efusi pleura dr. indra buana, spp.ppt

8/16/2019 EFUSI PLEURA Dr. INDRA BUANA, SpP.ppt

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PENYAKITPENYAKITPLEURA PLEURA

Dr . INDRA BUANA SpPDr . INDRA BUANA SpP


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ANATOMI PLEURA ANATOMI PLEURA

I. Pleura: membran serous, .a.:I. Pleura: membran serous, .a.:

!. Pleura "#s$eral#s: membun%&us paru s'(!. Pleura "#s$eral#s: membun%&us paru s'(

)ssura)ssura

#nerlobar#s#nerlobar#s *. Pleura par#eal#s: membun%&us*. Pleura par#eal#s: membun%&us

me(#as#num,me(#as#num,

(#a+ra%ma (an (#n(#n% (a(a ba%#an (alam.(#a+ra%ma (an (#n(#n% (a(a ba%#an (alam.

D#anara &e(ua pleura (p ron%%a:D#anara &e(ua pleura (p ron%%a:ron%%a pleura.ron%%a pleura.

II. Ron%%a pleura: eruup, (p $a#ranII. Ron%%a pleura: eruup, (p $a#ran

#p#s'se(##p#s'se(#

men-a%a perle&aan &e(ua pleura men-a%a perle&aan &e(ua pleura


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III. #solo%#: sau lap#s sel mesoel, (#ba/a0n1aIII. #solo%#: sau lap#s sel mesoel, (#ba/a0n1a

(p -ar#n%an #&a lon%%ar 2ber#s# serabu(p -ar#n%an #&a lon%%ar 2ber#s# serabuelas#s (an &ola%en3, pembulu0 (ara0 (anelas#s (an &ola%en3, pembulu0 (ara0 (anpembulu0 l#m+e 1% bermuara sb% somapembulu0 l#m+e 1% bermuara sb% soma

2pleura par#eal#s3.2pleura par#eal#s3.S#+a mesoel: sens##+ (an respons#+ er0a(apS#+a mesoel: sens##+ (an respons#+ er0a(ap

berba%a# s#mul# (an (apa beruba0 men-a(#berba%a# s#mul# (an (apa beruba0 men-a(#ma&ro+a%.ma&ro+a%.

Ele&ron m#&ros&op: m#$ro"#ll# p( &e4* pleura,Ele&ron m#&ros&op: m#$ro"#ll# p( &e4* pleura,belum -elas +un%s#n1a, (#(u%a sb% pemolesbelum -elas +un%s#n1a, (#(u%a sb% pemoles%l#&oproe#n, &0ususn1a p( ba% ba/a0 (a(a.%l#&oproe#n, &0ususn1a p( ba% ba/a0 (a(a.


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I5. 6a#ran pleura: 1an% pen#n%I5. 6a#ran pleura: 1an% pen#n%

(#per0a#&an a(ala0: "olume,(#per0a#&an a(ala0: "olume,

&omponen sel (an )s#&om#an1a.&omponen sel (an )s#&om#an1a.

Normal "olume san%a se(#,Normal "olume san%a se(#,

ber#s# sel le&os#, -umla0 normal:ber#s# sel le&os#, -umla0 normal:

!.788'mm9 2!; monos#3,!.788'mm9 2!; monos#3,

er#ros# < sel mesoel. Se-umla0er#ros# < sel mesoel. Se-umla0&e$#l proe#n, m#neral (ll (p (lm&e$#l proe#n, m#neral (ll (p (lm

$a#ran pleura men1erupa# plasma.$a#ran pleura men1erupa# plasma.


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5.Dara0: (#(apa (ar# s#r&ulas# s#sem#& p( &e4* 5.Dara0: (#(apa (ar# s#r&ulas# s#sem#& p( &e4*

pleurapleura

5I. L#m+e: pa(a pleura par#eal#s (p soma 5I. L#m+e: pa(a pleura par#eal#s (p soma

$a#ran$a#ran

pleura masu& &e soma. Tap# #(a& pa(apleura masu& &e soma. Tap# #(a& pa(a

pleura "#s$eral#s.pleura "#s$eral#s.

5II.Iner"as#: sara+ sensor#s (p pa(a pleura 5II.Iner"as#: sara+ sensor#s (p pa(a pleura

par#eal#s 2eruama pars $osal#s (anpar#eal#s 2eruama pars $osal#s (an

(#a+ra%ma#&a3. Se(an% p( pleura(#a+ra%ma#&a3. Se(an% p( pleura

"#s$eral#s a& (p sara+ sensor#s u& "#s$eral#s a& (p sara+ sensor#s u&

n1er#.n1er#.


