tugas mandiri ske 1 muskulo.docx

7/24/2019 Tugas mandiri ske 1 muskulo.docx

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SATRIYO MADIPURWO FKB YARSI 2013

1102013265

TUGAS MANDIRI

LO 1. M.M. ANATOMI PERSENDIAN

1.1 MAKRO

Siste !s"!#$s"e#et%# &%'% %(!si% te)'i)i '%)i t!#%(*+ $t$t '%( &e)se('i%(

,'i-%(t! $#e te('$(+ #i*%e( '%( t!#%(* )%/%(. Siste i(i e!(*"i("%( A('%

!(t!" '!'!"+ -e)'i)i+ -e)%#%( %t%! e#%"!"%( "e*i%t%( #%i((% '%#% "ei'!&%(

se%)i%)i. Se#%i( se-%*%i &e(!(%(* '%( &e-e(t!" t!-!+ t!#%(* !*% -e)4!(*si

se-%*%i &e#i('!(* $)*%( '%#%. Te&%t &e)te!%( 2 t!#%(* %'%#% &e)se('i%(+ %(*

-e)&e)%( '%#% e&e)t%%("%( "e#e(t!)%( "e)%(*"% t!-!. T%(&% &e)se('i%(+ A('%ti'%" !(*"i( -is% e#%"!"%( -e)-%*%i *e)%"%(. Se'%(*"%( %(* -e)4!(*si e(%)i"

t!#%(* &%'% s%%t A('% -e)*e)%" %'%#% $t$t+ %(* e)!&%"%( %)i(*%( e#%sti" %(*

"!%t.

A'% 3 e(is &e)se('i%( %(* 'i-e'%"%( -e)'%s%)"%( %(*"%!%( *e)%"%( %(* 'ii#i"i

Pe)se('i%( Fi-)$s%+ %it! &e)se('i%( %(* ti'%" '%&%t 'i*e)%""%(+ 'i%(% #et%"

t!#%(*t!#%(*(% s%(*%t -e)'e"%t%( '%( %(% 'i&is%"%( $#e se#%&is %)i(*%(

i"%t 4i-)$s%+ $(t$(% s!t!)% 'i %(t%)% t!#%(*t!#%(* te(*"$)%".

Pe)se('i%( K%)ti#%*e($s%+ %it! &e)se('i%( %(* *e)%"%((% te)-%t%s+ 'i%(%

t!#%(*t!#%(*(% 'i!-!(*"%( $#e t!#%(* )%/%( i%#i(+ $(t$(% t!#%(* i*%. Pe)se('i%( Si($7i%#+ %it! &e)se('i%( %(* *e)%"%((% -e-%s+ e)!&%"%( -%*i%(

te)-es%) '%)i &e)se('i%( &%'% t!-! $)%(* 'e/%s%+ $(t$(% se('i -%! '%(

&%(**!#+ si"!t '%( #!t!t+ se('i &%'% t!#%(*t!#%(* %)i t%(*%( '%( "%"i+

&e)*e#%(*%( t%(*%( '%( "%"i.

M%%%% ti&e &e)se('i%(

1. S(%)t)$sis

Si(%)t)t$sis %'%#% &e)se('i%( %(* ti'%" e&e)-$#e"%( &e)*e)%"%(. D%&%t

'i-e'%"%( e(%'i '!% s!t!)% %'%#% te)'%&%t %)i(*%( 4i-)$s% %(* ti&is se"%#i se&e)ti s!t!)% s%*it%#is

'i%(t%)% t!#%(*

s('es$sis %'%#% 'i%(t%)%

t!#%(* te)'%&%t %)i(*%( *i-)$s% se&e)ti

s('es$sis )%'i$!#(%)is

s($(')$sis %'%#%

'i%(t%)% t!#%(* te)'%&%t t!#%(*

)%/%( se&e)ti s&isis

&!-is


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si('e#sis %'%#% s%t! t!#%(* %(* %s!" "e'%#% e#% t!#%(* se&e)ti &%'%

)e$st)! s&e($i'%#e

*%&$sis %'%#% t!#%(* se&e)ti t%('!" %s!" "e '%#% #!-%(* t!#%(* se&e)ti

*i*i '%#% *)%%

2. Di%)t)$sis

Se('i %(* '%&%t -e)*e)%" -e-%s 'ise-!t !*% se('i s($7i%# %(* ei#i"i )$(**% se('i

%(* -e)isi %i)%( s($7i%#+ s!%t! "%&s!# se('i %(* e(%-!(* "e'!% t!#%(* '%(

!!(* t!#%(* &%'% se('i si(&7i%# 'i#%&isis "%)ti#%*$ %)ti!#%).

Di%)t)$sis %'%#% &e)se('i%( %(* e!(*"i("%( te)%'i(% *e)%"%(. D%&%t

'i"e#e&$""%( e(%'i

Se('i &e#!)! &e)se('i%( %(* e!(*"i("%( &e)*e)%"%( "e se*%#% %)%.

8$(t$ !-!(*%( t!#%(* #e(*%( %t%s 'e(*%( t!#%(* -e#i"%t.

Se('i &e#%(% &e)se('i%( %(* e!(*"i("%( -e-e)%&% *e)%"%( )$t%si+ (%!(

ti'%" "e se*%#% %)%. 8$(t$ !-!(*%( t!#%(* te#%&%" t%(*%( '%( %)i t%(*%(.

Se('i &!t%) &e)se('i%( %(* e!(*"i("%( *e)%"%( -e)&!t%) ,)$t%si. 8$(t$

!-!(*%( t!#%(* te(*"$)%" 'e(*%( t!#%(* -e#%"%(* I ,%t#%s

Se('i #!(!)9*ese) &e)se('i%( %(* e!(*"i("%( *e)%" )$t%si &%'% s%t!

-i'%(* '%t%). 8$(t$ !-!(*%( t!#%(* &e)*e)#%(*%( "%"i.

Se('i e(*se# &e)se('i%( %(* e!(*"i("%( *e)%"%( s%t! %)%. 8$(t$ se('i

si"! %(t%)% t!#%(* #e(*%( %t%s '%( t!#%(* %st%.

