Histo Sistem

Kardiovaskuler
Salim A

Arteri Besar

Arteri & Vena Sedang

Arteri & Vena Kecil

Atrium

Valvula Atrioventrikuer

Serat Purkinye

Anatomy Sistem
Kardiovaskuler
Salim A

Mikrobiologi Sistem
Kardiovaskuler
Salim A

Staph.Aureus
Tes
DNAse

Katalase

Koagulase

MSA

Blood Agar

Resisten

Bacitracin

Sensistive

Novobiocin

Pigmen

Kuning keemasan

Staph.Epidermidis
Tes
DNAse

Katalase

Koagulase

MSA

Blood Agar

Resisten

Bacitracin

Sensistive

Novobiocin

Pigmen

putih

Staphylococc
us

Streptococc
us

GAMBARAN
MIKROSKOPIS

Staphylococcus aureus

Staphylococcus
epidermidis

Hemolisis

 - hemolysis

Staphylococc
us

Streptococc
us

KOLONI DI
ATAS BAP

 - hemolysis

 - hemolysis

SIFAT-2 STAPHYLOCOCCI

SIFATSIFAT
Pigment

S. aureus

S.
S.
epidermi saproph
dis
yticus
Yellow to
White
White to
white
pale
gray
+

Hemolysi
s
Coagulas
Yes
No
No
e
productio
n
Mannitol
Yes
No
No
fermenta
tion
Novobioci Sensitive Sensitive Resistan
n
cE

Bacitracin
Test
A. Resisten
B. Sensitif

TES KOAGULASE

TES
KOAGULASE

TES KATALASE

Positif

Negatif

Positif
Negatif

TES
MANNIT
OL

Mannitol Test
Negatif

Tes
DNAse

A.Posit
if
B.
Posit
if
C.
Nega
tif

Bile
Esculin
Test
A.Positif
B. Negatif

Optochin Test
A. Sensitif (+)
B. Resisten (-)

Rangkuman PA Sistem
KV
Salim A

This is mild coronary atherosclerosis. A few scattered yellow lipid plaques are seen
on the intimal surface of the opened coronary artery traversing the epicardial surface
of a heart. The degree of atherosclerosis here is not significant enough to cause
disease, but could be the harbinger of worse atherosclerosis to come.

This is a normal coronary artery with no atherosclerosis and a widely patent

lumen that can carry as much blood as the myocardium requires.

The interventricular septum of the heart has been sectioned to reveal an extensive
acute myocardial infarction. The dead muscle is tan-yellow with a surrounding
hyperemic border.

This cross section reveals a large myocardial infarction involving the anterior left
ventricular wall and septum.

The tan to white areas of myocardial scarring seen from the endocardial surface here
represent a remote healed myocardial infarction.

There has been a previous

extensive transmural myocardial
infarction involving the free wall of
the left ventricle. Note that the
thickness of the myocardial wall is
normal superiorly, but inferiorly is
only a thin fibrous wall. The thinned
area represents a ventricular
aneurysm that has developed as a
consequence of the healed infarct.
Such an aneurysm represents noncontractile tissue that reduces stroke
volume and strains the remaining
myocardium. The stasis of blood
in the aneurysm predisposes to
mural thrombosis.

The pale yellow lipid streaks in the aorta are the earliest lesion of atherosclerosis

Three aortas are shown to demonstrate mild, moderate, and severe

atherosclerosis from bottom to top.

Microscopically, the aortic atheromatous plaque is thicker than the remaining media
at the right. The plaque contains amorphous pink material with slit-like "cholesterol
clefts" of lipid material. There is overlying recent hemorrhage at the left. Thrombus
may form on top of such a plaque.

At higher magnification, many foam cells (macrophages full of lipid material)

are seen in this atheromatous plaque

The degree of atherosclerosis is much greater in this coronary artery, and the lumen
is narrowed by half. A small area of calcification is seen in the plaque at the right.

Angina
Stable

Angina
Unstable
The coronary at the left is narrowed by 60 to 70%. The coronary at the right is even
worse with evidence for previous thrombosis with organization of the thrombus and
recanalization such that there are three small lumens remaining.

These cross sections of the left anterior descending coronary artery demonstrate
more pronounced atherosclerosis with narrowing at the left, which is the proximal
portion of this artery. Atherosclerosis is generally worse at the beginning of an artery
where turbulence is greater.

This is an atheromatous plaque in a coronary artery that shows endothelial

denudation with disruption and overlying thrombus formation at the right.

