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  • 7/24/2019 Skenario 3 Blok Hematologi

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    Dira Adhitiya Ningrum | 1102014077

    SASARAN BELAJAR

    1. MM Limfadenopati1.1. Denisi1.2. Etiologi1.3. Klasifuasi1.!. Epidemiologi

    1.". #atosiologi1.$. Manifestasi linis1.%. Diagnosis dan diagnosis &anding1.'. (ata lasana1.). Kompliasi1.1*. #+ognosis

    1. Limfadenopati

    1.1. DenisiLimfadenopati merupakan pembesaran kelenjar getah bening dengan ukuran lebih besar dari 1 cm.

    Kepustakaan lain mendefinisikan limfadenopati sebagai abnormalitas ukuran atau karakter kelenjar

    getah bening. Terabanya kelenjar getah bening supraklavikula, iliaka, atau popliteal dengan ukuran

    berapa pun dan terabanya kelenjar epitroklear dengan ukuran lebihbesar dari 5 mm merupakan

    keadaan abnormal.

    II !endekatan iagnosis Limfadenopati

    1.2. EtiologiEtiologi

    1. !eningkatan jumlah limfosit makrofag jinak selama reaksi terhadap antigen.

    2. Infiltrasi oleh sel radang pada infeksi yang menyerang kelenjar limfe.

    3. !roliferasi in situ dari limfosit maligna atau makrofag.

    4. Infiltrasi kelenjar oleh sel ganas metastatik.

    5. Infiltrasi kelenjar limfe oleh makrofag yang mengandung metabolit dalam penyakit cadangan lipid.

    "da berbagai infeksi yang menyebabkan limfadenopati generalisata, lokalisata dan limfadenitis. Infeksi

    limfadenopati generalisata sering disebabkan oleh virus, bakteri, jamur dan proto#oa (Tabel 1). Infeksi yangmenyebabkan limfadenopati lokalisata maupun limfadenitis dapat berasal bukan dari penyakit menular seksual, dapat

    juga berasal dari penyakit menular seksual $limfadenopti inguinal primer% serta sindrom limfokutaneus $Tabel 2).

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    &treptokokus dan bakteri staphylococcal adalah penyebab paling umum dari limfadenitis, meskipun virus,

    proto#oa, rickettsiae, jamur, dan basil T' juga dapat menginfeksi kelenjar getah bening. &treptokokus dan bakteri

    penyebab adalah pagar staphylococcal limfadenitis (mum, meskipun virus, proto#oa, rickettsiae, jamur, dan T') juga

    dapat menginfeksi kelenjar getah bening.

    !enyakit yang melibatkan kelenjar getah bening di seluruh tubuh termasuk mononucleosis, infeksi

    sitomegalovirus, toksoplasmosis, dan brucellosis. *ejala a+al limfadenitis adalah pembengkakan kelenjar yang

    disebabkan oleh penumpukan cairan jaringan dan peningkatan jumlah sel darah putih akibat respon tubuh terhadap

    infeksi. Kehilangan nafsu makan, vehicles keringat, nadi cepat, dan kelemahan.

    'anyak keadaan yang dapat menimbulkan limfadenopati. Keadaankeadaan tersebut dapat diingat dengan

    mnemonik MIAMI:

    - Malignancies$keganasan%

    - Infections (infeksi%

    - Autoimmune disorders$kelainan autoimun%

    Miscellaneous and unusual conditions$lainlaindan kondisi takla#im%

    - Iatrogeniccauses $sebabsebab iatrogenik%.

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    1.3. Klasiasi

    'erdasarkan luas limfadenopati

    1. Generalisata Limfadenopati pada / atau lebih regio anatomi yang berbeda. Limfadenopatigeneralisata yang persisten $persistent generali#ed lymphadenopathy 0!*L% adalah limfadenopati

    pada beberapa kelenjar getah bening yang bertahan lama. !*L adalah gejala khusus infeksi I2

    yang timbul pada lebih dari 534 dha dan sering disebabkan oleh infeksi I2 sendiri. 'atasan

    limfadenopati pada infeksi I2 adalah sbb 6elibatkan sedikitnya dua kelompok kelenjar getah

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    bening. &edikitnya dua kelenjar yang simetris berdiameter lebih dari 1cm dalam setiap kelompok,

    'erlangsung lebih dari satu bulan 7 Tidak ada infeksi lain yang menyebabkannya !embengkakan

    kelenjar getah bening ini bersifat tidak sakit, simetris $kirikanan sama%, dan kebanyakan terdapat di

    leher bagian belakang dan depan, di ba+ah rahang ba+ah, di ketiak serta di tempat lain, tidak

    termasuk kunci paha. 'iasanya kulit pada kelenjar yang bengkak karena !*L akibat I2 tidak

    ber+arna merah.

    /. Lokalisata Limfadenopati pada 1 regio.

    '89"&"9K": T86!"T

    A. Limfadenopati epitroklearTerabanya kelenjar getah bening epitroklear selalu patologis. !enyebabnya meliputi infeksi di lengan ba+ah atau

    tangan, limfoma,sarkoidosis, tularemia, dan sifilis sekunder.

