Kanker Payudara

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Kanker payudara memperlihatkan proliferasi keganasan sel epitel yang membatasi duktus atau lobus payudara. Pada awalnya hanya terdapat hyperplasia sel dengan pekembangan sel-sel atipikal. Sel-sel ini kemudian berlanjut menjadi karsinoma in situ dan menginvasi stroma. Kanker membutuhkan waktu 7 tahun untuk tumbuh dari satu sel menjadi massa yang cukup besar untuk di palpasi (kira-kira berdiameter 1 cm). pada ukuran itu, seitar 25% kanker payudara sudah mengalami metastasis.

Kanker payudara adalah kanker paling sering pada perempuan (diluar kanker kulit), walaupun kanker ini sangat jarang pada laki-laki. Kanker payudara adalah kanker penyebab kematian kedua pada perempuan (setelah kanker paru) di Amerika Serikat. Dari tahun 1973-1991, insidens kanker payudara invasive di Amerika Serikat meningkat 25,8% pada Kukasian dan 30,3% pada keturunan Amerika Afrika, atau secara kasar adalah 2% per tahun.

Kanker payudara dapat muncul di usia berapa pun di luar masa kanak-kanak, namun insidensnya rendah selama tiga decade pertama, dan meningkat secara bertahap etelahnya. Secara keseluruhan, risiko pada perempuan seumur hidupnya untuk berkembnag kanker payudara adalah 1 berbanding 8. Ini adalh gambaran menyeluruh untuk semua perempuan berdasarkan masa hidupnya hngga 85 tahun, namun hal ini tidak memberikan kelonggaran terhadap factor-faktor yang mempengaruhi risiko individual untuk perempuan tertentu.

Penyebab kanker payudara belum dapat ditentukan namun terdapat berbagai factor resiko yang telah ditetapkan, keduanya adalah lingkungan dan genetic. Factor-faktro yang berkaitan dengan peningkatan risiko kanker payudara adalah tempat tinggal di Negara berkembang bagian barat, keadaaan sosioekonomi yang rendah, ras, riwayat penyakit payudara proliferative, awitan dini menarke, terlambatnya kelahiran anak pertama, menopause yang terlambat, keadaan nulipara, terapi hormon eksogen, terpajan radiasi, fakot-faktor makanan dan asupan alcohol tinggi.

Bila ibu atau kakak perempuan dari seorang wanita menderita kanker payudara, risiko perempuan tersebut untuk terkena kanker payudara akan meningkat dua atau tiga kali lipat. Memiliki ibu dan kakak perempuan yang menderita kanker payudara, menaikkan risikonya menjadi enam kali lipat. Pada keluarga dengan riwayat kanker payudara yang kuat, banyak perempuan memiliki mutasi pada gen BRCA-1 dalam kromoson 17, diperkirakan bahwa 86% perempuan ini akan mendapat kanker payudara pada usia 70 tahun. Pola keturunan adalah dominan autosomal dan dapat diturunkan melalui garis maternal maupun paternal. Gen BRCA-1 juga berkaitan dengan berkembangnya kanker ovarium dan kanker prostat. Sindrom kanker payudara familial lainnya berkaitan dengan gen pada kromosom 13, yang disebut BRCA-2. Namun, hanya antara 5% hingga 10% dari semua kanker payudara yang kelihatannya disebabkan oleh mutasi genetic yang diturunkan. Gen-gen kanker payudara lainnya sedang aktif dicari. Melalui deteksi gen-gen abnormal ini, sekarang sudah mungkin untuk menggunakan teknik genetic moekuar untuk mengidentifikasi individu-individu yang berisiko mendapat kanker payudara, walaupun jalan terbaik untuk menangani pasien-pasien ini secara klinis belum diketahui.

Sebagian besar tumor payudara adalah adenokarsinoma. Terdapat dua jenis utama histologis adenokarsinoma payudara, yang berasal dari duktus terminalis dan unit-unit lobular. Karsinoma payudara insitu non invasive (missal, karsinoma duktus in situ[DCIS] atau karsinoma lobular in situ[LCIS]) adalah di dalam lumen duktus atau lobules. Pemindaian raiologis dapat mengidentifikasi sebagian besar karsinoma payudara intraduktus atau intralobular. Arti pentingnya karsinoma dini non invasive adalah bahwa terdapat resiko tinggi untuk berkembang menjadi kanker payudara invasive pada waktu yang akan dating.

Pemeriksaan payudara klinis (CBE) oleh ahli kesehatan yang professional dan mammografi adalah metode utama untuk mendeteksi dini kanker payudara. Penapisan mammogram digunakan pada perempuan yang tidak terdapat gejala kanker untuk mendeteksi berbagai ketidaknormalan pada stadium praklinis sebelum penyebaran atau sebelum terlibatnya kelenjar getah bening aksilaris ketika angka pengobatan tinggi. Angka harapan hidup langsung berhubungan dengan ukuran tumor dan keadaan kelenjar getah bening aksilaris, sehingga sangat penting untuk membuat diagnose dini. Namun, kanker payudara sering kali ditemukan pertama kali oleh perempuan itu sendiri melalui pemeriksaan payudara sendiri (SBE) setelah massa dapat teraba (sekitar 1 cm).

Hipersensitivitas

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Hipersensitivitas adalah peningkatan reaktivitas atau sensitivitas terhadap antigen yang pernah di pajankan atau dikenal sebelumnya. Reaksi hipersensitivitas terdiri atas berbagai kelainan yang heterogen yang dapat dibagi menurut berbagai cara.

I. Pembagian Reaksi Hipersensitivitas Menurut Waktu Timbulnya Reaksi
a. Reaksi Cepat; Terjadi dalam hitungan detik, menghilang dalam 2 jam.
b. Reaksi Intermediet: Terjadi setelah beberapa jam dan menghilang dalam 24 jam
c. Reaksi Lambat: Terlihat sampai 48 jam setelah terjadi pajanan dengan antigen yang terjadi oleh aktivasi sel Th.

II. Pembagian Hipersensitivitas Menurut Gell dan Coombs

Tipe I: IgE
Gejala: anafilaksis, urtikaria, angioderm, mengi, hipotensi, nausea, muntah, sakit abdomen, diare
Contoh: Penisilin, enzim, anti serum

Tipe II: Sitotoksis (IgG dan IgM)
Gejala: Agranulositosis, anemia hemolitik, trombositopenia
Contoh: antikonvulsan, kinidin, sulfonamid

Tipe III: Kompleks Imun (IgG dan IgM)
Gejala: Panas, urtikria, atralgia, limfadenopati, serum sickness
Contoh: sulfonamid, fenitoin, streptomisin

Tipe IV: Hipersensitivitas selular
Gejala: eksim, eritema, lepuh, pruritus
Contoh: penisislin, anastetik lokal, antihistamin topikal

Kenali Bahaya Kanker Payudara

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Kanker payudara merupakan jenis kanker yang menyerang organ payudara, dimana sel dalam payudara membelah dan tumbuh diluar kendali. Kanker ini merupakan salah alah satu jenis kanker yang paling banyak diderita oleh masyarakat, khususnya wanita. Wanita beresiko besar terkena kanker payudara, akan tetapi tidak menghilangkan kemungkinan bahwa pria juga dapat terserang kanker payudara.

