efusi pleura
TRANSCRIPT
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EFUSI PLEURAEFUSI PLEURA
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EFUSI PLEURA
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EFUSI PLEURA
• ANGKA KEJADIAN ( BAGIAN PARU)• EFUSI PLEURA
– TB : 7.2 %– GANAS : 5 %– LAIN-LAIN : 0.8 %
• EMPIEMA : 2.2 %
EFUSI PLEURA TB : + 41 % ( 27 DARI 66)
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NORMAL : CAIRAN PLEURA < 20 ML LUBRIKASI
AKUMULASI CAIRAN DI RONGGA PLEURATRANSUDASI TRANSUDATEKSUDASI EKSUDAT
FILTRASI ABSORBSI
PLEURA PARIETAL
PLEURA VISERAL
SISTIM LIMFE
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• TERJADINYA PENINGKATAN FILTRASI KARENA:
• TEKANAN KOLOID OSMOTIK MENURUN(hipoalbiminemia)
• TEKANAN HIDROSTATIK KAPILER MENINGKAT (kegagalan jantung)
• PERMEABILITAS KAPILER MENNGKAT (peradangan, neoplasma)
• TEKANAN NEGATIF RONGGA PLEURA BERTAMBAH (atelektasis)
• ABSORBSI TERGANGGU KARENA :• OBSTRUKSI ALIRAN LIMFE (sel tumor)
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• ETIOLOGI EFUSI PLEURA• INFEKSI
– TUBERKULOSIS– NON TUBERKULOSIS
• NON INFEKSI– HIPOPROTEINEMIA– NEOPLASMA– KELAINAN SIRKULASI– TRAUMATIK
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• EKSUDAT:• KEGANASAN ( PRIMER , METASTASE)• INFEKSI ( TB , NON TB)• INFARK PARU
• TRANSUDAT :• PAYAH JANTUNG• ASITES• SINROMA NEFROTIK• TUMOR GANAS • SIROSIS HATI • MEIGS SYNDROME• SINDROMA VENA KAVA SUPERIOR
• EFUSI HEMORAGIS :• TUMOR GANAS • TRAUMA HEMOTORAKS• INFEKSI ( TB, NON TB)
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MEMBEDAKAN EKSUDAT DAN TRANSUDAT
TRANSUDTRANSUDATAT EKSUDATEKSUDAT
RIVALTARIVALTA -- ++BERAT JENISBERAT JENIS < 1.016< 1.016 > 1.016> 1.016
PROTEINPROTEIN < 3 gr / 100 < 3 gr / 100 mlml
> 3 gr / 100 > 3 gr / 100 mlml
PROT. CAIRAN PLEURA / PROT. PROT. CAIRAN PLEURA / PROT. SERUMSERUM < 0.5< 0.5 > 0.5> 0.5
LACTIC DEHYDROGENASE (LDH)LACTIC DEHYDROGENASE (LDH) < 200 U / L< 200 U / L > 200 U / > 200 U / LL
LDH CAIRAN PLEURA / LDH LDH CAIRAN PLEURA / LDH SERUMSERUM < 0.6< 0.6 > 0.6> 0.6
LEUKOSITLEUKOSIT < 1000 / < 1000 / mm3mm3
> 1000 / > 1000 / mm3mm3
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• GAMBARAN KLINIK–KELUHAN :• DEMAM ( TINGGI, MENGGIGIL)• MALAISE• RASA TAK ENAK DI DADA, NYERI • BATUK BATUK• SESAK NAFAS
– PEMERIKSAAN FISIS :• KELAINAN BILA CAIRAN PLEURA >
500 CC, INSPEKSI, PALPASI, FREMITUS, PERKUSI, DAN AUSKULTASI
–RADIOLOGIS :• TERLIHAT BILA CAIRAN > 300 CC• TAMPAK GARIS ELLIS D ‘AMOISEAU
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PEMERIKSAAN TAMBAHAN1. PUNGSI CAIRAN PLEURA ANALISA2. BIOPSI PLEURA LAB. PATOLOGI ANATOMI3. TORAKOSKOPI
ANALISA CAIRAN PLEURA RIVALTA : PROTEIN : GR / 100 ML GLUKOSA : MG / 100 ML CELL : / mm 3 ERITROSIT : / mm 3 LEUKOSIT : / mm 3 DIFF. COUNT :
PMN : % MN : %
BTA :
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• ANALISA CAIRAN PLEURA– LEUKOSIT > 25. 000 / mm 3– NEUTROFIL >>:
» PNEUMONIA» INFARK PARU» PANKREATITIS» TB DINI
– LIMPOSIT >>:» TB» LIMFOMA» KEGANASAN
– EOSINOFIL >>:» JAMUR» PARASIT» POLIATRITIS NODOSA
– ERITROSIT > 100.000 / mm 3» TRAUMA» INFARK PARU» KEGANASAN
