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SMF/BAGIAN ILMU RADILOGI
LAPORAN KASUS
FAKULT FAKULTAS KEDOKTERAN KEDOKTER AN
FEBRUARI FEBRUA RI 2017
UNIVERSITAS NUSA CENDANA
PENYAKIT PENYAKIT PARU OBSTRUKSI KRONIK
Disusun Ole ! M"#i" Me$il%" B&s#i' S(Ke% 110)0120*+
Pe,-i,-in$ ! %#( Els.e Tene' S( R"%
DIBAAKAN DALAM RANGKA KEPANITRAAN KLINIK SMF/ BAGIAN ILMU RADILOGI FAKULTAS KEDOKTERAN UNIVERSITAS NUSA CENDANA RSUD PROF(DR(((O3ANNES KUPANG 2017
1
BAB I PENDAHULUAN PPOK "4"u Pen."5i4 P"#u O-s4#u5si K#&nis ,e#u"5"n en."5i4 ."n$ %""4 %i6e$" %"n %i#""4 %en$"n -e-e#"" $e8"l" e5s4#"ul,&n"#i ."n$ si$ni9i5"n' ."n$ %""4 ,en$"5i-"45"n 4in$5"4 5e"#""n ."n$ -e#-e%" "%" 4i" in%i:i%u"l(1 As" #&5&5 ,e#u"5"n s"4u;s"4un." en.e-"- 4e#en4in$' 8"u le-i en4in$ %"#i 9"54 en.e-"- l"inn."( F"54 #esi5& $ene4i5 ."n$ "lin$ se#in$ %i8u,"i "%"l" %e9isiensi "l9";1 "n4i4#isin' ."n$ ,e#u"5"n ini-i4 si#5ul"si u4"," %"#i #&4e"se se#in( Be#%"s"#5"n Be#%"s"#5"n Gl&-"l Ini4i"4i: Ini4i"4i:ee 9 C#&ni6 C#&ni6 O-s4#u64i:e O-s4#u64i:e Lun$ Dise"se Dise"se
%e#"8"4' ."i4u ! %e#"8"4 1
2
BAB II TINJAUAN PUSTAKA
2.1 Definisi Pen."5i4 P"#u K#&ni5 O-s4#u54i9
",-"4"n "li#"n u%"#" %i s"lu#"n n"9"s ."n$ -e#si9"4 #&$#esi9 n&n #e:e#si-el "4"u #e:e#si-el "#si"l( PPOK 4e#%i#i %"#i -#&n5i4is 5#&ni5 %"n e,9ise," "4"u $"-un$"n 5e%u"n."(1 2.2 Epidemioloi Es4i,"si %"#i 12 ne$"#" Asi" Ten$$"#" %ie#5i#"5"n -"" #e:"lensi PPOK se-es"# @(* %en$"n #e:"lensi ,"5si,u, "%" %i ne$"#" Vie4n", <@(7= %"n RRC <@(+=( 2 3"sil eneli4i"n Buis4 ."n$ %il"5u5"n %en$"n e,e#i5s""n si#&,e4#i' 5uesi&ne# ."n$ -e#isi $e8"l" #esi#"si' s4"4us 5ese"4"n %"n 9"54 "8"n"n ,enun8u55"n -"" se6"#" u,u, #e:"lensi PPOK le-i 4in$$i "%" lel"5i %i-"n%in$5"n e#e,u"n(* World Health Organization <3O= ,en.e-u45"n PPOK ,e#u"5"n en.e-"- 5e,"4i"n 5ee,"4 %i%uni"( Menu#u4 e#5i#""n se5i4"# )0 8u4" "n$ "5"n ,en%e#i4" PPOK "%" 4"un 200+ %en$"n ,e#u8u5 "%" + %"#i selu#u 5e,"4i"n se6"#" $l&-"l( T&4"l 5e,"4i"n "5i-"4 PPOK %i#&.e5si5"n "5"n ,enin$5"4 *0 "%" 10 4"un ,en%"4"n$( 3"l ini %iu-un$5"n %en$"n e#4",-""n en%u%u5' 5e-i"s""n ,e#&5&5 ."n$ ,enin$5"4' in%us4#i"lis"si %"n &lusi u%"#"(> Di In%&nesi" 4i%"5 "%" %"4" ."n$ "5u#"4 ,en$en"i #e:"lensi 4e#8"%in." PPOK' n",un "%" su#:ei 5ese"4"n #u," 4"n$$" De5es RI "%" 4"un 12 "s,"' -#&n5i4is 5#&nis %"n e,9ise," ,en%u%u5i e#in$5"4 5e;@ se-"$"i en.e-"- 5es"5i4"n 4e#-"n."5 %"#i 10 en.e-"- 4e#se#in$ 5e,"4i"n %i In%&nesi"(1 2.! "#$%o& Resi$o Be-e#"" 9"54 #esi5& "n4"#" l"in ! 1( P"8"n"n %"#i "#4i5el "n4"#" l"in !
