DINAMIKA SIRKULASI

DARAH DAN LIMFE

ZULKHAH NOOR
CAIRAN TUBUH
Total 60%, 2/3 dalam sel (intraseluler) dan 1/3
berada di luar sel (ekstraseluler)
Cairan ekstraseluler berada dalam pembuluh
darah dan ruang interstisiil
Cairan ekstraseluler selalu bergerak mengalir
ke seluruh tubuh
Cairan ekstrasel mengandung berbagai
komponen yang sangat dibutuhkan untuk
tetapnya kehidupan
Cairan ekstrasel merupakan lingkungan
dalam mahluk hidup
FLUID COMPARTMENTS
A Cell and Its Associated Fluids

Fluid between the Cell

cells (intercellular membrane
or interstitial)

Nucleus

Fluid within the

cell (intracellular)

Fluid (plasma) within the blood

vessels (intravascular)

Blood vessel
Continuous Mixing of Body Fluids
CAIRAN TUBUH SEBAGAI
FLUIDA
Mengukuti hukum fisika fluida (zat alir)
Hydrostatika= ilmu tentang zat alir dalam kedaan
tidak bergerak
Hydrodinamika= ilmu tentang zat alir dalam
keadaan bergerak
Aerodinamika= ilmu khusus mempelajari gas yang
mengalir teristimewa udara.
Hemodinamika: Ilmu tentang aliran darah
SIFAT-SIFAT FLUIDA
Kerapatan (density/massa jenis/ rho ()
didefinisikan sebagai massa per satuan
volume = m/v
Masa jenis cairan dipengaruhi oleh suhu,
tekanan dan konsentrasi
Osmolaritas adalah konsentrasi jumlah mol
zat terlarut per liter larutanmembentuk
tekanan osmotik, suatu kekuatan untuk
menahan air atau menarik air
SIFAT-SIFAT FLUIDA
Viskositas (etha= ) adalah kekuatan ikatan
internal antar molekul penyusun cairan (gaya
kohesi). Lebih kental suatu cairan, maka
diperlukan gaya lebih besar untuk
menggerakkan (mengalir)
F= Av/l atau = Fl/vA
Tekanan hidrostatik (tekanan) adalah jumlah
gaya total cairan terhadap luas total wadahnya
atau secara umum: P= F/A = m.a/A = m.g/A
TEKANAN SUATU CAIRAN DALAM
WADAH
Tekanan diteruskan ke semua jurusan dan
sama rata
P=F/A = Ahg/A = gh atau

P=m.g/A
Bervariasi oleh kedalaman/ketinggian, masa
fluida, masa jenis fluida dan luas penampang
wadah
F= mg, m= V = Ah, maka
F = Ahg, dengan Ah adalah volume kolom,
kerapatan cairan, g adalah percepatan
gravitasi
PENGARUH KETINGGIAN
TERHADAP TEKANAN DARAH
Jika tekanan arteri setinggi jantung= 100 mmHg
Densitas darah =0,77

Tekanan darah di kaki (105 cm dibawah jantung)

= 100+ (105x0.77) = 180 mmHg
Tekanan darah di kepala (50 cm diatas jantung)

= 100 (50x0,77) = 62 mmHg

BERBAGAI FAKTOR
MEMPENGARUHI TEKANAN
P=F/A=m.g/A
Merupakan tekanan hidrostatis suatu cairan
(sering disebut tekanan saja)
Dipengaruhi oleh:
berbagai faktor yang mengubah jumlah darah
dalam pembuluh (perdarahan, dehidrasi, cardiac
output, retensi air)
Berbagai faktor yang mempengaruhi percepatan
(gravitasi, percepatan oleh kontraksi jantung,
posisi dan letak)
Berbagai faktor yang mempengaruhi luas
pnampang pembuluh
CARDIOVASCULAR SYSTEM
Vaskuler
 Perbedaan Vena dan Arteri

