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PATOFISIOLOGI SISTEM

PERNAFASAN

MARIDI MD
Infeksi Saluran Pernafasan
Neoplasma dan Kelainan
Pada Anak
Area yang terlibat dalam Infeksi
Saluran Pernafasan

• Salaran pernafasan bagian atas


– Hidung, orofaring, dan laring
• Saluran pernfasan bawah
– Jalan nafas bagian bawah dan paru-paru
• Keduanya (bagian atas dan bawah)
Infeksi Pernafasan Tersering

• Common cold
• Influenza
• Pneumonia
• Tuberculosis
• Infeksi Fungi pada paru
Faktor yang mempengaruhi tanda
dan gejala Infeksi Saluran
Pernafasan
• Fungsi dari struktur yang terkena
• Beratnya proses infeksi
• Umur pasien dan status kesehatan secara
umum
Rhinitis dan Sinusitis

• Rhinitis
– Inflamasi pada mukosa hidung
• Sinusitis
– Inflamasi pada sinus paranasalis
Jenis Sinus

• Sinus Paranasalis
– Sel-sel udara yang dikoneksikan oleh lubang yang
menyemnpit atau ostia dengan turbinasi hidung
bagian superior tengah dan bawah dari ringga
hidung.
• Sinus Maksillaris
– Inferior to the bony orbit and superior to the hard
palate
– Its opening is located superiorly and medially in
the sinus, a location that impedes drainage
• Frontal sinuses
– Open into the middle meatus of the nasal cavity
Types of Sinuses (cont.)

• Sphenoid sinus
– Just anterior to the pituitary fossa behind the
posterior ethmoid sinuses
– Its paired openings drain into the
sphenoethmoidal recess at the top of the nasal
cavity
• Ethmoid sinuses
– Comprise 3 to 15 air cells on each side, with each
maintaining a separate path to the nasal chamber
Sinus Paranasalis
Classifications of Rhinosinusitis

• Acute rhinosinusitis
– May be of viral, bacterial, or mixed viral-bacterial
origin
– May last from 5 to 7 days up to 4 weeks
• Subacute rhinosinusitis
– Lasts from 4 weeks to less than 12 weeks
• Chronic rhinosinusitis
– Lasts beyond 12 weeks
Allergic Rhinosinusitis

• Occurrence
– Occurs in conjunction with allergic rhinitis
– Mucosal changes are the same as allergic rhinitis
• Symptoms
– Nasal stuffiness, itching and burning of the nose,
frequent bouts of sneezing, recurrent frontal
headache, watery nasal discharge
• Treatment
– Oral antihistamines, nasal decongestants, and
intranasal cromolyn
Types of Influenza Viruses

• Type A
– Most common type
– Can infect multiple species
– Causes the most severe disease
– Further divided into subtypes based on two
surface antigens: hemagglutinin (H) and
neuraminidase (N)
• Type B
– Has not been categorized into subtypes
Antiviral Drugs

• Amantadine
• Rimantadine
• Zanamivir
• Oseltamivir
Types of Influenza Vaccinations

• Trivalent inactivated influenza vaccine (TIIV)


– Developed in the 1940s
– Administered by injection
• Live, attenuated influenza vaccine (LAIV)
– Approved for use in 2003
– Administered intranasally
Pneumonia

• Definition
– Respiratory disorders involving inflammation of
the lung structures (alveoli and bronchioles)
• Causes
– Infectious agents: such as bacteria and viruses
– Noninfectious agents: such as gastric secretions
aspirated into the lungs
Factors Facilitating Development
of Pneumonia

• An exceedingly virulent organism


• A large inoculum
• Impaired host defenses
Classifications of Pneumonias

• According to source of infection


– Community-acquired
– Hospital-acquired
• According to immune status of the host
– Pneumonia in the immunocompromised person
Pembagian Berdasarkan Lokasi

• Pneumonia Lobaris

• Pneumonia Interstitial

• Pneumonia Lobularis (Bronkopneumonia)


Patogenesis
• Fase engorgement (4 – 12 jam): eksudat serosa mengalir
ke alveoli dari pembuluh darah yang bocor dan dilatasi.
• Fase hepatisasi merah (48 jam berikutnya): paru tampak
granular kemerahan karena sel darah merah, fibrin, dan
PMN mengisi alveoli.
• Fase Hepatisasi kelabu (3 - 8 hari): paru menjadi tampak
kelabu karena leukosit dan fibrilasi melakukan konsolidasi
ke dalam alveoli yang terkena.
• Fase Resolusi (7 – 11 hari): eksudat di hancur dan diserap
kembali dan perbaikan jaringan ke jaringan yang normal
Bacterial Pneumonia
Infeksi bakteri, virus atau jamur dapat meyebabkan
peradangan pada paru dimana cairan mengisi
alveoli
Categories of Persons with
Community-Acquired Pneumonia
• Persons without cardiopulmonary disease or
other modifying factors that can be treated on an
outpatient basis
• Persons with cardiopulmonary disease and/or
other modifying factors who can be treated on an
outpatient basis
• Persons who require hospitalization but not
admission to the intensive care unit (ICU)
• Persons who require admission to the ICU either
because of cardiopulmonary disease or type of
infectious organism causing the infection
Symptoms of Legionella
Pneumonia

