Pendahuluan

Penyakit & Kelainan

Kongenital/ Herediter Asthma Hernia diafragmatika Tracheoeosophageal fistule Didapat Infeksi (TB, Bronchitis, empisema, PPOK/COPD, N5A1, SARS, dll) Kanker Paru Skeleosis, Kiposis Trauma Kontusio paru Fraktur costa Ruptur trachea

Obstructive Lung Disease

Aliran udara terbatas
Rate ekspirasi lambat Volume umumnya

normal

Restrictive Lung Disease

Pengembangan paru yang terbatas Terbatasnya volume &

flow rate

Major Determinants of Disease

Diseases of one lung compartment tend to affect the others The lungs are open to the environment, exposing them to

infectious agents, allergens, irritants, & carcinogens Most lung disease is caused by inhalation of material; the most common exception is autoimmune lung disease Lost pulmonary membrane is not recoverable Smoking is a major cause of lung disease The heart & lungs are a functional unit; lung disease usually affects the heart; & heart disease usually affects the lungs

Upper Respiratory Infections

Allergic rhinitis

hay fever nasal mucosal edema nasal discharge sneezing allergic conjunctivitis

Colds transmitted through respiratory droplets

clear nasal discharge low grade fever if nasal discharge becomes colorful, it is an

indication of secondary bacterial infection sore throat usually viral bacterial infections more serious red, swollen tonsils

Acute pharyngitis

Carcinoma of the Larynx

Common Mostly in male smokers over 40 Alcohol abuse increases the risk Presents with

hoarseness pain cough dysphagia hemoptysis

Asthma
Chronic inflammatory disease of small bronchi &

bronchioles Characterized by bronchospasm & air trapping Airflow out is impaired Triggered by inhaled irritants & classified by irritant Allergic
type I hypersensitivity

Occupational Exercise-induced Infectious Others

drug reactions emotional stress severe air pollution

Hyperplastic mucous glands in bronchi, hypertrophied

smooth muscle, edema, & marked inflammation

Atelectasis
Collapse of a lung or part of a

lung Resorption

bronchial obstruction air below obstruction

completely absorbed obstructions are

mucous plug asthma bronchitis tumors

Compression
pressure exerted from pleural

space or upward pressure on diaphragm

Contraction
scars cause constriction &

collapse TB

Chronic Obstructive Pulmonary Disease (COPD)

Related diseases

Chronic bronchial outflow obstruction

Overlapping features

Emphysema
Destruction of alveolar

walls, alveoli merge to form large air spaces Loss of surface area affects diffusion 90% of cases are smokers

 Cigarette smoke irritates

lung & causes inflammation Inflammatory cells release digestive enzymes These enzymes normally inhibited by alpha-1 antitrypsin AAT inhibited by smoke & so enzymes digest lung tissue

 Shortness of breath
Wheezing &

coughing Weight loss Barrel-chested Exhibits tripoding

Chronic Bronchitis
Chronic cough that produces

sputum for 3 consecutive months 2 years in a row Primary cause is cigarette smoking Chronic inflammation of bronchi Simple chronic bronchitis Chronic asthmatic bronchitis Obstructive chronic bronchitis

 Most patients have chronic

bronchitis & emphysema in varying degrees pink puffers

emphysema
usually thin barrel-chested short of breath but well

oxygenated

blue bloaters
obstructive chronic bronchitis wheezing, coughing sputum production cyanotic

no lost pulmonary membrane

All at risk of chronic hypoxia

Bronchiectasis
Marked, permanent dilation of small bronchi Destruction of smooth muscle & elastic supporting tissue Must have obstruction & infection
obstruction causes mucus retention infection damages bronchial walls which causes excess

mucus production

Not a primary condition Typically involves lower lobes Persistent cough

Restrictive Lung Disease

Chronic inflammation

making lungs stiff & inelastic Affects diffusion Scar tissue accumulates in the interstitium Mostly cause is unknown Equal decline in FEV1 & FVC Usually presents with shortness of breath Can lead to pulmonary HTN

Interstitial Fibrosis without Granulomatous Inflammation

Usually middle-aged

men at time of diagnosis Shortness of breath; may progress to cor pulmonale, hypoxia Pneumoconioses
black lung disease silicosis

most common chronic occupational disease mesothelioma

asbestosis

Interstitial Fibrosis with Granulomatous Inflammation

Sarcoidosis cause unknown affects many tissues but mostly lungs present with shortness of breath, cough, chest pain, hemoptysis