Kanker payudara sulit untuk disembuhkan dan kemungkinan penderita untuk sembuh sangat kecil, sehingga wajar jika kanker payudara ditakuti oleh masyarakat. Meskipun demikian tidak berarti bahwa kanker payudara tidak dapat disembuhkan sama sekali.
Faktor penyebab kanker payudara

Ada banyak faktor yang diduga dapat memicu tumbuhnya sel kanker payudara. Faktor-faktor tersebut digolongkan menjadi dua faktor utama, yakni faktor yang tidak dapat dikendalikan dan faktor yang dapat dikendalikan. Berikut adalah faktor-faktor resiko penyebab kanker payudara dan penjelasannya :
A. Faktor yang tidak dapat dikendalikan

Faktor yang tidak dapat dikendalikan adalah faktor resiko yang merupakan bawaan sejak lahir dan tidak dapat diubah seperti :

1. Riwayat keluarga

Wanita yang memiliki anggota keluarga yang pernah menderita kanker payudara memiliki resiko yang lebih besar. Jika seorang wanita memiliki ibu, bibi atau saudara perempuan yang menderita kanker payudara, ia memiliki resiko 2 kali lipat menderita kanker payudara. Sementara resiko pada generasi selanjutnya, misalnya jika wanita tersebut memiliki anak, maka anak dari wanita tersebut memiliki resiko tiga kali lebih besar dari ibunya.

2. Gender

Gender atau jenis kelamin adalah salah satu faktor resiko kanker. Wanita beresiko 100 kali lebih besar menderita kanker payudara dibanding laki-laki. Hal ini disebabkan karena pada wanita, payudara lebih berkembang dan memiliki lebih banyak jaringan didalamnya dibandingkan pria.

Jaringan dalam payudara pria tidak mengalami pertumbuhan sebagaimana payudara wanita. Selain itu pria tidak memiliki kadar estrogen dan progesteron yang tinggi seperti pada wanita. Kedua hormon ini adalah salah satu pemicu kanker payudara.

3. Genetik

Sekitar 5% sampai 10% dari penderita kanker payudara disebabkan oleh faktor genetik. Tubuh manusia normal memiliki gen yang mengendalikan pertumbuhan tumor yang disebut Gen BRCA1 dan BRCA2. Apabila gen ini rusak atau bermutasi, maka pertumbuhan sel tidak dapat dikendalikan dan akhirnya timbul sel kanker.

4. Usia

Wanita yang berusia lebih dari 55 tahun beresiko lebih besar terkena kanker payudara. Hal ini disebabkan oleh kemampuan pengendalian sel dan fungsi organ tubuh yang sudah menurun sehingga menyebabkan sel tumbuh tidak terkendali. Dua dari tiga penderita kanker payudara adalah wanita diatas usia 55 tahun.
5. Riwayat Individu

Wanita yang pernah menderita kanker payudara pada salah satu bagian payudaranya, misalnya payudara kanan, beresiko menjalarkan kanker payudara tersebut pada bagian lain tubuhnya yakni payudara sebelah kiri. Meskipun sel kankernya sudah diangkat dari dalam jaringan payudaranya, tetap saja wanita tersebut masih beresiko terserang kanker payudara.

B. Faktor yang dapat dikendalikan

Yang dimaksud dengan faktor yang dapat dikendalikan adalah faktor resiko yang menyangkut pola dan gaya hidup seseorang. Simak penjelasan berikut ini untuk mengetahui faktor apa saja yang dapat dikendalikan untuk mencegah penyakit kanker payudara :

1. Olahraga

Kurang berolahraga adalah satu faktor resiko yang dapat menyebabkan penyakit kanker. Seseorang yang rutin berolahraga 4 jam sehari dapat mengurangi resiko terkena kanker payudara sampai 14%.

2. Makanan

“Kamu adalah apa yang kamu makan”, ungkapan ini menggambarkan bahwa seseorang bisa terkena penyakit disebabkan oleh  pola makan yang tidak sehat. Kurangnya konsumsi sayuran dan buah menyebabkan tubuh kekurangan antioksidan yang berfungsi untuk menangkal radikal bebas. Radikal bebas adalah senyawa yang berbahaya bagi tubuh dan dapat menyebabkan kerusakan sel termasuk gen BRCA1 dan BRCA2.

3. Alkohol

Pada dasarnya alkohol adalah senyawa kimia yang dapat menggangu proses dan fungsi organ tubuh. Wanita yang mengkonsumsi alkohol secara rutin beresiko 1 ½ kali lebih besar terkena kanker payudara dibandingkan mereka yang bukan peminum.

4. Radiasi

Meskipun jarang ditemukan, radiasi bisa menjadi salah satu faktor resiko penyebab kanker. Radiasi sinar X atau yang biasa kita kenal dengan rontgen memiliki kemampuan untuk memicu mutasi yang terjadi pada sel, akibatnya sel mengalami kerusakan dan kehilangan kemampuan untuk mengendalikan pembelahan dirinya.

5. Merokok

Tidak diragukan lagi, merokok merupakan perilaku yang menyebabkan banyak penyakit termasuk kanker payudara. Rokok mengandung ratusan bahan kimia yang dapat merusak organ dan sel tubuh yang memicu perkembangan sel kanker.

6. Berat badan

Kelebihan berat badan atau kegemukan bisa meningkatkan resiko terkena kanker. Hal ini disebabkan karena hormon estrogen yang merupakan pemicu kanker dihasilkan oleh sel lemak. Semakin banyak sel lemak yang ada dalam tubuh, semakin besar resiko kanker payudara yang dimilki.

Gejala kanker payudara
Kanker payudara memiliki gejala yang khas dan dapat diketahui dengan jelas dengan cara pemeriksaan payudara sendiri ( SADARI). Berikut adalah gejala-gejala yang timbul apabila seseorang menderita kanker payudara :

1. Tektur berubah

Salah satu gejala kanker payudara adalah berubahnya tekstur payudara itu sendiri. Maka dari itu, anda sebagai pemilik payudara harus melakukan pemeriksaan terhadap payudara anda sendiri, apakah terjadi perubahan bentuk atau tidak.

2. Terdapat benjolan

Munculnya benjolan pada payudara merupakan gejala umum kanker payudara yang perlu anda waspadai. Benjolan pada payudara tidak selalu menjadi indikator seseorang terjangkit kanker payudara, pasalnya tanpa adanya benjolan pada payudara pun, seseorang bisa dikatakan menderita kanker payudara. Meskipun begitu, benjolan pada payudara tetap harus anda waspadai.

3. Keluar cairan kuning

Pada penderita kanker payudara, jika putingnya ditekan akan keluar cairan berwarna kuning seperti nanah. Maka dari itu, cobalah tekan puting anda dengan lembut dan periksa, apakah keluar cairan atau tidak.

4. Benjolan di ketiak

Terdapat benjolan dibawah ketiak merupakan salah satu indikasi kanker payudara yang paling umum. Segeralah melakukan pemeriksaan kesehatan, jika memungkinkan lakukan pemeriksaan USG.

5. Warna berubah

Selain adanya benjolan dan perubahan bentuk pada payudara, gejala lain kanker payudara adalah berubahnya warna payudara itu sendiri. Periksa payudara anda di depan cermin, dan lihat apakah warna payudara anda berubah atau tidak.