Trombus

This is coronary thrombosis, one of the

complications of atherosclerosis. The
dark red thrombus is seen in the anterior
descending coronary artery.

A coronary thrombosis is seen microscopically occluding the remaining small

lumen of this coronary artery.

This is the gross appearance of severe coronary atherosclerosis, which involves

virtually 100% of the surface of the coronary. There is extensive calcification,
especially at the right where the lumen is narrowed

Here is a coronary artery with atherosclerotic plaques. There is hemorrhage into the
plaque in the middle of this photograph. This is one of the complications of
atherosclerosis. Such hemorrhage could acutely narrow the lumen.

The cholesterol clefts of lipid, along with a few scattered foam cells and a couple of
lymphocytes, are seen at high magnification in this atheromatous plaque.

Atherosclerosis may weaken the wall of

the aorta such that it bulges out to form
an aneurysm. An atherosclerotic aortic
aneurysm typically occurs in the
abdominal portion below the renal
arteries, as shown here. Aortic
aneurysms that get bigger than 6 or 7
cm are likely to rupture.

This is a different kind of arteriosclerosis. This is hyperplastic arteriolosclerosis, which

most often appears in the kidney in patients with malignant hypertension. The
arteriolar wall is markedly thickened and the lumen is narrowed.

Sometimes the small arteries and arterioles can be damaged so severely in

malignant hypertension that they demonstrate necrosis with a pink fibrin-like quality
that gives this process its name--fibrinoid necrosis.

In diabetics, hyaline arteriolosclerosis is common. The glomerulus here stained

with PAS shows nodular deposits of amorphous material (nodular
glomerulosclerosis) along with a thickened arteriole at the lower right.

This is Monckeberg's medical calcific sclerosis, which is the most insignificant

form of arteriosclerosis (both atherosclerosis and arteriolosclerosis are definitely
significant). Note the purplish blue calcifications in the media; note that the lumen is
unaffected by this process. Thus, there are no real clinical consequences. Remember
this process when calcified muscular arteries show up on a radiograph of the pelvic
region in an older person.

The main pulmonary trunk and pulmonary arteries to right and left lungs are seen
here opened to reveal a large "saddle" pulmonary thromboembolus. Such an
embolus will kill your patient.

Here is another pulmonary

thromboembolus. Such
thrombi embolize from
large veins in the legs and
pelvis.

This pulmonary thromboembolus is occluding the main pulmonary artery.

This is the microscopic appearance of a pulmonary embolus (PE) in a major

pulmonary artery branch.

This pulmonary embolus is adherent to the pulmonary arterial wall. If the patient
survives, the thromboembolus will organize and, for the most part, be removed.

These are "lines of Zahn" which are the alternating pale pink bands of
platelets with fibrin and red bands of RBC's forming a true
thrombus.

Occlusion of the main pulmonary

arteries can kill the patient suddenly.
Occlusion of small pulmonary arteries
has no major immediate effect.
Occlusion of a medium-sized branch
of pulmonary artery can lead to a
pulmonary infarction in a person with
compromised cardiac or respiratory
status. A pulmonary infarct is
hemorrhagic because of the dual
blood supply from the non-occluded
bronchial arteries which continue to
supply blood, but do not prevent the
infarction

Here is an actual electron micrograph of a platelet. Note that this platelet bears a
striking resemblance to a chocolate chip cookie. The chocolate chips are the alpha
and dense granules that contain a variety of mediators such as ADP. When activated,
platelets release their granules to promote coagulation, change shape, and become
sticky to aggregate and plug small vascular holes.

Here are petechial hemorrhages seen

on the epicardium of the heart.
Petechiae are classically found when a
coagulopathy is due to a low platelet
count. They can also appear following
sudden hypoxia.

The blotchy areas of hemorrhage in the skin are called ecchymoses (singular
ecchymosis), or also as areas of purpura. Ecchymoses are larger than petechiae.
They can appear with coagulation disorders.

Disseminated intravascular coagulation (DIC) is a consequence of widespread

activation of the coagulation system through endothelial injury and/or release of
thromboplastic substances into the circulation. DIC can be seen with severe
infections, trauma, neoplasia, and obstetric complications, among others. Small fibrin
thrombi can form in small arteries of brain, heart, lungs, kidneys, and other organs to
produce ischemic tissue damage.