    B. Limfadenopati aksila

    &ebagian besar limfadenopati aksila disebabkan oleh infeksi atau jejas pada ekstremitas atas. "denokarsinoma

    payudara sering bermetastasis ke kelenjar getah bening aksila anterior dan sentral yang dapat teraba sebelum

    ditemukannya tumor primer. Limfoma jarang bermanifestasi sejak a+al atau, kalaupun bermanifestasi, hanya di

    kelenjar getah bening aksila. Limfadenopati antekubital atau epitroklear dapat disebabkan oleh limfoma atau

    melanoma di ekstremitas, yang bermetastasis ke kelenjar getah bening ipsilateral.

    C. Limfadenopati supraklavikula

    Limfadenopati supraklavikula mempunyai keterkaitan erat dengan keganasan. !adapenelitian, keganasan

    ditemukan pada ;

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    1.!. Epidemiologi

    EpidemiologyFrequency

    United States

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    The precise incidence of lymphadenopathy is not known, but estimates of palpable adenopathy in childhood vary from 38-45,!"# and lymphadenopathy is one of the most common clinical problems encountered in pediatrics$ !%# &etermining whetheradenopathy is simply a normal response to fre'uent viral infections within an age group or if it is significant enough toconsider more serious underlying disease is often difficult$

    (n the )nited *tates, common viral and bacterial infections are overwhelmingly the most common cause of adenopathy$(nfectious mononucleosis and cytomegalovirus +./are important etiologies, but adenopathy is usually caused bycommon viral upper respiratory tract infections$ 0ocali1ed lymphadenitis is most often caused by staphylococci and beta-hemolytic streptococci$

    2ther infections, such as human immunodeficiency virus +(./, malignancies, and autoimmune diseases, are less commoncauses of adenopathy$

    International

    (nfections that are rarely observed in the )nited *tates, such as tuberculosis, typhoidfever, leishmaniasis,trypanosomiasis, schistosomiasis, filariasis,and fungal infections, are common causes oflymphadenopathy in developing nations$!3# (. infections must be strongly considered in areas of high incidence$

    Mortality/Morbidity

    (n the )nited *tates, mortality and serious morbidity caused by adenopathy are unusual given the common infectiousetiologies$

    alignancies, such as leukemia, lymphomas, and neuroblastoma, are the primary causes of mortality in the )nited

    *tates$ !4#

    *ignificant morbidity and mortality are also associated with autoimmune disorders +eg,uvenile rheumatoid

    arthritis, systemic lupus erythematosus/,histiocytoses,and storage diseases$

    (. is an uncommon cause of adenopathy in the )nited *tates, but its associated mortality re'uires consideration$

    Race

    ace is not a factor in most lymphadenopathy$ are causes may be associated with particular ethnic groups +eg, sarcoidosisin 6fricans, 7ikuchi-uimori disease in 6sians/$

    Sex

    *e9 does not influence childhood lymphadenopathy$

    Age

    6denopathy is most common in young children whose immune systems are responding to newly encountered infections$6denopathy may be seen in one third of neonates and infants, usually in nodes that drain areas with mild skin irritation$:enerali1ed adenopathy is rare in the neonate and suggests congenital infections, such as .$ 6denopathy related tomalignancy is rare at all ages$ (f diagnosed, it is often secondary to leukemia or neuroblastoma in younger children, andtoodgkin lymphomain adolescents$!5#

    1.". #atosiologi

    &istem limfatik berperan pada reaksi peradangan sejajar dengan sistem vaskular darah.

    'iasanya ada penembusan lambat cairan interstisial kedalam saluran limfe jaringan, dan limfe yang

    terbentuk diba+a kesentral dalam badan dan akhirnya bergabung kembali kedarah vena. 'ila daerah

    terkena radang, biasanya terjadi kenaikan yang menyolok pada aliran limfe dari daerah itu. Telah

    diketahui bah+a dalam perjalanan peradangan akut, lapisan pembatas pembuluh limfe yang terkecil

    agak meregang, sama seperti yang terjadi pada venula, dengan demikian memungkinkan lebihbanyak bahan interstisial yang masuk kedalam pembuluh limfe. 'agaimanapun juga, selama

    peradangan akut tidak hanya aliran limfe yang bertambah, tetapi kandungan protein dan sel dari

    cairan limfe juga bertambah dengan cara yang sama.

