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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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02/11/16 #
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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02/11/16 1#
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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02/11/16 #0
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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02/11/16 #1
-. *ortal vein =strction
de to ' thromosis
intrahepatic diseases splenectomy
polycytemia vera
6. $aricose vein $ari
anormal vein dilation which restricted
de to intralminal pressre increamentand loss of srronding tisse spport.
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tio ' hereditary wea,ness
vein ostrction
intraadominal pressre
elderly people
standing too mch+ hard wor,
vein inflammation chronic constipation
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*ortal hypertension hemorrhoid
oesophageal varices
)re"ently on sperficial vein of lower
etremities.
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02/11/16 ##
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02/11/16 #-
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02/11/16 #6
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1. 4oronary heart disease
All of myocardim disorders de to a.coronary insffisience
( arterisclerosis ;;J
( rhematica
( sifilis
( arteritis
( polyarteritis
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$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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Terima ,asih