada lymphangiographyMengalir ke dalam lymph nodes

  • *Nodus Limfatik: bean shaped organs sepanjang lymphatic collecting vesselsUkiuran: bisa sampai 1 inchClusters of both deep and superficial LNs

  • *Superficial groups-Cervical-Axillary-InguinalDeep groups-Tracheobronchial-Aortic-IliacDrainage-Superior R 1/4 of body: R lymphatic duct (green) *-The rest: thoracic duct *Lymph Nodes**

  • *Fibrous capsule sends in dividing trabeculaeAfferent & efferent lymphatic vesselsLymph percolates through lymph sinusesFollicles: masses of lymphoid tissue divided into outer cortex & inner medulla (details in later slides)

  • *Macrophages on reticular fibers consume pathogens and foreign particles

    Usually pathogen free lymph enters lymph trunks

  • *Lymphatic Trunks

    (Semua berpasangan, kecuali yang di intestinal trunk)LumbarIntestinalReceives fatty lymph (chyle) absorbed through lacteals in fingerlike villi of intestinesBroncho-mediastinalSubclavianJugular

  • *Lymph ducts(variable)Thoracic duct: everyone has

    20% also have a right lymphatic duct*20%

  • *

  • Sistem Imun Tubuh Leukosit ( sel darah putih )

  • *Sistem ImunMengenali molekul asing yang spesifik Setiap paparan (patogen yang sama) meningkatkan efektivitasLymphoid organsLymph nodesSpleenThymusTonsilsSmall intestine & appendix aggregated lymphoid nodules

  • *Imunologi DasarTergantung kemampuan sistem imun untukmembedakan antara self dan non-self moleculesSelf molecules: komponen otubuh yang dapat dibegadakan dari subtans asing oleh sistem imun. Autoimmunity is an immune reaction against self molecules (causes various diseases)Non-self molecules: dikenali sebagai molekul asing One class of non-self molecules are called antigens (short for antibody generators) and are defined as substances that bind to specific immune receptors and elicit an immune response

  • Jenis Leukosit Granulosit Neutrofil 62,0% Eosinofil 2,3% Basofil 0,4%

    Agranulosit

    Monocytes 5,3% Lymphocytes 30,0%

    Jumlah Leukosit 9000 sel / mm3 darah ( liter) atau 4 11 x 109 / liter

  • Fungsi Leukosit Menahan atau mengeliminasi sel abnormal, atau benda asing yang berpotensi merusak.

    Menahan invasi patogen penyebab penyakitMengidentifikasi & menghancurkan sel kankerMembersihkan sampah tubuh memfagositosis debris/sel-sel mati

  • Sistem Imun TubuhNon Spesifik SpesifikGranulositMonosit-makrofagLimfosit BLimfosit T

  • Sistem Imun Non Spesifik Fisik / Mekanik Kulit, selaput lendir, silia, batuk, bersin Biokimia Asam lambung, lisosim, lactoferin, spermin Humoral Komplemen InterferonC-reaktive protein (CRP)Selular FagositNatural killer cell

  • Sifat Pertahanan Netrofil dan Monosit Makrofag

    Marginasi (menepi)

    Diapedesis (menembus dinding pori-pori)

    Ameboid motion (bergerak seperti amoeba)

    Chemotaxis (bergerak mendekati sumber bahan kimia) Kelompok Chemokines, yaitu : * Complement system * Leukotrien * Polipeptida, hasil dari limfosit, mast cell dan basofil Efektif : radius 100 daerah radang

    Fagositosis (= endositosis) Selektif dan bersyarat * permukaan partikel harus kasar * tidak dilapisi protein * dapat : Opsonisasi

  • Gambar sifat leukosit:

    Marginasi

    Diapedesis

    Amoeboid Motion

    Chemotaxis Tjitra Wardani , dr., MSBag. I Faal F.K. Unair

  • Fagositosis NetrofilMakrofagMelekat pada reseptor partikelPseudopaniaMenyatu Vesikel fagosit( fagosome)Pembunuh bakteri (secara oksidatif)

    = Pengoksidir :

    Superoxide radikal (O2)

    Hidrogenperoxida (H2O2)

    Hidroxyl radikal (OH) Llsosom Berisi : Enzim proteolitik Lipase Lisosim Myeloperoksidase (mpo) Diproduksi oleh : Membran fagosom PeroxisomeH2O2 + C1hypochlorite

