Pemicu 1 respirasi

Christabella Monica

405090013

Anatomi saluran napas atas

Sinus Paranasal

Anatomi Faring

Histologi saluran napas atas

Fisiologi saluran napas atas

Respirasi(pernapasan) merupakan keseluruhan proses yang menyebabkan pergerakan pasif O2 dari atmosfer ke jaringan untuk menunjang metabolisme sel, serta pergerakan pasif CO2 selanjutnya yang merupakan produk sisa metabolisme dari jaringan ke atmosfer.

Respirasi dibagi menjadi 2 :

RESPIRASI INTERNAL

RESPIRASI EKSTERNAL

Respirasi Internal

Respirasi internal atau seluler lebih mengacu kepada proses metabolisme intrasel yang berlangsung di dalam mitokondria, yang menggunakan O2dan menghasilkan CO2selama penyerapan energi dari molekul nutrien.

Respirasi Eksternal

Respirasi eksternal mengacu kepada keseluruhan rangkaian kejadian yang terlibat dalam pertukaran O2dan CO2 antara lingkungan eksternal dan sel tubuh.

Inspirasi dan ekspirasi

Rhinitis alergi

definisi

Penyakit inflamasi yg disebabkan oleh reaksi alergi pada pasien atopi yg sebelumnya sudah tersensitasi dgn alergen yg sama serta dilepaskannya suatu mediator kimia ketika terjadi paparan ulang alergen spesifik tersebut (von Pirquet, 1986).

Kelainan pd hidung dg gejala bersin2, rinore, rasa gatal, dan tersumbat setelah mukpsa hidung terpapar alergen yg diperantarai oleh IgE (WHO ARIA, 2001).

epidemiologi United states

Allergic rhinitis affects approximately 40 million people in the United States.

International

Scandinavian studies have demonstrated a cumulative prevalence rate of 15% in men and 14% in women.

The prevalence of allergic rhinitis may vary within and among countries. This may be due to geographic differences in the types and potency of different allergens and the overall aeroallergen burden.

Race

Allergic rhinitis occurs in persons of all races. Prevalence of allergic rhinitis seems to vary among different populations and cultures, which may be due to genetic differences, geographic factors or environmental differences, or other population-based factors.

Sex

In childhood, allergic rhinitis is more common in boys than in girls, but in adulthood, the prevalence is approximately equal between men and women.

Age

Onset of allergic rhinitis is common in childhood, adolescence, and early adult years, with a mean age of onset 8-11 years, but allergic rhinitis may occur in persons of any age. In 80% of cases, allergic rhinitis develops by age 20 years. The prevalence of allergic rhinitis has been reported to be as high as 40% in children, subsequently decreasing with age. In the geriatric population, rhinitis is less commonly allergic in nature.

klasifikasi

Berdasarkan sifat berlangsungnya :

1. Intermiten (kadang-kadang) : bila gejala 4minggu.

klasifikasi

Berdasarkan berat ringannya penyakit :

1. Ringan : bila tidak ditemukan g3an tidur, g3an aktivitas harian, bersantai, berolahraga, belajar, bekerja, dll.

2. Sedang-berat : bila terdapat 1/> dr g3an tsb diatas.

Faktor pencetus

pollens outdoors, mold spores while doing yard work, specific animals, or dust while cleaning the house.

Irritant triggers such as smoke, pollution, and strong smells can aggravate symptoms in a patient with allergic rhinitis.

patofisiologi

1. Tahap sensitisasi

2. Tahap provokasi/reaksi alergi Fase cepat -> sejak kontak dg alergen sampai 1 jam setelahnya.

Fase lambat -> 2-4jam, puncak 6-8jam, dpt berlangsung sampai 24-48jam.

patofisiologi

patofisiologi Allergic rhinitis involves inflammation of the mucous membranes of

the nose, eyes, eustachian tubes, middle ear, sinuses, and pharynx. The nose invariably is involved, and the other organs are affected in certain individuals. Inflammation of the mucous membranes is characterized by a complex interaction of inflammatory mediators but ultimately is triggered by an immunoglobulin E (IgE)mediated response to an extrinsic protein.[6]

The tendency to develop allergic, or IgE-mediated, reactions to extrinsic allergens (proteins capable of causing an allergic reaction) has a genetic component. In susceptible individuals, exposure to certain foreign proteins leads to allergic sensitization, which is characterized by the production of specific IgE directed against these proteins. This specific IgE coats the surface of mast cells, which are present in the nasal mucosa. When the specific protein (eg, a specific pollen grain) is inhaled into the nose, it can bind to the IgE on the mast cells, leading to immediate and delayed release of a number of mediators.[6, 7, 8]

patofisiologi The mediators that are immediately released include histamine, tryptase, chymase,

kinins, and heparin.[7, 8] The mast cells quickly synthesize other mediators, including leukotrienes and prostaglandin D2.[9, 10, 11] These mediators, via various interactions, ultimately lead to the symptoms of rhinorrhea (ie, nasal congestion, sneezing, itching, redness, tearing, swelling, ear pressure, postnasal drip). Mucous glands are stimulated, leading to increased secretions. Vascular permeability is increased, leading to plasma exudation. Vasodilation occurs, leading to congestion and pressure. Sensory nerves are stimulated, leading to sneezing and itching. All of these events can occur in minutes; hence, this reaction is called the early, or immediate, phase of the reaction.

Over 4-8 hours, these mediators, through a complex interplay of events, lead to the recruitment of other inflammatory cells to the mucosa, such as neutrophils, eosinophils, lymphocytes, and macrophages.[12] This results in continued inflammation, termed the late-phase response. The symptoms of the late-phase response are similar to those of the early phase, but less sneezing and itching and more congestion and mucus production tend to occur.[12] The late phase may persist for hours or days.

