You are on page 1of 29

5.

Penyakit Respirasi yang sering ditemukan


1. Acute Bronchitis and
2. Aspiration Pneumonia
3. Chronic Obstr. Inflamtory Lung Dis.
3.1. Chronic Bronchitis
3.2. Emphysema
3.3. Asthma . senin tgl 23/06/2014
Prof. Rusdidjas,SpA(K), Prof Rafita Ramayati.,SpA(K)
DR. dr Hj Oke Rina Ramayani.SpA
Bgn Ilmu Kes. Anak FK-USU
20.6.2000

1. Acute bronchitis

Acute inflammation of the


mucous membranes of the
trachea and bronchi (duration < 4
weeks)

productive cough
upper respiratory tract symptoms
general symptoms (in 10 - 50%)
2

29.8.2011

3
20.6.2000

Aetiology of acute bronchitis


Common resp. tract viruses (80%) RSV
[Respiratory Synsitial Virus]
Bacteria (in about 20% of cases):

Pneumococci ( in 2 - 30%)?
Haemophilus ( in 2 - 8%)?
Mycoplasma (in 0.5 - 11%)
Chlamydia (in 0 -18%)
(Pertussis (in 0 - 7%))
4

20.6.2000

Diagnosis of acute bronchitis


The aim is to diffnciated

Dari semua pasien yg BATUK, Identifikasi Peny.


Lain yg memerlukan pengobatan spesifik ( ump:
pneumonia, sinisitis, asthma)
(identify, among all patients with cough, those with other illnesses
needing specific treatment (e.g. pneumonia, sinusitis, asthma)

Dari semua pasien yg BRONCHITIS,


Identifikasi Peny. yg memerlukan Antibiotika
(identify, among all patients with bronchitis, those who would
benefit from antibiotics)
5

20.6.2000

(Differential) diagnosis

History (e.g. asthma) ada mengiik


Health status (general condition, auscultation)
X-ray (to exclude pneumonia)
CRP (high CRP refers to bacterial aetiology or
pneumonia)

Sinus ultrasound (to exclude sinusitis)


Antibody testing (of a few representative patients
if needed to establish an epidemic)

Easy access to a follow-up visit (inform your


assistants!)
6

20.6.2000

Kapan perlu di X-ray


When is chest x-ray needed?

patient is particularly unwell (Kurang sahat)


patient is particularly prone to pneumonia due
(menjurus ke pneumonia)
to underlying disease, age or alcoholism
history of pneumonia within the preceding year
upper respiratory tract symptoms absent
patient requests x-ray (pneumonia can not be
excluded on clinical symptoms and findings
only)
7

20.6.2000

Treatment of acute bronchitis

First choice: no antibiotics!


Factors supporting antibiotic treatment:

CRP > 50 mg/l


patient is particularly unwell or becoming so
pyrexia of over weeks duration or patient
pyrexial following a period of apyrexia
epidemiological state
patient is immunocompromised
8

20.6.2000

Antimicrobial therapy of acute bronchitis 1

First choice:

in most cases good effect on pneumococci is sufficient


penicillin resistance in pneumococci in Finland is low
(R < 1%) (A)
penicillin V:
V 1-1.5 mega units 8 hourly for 5 7 days [ 1 tab
= 250 mg = 400.000 unit] Dosis:
< 12 thn : 25-50 mg/Kg/day dibagi 6-8 jam /x
> 12 thn, adult : 125 500 mg/Kg/day -

for patients with penicillin allergy a first -generation


cephalosporin

9
20.6.2000

Antimicrobial therapy of acute bronchitis

Other choices:
probable mycoplasma or chlamydia infection:
doxycycline 100-150 mg daily for 5 7 days
a macrolide:
macrolide erythromycin 500mg 3 - 4
times daily, roxithromycin 150 mg twice
daily, klarithromycin 250mg twice daily or
azithromycin 250 mg daily for 5 7 days
underlying chronic lung disease:
amoxicillin, sulphatrimethoprim

10
20.6.2000

Symptomatic treatment of acute bronchitis

No benefit is gained on cough with codeine,


salbutamol or dextromethorphan as compared
with a placebo,
...but cough improves considerably even during a
placebo-treatment
patient often presents with additional symptoms,
which can be eased with antihistamines,
anticholinergic and/or sympatomimetic
agents, but their benefit remains controversial!

