morfologi & cara membuat diagsis

7/29/2019 Morfologi & Cara Membuat Diagsis

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MORFOLOGI & CARA

MEMBUAT DIAGSIS

Benny Effendi Wiryadi


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URUTAN PEMERIKSAAN &MENENTUKAN DIAGNOSIS

1. ANAMNESIS

. Berobat utk peny apa / keluhannya apa

. Riw peny, penggunaan obat utk peny ygdiderita, maupun peny lain, peny ygdiderita oleh anggota keluarga yg lain, penylain yg diderita sekarang maupun pada

masa lampau, dan kebiasaan tertentu


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LANJUTAN URUTAN PEMERIKSAAN

2. Inspeksi

Mutlak dilakukan dlm ruangan yg terang

Boleh memakai kaca pembesar

Anamnesis terarah ditanyakan saat inspeksi,utk melengkapi data D/ (mis dalam haldermatitis pada tangan, perlu ditanyakan kln-

an di tempat lain.Dalam hal ini perlupemeriksaan seluruh kulit tubuh.


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Perlu pem rambut, kuku, & mukosaterutama pd peny tertentu, mis likenplanus & sifilis.

Perhatikan lokalisasi, warna, bentuk,ukuran, penyebaran, batas, & efloresensiyg khusus.

Bila terdapat kemerahan pada kulit, ada3 kemungkian: eritema,purpura, dantelangiektasis


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CARA MEMBEDEKAN KEMERAHANKULIT

Tekan dgn jari & digeser

eritem: akan menghilang & warna akankembali setelah jari dilepaskan, krn terjadi

vasodilatasi kapiler

purpura: tidak menghilang, sebab terjadiperdarahan di kulit

telangiektasis: juga tidak hilang, sebabterjadi pelebaran kapiler yg. menetap


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LANJUTAN MEMBEDAKANKEMERAHAN KULIT

Pemeriksaan diaskopi (menekan dgn bendatransparan di tempat kemerahan)

diaskopi pos: warna merah menghilang

(eritema)diaskopi neg: warna merah tidak menghilang

(purpura atau telangiektasis). Telangiektasis akantampak spt benang berkelok-kelok yg berwarna

merah atau biru


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PALPASI

perhatikan tanda radang akut (dolor,kalor, fungsiolesa {rubor & tumor dapat

pula dilihat}, indurasi, fluktuasi, &pembesaran kelenjar regional maupungeneralisata

Setelah pem dermatologik dan pemumum selesai, dpt dibuat D/sementaradan DD/


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Konsultasi ke bagian lain, mis utk pemumum internis

Juga dpt dilakukan pem pembantu, misdarah, urin, bakteriologik, mikologik,histopatologik, dan imunologik ( a.l.,serologik, tes tempel, imunofloresensi)

Setelah pem selesai dpt diharapkansampai pada D/ pasti


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MORFOLOGI KULIT

Utk mempelajari ilmu peny kulit mutlakdiperlukan pengetahuan tentang efloresensi(ruam) kulit/ morfologi/ ilmu yg mempelajari

lesi kulit.

Demi kepentingan diagnosis penting sekaliutk mencari kelainan yg pertama (efloresensi

primer), yg biasanya khas utk peny tsb.


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LAN. Morfologi Kulit

Efloresensi kulit dpt berubah padawaktu berlangsungnya peny

Proses tsb dpt merupakan akibatbiasa dalam perjalanan prosespatologik


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LAN.MORFOLOGI

Kadang kadang perubahan juga dapatterjadi akb Keadaan dari luar, mis traumagarukan, pengobatan yg diberikan, sehingga

perubahan tsb tidak biasa lagi. Gambaranklinis morfologik peny menyimpang daribiasanya & sulit dikenali

Efloresensi yg timbul kemudian setelahefloresensi primer ini, disebut efloresensisekunder.


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EFLORESENSI

Efloresensi primer:

Makula, papul, plak, urtika, nodus,nodulus, vesikel, bula, pustul, dan kista

Efloresensi sekunder:

skuama (jarang sekali timbul sbgefloresensi primer), krusta, erosi, ulkus,dan sikatriks


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Lan. Morfologi Kulit

Definisi morfologi kulit ini dikutip dari:

Garg A, Levin NA, and Bernhard JD.: Structureof skin lesion and fundamentals of clinical

diagnosis; in Wolff K, Goldsmith LA, Katz SI,Gilchrest BA, Paller AS, and Leffell DJ, :Fitzpatricks Dermatology in General Medicine;7th ed, pp 23-40 (Mc Graw-Hill Medical, New

York 2008).

