Sistem Saluran Napas Pada Anak

8/17/2019 Sistem Saluran Napas Pada Anak

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Roni NaningDeprtemen Ilmu KesehatanAnak Fakultas Kedokteran UGM

Yogyakarta

Sistem Saluran Napas pada Anak

…. fokus klirens mukosilier dan peran mukoregulator


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ANATMIS

•

HIDUNGPERMUKAAN RELATIF LEBIH LUAS

DIBATASI EPITEL KAYA PEMBULUH DARAH

DAN BERSILIA

75% PEMANASAN/PELEMBABAN UDARA

PENYARINGAN UDARA UKURAN >10-15 u

• LARING

UKURAN RELATIF SEMPITCINCIN KARTILAGO

RELATIF LEBIH MUDAH OBSTRUKSI,BILARADANG


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!!"#"$&'(

• HIDUNG

PERMUKAAN RELATIF LEBIH LUAS

DIBATASI EPITEL KAYA PEMBULUH DARAH

DAN BERSILIA

75% PEMANASAN/PELEMBABAN UDARA

PENYARINGAN UDARA UKURAN >10-15 u

• LARING

UKURAN RELATIF SEMPITCINCIN KARTILAGO

RELATIF LEBIH MUDAH OBSTRUKSI,BILARADANG


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!!"#"$&'(

•

TRAKEA DAN BRONKUSEPITEL SILENDER, BERSUSUN, BERSILIA

)*75 SILIA/SEL+, SEL GOBLET

KELENAR MUKUS 1/ TEBAL DINDINGCINCIN TULANG RA.AT DAN OTOT

NORMAL 100 ML MUKUS/HARI

*5 % PEMANASAN UDARA YANG DIHIRUP


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• S(' ("2u"# #"3"(

(2 &u(" 4"# (("

(2 62$ 4"# (2 C2"" $"#(u4"(' u"# "(u2"

8"'"# "22"


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MEKANISME PERLINDUNGAN PARU

• FILTRASI PARTIKEL DI HIDUNG

• REFLEKS EPIGLOTIS

•

REFLEKS BATUK • SELIMUT MUKOSILIER

• FAGOSITOSIS OLEH MAKROFAG

AL9EOLUS• NETRALISASI KUMAN )IMUN LOKAL+

• DRAINASE 9IA SISTEM LIMFATIK


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K#(3 U&u& P$":"#"# P"u

• P2'#4u#"# ("2u"# (3'"$' u&'$ #"&u#("2'# &2#"3'

• S'($& 3$":"#"# #&"2 &#8": &"(u#;"4"# &#:'2"#"# &"$'"2 "('# 4"' ("2u"#

(3'"$', &2'3u$' <1! F'2$"(' 3"$#

*! B"$u

! P&6(':"# &u('2'

=!P$":"#"# "('$('( )##(3('?+


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T: Cu: R


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! P&6(':"# Mu('2'

• E?('#(', $"#$u# 3"4" <

'#$'$"( ('2'" 3'$2

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SI!IA

• Mu3""# $#@2"# 3"4"3&u""# (2 2u &u2"'

$""-6#'2u(

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• B4#;u$ 1000 /&#'$ &#""# (2 &u(" "":3('&"2 83"$"# 10

&&/$ 4"2"& $""!


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•

G""# <$' 4"# 6('"$ metakronik

antipletik "": cephalad.

•

S"" ('&3"$'( <&#'#"$"# ""# ('2'"!

• S"" 3""('&3"$'( <

&&32"&6"$ ""# ('2'"!

!! ('2'"


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S2 G62$ ("2u"##" "(


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S'2'" 4"# S2 K2u"


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Mukus

• D':"('2"# 2#@" (u6&u(" 4"# (2G62$!

• 5 % $4'' 4"' "'!

• 5 % $4'' 4"' 2$2'$, "("& "&'#,2'3'4!

• S(' 10 100 &2 / :"'!

•

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K2'#( &u('2'

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-'#$'$"( ('2'" 3'$2!

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3'('2'-'(('$"(!

-('"$ 6''&'" ((' ("2u"# #"3"(.