*
"( Me#&5&5( Me#&5&5 ,e#u"5"n en.e-"- PPOK 4e#-"n."5 <+ 5"sus= %i ne$"#" -e#5e,-"n$(1 Pe#&5&5 "54i9 %""4 ,en$"l",i ie#e5s#esi ,u5us %"n &-s4#u5si 8"l"n n"9"s 5#&ni5( -( P&lusi indoor ( Me,"s"5 %en$"n -""n -i&,"ss %en$"n :en4il"si %"u# ."n$ 8ele5 ,is"ln." 4e#"8"n "s" -""n -"5"# 5".u %"n "s" -""n -"5"# ,in."5 %ie#5i#"5"n ,e,-e#i5"n 5&n4#i-usi s","i *+(+ 6( P&lusi outdoor. P&lusi u%"#" ,e,-e#i5"n en$"#u -u#u5 "%" VEP( In"l"n ."n$ "lin$ 5u"4 ,en.e-"-5"n PPOK "%"l" C"%,iu,' in6 %"n %e-u -""n "s" e,-"5"#"n( %( P&lusi %i 4e,"4 5e#8"( P&lusi %"#i 4e,"4 5e#8" ,is"ln." %e-u %e-u $"ni5' in%us4#i 4e5s4il %"n lin$5un$"n in%us4#i -esi -"8"' -""n 5i,i" "-#i5 see#4i 6"4' 4in4" se-"$"in." %ie#5i#"5"n ,en6""i 1(@ 2( Gene4i5( De9isiensi Al" 1;"n4i4#.sin ,e#u"5"n 9"54 #esi5& %"#i $ene4i5 ."n$ ,e,-e#i5"n 5&n4#i-usi 1;* "%" "sien PPOK(7 *( Ri"."4 in9e5si s"lu#"n n"9"s -e#ul"n$( In9e5si s"lu#"n n"9"s "5u4 ."n$ -"n."5 4e#8"%i "%" "n"5"n"5 ,e,-e#i5"n 5e6"4"4"n s","i %e"s" %i,"n" "l ini ,e,-e#i5"n u-un$"n %en$"n 4e#8"%in." PPOK() >( Gen%e#' usi"' 5&nsu,si "l5&&l %"n 5u#"n$n." ,el"5u5"n "54i:i4"s 9isi5 ,e,-e#i5"n 5&n4#i-usi 4e#8"%in." PPOK( 2.' Kl#sifi$#si
Be#%"s"#5"n Pe#i,un"n D&54e# P"#u In%&nesi"
PPOK #in$"n "%"l" "sien %en$"n 4i%"5 "%" $e8"l" "54u is4i#""4 n",un "sien %en$"n $e8"l" #in$"n "%" l"4i"n se%"n$
>
•
PPOK se%"n$ "%"l" "sien %en$"n "%" $e8"l" #in$"n "54u is4i#""4 n",un "sien ,ul"i 4e#"s" $e8"l" "%" l"4i"n/5e#8" #in$"n
•
e,e#i5s""n si#&,e4#i VEP *0 )0 #e%i5si VEP/KVP 7+( PPOK -e#"4 "%"l" "sien %en$"n $e8"l" se%"n$ "%" "54u is4i#""4 "4"u $e8"l" -e#"4 "%" s""4 is4i#""4 %"n 4e#%""4 4"n%" 4"n%" 5ul,un"l( D"#i e,e#i5s""n