Parallel & amplify those of the DermatologyLexicon Project.


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Morphologic Lesions

Raised Depressed

Flat SurfaceChange

Fluidfilled

Vascular

Papule Erosion Macule Scale Vesicle Purpura

Plaque Ulcer Patch Crust Bulla Telangiectasia

nodule Atrophy Erythema Excoriation

Pustule Infarct

Cyst Poikiloderma

Erythroderma

Fissure Furuncle

Wheal Sinus Lichenific

ation

Abscess

Scar Striae Keratoderma

Comedo Burrow Eschar

Horn Sclerosis

Calcinosis


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Papul (Papule)

Penonjolan padat di atas permukaan kulit,

Diameter


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Plak (Plaque)

.Peninggian diatas permukaan kulit,

Permukaan rata

Berisi zat padat (biasanya infiltrat) Diameternya > 0.5 cm

Dapat terbentuk dari papul yg

melebar atau papul-papulberkonfluensi pada psoriasis.


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Nodul (Nodule)

Lesi kulit yg dapat diraba, padat, bulat atau oval

Diameter > 0.5 cm

Letaknya bisa epidermal, epidermal-dermal, dermal,

dermal-subdermal, dan subcutaneous Tumor kadang kadang dimasukkan dalam heading

nodul.

Bila diameter >1 cm disebut nodus

Gumma: specifically granulomatous nodular lesionoftertiary syphilis


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Kista (cyst)

Ruangan berdinding atau kantong yg dilapisioleh epitel sejati ( true epithelium)

Isinya ialah cairan atau semisolid material (sel

/ produk sel seperti keratin) Palpasi: biasanya resilient

Kista terbentuk bukan akibat peradangan,walaupun kemudian dapat meradang.

Kista terbentuk dari kelenjar yg melebar &tertutup, saluran kelenjar, pembuluh darah,saluran getah bening, atau lapisan epidermis


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Urtika (Wheal)

Edema setempat yg mendadak & menghilangperlahan lahan (evanescent), disebabkankeluarnya plasma melalui dinding pembuluhdarah di dermis bagian atas

Disebut juga Hive / urticaria

Bisa berupa tiny papule (2-4mm) sampai giantplaques (sampai > 10 cm)

Angioedema: a deeper, edematous reaction thatoccurs in areas with very loose dermis &subcutaneous tissue (lip, eyelid, or scrotum)


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Sikatriks (Scar)

Terjadi dari proliferasi jaringan fibrosa, ygmenggantikan kolagen normal setelah lukaatau ulserasi sampai dermis retikularis.

Epidermis menipis & mengerut (wrinkled)tidak ada adneksa kulit

Sikatriks dapat atrofik (kulit mencekung) atauhipertrofik yg kelihatan menonjol, krn

kelebihan jaringan ikat. sikatriks hipertrofik yg pertumbuhannya

>batas luka,disebut keloid


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Komedo (Comedo)

Hair follicle infudibulum yg melebar &tersumbat oleh keratin & lipid

Bila pilosebaceous unit terbuka sampai ke

permukaan kulit dan terlihat keratinaceuosplug,disebut open comedo.

The oxidized sebaceous content of theinfudibulum (black head)

A closed infudibulum (follicular opening isunapparent accumulates whitish keratin)disebut closed comedo


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Horn

A conical mass of cornified cellsarising over an abnormallydifferentiating epidermis.

Contohnya: squamous cellcarcinoma, veruka vulgaris.


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Calcinosis

Deposit of calcium in the dermis orsubcutaneous tissue may beappreciated as hard, whitish nodules

or plaques, with or without visiblealteration of the skins surface

Cutaneous calcinosis in

dermatomyositis


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Erosi (Erosion)

A moist, circumscribed, depressedlesion

Result from loss of a portion or all ofthe viable epidermal or mucosalepithelium

Unless they become secondarilyinfected, erosion do not scar

Toxic epiderma necrolysis


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Ekskoriasis (Excoriasion)

Loss of tissue that extending to themost superficial parts of dermis (tipof the papilla dermis)

May result in pin-point bleeding


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Ulkus (Ulcers)

A defect in which the epidermis & atleast the upper (papillary) dermis hasbeen removed

Breach (menembus) dermis &destruction of adnexal structuresimpedes re-epithelialization & the

defect heal with scarring Mempunyai tepi, dinding, dasar dan isi.