3. A4i%)t$sis

&e)se('i%( %(* 'i!-!(*"%( $#e %)i(*%( t!#%(* )%/%( sei(**% e!(*"i("%(

te)%'i(% se'i"it *e)%"%(

Si('es$sis T!#%(* 'i!-!(*"%( $#e %)i(*%( i"%t se)%-!t '%( #i*%e(.

8$(t$&e)se('i%( %(t%)% 4i-!#% '%( ti-i%.

Si4isis T!#%(* 'i!-!(*"%( $#e %)i(*%( t!#%(* )%/%( %(* -e)-e(t!" se&e)i

%")%. 8$(t$ !-!(*%( %(t%)% )!%s)!%s t!#%(* -e#%"%(*.

Si&%i 'i%)t)$sis -e)7%)i%si '%#% st)!"t!)+ te)*%(t!(* se('i(%. Tet%&i &%'% !!(% si&%i

i(i 'i-e(t!" $#e '!% -%*i%( #%&is%( se('i 4i)-)$s% #!%) '%( #%&is%( si($7i%#

'i'%#%(%.

1.2 MIKRO

1.3 FUNGSI ALAT GERAK

LO 2. M.M. METABOLISME DAN SEKRESI ASAM URAT

As% !)%t e)!&%"%( sis%sis% et%-$#ise :%t &!)i( %(* -e)%s%# '%)i %"%(%( %(*

'i"$(s!si sese$)%(*. I% !*% '%&%t -e)%s%# '%)i %si# s%&i(* &ee%%( se#se# '%#%

'%)%.

P%'% t!-! %(!si% se%t+ %s% !)%t %"%( 'i"e#!%)"%( '%#% t!-! e#%#!i 4eses ,"$t$)%('%( !)i(. Tet%&i "%#%! *i(%# ti'%" %&! e(*e#!%)"%( %s% !)%t+ %"% "%'%)(% 'i '%#%


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'%)% %"%( e(i(*"%t. As% !)%t %(* -e)#e-i %"%( te)"!&!# &%'% &e)se('i%(+ sei(**%

e(e-%-"%( )%s% (e)i %t%! -e(*"%".

S%#% s%t! %s%# !#% %s% !)%t e(i(*"%t %'%#% sis%sis% et%-$#ise :%t &!)i( %(* -e)%s%#

'%)i %"%(%( %(* 'i"$(s!si. Seti%& %"#!" i'!&+ te)%s!" t!-!%( '%( e/%(+ &%sti

e(*%('!(* &!)i(. Dei"i%( !*% %(!si%. Keti"% %(!si% e(*"$(s!si &%(*%( (%-%ti%!&!( &%(*%( e/%(i+ %"% :%t te)se-!t %"%( -e)&i('% "e t!-! %(!si%. De(*%(

'ei"i%(+ "%'%) &!)i( '%#% t!-! %"i( -e)t%-%. A&%#%*i &!)i( !*% '%&%t -e)%s%# '%)i

%si# &e)!s%"%( se#se# t!-! %(* te)%'i se%)% ($)%#+ %t%! %"i-%t &e(%"it&e(%"it

te)te(t!.

As% !)%t 'i4i#t)%si e#%#!i *#$e)!#!s se%)% -e-%s+ 'i)e%-s$)-si s%-i# 'ise")esi e#%#!i

t!-!#i &)$;i%#+ '%( )e%-s$)-si te)%'i #%*i 'i -%*i%( t!-!#i 'ist%#+ sei(**% '%#% "e%'%%(

($)%# &)$ses e"s")esi "e '%#% !)i( te)%'i s%(*%t e4isie(. Se")esi t!-!#e) *i(%# -e)t%-%

se%)% 4%%#%( &%'% &%sie( 'e(*%( %si'$sis &%'% 'i%-etes+ "et$%si'$sis+ "e)%!(%( %#"$$#

%t%! s%#isi#%t+ '%( "et$sis "%)e(% $*$" %"%(. Se'%(*"%( )e%-s$)-si %(* -%(%" ,e"s")esi

!)%t -e)"!)%(* te)%'i &%'% &e%"%i%( 'i!)eti" '%( &e(%"it 'i%-etes i(si&i'!s.

,tt&99///.i/%('%)%(s%./e-.i'9e'i%#.&&RITIS

3.1 DEFINISI

A)t)itis G$!t %'%#% s!%t! &)$ses i(4#%%si ,&e-e(*"%"%( %(* te)%'i "%)e(% 'e&$sisi+

'e&$sit9ti-!(%( ")ist%# %s% !)%t &%'% %)i(*%( se"it%) se('i %t%! t$4i. G$!t !*% e)!&%"%(

isti#% %(* 'i&%"%i !(t!" se"e#$&$" *%(**!%( et%-$#i" %(* 'it%('%i 'e(*%( e

(i(*"%t(% "$(se(t)%si %s% !)%t.

3.2 ETIOLOGI

A)t)itis G$!t 'ise-%-"%( $#e e(i(*"%t(% %s% !)%t %(* e#e-ii "%'%) ($)%#. P%'%

&)i% "%'%) ($)%# %s% !)%t 'i-%/% ? *9'#+ se'%(*"%( &%'% /%(it% "%'%) %s% !)%t

'i-%/% 6 *9'#.

As% U)%t %'%#% %si# &)$'!"si $#e t!-!+ e)!&%"%( %si# %"i) et%-$#ise &!)i(. P!)i(

%'%#% &)$tei( %(* te)%s!" *$#$(*%( (!"#e$ &)$tei(.

P!)i( 'i'%&%t '%)i %"%(%(se#%i( it! !*% -e)%s%# '%)i &e(*%(!)%( se#se# t!-! %(* s!'%

t!%.

Pe-!%t%( %t%! si(tesis &!)i( !*% -is% 'i#%"!"%( $#e t!-! se('i)i '%)i -%%(-%%(

se&e)ti 8O2+ *#!t%i(e+ *#isi(+ %s% %s&%)t%t '%( %s% 4$#%t.

Di'!*% %si# et%-$#ise &!)i( 'i%(*"!t "e %ti+ #%#! e(*%#%i $"si'%si e(%'i %s% !)%t+

'%( "e#e-i%( %s% !)%t 'i-!%(* e#%#!i *i(%# #e/%t !)i(e '%( !s!s.