6. Bentuk puting berubah

Periksa payudara anda, apakah ada perubahan pada puting payudara anda seperti rasa gatal, seakan terbakar dan puting seperti tertarik ke dalam. Karena hal tersebut merupakan salah satu indikasi seseorang menderita kanker payudara.
7. Keluar darah

Keluarnya darah dari puting juga termasuk gejala kanker payudara yang perlu diperhatikan. Hal ini harus anda waspadai, karena tidaklah normal jika puting anda mengeluarkan cairan seperti darah apabila tidak dalam kondisi hamil atau menyusui.

8. Terdapat lesung

Seperti yang kita tahu bahwa kanker payudara tidak selalu ditandai dengan adanya benjolan pada payudara. Pasalnya, terdapat cekungan seperti lesung pipi pada payudara juga merupakan indikasi seseorang menderita kanker payudara.

Dalam hal ini, sangat disarankan bagi anda untuk melakukan pemeriksaan USG guna memastikan ada tidaknya kanker pada payudara anda. Selain itu, ada beberapa gejala lain yang perlu anda waspadai seperti :

1.Sebagian area payudara membengkak dan berwarna merah
2.Timbulnya kerutan kecil seperti kulit jeruk pada area payudara
3.Jika puting ditarik, putik tidak segera kembali ke bentuk normal melainkan mengendur
4.Timbul rasa sakit setelah puting ditarik
5.Adanya pembengkakan di area ketiak

Jenis-jenis kanker payudara
Pada umumnya kanker dapat dibedakan menjadi dua jenis yakni kanker jinak atau disebut juga sebagai tumor dan kanker ganas atau kanker itu sendiri.

Kanker jinak atau tumor adalah kumpulan sel yang merupakan hasil pembelahan abnormal pada suatu jaringan yang menetap di dalam suatu area organ tubuh. Tumor tidak berpindah tempat atau menyebar ke organ lain, terlebih lagi tumor bisa dengan mudah ditangani lewat tindakan medis.

Kanker ganas atau kanker payudara adalah sekelompok sel yang tumbuh secara tidak terkendali dalam jaringan dan berpotensi menyebar sekaligus berpindah pada organ lain.

Sel kanker dapat dengan mudah masuk ke dalam saluran darah dan menempel di organ  lain. Proses menyebarnya sel kanker disebut dengan metastatis. Penyakit kanker sulit untuk diobati karena apabila kumpulan sel ini diangkat dari dalam tubuh, maka tidak menutup kemungkinan sel yang sudah menyebar dapat tumbuh dan kembali menjangkiti organ tubuh yang lain.

Bagaimana cara mendeteksi kanker payudara ?

Ada beberapa cara yang bisa anda lakukan untuk mendeteksi gejala awal kanker payudara, diantaranya :

1. Melakukan pemeriksaan payudara sendiri (SADARI)

Pemeriksaan payudara sendiri dapat dilakukan dengan mudah di rumah. Ikuti langkah-langkah berikut ini untuk mengetahui apakah ada kelainan pada payudara anda :

Berdirilah di depan cermin dengan melepaskan pakaian anda
Amati jika terdapat perubahan fisik pada payudara anda
Angkat satu tangan ke atas dan rabalah bagian payudara dengan seksama
Perhatikan dengan benar, jika anda menemukan benjolan sebaiknya lakukan pemeriksaan medis untuk mendapatkan diagnosis yang lebih akurat
Cara ini juga bisa dilakukan saat mandi dengan menggunakan sabun. Sabun membuat permukaan payudara lebih licin, sehingga jika ada benjolan dalam payudara, akan lebih mudah untuk mengetahuinya.

Apabila ditemukan benjolan pada payudara anda, langkah selanjutnya yang perlu anda lakukan bisa dilihat pada diagram berikut :

cara mendeteksi kanker

2. Mammogram

Mammogram adalah metode untuk memeriksa apakah benar terdapat benjolan dalam payudara dengan menggunakan sinar X. Mammogram hanya dapat mendeteksi adanya benjolan dan tidak dapat memastikan apakah benjolan tersebut merupakan sel kanker. Untuk mengetahui apakah sel tersebut merupakan sel kanker perlu dilakukan pemeriksaan lebih lanjut.

3. Ultrasound

Metode Ultrasound atau yang juga dikenal dengan USG dapat digunakan untuk mendeteksi adanya benjolan pada payudara. Jika benjolan/ kista yang ditemukan berukuran kecil, maka dapat dilakukan Fine Needle Aspiration (FNA) untuk memeriksa dan mengangkat kista tersebut.

Namun apabila ditemukan kista berukuran sedang atau besar dan padat serta berpotensi menimbulkan kanker, maka konsultasikan dengan dokter apa yang sebaiknya dilakukan. Biasanya dokter akan menyarankan operasi pengangkatan payudara sebagian (lumpectomy) atau pengangkatan payuda total (mastectomy).

Pencegahan kanker payudara

Meskipun belum ada fakta atau bukti ilmiah yang pasti tentang cara mencegah kaker payudara, beberapa tindakan preventif berikut ini bisa dilakukan untuk mengendalikan faktor resiko penyebab kanker payudara :

Jauhi rokok

jauhi rokok mencegah kanker payudara

Rokok mengandung banyak partikel kimia yang dapat menyebabkan kerusakan jaringan dan sel. Tidak hanya menghindari kegiatan merokok, menjauhi asap rokok adalah salah satu cara untuk mengurangi resiko kanker payudara.

Konsumsi serat

Banyak mengkonsumsi serat yang berasal dari sayur dan buah sangat bermanfaat untuk tubuh. Serat dan antioksidan yang terkandung dalam buah dan sayur dapat menangkal pengaruh radikal bebas yang berbahaya bagi tubuh.

Menjaga berat badan

Salah satu kunci menjaga kesehatan adalah memiliki berat badan yang ideal. Berat badan dan indeks massa tubuh yang berlebih tidak hanya memicu resiko kanker tetapi penyakit degeneratif lainnya seperti diabetes, stroke dan penyakit jantung.

Hindari konsumsi alkohol

jauhi alkohol mencegah kanker payudara
Gambar dari thealbanianfitness.com
Sebagaimana telah disebutkan sebelumnya bahwa alkohol adalah salah satu faktor pemicu kanker payudara. Sebisa mungkin hindari konsumsi alkohol, terutama jika anda terbiasa meminumnya. Jika anda tidak dapat menghentikan kebiasan minum secara total, lakukan perlahan-lahan dengan mengurangi takaran alkohol setiap harinya.

Olahraga teratur

Olahraga teratur dapat meningkatkan sistem kekebalan tubuh dan menjadikan tubuh anda lebih sehat sehingga tidak mudah terserang penyakit. Olahraga juga dapat membakar sel lemak sehingga mengurangi kadar estrogen yang dihasilkan dalam tubuh.

Konsumsi vitamin

Vitamin juga berperan penting dalam meningkatkan fungsi tubuh, menjaga kekebalan dan membantu proses pemulihan. Konsumsi vitamin C dapat meningkatkan kemampuan tubuh untuk menangkal radikal bebas dan mengurangi efek kerusakan yang ditimbulkannya.

Lakukan tes pencegahan

lakukan tes mammogram

Jika pemeriksaan payudara sendiri dirasa belum cukup, anda bisa berkujung di fasilitas kesehatan setempat untuk mendapatkan tes mammogram yang hasilnya lebih akurat.