    http://emedicine.medscape.com/article/963090-overviewhttp://emedicine.medscape.com/article/963090-overviewhttp://emedicine.medscape.com/article/969401-overviewhttp://emedicine.medscape.com/article/998804-overviewhttp://emedicine.medscape.com/article/1000389-overviewhttp://emedicine.medscape.com/article/1000389-overviewhttp://emedicine.medscape.com/article/999469-overviewhttp://emedicine.medscape.com/article/998011-overviewhttp://emedicine.medscape.com/article/998011-overviewhttp://emedicine.medscape.com/article/988284-overviewhttp://emedicine.medscape.com/article/1007276-overviewhttp://emedicine.medscape.com/article/1007276-overviewhttp://emedicine.medscape.com/article/1007276-overviewhttp://emedicine.medscape.com/article/1008066-overviewhttp://emedicine.medscape.com/article/1008066-overviewhttp://emedicine.medscape.com/article/958026-overviewhttp://emedicine.medscape.com/article/958026-overviewhttp://emedicine.medscape.com/article/987101-overviewhttp://emedicine.medscape.com/article/987101-overviewhttp://emedicine.medscape.com/article/963090-overviewhttp://emedicine.medscape.com/article/969401-overviewhttp://emedicine.medscape.com/article/998804-overviewhttp://emedicine.medscape.com/article/1000389-overviewhttp://emedicine.medscape.com/article/999469-overviewhttp://emedicine.medscape.com/article/998011-overviewhttp://emedicine.medscape.com/article/988284-overviewhttp://emedicine.medscape.com/article/1007276-overviewhttp://emedicine.medscape.com/article/1007276-overviewhttp://emedicine.medscape.com/article/1008066-overviewhttp://emedicine.medscape.com/article/958026-overviewhttp://emedicine.medscape.com/article/987101-overview
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    &ebaliknya, bertambahnya aliran bahanbahan melalui pembuluh limfe menguntungkan

    karena cenderung mengurangi pembengkakan jaringan yang meradang dengan mengosongkan

    sebagian dari eksudat. &ebaliknya, agenagen yang dapat menimbulkan cedera dapat diba+a oleh

    pembuluh limfe dari tempat peradangan primer ketempat yang jauh dalam tubuh. engan cara ini,

    misalnya, agenagen yang menular dapat menyebar. !enyebaran sering dibatasi oleh penyaringan

    yang dilakukan oleh kelenjar limfe regional yang dilalui oleh cairan limfe yang bergerak menuju

    kedalam tubuh, tetapi agen atau bahan yang terba+a oleh cairan limfe mungkin masih dapat

    mele+ati kelenjar dan akhirnya mencapai aliran darah. $!rice, 1>>5? ;> >>? ;A/%. 'iopsi sayatan &ebagian

    kecil jaringan tumur mame diamdil melalui operasi dengan anestesi umum jaringan tumor itu

    dikeluarkan, lalu secepatnya dikirim kelaborat untuk diperriksa. 'iasanya biopsi ini dilakukan untuk

    pemastian diagnosis setelah operasi. $ s+ari, /333? /

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    - #AL$%A& &A'A# 'atuk lama atau lebih / minggu hilang timbul, "&6", sering batuk kecil atauberdehem, sering menarik napas dalam.

    - (I$&G) *"LI&GA *"&GG+%+,A& !ilek lama lebih dari / minggu hilang timbul, bila pilek lamasering disertai sakit telingasering bersin, hidung buntu, terutama malam dan pagi hari. 6I6I&":,

    &I:(&ITI&, hidung sering gatal digosokgosok atau hidung sering digerakgerakkan ,rabbit nose-. Kotorantelinga berlebihan, sedikit berbau, sakit telinga bila ditekan $otitis eksterna%. Telinga sering berdengung atau

    gemuruk .

    - ,$LI* :Kulit timbul 'I&(L, kemerahan, bercak putih dan bekas hitam seperti tergigit nyamuk. Timbul

    +arna putih pada kulit seperti -panu-. !erioral dermatitis timbul bintil kemerahan atau jera+at di sekitarmulut. ipinggir kuku kulit sering terkelupas, kulit diba+ah kuku bengkak bahkan sampai terlepas

    $paronichia% &ering menggosok mata, hidung, telinga, sering menarik atau memegang alat kelamin karenagatal.

    - #AL$%A& C"%&A 6udah 6(:T" bila menangis, berlari atau makan banyak. MA! pagi "ari. &ering

    'uang "ir 'esar $'"'% ; kali0hari atau lebih, sulit '"' $obstipasi%, kotoran bulat kecil hitam seperti kotorankambing, keras, sering buang angin, berak di celana. &ering K86'(:*, sering buang angin dan bau tajam.

    &ering :C89I !89(T. Kadang nyeri di daerah kantung empedu. Daspadai bila nyeri perut hebat bila divonis

    usus buntu harus segera second opinion ke dokter lain. &ering salah diagnosis karena gejala mirip.

    - GIGI A& M$L$* :yeri gigi, gigi ber+arna kuning kecoklatan, gigi rusak, gusi mudah

    bengkak0berdarah. 'ibir kering dan mudah berdarah, sering &"9I"D":, lidah putih 7 berpulau, mulut

    berbau, air liur berlebihan.

    - '"MB$L$( A%A(2askulitis $pembuluh darah kecil pecah% sering !#$AM %#$I&A'pada tulang

    kering kaki atau pipi atas seperti bekas terbentur. 'erdebardebar, mudah pingsan, tekanan darah rendah.