• Begin approximately 2 to 10 days after


infection:
– Malaise, weakness, lethargy, fever, and dry cough.
• Other manifestations include:
– Disturbances of central nervous system function
– Gastro-intestinal tract involvement
– Arthralgias
– Elevation in body temperature
Forms of Tuberculosis

• M. tuberculosis hominis (human


tuberculosis)
– Airborne infection spread by minute droplet nuclei
harbored in the respiratory secretions of persons
with active tuberculosis
– Living under crowded and confined conditions
increases the risk for spread of the disease
• Bovine tuberculosis
– Acquired by drinking milk from infected cows;
initially affects the gastrointestinal tract
– Has been virtually eradicated in North America
and other developed countries
Positive Tuberculin Skin Test

• Results from a cell-mediated immune


response
– Implies that a person has been infected with M.
tuberculosis and has mounted a cell-mediated
immune response
– Does not mean the person has active tuberculosis
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Classification of Fungi

• Yeasts
– Are round and grow by budding
• Molds
– Form tubular structures called hyphae
– Grow by branching and forming spores
• Dimorphic Fungi
– Grow as yeasts at body temperatures and as
molds at room temperatures
Laboratory Tests to Diagnose
Histoplasmosis

• Cultures
• Fungal stain
• Antigen detection
• Serologic tests for antibodies
Categories of Bronchogenic
Carcinomas

• Squamous cell lung carcinoma (25% to 40%)


• Adenocarcinoma (20% to 40%)
• Small cell carcinoma (20% to 25%)
• Large cell carcinoma (10% to 15%)
Categories of the Manifestation of
Lung Cancer
• Those due to involvement of the lung and
adjacent structures
• The effects of local spread and metastasis
• The nonmetastatic paraneoplastic
manifestations involving endocrine,
neurologic, and connective tissue function
• Nonspecific symptoms such as anorexia and
weight loss
Stages of Lung Development

• Embryonic period
• Pseudoglandular period
• Canicular period
• Saccular period
• Alveolar period
Respiratory Disorders in the
Neonate

• Respiratory Distress Syndrome


• Bronchopulmonary Displasia
Respiratory Disorders in Children

• Upper airway infections


– Viral croup
– Spasmodic croup
– Epiglottis
• Lower airway infections
– Acute bronchiolitis
KELAINAN VENTILASI
DAN PERTUKARAN GAS
Penyebab Kelainan Daya Kembang
Paru

• Kondisi yang menyebabkan kompresi atau


kolap paru
– Kompresi paru disebabkan oleh suatu
penumpukan cairan di rongga pleura.
– Kolaps komplit pada paru yg terkenaadisebakan
oleh pneumothoraks
– Kolaps pada segment paru disebabkan atelektasis
Characteristics and Symptoms of
Pleural Pain
• Abrupt in onset
• Unilateral, localized to lower and lateral part
of the chest
• May be referred to the shoulder
• Usually made worse by chest movements
• Tidal volumes are kept small
• Breathing becomes more rapid
• Reflex splinting of the chest may occur
Pleural Effusion
• Definition
– An abnormal collection of fluid in the pleural
cavity
• Types of fluid
– Transudate
– Exudate
– Purulent drainage (empyema)
– Chyle
– Blood
Diagnosis and Treatment of Pleural
Effusion
• Diagnosis
– Chest radiographs, Chest ultrasound
– Computed tomography (CT)
• Treatment: Directed at the cause of the
disorder
– Thoracentesis
– Injection of a sclerosing agent into the pleural
cavity
– Open surgical drainage
Types of Pneumothoraxes

• Spontaneous pneumothorax
– Occurs when an air-filled blister on the lung
surface ruptures
• Traumatic pneumothorax
– Caused by penetrating or non-penetrating injuries
• Tension pneumothorax
– Occurs when the intrapleural pressure exceeds
atmospheric pressure
Atelectasis

• Definition
– The incomplete expansion of a lung or portion of a
lung
• Causes
– Airway obstruction
– Lung compression such as occurs in
pneumothorax or pleural effusion
– Increased recoil of the lung due to loss of
pulmonary surfactant
Types of Atelectasis

• Primary
– Present at birth
• Secondary
– Develops in the neonatal period or later in life
Causes of Chronic Obstructive
Airway Disease

• Chronic bronchitis
• Emphysema
• Bronchiectasis
• Cystic fibrosis
Airway Responsiveness

• Definition
– The reaction of the airways to various stimuli
– Increased airway responsiveness leads to
narrowing of the airways
• Movement of gases through the airways
depends on:
– The pressure moving the gases
– The radius and patency of the airways
Functions of Bronchial Smooth
Muscle