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Intrapleural pressure

- 11,2 Cm H2O 0 Cm H2O

inspiration expiration

Negative / sub atmospheric pressure

-8,2Cm H2O


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=ISIOLO>I PLEURA =ISIOLO>I PLEURA

II. Pembenu&an $a#ran pleura: bersumber pa(aII. Pembenu&an $a#ran pleura: bersumber pa(a

-ar#n%an #ners##al paru -ar#n%an #ners##al paru

&ap#ler pleura 2"#s$eral#s3 &ap#ler pleura 2"#s$eral#s3

l#m+e #nraora&al l#m+e #nraora&al

ron%%a peru ron%%a peru

umla0 $a#ran san%a se(#, pro(u&s# 8,8! ml'&%'-am umla0 $a#ran san%a se(#, pro(u&s# 8,8! ml'&%'-am umla0 sel : !788 sel'mm umla0 sel : !788 sel'mm99 : (en%an &ompos#s#:: (en%an &ompos#s#:o !; monos#!; monos#o !!; l#m+os#!!; l#m+os#o C; mesoelC; mesoel

o ; ma&ro+a%; ma&ro+a%o *; PMN*; PMN


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=ISIOLO>I PLEURA =ISIOLO>I PLEURA

III. Absorbs# $a#ran pleura:III. Absorbs# $a#ran pleura:L1mp0a#$ $learan$eL1mp0a#$ $learan$e pleurapleura

par#eal#s, berlan%sun% eruspar#eal#s, berlan%sun% erus

menerus, s0% #(a& menumpu&, (%nmenerus, s0% #(a& menumpu&, (%n&apas#as s'( * &al# proses&apas#as s'( * &al# prosespembenu&ann1a, s0% merupa&anpembenu&ann1a, s0% merupa&anba%#an uama proses absorbs# $a#ranba%#an uama proses absorbs# $a#ranpleura.pleura.

Absorbs# &ap#ler: (alam -umla0 &e$#l Absorbs# &ap#ler: (alam -umla0 &e$#l(an unu& a#r (an mole&ul* &e$#l(an unu& a#r (an mole&ul* &e$#lla#nn1ala#nn1a


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MANI=ESTASI KLINIK DANMANI=ESTASI KLINIK DAN

PEMERIKSAANPEMERIKSAAN

I. >e-ala: n1er# (a(a 2pleur##$ $0es pa#n3,I. >e-ala: n1er# (a(a 2pleur##$ $0es pa#n3,sesa&,sesa&,

bau& &er#n%.bau& &er#n%.

II. PD: EPII. PD: EP as#mer#s, +rem#us melema0,as#mer#s, +rem#us melema0,

be(a0, suara na+as melema0' men%0#lan%be(a0, suara na+as melema0' men%0#lan% PTPT as#mer#s, +rem#us melema0,as#mer#s, +rem#us melema0,

0#personor, suara na+as melema0'0#personor, suara na+as melema0'men%0#lan%men%0#lan%

III. Laboraor#um: +oo ora&, pun%s# pleura,III. Laboraor#um: +oo ora&, pun%s# pleura,anal#sa $a#ran pleura 2m#a, sel,anal#sa $a#ran pleura 2m#a, sel,m#&rob#olo%#, s#olo%#, serolo%#3, uber&ul#nm#&rob#olo%#, s#olo%#, serolo%#3, uber&ul#nes, b#ops# pleura, bron&os&op# < ora&os&op#.es, b#ops# pleura, bron&os&op# < ora&os&op#.


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MA6AM PENYAKITMA6AM PENYAKIT

PLEURA PLEURA E+us# pleuraE+us# pleura

Pnemoora&sPnemoora&s

Emp#emaEmp#ema emoora&semoora&s

K#loora&sK#loora&s

Mesoel#omaMesoel#oma Dll: )broora&s, &als#)&as#,Dll: )broora&s, &als#)&as#,

splenos#s (ll.splenos#s (ll.


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DE=INISI:DE=INISI: EP a(ala0 penumpu&anEP a(ala0 penumpu&an

$a#ran (alam ron%%a pleura, aba$a#ran (alam ron%%a pleura, aba

er-a(#n1a penamba0an pro(u&s# aauer-a(#n1a penamba0an pro(u&s# aau

pen%uran%an absorbs#, aau &e(uan1a.pen%uran%an absorbs#, aau &e(uan1a.

E=USI PLEURA E=USI PLEURA

1)1)Tekanan hidrostatik tinggi.Tekanan hidrostatik tinggi.

2)2)Tekanan onkotik turun .Tekanan onkotik turun .