    - +*+* A& *$LA&G nyeri kaki atau kadang tangan, sering minta dipijat terutama saat malam hari.Kadang nyeri dada. Kadang otot sekitar rahang atas dan rahang ba+ah kaku bila mengunyah terganggu, bila

    tidur gigi sering gemeretak, tot di leher belakang dan punggung sering kaku dan nyeri

    - #AL$%A& ,"&CI&G &ering minta kencing, '8 D8TTI:* $semalam ngompol /; kali%

    - MA*A 6ata gatal, timbul bintil di kelopak mata $hordeolum%. Kulit hitam di area ba+ah kelopak mata.

    memakai kaca mata $silindris% sejak usia E1/ tahun.

    - (+%M+&AL rambut berlebihan di kaki atau tangan, keputihan, gangguan pertumbuhan tinggi badan.

    *angguan pada de+asa rambut rontok, !rementrual &yndrome $gangguan saat menstruasi%, jera+at,

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    - Men!alami Gi-i Ganda bisa kurus, sulit naik berat badan atau kegemukan. !ada kesulitan kenaikkan erat

    badan sering disertai kesulitamn makan dan nafsu makan kurang. &ebaliknya pada kegemukan sering

    mengalami nafsu makan berlebihan

    - ,esulitan Makan dan !an!!uan Makan :afsu makan buruk atau gangguan mengunyah menelan

    - Kepala,telapak kaki atau tangan sering teraba hangat. 'erkeringat berlebihan meski dingin $malam atau ac%.

    Keringatberbau.

    - A*I/$" atau ,"L"LA(A& mudah lelah, sering minta gendong, !ada de+asa sering mengeluh

    ,capek-0 aa taan menurun sering sakit demam, batuk, pilek setiap bulan bahkan sebulan / kali. (normal sait

    se"arusnya 2- bulan seali). Karena sering sakit berakibat Tonsilitis kronis $"6":8L 686'8&"9%.

    1.%. Diagnosis Diagnosis Banding

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    A&AM&"#I# :

    - Lokasi, gejala penyerta, ri+ayat penyakit, ri+ayat pemakaian obat, pekerjaan.

    '"M"%I,#AA& I#I, :

    - (kuranya normal jika diameter F 3.5cm, jika G 1.5cm abnormal

    - :yeri tekan umumnya akibat peradangan atau proses perdarahan.

    - Konsistensi nya jika keras seperti batu mengarahkan kepada keganasan, padat seperti karet

    mengarahkan kepada Limfoma, jika lunak mengarah kapada Infeksi, Bluktuatif mengarah kepada

    "bses.

    '"M"%I,#AA& '"&$&A&G :

    1. $ltrasono!rafi $#G

    (&* merupakan salah satu teknik yang dapat dipakai untuk mengetahui ukuran, bentuk, dan gambaran mikronodular.

    2. Biopsi

    'iopsi dapat dilakukan dengan mengambil sel keluar melalui jarum atau dengan operasi menghapus satu atau lebih

    kelenjar getah bening. &elsel atau kelenjar getah bening akan diba+a ke lab dan diuji. 'iopsy K*' memiliki nilai

    sensitifitas >= 4 dan spesifisitas >5 4. Kegagalan untuk mengecil setelah

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    dilaksanakan biopsy K*'. 'iopsi dilakukan terutama bila terdapat tanda dan gejala yang mengarahkan kepada

    keganasan.

    3. ,ultur

    Kultur $contoh dikirim ke laboratorium dan diletakkan pada kultur medium yang membiarkan mikroorganisme untuk

    berkembang% kemungkinan diperlukan untuk memastikan diagnosa dan untuk mengidentifikasikan organisme

    penyebab infeksi.

    4. C* #6an)T &can adalah mesin Hray yang menggunakan komputer untuk mengambil gambar tubuh "nda untuk mengetahui

    apa yang mungkin menyebabkan limfadenitis "nda. &ebelum mengambil gambar, "nda mungkin akan diberi pe+arna

    melalui I2 di pembuluh darah "nda agar dapat melihat gambar dengan jelas. )T &can dapat mendeteksi pembesaran

    K*' servikalis dengan diameter 5 mm atau lebih.

    5. Ma!neti6 %esonan6e Ima!in! M%I

    6agnetic resonance imaging $69I% digunakan untuk melihat dalam tubuh "nda. okter dapat menggunakan gambar