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PATOFISIOLOGI EFUSI PLEURA TB1. PROSES TB SUB PLEURA
2. PENYEBARAN HEMATOGEN3. PENYEBARAN LANGSUNG
1. KELENJER LIMFE CERVICAL2. KELENJER LIMFE MEDIASTINUM3. KELENJER LIMFE INTER KOSTAL4. ABSES DINGIN ( SPONDILITIS TB)
• RX. HIPERSENSITIVITAS TYPE LAMBAT• RADANG
– PERMEABILITAS KAPILER – PROTEIN AKUMULASI CAIRAN
• RADANG – GANGGUAN ALIRAN LIMFE AKUMULASI CAIRAN
PERKEJUAN PECAH MENGENAI PLEURA TUBERKEL PLEURA
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• DIAGNOSIS EFUSI PLEURA TB• RO FOTO TORAKS ADANYA PROSES TB• BTA : SPUTUM & CAIRAN
PLEURA• BIOPSI PLEURA : PA GAMBARAN TB• CAIRAN PLEURA EKSUDAT, ETIO LAIN (-)• UMUR MUDA• ADENOSIN DEAMINASE ( ADA) : > 70
U/ L• CT SCAN :
» KAVITAS» INFILTRAT
• RO FOTO TORAKS PA -- T. A. K• POLYMERASE CHAIN REACTION ( PCR +)
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• DIAGNOSIS EFUSI PLEURA MALIGNA
• TUMOR GANAS DI PARU• SEL GANAS ( + ) :
» SPUTUM» CAIRAN PLEURA ( 50 – 60 % )» BRONKOSKOPI
• BIOPSI PLEURA :» PATOLOGI ANATOMI KEGANASAN ( + )
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• PENATALAKSANAAN:1. OBATI PENYAKIT DASAR2. PENGELUARAN CAIRAN PLEURA :
• PUNGSI : – INDIKASI
» SESAK NAFAS» CAIRAN PRODUKTIF» TINGGI CAIRAN I.C II
• WSD
3. KORTIKOSTEROID TAPERING OFF4. PLEURODESIS :
• TETRASIKLIN, TALK• SITOSTATIKA
– THIOTHEPA– BLEOMISIN
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CARA MENGELUARKAN CAIRAN PLEURA
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PUNGSI PLEURA :
• TINDAKAN UNTUK MENGELUARKAN CAIRAN DARI RONGGA PLEURA DENGAN MENUSUKKAN JARUM KE DALAM RONGGA PLEURA
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PASTIKAN ADANYA CAIRAN
DIAGNOSTIK FISIKFOTO TORAKSCT SCAN DALAM KEADAAN TERTENTU
2
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TENTUKAN LOKASI TEMPAT PUNGSI
POSISI PASIENKENALI TOPOGRAFI ALAT-ALAT TUBUHPERIKSA FISIK :
PERKUSIAUSKULTASI
TENTUKAN TITIK PUNGSI
3
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DESINFEKSI DAERAH PUNGSI
CUKUP LUASBETADINE SOLUTIONALKOHOL 70%
4
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ANESTESI LOKAL
XYLOCAIN INJ 1%-2% UNTUK PUNGSI 3-5 ML XYLOCAIN 2% UNTUK WSD 8-10 ML XYLOCAIN 2%
5
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POSISI PASIEN
DUDUK DENGAN LENGAN DIANGKAT KE ATAS KEPALA
DUDUK AGAK MEMBUNGKUK SAMBIL MEMELUK BANTAL
BERBARING, PERLU DOEK STERIL
6
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ALAT-ALAT
SPUIT 5ML, 10ML, 50MLABOCATH NO. 12-14TRANSFUSION SETTHREE WAYTEMPAT PENAMPUNG CAIRANBOTOL STERIL UNTUK BAHAN PEMERIKSAAN
8
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WSD (Water Sealed Drainage)
WSD ADALAH TINDAKAN UNTUK MENGELUARKAN CAIRAN ATAU UDARA DARI RONGGA PLEURA SECARA TERTUTUP
9
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MINI WSD : ABOCATH
WSD : THORACIC TROCARD CATHETER NO. 16 - 20 UNTUK CAIRAN KENTAL DIPAKAI DIAMETER
LEBIH BESAR : NO. 24 - 28
10
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BOTOL WSD
BOTOL BEKAS INFUSBOTOL KHUSUS
11
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EFUSI PLEURA
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EFUSI PLEURA
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EFUSI PLEURA