si#&,e4#i %i%""45"n VEP1*0 #e%i5si VEP1/KVP 7+( 2.( P#%ofisioloi 1 S"l" s"4u 5"#"54e#is4i5 %"#i PPOK "%"l" 4e#8"%in." in9l","si 5#&nis ."n$ %i,ul"i %"#i s"lu#"n n"9"s' "#en5i, "#u s","i s4#u54u# :"s5ule# ul,&n"l( P"%" ""ln." #&ses in9l","si 4e#8"%i %i5"#en"5"n "%"n." #&ses 5&n4"5 4e#"%" in"l"n -""n ."n$ -e#-""."' n",un l"," 5el",""n in9l","si ini 4e#8"%i 4e#us ,ene#us sein$$" ,en8"%i 5#&ni5( P"%" e#u-""n "4&l&$is %isini %""4 %i4e,u5"n in9il4#"si sel;sel #"%"n$ "%" e#,u5""n ei4el( Kelen8"#;5elen8"# ,ense5#esi ,u5us ,e,-es"# %"n 8u,l" sel $&-le4 ,enin$5"4( Kel"in"n ini ,en.e-"-5"n ie#se5#esi -#&n5us( P#&ses -e#ul"n$n." si5lus in8u#. %"n #e"i# "%" in9l","si 5#&nis "5"n ,en$"5i-"45"n 4e#6i4"n." structural remodeling %"#i %in%in$ s"lu#"n e#n"9"s"n %en$"n enin$5"4"n 5"n%un$"n 5&l"$en %"n e,-en4u55"n 8"#in$"n i5"4 ."n$ ,en.e-"-5"n en.e,i4"n lu,en %"n &-s4#u5si 5#&nis s"lu#"n e#n"9"s"n( P"%" "#en5i, "#u "5"n 4e#8"%i %e5s4#u5si 4e#us ,ene#us( Pe#u-""n s4#u54u# ."n$ e#4"," 5"li 4e#8"%i ."i4u ene-"l"n 4uni5" in4i," ."n$ %ii5u4i %en$"n enin$5"4"n &4&4 &l&s %"n in9il4#"si %in%in$ e,-ulu %"#" &le sel;sel #"%"n$( i5" en."5i4 -e#4",-" l"n8u4' #&%u5si #&4e&$li5"n %"n 5&l"$en "5"n -e#4",-" -"n."5 sein$$" %in%in$ e,-ulu %"#" "5"n se,"5in 4e-"l( P"%" -#&n5i4is "5u4 ,"uun e,9ise," 4e#8"%i en.e,i4"n s"lu#"n n"9"s( Pen.e,i4"n ini %""4 ,en$"5i-"45"n &-s4#u5si %"n ,eni,-ul5"n ses"5( P"%" -#&n6i4is 5#&nis s"lu#"n n"9"s "5"n ,en8"%i le-i se,i4 %"n -e#5el&5 5el&5( Pen.e,i4"n ini 4e#8"%i %i5"#en"5"n ,e4"l"si" sel
+
sel $&-le4 %"n ie#l"si" 5elen8"# ,u5us( Se%"n$5"n "%" e,9ise," 4e#8"%i en.e,i4"n s"lu#"n e#n"9"s"n ."n$ %ise-"-5"n &le -e#5u#"n$n." el"s4isi4"s "#u(
G",-"# 1( Al$i4,e P"4&9isi&l&$is %"#i PPOK 1
2.) Di#nosis
Di"$n&sis %i-u"4 -e#%"s"#5"n ! 1. *#m+#n Klinis
D"#i "n",nesis %i%""45"n #i"."4 en."5i4 ."n$ %i4"n%"i %en$"n $e8"l";$e8"l" ."n$ "%" %i-"" ini !