    ini untuk mencari penyebab limfadenitis

    &ifferential &iagnoses

    6cute omplications of *arcoidosis

    6cute 0ymphoblastic 0eukemia

    ;rucellosis

    occidioidomycosis

    &iaper &ermatitis

    :aucher &isease

    :roup 6 *treptococcal (nfections

    istiocytosis

    istoplasmosis

    odgkin 0ymphoma

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    7awasaki &isease

    easles

    =euroblastoma

    >ediatric 6cute yelocytic 0eukemia

    >ediatric hickenpo9

    >ediatric (. (nfection

    >ediatric ononucleosis and Epstein-;arr .irus (nfection

    >ediatric =on-odgkin 0ymphoma

    >ediatric habdomyosarcoma

    >ediatric ubella

    >ediculosis and >thiriasis +0ice (nfestation/

    >lague

    *erum *ickness

    *inonasal anifestations of ystic ibrosis

    *phingomyelinase &eficiency

    *yphilis

    *ystemic 0upus Erythematosus +*0E/

    Taenia (nfection

    To9oplasmosis

    Tuberculosis

    1.'. (ata Lasana

    !embesaran K*' biasanya disebabkan oleh virus dan sembuh sendiri, +alaupun pembesaran K*' dapat berlangsung

    mingguan. !engobatan pada infeksi K*' oleh bakteri $limfadenitis% adalah antibiotic oral 13 hari dengan

    pemantauan dalam / hari pertama flu6lo7a6illin /5 mg0kg'' empat kali sehari. 'ila ada reaksi alergi terhadap

    antibiotic golongan penicillin dapat diberikan 6epale7in /5 mg0kg $sampai dengan 533 mg% tiga kali sehari atau

    ertrom6in 15 mg0kg $sampai 533 mg% tiga kali sehari.

    'ila penyebab limfadenopati adalah mycobacterium tuberculosis maka diberikan obat anti tuberculosis

    selama >1/ bulan. 'ila disebabkan mycobacterium selain tuberculosis maka memerlukan pengangkatan K*' yang

    terinfeksi atau bila pembedahan tidak memungkinkan atau tidak maksimal diberikan antibiotic golongan makrolida

    dan antimycobacterium

    I*L:*K": "T"& / K8L6!K 1. +BA* LI&I81

    Isonia#id, 9ifampisin, 8tambutol, &treptomisin dan pira#inamid.

    http://emedicine.medscape.com/article/965367-overviewhttp://emedicine.medscape.com/article/966220-overviewhttp://emedicine.medscape.com/article/439263-overviewhttp://emedicine.medscape.com/article/987228-overviewhttp://emedicine.medscape.com/article/969773-overviewhttp://emedicine.medscape.com/article/965086-overviewhttp://emedicine.medscape.com/article/963894-overviewhttp://emedicine.medscape.com/article/987540-overviewhttp://emedicine.medscape.com/article/988803-overviewhttp://emedicine.medscape.com/article/968523-overviewhttp://emedicine.medscape.com/article/225013-overviewhttp://emedicine.medscape.com/article/235627-overviewhttp://emedicine.medscape.com/article/332032-overviewhttp://emedicine.medscape.com/article/862538-overviewhttp://emedicine.medscape.com/article/951564-overviewhttp://emedicine.medscape.com/article/229461-overviewhttp://emedicine.medscape.com/article/332244-overviewhttp://emedicine.medscape.com/article/999727-overviewhttp://emedicine.medscape.com/article/230802-overviewhttp://emedicine.medscape.com/article/965367-overviewhttp://emedicine.medscape.com/article/966220-overviewhttp://emedicine.medscape.com/article/439263-overviewhttp://emedicine.medscape.com/article/987228-overviewhttp://emedicine.medscape.com/article/969773-overviewhttp://emedicine.medscape.com/article/965086-overviewhttp://emedicine.medscape.com/article/963894-overviewhttp://emedicine.medscape.com/article/987540-overviewhttp://emedicine.medscape.com/article/988803-overviewhttp://emedicine.medscape.com/article/968523-overviewhttp://emedicine.medscape.com/article/225013-overviewhttp://emedicine.medscape.com/article/235627-overviewhttp://emedicine.medscape.com/article/332032-overviewhttp://emedicine.medscape.com/article/862538-overviewhttp://emedicine.medscape.com/article/951564-overviewhttp://emedicine.medscape.com/article/229461-overviewhttp://emedicine.medscape.com/article/332244-overviewhttp://emedicine.medscape.com/article/999727-overviewhttp://emedicine.medscape.com/article/230802-overview
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    2. +BA* LI&I82

    Bluorokuinolon, &ikloserin, 8tionamid, "mikasin, Kanamisin, Kepreomisin.

    1.). Kompliasi

    1. 'em9entukan a9ses"bses adalah suatu penimbunan nanah, biasanya terjadi akibat suatu infeksi bakteri. @ika bakteri menyusup ke

    dalam jaringan yang sehat, maka akan terjadi infeksi. &ebagian sel mati dan hancur, meninggalkan rongga

    yang berisi jaringan dan selsel yang terinfeksi. &elsel darah putih yang merupakan pertahanan tubuh dalam

    mela+an infeksi, bergerak ke dalam rongga tersebut dan setelah menelan bakteri, sel darah putih akan mati.

    &el darah putih yang mati inilah yang membentuk nanah, yang mengisi ronggatersebut.

