Pathophyisiology

Vascular disorders

2012 Pearson Education, Inc.

Capaian Pembelajaran

1. Mahasiswa mampu menjelaskan macam-macam gangguan

arteri dan vena
2. Mahasiswa mampu menjelaskan penyebab gangguan arteri
dan vena
3. Mahasiswa mampu menjelaskan mekanisme gangguan
arteri dan vena
OUTLINE

DISORDERS OF THE ARTERIAL CIRCULATION

DISORDERS OF THE VENOUS CIRCULATION
DISORDERS OF BLOOD FLOW DUE TO EXTRAVASCULAR
FORCES
 DISORDERS OF THE ARTERIAL CIRCULATION
The arterial system delivers oxygen and nutrients to the tissues.
Disorders of the arterial circulation produce ischemia Infarction
narrowing of blood vessels
Atherosclerosis
Raynauds Disease and Phenomenon
Inflammation
Vasculitis, Polyarteritis Nodosa, Giant Cell Temporal Arteritis
thrombus formation associated with platelet adhesion
Acute Arterial Occlusion, Atherosclerotic Occlusive Disease, Thromboangiitis
Obliterans,
weakening of the vessel wall
Aneurysms and Dissection
Atherosclerosis

is a progressive disease characterized by the formation of

fibrofatty plaques in the intima of large and medium-sized
vessels, including the aorta, coronary arteries, and cerebral
vessels.
is a type of arteriosclerosis or hardening of the arteries.
is an important cause of peripheral vascular disease (PVD)
The major risk factors for atherosclerosis are
hypercholesterolemia
inflammation.
risk factors for atherosclerosis
Positive Risk Factors
Age
Men: 45 years
Women: 55 years or premature menopause without estrogen
replacement therapy
Family history of premature coronary heart disease
definite myocardial infarction or sudden death
before 55 years of age in father or other male firstdegree relative
before 65 years of age in mother or other female first-degree relative
risk factors for atherosclerosis
Positive Risk Factors
Current cigarette smoking
Hypertension (140/90 mm Hg* or on antihypertensive medication)
Low HDL cholesterol (<40 mg/dL*)
Diabetes mellitus
C-reactive protein (CRP)

Negative Risk Factor

High HDL cholesterol (60 mg/dL)
Sites of severe atherosclerosis in order of frequency.
(Rubin E., Farber J. L. [1999]. Pathology [3rd ed., p. 508]. Philadelphia: Lippincott-Raven)
Effect of atherosclerosis
It depend on the vessels involved and the extent of vessel obstruction.
production of ischemia
Sudden vessel obstruction due to plaque hemorrhage or rupture
thrombosis and formation of emboli resulting from damage to the vessel
endothelium
aneurysm formation due to weakening of the vessel wall.
Systemic artery: hypertension
Cerebral arteries: stroke, dementia
Heart: IHD
Kidneys: renal insuficient- failure
lower extremities: PVD, infark, claudicatio intermittent
Aneurysms

Aneurysms represent an abnormal localized dilatation of an

artery due to a weakness in the vessel wall.
As the aneurysm increases in size, the tension in the wall of
the vessel increases and it may rupture.
The increased size of the vessel also may exert pressure on
adjacent structures.
Vasculitis

is an inflammation of the blood vessel wall resulting in

vascular tissue injury and necrosis.
Arteries, capillaries, and veins may be affected.
The inflammatory process may be initiated by
direct injury
infectious agents
immune processes
DISORDERS OF THE VENOUS CIRCULATION

Venous Circulation of the Lower Extremities

Disorders of the Venous Circulation
Varicose Veins
Chronic Venous Insufficiency
Venous Thrombosis
 Varicose Veins
dilated, tortuous veins of the lower extremities
Primary varicose veins originate in the superficial saphenous veins
secondary varicose veins result from impaired flow in the deep venous channels
Etiology
Heredity
deep vein thrombosis.
congenital or acquired arteriovenous fistulas
Congenital venous malformations
pressure on the abdominal veins caused by pregnancy or a tumor.
Contributing factor :Prolonged standing and intraabdominal pressure
Chronic Venous Insufficiency

physiologic consequences of deep vein thrombosis (DVT),

valvular incompetence, or a combination of both conditions
 Chronic Venous Insufficiency
venous insufficiency

Impairment of tissue tissue congestion

nutrition

stasis dermatitis Necrosis of subcutaneous fat deposits breakdown of red blood cells edema

hemosiderin deposits

Stasis or venous ulcers skin atrophy Brown pigmentation of the

skin
Venous Thrombosis

thrombophlebitis
Describes the presence of thrombus in a vein and the
accompanying inflammatory response in the vessel wall
etiology: triad Virchow:
stasis of blood
increased blood coagulability
vessel wall injury.
Risk Factors Associated With Venous Thrombosis
Venous Stasis Hyperreactivity of Blood
Bed rest Coagulation
Immobility Genetic factors
Spinal cord injury Stress and trauma
Acute myocardial Pregnancy
infarction Childbirth
Congestive heart Oral contraceptive and hormone
failure replacement use
Shock Dehydration
Venous obstruction Cancer
Vascular Trauma Antiphospholipid syndrome
Indwelling venous catheters Hyperhomocysteinemia
Surgery
Massive trauma or infection
Fractured hip
Orthopedic surgery
DISORDERS OF BLOOD FLOW DUE TO EXTRAVASCULAR
FORCES
Compartment Syndrome
Pressure Ulcers