Pe(e-%- ti(**i(% %s% !)%t '%#% '%)% i(**% te)%'i i&e)!)isei% %'% -e-e)%&% %it!
http://www.iwandarmansjah.web.id/medical.php?id=335http://www.iwandarmansjah.web.id/medical.php?id=335


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P)$'!"i %s% !)%t '%#% t!-! e(i(*"%t 'ise-%-"%( $#e

%'%(% *%(**!%( et%-$#ise &!)i( -%/%%(

"e#%i(%( &e-%/% si4%t %t%! *e(

"e#e-i%( e(*"$s!si %"%( -e)"%'%) &!)i( ti(**i se&e)ti

'%*i(*+ e)$%(+ "e&iti(*+ "e)%(*+ "e!+ "%%(* t%(%+ -%%+ -!is. &e(%"it se&e)ti #e!"ei% ,"%("e) se# '%)% &!ti+ "e$te)%&i+ )%'i$te)%&i

Pe-!%(*%( %s% !)%t s%(*%t -e)"!)%(* -is% 'ise-%-"%( %(t%)% #%i(

i(! $-%t te)te(t! ,%(ti TB9&i):i(%i'+ 'i!)eti+ s%#isi#%t

'%#% "e%'%%( "e#%&%)%(9 &!%s%+ 'iet %(* te)#%#! "et%t

"e)%!(%(

$#% )%*% te)#%#! -e)%t

e(i(*"%t(% "%'%) "%#si! '%)% %"i-%t &e(%"it i&e)&%)%ti)$i'+ !(*"i( !*%

i&e)ti)$i'

i&e)te(si

*%*%# *i(%#

Pe(e-%- #%i((% %(* e(e-%-"%( ti(**i(% "%'%) %s% !)%t '%#% '%)% 9 i&e)!)isei%

)%s '%( "e*e!"%( 9 $-esit%s.

M%"%(%( %(* -%(%" e(*%('!(* &!)i(

@e)$%(+ -%%+ e(t*%+ '!)i%(+ '%*i(*+ %"%(%( #%!t+ e#i($ 9 e&i(*+ e(*"$#+ &et%i+ t%&e+

s%)'e(+ s%(t%(+ %#&!"%t+ *$)e(*%(+ %"$$#

3.3 EPIDEMIOLOGI

G$!t %)t)itis -%(%" 'i'e)it% $#e #%"i#%"i '%( /%(it% &$ste($&%!se+ %)%(*

&%'% #%"i#%"i se-e#! )e%% '%( /%(it% se-e#! e($&%!se. P)e7%#e(si *$!t e(i(*"%t

sei)i(* 'e(*%( -e)t%-%(% !si% %it! e(i(*"%t s%&%i &%'% #%"i#%"i 'e(*%( !si%

#e-i '%)i C0 t%!( '%( 6 &%'% /%(it%. K$(se(t)%si se)! !)%t &%'% #%"i#%"i

#e-i -es% ) 1 *9'L'%)i&%'% /%(it%+ tet%&i sete#% e($&%!se #e7e# se)! !)%t &%'%

/%(it% e(i(*"%t sei(**% e('e)!(* s%% 'e(*%( #%"i#%"i. Pe)-e'%%( se)! !)%t &%'%

#%"i#%"i '%( /%(it% i(i "%)e(% &e(*%)! $)$( est)$*e((%. P%'% s%%t &)ee($&%!se

$)$( est)$*e( i(i e(e-%-"%( "#i)e(s %s% !)%t &%'% *i(%# #e-i e4isie(. Pe(i(*"%t%(

&)e7%#e(si *$!t !*% -is% 'ise-%-"%($#e 'iet '% ( #i4e st#e %(* "!)%(* te)"$(t)$#+

$-esit%s+ i&e)te(si si(')$% et%-$#i"+t)%(s%(t%si $)*%(+ e(i(*"%t(%

&e(** !(%%( $- %t$-%t%( se&e)ti s%#i#%te '%( 'i!) eti" '$sis )e('%.

3. PATOFISIOLOGI

Pe(i(*"%t%( "%'%) %s% !)%t se)! '%&%t 'ise-%-"%( $#e &e-e(t!"%( -e)#e-i%(

%t%! &e(!)!(%( e"s)esi %s% !)%t+ %t%!&!( "e'!%(%. As% !)%t %'%#% &)$'!" %"i)

et%-$#ise &!)i(. Se%)% ($)%#+ et%-$#ise &!)i( e(%'i %s% !)%t '%&%t

'ite)%(*"%( se-%*%i -e)i"!t


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Si(tesis &!)i( e#i-%t"%( '!% %#!)+ %it! %#!) de novo '%( %#!) &e(*e%t%( ,salvage

pathway.

1. @%#!) 'e ($7$ e#i-%t"%( si(tesis &!)i( '%( "e!'i%( %s% !)%t e#%#!i &)e"!)s$)

($(&!)i(. S!-st)%t %/%#(% %'%#% )i-$s%54$s4%t+ %(* 'i!-% e#%#!i se)%(*"%i%(

:%t %(t%)% e(%'i (!"#e$ti'% &!)i( ,%s% i($si(%t+ %s% *!%(i#%t+ %s% %'e(i#%t.

@%#!) i(i 'i"e('%#i"%( $#e se)%(*"%i%( e"%(ise %(* "$e"s+ '%( te)'%&%t-e-e)%&% e(:i %(* e&e)e&%t )e%"si %it! 54$s4$)i-$si#&i)$4$s4%t ,PRPP

si(tet%se '%( %i'$4$s4$)i-$si#t)%(s4e)%se ,%i'$PRT. Te)'%&%t s!%t! e"%(ise

i(i-isi !&%( -%#i" $#e (!"#e$ti'% &!)i( %(* te)-e(t!"+ %(* 4!(*si(% !(t!"

e(e*% &e-e(t!"%( %(* -e)#e-i%(.

