sindroma alergi
DESCRIPTION
rinitisTRANSCRIPT
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RINITIS
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KLASIFIKASI
1. Infeksi
2. Alergi
3. Okupasional
4. Medikamentosa
5. Hormonal
6. Penyebab lain
7. Idiopati
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Rinitis Alergika
Inflamasi mukosa hidung Diperantarai IgE Gejala :
Pilek Gatal Bersin Buntu hidung
Sembuh spontan / obat
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PATOFISIOLOGI :Reaksi Ag - Ab - dilatasi
- permeabilitas pemb. darah
- sekresi kelenjar- udem- eosinofilia
KLINIS- Gatal : hidung, mata, palatum mole- Bersin : pilek encer, buntu hidung- Gangguan pembauan : mata sembab, chepalgi- Manifestasi alergi organ lain/ keluarga
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Tanda Infeksi (-) Kambuh bila kontak dengan alergen
Anamnesa RA : Konka, Udem, Pucat, Sekret encer X Foto Sin.Paranasalis (Water’s Position) Lab : - Eo Hidung
- Eo Darah Tes kulit : Prick tes IGE total, IGE spesifik, tes provokasi hidung
DIAGNOSA
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Allergen reacts with IgE antibodyattached to mast cell membrane
Mast cell degranulation and releaseof chemical mediators (histamin,SRS-A, ECF-A, PAF)
Dilatation of blood vesselsbronchoconstrictionsecretion from exocrine glandseosinophilia
Fig. 3.13. Type 4 immune reactionType I reaction (anaphylactic reaction)
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KLASIFIKASI RINITIS ALERGI1. “Intermittent”
2. “Persistent”
3. “Mild”
4. “Moderate severe”
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RINITIS ALERGI“INTERMITTENT” Gejala kurang dari 4 minggu Gejala kurang dari 4 hari per minggu
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RINITIS ALERGI“PERSISTENT” Gejala lebih dari 4 minggu Gejala lebih dari 4 hari per minggu
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RINITIS ALERGI“MILD” Tidak ada gangguan tidur Tidak ada gangguan aktivita sehari-hari Tidak ada gangguan sekolah/ bekerja
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RINITIS ALERGI“MODERATE-SEVERE”Terjadi satu atau lebih gangguan Gangguan tidur Gangguan aktivitas sehari-hari Gangguan sekolah / bekerja
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RINITIS ALERGI
Seasonal (musiman) Perennial (sepanjang tahun) Okupasional (tempat kerja)
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RINITIS ALERGIETIOLOGI Alergen
Pembagian: Inhalan (Dewasa) Ingestan (Anak) Kontaktan
In door Out door
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RINITIS ALERGIALERGEN INHALAN Debu rumah (house dust) Tungau (mite) Jamur Tepung sari (pollen) Kecoak Serat kapuk
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RINITIS ALERGIALERGEN INGESTAN Susu Telur Coklat Ikan laut Kacang tanah dll
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DD RV RH Rinitis karena iritan Rinitis homonal
Sinusitis paranasales
Poliposus Nasi Otitis media
PENYULIT
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Pengobatan Hindari alergen penyebab Simptomatik :
. Antihistamin . ß2 Adrenergik
. Kortikosteroid . Dekongestan oral . Dekongestan lokal
Desensitisasi / Hiposensitisasi kondisi badan
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Hindari Alergen Penyebab INHALAN
- Meminimalkan tungau debu rumah (mite)
- Rumah cukup ventilasi & sinar matahari
- Langsung pel / lap basah
- Perabot polos
- Bantal/ guling/ kasur busa INGESTAN
- Hindari susu, telur, kacang, coklat, ikan laut
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Antihistamin
Kompetitif inhibitor dengan histamin
di organ target Klasik - baru (Newly Generated)
Klasik sedatif (CTM. Diphenhydramin)
Baru non sedatif (Loratadine,
Cetirizine, Fexofenadine,
Mequitazine)
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Dekongestan
ORAL
Pseudoepherdrin 3 x 30 - 60 mg/ hari
LOKAL
- Sol ephedrin Hcl 1/2 - 1 %
- Oxymetazoline
- Xylometazoline
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ß2 Adrenergik
Stabilisator mastosit
Terbutaline sulfat :
- Dosis rendah
- Dosis tinggi Bronkodilator
Efek samping : palpitasi, tremor
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Kortikosteroid
SISTEMIK
Efek samping >> (gastritis, ulkuspeptikum,
osteoporosis, full moon face, dll)
Tidak dipakai secara rutin
LOKAL
Efek samping < (epistaksis, superinfeksi,
atropi mukosa, perforasi septum)
Beclometason, Budesonide, Fluticasone
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Desensitisasi / Hiposensitisasi Penyuntikan alergen secara bertahap
(Dosis sampai mencapai dosis optimal)
Terbentuk blocking antibodi (Ig G4)
2-3 tahun setelah keluhan hilang
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Meningkatkan Kondisi Badan
Olah raga pagi rutin Istirahat cukup
Gizi cukup
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Rinitis Vasomotorika
Pasti ? Ketidak seimbangan sistem syaraf otonom Hubungan dengan kelembaban udara yang
