k32_pa_(kelas a2) cardiovascular smlt-inter

7/25/2019 k32_pa_(Kelas a2) Cardiovascular Smlt-Inter

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02/11/16 1

BLOOD AND LYMPHATICVESSEL

Dr.H.Joko S.Lukito, SpPA

Dept. Pathology Anatomy

FK USU


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ARTERY

CONGENITAL ABNORMALITIES

Especially aorta large arteries!enerally are assosiate" #ith congenital

heart "isease

$. Ascen"ing aorta hypoplasia

%. Aortic arch anomalies

& Aorta coarctation

& Patent Ductus Arteriosus& 'ight Su(cla)ian artery posterior

& Aortic arch on the right

& Dou(le aortic arch


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Degenerative Disease

1. Atheroma

2. Arteriosclerosis

Atheroma Normal Arteriosclerosis

Deposition of yellow lipid Tnica intima !eneralised

material in pla"e nder Tnica elastica degeneration

the intima Tnica media media

Tnica adventitia


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Degenerative Disease of the $essel

Arteries %schaemia

$eins/lymphatic congestive edema

&ymptoms ' ( )nctional disorders

( *ain+ de to '

( %nfarction( Trophic disorder

( &,in lceration


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Pathogenesis

1. The developmental of focal areas ofchronic endothelial inry

2. %ncreased insdation of lipoproteins into

the vessel wall+ mainly D or modifiedD with its high cholesterol content

3. A series of celllar interactions in the foci

of inry involving 4s+ monocytes/macrophage+ T lymphocytes+ and &4s

of intimal or medial origin


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#. *roliferation of smooth mscle cells inthe intima with formation of etracelllarmatri y the &4s.

4hronic endothelial inry 7 hyperlipidemia+

hypertension+ smo,ing+ etc89endothelial dysfnction 7 increasedpermeaility+ lecocytes adhesion8

monocytes adhesion and emigration 9smooth mscle emigration from media tointima+ macrophage activation 9


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macrophage and smooth mscle cells (

englf lipid+ macroscopically as fatty

strea,s 9 smooth mscle (prolliferation+ collagen and other 4 deposition + etra

selller lipid 7 so called firos cap 8 9

firofatty atheroma 9 firos pla"es


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NORMAL OF BLOOD VESSEL


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ATHEROSCLEROTIC IN BLOOD VESSEL


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Atheroma ( 4oronary heart disease

( cererovasclar accident

( etremities gangrene

aor ris, factor '


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4linical manifestation cased y

ischaemic pain

growth disorder

s,in lceration

Arteriosclerosis complication'

1. >lood vessel occltion

2. &,in lceration3. Thromosis

#. molism


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2. Monckebeg sc!eosismedial

calsification

on tnica media ? internal lamina elastica ofarteries groping 4a sedimentation

Aging process

elastic tisse of intima arranged li,e onion

s,in appearance

&intimal hyaline sedimentation.

3.Ateiosc!eosisarteriole

sclerosis


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IN"LAMMATION O" ARTERIESIN"LAMMATION O" ARTERIES

1. Acte %nfectios Arteritis

tio ' ( *erivasclar inflammation ' acte

meningitis+ celllitis+ pnemonia

( %ntravasclar ' septicaemia+

septic emolism.

2. *eriarteritis nodosa polyarteritis panarteritis


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*linical mani+estations'

( intermitten fever

( malaise+ lethargy( loss of ody weight

( peripheral neritis

( myalgia+ progressive arthralgia

@ ale female

@ At all age@ >ody organs which are involved ' ,idney+

rain+ heart+ s,in+ lng


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acroscopic finding '

protrding mass B 2(# mm along the

arteries specially in a. mesenteric+ !%T+pancreas+ ,idney+ striated mscle.

icroscopic '

=edema with firinos edate

)irinos necrotic media

Damage of internal elastic laminaC>4 infiltration in arterial wall

)irolast proliferation


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Peiatheitis No#osa $Peiatheitis No#osa $

The Conse%&encesThe Conse%&ences

minal oliteration

ThromosisAnerysm

%nfarct


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S'esi(ic ateitisS'esi(ic ateitis

1. &yphylitic arteritis

2. Terclosis arteritiswith tercle

central necrosis srronded y

lymphocyte cells+ epitheloid cells+ plasma

cells+ and anghans datia cells.