    "kibat penimbunan nanah ini, maka jaringan di sekitarnya akan terdorong. @aringan pada akhirnya tumbuh di

    sekeliling abses dan menjadi dinding pembatas abses? hal ini merupakan mekanisme tubuh untuk mencegah

    penyebaran infeksi lebih lanjut. @ika suatu abses pecah di dalam, maka infeksi bisa menyebar di dalam tubuh

    maupun diba+ah permukaan kulit, tergantung kepada lokasi abses.

    2. #elulitis infeksi kulit

    &elulitis adalah suatu penyebaran infeksi bakteri ke dalam kulit dan jaringan di ba+ah kulit. Infeksi dapatsegera menyebar dan dapat masuk ke dalam pembuluh getah bening dan aliran darah. @ika hal ini terjadi,

    infeksi bisa menyebar ke seluruh tubuh.

    3. #epsis septikemia atau kera6unan dara

    &epsis adalah kondisi medis yang berpotensi berbahaya atau mengancam nya+a, yang ditemukan dalam

    hubungan dengan infeksi yang diketahui atau dicurigai $biasanya namun tidak terbatas pada bakteribakteri%.

    4. istula terliat dalam limfadenitis an! dise9a9kan ole *BC

    Limfadenitis tuberkulosa ini ditandai oleh pembesaran kelenjar getah bening, padat 0 keras, multiple dan dapat

    berkonglomerasi satu sama lain. apat pula sudah terjadi perkijuan seluruh kelenjar, sehingga kelenjar itu

    melunak seperti abses tetapi tidak nyeri. "pabila abses ini pecah ke kulit, lukanya sulit sembuh oleh karena

    keluar secara terus menerus sehingga seperti fistula. Bistula merupakan penyakit yang erat hubungannyadengan immune system 0 daya tahan tubuh setiap individual.

    1.1*. #+ognosis

    !rognosis untuk pemulihan adalah baik jika segera diobati dengan antibiotik. alam kebanyakan kasus, infeksi dapat

    dikendalikan dalam tiga atau empat hari. :amun, dalam beberapa kasus mungkin diperlukan +aktu beberapa minggu

    atau bulan untuk pembengkakan menghilang, panjang pemulihan tergantung pada penyebab infeksi. !enderita dengan

    limfadenitis yang tidak diobati dapat mengembangkan abses, selulitis, atau keracunan darah $septikemia%, yang

    kadangkadang fatal.

    "BT"9 !(&T"K"1. &oeparman, Daspadji &.Ilmu !enyakit alam. @ilid [email protected] 'alai !enerbit BK(I, 1>>3/. 6ansjoer ", Triyanti, &avitri 9, et al. Kapita selektakedokteran. @ilid I. 8disi ketiga. @akarta6edia

    "esculapius BK(I, 1>>>

    ;. &jamsuhidajat. 9, Dim de @ong./335.$uu A*ar Ilmu $eda" #disi 2. 8*) @akarta.

    >E.Atlas $er,arna +aripati enyait %ulit. @akarta 8*)

    A. &ar+ono. 1>>E.$uu A*ar Ilmu enyait alam. @ilid !ertama, 8disi Ketiga. @akrta 8*)

    =. 6ehta, "tul. 7 offbrand, 2ictor. /33E.At a /lance 0ematologi. 8disi kedua. @akartaa 8rlangga

    >. Berrer 9. Lymphadenopathy ifferential diagnosis and evaluation. "m Bam !hysician.

    1>>=?5=1;15.

    13. 'a#emore "D. &mucker 9. Lymphadenopathy and malignancy. "m Bam !hysician. /33/?EE/13;

    13.

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    11. medicastore.com0penyakit01>50Limfadenitis

    1/. )hisholm'urns,6arie "., Dells,'arbara *., &ch+inghammer,Terry L., 6alone, !atrick 6., Kolesar,

    @ill 6., 9otschafer, @ohn )., ipiro, @oseph T., /33=,"armacot"erapy: rinciples and racticeThe

    6c*ra+ill )ompanies, (&", 1;A11;=;

    1;. &ukandar, 8lin C., dkk, /311, I& B"96"KT89"!I /, !enerbit Ikatan "poteker Indonesia, @akarta.

    1

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    ?hat is the lymph [email protected]

    2ur bodies have a network of lymph vessels and lymph nodes$ +0ymph is pronounced limf$/ This network is a part of

    the bodyAs immune system$ (t collects fluid, waste material, and other things +like viruses and bacteria/ that are in the

    body tissues, outside the bloodstream$

    0ymph vessels are a lot like the veins that collect and carry blood through the body$ ;ut instead of carrying blood,

    these vessels carry the clear watery fluid called lymph$

    The lymph system

    0ymph fluid flows out from capillary walls to bathe the bodyAs tissue cells$ (t carries o9ygen and other nutrients to the

    cells, and carries away waste products like carbon dio9ide +2 // that flow out of the cells$ 0ymph fluid also contains

    white blood cells, which help fight infections$

    0ymph fluid would build up and cause swelling if it were not drained in some way$ ThatAs the role of the lymph vessels$

