Pemicu 2“Mulutku tidak bisa dibuka”
JESLY CHARLIES, 405100171
Kelompok 14_Blok Sistem Respirasi
Learning Objectives
1. Menjelaskan anatomi faring, laring dan kepala leher; struktur yang ada di dalamnya; dan hubungannya.
2. Menjelaskan kelainan di nasofaring.3. Menjelaskan kelainan di orofaring.4. Menjelaskan kelainan di laringofaring.5. Menjelaskan kelainan di kepala leher.
LO 2-5 Definisi, etiologi, faktor risko & predisposisi,
patofisiologi, klasifikasi, gejala dan tanda klinis, diagnosis & pemeriksaan, diagnosa banding, tatalaksana, komplikasi, prognosis.
LO1.
Menjelaskan anatomi faring, laring dan kepala leher; struktur yang ada di dalamnya; dan hubungannya.
Pharynx
Adalah saluran pernapasan (dan pencernaan) bagian atas, terletak di belakang hidung, rongga mulut, dan larynx.
Batas Superior : basis cranii Inferior :
Anterior : pinggir inferior cartilago cricoidea Posterior : pinggir inferior vertebra C6
Pharynx dibagi 3:NasopharynxOropharynxLaryngopharyx
1. Nasopharynx
Batas-batas Anterior : choanaSuperoposterior : permukaan inferior
corpus os sphenoidalis dan pars basilaris os occipitalis
Inferior : palatum molle Ada 5 saluran : 2 tuba eustachius, 2
choana, pintu ke oropharynx Terdapat tonsilla pharyngealis
2. Oropharynx
Batas-batasAnterior : faucium (isthmus
oropharyngeal)Superior : palatum molleInferior : epiglottis
Terdapat :Tonsilla palatina 2 buahTonsilla lingualis
3. Laryngopharynx
Bagian dr saluran pencernaan dan pernapasan
Batas-batasSuperior : epiglottisInferior :
Anterior : pinggir inferior cartilago cricoidea
Posterior : pinggir vertebra C6
Berhubungan dg larynx melalui aditus laryngeus
Larynx
Larynx kompleks organ yg berfungsi memproduksi suara, terletak di leher depan setinggi vertebrae C3-C6, menghub laryngopharynx dg trachea
Fungsi :Sbg katup yg menjaga agar tractus
respiratorius tdk kemasukan makanan sewaktu menelan
Pengatur banyaknya udara yg masuk sesuai dg berbagai keaktifan
Vokalisasi
Rangka pembentuk larynx Cartilago thyroidea terbesar, cartilago hyaline, ♂ > ♀, tdr ats
2 lamina yg bsatu di anterior membentuk prominencia laryngea (adam’s apple), yg lbh menonjol pd pria
Cartilago cricoidea bbtk cincin stempel, bag anterior > rendah = arcus, bag posterior > tggi = lamina
Epiglotis cartilago elastin bbtk spt daun, bersifat elastis, tltak di posterior radix lingua& os hyoideum, dianterior aditus laryngeus, bgrak membuka/menutup aditus laryngeus ketika menelan makanan
Cartilago arytoneidea (2) bbtuk segitiga, tltak datas lamina cartilago cricoidea, berperan dlm pmbtkan suara
Cartilago corniculata (2) menempel pd apex cartilago arytenoidea, muncul sbg nodul kcl di bag posterior plica arypiglittica, menyokong struktur epiglotis
Cartilago cuneiformis (2) tltak didepan cartilago corniculata, muncul sbg nodul kecil di bag posterior plica arypiglottica, tdk meempel/berhub dg cartilago lain, menyokong struktur epiglotis
LO2.
Menjelaskan kelainan di nasofaring.
Cincin Waldeyer terdiri atas susunan kelenjar limfe yg terdapat di nasofaring dan orofaring yaitu:tonsil faringeal (adenoid)tonsil palatinatonsil lingualtonsil tuba Eustachius (tonsil tubaria)
Adenoid
Adenoid produce B cells give rise to IgG & IgA.
Serve as immunological memory in younger children.
The adenoid may be implicated in upper respiratory tract disease due to partial or complete obstruction of the nasal choanae or as a result of sepsis.
Clinical Grading of Adenoid Size (Clemens et al.)