Vena Arteri
1. Membawa darahtinggi 1. Membawa darah Tinggi
CO2 kecuali vena O2 kecuali arteri pulmonalis
pulmonalis
2. Mempunyai dinding yang 2. Mempunyai dinding yang
tipis tebal
3. Jaringannya kurang 3. Jaringannya elastis
elastis
4. Mempunyai katup-katup 4. Katup hanya pada
sepanjang jalannya menuju permulaan keluar dari
jantung jantung
5. Tidak menunjukkan 5. Menunjukkan adanya
adanya tempat untuk tempat untuk mendengar
mendengar denyut denyut jantung (pulsus)
Pertuka-
ran Zat
hanya
terjadi di
kapiler
SIRKULASI
SIRKULASI
Nutrien dari saluran gastrointestinal
diangkut ke dalam cairan
ekstraseluler, bersama dengan
oksigen dari pulmo.
Produk limbah dari cairan
ekstraseluler diangkut ke ginjal
untuk diekskresikan, dan CO2
diangkut ke pulmo untuk
diekspirasikan.
LANJUTAN
Dinding endotel kapiler dan sinusoid
permeable terhadap air, ion-ion, serta
molekul-molekul kecil, tetapi tidak
permebel bagi molekul besar, seperti
protein plasma, dan sel-sel darah yang
beredar di dalam darah.
Air, ion-ion dan molekul-molekul kecil
dipaksa keluar dari ujung arterial kapiler
ke dalam cairan ekstraseluler oleh
keseimbangan tekanan-tekanan
hidrostatik dan osmotik melintasi
dindingnya.
LANJUTAN
Ketika darah mengalir ke arah ujung
venosa kapiler, tekanan hidrostatiknya
turun, sedangkan tekanan osmotiknya naik
karena protein plasma menjadi lebih pekat,
yang diakibatkan oleh hilangnya air ke
dalam cairan ekstraseluler.
KONTROL SIRKULASI
Dikendalikan oleh kebutuhan jaringan
Output jantung dikontrol terutama oleh
jumlah semua aliran lokal dari jaringan
(venous return)
Secara umum tekanan arteri
dikendalikan oleh baik kontrol aliran
darah lokal (oksigenasi jaringan) atau
kontrol curah jantung (tekanan arteri)

Pemenuhan kebutuhan jaringan

ALIRAN DARAH MENURUT
POIESEULLE
Jika
fluida tidak memiliki kekentalan, ia
dapat mengalir melalui tabung atau pipa
mendatar tanpa memerlukan gaya.
Adanya kekentalan, perbedaan tekanan
antara kedua ujung tabung diperlukan
untuk aliran mantap setiap fluida nyata
misalnya darah dalam sistem sirkulasi.
PERSAMAAN POESEULLE
Laju alir fluida dalam tabung bulat bergantung
pada kekentalam fluida, perbedaan tekanan, dan
dimensi tabung
Persamaan Poiseulle untuk laju alir fluida yang
tak mampat yang mengalir laminar dalam
tabung :
Q = r4 (P1-P2)
8L
r = jari-jari tabung, L= panjang tabung, P1-P2 =
perbedaan tekanan, Q= laju alir volume (volume
fluida yang melintasi titik tertentu persatuan
waktu) sering disebut aliran (Flow), faktor
kekentalan dan pembuluh=R
Jika faktor konstanta dianggap tetap, maka

F= (P1-P2)/R
DITENTUKAN OLEH KONTRAKSI
VENTRIKEL

Figure 15-4: Elastic recoil in the arteries

 TEKANAN DARAH :
PENGUKURAN
"Tekanan Darah"
Systolicdan diastolic
Sekitar 120/80 mmHg
Sphygmomanometer
"Estimate of pressure"
Korotkoff sounds
TEKANAN DARAH : PENGUKURAN

Figure 15-7: Measurement of arterial Tekanan Darah

TEKANAN DARAH:
PULSE DAN MEAN ARTERIAL
PRESSURES

Pulse pressure = SystolicDiastolic

Mean arterial pressure (MAP) = Diastolic + 1/3
pulse p
FAKTOR YANG MENGONTROL MAP :

Volume darah
Cardiac output

Resistensi

Distribusi
Faktor yang Mengontrol MAP :

Figure 15-10: Factors that influence mean arterial pressure

ALIRAN DARAH VENA
Tekanan osmotik darah kapiler dekat venula
akan menarik air dari jaringan masuk ke
pembuluh vena
Kontraksi otot

Katup vena

Inspirasi

menentukan jumlah darah yang kembali ke

jantung
Pertukaran kapiler-jaringan
 PERGERAKAN AIR TUBUH ANTAR
KOMPARTEMEN
DIKONTROL OLEH DUA KEKUATAN:
1. Tekanan hidrostatik: kekuatan desakan oleh cairan
melawan permukaan kompartemen dimana cairan
berada, kekuatan dorongan ke takanan yang lebih
rendah
2. Tekanan osmotik: tekanan potensial yang dibentuk
oleh konsentrasi zat terlarut dalam larutan.
Merupakan tekanan yang diperlukan untuk
menghentikan perpindahan secara osmotik air ke
larutan, kekuatan menarik air
PERTUKARAN CAIRAN MELALUI MEMBRAN
KAPILER
Kekuatan yang cenderung menggerakkan cairan
keluar kapiler: Arteri
-Tekanan hidrostatis intrakapiler : 30,0 mmHg
-Tek. hidrost. Interstisial (negatif) : - 3 mmHg
-Tekanan osmotik interstisial : 8,0 mmHg
KEKUATAN TOTAL KELUAR : 41, mmHg
Kekuatan yang cenderung menggerakkan cairan
ke dalam kapiler:
-Tekanan osmotik plasma : 28,0 mmHg
KEKUATAN TOTAL KEDALAM : 28,0 mmHg
Kekuatan bersih adalah keluar sebesar 40- 28,0 =
13 mmHg
Di KAPILER dekat VENULA Kapiler venosa