Pulmonary Edema
Fluid in alveoli Increased BP in lung
normal is 25/8 mmHg with

average at 15 mmHg

Microvascular injury
due to toxic fumes hot gases septicemia IV drug abuse

Main symptom is SOB

Pulmonary Thromboembolism
About 50,000 deaths annually Mostly from DVT Inflammation predisposes you

to it Promoted by

CHF pregnancy birth control pills prolonged bed rest metastatic cancer genetics

Most associated with no

symptoms but some

cause lung infarcts chest pain & dyspnea death

Adult Respiratory Distress Syndrome

ARDS Alveolar or pulmonary capillary damage Pathogenesis

injury to endothelium or alveoli neutrophils infiltrate protein-rich fluid exudes into alveolar space SOB occurs with rapid breathing which dries the fluid into a thick membrane stiffens lungs limits airflow & interferes with diffusion hypoxia

50% fatality Causes

sepsis smoke inhalation near drowning O2 toxicity burns DIC fat embolism endotoxic shock

Pneumonia
Inflammation of the

lungs Usually caused by bacteria 80,000 deaths/yr Alveolar pneumonia

usually acute fill with inflammatory

exudate most common

 Bronchopneumonia patchy inflammation involves alveoli of more than 1 lobe usually in basilar parts Lobar pneumonia consolidation of an entire lobe almost always caused by S. pneumoniae

Pulmonary Hypertension
Sustained systolic pressure over 30 mmHg or average in excess of 25

mmHg Vicious cycle Most common cause is increased pulmonary vascular resistance Usually secondary to

COPD heart disease collagen vascular diseases recurrent pulmonary thromboemboli

With R heart failure is cor pulmonale Thickening of arteriolar walls SOB

chest pain fatigue

Interstitial Pneumonia
Inflammation in

septa Diffuse & bilateral Usually viral

 Etiology mostly bacterial

S. pneumoniae Haemophilus influenzae Staph E. coli Pseudomonas

Pathogenesis inhalation of droplets, aspiration of gastric contents, blood-borne spread those susceptible include

immune deficiency decreased cough reflex impaired cilia accumulated secretions pulmonary congestion

 Community-acquired
acute pneumonia bronchopneumonia lobar pneumonia Legionnaires disease atypical pneumonia

Nosocomial
Commonly S. aureus & E.coli Seen in

People with severe disease Prolonged antibiotic therapy People with internal mechanical devices

Mycoplasma

Aspiration
Inflammatory reaction due

to corrosive effects Those who are comatose or those with a stroke Hi mortality rate

 Terjadi pada usia muda & orang tua Hypoxia & death Bacterial
high fever & chills purulent sputum increased neutrophils cough

SOB

Interstitial
less severe increased lymphocytes cough SOB

Lung Abscess
Purulent inflammation

with tissue necrosis & liquefaction Usually have several types of bacteria with anaerobic Most commonly due to aspiration of gastric contents Foul-smelling sputum

Tuberculosis
Mycobacterium tuberculosis

Chronic granulomatous inflammation with caseous necrosis

Pathogenesis

 Affects about 2 billion worldwide

Kills about 2 million/yr 2nd only to AIDS Associated with poverty, crowding, malnourishment,

& chronic disease PPD

 Low-grade fever
Night sweats Malaise

Weight loss anorexia

Mycoses
Histoplasmosis
Coccidiomycosis Cryptococcus

Lung Neoplasms
Mostly due to metastasis
Bronchogenic carcinoma is the most common most common of all cancers #1 cancer death about 90% are cigarette smokers

Bronchogenic Carcinoma

Mostly caused by cigarettes

Direct relationship between incidence of cancer &

number of cigarettes smoked Direct relationship between precancerous changes in bronchial mucosa & number of cigarettes smoked

 Small cell carcinoma

20% of cases arise from specialized

Adenocarcinomas
30% of cases most well-differentiated somewhat better prognosis more peripheral in smaller

neuroendocrine cells of the bronchus strongest relationship to cigarettes aggressively malignant

bronchi less associated with smoking

Squamous cell carcinoma

30% of cases
bronchial epithelium that

Large cell carcinoma

15% of cases poor prognosis metastasizes early

has undergone metaplasia arises centrally most common in men who smoke grows slower so better prognosis

Bronchial Carcinoid Tumor

5% of lung cancers
Arise from bronchial neuroendocrine cells Much less aggressive Grows slow

Pneumothorax
Air in pleural space Causes atelectasis May occur spontaneously More frequent in people with emphysema who have large blebs near pleura Traumatic penetration Can be fatal Tension pneumothorax
air in but not out

Pleural Effusion
Fluid in pleural space
Transudate from CHF most common If blood, called hemothorax

Pleuritis
Inflammation
Pleurisy with each breath Mostly caused by pneumonia

Perawatan
Tenangkan pasien
Letakan di ruang hangat

dgn posisi duduk atau setengah duduk Berikan Oksigen tambahan Beri pengobatan sesuai instruksi dokter