3. hematoid arteritisE firinoid necrosis

#. Datia 4ells arteritis !iant cell arteritis

temporalis arteritis


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Datia 4ells Arteritis

4linical manifestation '

( )ever

( =ccrs especially in elders 7-0yrs old8( Temporal+ occipital and s,ll arteries

segmental inflamation

( ecocytosis+ >& increased( 4ases lindness in chronic inflamation

7months8


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tiology' n,nown

icroscopic '

( %nflamation reaction on media and internalelastic lamina of the vessels

( Datia cells 7?8

( )irosis of the intima( Thic,ening of the adventitia

Datia Ce!!s Ateitis


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-. Taka)as& #iseaseTaka)as& #isease

* '&!se!ess #isease* '&!se!ess #isease

* Aotic ach s)n#o+e* Aotic ach s)n#o+e

Clinical appearance :

( plseless disease( chronic and progressive

( occrs especially in yong women

( visal distrances

( pper etremities parasthesia

( lethargy 7general wea,ness8(syncope


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Taka)as& #iseaseTaka)as& #isease

icroscopic '

( pan(arteritis

( thic,ening of the intima

( coaglative necrosis( plasma cells + lymphocyte and datia cells

inflitration

( firosis( perivasclar infiltration


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Pei'hea! Ateia! DiseasePei'hea! Ateia! Disease

%. Arteriosclerosis = arteriosclerosis obliteransArteriosclerosis = arteriosclerosis obliterans

4linical findings '

( ischemic atrophy( cold and painfl

( cyanotic

( etremities soft tisse gangrene from distal

toes to the proimal legs

( mscle spasm

( cladicatio intermitten

( pale lower etremities when elevated


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Patho!og)Patho!og)

& occurs in mi"li+e an" el"ers

& luminal narro#ing

& throm(otic o(struction

& une)en thickening o+ the artery, har"ening (ut+ragile

& liac artery, +emoral artery, poplitea artery, ti(ial

artery.& complicate" in "ia(etes mellitus, hipertension

an" artherosclerotic patients.


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,- Ra)na #isease,- Ra)na #isease

A vasospastic syndrome cased y

freeFing + restricted on fingers only.

Gong women

tiology ' lood vessels spasm


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4linical findings

( distal fingers paleness

( tingling/ nmness and hot( cyanotic and alternate reddening

( can progress to ichaemic necrotic fingers


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%%. &cleroderma

*rogressive &ystemic &clerosis

( A systemic disease

( specially effected the s,in

()irosis in the internal organ

( 30(-0 years old

( )emale


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III- B&ege #iseaseIII- B&ege #isease

* Tho+boangitis ob!iteans* Tho+boangitis ob!iteans

./ini /ate 0 ./ini /ate 0 yong male + heavy smo,ers

persistent painfl legs+ case y distal

arterial ostrction and occlsion

persistent ischemia of 1 or more toes

sperficial thromophleitis


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-acroscopic '

Cire li,e lood vessels 7hardening8

>lood vessels occlded y yellow/ grayish mass de to thromosis

*erivasclar firosis


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Micosco'ic $Micosco'ic $

( throms filled lmen( intact elastic lamina

( lymphocyte infiltration of media H

adventitia( widening of vasa vasorm

( firosis of adventitia

( granlomatos focal with datia cell orsprative milier focal


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Ane&)s+Ane&)s+

local anormal dilatation of the artery deto wall defect.

Etiology '

( artheriosclerosis

( syphilis + acterial or fngal infection

( congenital

( trama


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4linical form of anerysm '

( saccler

( fsiform

( cylindric

( dissecans

( circoid / racemoss


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)avorite localiFation '

( aortic arch

( adominal aorta

( popliteal artery( femoral artery

( carotid artery or sclavia artery


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Co+'!ication $

& rupture

& hemorrhage

& compression to other organ& erosion


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VeinsVeins

In(!a+ation

Acte phleitis'

*rlent phleitis ' Acess+ meningitis+

pnemonia

Non *rlent phleitis ' dermatitis+

rhematoid fever+ drg allergy+ rhematoid

arthritis


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icroscopic '

( %nflamation cell infiltration

( oedema ( hyperemia

( lood vessel wall destrction


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Vein Obst&ction Abno+a!itiesVein Obst&ction Abno+a!ities

1. *hleothromosis

$ein thromosis withot regional lood

vessel destrction.