Grade Description
Grade I Adenoid tissue filling one-third of the vertical portion of the choanae
Grade II Adenoid tissue filling one-third to two-thirds of the choanae
Grade III From two-thirds to nearly complete obstruction of the choanae
Grade IV Complete choanal obstruction
Adenoid Hypertrophy
Adenoid Hypertrophy
Pertumbuhan berlebih dari jaringan limfoid sekitar umur 3 sampai 8 tahun dapat menunjukkan gejala seperti: Snoring (mendengkur) Mouth breathing Apnea Dysphagia
Mungkin mempunyai riwayat: Snorting (mendengus) Gasping (terengah-engah) Hyponasal speech Restless sleep Enuresis (ngompol) Growth disturbance Failure to thrive
Adenoid Hypertrophy
PF tonsilar hypertrophy Endoscopy or lateral soft tissues
radiographs adenoid hypertrophy Lymphoid hypertrophy and relaxation
of the pharyngeal musculature during sleep increases the obstruction
Children craniofacial anomalies / neuromuscular disorders
Causing:FeverSore throatOdynophagia (painful swallowing)MalaiseOropharyngeal erythemaEdemaExudatesRash or lymphadenopathy
Tonsillectomy/Adenoidectomy
Indication of Tonsillectomy +/- Adenoidectomy
Absolute indications
Upper airway obstruction
Severe dysphagia
Cardiopulmonary complication
Unresponsive or recurrent peritonsillar abscess
Tonsillitis with febrile convulsions
Biopsy needed for tissue pathology
Relative indications
3 or more tonsillar infections per year despite proper medical treatment
Persistent foul taste or halitosis
Chronic or recurrent tonsillitis in a streptococcal carrier unresponsive to medical management
Unilateral tonsillar hypertrophy presumed to be of neoplastic origin
Complications of Adenoidectomy Bleeding Dental trauma Airway obstruction (retained swab,
nasopharyngeal blood clot) Infection Cervical spine injury Velopharyngeal dysfunction Regrowth of adenoid
LO3.
Menjelaskan kelainan di orofaring.
Acute Pharyngitis
Acute pharyngitis: common inflammation of the pharynx and tonsils.
Gejala utama acute onset sore throat
Etiology of Pharyngitis
Bacterial• Group A β-hemolytic Streptococcus (GABHS)• Group C and G β-hemolytic Streptococcus• Arcanobacterium hemolyticum• Neisseria gonorrhoeae• Mycoplasma pneumoniae• Chlamydia pneumoniae• Corynebacterium diphtheriae
Viral• Rhinovirus• Corona virus• Influenza virus• Respiratory syncytial virus• Parainfluenza virus• Epstein – Barr virus• Human immunodeficiency virus
Fungal• Candida albicans
Pathophysiology
Bacteria or viruses may directly invade the pharyngeal mucosa local inflammatory response.
Rhinovirus irritation of pharyngeal mucosa secondary to nasal secretion.
Streptococcal infections local invasion and release of extracellular toxins and proteases.
Tonsillitis
The causative organism in acute suppurative tonsillitis is GABHS.
Diagnosis, based on a history of:Pyrexial illnessSore throat with a painful swallowPharyngeal erythema with or without
tonsillar exudates and painful cervical adenopathy
Diagnosis of Causative Agent Bacteriological culture of a throat
swab (+) culture for GABHS Rapid Antigen Testing (RAT)
Complication of acute tonsillitis Systemic sepsis septicaemia, septic
arthritis GABHS acute exanthematous reaction
with a macular rash scarlet fever Noninfective sequelae of GABHS
rheumatic fever and glomerulonephritis (under Immunocomplex disorders)
Peritonsillar abscess (Quinsy) Retropharyngeal abscess Parapharyngeal abscess Lemierre’s syndrome
Peritonsillar Abscess (quinsy) Peritonsillar Abscess a collection of pus forms in the
potential space between the tonsil and its bed Anaerobic organism and GABHS Presentation:
Severe pharyngitis Servere trismus Airway compromise and dehydration Progressive Unilateral Dysphagia Trismus Drooling of saliva Ipsilateral lymphadenopathy Odynophagia Ipsilateral otalgia Enlarged jugulodigastric node
Peritonsillar Space Infections Komplikasi dr tonsillitis Gambaran klinis:
Merah Tonsil bengkak bilateral, biasanya eksudat Pembengkakan signifikan di lateral dan superior tonsil
pada 1 sisi Kasus berat uvula displaced krn efek dr adanya masa Nyeri saat membuka mulut jika infeksi dan inflamasi
meluas ke M.pterygoid internal di parapharyngeal space
Serious peritonsillar space infections severe cellulitis and abscess
Nyeri saat membuka mulut ada abses Tidak nyeri saat membuka mulut tdk ada abses
Strep viridans , Stap aureus, H influenzae
Risk of aspiration use of local anesthesia prior to incision exacerbates this risk
Treatment high dose penicillin IV or cephalosporin, erythromicin, incision and drainage
Retropharyngeal abscess
S.viridans , S.aureus Treatment high dose AB + urgent
incision and drainage fever, irritability, lymphadenopathy,
poor oral intake, sore throat, drooling pain, dysphagia, snoring, nasal
obstruction, Dyspnea and respiratory distress Lateral posterior oropharyngeal wall
bulge
Retropharyngeal Space Infections Gejala klinis:
DemamDisfagiaIrritabilityMuffled (teredam) cry or speechTorticollisStertorDrooling and stridor kasus berat
Parapharyngeal abscess
Klebsiella pneumoniae, streptococcus viridans
Treatment penicillin, broad spectrum AB IV, aspiration
Patient usually severely systemically unwell, with severe trismus and possibly airways compromise
Recurrent streptococcal tonsillitis is diagnosed when an individual has 7 culture-proven episodes in 1 year, 5 infections in 2 consecutive years, or 3 infections each year for 3 years consecutively.