• The tone of the bronchial smooth muscles


surrounding the airways determines airway
radius
• The presence or absence of airway secretions
influence airway patency
• Bronchial smooth muscle is innervated by the
autonomic nervous system
Role of Inflammatory Mediators

• Increase airway responsiveness by:


– Producing bronchospasm
– Increasing mucus secretion
– Producing injury to the mucosal lining of the
airways
Factors Involved in the
Pathophysiology of Asthma
• Genetic
– Atopy
• Environmental
– Viruses
– Allergens
– Occupational exposure
• Mechanisms of
early and late
phase Ig-E
mediated
bronchospasm.
Factors Contributing to the
Development of an Asthmatic Attack
• Allergens
• Respiratory tract infections
• Exercise
• Drugs and chemicals
• Hormonal changes and emotional upsets
• Airborne pollutants
• Gastroesophageal reflux
Classifications of Asthma Severity

• Mild intermittent
• Mild persistent
• Moderate persistent
• Severe persistent
Characteristics of Type A
Pulmonary Emphysema
• Smoking history
• Age of onset: 40 – 50 years
• Often dramatic barrel chest
• Weight loss
• Decreased breath sounds
• Normal blood gases until late in disease process
• Cor pulmonale only in advanced cases
• Slowly debilitating disease
Characteristics of Type B Chronic
Bronchitis
• Smoking history
• Age of onset 30 – 40 years
• Barrel chest may be present
• Shortness of breath predominant early
symptom
• Rhonchi often present
• Sputum frequent early manifestation
Characteristics of Type B Chronic
Bronchitis (cont.)

• Often dramatic cyanosis


• Hypercapnia and hypoxemia may be present
• Frequent cor pulmonale and polycythemia
• Numerous life threatening episodes due to
acute exacerbations
Types of Chronic Obstructive
Pulmonary Disease
• Emphysema
– Enlargement of air spaces and destruction of lung
tissue
– Types: centriacinar and panacinar
• Chronic obstructive bronchitis
– Obstruction of small airways
Jenis Empisema
Cystic Fibrosis

• Definition
– An autosomal recessive disorder involving fluid
secretion in the exocrine glands, the epithelial
lining of the respiratory, gastrointestinal and
reproductive tracts
• Cause
– Mutations in a single gene on the long arm of
chromosome 7 that encodes for the cystic fibrosis
transmembrane regulator (CFTR), which functions
as a chloride (Cl-) channel in epithelial cell
Manifestations of Cystic Fibrosis

• Pancreatic exocrine deficiency


• Pancreatitis
• Elevation of sodium chloride in the sweat
• Excessive loss of sodium in the sweat
• Nasal polyps
• Sinus infections
• Cholelithiasis
Diffuse Interstitial Lung Diseases

• Definition
– A diverse group of lung disorders that produce
similar inflammatory and fibrotic changes in the
interstitium or interalveolar septa of the lung
• Types
– Sarcoidosis
– The occupational lung diseases
– Hypersensitivity pneumonitis
– Lung diseases caused by exposure to toxic drugs
Pulmonary Embolism

• Development
– A blood-borne substance lodges in a branch of the
pulmonary artery and obstructs the flow
• Types
– Thrombus: air accidentally injected during
intravenous infusion
– Fat: mobilized from the bone marrow after a fracture
or from a traumatized fat depot
– Amniotic fluid: enters the maternal circulation after
rupture of the membranes at the time of delivery
Prevention of Pulmonary Embolism

• Identification of persons at risk


• Avoidance of venous stasis and
hypercoagulability states
• Early detection of venous thrombosis
Signs and Symptoms of Secondary
Pulmonary Hypertension

• Dyspnea and fatigue


• Peripheral edema
• Ascites
• Signs of right heart failure (cor pulmonale)
Cor Pulmonale

• Right heart failure resulting from primary lung


disease and long-standing primary or
secondary pulmonary hypertension
• Involves hypertrophy and the eventual failure
of the right ventricle
• Manifestations include the signs and
symptoms of the primary lung disease and the
signs of right-sided heart failure
Causes of ARDS

• Aspiration of gastric contents


• Major trauma (with or without fat emboli)
• Sepsis secondary to pulmonary or non-
pulmonary infections
• Acute pancreatitis
• Hematologic disorders
• Metabolic events
• Reactions to drugs and toxins
Mekanisme ARDS
Causes of Respiratory Failure

• Impaired ventilation
– Upper airway obstruction
– Weakness of paralysis of respiratory muscles
– Chest wall injury
• Impaired matching of ventilation and
perfusion
• Impaired diffusion
– Pulmonary edema
– Respiratory distress syndrome
Signs and Symptoms of Hypercapnia

• Increased PCO2
• Headache
• Conjunctival hyperemia
• Flushed skin
• Increased sedation
• Tachycardia
• Diaphoresis
• Mild to moderate increase in blood pressure