Pemeriksan payudara sendiri (SADARI)

Untuk mengetahui adanya perubahan fisik terutama pada payudara sebaiknya lakukan pemeriksaan pada tubuh dengan menggunakan tangan anda sendiri. Pemeriksaan ini efektif untuk mengetahui gejala awal kanker payudara, sehingga jika ditemukan sesuatu yang tidak semestinya anda bisa langsung melakukan pemeriksaan medis dan mendapat penanganan yang lebih cepat.

Dislipidemia

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  Dislipidemia adalah gangguan kesehatan akibat kelainan lemak dalam darah. Pada dislipidemia kadar lemak-lemak jahat yaitu LDL kolesterol dan trigliserida mengalami peningkatan. Sebaliknya kadar lemak yang baik yaitu HDL kolesterol justru mengalami penurunan.
      LDL kolesterol dan Trigliserida disebut lemak jahat karena lemak ini membawa kolesterol dari dalam hati dan melepaskannya pada dinding pembuluh darah. Keadaan ini bisa menimbulkan timbunan kolesterol (plak) pada dinding pembuluh darah yang disebut ateroma.        Ateroma menyebabkan penyempitan dan pengerasan pembuluh darah yang dinamakan aterosklerosis. Kalau penyempitan ini terjadi di pembuluh darah jantung akan menyebabkan jantung koroner, bila terjadi di ginjal akan menyebabkan gagal ginjal dan bila terjadi di otak akan menyebabkan stroke.
      HDL kolesterol disebut lemak yang baik karena jenis ini berperan mengangkut kolesterol yang tercecer pada dinding pembuluh darah dan dibawa kembali ke hati. Dengan kata lain HDL kolesterol mencegah terjadinya aterosklerosis sehingga tidak terjadi penyakit jantung koroner.
       Dislipidemia dapat terjadi akibat faktor asupan (intake) lemak yang tinggi dan adanya faktor keturunan / riwayat penyakit keluarga, alkohol, hormon estrogen, dan obat-obatan.
Pada wanita, saat usia menopause akan meningkat resiko dislipidemianya lebih tinggi.
      Asupan lemak total berkaitan dengan kegemukan (berat badan berlebih). Untuk mengetahui apakah anda kegemukan atau tidak gunakan rumus: BB / TB (M)2. Bila hasilnya adalah: 18.5 – 22.9 maka ia normal, bila 23 – 24.9 maka ia overweight, dan di atas 25 maka ia obesitas.
     Pengendalian dislipidemia utamanya menggunakan tindakan nonfarmakologis yaitu: modifikasi diet,
latihan jasmani, dan
pengelolaan berat badan.
Ketiganya seharusnya dilakukan secara simultan untuk mendapatkan hasil yang optimal.

Gout

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      Kadar asam urat tinggi (hiperurikemia) yang berlangsung terus-menerus menyebabkan terjadinya pengendapan kristal di sendi-sendi dan jaringan lunak sekitarnya, sehingga menimbulkan manifestasi klinis penyakit gout.
Gout sebagian dipicu oleh faktor genetik. Bila orang tua Anda menderita gout, kemungkinannya 20% Anda akan terkena gout.Kebiasaan makan dan gaya hidup, seperti berlebihan mengkonsumsi jeroan dan makanan tinggi purin lainnya juga meningkatkan risiko gout. Serangan gout sebelum umur 30 atau pada wanita pra-menopause bisa mengindikasikan cacat enzim warisan, penyakit ginjal berat atau keracunan obat atau toksin, seperti etanol atau timbal.
     Ada empat tahap penyakit gout. Jika Anda memiliki gout, penting sekali untuk mengetahui empat tahap ini sehingga dapat memahami perkembangan kondisi Anda. Dengan pengelolaan asam urat yang baik, Anda dapat menghindari tahap terakhir gout yang melumpuhkan.

Tahap 1: Hiperurikemia Asimtomatik
Kadar asam urat di tubuh Anda tinggi, tetapi tidak menimbulkan gejala. Sebagian besar orang dalam tahap ini menyadari kondisi mereka setelah melakukan tes darah yang mengukur jumlah asam urat yang terkandung dalam sistem peredaran darah.
Perawatan biasanya tidak diperlukan pada tahap ini. Kebanyakan pasien memiliki kadar asam urat tinggi selama bertahun-tahun sebelum serangan pertama mereka. Risiko serangan meningkat dengan meningkatnya kadar asam urat. Pengobatan yang tepat dalam tahap ini adalah berupaya mengurangi kadar asam urat dalam tubuh.

Tahap 2: Serangan gout akut
Hiperurikemia berkelanjutan menyebabkan penumpukan kristal natrium urat di persendian. Kristal ini kemudian merangsang pelepasan berbagai mediator inflamasi yang menimbulkan serangan akut. Pasien biasanya terbangun di malam hari karena rasa sakit dan pembengkakan sendi. Gejala gout tahap ini meliputi nyeri dan peradangan, sendi yang terkena menjadi panas dan lembek bila disentuh, terlihat kemerahan atau memar, terasa gatal dan mengelupas setelah sakitnya mereda.
Tingkat keparahan rasa sakit bervariasi dari kedutan ringan sampai nyeri hebat sehingga sendi tidak bisa disentuh. Gejala sistemik seperti demam, menggigil, dan malaise, mungkin juga terjadi dan merupakan hasil dari beberapa mediator inflamasi yang bocor ke sirkulasi vena. Rasa sakit akan menghilang dalam 3-10 hari, bahkan bila tanpa pengobatan.

Tahap 3: Interval kritis
Ini adalah tahap setelah episode gout yang bebas gejala. Pada kebanyakan orang, tahap ini berlangsung dari enam bulan sampai dua tahun setelah serangan pertama gout. Pada yang lainnya, kondisi tanpa gejala ini dapat berlangsung 5 – 10 tahun. (Sekitar 66% pasien akan mengalami serangan kedua dalam satu tahun).
Ini adalah waktu ideal untuk mencegah serangan di masa depan. Gout secara klinis tidak aktif tetapi masih ada dan penyakit itu terus berkembang jika asam urat tidak dikendalikan. Semakin besar kadar asam urat, semakin pendek interval untuk serangan berikutnya.

Tahap 4: Gout tingkat lanjut
Pada tahap akhir gout ini, gejala dan efeknya menetap. Sejumlah besar asam urat telah mengkristal menjadi deposit di tulang rawan serta tendon dan jaringan lunak, dan bahkan pada selaput antar tulang. Pasien sering mengalami berbagai gejala, seperti kekakuan sendi, keterbatasan gerakan sendi, nyeri sendi terus-menerus, luka dengan nanah putih di daerah yang terkena, nyeri sendi simultan pada berbagai bagian tubuh, dan fungsi ginjal memburuk. Pasien gout memiliki kecenderungan untuk mendapatkan batu ginjal lebih sering daripada yang lain.
Tahap ini juga disebut tahap tofus. Tofus (jamak: tofi) adalah massa kristal urat yang disimpan dalam jaringan lunak, yang dapat menghancurkan jaringan lunak dan persendian.Tofus paling sering berkembang di siku, lutut, jari kaki, tendon Achilles, dan, lebih jarang, di daun telinga.