2. @%#!) &e(*e%t%( %'%#% %#!) &e-e(t!"%( (!"#e$ti'% &!)i( e#%#!i -%s% &!)i(

-e-%s(%+ &ee%%( %s% (!"#e%t+ %t%! %s!&%( %"%(%(. @%#!) i(i ti'%" e#%#!i :%t

:%t &e)%(t%)% se&e)ti &%'% %#!) 'e ($7$. B%s% &!)i( -e-%s ,%'e(i(+ *!%(i(+

i&$;%(ti( -e)"$('e(s%si 'e(*%( PRPP !(t!" e-e(t!" &)e"!)s$) (!"#e$ti'%&!)i( '%)i %s% !)%t. Re%"si i(i 'i"%t%#isis $#e '!% e(:i i&$;%(ti( *!%(i(

4$s4$)i-$si#t)%(s4e)%se ,>GPRT '%( %'e(i( 4$s4$)i-$si#t)%(s4e)%se ,APRT.

As% !)%t %(* te)-e(t!" '%)i %si# et%-$#ise &!)i( %"%( 'i4i#t)%si se%)% -e-%s $#e

*#$e)!#!s '%( 'i)es$)&si 'i t!-!#!s &)$"si%# *i(%#. Se-%*i%( "ei# %s% !)%t %(*

'i)es$)&si "e!'i%( 'ie"s")esi"%( 'i (e4)$( 'ist%# '%( 'i"e#!%)"%( e#%#!i !)i(.

P%'% &e(%"it *$!t%)t)itis+ te)'%&%t *%(**!%( "eseti-%(*%( et%-$#ise ,&e-e(t!"%(

'%( e"s")esi '%)i %s% !)%t te)se-!t+ e#i&!ti

1. Pe(!)!(%( e"s")esi %s% !)%t se%)% i'i$&%ti"


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2. Pe(!)!(%( e"s)e"si %s% !)%t se"!('e)+ is%#(% "%)e(% *%*%# *i(%#

3. Pe(i(*"%t%( &)$'!"si %s% !)%t+ is%#(% 'ise-%-"%( $#e t!$) ,%(*

e(i(*"%t"%( cellular turnover %t%! &e(i(*"%t%( si(tesis &!)i( ,"%)e(% 'e4e" e(:i

e(:i %t%! e"%(ise !&%( -%#i" i(i-isi %(* -e)&e)%(

. Pe(i(*"%t%( %s!&%( %"%(%( %(* e(*%('!(* &!)i(

Pe(i(*"%t%( &)$'!"si %t%! %-%t%( e"s")esi %"%( e(i(*"%t"%( "%'%) %s% !)%t '%#%

t!-!. As% !)%t i(i e)!&%"%( s!%t! :%t %(* "e#%)!t%((% s%(*%t )e('% sei(**%

e('e)!(* e-e(t!" ")ist%#. Pe(i-!(%( %s% !)%t &%#i(* -%(%" te)'%&%t 'i se('i

'%#% -e(t!" ")ist%# $($(%t)i! !)%t. Me"%(ise(% i(**% s%%t i(i %si -e#!

'i"et%!i.

A'%(% ")ist%# $($(%t)i! !)%t i(i %"%( e(e-%-"%( i(4#%%si e#%#!i -e-e)%&% %)%

1. K)ist%# -e)si4%t e(*%"ti4"%( siste "$ee( te)!t%% 83% '%( 85%. K$ee(

i(i -e)si4%t "e$t%"ti" '%( %"%( e)e")!t (e!t)$4i# "e %)i(*%( ,se('i '%( e-)%(si($7i!. F%*$sit$sis te)%'%& ")ist%# ei! &e(*e#!%)%( )%'i"%# -e-%s t$"si" '%(

#e!"$t)ie(+ te)!t%% #e!"$t)ie( B. Ke%ti%( (e!t)$4i# e(e-%-"%( "e#!%)(% e(:i

#is$s$ %(* 'est)!"ti4.

2. M%")$4%* %(* !*% te)e")!t &%'% &e(*e('%&%( ")ist%# !)%t '%#% se('i %"%(

e#%"!"%( %"ti7it%s 4%*$sit$sis+ '%( !*% e(*e#!%)"%( -e)-%*%i e'i%t$)

&)$i(4#%%si se&e)ti IL1+ IL6+ ILC+ '%( TNF. Me'i%t$)e'i%t$) i(i %"%(

e&e)"!%t )es&$(s &e)%'%(*%(+ 'i s%&i(* it! e(*%"ti4"%( se# si($7i! '%( se#

t!#%(* )%/%( !(t!" e(*%si#"%( &)$te%se. P)$te%se i(i %"%( e(e-%-"%( e'e)%

%)i(*%(.


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Pe(i-!(%( ")ist%# !)%t '%( se)%(*%( %(* -e)!#%(* %"%( e(e-%-"%( te)-e(t!"(%

e('%&%( se&e)ti "%&!) &!ti %(* 'ise-!t t$4i9t$4!s ,tophus 'i t!#%(* )%/%( '%( "%&s!#

se('i. Di te&%t te)se-!t e('%&%( %"%( ei! )e%"si &e)%'%(*%( *)%(!#$%t$s%+%(* 'it%('%i 'e(*%( %ss% !)%t %$)4 ,")ist%# 'i"e#i#i(*i $#e %")$4%*+ #i4$sit+

4i-)$-#%s+ '%( se# )%"s%s% -e('% %si(*. Pe)%'%(*%( ")$(is %(* &e)siste( '%&%t

e(e-%-"%( 4i-)$sis si($7i!+ e)$si t!#%(* )%/%(+ '%( '%&%t 'ii"!ti $#e 4!si se('i

,%("i#$sis. T$4!s '%&%t te)-e(t!" 'i te&%t #%i( ,is%#(% te('$(+ -!)s%+ %)i(*%(

#!(%". Pe(*e('%&%( ")ist%# %s% !)%t '%#% t!-!#!s *i(%# '%&%t e(*%"i-%t"%(

&e(!-%t%( '%( (e4)$&%ti *$!t.

,tt&99seti$%'%7e)is./$)'&)ess.$9%)ti"e#"e'$"te)%(9&%t$4isi$#$*i*$!t%)t)itis9

3.5 MANIFESTASI KLINIS

T%%& I i&e)!)isei% %sit$%ti" -e#! e(!(!"%( *e%#% se#%i( &e(i(*"%t%(

%s% !)%t se)!

T%%& II %)t)itis *$!t %"!t te)%'i &e-e(*"%"%( e('%'%" '%( (e)i #!%) -i%s%+

se('ise('i #%i( '%&%t te)se)%(* te)%s!" se('i %)i%)i t%(*%(+ #!t!t %t% "%"i+ &e)*e#%(*%(

t%(*%( '%( si"!