2. Thromophleitis

Thromosis case vessel wall

destrction.


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3. $. 4ava &perior =strction

de to ' ronchogenic 4arcinoma

mediastinal lymphoma

Aortic anerysm

casing ' cyanotic and congestion of

cephalic v+ nec, and pper etremities v.

#. $ena 4ava %nferior =strction

de to ' liver tmor and renal cell 4a.

anerysm

ascites and inflamation


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-. *ortal vein =strction

de to ' thromosis

intrahepatic diseases splenectomy

polycytemia vera

6. $aricose vein $ari

anormal vein dilation which restricted

de to intralminal pressre increamentand loss of srronding tisse spport.


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tio ' hereditary wea,ness

vein ostrction

intraadominal pressre

elderly people

standing too mch+ hard wor,

vein inflammation chronic constipation


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*ortal hypertension hemorrhoid

oesophageal varices

)re"ently on sperficial vein of lower

etremities.


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1. 4oronary heart disease

All of myocardim disorders de to a.coronary insffisience

( arterisclerosis ;;J

( rhematica

( sifilis

( arteritis

( polyarteritis


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$ariant of coronary heart disease '

1. Arteriosclerotic heart disease

2. Angina pectoris

3. yocardial infarction

%nflenced y '

1. )low of a. coronary

2. &ensitivity myocardim towardischaemia

3. =2 concentration of lood


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4ondition associated to 4


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Ad.1. 4oronary insfficiency de to '

a. Aortitis letica

. !ranlation tisse of proimal a.coronary

c. A. coronaria anerysm

d. >erger disease

e. *olyarteritis nodosa/ hematica


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Ad.2. Activity of myocardial inflenced y '

a.


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*redisposition factors '

1. ipoprotein serm , soft drink,

obesity, alkohol2. Increased blood pressure

3. Increased blood glucose

4. Stress

5. Lack of exercise

6. Soking

!. "ric acid seru


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1. Arterioscerotic


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contLd '

myocardim fier atrophy and containlipochrom >rown atrophy so that corecomes '

small normal

swelling 7in D48

$alve anormalities ' mitral valve firosis chorda tendinea firosis calcification


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C!inica! Mani(estation $

asymptomatic

old age with angina pectoris

mitral / aortic mrmr

damage myocardim on 4!

heart congestivearrhythmia and myocardim infarction


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ANGINA PECTORISANGINA PECTORIS

%s the clinical symptom mar,edly

temporary paroysmal pain attac, in

ssternal or precordial and commonly

arise after eercise and disappear in rest.

yocardim damage not appear

normal at 4!


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BasicBasic'

yocardim hypoia de to '

coronary arteriosclerosis myocardim letica polyarthritis nodosa aortic valve insfficience Anemia


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G=4AD%M %N)A4T 7 4% 8

4oronary insfficiency de to '

coronary arteriosclerotic ;; J

thromosis and emolism disease of vessels

narrowing ostim de to syphilis

arteriosclerose and hypotension.

MCIMCI


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MCIMCI

Predilection :

right a. coronary #0 J

left anterior a. coronary #0 J

left ventricle

Morphology :

estricted on central myocardim

yocardim ' epicardim ? endocardimecomes thic, 7B 3 E # cm8.

ahn %nfarction+ sendocardial small lesion

M #i I ( t P i itM #i I ( t P i it


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M)oca#i&+ In(act Pogessi1it) $M)oca#i&+ In(act Pogessi1it) $O 12 hors ' vage or pale

1: ( 2# hors ' clearly anemic+ rown(gray+stale mscle consistency.2 E # days ' well defined necrotic tisse

order srrond y hyperaemic

area+ soft+ yellow incolor+ de to fatty changes# E 10 days ' progressive fatty degeneration+

central ne,rosis+ soft +

haemorrhage 7grayish yellow8+well (defined order6 wee,s ' firosis


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icroscopic '

lood vessel ischaemic 9 coaglative

necrosis in myocardim cell

interstitial edema

haemorrhage / haemosiderin pigment

netrophyl edation

firosis


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4omplication '

