TUBERKULOSIS

PARU
Septi Dwi Sulistyowati
30101507559

Advisor :
dr. Noviyani Leksomono, Sp. A
 Tuberkulosis
Penyakit menular langsung yang disebabkan oleh kuman TB (mycobacterium tuberculosis).
 Lokasi anatomi
penyakit
Klasifikasi Riwayat pengobatan
sebelumnya
Hasil pemeriksaan uji
kepekaan obat

Status HIV
 Penyakit ini sering disebut
Sekitar 3%, infeksi virus laringitis subglotis akut (ASL). 
saluran pernafasan yang Istilah seperti pseudocroup,
terjadi pada anak-anak sindrom croup, laringitis
menyebabkan penyempitan obstruktif akut, dan spasmodik
lumen laring di daerah ABSTRACT croup
subglotis mengakibatkan
gejala seperti suara serak,
batuk menggonggong,
stridor, dispnea dan
kegagalan pernafasan

Diagnosis banding harus mencakup penyakit langka lainnya seperti

epiglottitis, difteri, laringitis fibrinosa dan bakteri trakeobronkitis,
diagnosis ASL harus selalu dibuat berdasarkan kriteria klinis.
 Definition and nomenclature
Croup

Pseudocroup (viral croup)

Spasmodic croup (spasmodic laryngitis)

Acute obstructive laryngitis

 Definition and nomenclature
Acute obstructive
laryngitis Penulis menyetujui
laringitis subglotis akut
adalah istilah yang paling
Laryngitis tepat untuk
mendefinisikan obstruksi
laring dalam infeksi virus
saluran pernapasan
Croup syndrome atas. 
 Etiologi
Obstruksi laring akut dalam infeksi virus saluran
pernapasan paling sering terjadi pada anak kecil ( 98%)

Virus parainfluenza (terutama tipe 1; jarang tipe 2 atau 3)

bertanggung jawab untuk sekitar ½ – ¾ kasus  kemampuan
mengaktifkan sekresi klorin dan untuk menghambat penyerapan Laringitis subglotis
natrium. Efek kumulatif dari kedua proses ini menghasilkan reaksi
edematosa yang intens. paling sering terjadi
disebabkan oleh virus
virus influenza, rhinovirus, adenovirus, parainfluenza.
enterovirus, coronavirus, bocaviruses dan
metapneumovirus, campak (biasanya dengan
obstruksi berat)

epiglottitis, difteri dan laryngotracheobronchitis

fibrinous. Mycoplasma pneumoniae
 Epidemiologi
 Paling sering dilaporkan di empat tahun pertama kehidupan. Paling sering didiagnosis antara 6
bulan dan 5 tahun, memuncak pada 2 umur tahun. Jarang terjadi pada bayi baru lahir dan bayi
<3 bulan. Mungkin hasil peran protektif dari antibodi IgG ibu. Penyakit ini menyerang sekitar 3%
anak-anak 1,4–2 kali lebih banyak pada anak laki-laki daripada pada anak perempuan

 Di Amerika Serikat, kunjungan darurat departemen karena laringitis subglotis akut hingga 15%
dari semua kunjungan yang disebabkan oleh penyakit pernapasan.

 Terjadi di keseluruhan tahun, tetapi paling sering terjadi pada bulan-bulan musim gugur.
Beberapa studi menunjukkan insiden kasus yang lebih tinggi dalam tahun ganjil, yang dapat
dijelaskan oleh peningkatan jumlah infeksi parainfluenza dilaporkan setiap 2 tahun

 Pada beberapa anak (terutama anak laki-laki), laringitis subglottic merupakan penyakit berulang.
Gejala berulang selama infeksi pernapasan. Tren ini menurun dari waktu ke waktu, yang
sebagian dapat dijelaskan oleh efek alami dari ukuran saluran pernafasan karena proses
pertumbuhan.
 Epidemiologi

Studi Belgia secara retrospektif, 235 anak-anak dengan kekambuhan subglottic akut laringitis
(setidaknya 3 kali setahun) menunjukkan kelainan pada bronkoskopi (61,7%). Kelainan : refluks
gastroesofageal, anomali lainnya tracheomalacia, penyempitan subglotis dari laring, dan kompresi
trakea oleh arteri brakiosefal. Pada beberapa anak, penyebab kekambuhan adalah multifaktorial.
Secara epidemiologis, ditemukan suatu hubungan yang mengkonfirmasi risiko asma bronkial yang
lebih tinggi setelah terjadinya laringitis subglotis akut

Penyakit ini terjadi terutama pada anak-anak

berusia antara 6 bulan dan 5 tahun. Beberapa
anak-anak cenderung kambuh.
 Patogenesis