T%%& III i(te))iti%#

T%%& I *$!t ")$(is

3.6 DIAGNOSIS DAN DIAGNOSIS BANDING

Di%*($s% 'ite*%""%( -e)'%s%)"%( %(%(es%+ &ee)i"s%%( "#i(is '%( #%-$)%t$)i!. Di%*($sis

%(* 'e4i(iti49gold standard+ %it! 'ite!"%((% ")ist%# !)%t ,MSU 'i %i)%( se('i %t%!

t$4!s. U(t!" e!'%"%( &e(e*%"%( 'i%*($sis arthritis*$!t %"!t+ '%&%t 'i*!(%"%( ")ite)i%

'%)i A8R ,American College$4 Re!%t$#$*

A. Dite!"%((% ")ist%# !)%t 'i %i)%( se('i+ %t%!

B. A'%(% t$4!s %(* -e)isi ")ist%# !)%t+ %t%!8. Te)'%&%t 6 '%)i 11 ")ite)i% "#i(is+ #%-$)%t$)is '%( )%'i$#$*is -e)i"!t


8/12

1. Te)'%&%t #e-i '%)i s%t! "%#i se)%(*%( %)t)itis %"!t

2. I(4#%%si %"si%# te)%'i '%#% /%"t! s%t! %)i

3. A)t)itis $($%)ti"!#e)

. Kee)%%( &%'% se('i

5. Be(*"%" '%( (e)i &%'% MTP1

6. A)t)itis !(i#%te)%# %(* e#i-%t"%( MTP1?. A)t)itis !(i#%te)%# %(* e#i-%t"%( se('i t%)s%#

C. Ke!)i*%%( %'%(% t$4!s

. Pe-e(*"%"%( se('i %(* %siet)is

10. Kist% s!-"$)ti"%# t%(&% e)$si

11. K!#t!) i")$$)*%(ise (e*%ti7 &%'% %i)%( se('i

Di%*($sis B%('i(*

Be)'%s%)"%( "e#!%( '%( &ee)i"s%%( #%(t%( se&e)ti (* ')e(%(%"%( $#e'$"te)+ %"%

'%&%t 'i"et%!i 'i%*($sis -%('i(* '%)i se(%)i$ 'i %t%s %'%#%&e(%"it&e(%"it

)e%ti".Pe(%"it )e%ti" ei#i"i 2 e(is "eti'%"%&!%(+ %it!"eti'%"%&!%( 4isi" '%(s$i%#. 8$(t$ '%)i "eti'%"%&!%( 4isi" %'%#%*%(**!%( e-!(*"!"+ -e)%#%( '%(

e(*%(*"%t. ,IPD "eti'%"%&!%(te)se-!t '&%t "it% te!"%( 'i se(%)i$+ sei(**%

'i%*($sis -%('i(*(% %'%#%1.

$ste$%)t)itis e)!&%"%( &e(%"it se('i %(* &%#i(* -%(%" '!&%i+&)e7%#e(si(%

e(i(*"%t sei)i(* -e)t%-%(% !si%. #e-i '%)i C5 &%sie(e(*e#!"%( te)*%(**!

%"ti7it%s+ se&e)ti s!s% (%i" t%(**%+ -e)%#%( '%(e(e"!" #!t!t.2.

)e!%t$i' %)t)itis &e(%"it %!t$i!( %(* 'it%('%i $#e si($7itise)$si4. '%&%" te)se)i(*

'%)i &e(%"it i(i %'%#% "e)!s%"%( se('i '%("e%%t%(.3.

%)t)itis *$!t &e(%"it %)t)itis *$!t 'i%"i-%t"%( $#e "%)e(% 'e&$sit K)ist%#$($s$'i!

!)%t 'i %)i(*%(. 'e&$sit -e)%s%# '%)i 8%i)%( E"st)% Se#!#e)%(* s!'% e(*%#%i

s!&e)s%t!)%si '%)i %si# %"i) et%-$#is &!)i(%it! %s% !)%t. "e#!%( )e%ti" -e)!&% (e)i+

"%"!+ -e(*"%" se('i. &%'%/%(it% %)%(* te)%'i se-e#! $($&$!se..

$ste$&$)$sis e)!&%"%( &e(%"it sistei" 'it%('%i $#e &e(!)!(%('e(sit%s %ss% t!#%(*

'%( &e)-!)!"%( i")$%)site"t!) t!#%(* sei(**%%ss% t!#%(* %'i )%&! '%( !'% &%t%.

4%t$) )isi"$ !!)+ #%%$($&$!se '%( "%'%) est)$*e( %(* )e('%. ,IPD&%t$4isi$#$*i $ste$%)t)itis

3.? PENATALAKSANAAN

NSAID DAN URI8OSURI8,FARMAKOTERAPI DAN NON FARMAKOTERAPI

I. NSAID

NSAID ,N$( Ste)$i'%# A(tii(4#%%t$) D)!*s e)!&%"%( s!%t! *$#$(*%( $-%t %(*

ei#i"i "%si%t %(%#*esi" ,&e)e'% (e)i+ %(ti&i)eti" ,&e(!)!( &%(%s+ '%(

%(tii(4#%%si ,%(ti )%'%(*. Isti#% ($( ste)$i' 'i*!(%"%( !(t!" e-e'%"%( e(is

$-%t$-%t%( i(i 'e(*%( ste)$i'+ %(* !*% ei#i"i "%si%t se)!&%. O-%t i(i 'i*!(%"%(

se%)% #!%s 'i se#!)! '!(i% !(t!" e(*%t%si (e)i %(* %"!t %!&!( %(* ")$(i".

NSAID e-e(t!" "e#$&$" %(* -e)-e'%-e'% se%)% "ii%+ tet%&i se!%(%e&!(%i "e%&!%( !(t!" e(*%-%t si"#$$"si*e(%se ,8OH. E(:i


9/12

#$$;*e(%se i(i -e)&e)%( '%#% e%! &e-e(t!"%( &)$st%*#%('i( '%(

t)$-$"s%( '%)i %s% %)%"i'$(%t. O-%t i(i )e#%ti4 %%( i"% 'i*!(%"%( '%#% %(*"%

/%"t! &e('e"+ (%!( e4e" s%&i(* -!)!" '%&%t te)%'i -i#% 'i*!(%"%( '%#% %(*"%

/%"t! &%(%(* %&%#%*i t%(&% &e(*%/%s%( '%)i te(%*% "ese%t%(.