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=! P#;"'$ '#('

5! P#;"'$ ## '#('! &'("2 #;" A(&"


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Mu8"8$' Du(


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Rhinathiolcarbocisteine

• C;($'# 4'"$' '$: " 6284 $:'2 6;"# "8$;2 u#8$'#

Under Rhinathiol the mucus/mucosaunit

returns to its physiological properties


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"ar#o$isteine%Mode o&a$tion

• R($( " u#8$'#"2 &u8u( 6;"8'2'$"$'# $: (;#$:('( ('"2&u8'#( 6; $: "8$'"$'# "#

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T'32 A8$'#

• Mu82;$'8

• A#$' I#"&&"$'# A#$' O'4"#$

•

A#$' B"8$'"2 "$$"8:&#$


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Mu82;$'8

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– L#4' &#@"4' #8

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A#$' O('4"# A#$'I#"&"('

"ar#o$isteine '- (&ek Anti ksidan ' mampu mem#uang radikal #e#as- (&ek Anti In)amasi' mengham#at migrasi neutro*l+

makro&ag dan eosino*l


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Terima kasih


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T: u 8&&# 822 $;3( '#

"'"; 3'$:2'u&

C D

A! N#8'2'"$4 82u" 822(B! G62$ C22(C! B"("2 C22(D! C'2'"$4 82u" 822(


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46'(, "#4 &'8"#'(&(!

R(3' 8" *00*, u2 )=7+ 7!


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A 1'5:$ &u8% 8'2'"1; $1"#(3%1$ #//4(<

- a normal $iliary system

with ciliated cells able to beat in a same d ir ect ion

- a physiologi$ mu$uswit h v iscous & fuid la y ers


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T: 4#(( $: (3'"$;&u8(" '&32; $: &8:"#'(&(

• " &u8 8'2'"; $"#(3$

• I&&u#26u2'#(

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Cu: '( " 4#(&8:"#'(&

• A 8&32 " 6'#( '$: $:($'&u2"$'# "# ''$"#$ 83$!

In healthy su#,e$t

Cu: 3"$'8'3"$($ 15 % $:

&u8(" 82"#('#

In #ron$hitis

Cu: 3"$'8'3"$($ =5 % $:

&u8(" 82"#('#

I& the mu$o%$iliary tranport isde$reased + the $ough must #e

domesti$ated #ut not stopped


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T: 2 (8$; IA

• T 3$8$ ""'#($ $: 28"2 "(('#

• T ' $: ':$ :2'8"2 33$'( $$: (3'"$; &u8u(

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S3u$u& 8&3('$'#

• D"'2; (8$'# 100&2

• S;#$:$'(4 6; 62$ 822( &u8u(2"#4(

• I$( ($u8$u" '( ## :&#u( – .'$: " (2 3:"( "$ $: 8'2'" 6"(

– A#4 " 2 3:"( "$ $: 8'2'" $'3(

The mu$ins o& the sputum prote$t themu$osa - stru$ture it


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Mu$inHeterogeneous glycoprotein

• #u$"2 &u8'#(

• A8'4 &u8'#( '$: ('"2&u8'#( (u2&u8'#(

A 3$'#'8 8#$"2 "'( 8"6:;4"$ ('48:"'#('$: "8'4 u8u( (u6u#'$(


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: '2'


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8'2'"; 6"$'# u#8; $:&u88'2'"; $"#(3$ "$

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T'&'# $: (3'"$; 3'$:2'"2

2('#(

1 2 3 4 5 6 7

18 !oss o& the tightened ,un$tions

2 + 3 &usion o& the $ilia

4 $ilia internalisation

5 $ilia loss

6 epithelium des.uamation #ut #asal $ellmaintained

7 "omplete des.uamation


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Mu8(" "#( "8 $ $:

"(((

• T: ?($ (3#( '( "# '#"&&"$;($"$

• T:'( ($"$ 34u8( "# '#8"( $:

&u8(" (8$; "8$''$; '$: "34u8$'# " $:'8 &u8u(

• I# 8"( " 2#-2"($'# '#"&&"$'#, $:3(( 6'#( 8:#'8

The repetitie acute respiratoryinfections in childhood can deelop

chronic respiratory disease in adults


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Sistem Saluran Napas Pada Anak

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