Systemic effects, including fatigue, sleepiness, and malaise, can occur from the inflammatory response. These symptoms often contribute to impaired quality of life.

Tanda&gejala

sneezing, itching (of nose, eyes, ears, palate), rhinorrhea, postnasal drip, congestion, anosmia, headache, earache, tearing, red eyes, eye swelling, fatigue, drowsiness, and malaise

Anamnesis

Gejala :

Bersin berulang

rinore yg encer dan banyak

hidung tersumbat

hidung dan mata gatal

Banyak keluar air mata (lakrimasi)

Pemeriksaan fisik

Rinoskopi anterior : Mukosa edema, berwarna pucat/livid,

Sekret banyak encer

Mukosa inferior hipertropi

Nasoendoskopi

Pemeriksaan lain : Allergic shiner (bayangan gelap di bawah mata

Pemeriksaan penunjang

In vitro

Eosinofil darah tepi : N/

IgE total : N (kecuali >1 penyakit)

IgE spesifik dg RAST/ELISA

Sitologi hidung : eosinofil >>

In vivo

Tes cukit kulit

Uji intrakutan/intradermal tunggal/berseri

SET -> alergen inhalan.

PDFT -> alergen ingestan, diet eliminasi&provokasi.

tatalaksana

The best treatment is to avoid what causes your allergic symptoms in the first place. It may be impossible to completely avoid all your triggers, but you can often take steps to reduce exposure.

For mild allergic rhinitis, a nasal wash can be helpful for removing mucus from the nose. You can purchase a saline solution at a drug store or make one at home using one cup of warm water, half a teaspoon of salt, and pinch of baking soda.

tatalaksana

ANTIHISTAMINES

Antihistamines work well for treating allergy symptoms, especially when symptoms do not happen very often or do not last very long.

Antihistamines taken by mouth can relieve mild to moderate symptoms, but many can cause sleepiness. Some may be bought over the counter, without a prescription.

Newer antihistamines cause little or no sleepiness. Some are available over the counter. They usually do not interfere with learning. These medications include loratidine (Claritin) and cetirizine (Zyrtec). Other antihistamines are available by prescription.

tatalaksana

ANTIHISTAMINES

Antihistamin dibagi mjd 2 golongan :

AH generasi 1 -> lipofilik -> menembus sawar darah otak&plasenta, efek kolinergik.

contoh obat : difenhidramin, klorfeniramin, promesatin, siproheptadin, azelastin.

AH generasi 2 -> lipofobik.

i : rinore, bersin, gatal, obstruksi hidung pd fase lambat.

dibagi mjd 2 golongan :

Astemisol&terfenadin -> kardiotoksik

Loratadin, setirisin, fexofenadin, desloratadin, levosetiristin.

tatalaksana

CORTICOSTEROIDS

Nasal corticosteroid sprays are the most effective treatment for allergic rhinitis.

They work best when used nonstop, but they can also be helpful when used for shorter periods of time.

tatalaksana

CORTICOSTEROIDS

Kortikosteroid topikal -> beklometason, budesonid, flunisolid, flutikason, mometason furoat, triamsinolon.

u/ mengurangi jumlah sel mastosit pd mukosa hidung, mencegah pengeluaran protein sitotoksik dr eosinofil, mengurangi aktifitas limfosit, mencegah bocornya plasma.

Sodium kromoglikat topikal -> menstabilkan mastosit -> pelepasan mediator dihambat.

tatalaksana

DECONGESTANTS

Decongestants may also be helpful in reducing symptoms such as nasal congestion.

Nasal spray decongestants should not be used for more than 3 days.

Be careful when using over-the-counter saline nasal sprays that contain benzalkonium chloride. These may actually worsen symptoms and cause infection.

tatalaksana

OTHER TREATMENTS

The leukotriene inhibitor Singulair is a prescription medicine approved to help control asthma and to help relieve the symptoms of seasonal allergies.

tatalaksana

Operatif

Konkotomi parsial( pemotongan sebagian konka inferior)

Multiple outfractured& Inferior turbinoplasty

Kauterisasi memakai AgNO3 25 % ( bila konka inferior hipertrofi)

Imunoterapi

Pada alergi inhalan dgn gejala berat

Tujuan: blocking IgG dan penurunan IgE

Diagnosa banding

Rinitis non alergi

Rinitis infeksi

Common cold

komplikasi

otitis media

eustachian tube dysfunction

acute sinusitis

chronic sinusitis.

Polip hidung.

Asma bronkial

prognosis

While allergic rhinitis itself is not life-threatening (unless accompanied by severe asthma or anaphylaxis), morbidity from the condition can be significant. Allergic rhinitis often coexists with other disorders, such as asthma, and may be associated with asthma exacerbations.

Numerous complications that can lead to increased morbidity or even mortality can occur secondary to allergic rhinitis.

Allergic rhinitis can be associated with a number of comorbidconditions, including asthma, atopic dermatitis, and nasal polyps. Evidence now suggests that uncontrolled allergic rhinitis can actually worsen the inflammation associated with asthma or atopic dermatitis. This could lead to further morbidity and even mortality.

prevention

Symptoms can sometimes be prevented by avoiding known allergens. During the pollen season, people with hay fever should remain indoors in an air-conditioned atmosphere whenever possible:

Most trees produce pollen in the spring.

Grasses usually produce pollen during the late spring and summer.

Ragweed and other late-blooming plants produce pollen during late summer and early autumn.

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