    0ymph vessels draw up the lymph fluid from around the cells to send it towards the chest$ There, lymph fluid collects

    into a large vessel that drains into a blood vessel near the heart$

    0ymph nodes and what they do

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    0ymph vessels route lymph fluid through nodes throughout the body$ 0ymph nodes are small structures that work as

    filters for harmful substances$ They contain immune cells that can help fight infection by attacking and destroying

    germs that are carried in through the lymph fluid$

    There are hundreds of lymph nodes throughout the body$ Each lymph node filters the fluid and substances picked up

    by the vessels that lead to it$ 0ymph fluid from the fingers, for instance, works its way toward the chest, oining fluid

    from the arm$ This fluid may filter through lymph nodes at the elbow, or those under the arm$ luid from the head,

    scalp, and face flows down through lymph nodes in the neck$ *ome lymph nodes are deep inside the body, such as

    between the lungs or around the bowel, to filter fluid in those areas$ The lymph fluid slowly flows in from all around the

    body, making its way back to the chest$ 6t the end of its ourney, the filtered fluid, salts, and proteins are dumped back

    into the bloodstream$

    *wollen lymph nodes

    ?hen thereAs a problem, such as infection, inury, or cancer, the node or the group of lymph nodes in that area may

    swell or enlarge as they work to filter out the BbadC cells$ This may be called lymphadenopathy+0(-ad-uh-N!-uh-

    thee/$ *wollen lymph nodes tell you that something is not right, but other symptoms help pinpoint the problem$ or

    instance, ear pain, fever, and enlarged lymph nodes near your ear are clues that you may have an ear infection or

    cold$

    *ome areas where lymph nodes commonly swell are in the neck, groin, and underarms$ (n most cases, only one area

    of nodes swells at a time$ ?hen more than one area of lymph nodes is swollen itAs called generalized

    lymphadenopathy$ *ome infections +such as strep throat and chicken po9/, certain medicines, immune system

    diseases, and cancers like lymphomaandleukemiacan cause this kind of swelling$ The health care provider will look

    for more information to figure out the cause of the swelling$ 0ymph node swelling is often caused by something other

    than cancer$

    ancer in the lymph nodes

    ancer can appear in the lymph nodes in % waysD it can either start there or it can spread there from somewhere else$

    ancer that starts in the lymph nodes is called lymphoma$ ou can read more about lymphoma in Hodgkin

    Diseaseand Non-Hodgkin Lymphoma$

    ore often, cancer starts somewhere else and then spreads to lymph nodes$ That is the focus of this section$

    ow does cancer spread to lymph [email protected]

    ancer can spread from where it started +the primary site/ to other parts of the body$

    ?hen cancer cells break away from a tumor, they can travel to other areas of the body through either the bloodstream

    or the lymph system$ ancer cells can travel through the bloodstream to reach distant organs$ (f they travel through

    the lymph system, the cancer cells may end up in lymph nodes$ Either way, most of the escaped cancer cells die or

    are killed before they can start growing somewhere else$ ;ut one or two might settle in a new area, begin to grow, and

    form new tumors$ This spread of cancer to a new part of the body is called metastasis$

    (n order for cancer cells to spread to new parts of the body, they have to go through several changes$ They first haveto become able to break away from the original tumor and then attach to the outside wall of a lymph vessel or blood

    vessel$ Then they must move through the vessel wall to flow with the blood or lymph to a new organ or lymph node$

    http://www.cancer.org/cancer/lymphoma/indexhttp://www.cancer.org/cancer/lymphoma/indexhttp://www.cancer.org/cancer/leukemia/indexhttp://www.cancer.org/cancer/leukemia/indexhttp://www.cancer.org/ssLINK/hodgkin-disease-detailed-guide-tochttp://www.cancer.org/ssLINK/hodgkin-disease-detailed-guide-tochttp://www.cancer.org/ssLink/non-hodgkin-lymphoma-detailed-guide-tochttp://www.cancer.org/cancer/lymphoma/indexhttp://www.cancer.org/cancer/leukemia/indexhttp://www.cancer.org/ssLINK/hodgkin-disease-detailed-guide-tochttp://www.cancer.org/ssLINK/hodgkin-disease-detailed-guide-tochttp://www.cancer.org/ssLink/non-hodgkin-lymphoma-detailed-guide-toc
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    ?hen cancer grows inside lymph nodes, it usually affects the lymph nodes near the tumor itself$ These are the nodes

    that have been doing most of the work to filter out or kill the cancer cells$

    ow is cancer in lymph nodes [email protected]

