infeksi paru kh
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infeksi paruTRANSCRIPT
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TORAKSTORAKS((paru)paru)
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Radiologis:Radiologis:• Lokasi biasanya posterio-basal.• Progresif.• Ruptur ke dalam bronkus menjadi
kavitas dengan air-fluid level.• Bisa multiple.
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Radang ParuRadang Paru• Inflamasi eksudat di alveoli dan
interstisial oleh bakteri, mycoplasma, virus.
• Morfologi dibagi:– Pneumonia lobaris– Bronkhopneumonia– Pneumonia interstisial
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Pneumonia lobaris:• Pneumonia alveolar• Inhalasi organisme kedalam alveoli• Menyebar melalui celah Kohn ke seluruh
lobus
Pneumonia lobaris dibagi:1. Kongesti (intra alveolar edema)2. Red hepatization (eksudat eritrosit)3. Yellow hepatization (eksudat leukosit)4. Gray hepatization (eksudat leukosit)5. Lysis.
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Bronkhopneumonia:Bronkhopneumonia:
• Pneumonia fokal: Pneumonia lobaris• Inhalasi atau hemogenik dari
organisme• Organisme di bronkhioli terjadi reaksi
inflamasi sekitar alveoli• Proses meluas seluruh lobularis• Gambaran: multifokal, penyebaran
berbercak.
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Pneumonia interstisial:Pneumonia interstisial:
• Penyebab organisme: mycoplasma, recketisia, virus.
• Melalui pernapasan, organisme merusak dinding bronkhial mengenai epitel bersilia.
• Edema dan infiltrasi limfositik.• Penyebaran melalui septa interlobularis
dan peribronkhial alveoli.• Gambaran mirip pneumonia lobularis.
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Abses pulmonum:Abses pulmonum:
• Penyebab: stafilokokus, klebsiella pneumonia.
• Komplikasi infark, bronkhiektasis atau obstruksi bronkhus distal.
• Fokus purulen dan pus dikeluarkan secara ekspektoran.
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Tuberkulosis Tuberkulosis
Penyebab tbc:• Mycobacterium tuberculosis hominus
(95%)• M. bovis• M. kausasii• M. balnei
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Faktor resiko tbc:Faktor resiko tbc:
• Usia tua• Peminum alkohol• D.M.• Terapi steroid• AIDS
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Pembagian tbc:Pembagian tbc:• Primer• Post primer
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Kompleks primer (Ranke):Kompleks primer (Ranke):• Fokal subpleural alveolitis/fokus
primer (Ghon)• Limfadenitis regional• Limfangitis
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Post primer tbc:Post primer tbc:• Tbc eksudatif• Tbc produktif• Tbc kavitas• Tbc fibro-sirrhotik.
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Pembagian berdasarkan Amerika:Pembagian berdasarkan Amerika:1. Minimal lesion:• Jumlah luas infiltrat tidak melebihi luas
yang dibatasi apeks, garis median, costac II dengan syarat tampak kavitas.
2. Moderately advance:• Luas infiltrat tidak melebihi 1 lobus atau
dengan kavitas berdiameter kurang dari 4cm.
3. Far advance:• Luas infiltrat lebih dari 1 lobus atau
dengan kavitas lebih dari 4cm.
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Tbc millier:• Bercak/nodul kecil tersebar di kedua
lapangan paru, terutama lapangan atas.
Fokus soliter:• Biasanya di apeks paru (fokus Simon;
Assmann infiltrat).
Pleuritis eksudatif:• Tuberkel pleura disertai efusi pleura yang
kaya dengan limfosit.
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Pneumocystis carinii Pneumocystis carinii pneumonia:pneumonia:
• 80% diffus, bilateral, granuler atau infiltrat retikuler.
• Biasanya di perifer, lapangan bawah atau lapangan atas paru.
• Limfadenopati hilus dan efusi pleura.
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Infeksi JamurInfeksi Jamur
I. Endemik:• Fungus patologik (histoplasmosis,
coccidioidomycosis, blastomycosis, sporotrichosis)
II. Opportunistik:• Fungus saprofit (aspergilosis,
candidiasis).
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Aspergilloma:• Tersering dari aspergilosis• Kavitas dengan fungus ball• Erosi dinding oleh enzymatik
Histoplasmosis:• Bercak-bercak konsolidasi• Pembesaran KGB mediastinum
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Candidiasis:• Diffuse bilateral alveolar atau dengan
interstisial• Abses kecil multiple• Nodul milier• Diffuse hemorrhagic
Aspergilosis:• Fokus konsolidasi multiple• Bulat, mungkin infark parenkim• “air crescent”• CT: halo ground glass
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Coccidioidomycosis:• Konsolidasi pneumonik dan nodul• Kadang-kadang kavitas• Stadium lanjut: fibrosis
Actinomycosis:• Nonsegmental, perifer konsolidasi• Dapat terjadi kavitas• Efusi: epiema• Osteomyelitis tulang iga• Pembengkakan jaringan lunak dinding dada
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Infeksi ParasitInfeksi Parasit
Penyebab:• Protozoa (amuba, toksoplasma,
pneumocystis)• Cacing (ecchinococcus, schistosoma,
ascarida)
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Amebiasis:• Bayangan opak di lapangan paru kanan
bawah• Disertai efusi pleura• Dapat terbentuk abses
Toxoplasmosis:• Fokal retikuler, linier• Opasitas kabur seperti viral pneumonia• Limfadenopati hilus
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Terima KasihTerima Kasih