Regulation of Thirst

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Another appetitive mechanism under hypothalamic control is thirst. Drinking is regulated by plasma osmolality and ECF volume in much the same fashion as vasopressin secretion. Water intake is increased by increased effective osmotic pressure of the plasma , by decreases in ECF volume, and by psychologic and other factors.Osmolality acts via osmoreceptors, receptors that sense the osmolality of the body fluids.These osmoreceptors are located in the anterior hypothalamus.

Decreases in ECF volume also stimulate thirst by a pathway independent of that mediating thirst in response to increased plasma osmolality. Thus, hemorrhage causes increased drinking even if there is no change in the osmolality of the plasma.

The effect of ECF volume depletion on thirst is mediated in part via the renin–angiotensin system.Renin secretion is increased by hypovolemia and results in an increase in circulating angiotensin II. The angiotensin II acts on the subfornical organ, a specialized receptor area in the diencephalon  to stimulate the neural areas concerned with thirst.Some evidence suggests that it acts on the organum vasculosum of the lamina terminalis (OVLT) as well. These areas are highly permeable and are two of the circumventricular organs located outside the blood–brain barrier.

However, drugs that block the action of angiotensin II do not completely block the thirst response to hypovolemia, and it appears that the baroreceptors in the heart and blood vessels are also involved. The intake of liquids is increased during eating (prandial drinking). The increase has been called a learned or habit response, but it has not been investigated in detail. One factor is an increase in plasma osmolality that occurs as food is absorbed. Another may be an action of one or more gastrointestinal hormones on the hypothalamus.

When the sensation of thirst is obtunded, either by direct damage to the diencephalon or by depressed or altered states of consciousness, patients stop drinking adequate amounts of fluid. Dehydration results if appropriate measures are not instituted to maintain water balance. If the protein intake is high, the products of protein metabolism cause an osmotic diuresis , and the amounts of water required to maintain hydration are large.

Most cases of hypernatremia are actually due to simple dehydration in patients with psychoses or hypothalamic disease who do not or cannot increase their water intake when their thirst mechanism is stimulated. Lesions of the anterior communicating artery can also obtund thirst because branches of this artery supply the hypothalamic areas concerned with thirst.

Other Factors Regulating Water Intake
•       A number of other well-established factors contribute to the regulation of water intake.
•       Psychologic and social factors are important.
•       Dryness of the pharyngeal mucous membrane causes a sensation of thirst.
•       Patients in whom fluid intake must be restricted sometimes get appreciable relief of thirst by sucking ice chips or a wet cloth.

Regulation of Hunger

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Factor that affecting food intake:

Leptin
•       Since the discovery of leptin and its receptors , there has been a rapid accumulation of information about genes, peptides, other neurotransmitters, and receptors in the hypothalamus and neighboring areas that are involved in appetite regulation.
•       leptin operates as part of a feedback loop by which the size of the body's fat depots can operate through a humoral link to regulate food intake
•       One important factor is neuropeptide Y
•       When injected into the hypothalamus, this 36-amino-acid polypeptide increases food intake, and inhibitors of neuropeptide Y synthesis decrease ood intake.
•       Neuropeptide Y-containing neurons have their cell bodies in the arcuate nuclei and project to
•       the paraventricular nuclei.
•       Neuropeptide Y mRNA in the hypothalamus increases during feeding and decreases during satiety.
•       Neuropeptide Y exerts its effect through three known receptors—Y1, Y2, and Y5—all coupled to G proteins.
•       Activation of the Y5 receptor increases food intake, but the situation is complex because activation of the Y2 receptor has an apparent inhibitory effect.
•       Knockout of the neuropeptide Y gene does not produce marked effects on feeding, indicating that other pathways are also involved, but knocking out the neuropeptide Y gene in leptin-deficient ob/ob mice causes them to eat less and expend more energy than ob/ob controls that have intact neuropeptide Y genes.


Orexin-A and orexin-B
•       Other polypeptides that increase food intake include orexin-A and orexin-B, derived from the same gene by alternate splicing.
•       They act on two receptors.
•       Orexins are synthesized in neurons located in the lateral hypothalamus.
•       They are also of interest because a mutation in one of the orexin receptor genes causes narcolepsy in dogs.


Melanin-concentrating hormone
•       Another polypeptide that increases food intake in mammals is melanin-concentrating hormone,
•        19-amino-acid polypeptide which is secreted by the pituitary in fish and is involved in the control of their skin color .
•       In mammals, its mRNA is found only in the lateral hypothalamus and the zona incerta


Pro-opiomelanocortin (POMC) derivatives
•       On the other hand, pro-opiomelanocortin (POMC) derivatives  decrease food intake.
•       There are four established receptors for these derivatives:
•       MC1-R, which is involved in skin pigmentation;
•       MC2-R, which is involved in adrenal glucocorticoid production;
•       MC3-R, which is associated with the control of sebaceous gland secretion; and
•       MC4-R, which mediates the effects on appetite.


CART (cocaine- and amphetamine-regulated transcript)
•       Another neuropeptide found in the hypothalamus that inhibits food intake is CART (cocaine- and amphetamine-regulated transcript).


CRH
•       CRH, the brain hormone that stimulates ACTH secretion also inhibits food intake


Catecholamines
•       Catecholamines are also involved in the regulation of body weight.
•       Mice in which norepinephrine and epinephrine synthesis is prevented by knocking out the gene for dopamine b-hydroxylase have increased food intake.
•       Interestingly, they do not become obese because they also have an unexplained simultaneous increase in metabolic rate.
•       Amphetamine and related drugs used clinically to suppress appetite presumably act by releasing norepinephrine in the CNS.
•       Mice in which the 5HT2C receptor is knocked out become obese, indicating that serotonin is also involved in the regulation of food intake.

Gastric bypass surgery

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Gastric bypass is surgery that helps you lose weight by changing how your stomach and small intestine handle the food you eat.
After the surgery, your stomach will be smaller. You will feel full with less food.
The food you eat will no longer go into some parts of your stomach and small intestine that absorb food. Because of this, your body will not get all of the calories from the food you eat.


Description
You will have general anesthesia before this surgery. You will be asleep and pain free.
There are two steps during gastric bypass surgery:

• The first step makes your stomach smaller. Your surgeon uses staples to divide your stomach into a small upper section and a larger bottom section. The top section of your stomach (called the pouch) is where the food you eat will go. The pouch is about the size of a walnut. It holds only about 1 ounce (oz) of food. Because of this you will eat less and lose weight.
• The second step is the bypass. Your surgeon connects a small part of your small intestine (the jejunum) to a small hole in your pouch. The food you eat will now travel from the pouch into this new opening and into your small intestine. As a result, your body will absorb fewer calories.
Gastric bypass can be done in two ways. With open surgery, your surgeon makes a large surgical cut to open your belly. The bypass is done by working on your stomach, small intestine, and other organs.
Another way to do this surgery is to use a tiny camera, called a laparoscope. This camera is placed in your belly. The surgery is called laparoscopy. The scope allows the surgeon to see inside your belly.
In this surgery:

• The surgeon makes 4 to 6 small cuts in your belly.
• The scope and instruments needed to perform the surgery are inserted through these cuts.
• The camera is connected to a video monitor in the operating room. This allows the surgeon to view inside your belly while doing the operation.
Advantages of laparoscopy over open surgery include:

• Shorter hospital stay and quicker recovery.
• Less pain.
• Smaller scars and a lower risk of getting a hernia or infection.
This surgery takes about 2 to 4 hours.
Why the Procedure is Performed
Weight-loss surgery may be an option if you are very obese and have not been able to lose weight through diet and exercise.
Doctors often use the body massa index (BMI) and health conditions such as type 2 diabetes and high blood pressure to determine which patients are most likely to benefit from weight-loss surgery.
Gastric bypass surgery is not a quick fix for obesity. It will greatly change your lifestyle. After this surgery, you must eat healthy foods, control portion sizes of what you eat, and exercise. If you do not follow these measures, you may have complications from the surgery and poor weight loss.
This procedure may be recommended if you have:

• A BMI of 40 or more. Someone with a BMI of 40 or more is at least 100 pounds over their recommended weight. A normal BMI is between 18.5 to 25.
• A BMI of 35 or more and a serious medical condition that might improve with weight loss. Some of these conditions are obstructive sleep apnea, type 2 diabetes, and heart disease
Risks
Gastric bypass is major surgery and it has many risks. Some of these risks are very serious. You should discuss these risks with your surgeon.
Risks for anesthesia and surgery in general include:

• Allergic reactions to medicines
• Breathing problems
• Bleeding, blood clots, infection
Risks for gastric bypass include:

• Gastritis (inflamed stomach lining), heartburn, or stomach ulcers
• Injury to the stomach, intestines, or other organs during surgery
• Leaking from the line where parts of the stomach have been stapled together
• Poor nutrition
• Scarring inside your belly that could lead to a blockage in your bowel in the future
• Vomiting from eating more than your stomach pouch can hold
Before the Procedure
Your surgeon will ask you to have tests and visits with other health care providers before you have this surgery. Some of these are:

• A complete physical exam.
• Blood tests, ultrasound of your gallbladder, and other tests to make sure you are healthy enough to have surgery.
• Visits with your doctor to make sure other medical problems you may have, such as diabetes, high blood pressure, and heart or lung problems, are under control.
• Nutritional counseling.
• Classes to help you learn what happens during the surgery, what you should expect afterward, and what risks or problems may occur afterward.
• You may want to visit with a counselor to make sure you are emotionally ready for this surgery. You must be able to make major changes in your lifestyle after surgery.
If you smoke, you should stop several weeks before surgery and not start smoking again after surgery. Smoking slows recovery and increases the risks of problems. Tell your doctor or nurse if you need help quitting
Tell your surgeon or nurse:

• If you are or might be pregnant
• What medicines, vitamins, herbs, and other supplements you are taking, even ones you bought without a prescription
During the week before your surgery:

• You may be asked to stop taking medicines that make it hard for your blood to clot. These include aspirin, ibuprofen (Advil, Motrin), vitamin E, warfarin (Coumadin), and others.
• Ask your doctor which drugs you should still take on the day of your surgery.
• Prepare your home for after the surgery.
On the day of surgery:

• Follow instructions about when to stop eating and drinking.
• Take the drugs your doctor told you to take with a small sip of water.
• Arrive at the hospital on time.
After the Procedure
Most people stay in the hospital for 1 to 4 days after surgery.
In the hospital:

• You will be asked to sit on the side of the bed and walk a little on the same day you have surgery.
• You may have a (tube) catheter that goes through your nose into your stomach for 1 or 2 days. This tube helps drain fluids from your intestine.
• You may have a catheter in your bladder to remove urine.
• You will not be able to eat for the first 1 to 3 days. After that, you can have liquids and then pureed or soft foods.
• You may have a tube connected to the larger part of your stomach that was bypassed. The catheter will come out of your side and will drain fluids.
• You will wear special stockings on your legs to help prevent blood clots from forming.
• You will receive shots of medicine to prevent blood clots.
• You will receive pain medicine. You will take pills for pain or receive pain medicine through an IV, a catheter that goes into your vein.
You will be able to go home when:

• You can eat liquid or pureed food without vomiting.
• You can move around without a lot of pain.
• You do not need pain medicine through an IV or given by shot.
Be sure to follow instructions for how to care for yourself at home
Outlook (Prognosis)
Most people lose about 10 to 20 pounds a month in the first year after surgery. Weight loss will decrease over time. By sticking to your diet and exercise from the beginning, you lose more weight.
You may lose half or more of your extra weight in the first 2 years. You will lose weight quickly after surgery if you are still on a liquid or pureed diet.
Losing enough weight after surgery can improve many medical conditions, including:

• Asthma
• Gastroesophageal reflux disease
• High Blood Pressure
• High Cholesterol
• Obstructive sleep apnea
• Type 2 diabetes
• High cholesterol
• Obstructive sleep apnea
• Type 2 diabetes
Weighing less should also make it much easier for you to move around and do your everyday activities.
To lose weight and avoid complications from the procedure, you will need to follow the exercise and eating guidelines that your doctor and dietitian have given you.

Vital Sign

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Vital signs are measurements of the body's most basic functions. The four main vital signs routinely monitored by medical professionals and health care providers include the following:

• Body temperature
• Pulse rate
• Respiration rate (rate of breathing)
• Blood pressure (Blood pressure is not considered a vital sign, but is often measured along with the vital signs.)
Vital signs are useful in detecting or monitoring medical problems. Vital signs can be measured in a medical setting, at home, at the site of a medical emergency, or elsewhere.


What is body temperature?
The normal body temperature of a person varies depending on gender, recent activity, food and fluid consumption, time of day, and, in women, the stage of the menstrual cycle. Normal body temperature can range from 97.8 degrees F (or Fahrenheit, equivalent to 36.5 degrees C, or Celsius) to 99 degrees F (37.2 degrees C) for a healthy adult. A person's body temperature can be taken in any of the following ways:

• Orally. Temperature can be taken by mouth using either the classic glass thermometer, or the more modern digital thermometers that use an electronic probe to measure body temperature.
• Rectally. Temperatures taken rectally (using a glass or digital thermometer) tend to be 0.5 to 0.7 degrees F higher than when taken by mouth.
• Axillary. Temperatures can be taken under the arm using a glass or digital thermometer. Temperatures taken by this route tend to be 0.3 to 0.4 degrees F lower than those temperatures taken by mouth.
• By ear. A special thermometer can quickly measure the temperature of the ear drum, which reflects the body's core temperature (the temperature of the internal organs).
• By skin. A special thermometer can quickly measure the temperature of the skin on the forehead.
Body temperature may be abnormal due to fever (high temperature) or hypothermia (low temperature). A fever is indicated when body temperature rises about one degree or more over the normal temperature of 98.6 degrees Fahrenheit, according to the American Academy of Family Physicians. Hypothermia is defined as a drop in body temperature below 95 degrees Fahrenheit.


What is the pulse rate?
The pulse rate is a measurement of the heart rate, or the number of times the heart beats per minute. As the heart pushes blood through the arteries, the arteries expand and contract with the flow of the blood. Taking a pulse not only measures the heart rate, but also can indicate the following:

• Heart rhythm
• Strength of the pulse
The normal pulse for healthy adults ranges from 60 to 100 beats per minute. The pulse rate may fluctuate and increase with exercise, illness, injury, and emotions. Females ages 12 and older, in general, tend to have faster heart rates than do males. Athletes, such as runners, who do a lot of cardiovascular conditioning, may have heart rates near 40 beats per minute and experience no problems.