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Fissure

A linear loss of continuity of the skinsurface or mucosa that result fromexcessive tension or decreased

elasticity of the involved tissue


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Atrofi (Atrophy)

Istilah atrofi dipergunakan utkukuransel, jaringan,organ, atau bagian daritubuh

A decreased in the number ofepidermal cells results in the thinningof the epidermis

Atrophic epidermis is glossy, almosttransparan, paper thin & wrinkled &may not retain normal skin lines


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Atrofi

Epidermal atrophy may also beassociated with similar alterations inthe dermis. A decreasein the papillary

& reticular dermal connective tissuemanifest as depression of the skin

Atrophy of the panniculus results in a

more substantial depression of theskin


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Poikiloderma

The combination of atrophy,telangiectasia, and varied

pigmentary changes (hyper- and

hypo-) over an area of skin.

This combination of features maygive rise to a dappled

appearance(belang belang) of theskin


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Sinus

A tract connecting deep suppurativecavities to each other or to thesurface of the skin

The contents of the cavity usuallypus, fluid, or keratin, may drain tothe surface when such

communication exists


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Striae

The linear depression of the skin thatusually measure several centimeters inlength & result from changes to the

reticular collagen that occur with rapidstretching of the skin.

The surface of the striae may be thin &wrinkled.

They may be pink to red in color & raisedbefore becoming paller & flattened out


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Burrow

A wavy, threadlike tunnel throughthe outer portion of the epidermisexcavated by a parasite.


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Sclerossis

A circumscribed or diffuse hardening or induration in theskin that isa result of dermal fibrosis.

It is detected more easily by palpation (on which theskin may feel board-like, immobile, & difficult to pick up)

Hypopigmentation or hyperpigmentation may alsodistinguish the area of induration from normal skin. Theepidermis overlying sclerotic dermis may be atrophy


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Lichenification

Repeated rubbing of the skin mayinduced a reactive thickening of theepidermis, with changes in thecollagen of the underlying su

Thickened skin with accentuatedmarkings, which may be resembletree barkperficial dermis


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Keratoderma

An excessive hyperkeratosis of thestratum corneum that results in a

yellowish thickening of the skin,

usually on the palms and soles, thatmay be inherited or acquired


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Eschar

The presence of an eschar impliestissue necrosis, infarction, deep burns,gangrene, or ulcerating process.

It is a circumscribed, adherent, hard,black crust on the surface of the skinthat is moist initially, protein rich, and

avascular.

This milieu fosters microbial growth


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Vesicle & Bulla

A vesicle is a fluid filled cavity orelevation smaller than or equal to 0.5cm, whereas a bulla measures larger

than 0.5 cm.


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Pustul (Pustule)

Vesicle yg berisi nanah

Bila nanah mengendap di bagianbawah vesikel, disebut hipopion


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Abses (Abscess)

Abscess is a localized accumulationpurulent material so deep in thedermis or subcutaneous tissue that

pus usually not visible on the surfaceof the skin

An abscess is a pink erythematous,

warm, tender, fluctuant nodule thatmay be associated with other signs ofinfection such as fever.


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Macule

A flat lesion, even with the surface level ofsurrounding skin, perceptible as an area of colordifferent from the surrounding skin mucousmembrane.

Macules are nonpalpable.

Their shapes are varied & borders may bedistinct or vague.

Maculosquamous is a neologism invented todescribe macules withn fine non-palpablescaling, which may become apparent only afterlight scraping & scratching


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Erythema

The blanchable change in color ofskin or mucous membrane that isdue to dilatation of arteries and veins

in the papillary & reticular dermis.


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Erythroderma

Generalized deep redness of the skininvolving more than 90% of the bodysurface with days to weeks. Scaling

or desquamation generally followsestablishment of the generalizederythema


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Scale, Desquamation (scaling)

A scale is flat plate or flake arisingfrom the outer-most layer of thestratum corneum


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Krusta (Crust)

Hardened deposits that result whenserum, blood, or purulent exudatedries on the surface of the skin


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Ukuran lesi

Milier

Lentikuler

Numuler plakat


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Susunan Lesi

Linear

Circiner/ arciner

Polisiklik Herpetiformis

Korimbiformis

morfologi & cara membuat diagsis

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