Faktor predisposisi Bentuk dan ukuran

laring

Hiperreaktivitas jalan
napas

kecenderungan pembengkakan
submukosa (Terutama di subglotis).
 Patogenesis
Lokasi obstruksi yang paling umum anak-anak adalah subglotis. Struktur anatomi spesifik laring
pada anak-anak. Bagian tersempit dari jalan napas (kartilago krikoid). Di laring, terutama di
subglotis, submukosa mengandung sejumlah besar jaringan ikat yang mudah membengkak
dengan obstruksi yang signifikan secara klinis sebagai hasilnya mediator inflamasi. Karena
bentuk dan strukturnya, tidak ada kemungkinan untuk kartilago krikoid membesar sehingga
pembengkakan menyebabkan pengurangan diameter internal.
 Patogenesis
Obstruksi laring hanya diamati pada beberapa anak dengan infeksi saluran pernapasan,
mungkin karena kecenderungan anatomi (diameter jalan nafas lebih kecil) atau respon imun
abnormal (Reaksi inflamasi dan edematous yang berlebihan). Ini dikonfirmasi oleh sejumlah
studi epidemiologis termasuk analisis kohort dari Tuscon yang menunjukkan nilai resistensi inspirasi
yang lebih tinggi pada bayi.
Infeksi virus pada saluran pernapasan biasanya berhubungan dengan inflamasi difus pada
membran mukosa jalan nafas (dari rongga hidung ke bronkus), dengan adanya kongesti,
pembengkakan mukosa, epitel nekrosis dan deskuamasi. Intensitas peradangan tergantung, antara
lain, pada jenis patogen dan juga pada kecenderungan individu

Edema pada Penyempitan Gangguan

mukosa laring lumen laring aliran udara
Bentuk dan strukturnya  kartilago krikoid tidak dapat membesar  pembengkakan 
pengurangan diameter internal peningkatan resistensi aliran udara (inspirasi dan ekspirasi)

Ventilasi secara signifikan meningkat (rongga pleura tekanan inspirasi turun menjadi sekitar 40-50
cm H2O, bukannya sekitar 10 cm H2O). Pada tingkat lebih rendah, tekanan ekspirasi juga
meningkat (hingga 10 cm H2O)

Peningkatan amplitudo tekanan inspirasi (aktivasi aksesori inspirasi otot)  kolapsnya struktur
thoraks dengan peningkatan resistensi inspirasi dan stridor.
Obstruksi yang sangat parah dapat menyebabkan asinkron pergerakan dinding dada dan perut
(paradoxical breathing), kelelahan, aliran udara menurun (paradoks, stridor mungkin berkurang)
dan akhirnya gagal napas.
 Patogenesis
Pada laringitis subglotis akut ringan hingga berat, resistensi aliran udara meningkat, terutama
selama inspirasi (sekitar empat kali lipat). Untuk yang lebih rendah luasnya, hambatan aliran udara juga
meningkat selama pernafasan (sekitar dua kali lipat). Kerja bernafas meningkat tiga kali lipat.
Ventilasi dipertahankan dengan peningkatan tingkat pernapasan dan penurunan volume tidal
(TV). Waktu inspirasi dan ekspirasi lebih pendek, tetapi proporsinya fase dengan obstruksi kecil tetap tidak
berubah. Dengan obstruksi yang lebih besar, fase inspirasi diperpanjang.
Karena pengurangan diameter saluran napas  kecepatan linear aliran udara di laring
meningkat  aliran udara menjadi turbulen  terjadi kenaikan amplitudo tekanan yang signifikan  untuk
mempertahankan inspirasi normal mengalir, meskipun aliran ekspirasi berkurang [terutama peak
expiratory flow (PEF) – oleh sekitar.
Rasio aliran dibalik; anak-anak sehat, aliran pertengahan ekspirasi lebih tinggi daripada aliran
pertengahan inspirasi. Namun, di obstruksi laring, aliran saat inspirasi lebih tinggi. Rasio waktu yang
diperlukan untuk mencapai puncak mengalir selama pernafasan ke waktu pernafasan meningkat
(penundaan pada puncak pernafasan)
 Patogenesis
Stridor adalah salah satu gejala utama sumbatan laring. Istilah ini mengacu pada yang keras,
seringkali suara nada tinggi diciptakan oleh yang cepat, aliran udara yang turbulen melewati saluran udara
yang menyempit besar di segmen ekstra-toraks. Itu terdengar terutama selama inspirasi dan dihasilkan
oleh dinding bagian tengah saluran pernapasan bergetar [25]. Stridor inspirasi berasal dari glotis (atau di
atas), sementara stridor ekspirasi berasal struktur yang terletak di bawah level itu (trakea, bronkus).
Kehadiran stridor tidak hanya bergantung pada tingkat penyempitan di saluran udara pusat, tetapi juga
pada aliran dan tekanan yang dihasilkan.
Untuk evaluasi stridor, penting untuk dianalisis berikut ini: fase pernapasan, intensitas suara, nada,
dan kondisi generasinya (Khususnya, saat istirahat).
Secara anatomis dan patofisiologis spesifisitas laring pada anak usia
dini pada kelompok ini lebih cenderung laringitis subglotis akut.
Konsekuensi utama dari reaksi inflamasi dalam laring
adalah gangguan aliran udara inspirasi dengan berbagai variasi tingkat
keparahan.
Gambaran Klinis
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Get a modern PowerPoint Presentation
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You can Resize without

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