*ericarditis firinosa / haemorrhagica

ral Thromosis 9 emolism

ptre infarction 9 heart tamponade

firosis and anerysm

Lab


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Lab'

Ne,rosis coaglativa

enFyme dehidrogenase P gltamic oaloacetic transaminase P

12 E 2# hors@ &!=T P

@ e,ositosis P

@ >& P

@ D< P

@ 4 eactive *rotein P

C!i i ! M i( t ti


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C!inica! Mani(estation $

&dden and deep pain on ssternal and

precordial.*ain referred to left ac, + arm to fingers

and chin.

*ressed feeling+ sweating + nasea+ vomitoss of energy

>lood vessel Q to shoc,

Dyspnoe


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4yanotic


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*eripheral resistence increased de to '

vasoconstriction lood vesselarteriole+

small arteries.diffse organic lood vessel disease


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scle hyperthrophy cased y '

activity 9 anoia

myocard wea,nesshypertension 9 coronary arteriosclerosis

9 myocardim anoia.

hypertension 9 damage renal loodvessel 9 eninP 9 Na4l ?


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Mo(o!og) $

left ventricle wall 7 2+- cm 8

heart weight

withot other heart disorders

microscopic ' normal cardiac mscle

thic,ened arterial wall


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C!inica! +ani(estation $

4ompensatory stadim ' asymptom


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RHE2MATIC HEART DISEASERHE2MATIC HEART DISEASE

hematic fever is the non sprative

systemic inflammation disease.

Associated with streptococcs eta

haemolitycs grop A infection and theimmnology reaction with ferile attac,

and prolonged remission.


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hematic fever is the collagen disease+

can occr in '

oint+

heart+

s,in+

seros+ lng lood vessel


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%ncidence '

age - E 1- years ;0 J

ow economics

=vercrowded area+ poor sanitation

ow ntrition


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hematic %nflammation 4hanges'

mcoid degeneration

firinoid necrosis

hyaline collagen degeneration


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Etiology

hematic fever arise after 1 ( # wee,s +

after infected y streptococcs

7 *haryngitis+ Tonsilitis+ &carlatina 8

Antigen( antiody reaction casing

focal allergic necrosis.

mar,edly y A&T= level P


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orphology '


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orphology '

&pecific disorders and pathognomonic '

Ascho++ (o"y9 focs firinoiddegeneration srronded y inflammationcell infiltration.

)ocs can e fond in ' ( heart+( &ynovial oint+

( fascia tendon.

$egetation nodle can e fond in s,in+sctis B 1 (# cm

&ctaneos nodle


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mitral+ aortic valve ' firotic vegetation+

calcification

tricspidale valve ' stenosis

4horda tendinea ' shorten and thic,en


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C!inica! Mani(estationC!inica! Mani(estation'

Ma3o Citeia o( 4ones$

1. *olyarthritis migrans :- J

2. 4arditis 6- J

3. 4horea sydenham

#. &ctaneos nodle

-. rythema marginatm


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Mino Citeia o( 4ones

1. ecocytosis

2. >& P

3. A&T= P

#. )ever

-. Arthralgia

6. *rolonged * interval5. rythema


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4ase of death '

1. Decompensatio cordis

2. >rain/ renal thromoemolism

3. >acterial ndocarditis

#. itral stenosis

= =


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4= *M=NA

The right ventricle hypertrophy+ de toplmonale disorders '

tiology '

1. Acte massive plmonary emolism+

so that dilatation right ventricle

2. 4hronic 1. *lmonary disease

2. 4hronic plmonary disease

3. Thora anormalities

Ad 1 ( Diffse ig/small arteries tromosis


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Ad.1. Diffse ig/small arteries tromosis

( molism

( Diffse vasclitis( )irosis ' ( sarcoidosis

( radiation

( asestosis

( erryliosis

Ad 2 ( mphysema


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Ad.2. mphysema

( 4hronic ronchitis

( *lmonary firosis de to T>4( &arcoidosis

( &evere pnemonia

( *lmonary resection

Ad 3 E Thic,ness plera ilateral


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Ad.3. Thic,ness plera ilateral