Individuals with chronic tonsillitis may present with chronic sore throat,halitosis, tonsillitis, and persistent tender cervical nodes.
Individuals with peritonsillar abscess (PTA) present with severe throat pain, fever, drooling, foul breath, trismus (difficulty opening the mouth), and altered voice quality (the "hot potato" voice).
Etiology
HSVEBVCytomegalovirusOther herpes virusesAdenovirusMeasles virusGABHSS pyogenesNeisseria gonorrheaS penumonia, Stap aureus, H influenzae
(recurrent)Bacteroides fragilis (anaerob recurrent tonsillitis)
Diagnosis
Rapid antigen testing of a throat swab for GABHS
Bacterial culture Clinical assessment
Treatment
Supportive analgesics and adequate hydration
Antibiotic benzylpenicillin (if theres no sign of improvement within 48-72 hours or in whom there is clinical concern because of the severity of symptoms)
TONSILITIS AKUT
GEJALA PEMERIKSAAN TERAPI
Tonsilitis viral Menyerupai common cold disertai rasa nyeri
tenggorokan
Rongga mulut tampak luka kecil pada
palatum dan tonsil yang sangat nyeri dirasakan pasien
Istrahat, minum cukup, analgetika
dan antivirus di beri jika gejala berat
Tonsilitis bakterial
Nyeri tenggorokan dan telan, demam, lesu,
rasa nyeri sendi, tidak nafsu makan
Tonsil membangkak, hiperemis dan kelenjar
submandibula membengkak dan
nyeri telan
Antibiotika spektrum lebar penisilin,
eritomisin, antipiretik dan obat kumur
mengandung desinfektan
TONSILITIS KRONIK GEJALA PEMERIKSAAN TERAPI
Fk predisposisinya : rangsangan menahun dr
rokok, beberapa jenis makanan, higiene mulut
yang buruk,pengaruh cuaca.
Rasa ganjalan di tenggorokan,
tenggorokan kering dan nafas berbau
Tonsil membesar dgn permukaan
tidak rata, kriptus melebar
Obat kumur dan obat isap
TONSILITIS MEMBRANOSA
GEJALA DAN TANDA PEMERIKSAAN TERAPI
Tonsilitis difteri
Nyeri kepala, suhu tubuh subfebris, tidak nafsu makan, badan lemah, nadi lambat,
nyeri telan
____ Anti difteri serum (ADS),
antibiotika, kortikosteroid
Tonsilitis septikPenyebab : streptokokus hemolitikus terdapat dalam susu sapi sehingga dapat timbul epidemi
Diphteria
Coryneabacterium diphteriae (three strains: gravis, intermedius, mitis)
Affecting young children Symptoms pharyngitis with sore throat
and malaise, feverish, development of charateristic grey pseudomembrane over the surface (consist of necrotic tssue, bacteria, dan rich fibrinous exudate) early removal causes bleeding
Endotoxin can cause a toxic myocarditis in the second week of the disease
Treatment high dose benzylpenicillin and antitoxin
Airway management removal of laryngeal membrane, administration of oxygen and humudification, and endotracheal intubation or tracheostomy
LO4.
Menjelaskan kelainan di laringofaring.
Acute Epiglottitis (Supraglottitis) Most common causes Haemophilus
influenza type B Toxic child with a short history of sore
throat, inspiratory stridor, muffled voice, and drooling due to odynophagia and dysphagia
Febrile, tachypnoeic and traditionally will be sitting upright, with the neck extended to optimize the airway, and using arms to provide support to the shoulder girdle to respiration
Secure airway with endotracheal intubation
LO5.
Menjelaskan kelainan di kepala leher.
Suppurative parotitis Suppurative cervical adenitis