    =ormal lymph nodes are tiny and can be hard to find, but when thereAs infection, inflammation, or cancer, the nodes

    can get larger$ Those near the bodyAs surface often get big enough to feel with your fingers, and some can even be

    seen$ ;ut if there are only a few cancer cells in a lymph node, it may look and feel normal$ (n that case, the doctor

    must check for cancer by removing all or part of the lymph node$

    ?hen a surgeon operates to remove a primary cancer, one or more of the nearby +regional/ lymph nodes may be

    removed as well$ emoval of one lymph node is called a biopsy$ ?hen many lymph nodes are removed, itAs

    calledlymph node sampling orlymph node dissection$ ?hen cancer has spread to lymph nodes, thereAs a higher risk

    that the cancer might come back after surgery$ This information helps the doctor decide whether more treatment,

    likechemoorradiation, might be needed aftersurgery$

    &octors may also take samples of one or more nodes using needles$ )sually, this is done on lymph nodes that are

    enlarged$ This is called a needle biopsy$ The tissue thatAs removed is looked at under the microscope by a pathologist

    +a doctor who diagnoses illness using tissue samples/ to find out if there are cancer cells in it

    )nder the microscope, any cancer cells in the nodes look like the cancer cells from the primary tumor$ or instance,

    when breast cancer spreads to the lymph nodes, the cells in the nodes look like breast cancer cells$ The pathologist

    prepares a report, which details what was found$ (f a node has cancer in it, the report describes what it looks like and

    how much was seen$

    &octors may also use scans or other imaging tests to look for enlarged nodes that deep in the body$ or more on this,

    see Imaging (Radiology) Tests$ 2ften, enlarged lymph nodes near a cancer are assumed to contain cancer$

    ?hat does it mean if thereAs cancer in my lymph [email protected]

    (t depends$ *ometimes there are so few cancer cells in the node that the pathologist must use special tests to find

    them$ (n the case of a very few cancer cells in a lymph node, it may not change the treatment plan at all$

    (f thereAs a lot of cancer in a node, the large mass can be seen easily$ (f the cancer is growing out of the lymph node

    through the layer of connective tissue on the outside +called the capsule/, itAs called etracapsular etension$

    ore cancer in the nodes may mean that the cancer is fast growing andFor more likely to spread to other places in the

    body$ ;ut if nearby lymph nodes are the only other place cancer is found beyond the main +primary/ site, surgery to

    remove the main tumor and the nearby lymph nodes may be able to get rid of it all$

    ancer that has spread to nodes further away from the primary cancer will more likely need e9tra treatment with

    chemo or radiation$

    ancer in nodes affects cancer stage

    Treatment of cancer is based on the type of cancer a person has, and the stage of the cancer$ &octors use a system

    to assign a stage to the cancer$ The most common staging system is the T= system$ The T in T= stands for tumor,

    the stands for metastasis, and the = stands for lymph nodes$ (f thereAs no cancer found in the lymph nodes near the

    cancer, the = is assigned a value of G$ (f nearby or distant nodes show cancer, the = is assigned a number such as ",

    % or sometimes 3, depending on how many nodes are affected, how much cancer is in them, how large they are, and

    where they are$

    http://www.cancer.org/ssLINK/treatment-and-side-effects-landinghttp://www.cancer.org/ssLINK/treatment-and-side-effects-landinghttp://www.cancer.org/ssLINK/chemotherapy-landinghttp://www.cancer.org/ssLINK/radiation-landinghttp://www.cancer.org/ssLINK/radiation-landinghttp://www.cancer.org/ssLINK/surgery-treatment-tochttp://www.cancer.org/ssLINK/surgery-treatment-tochttp://www.cancer.org/ssLINK/imaging-radiology-tests-tochttp://www.cancer.org/ssLINK/treatment-and-side-effects-landinghttp://www.cancer.org/ssLINK/chemotherapy-landinghttp://www.cancer.org/ssLINK/radiation-landinghttp://www.cancer.org/ssLINK/surgery-treatment-tochttp://www.cancer.org/ssLINK/imaging-radiology-tests-toc
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    6 cancer with lower T= numbers is usually easier to treat and has a better outlook for survival$ or instance, a

    cancer with T", =G, G, would be a cancer that was found very early, before it spread$ The T" would mean a small

    tumor, the =G means that no nodes are involved, and the G means that no metastases were found$ or more

    information on staging, see information about your cancer type, or read !taging$

    Effects of removing lymph nodes

    =odes that have been removed during cancer surgery can leave part of the body without a way to drain off the lymph

    fluid in the affected area$ any of the lymph vessels now run into a dead end where the node used to be, and fluid can

    back up$ This is called lymphedema"and it can become a life-long problem$ The more lymph nodes that are removed,

    the more likely it is to occur$

    /ttp0.ane+.o+gane+ane+&asisl4mp/5nodes5and5ane+

    http://www.cancer.org/Cancer/ShowAllCancerTypes/indexhttp://www.cancer.org/ssLINK/staginghttp://www.cancer.org/ssLINK/lymphedema-landinghttp://www.cancer.org/ssLINK/lymphedema-landinghttp://www.cancer.org/cancer/cancerbasics/lymph-nodes-and-cancerhttp://www.cancer.org/Cancer/ShowAllCancerTypes/indexhttp://www.cancer.org/ssLINK/staginghttp://www.cancer.org/ssLINK/lymphedema-landinghttp://www.cancer.org/cancer/cancerbasics/lymph-nodes-and-cancer