( Nero anormalities '

*oliomyelitisyasthenia gravis

scle distrophy

Syphoscoliosis

4linical anifestation '

( dyspnoe ( dilatation of vein( oedema ( ascites

( hydrothora ( hepatosplenomegaly

4=N!N%TA


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4=N!N%TA


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1. oger s disease

ventricle septal sefect

anifest in %$($%% wee,sacros ' ( defect+ mmcm

( right ventricle

( thic,ening endocardimparallel of defect

4linically ' ( hard systole mrmr

machinary mrmr ( plmonary hypertension

( tardive cyanosis


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Death ecase of ' ( right disease

( endocarditis


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2. Atrim &eptal Defect

=ver %$ wee,s

Defect of foramen ovale

4linically ' ( cyanotic right sided overload

( hypertrophy right ventricle

( plmonary hypertension ( systolic mrmr


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3. Lutembachers disease

A&D ? &tenosis mitral+ right H leftventricle dilatation+ hypertrophy rightventricle

4. Tetralogi allot

a. Defect septm interventricle

. Detroposed overriding aorta

c. &tenosis plmonal valve

d. ight ventricle hypertrophy


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4linical manifestation '

cyanosis from neworncling of the fingergrowing disorder

>ad *rognose+ case of death '

( ight D4

(

ndocarditis acterialis( >rain acess

( espiratory Tr. %nfection


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-. !isenmenger Comple"

$ariant of Tetralogi )allot withot &tenosis

*lmonalis

6. Patent #uctus Arteriosus

)rom dcts >otalli connected with a.

plmonale H aorta( Dcts >otalli e closed at 1(2 yrs

after orned

( The lood flow from aorta to a.

*lmonalis+ that cased decreased lood incirclation

( ight ventricle hypertrophy


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C$A%CTAT&$ A$%TA

Aortic &tenosis

left ventricle hypertrophy

proimal dilatation+ lood headache

distal vasoconstriction pale of

etremity H cold


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P!%&CA%#&'M

)lid QQ in cavm pericardim

1. Hy"ropericar"iumNormal ' 30(-0cc+ seros

-0cc ( D.4+

( 4hronic ,idney disease

(


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2.Hemopericar"ium

>lood pericardim+ ecase 'Trama

ptre of mscle infar, myocard

rptre of aortamalignant tmor

rptre of a. coronary


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P!%&CA%#&T&(

Msally secndairy of ' ( hematogen ( lymphogen

(

percontinitatm4lassification of pericardim ased of

etiology 'Terclosis pericarditis>acterialis pericarditishematica pericarditis


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orphologi '

( dilatation of vein H irreglarity+ ectasion

( valves thic,ening

( different of wall thic,ned

( elastic tisse changed y firotic


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Classi)ication o) pericardium

ased of etiology 'Terclosis pericarditis>acterialis pericarditishematica pericarditis

Mremic pericarditis$irs pericarditis4arcinomatosa pericarditis

4% ecase of pericarditis&ecndair of ' ( parasit ( fngal %diopathic


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4lassification from inflammatory edate '

1. &erosa pericarditis

2.

&erofirinos pericarditis

3. )irinos pericarditis

#. &pprative pericarditis

* th i


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*athogenesis

1.


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4omplications '

1. 4onstrictive pericarditis2. =literative+ focal/diffse pericarditis

3. $. cava compression

( ascites ( hepatosplenomegaly

#. D4


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4linical manifestations '

pain

congesion H edema

static dermatitis

celllitis

chronic lceration


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4omplications '

inflammation

perforated of vein

thromosis

lceration ? dermatitis


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*essel + Lymph Tumors

>enign4apillary


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ndothelioma


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!lomangioma ? !loms Tmor&mall+ nder the s,in / nail

aligna

Angiosarcoma

SaposiLs &arcoma


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p

&ctanes pla"e or vercoss

%t contains ' ( endothelial proliferation

etravasclar hemorrhage

anaplastic firolast proliferation

granlation li,e inflammatory reaction

$ery painfll tmor


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$irs pericarditis4arcinomatosa pericarditis

4% ecase of pericarditis

&ecndair of ' ( parasit

( fngal

%diopathic


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