3)3)Tekanan rongga pleuraTekanan rongga pleura

bertambah turunbertambah turun

4)4)Permeabilitas dinding kapilerPermeabilitas dinding kapiler

bertambah.bertambah.

PATO>ENESISPATO>ENESIS


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. Pen1umbaan saluran l#m+e. Pen1umbaan saluran l#m+e

. #n"as# sel umor &e ron%%a. #n"as# sel umor &e ron%%a

pleurapleura

. Pleur##s. Pleur##s

C. Rea&s# 0#persens##)asC. Rea&s# 0#persens##)as


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!3!3 >e-ala &l#n#&.>e-ala &l#n#&.*3*3 Pemer#&saan )s#&.Pemer#&saan )s#&.

9393 ra(#olo%#s.ra(#olo%#s.

F3F3 Tora&osenes#s.Tora&osenes#s.

7373 Anal#sa $a#ran, 2ma&ros&op#s, Anal#sa $a#ran, 2ma&ros&op#s,

m#&ros&op#s, m#a, s#olo%#s3.m#&ros&op#s, m#a, s#olo%#s3.

33 B#ops# pleura.B#ops# pleura.

33 Tuber&ul#n es.Tuber&ul#n es.33 Bron&os&op#,Bron&os&op#,

C3C3 Tora&os&op#Tora&os&op#

DIA>NOSIS E=USI PLEURA DIA>NOSIS E=USI PLEURA


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>EALA KLINIK>E ALA KLINIK As#moma#s. As#moma#s.

Sesa& na+as, sa (a(a, bau&' (ara0,Sesa& na+as, sa (a(a, bau&' (ara0,

(a(a rasa penu0.(a(a rasa penu0. 6ape&, BB urun, ma&an &uran%,6ape&, BB urun, ma&an &uran%,

(emam.(emam.

PEMERIKSAAN =ISIK PEMERIKSAAN =ISIK >era&an (#n(#n% (a(a s#mer#s '>era&an (#n(#n% (a(a s#mer#s '

as#mer#s, +rem#us suara melema0,as#mer#s, +rem#us suara melema0,

per&us# re(up ' be(a0, (e"#as#per&us# re(up ' be(a0, (e"#as#

&onralaeral, aus&ulas# "es#&uler&onralaeral, aus&ulas# "es#&uler



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RADIOLO>ISRADIOLO>IS N#la#n1a #n%%#, e#olo%# 243.N#la#n1a #n%%#, e#olo%# 243. Perselubun%an se(# 2!88 G 988 ml3.Perselubun%an se(# 2!88 G 988 ml3. Kon(#s# erenu bua pos#s# laeralKon(#s# erenu bua pos#s# laeral

(e&ub#us(e&ub#us ..Marenson (an #melman memba%# EP:Marenson (an #melman memba%# EP:!.!. Se(# : s#nus &oso+er#n#&us, (#a+rama 243.Se(# : s#nus &oso+er#n#&us, (#a+rama 243.

*.*. Se(an% : !'9 ron%%a (a(a.Se(an% : !'9 ron%%a (a(a.

9.9. Mas#+ : leb#0 (ar# se(an%.Mas#+ : leb#0 (ar# se(an%.

Pemeriksaan lain USG, CT Scan / MRI bila fotodada gagal (EP terlokalisir, penebalan plera!



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TORAKOSENTESISTORAKOSENTESIS

Seba%a# (#a%nos#& (an erapeu#&.Seba%a# (#a%nos#& (an erapeu#&.

Pos#s# (u(u& : l#nea a&s#lar#s,Pos#s# (u(u& : l#nea a&s#lar#s,

poser#or, aner#or, -arum &eara0poser#or, aner#or, -arum &eara0

ulan% bela&an%.ulan% bela&an%.

T#(a& leb#0 (ar# ! l#er.T#(a& leb#0 (ar# ! l#er.

Kompl#&as#H pneumoora&s,Kompl#&as#H pneumoora&s,0emoora&s (an u(em paru.0emoora&s (an u(em paru.



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MA6AM E=USI PLEURA MA6AM E=USI PLEURA

E=USI PLEURA EKSUDATI5A E=USI PLEURA EKSUDATI5A E=USI PLEURA TRANSUDATI5A E=USI PLEURA TRANSUDATI5A E=USI PLEURA MALI>NA: b#laE=USI PLEURA MALI>NA: b#la

(#sebab&an(#sebab&an&arena proses &e%anasan&arena proses &e%anasan

EMPIEMA: b#la $a#ran berupa nana0EMPIEMA: b#la $a#ran berupa nana0 EMOTORAKS: b#la $a#ran berupaEMOTORAKS: b#la $a#ran berupa

(ara0(ara0 KILOTORAKS: b#la $a#ran berupa losKILOTORAKS: b#la $a#ran berupa los


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EKSUDATEKSUDAT TRANSUDATTRANSUDAT

!.!. UI R#"alaUI R#"ala

*.*. Proe#nProe#n

9.9. Bera -en#sBera -en#s

F.F. LD.LD.