Early Plaques

Advance Plaques

Lawrence GS

Unstable Plaque

Stable Plaque

Lawrence GS

Cytokines , Proteases
Coagulation factor

MMP-1, MMP-3, MMP-9

MMP-2 + MMP-9

PDGF

IL-1
TNF-
TGF-

Lawrence GS

Rangkuman Gizi
Sistem KV
Salim A

1
Seorang laki-laki Indonesia umur 45 tahun BB 75 kg TB 160
cm:
A. Direktur perusahaan PT ABC .
B. Kadar Kolesterol serum 289 mg%,
C. Tak pernah olah raga.
D. Merokok 16 batang/hari,
E. Tekanan Darah 165/100 mm Hg.
Faktor risiko major untuk penyakit jantung koroner
yaitu :........

2 . Seorang laki-laki Indonesia umur 45 tahun BB 75 kg TB

160 cm: Direktur perusahaan PT ABC . Kadar Kolesterol
serum 289 mg%,, Tak pernah olah raga,Merokok 16
batang/hari, Tekanan Darah 165/100 mm Hg.
Status Gizi nya :
A. PEM Berat
B. Obesitas
C. Gizi kurang
D.Normal
E.Overweight

3. Seorang laki-laki Indonesia umur 45 tahun BB 75

kg TB 160 cm: Direktur perusahaan PT ABC .
Kadar Kolesterol serum 289 mg%,, Tak pernah olah
raga,Merokok 16 batang/hari, Tekanan Darah 165/100 mm
Hg.
Masalah-masalah gizinya yaitu dalam hal :
A.Energi
B.Energi + Lemak
D.Energi + Lemak +Natrium
C.Energi + Lemak +Natrium + Protein
E.Energi + Lemak +Natrium + Protein + Karbohidrat

4 . Seorang laki-laki Indonesia umur 45 tahun BB 75 kg TB

160 cm: Direktur perusahaan PT ABC . Kadar Kolesterol
serum 289 mg%,, Tak pernah olah raga,Merokok 16
batang/hari, Tekanan Darah 165/100 mm Hg.
Diet yang harus diberikan yaitu:
A. Diet rendah energy.
B. Diet rendah lemak
C.Diet Energi normal -, kolesterol rendah-, lemak terbatas
D. Diet rendah Energi -, kolesterol rendah-, lemak terbatas
E. Diet rendah Energi -, kolesterol rendah-, lemak terbatas Rendah Natrium

5. Seorang laki-laki Indonesia umur 45 tahun BB 75 kg TB

160 cm: Direktur perusahaan PT ABC . Kadar Kolesterol
serum 289 mg%,, Tak pernah olah raga,Merokok 16
batang/hari, Tekanan Darah 165/100 mm Hg.
Bahan makanan yang dapat diberikan untuk meningkatkan
rasa asin yaitu:
A. Biskuit Crackers
B.Mono sodium glutamate (MSG)
C.Keju
D. Garam Morton
E.Ikan asin

6. Seorang laki-laki Indonesia umur 48 tahun BB 80 kg, TB 160

cm , Seorang Dosen di Universitas , kadar glukosa puasa 237 mg/dl,
kadar kolesterol serum 287 mg%, Tekanan darah 150/100 mm Hg. Pada
suatu malam ia kena serangan jantung . Ia dimasukkan ke rumah sakit.
Pada hari kedua : Keadaan umum membaik , sadar, masih merasa
sedikit nyeri di dada kirinya. Diet yang harus diberikan yaitu:
A. Diit DM 2500 kcal
C. Diit Jantung 4
D. Diet Jantung3
B. Diet Jantung2
E. Diet Jantung1

7
Seorang laki-laki Indonesia umur 48 tahun BB 80 kg, TB 160
cm , Seorang Dosen di Universitas , kadar glukosa puasa 237 mg/dl,
kadar kolesterol serum 287 mg%, Tekanan darah 150/100 mm Hg.
Pada suatu malam ia kena serangan jantung . Ia dimasukkan ke rumah
sakit. Pada hari kedua : Keadaan umum membaik , sadar, masih
merasa sedikit nyeri di dada kirinya.
Keperluan energinya:
A. 5500 kcal
C. 4500 kcal
D. 3500 kcal
B. 2500 kcal
E. 1500 kcal

8
Langkah kedua pada Nutritional care process
A. Assessment
B. Planning
C. Evaluation
D. Re evaluation
E. Implementation

9
Setting objectives merupakan langkah ke .. pada
A. Evaluation
B. Re evaluation
C. Implementation
D. Planning
E. Assessment

Nutritional care process

10. Data subjektif data pada Nutritional Assessment :

1. Data Biokimia
2. Riwayat Diet
3. Data Psikososial
4. Hasil pemeriksaan klinik