A'% 3 e(is $-%t *$#$(*%( NSAID

1.8OH1 se#eti7e i(i-it$). Y%it! $-%t *$#$(*%( NSAID %(* -e"e)% e(*%-%t

%"ti7it%s 8OH1+ $(t$(% %s% e4e(%%t.

2.8OH2 se#eti7e i(i-it$). G$#$(*%( $-%t NSAID %(* e(*%-%t %"ti7it%s 8OH

2+ $(t$(% e#e$;i-+ et$)i$;i- '%( 7%#'e$;i-

3.N$(se#eti7e 8OH i(i-it$). O-%t NSAID *$#$(*%( i(i e(*%-%t %"ti7it%s 8OH

1 '%( 8OH2+ $(t$(% %s&i)i( '%( &%)%set%$#.

E4e" s%&i(* '%)i &e(**!(%%( NSAID %(* &%#i(* !! '%( &%#i(* se)i(* te)%'i%'%#% *%(**!%( *%st)$i(testi(%# se&e)ti !%# '%( 'i%)e. Ge%#% i(i te)!t%% %"i-%t

i)it%si #%-!(* "%)e(% i#%(*(% e4e" &e)#i('!(*%( &)$st%*#%('i( 'i('i(* #%-!(*.

Te)"%'%(* e4e" s%&i(* i(i e(e-%-"%( t!"%" #%-!(* '%( -%"%( #!-%(* i"%

se%"i( &%)%. I)it%si #%-!(* '%&%t -e)si4%t #$"%# %(* e(i-!#"%( 'i4!si "e-%#i

%s% #%-!(* "e !"$s% '%( e(e-%-"%( "e)!s%"%( %)i(*%( '%( !*% -e)si4%t

sistei" e#%#!i %-%t%( -i$si(tesis PGE2 '%( PGI2 '%( '%&%t e(e-%-"%(

&e)'%)%%( #%-!(*.

E4e" s%&i(* #%i( %(* !(*"i( te)%'i %'%#% *%(**!%( 4!(*si t)$-$sit %"i-%t

&e(*%-%t%( -i$si(tesis t)$-$"s%( A2 'e(*%( %"i-%t &e)&%(%(*%( /%"t!&e)'%)%%(. E4e" i(i 'i%(4%%t"%( !(t!" te)%&i &)$4i#%"sis t)$-$e-$#i ,se&e)ti+

st)$"e+ $(t$(% %'%#% %s&i)i(.

Pe(**!(%%( NSAID &%'% %(%"%(%" %(* e(*%#%i 'ei')%si '%&%t e(e-%-"%(

*%*%# *i(%# %"!t. >%-%t%( -i$si(tesis &)$st%*#%('i( PGE2 'i *i(%# e(e-%-"%(

%#i)%( '%)% *i(%# '%( "ee&%t%( 4i#t)%si *#$e)!#!s *i(%# e(%'i -e)"!)%(*.

Sei(**%+ &%s$"%( '%)% %(* -e)"!)%(* &%'% *i(%# e(e-%-"%( -%*i%( *i(%#

se&e)ti %)i(*%( t!-!#%) '%( i(te)siti%# e(%'i &e(e&it%(. @i"% ti'%" e('%&%t

&e)%/%t%( %(* -%i"+ %)i(*%( t!-!#%) '%( i(te)siti%# *i(%# %"%( e(*%#%i "e%ti%(

%)i(*%(.

Obat Dosis Efek sampingGol. Salisilat*Mg salisilatAspirin

Trisilat

2.600 mg atau lebih Telinga menenging!gangguan saluran "ernaatas an gumpalan selarah

Gol. #nole#nometasin $ino"in%

2&'200 mg! ( ) sehari Gangguan sal. erna!gangguan kesaaran! sakitkepala! gangguanpenglihatan

Sulina" $"linori% +00',00 mg! 2 ) sehari -ash kulit! penumpukan"airan! sariaan!hematuria


10/12

Gol. /ra1olephenilbuta1one $a1oli!buta1oliine%

(00',00 mg! 2'+ ) sehari Gangguan sal. erna

Gol. Asam propionate#buprofren $motrin rufen%

3enoprofen "al"ium

400'2.,00 mg! +', )sehari

Gangguan sal. erna

Gol. 5en1otia1inepiro)i"am $felene%

20 mg! ( ) sehari Diare berat an "olitis

II. URI8OSURI8

A'% 2 "e#$&$" $-%t &e(%"it &i)%i+ %it! $-%t %(* e(*e(ti"%( &)$ses i(4#%%si%"!t+

is%#(% "$#"isi(+ 4e(i#-!t%:$(+ $"si4e(%-!t%:$(+ '%( i('$et%si(+ '%( $-%t %(*

e&e(*%)!i "%'%) %s% !)%t+ is%#(% &)$-e(esi'+ %##$&!)i($#+ '%( s!#4i(&i)%:$(.

1. K$#"isi(

A'%#% s!%t! %(tii(4#%%si %(* !(i" %(* te)!t%% 'ii('i"%si"%( &%'% &e(%"it

&i)%i. O-%t i(i e)!&%"%( %#"%#$i' 8$#i! %!t!(%#e+ see(is -!(*% #e#i.

F%)%"$'i(%i"

Si4%t %(ti)%'%(* "$#"isi( s&esi4i" te)%'%& &e(%"it &i)%i '%( -e-e)%&% %)t)itis+

!(t!" )%'%(* !! $-%t i(i ti'%" e4e"ti4. K$#"isi( ti'%" ei#i"i e4e" %(%#*esi.

