Dr Sumardi PPOK_Emfisema-UII

22
PENYAKIT PARU OBTRUKTIF KRONIK (PPOK) Bronkitis kronis Batuk + dahak kumat2-an lebih dari 2 tahun oleh karena merokok atau polusi Emfisema Sesak nafas + batuk kumat2an lebih dari 2 tahun oleh karena merokok atau polusi

description

Dr Sumardi PPOK_Emfisema-UII

Transcript of Dr Sumardi PPOK_Emfisema-UII

Page 1: Dr Sumardi PPOK_Emfisema-UII

PENYAKIT PARU OBTRUKTIF KRONIK (PPOK)

Bronkitis kronis

Batuk + dahak kumat2-an lebih dari 2 tahun oleh karena merokok atau polusi

Emfisema

Sesak nafas + batuk kumat2an lebih dari 2 tahun oleh karena merokok atau polusi

Page 2: Dr Sumardi PPOK_Emfisema-UII

EMFISEMA• Klinis: dyspnea keadaan istirahat, dada

cembung (tong chest), hipersonor, sianotik, jari tabuh.

• CXR: hiperlusen, diafragma datar• Kelainan utama pada cabang bronkus

terminal yg. berhubungan dengan alveoli• Septa alveoli rusak luas alveoli

inefisiensi pertukaran gas• Kerusakan septa o.k. elastase yang

dihasilkan netrofil lebih tinggi dari alfa-1 antitripsin yg melindungi integritas alveoli

• Kerusakan bersifat irreversibel

Page 3: Dr Sumardi PPOK_Emfisema-UII

Emphysema. PA Chest radiography in a patient with severe emphysema secondary to alpha-1 antitrypsin

deficiency

Page 4: Dr Sumardi PPOK_Emfisema-UII

Emphysema. Graphic depiction of centrilobular versus panlobular emphysema

Page 5: Dr Sumardi PPOK_Emfisema-UII

Pathology …. 13 (normal parenchyma)

Page 6: Dr Sumardi PPOK_Emfisema-UII

Pathology …. 14 (emphysema)

Page 7: Dr Sumardi PPOK_Emfisema-UII

Pathology …. 15

Page 8: Dr Sumardi PPOK_Emfisema-UII

Pathology …. 16 (normal small airway)

Page 9: Dr Sumardi PPOK_Emfisema-UII

Pathology …. 17

Page 10: Dr Sumardi PPOK_Emfisema-UII

“Small Airways Dysfunction”

Flow

Volume

Expiratory flow limitation

On forced exhalation

During exercise

At rest

Page 11: Dr Sumardi PPOK_Emfisema-UII

Bronchus

Wall thickening – inflammation -- mucus gland hypertrophy

↑ Secretions

Alveoli

Wall thinning - inflammation - elastolysis

Coalescence

↓ Elasticity

Bronchiole

Wall thickening – inflammation – repair -- remodeling

Loss of alveolar attachments

Page 12: Dr Sumardi PPOK_Emfisema-UII

Airway

Resistance

Normal Central Air way Obst.

Small Air-way Obst.

Central 80 160 80

Peripheral 20 20 40

R total 100 180 120

Silent Zone

COPD and the Distribution of Airway

Resistance

Large airway

Small airway

Page 13: Dr Sumardi PPOK_Emfisema-UII

COPD Pathology and Abnormal Breathing Mechanics

• ↑ Airway resistance • ↓ Elastic recoil • Expir. flow limitation• Air trapping and

dynamic hyperinflation• ↑ Work of breathing• Dyspnea, cough and

other respiratory ssx• ↓ Quality of life

Page 14: Dr Sumardi PPOK_Emfisema-UII

Pathology of Breathing Peripheral Lung Zone

• Airways open and not prone to collapse low resistance

• Lung recoil strong enough to drive tidal expiration (passive)

• Work of breathing is minimal

Page 15: Dr Sumardi PPOK_Emfisema-UII

Pathology:Altered Lung Mechanics

• Airway wall thickened and collapsing high resistance

• Alveoli thinned out poor elastic recoil

• Expiratory flow limitation

• Residual volume increased

Page 16: Dr Sumardi PPOK_Emfisema-UII

Thin-section CT scan of a Smoker

End-inspiration End-expiration

Page 17: Dr Sumardi PPOK_Emfisema-UII

Pathology …..

Page 18: Dr Sumardi PPOK_Emfisema-UII

Pathology …..

Page 19: Dr Sumardi PPOK_Emfisema-UII

Pathology …..

Page 20: Dr Sumardi PPOK_Emfisema-UII

PPOK

Eksaserbasi Akut

1. Batuk + dahak berlebihan

2. Dahak berubah warna kuning,hijau,bau

3. Demam tanda infeksi

4. Sesak nafas memberat (emfisema)

Page 21: Dr Sumardi PPOK_Emfisema-UII

PPOK Eksaserbasi Akut

Manajemen:1. Istirahat + O2 2-3 liter/menit2. Diet tinggi kalori,tinggi protein, rendah karbohidrat3. Antibiotika: makrolid, kuinolon, penisilin4. Steroid oral: metil prednisolon, prednison 40-60

mg/hari 7-10 hari5. Steroid inhalasi: budesonid/flutikason 1-2 mg/hari6. Bronkodilator inhalasi: salbutamol/terbutalin 600-

1200 mcg/hari+Ipatrium bromid (Combivent)7. Aminofilin lepas lambat 200-400 mg 2x/hari8. Mukolitik: N asetil sistein, ambroksol, OBH, GG

Page 22: Dr Sumardi PPOK_Emfisema-UII

SUMMARY

• OXYDATIVE STRESS INFLAMATION• INCREASE CYTOKINE + CHEMOKINE• IMBALANCE PROTEASE-ANTIPROTEASE• MUCOUS SECRETION• REMODELLING SMALL AIRWAY• PARTIALLY IRREVERSIBLE IRREVERSIBLE

• OBSTRUCTION AIRTRAPPING• DESTRUCTION PARENCHYMA EMPHYSEMA