7.7. LD EP'PlasmaLD EP'Plasma

.. Leu&os#Leu&os#

.. P.P... >lu&osa.>lu&osa.

C.C. Al&al# +os+aase Al&al# +os+aase

!8.!8.Proe#n EP 'Proe#n EP 'PlasmaPlasma

Pos##pPos##p

9 %r ; 9 %r ;

!,8! !,8!

*88 IU *88 IU

8, 8,

!888 !888

,9 ,9 plasma plasma

7 U 7 U

8,7 8,7

Ne%a#pNe%a#p

9 %r ; 9 %r ;

!,8! !,8!

*88 IU *88 IU

8, 8,

!888 !888

,9 ,9 PlasmaPlasma

7 U 7 U

8,7 8,7

PERBEDAAN 6AIRANPERBEDAAN 6AIRAN


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EKSUDATEKSUDAT

TRANSUDATTRANSUDAT

TB ParuTB Paru

TumorTumor

pneumon#apneumon#a

TraumaTrauma

Pen1a Kolla%enPen1a Kolla%en

Asbesos#s Asbesos#sUrem#aUrem#a

Ra(#as#Ra(#as#

Sar&o#(os#sSar&o#(os#s

Embol# paru, (llEmbol# paru, (ll

>a%al -anun%>a%al -anun%

S#n(roma ne+ro#&S#n(roma ne+ro#&

S#rros#sS#rros#s

S#n(roma Me#%JsS#n(roma Me#%Js

#(rone+ros#s#(rone+ros#s

D#al#se per#onealD#al#se per#oneal



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E"USI P#EUR$

Tuber&ulosaTuber&ulosa

In+e&s# non TBIn+e&s# non TB

Emp#emaEmp#emaK#loora&sK#loora&s

R arer##s.R arer##s.

Mesoel#omaMesoel#oma

PS 2abses 0a#3PS 2abses 0a#3

6a, rauma. In+ar& paru,6a, rauma. In+ar& paru,

#n+e&s# anaerob#&.#n+e&s# anaerob#&.

!.!. SerousSerous

*.*. Keru0 &un#n%.Keru0 &un#n%.

9.9. Keru0 susu.Keru0 susu.F.F. K#l#+orm#s .K#l#+orm#s .

7.7. Keru0 0#-au.Keru0 0#-au.

.. Kenal.Kenal.

.. 6o&la susu.6o&la susu.

.. emor0a%#s.emor0a%#s.

C.C. Bau busu&.Bau busu&.


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MIKROSKOPIS

NORMA S! 1"00 # 2"00 $ CC

!%KOSI& ' 2"00$CC ( ' pmn ( IN)!KSI P*O+!NIK

ANAISA KIMIA

!A%ASI P!R%.AHAN PH ( tanpa u/ara, lemari es

PH , 3 e4su/at

PH 5,5 4emun64inan 7istel eso7a6us 9:

E"USI P#EUR$


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.IOPSI P!%RA

.iopsi mem;uta ( o?o;us 1@10:

.iopsi ter;u4a

&%.!RK%IN &!S

Masi /iperlu4an, &.C, asil ;er;e/a-;e/a

P!M!RIKSAAN BAHAK, K%&%R >ARIN+AN

P!%RA, .RONKOSKOPI

&erutama tumor peri7er, ' a/eno CA

E"USI P#EUR$


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P!NA&AAKSANAAN

&er6antun6 2 aspe4 (

Pena4it an6 men/asarina

Pen6o;atan lo4al antara lain (

Pun4si pleura, 1 liter

Pasan6 salir se4at air DSBE Fater seale/ /raina6e:

Pleuro/esis ;leomisin 0 # 50 m6 $ "0 # 100 ml, tal4sterill # 5 6ram, tetrasi4lin " m6r $ K6 ..

Pirau pleuroperitoneum

Pleure4tomi /an /e4orti4asi

Ra/ioterapi

E"USI P#EUR$


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K!SIMP%AN

&er6antun6 2 aspe4 (

!7usi pleura merupa4an pena4it an6 /apat /ise;a;4anintra /an e4stra pulmonal

)oto /a/a merupa4an pemeri4saan an6 nilaina tin66i

/alam men/ia6nosa !P

Masala ;esar a/ala e7usi pleura 6anas3 asal tumor,

efusi pleura dr. indra buana, spp.ppt

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