Kekuatan yang cenderung menggerakkan cairan ke

dalam kapiler:
-Tekanan osmotik plasma : 28,0 mmHg
KEKUATAN TOTAL KEDALAM : 28,0 mmHg -
Kekuatan yang cenderung menggerakkan cairan ke
luar kapiler:
Tekanan hidrostatis intrakapiler : 10,0 mmHg
-Tek. hidrost. Interstisial (negatif) : 3 mmHg
-Tekanan osmotik interstisial : 8,0 mmHg
KEKUATAN TOTAL KELUAR : 21 mmHg

Kekuatan bersih adalah kedalam sebesar 28,0-21,0 =

7 mmHg
EDEMA : KETIDAKSEIMBANGAN
PERGERAKAN CAIRAN
EDEMA adalah peningkatan air secara
abnormal di ruang interstisial
Beberapa Penyebab:

1. Protein plasma keluar kapiler (kerusakan

dinding kapiler p.darah)
2. Penyakit hepar: sintesis protein plasma
menurun tekanan osmotik intrakapiler
menurun
3. Peningkatan tek.hidrostatis intra
kapiler/ vena
4. Obstruksi pembuluh limfa
LYMPHATIC
SYSTEM
One way system: to
the heart
Return of collected
excess tissue fluid
Return of leaked
protein
Lymph is this fluid

Edema results if
system blocked or
surgically removed 41
 Lymph capillaries
Have one way minivalves allowing
excess fluid to enter but not leave
Picks up bacteria and viruses as
well as proteins, electrolytes and
fluid
(lymph nodes destroy most
pathogens)