tinggi dan udara dingin
? Bersin
PilekBuntu Hidung
Etiologi
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PENYULIT
Sinusitis para nasales Poliposus nasi Otitis media
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RINITIS NON ALERGI
Gejala : Pilek Buntu Bersin
Tes kulit (-) IgE spesifik (-)
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Patofisiologi Mekanisme belum jelas (idiopati)
Hiperaktifitas mukosa hidung Stimulus tidak spesifik
Rokok Bau mnyengat Bau minyak wangi Dingin Makanan panas-pedas
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Sneezers Runners Blockers
Diagnosis :Anamnesa
Pemeriksaan lokal
Tes kulit
Eosinofil hidung
X-foto
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Diferensial diagnosis Rinitis Alergi Rinitis Akuta Malignancy (perdarahan, nyeri)
Terapi : Antihistamin ==> efek (-)
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Gejala Klinis Bersin Pilek encer Buntu hidung Pagi / dingin, kelembaban tinggi
Ax RA : - Konka udem - Sekret seromukus Tes alergi : -
Dx
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DDPENYULITTERAPI Kombinasi Antihistamin
Dekongestan OR Kondisi badan Buntu : . TH
. Kaustik
. Konkotomi
Actifed
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Rinitis Hiperemika Rinitis Medikamentosa
Rinitis akuta berulang Obat anti hipertensi (Reserpin) Rebound efek : TH berlebihan/ lama
Etiologi
Klinis
Pemeriksaan Buntu hidung
RA : Mukosa udem, Hiperemi, Hipertrofi
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Terapi
Hindari faktor penyebab
Melonggarkan kavum nasi
- Kaustik
- Konkotomi
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Polip Nasi Polip panjang dan bertangkai Etiologi :
- radang kronis- alergi- Fenomena Bernoulli- Perubahan poli sakharida- Gangguan keseimbangan vasomotor
Udem penonjolanmukosa
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Lokasi :
Tergantung : Densitas jaringan ikat Pembuluh darah
Konka inferior
Septum nasi <<
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Mikroskopis : Stroma direnggangkan cairan interstitiil Saluran lymphe >> dan melebar Pembuluh darah << Saraf <<
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Polip : Multiple : Sel. Etmoidalis Soliter : Sinus maksilaris polip koanal Seromukus : Licin, lunak, dipecah
Seromukus Fibroudematus : Kasar, padat, darah
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Klinis : Buntu hidung Pilek dan bersin Gangguan pembauan Nyeri dahi Post nasil drip Epistaksis
progresif
Bila sisi terlalu keras
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Figure 18.3 Nasal polyps. This coronal section shows how most of the polyps
originate within the ethmoid sinuses. As their stalks elongate, they protrudethrough the sinus ostia into the middle meati, and eventually into the main body
of the nasal passages.
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Figure 18.2 Nasal polyps. This sagittal section of the nose shows numerous polyps
protruding downward from the middle meatus. Most have arisen within the anteriorethmoid air cells. One polyp, protruding from the superior meatus, has probably
arisen in one of the posterior ethmoid air cells.
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Diagnosis : Inspeksi : ‘Frog Face Deformity’ RA : - Polip soliter/ multipel, sekret
- Dibedakan dengan konka RP : Polip Koanal Dx :
. Ax . Tes alergi . X foto sinus paranasales (water’s) . Antroskopi
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DD
Angiofibroma Juvenilis ‘Inverted Cell Papiloma’ Meningokel
Sinusitis paranasales Otitis media Polip dalam sinus
PENYULIT
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Terapi : Medical:
Kortikosteroid topikal Hiposensitisasi (Faktor alergi)
Surgical: Polip ekstraksi Etmoidektomi (Polip multiple) FESS Cladwell luc (Polip sinus maksilaris)
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Rinitis Kronika Atrofikans Foetida (Ozaena) Non Foetida
Ozaena :Etiologi ?Predis Posisi :1. Infeksi : Coccobacillus Ozaenae. Kiebsiella
Ozaenae2. Herediter3. Malnutrition / Avitaminosis A4. Hormonal5. Defisiensi FE.
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Patologi
End Arteritis Obliterans Atrofi- Mukosa- Kelenjar- Saraf
Insidens : P : L = 5 : 1 Dx : 1. AX : - Foetor Nasi (orang lain)
- Anosmia - Pilek - Buntu hidung - Tenggorok kering
2. RA : - Kavum nasi luas
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Sekret Kental Krusta kering hijau kehitaman Foetor (pembusukan protein)
DD :Sinusitis Maksilaris kronika- Unilateral- Foetor Nasi (penderita sendiri)
Terapi :1. INH2. Vit A3. Estrogen4. Fe
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Simptomatis Cuci hidung
R/ Natrium Bicarbonas
Natrium Chlorida
Amonium Chloridaaaa5
Ag Ad 200
Operasi : Menyempitkan kavum nasi :
Menebalkan septum
Membesarkan konka
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Rinitis Kronika Atrofikans (non foetida)
Konkotomi berlebihan Ekstraksi polip besar
Radiasi