How to check your pulse
As the heart forces blood through the arteries, you feel the beats by firmly pressing on the arteries, which are located close to the surface of the skin at certain points of the body. The pulse can be found on the side of the neck, on the inside of the elbow, or at the wrist. For most people, it is easiest to take the pulse at the wrist. If you use the lower neck, be sure not to press too hard, and never press on the pulses on both sides of the lower neck at the same time to prevent blocking blood flow to the brain. When taking your pulse:

• Using the first and second fingertips, press firmly but gently on the arteries until you feel a pulse.
• Begin counting the pulse when the clock's second hand is on the 12.
• Count your pulse for 60 seconds (or for 15 seconds and then multiply by four to calculate beats per minute).
• When counting, do not watch the clock continuously, but concentrate on the beats of the pulse.
• If unsure about your results, ask another person to count for you.
If your doctor has ordered you to check your own pulse and you are having difficulty finding it, consult your doctor or nurse for additional instruction.


What is the respiration rate?
The respiration rate is the number of breaths a person takes per minute. The rate is usually measured when a person is at rest and simply involves counting the number of breaths for one minute by counting how many times the chest rises. Respiration rates may increase with fever, illness, and with other medical conditions. When checking respiration, it is important to also note whether a person has any difficulty breathing.
Normal respiration rates for an adult person at rest range from 12 to 16 breaths per minute.


What is blood pressure?
Blood pressure, measured with a blood pressure cuff and stethoscope by a nurse or other health care provider, is the force of the blood pushing against the artery walls. Each time the heart beats, it pumps blood into the arteries, resulting in the highest blood pressure as the heart contracts. One cannot take his or her own blood pressure unless an electronic blood pressure monitoring device is used. Electronic blood pressure monitors may also measure the heart rate, or pulse.

Two numbers are recorded when measuring blood pressure. The higher number, or systolic pressure, refers to the pressure inside the artery when the heart contracts and pumps blood through the body. The lower number, or diastolic pressure, refers to the pressure inside the artery when the heart is at rest and is filling with blood. Both the systolic and diastolic pressures are recorded as "mm Hg" (millimeters of mercury). This recording represents how high the mercury column in an old-fashioned manual blood pressure device (called a mercury manometer) is raised by the pressure of the blood. Today, your doctor's office is more likely to use a simple dial for this measurement.

High blood pressure, or hypertension, directly increases the risk of coronary heart disease (heart attack) and stroke (brain attack). With high blood pressure, the arteries may have an increased resistance against the flow of blood, causing the heart to pump harder to circulate the blood.
According to the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health, high blood pressure for adults is defined as:

• 140 mm Hg or greater systolic pressure

or
• 90 mm Hg or greater diastolic pressure
In an update of NHLBI guidelines for hypertension in 2003, a new blood pressure category was added called prehypertension:

• 120 mm Hg – 139 mm Hg systolic pressure

or
• 80 mm Hg – 89 mm Hg diastolic pressure
The NHLBI guidelines now define normal blood pressure as follows:

• Less than 120 mm Hg systolic pressure

and
• Less than 80 mm Hg diastolic pressure
These numbers should be used as a guide only. A single elevated blood pressure measurement is not necessarily an indication of a problem. Your doctor will want to see multiple blood pressure measurements over several days or weeks before making a diagnosis of hypertension (high blood pressure) and initiating treatment. A person who normally runs a lower-than-usual blood pressure may be considered hypertensive with lower blood pressure measurements than 140/90.


Why should I monitor my blood pressure at home?
For people with hypertension, home monitoring allows your doctor to monitor how much your blood pressure changes during the day, and from day to day. This may also help your doctor determine how effectively your blood pressure medication is working.


What special equipment is needed to measure blood pressure?
Either an aneroid monitor, which has a dial gauge and is read by looking at a pointer, or a digital monitor, in which the blood pressure reading flashes on a small screen, can be used to measure blood pressure.


Before you measure your blood pressure:
• Rest for three to five minutes without talking before taking a measurement.
• Sit in a comfortable chair, with your back supported and your legs and ankles uncrossed.
• Sit still and place your arm, raised level with your heart, on a table or hard surface.
• Wrap the cuff smoothly and snugly around the upper part of your arm. The cuff should be sized to fit smoothly, while still allowing enough room for one fingertip to slip under it.
• Be sure the bottom edge of the cuff is at least one inch above the crease in your elbow.
It is also important, when taking blood pressure readings, that you record the date and time of day you are taking the reading, as well as the systolic and diastolic measurements. This will be important information for your doctor to have. Ask your doctor or another health care professional to teach you how to use your blood pressure monitor correctly. Have the monitor routinely checked for accuracy by taking it with you to your doctor's office. It is also important to make sure the tubing is not twisted when you store it and keep it away from heat to prevent cracks and leaks.
Proper use of your blood pressure monitor will help you and your doctor in monitoring your blood pressure.

Heart Transplant

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A heart transplant is surgery to remove a damaged or diseased heart and replace it with a healthy donor heart.

Finding a donor heart can be difficult. The heart must be donated by someone who is brain-dead but is still on life support. The donor heart must be matched as closely as possible to your tissue type to reduce the chance that your body will reject it.
You are put into a deep sleep with general anesthesia, and a cut is made through the breastbone.

• Your blood flows through a heart-lung bypass machine while the surgeon works on your heart. This machine does the work of your heart and lungs while they are stopped, and supplies your body with blood and oxygen.
• Your diseased heart is removed and the donor heart is stitched in place. The heart-lung machine is then disconnected. Blood flows through the transplanted heart, which takes over supplying your body with blood and oxygen.
• Tubes are inserted to drain air, fluid, and blood out of the chest for several days, and to allow the lungs to fully re-expand.


Why the Procedure is Performed
A heart transplant may be done to treat:

• Severe heart damage after a heart attack
• Severe heart failure, when medicines, other treatments, and surgery no longer help
• Severe heart defects that were present at birth and can't be fixed with surgery
• Life-threatening abnormal heartbeats or rhythms that do not respond to other treatments
Heart transplant surgery may not be used in people who:

• Are malnourished
• Are older than age 65 to 70
• Have had a severe stroke or dementia
• Have had cancer less than 2 years ago
• Have HIV infection
• Have infections, such as hepatitis, that are active
• Have insulin-dependent diabetes and other organs, such as the kidneys, that aren't working correctly
• Have kidney, lung, nerve, or liver disease
• Have no family support and do not follow their treatment
• Have other diseases that affect the blood vessels of the neck and leg
• Have pulmonary hypertension (thickening of blood vessels in the lung)
• Smoke or abuse alcohol or drugs, or have other lifestyle habits that may damage the new heart
• Are not reliable enough to take their medicines, or if the person is not able to keep up with the many hospital and medical office visits and tests

Risks
Risks from any anesthesia are:

• Reactions to medicines
• Problems breathing
Risks from any surgery are:

• Bleeding
• Infection
Risks of transplant include:

• Blood clots (deep venous thrombosis)
• Damage to the kidneys, liver, or other organs from anti-rejection medicines
• Development of cancer from the drugs used to prevent rejection
• Heart attack or stroke
• Heart rhythm problems
• High cholesterol levels, diabetes, and bone thinning from the use of rejection medicines
• Increased risk for infections due to anti-rejection medicines
• Lung and kidney failure
• Rejection of the heart
• Severe coronary artery disease
• Wound infections
Before the Procedure
Once you are referred to a transplant center, you will be evaluated by the transplant team. They will want to make sure that you are a good candidate for a transplant. You will visit many times over several weeks or even months. You will need to have blood drawn and x-rays taken. The following may also be done:

• Blood or skin tests to check for infections
• Tests of your kidney and liver
• Tests to evaluate your heart, such as EKG,echocardiogram, and cardiac catheterization
• Tests to look for cancer
• Tissue and blood typing, to help make sure your body will not reject the donated heart
• Ultrasound of your neck and legs
You will want to look at one or more transplant centers to see which would be best for you:

• Ask them how many transplants they perform every year and what their survival rates are. Compare these numbers with the numbers from other centers.
• Ask what support groups they have available and how much help they offer with travel and housing.
• Ask about the costs of medicines you will need to take afterwards.
If the transplant team believes you are a good candidate, you will be put on a regional waiting list for a heart:

• Your place on the list is based on several factors. Key factors include the type and severity of your heart disease, and how sick you are at the time you are listed.
• The amount of time you spend on a waiting list is usually NOT a factor for how soon you get a heart, except in the case of children.
Most, but not all, people who are waiting for a heart transplant are very ill and need to be in the hospital. Many will need some sort of device to help their heart pump enough blood to the body. Most often, this is a ventricular assist device (VAD).
After the Procedure
You should expect to stay in the hospital for 7 to 21 days after a heart transplant. The first 24 to 48 hours will likely be in the intensive care unit (ICU). During the first few days after a transplant, you will need close follow-up to make sure that you do not get an infection and your heart is working well.
The recovery period is about 3 months and often, your transplant team will ask you to stay fairly close to the hospital during that time period. You will need to have regular check-ups with blood tests, x-rays, and echocardiograms for many years.
Fighting rejection is an ongoing process. The body's immune system considers the transplanted organ a foreign body and fights it. For this reason, organ transplant patients must take drugs that suppress the body's immune response. To prevent rejection, it is very important to take these medicines and carefully follow your self-care instructions.
Biopsies of the heart muscle are often done every month during the first 6 to 12 months after transplant, and then less often after that. This helps determine if your body is rejecting the new heart, even before you have symptoms.
You must take drugs that prevent transplant rejection for the rest of your life. You will need to understand how to take these medicines, and know their side effects.
You can go back to your normal activities 3 months after the transplant as soon as you feel well enough, and after talking with your health care provider. However, avoid vigorous physical activity.
To make sure that you do not develop coronary disease after a transplant, you may have cardiac catheterization every year.
Outlook (Prognosis)
Heart transplant prolongs the life of people who would otherwise die. About 80% of heart transplant patients are alive 2 years after the operation. At 5 years, 70% of patients will still be alive after a heart transplant.
The main problem, as with other transplants, is rejection. If rejection can be controlled, survival increases to over 10 years.

Cardiovascular system

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The cardiovascular system consists of the heart, which is an anatomical pump, with its intricate conduits (arteries, veins, and capillaries) that traverse the whole human body carrying blood. The blood contains oxygen, nutrients, wastes, and immune and other functional cells that help provide for homeostasis and basic functions of human cells and organs.

The pumping action of the heart usually maintains a balance between cardiac output and venous return. Cardiac output (CO) is the amount of blood pumped out by each ventricle in one minute. The normal adult blood volume is 5 liters (a little over 1 gallon) and it usually passes through the heart once a minute. Note that cardiac output varies with the demands of the body.

The cardiac cycle refers to events that occur during one heart beat and is split into ventricular systole (contraction/ejection phase) and diastole (relaxation/filling phase). A normal heart rate is approximately 72 beats/minute, and the cardiac cycle spreads over 0.8 seconds. The heart sounds transmitted are due to closing of heart valves, and abnormal heart sounds, called murmurs, usually represent valve incompetency or abnormalities.

Blood is transported through the whole body by a continuum of blood vessels. Arteries are blood vessels that transport blood away from the heart, and veins transport the blood back to the heart. Capillaries carry blood to tissue cells and are the exchange sites of nutrients, gases, wastes, etc.

Heart
The heart is a muscular organ weighing between 250-350 grams located obliquely in the mediastinum. It functions as a pump supplying blood to the body and accepting it in return for transmission to the pulmonary circuit for gas exchange. The heart contains 4 chambers that essentially make up 2 sides of 2 chamber (atrium and ventricle) circuits; the left side chambers supply the systemic circulation, and the right side chambers supply the pulmonary circulation. The chambers of each side are separated by an atrioventricular valve (A-V valve). The left-sided chambers are separated by the mitral (bicuspid) valve, and right-sided chambers are divided by the tricuspid valve. Blood flows through the heart in only one direction enforced by a valvular system that regulates opening and closure of valves based on pressure gradients

Unique properties of cardiac muscle
Cardiac muscle cells are branching striated, uninucleate (single nucleus) cells that contain myofibrils.
Adjacent cardiac cells are connected by intercalated discs containing desmosomes and gap junctions. The myocardium behaves as a functional syncytium because of electrical coupling action provided by gap junctions.
Cardiac muscle has abundant mitochondria that depend on aerobic respiration primarily to generate adenosine tri-phosphate (ATP), the molecule that provides energy for cellular function

Systemic Circulation
The systemic circuit originates in the left side of the heart and functions by receiving oxygen-laden blood into the left atrium from the lungs and flows one way down into the left ventricle via the mitral valve. From the left ventricle, oxygen rich blood is pumped to all organs of the human body through the aortic semilunar valve
Pulmonary Circulation
The pulmonary circuit is on the right side of the heart and serves the function of gas exchange. Oxygen-poor systemic blood reaches the right atrium via 3 major venous structures: the superior vena cava, inferior vena cava, and coronary sinus. This blood is pumped down to the right ventricle via the tricuspid valve and eventually through the pulmonic valve,leading to the pulmonary trunk that takes the oxygen deprived blood to the lungs for gas exchange. Once gas exchange occurs in the lung tissue, the oxygen-laden blood is carried to the left atrium via the pulmonary veins, hence completing the pulmonary circuit (see the image above).

Coronary Circulation
Coronary circulation is the circulation to the heart organ itself. The right and left coronary arteries branch from the ascending aorta and, through their branches (anterior and posterior interventricular, marginal and circumflex arteries), supply the heart muscle (myocardial) tissue. Venous blood collected by the cardiac veins (great, middle, small, and anterior) flows into the coronary sinus. Delivery of oxygen-rich blood to the myocardial tissue occurs during the heart relaxation phase

Vessel Anatomy
An artery is a blood vessel that carries blood away from the heart to peripheral organs (see the image below). They are subdivided into larger conducting arteries, smaller distributing arteries, and the smallest arteries, known as arterioles, that supply the capillary bed (the site of active tissue cells gas exchange).

Capillaries are vessels that are microscopic in size and provide a site of gas, ion, nutrient, and cellular exchange between blood and interstitial fluid. They have fenestrations that allow for and enhance permeability for exchange of gas, ion, nutrient, and cellular elements
A vein is a blood vessel that has a larger lumen, and sometimes veins serve as blood reservoirs or capacitance vessels, containing valves that prevent backflow. This system of vessels in general returns blood to the heart from the periphery