P%'% &e(%"it &i)%i+ "$#"isi( ti'%" e(i(*"%t"%( e"s")esi+ si(tesis %t%! )%'%(* %s%

!)%t '%#% '%)%. O-%t i(i -e)i"%t%( 'e(*%( &)$tei( i")$t!-!#%) '%( e(e-%-"%(

'e&$#ie)%si '%( e(*i#%(*(% i")$t!-!# 4i-)i#%) *)%(!#$sit '%( se# -e)*e)%"

#%i((%. >%# i(i e(e-%-"%( &e(*%-%t%( i*)%si *)%(!#$sit "e te&%t )%'%(*

sei(**% &e#e&%s%( e'i%t$) %(tii(4#%%si 'ite"%(. K$#"isi( e(e*% &e(*#e&%s%(

*#i"$&)$tei('%)i #e!"$sit &%'% &%sie( *$!t e(e-%-"%( (e)i '%( )%'%(* se('i.

F%)%"$"i(eti"A-s$)-si e#%#!i s%#!)%( e)(% -%i". O-%t i(i 'i'ist)i-!si"%( se%)% #!%s

'%#% %)i(*%( t!-!. K%'%) ti(**i -e)%'% 'i '%#% *i(%#+ %ti+ #i&%+ '%( s%#!)%(

e)(%+ tet%&i ti'%" te)'%&%t 'i '%#% $t$t )%(*"%+ %(t!(*+ '%( $t%". Se-%*i%( -es%)

'ie"s")esi"%( '%#% -e(t!" ti(%+ 1020 e#%#!i !)i(. P%'% &%sie( &e(%"it %ti

#e-i -%(%" e#%#!i !)i(. K$#"isi( '%&%t 'ite!"%( '%#% #e!"$sit '%( !)i(

se'i"it(% !(t!" %)i sete#% s!%t! s!(ti"%( I.

I('i"%si

K$#"isi( e)!&%"%( !(t!" $-%t &i)%i+ $#e "%)e(% it! &e-e)i%( %)!s

'i-e)i"%( see&%t(% &%'% %/%# se)%(*%( '%( 'ite)!s"%( s%&%i *e%#% i#%(* %t%!

ti-!# e4e" s%&i(* %(* e(**%(**!. Bi#% $-%t te)#%#! te)#%-%t+ e4e"ti7it%s(%

"!)%(*. K$#"isi( !*% -e)*!(% !(t!" &)$4i#%"ti" se)%(*%( &e(%"it &i)%i %t%!

e(*!)%(*i -e)%t(% se)%(*%( '%( $-%t i(i !*% '%&%t e(e*% se)%(*%( %(*

'iet!s"%( $#e $-%t !)i"$s!)i" '%( %#$&!)i($#. U(t!" &)$4i#%"sis+ !"!& 'i-e)i"%(

'$sis "ei#.

D$sis "$#"isi( 0+50+6 *9% %t%! 1+2 * se-%*%i '$sis %/%# 'ii"!ti 0+50+6

*92% s%&%i *e%#% &e(%"it i#%(* %t%! *e%#% s%#!)%( e)(% ti-!#. U(t!"

&)$4i#%"sis 'i-e)i"%( 0+51 * se%)i. Pe-e)i%( I 12 * 'i#%(!t"%( 'e(*%( 0+5

* ti%& 122 %. D$sis %(*%( e#e-ii * 'e(*%( s%t! )e*ie( &e(*$-%t%(.

U(t!" e(e*% i)it%si %"i-%t e"st)%7%s%si se-%i"(% #%)!t%( 2 L 'ie(e)"%(

e(%'i 10 L 'e(*%( #%)!t%( *%)% 4%%#.

E4e" S%&i(*


11/12

E4e" s%&i(* %(* &%#i(* se)i(* %'%#% !(t%+ !%#+ '%( 'i%)e+ '%&%t

e(**%(**! te)!t%% 'e(*%( '$sis %"si%#. Bi#% e4e" te)%'i+ &e(*$-%t%( %)!s

'ie(ti"%( /%#%!&!( e4e" te)%&i -e#! te)%&%i. De&)esi s!s! t!#%(*+ &!)&!)%+

(e!)itis &e)i4e)+ i$&%ti+ %(!)i%+ %#$&esi%+ *%(**!%( %ti+ )e%"si %#e)*i+ '%( $#itis

e$)%*i" te)%'i "%)e(% '$sis %(* -e)#e-i%( '%( &%'% &e-e)i%( I+ *%(**!%(

e"s")esi %"i-%t "e)!s%"%( *i(%# '%( "$-i(%si "e%'%%( te)se-!t. K$#"isi( %)!s'i-e)i"%( %ti%ti &%'% &%sie( !si% #%(!t+ #e% %t%! &%sie( 'e(*%( *%(**!%( *i(%#+

"%)'i$7%s"!#%)+ '%( s%#!)%( e)(%.

2. A#$&!)i($#

A#$&!)i($# -e)*!(% !(t!" e(*$-%ti &e(%"it &i)%i "%)e(% e(!)!("%( "%'%)

%s% !)%t. Pe(*$-%t%( %(*"% &%(%(* e(*!)%(*i 4)e"!e(si se)%(*%(+ e(*%-%t

&e-e(t!"%( t$4i+ e$-i#is%si %s% !)%t '%( e(*!)%(*i -es%)(% t$4i. M$-i#is%si

%s% !)%t '%&%t 'iti(*"%t"%( 'e(*%( e-e)i"%( !)i"$s!)i". Ke*!(%%( $-%t i(i

te)!t%% !(t!" e(*$-%ti &i)%i ")$(i" 'e(*%( i(s!4isie(si *i(%# '%( -%t! !)%t '%#%

*i(%#+ tet%&i '$sis %/%# %)!s 'i"!)%(*i. O-%t i(i !*% -e)*!(% !(t!" &e(*$-%t%( &i)%i

se"!('e) %"i-%t $#isitei% 7e)%+ et%%si% e#$i'+ #e!"ei%+ #i4$%+ &s$)i%sis+

i&e)!)isei% %"i-%t $-%t+ '%( )%'i%si.

O-%t i(i -e"e)% 'e(*%( e(*%-%t ;%(ti( $"si'%se+ e(:i !%(* e(*!-%

i&$;%(ti( e(%'i ;%(ti( '%( se#%(!t(% e(%'i %s% !)%t. A#$&!)i($#

e(*%-%t si(tesis &!)i( %(* e)!&%"%( &)e!)s$) ;%(ti(. A#$&!)i($# e(*%#%i

-i$t)%(s4$)%si $#e e(:i ;%(ti( $"si'%se e(%'i %#$;%(ti( %(* %s% &%)!(%

#e-i &%(%(* '%)i&%'% %##$&!)i($#+ $#e "%)e(% it! %##$&!)i($# !"!& 'i-e)i"%( s%t!

