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1.

Why the patient complain cough with blood, shortness of breath, tightness when breathing
and pain in right chest?
Paparan bahan karsinogenik(rokok, polutan) terinhalasi ke saluran
nafasinflamasirespon bronkokontriksi, hipervaskularisasi, hipersekresi
mucusrusaknya silia dan perubahan metaplasia(sel berubah bentuk)terbentuk massa
parumembesarmemenuhi ruang potensial di cavum pleura

Nyeri dadaada infiltrasi di rongga intersisilmenyebar ke pleura parietalis pars


costalisn.intercostalis terdesaknyeri terasa di sepanjang dada

2. How can decreased appetite, weight loss, and fever?

InflamasiTNF meningkatmerangsang pusat kenyang pada hipotalamuspengisian lambung


terhambat padahal metabolisme meningkatBB turun

Ada perkembangan dari sel kanker(pertumbuhan cept dan tdk terkontrol)nutrisi, 02, ruangan
digunakan untuk pertumbuhan sel kankerBB turun

Fever : smoking mediator inflammation stimulate monocyte, macrophage and


other endotel cell stimulate pyrogenic cytokines stimulate hypothalamus
anterior stimulate PGE2 increase set point thermoregulation fever

3. Why does doctor do pleura pungsi?


Because there are increases fluid in cavum pleura, so the doctor do pleura pungsi
to remove the fluids decreases short breathing
to analysis the fluids (exudate or transudate)

4. What relationship between smoke and lung malignancy?


Smoking and environment activation metabolic p-450 mono oxygenate system
inactivation tumor gen suppressor mutation of TP 53 or activation K-RAS
oncogene mutation airway epithelial hyperplasia basal cell and metaplasia
squamous cell dysplasia squamous cell and carcinoma in situ accumulation of
cell mutation lung malignancy
Smoke contain tar agent carcinogenic destroy airway epithelial
metaplasia (respiratory cell squamous cell) destroy cilia of airway disturb
cleaning of mucus in airway because the cilia became shortness

5. What relationship between lung malignancy and pleura effusion


Pleura effusion is the complication of lung malignancy
Lung malignancy metastasis to pleura destroy capillary membrane and leakage plasma
protein increases cavum pleura fluids

Efusi pleura (adanya cairan dirongga pleura), cairan dapat berupa eksudat dan transudat.

Transudat adalah penimbunan cairan dalam rongga serosa sebagai akibat karena gangguan keseimbangan
cairan dan bukan merupkan proses radang.
Eksudat adalah cairan patologis dan sel yang keluar dari kapiler dan masuk ke dalam jaringan pada waktu
radang.
Ketika pleura diisi transudat ,keadaan ini disebut hydrothorax
Ketika pleura diisi eksudat, salah satunya disebabkan oleh kanker sel pada hyperplasia dan dysplasia dan sel
kanker menembus ke ruangan pleura terjadi efusi

6. What is the interpretation from physical examination?


Percussion : because there are many fluids in cavum pleura dullness of percussion
Palpation : because there are many fluids in cavum pleura decreases fremitus
vocal
Auscultation : because there are many fluids in cavum pleura sound of the lung
loss

7. What is interpretation from X ray?


Radiopaque in right hemi thorax. Located in inferior lobe of the lung because fluid influence
by gravitation

8. What are causes of pleura effusion?


Exudate : inflammation of lung or pleura, disturb of drainage lymphatic
Transudate : increases pressure of hydrostatic and oncotic, increases pressure of
pulmonary, decrease protein in blood.

9. How pathogenesis of lung malignancy?


Merokok dan gangguan lingkungan pengaktifan metabolik sistem enzim monooksigenase
P-450 Inaktivasi gen supressor tumor Mutasi TP 53/ Aktivasi onkogen K-RAS mutasi
epitel jalan napas (efek lapanganifield effect ) hiperplasia sel basal dan metaplasia
skuamosa displasia skuamosa dan karsinoma in situ akumulasi sel-sel mutasi
karsinoma paru

Smoking and environment activation metabolic p-450 mono oxygenate system


inactivation tumor gen suppressor mutation of TP 53 or activation K-RAS oncogene
mutation airway epithelial hyperplasia basal cell and metaplasia squamous cell
dysplasia squamous cell and carcinoma in situ accumulation of cell mutation lung
malignancy metastasis to pleura destroy capillary membrane and leakage plasma
protein increases cavum pleura fluids

10. Explain the diagnostic examination to evaluate lung malignancy?


Anamnesis : symptom (dispnea, decrease appetite, right chest pain, cough with
blood)

Perkusi redup karena ada cairan infiltrasi dari inflamasi di intersisil

Karena ada cairan di cavum pleura dan recessuss

Auskultasi menghilang cairan tidak baik menghantarkan suara


LI:

Inspeksi: asimetris saat dinamis(yg ada massnya tertinggal). Statis simetris. Jari
tabuh, pembesaran kelenjar getah bening di axilla dan leher
Palpasi : nyeri, bengkak, strem fremitus turun
Perkusi : pekak
Auskultasi : suara napas menurun, mirip asma bronkial, stad lanjut muncul lebih
berat (parrol,syndrome horner, gejala neurologik, sindrome vena cava)

11. What are the type, staging and complication of lung malignancy?
12. How are the principle of management of lung malignancy?
13. How is the prognosis of lung malignancy?

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