  • kerusakan jaringan Memproduksi - Histamine - Bradikinine - Serotonine - Prostaglandin Hasil suatu sistem komplemen Hasil reaksi sistem koagulasi darah Lymphokinesterjadi perubahan jaringanbakteri trauma panasbahan kimiaKeradangan

  • Vasodilatasi pembuluh darah lokalPermeabilitas kapiler meningkatPenjendalan cairan interstitialMigrasi granulosit dan monositPembengkakan sel jaringanPerubahan jaringan keradangan tanda tanda kardinal keradangan yaitu Dolor (nyeri), Calor (panas), Rubor (kemerahan), Tumor (bengkak) dan Functio laesa (gangguan fungsi)

  • The first line of defense Respon Netrofil Makrofag terhadap keradangan The second line of defenseAksi fagositosMobil makrofag(dilepas)

    Inflamasi Neutrofilia 15.000-25.000/1KapilerMembranProduk radangMarginasiDiapedesiskemotaksisThe third line Of defense IIIBone Marrow Stem cellsMonositBloodmokrofagIIIThe fourth line of defense GranulakositMonosit3 4 hrProd : 50 x NIV

  • Eosinofil 1 3 % sel darah putih Fagosit lemah Mencegah infeksi tertentu Jumlah eosinofil meningkat pada

    major basic protein (MBP) dan menghancurkan alergen

    untuk membunuh larvainfeksi parasit reaksi alergi

    enzim hidrolitik (lisosim) chemotactic factor

    oksigen reaktif untuk detoksifikasi

  • Basofil

    0,5 % sel darah putih

    Serupa dengan mast cell (sel besar dalam kapiler-kapiler)

    Mengeluarkan :

    Heparin

    Histamin

    Bradikinin

    Serotonin

    Slow reacting substance (SRS

    Enzym lisosim

    dikeluarkan selama terjadi keradangan

  • Sistem Imun SpesifikACQUIRED IMMUNITYHumoral Immunity Cell-mediated Immunity

    B-cell immunity T-cell immunity Antibodi Activated Lymphocytes

  • Antigen Adalah bahan yang mampu bereaksi dengan antibodi yang diproduksi atas rangsangan imunogen

    Imunogen Adalah setiap bahan yang dapat menimbulkan respons imun spesifik baik respons seluler maupun humoral (protein besar dengan BM 100.000) Hapten determinan antigen dengan BM kecil Untuk menjadi antigen harus terikat oleh molekul besar (carrier)AntibodiAdalah imunoglobulin (Ig) yang merupakan gol. Protein yang dibentuk oleh sel plasma, yang berasal dari proliferasi sel B akibat adanya kontak dengan antigen.

  • *Lymphocytesthe primary cells of the lymphoid systemRespond to:Invading organismsAbnormal body cells, such as virus-infected cells or cancer cellsForeign proteins such as the toxins released by some bacteriaTypes of lymphocytesT cells (thymus-dependent)B cells (bone marrow-derived)NK cells (natural killer)

  • *T Cells80% of circulating lymphocytesSome of the types:Cytotoxic T cells: attack foreign cells or body cells infected by viruses (cell-mediated immunity)Regulatory T cells: Helper T cells and suppressor T cells (control activation and activity of B cells)Memory T cells: produced by the division of activated T cells following exposure to a particular antigen (remain on reserve, to be reactivated following later exposure to the same antigen)

  • *B Cells10-15% of circulating lymphocytesCan differentiate into plasmocytes (plasma cells) when stimulated by exposure to an antigenPlasma cells produce antibodies: soluble proteins which react with antigens, also known as immunoglobulins (Igs)Humoral immunity, or antibody-mediated immunityMemory B cells: produced by the division of activated B cells following exposure to a particular antigen (remain on reserve, to be reactivated following later exposure to the same antigen)

  • *NK Cells5-10% of circulating lymphocytesAttack foreign cells, normal cels infected with viruses, cancer cells that appear in normal tissuesKnown as immunologic surveillance

  • Antigen Kontak II

    AntigenKontak ITerbentuk klon limfositSel memori

    Respons sekunder spesifik(lebih cepat dan intensif) Dihancurkan sel imunProliferasi klon limfosit

  • *Humoral vs Cell mediatedCell-mediated immunity - direct attack by activated T cells (react with foreign antigens on the surface of other host cells)

    Antibody-mediated (humoral) immunity attack by circulating antibodies, also called immunoglobins (Igs), released by the plasma cells derived from activated B cellshumor from old-fashioned word for stuff in the blood, like good humors and bad humors

    These two systems interact with each other

  • Gambar: Cell-mediated immunity dan Humora