"%#i se%)i "%)e(% %s% &%)!(% &e('e".

E4e" s%&i(* %(* se)i(* te)%'i i%#% )e%"si "!#it. Bi#% "ee)%%( "!#it

ti-!#+ $-%t %)!s 'ie(ti"%( "%)e(% *%(**!%( !(*"i( e(%'i #e-i -e)%t.

A##$&!)i($# '%&%t e(i(*"%t"%( 4)e"!e(si se)%(*%( sei(**% se-%i"(% &%'% %/%#

te)%&i 'i-e)i"% "$#"isi(. Se)%(*%( e(*i#%(* sete#% -e-e)%&% -!#%( &e(*$-%t%(.D$sis !(t!" &e(%"it &i)%i )i(*%( 20000 *9%)i+ 00600 * !(t!"

&e(%"it %(* #e-i -e)%t. U(t!" &%sie( %(* *%(**!%( *i(%# '$sis(% !"!& 100

200 *9%)i. U(t!" %(%" 610 t%!( 300 *9%)i '%( 150 *9%)i !(t!" %(%" 'i

-%/% 6 t%!(.

3. P)$-e(esi'

O-%t i(i -e)e4e" e(e*% '%( e(*!)%(*i "e)!s%"%( se('i se)t%

&e-e(t!"%( t$4i &%'% &e(%"it &i)%i+ ti'%" e4e"ti4 !(t!" e(*%t%si se)%(*%( %"!t.

O-%t i(i !*% -e)*!(% !(t!" &e(*$-%t%( i&e!)esei% se"!('e).

E4e" s%&i(* %(* &%#i(* se)i(* %'%#% *%(**!%(* s%#!)%( e)(%+ (e)i

"e&%#%+ '%( )e%"si %#e)*i. G%(**!%( s%#!)%( e)(% #e-i )i(*%( 'i-%('i(*"%(

s!#4i&i)%:$(+ tet%&i %ti%ti &e-e)i%( &%'% &%sie( %(* 'e(*%( )i/%%t !#"!s &e&ti.S%#isi#%t e(*!)%(*i e4e" &)$-e(esi'.

P)$-e(esi' e(*%-%t e"s")esi )e(%# '%)i s!#4i(&i)%:$(+ i('$et%si(+

&e(isi#i(+ PAS+ s!#4$(%i'e+ '%( !*% -e)-%*%i %s% $)*%(i+ sei(**% '$sis $-%t

%)!s 'ises!%i"%( -i#% 'i-e)i"%( -e)s%%%(. D$sis &)$-e(esi' 2 "%#i 250 *9%)i

se#%% sei(**! 'ii"!ti 'e(*%( 2 "%#i 500 *9%)i.

. S!#4i(&i)%:$(

O-%t i(i e(e*% '%( e(*!)%(*i "e#%i(%( se('i '%( t$4i &%'% &e(%"it &i)%i

)$(i" -e)'%s%)"%( %-%t%( )e%-s$)-si t!-!#%) %s% !)%t. K!)%(* e4e"ti4

e(!)!("%( "%'%) %s% !)%t 'i-%('i(*"%( 'e(*%( %##$&!)i($# '%( ti'%" e4e"ti4

e(*%t%si se)%(*%( &i)%i %"!t. O-%t i(i ti'%" -$#e 'i-e)i"%( &%'% &%sie( 'e(*%(

)i/%%t !#"!s &e&ti. A(ei%+ #e!"$&e(i%+ %*)%(!#$sit$sis '%&%t te)%'i. S!#4i(&i)%:$(


12/12

'%&%t e(i(*"%t"%( e4e" i(s!#i( '%( $-%t i&$*#i"ei" $)%# sei(**% %)!s 'i-e)i"%(

-e)s%% 'e(*%( $-%t$-%t%( se&e)ti 4e(i#-!t%:$( '%( $"si4e($-!t%:$(.

D$sis s!#4i(&i):$( 2"%#i 100200 *9%)i+ 'iti(*"%t"%( s%&%i 00C00 *

"e!'i%( 'i"!)%(*i s%&%i '$sis e4e"ti4 i(i%#.

5. Ket$)$#%"

Me)!&%"%( $-%t %(%#*esi &$te( 'e(*%( ee" %(tii(4#%%si se'%(*. A-s$)-si$)%# '%( IM -e)#%(*s!(* e&%t e(%&%i &!(%" '%#% 3050 e(it.

D$sis IM 3060 *+ I 1530 *+ '%( $)%# 530 *.

E4e" s%&i(*(% -e)!&% (e)i 'i te&%t s!(ti"%(+ *%(**!%( s%#!)%( e)(%+

"%(t!"+ &!si(*+ '%( s%"it "e&%#% %(* 'i#%&$)"%( te)%'i "i)%"i)% 2 "%#i %e-$. O-%t

i(i s%(*%t se#e"ti4 e(*%-%t 8OH1+ %"% $-%t i(i %(% 'i%(!)"%( 'i&%"%i ti'%"

#e-i '%)i 5 %)i "%)e(% "e!(*"i(%( t!"%" #%-!(* '%( i)it%si #%-!(* -es%) se"%#i.

6. Et$'$#%"

Me)!&%"%( NSAID "e#$&$" %s% &i)%($"%)-$"si#%t '%( $-%t i(i e)!&%"%(

#e-i se#e"ti4 te)%'%& 8OH2 'i-%('i(*"%( 'e(*%( NSAID !!(%. Et$'$#%"

e(*%-%t -)%'i"i( %(* 'i"et%!i e)!&%"%( s%#% s%t! e'i%t$) &e)%(*s%(*

(e)i.M%s% "e)%(% &e('e" sei(**% %)!s 'i-e)i"%( 3 "%#i se%)i. Be)*!(%

!(t!" %(%#*esi+ &%s%-e'%. D$sis 20000+ 3 "%#i se%)i.

PUSTAKA ,-e#! 'i -!%t ses!%i &!st%"%%(

Dra. Misnadiarly. AS. APU

Puslitbang Biomedis Dan Farmasi, Badan itbang!es

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