11
20.6.2000

TKS
2. Bersambung Aspirasi
pnmnia

12
20.6.2000

2. Aspirasi Pneumonia
Pada anak Bayi sering ter
sedak, masuk susu / ASI
atau benda asing (corpus
aliena) kedalam Alveoli.
edema, cairan Radang

Pada anak Besar :


-Kacang tojin
-wang coin
- Benda asing
- dll

Managemen Aspirasi Pneumonia


Dpt dikethui dengan Anamnesis yang teliti
Konsultkan ke Bgn THT
Benda asing yang padat Endoskopy
Susu / ASI sama dgn pengobatan
Pneumonia
Harus dirawat di RS

3. Obstructive and Inflamtory


Lung Disease

3.1.Chronic bronchitis
3.2.Emphysema
3.3. Asthma

16
20.6.2000

3.1. Chronic Bronchitis

Recurrent or chronic productive


cough for a minimum of 3
months for 2 consecutive years.
Risk factors
Cigarette smoke
Air pollution
17

20.6.2000

Chronic Bronchitis
Pathophysiology

Chronic
inflammation
Hypertrophy &
hyperplasia of
bronchial glands
that secrete mucus
Increase number of
goblet cells
Cilia are destroyed
18

20.6.2000

Chronic Bronchitis
Pathophysiology ..
Bronchospasm often occurs
End result
Hypoxemia
Hypercapnea
Polycythemia (increase RBCs)
Cyanosis
Cor pulmonale (enlargement of right side of
heart)

19
20.6.2000

Chronic Bronchitis
Pathophysiology ..

Narrowing of airway
Starting w/ bronchi
smaller airways
airflow resistance
work of breathing
Hypoventilation & CO2
retention hypoxemia
& hypercapnea

20
20.6.2000

Chronic Bronchitis:
Diagnostic Tests

PFTs (Pulmonary Function Tests)

ABGs (Arterial Blood Gas analysis)

FVC: Forced vital capacity


FEV1:
Forcible exhale in 1 second
FEV1/FVC = <70%
PaCO2
PaO2

CBC (Cell Blood Counts)

Hct

3.2.Emphysema: Pathophysiology

Structural changes
Hyperinflation of
alveoli
Destruction of alveolar
& alveolar-capillary
walls
Small airways narrow
Lung elasticity
decreases
22

20.6.2000

Emphysema: Pathophysiology

Abnormal distension
of air spaces
Actual cause is
unknown
Mungkin ok ada
Pores of Kohn (ada
hubungan dari alv
ke alv yg lain)
23

20.6.2000

3.3. Asthma

Reversible inflammation &


obstruction
Intermittent attacks
Sudden onset
Varies from person to person
Severity can vary from shortness of
breath to death

Asthma
Triggers

Allergens
Exercise
Respiratory infections
Drugs and food additives
Nose and sinus problems
GERD [Gastro Esophageal Reflux Disorder
Emotional stress

Asthma: Pathophysiology

1. Swelling of mucus
membranes
(edema)
2. Spasm of smooth
muscle in
bronchioles

Increased airway
resistance

3. Increased mucus
gland secretion
26

20.6.2000

Asthma: Early Clinical Manifestations

Expiratory & inspiratory wheezing


Dry or moist non-productive cough
Chest tightness
Dyspnea
Anxious &Agitated
Prolonged expiratory phase
Increased respiratory & heart rate
Decreased PEFR [Pulmo. Expitory Flow Rate]

Pencetus Asthma

TKSS
29
20.6.2000