42
43
LYMPH CHANNELS OF THE BODY
Almost all tissues of the body have special lymph channels that drain
excess fluid directly from the interstitial spaces. The exceptions
include the superficial portions of the skin, the central nervous
system, the endomysium of muscles, and the bones. But, even these
tissues have minute interstitial channels called prelymphatics
through which interstitial fluid can flow; this fluid eventually empties
either into lymphatic vessels or, in the case of the brain, into the
cerebrospinal fluid and then directly back into the blood.
Essentially all the lymph vessels from the lower part of the body
eventually empty into the thoracic duct, which in turn empties into
the blood venous system at the juncture of the left internal jugular
vein and left sub-clavian vein,
Lymph from the left side of the head, the left arm, and parts of the
chest region also enters the thoracic duct before it empties into the
veins.
Lymph from the right side of the neck and head, the right arm, and
parts of the right thorax enters the right lymph duct(much smaller
than the thoracic duct), which empties into the blood venous system
at the juncture of the right subclavian vein and internal jugular vein
TERMINAL LYMPHATIC
CAPILLARIES AND THEIR
PERMEABILITY.
Most of the fluid filtering from the arterial ends of blood capillaries
flows among the cells and finally is reabsorbed back into the venous
ends of the blood capillaries; but on the average, about 1/10 of the
fluid instead enters the lymphatic capillaries and returns to the blood
through the lymphatic system rather than through the venous
capillaries.
The total quantity of all this lymph is normally only 2 to 3 liters each
day. Curah jantung istirahat rata2 = 5L permenit
The fluid that returns to the circulation by way of the lymphatics is
extremely important because substances of high molecular weight,
such as proteins cannot be absorbed from the tissues in any other
way, although they can enter the lymphatic capillaries almost
unimpeded. The reason for this is a special structure of the lymphatic
capillaries,
the endothelial cells of the lymphatic capillary attached by anchoring
filaments to the surrounding connective tissue. At the junctions of
adjacent endothelial cells, the edge of one endothelial cell overlaps
the edge of the adjacent cell in such a way that the overlapping edge
is free to flap inward, thus forming a minute valve that opens to the
interior of the lymphatic capillary
 Interstitial fluid, along with its suspended
particles, can push the valve open and flow
directly into the lymphatic capillary. But this
fluid has difficulty leaving the capillary once it
has entered because any backflow closes the flap
valve.
the lymphatics have valves at the very tips of the
terminal lymphatic capillaries as well as valves
along their larger vessels up to the point where
they empty into the blood circulation.
SPECIAL STRUCTURE OF THE
LYMPHATIC CAPILLARIES THAT
PERMITS PASSAGE OF SUBSTANCES
OF HIGH MOLECULAR WEIGHT INTO
THE LYMPH.
FORMATION OF LYMPH
The protein concentration in the interstitial fluid of most tissues
averages about 2 g/dl,
lymph formed in the liver has a protein concentration as high as 6
g/dl, and lymph formed in the intestines has a protein
concentration as high as 3 to 4 g/dl. About two thirds of all lymph
normally is derived from the liver and intestines,
the thoracic duct lymph, which is a mixture of lymph from all areas
of the body, usually has a protein concentration of 3 to 5 g/dl.
The lymphatic system is also one of the major routes for absorption
of nutrients from the gastrointestinal tract, especially for
absorption of virtually all fats in food, after a fatty meal, thoracic
duct lymph sometimes contains as much as 1 to 2 per cent fat.
large particles, such as bacteria, can push their way between the
endothelial cells of the lymphatic capillaries and in this way enter
the lymph. As the lymph passes through the lymph nodes, these
particles are almost entirely removed and destroyed,
EFFECT OF INTERSTITIAL FLUID
PRESSURE ON LYMPH FLOW
normal lymph flow is very little at interstitial fluid
pressures more negative than the normal value of -6 mm
Hg. Then, as the pressure rises to 0 mm Hg (atmospheric
pressure),flow increases more than 20-fold.
any factor that increases interstitial fluid pressure also
increases lymph flow if the lymph vessels are functioning
normally.
Such factors include the following: Elevated capillary
pressure, Decreased plasma colloid osmotic pressure,
Increased interstitial fluid colloid osmotic pressure,
Increased permeability of the capillaries All of these cause a
balance of fluid exchange at the blood capillary membrane
to favor fluid movement into the interstitium, thus
increasing interstitial fluid volume, interstitial fluid
pressure, and lymph flow all at the same time.
RATE OF LYMPH FLOW
About 100 milliliters per hour of lymph flows
through the thoracic duct of a resting human,
and approximately another 20 milliliters flows
into the circulation
each hour through other channels, making a total
estimated lymph flow of about 120 ml/hr or 2 to 3
liters per day
LYMPHATIC PUMP INCREASES
LYMPH FLOW
Valves exist in all lymph channels;
when a collecting lymphatic or larger lymph vessel
becomes stretched with fluid, the smooth muscle in
the wall of the vessel automatically contracts.
each segment of the lymph vessel between successive
valves functions as a separate automatic pump. That
is, even slight filling of a segment causes it to
contract, the process continuing all along the lymph
vessel until the fluid is finally emptied into the blood
circulation.
In a very large lymph vessel such as the thoracic
duct, this lymphatic pump can generate pressures as
great as 50 to 100 mm Hg.
STRUCTURE OF LYMPHATIC CAPILLARIES
AND A COLLECTING LYMPHATIC,
SHOWING ALSO THE LYMPHATIC VALVES
PUMPING CAUSED BY EXTERNAL
INTERMITTENT COMPRESSION
OF THE LYMPHATICS
In order of their importance, such factors are:
Contraction of surrounding skeletal muscles
Movement of the parts of the body
Pulsations of arteries adjacent to the lymphatics
Compression of the tissues by objects outside the
body
The lymphatic pump becomes very active during
exercise, often increasing lymph flow 10- to 30-
fold. Conversely, during periods of rest, lymph
flow is sluggish, almost zero.
.
LYMPHATIC CAPILLARY PUMP
the walls of the lymphatic capillaries are tightly
adherent to the sur-rounding tissue cells by means of
their anchoring filaments.
The lymphatic capillary endothelial cells also contain
a few contractile actomyosin filaments, these filaments
have been observed to cause rhythmical contraction of
the lymphatic capillaries in the same way that many
of the small blood and larger lymphatic vessels also
contract rhythmically. Therefore, it is probable that at
least part of lymph pumping results from lymph
capillary endothelial cell contraction in addition to
contraction of the larger muscular lymphatics.
 Lymph Nodes

*
Superficial groups
-Cervical
-Axillary
-Inguinal
Deep groups
-Tracheobronchial
*
-Aortic
-Iliac
Drainage
-Superior R 1/4 of body: R
lymphatic duct (green) *
-The rest: thoracic duct * 57
 Fibrous capsule sends in dividing trabeculae
Afferent & efferent lymphatic vessels

Lymph percolates through lymph sinuses

Follicles: masses of lymphoid tissue divided into

outer cortex & inner medulla

58
 DEVELOPMENT OF
LYMPHOCYTES
Originate in bone marrow from lymphoid stem cells
B cells stay in bone marrow, hence B cells
T cells mature in thymus, hence T cells

These divide rapidly into families

Each has surface receptors
able to recognize one
unique type of antigen=
immunocompetence

60
61
yang kepunyaan-Nya-lah kerajaan langit dan bumi,
dan Dia tidak mempunyai anak, dan tidak ada sekutu bagi-Nya dalam kekuasaan
(Nya), dan Dia telah menciptakan segala sesuatu, dan Dia menetapkan ukuran-
ukurannya dengan serapi-rapinya.