"( Ses"5 N"9"s Ses"5 %i#"s"5"n 4i,-ul se6"#" #&$#esi9 %"l", -e-e#"" 4"un' ,"5in l"," ,"5in ,en$"n$$u "54i:i4"s se"#i;"#i( -( B"4u5 K#&nis B"4u5 -e#%""5 %""4 4e#8"%i eis&%i5 "4"u -e#4e,-" -e#"4 "%" s""4 "$i "#i( D""5 -i"s"n." -e"#n" u#ulen "%" s""4 e5s"se#-"si "5u4( 6( Ses"5 N"9"s
@
Wheezing "%" PPOK 4e#8"%i -i"s"n." "%" en$e#""n 4en"$"
P"sien -i"s"n." 4","5 5u#us %en$"n Barel chest shaped chest F#e,i4us 4"54il %"%" -e#5u#"n$ "4"u 4i%"5 "%" Pe#5usi %"%" ie#s&n' -"4"s "#u %"n "4i le-i #en%" Su"#" n"9"s 4e#%en$"# -e#5u#"n$' e5si#"si ,e,"n8"n$'4e#%""4 "%"n." su"#" 4",-""n see#4i #&n5i "4"u wheezing (
!. Peme&i$s##n Pen,n-#n Pe,e#i5s""n R"%i&l&$i
A. F&4& R&n4$en T" R#dioloi B&on$i%is K&onis
U,u,n." n,"l
C"5"n -#&n5&"l:e&l"# -e#4",-"
7
G",-"# 1 F&4& 4"5s -#&n5i4is 5#&nis R#dioloi Emfisem#
S4"%iu, ""l n,"l(
S4"%iu, l"n8u4 "( T"n%";4"n%" ie#in9l"si <#"%i&lusen=
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Di"9#"$," ,en%"4"#
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Ru"n$ #e4#&s4e#n"l ,ele-"#
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G",-"# 2( F&4& 4"5s e,9ise," ,enun8u55"n enin$5"4"n lusensi' %i"9#"$," ,en%"4"# %"n #u"n$ #e4#&s4e#n"l ,ele-"#
G",-"# *( G",-"#"n 3ie#in9l"si P"#u
G",-"# *( CT S6"n P"#u "#u ,en$$",-"#5"n %ensi4"s ."n$ 4i%"5 &,&$en "%" en%e#i4" PPOK Pe,e#i5s""n 9un$si "#u
Me#&5&5' se-"$"i 9"54 #isi5& u4","n." 8u$" 4i%"5 ,u4l"5 ,en.e-"-5"n PPOK "%" se,u" "n$( 3"l ini 8u$" %ien$"#ui &le in4ensi4"s "8"n"n "s" #&5&5' usi" en8",u se#4" 9un$si "#u si en8",u sen%i#i( Se6"#" "l",i' se,"5in -e#4",-"n." usi" ,"5" 9un$si "#u 8u$" "5"n ,enu#un( 3"l ini %""4 %i4un8u55"n &le #orced $xpirator% &olume in one second (#$&')&olume $spirasi "ertama (&$"') %i-"n%in$ %en$"n #&* (#orced &ital *apacit%) J +apasitas &ital "asa (+&") ."n$ %ii4un$ ,el"lui si#&,e4#i( VEP1 "%"l" 8u,l" u%"#" ."n$ %""4 %ie,-us5"n se6"#" "5s" %"l", 1
10
%e4i5 se4el" 1 insi#"si %"l",( Si#&,e4#i "%"l" e,e#i5s""n 9un%",en4"l %"l", %i"$n&sis PPOK( Si#&,e4#i %i$un"5"n un4u5 ,enil"i VEP1' VEP1 #e%i5si' KVP' VEP1/KVP(! • • •
O-s4#u5si %i4en4u5"n &le nil"i VEP1 #e%i5si < = %"n "4"u VEP1/KVP < =( O-s4#u5si ! VEP1
Pe,e#i5s""n $"s %"#" 4e#u4"," un4u5 ,enil"i ! •
G"$"l n""s 5#&nis s4"-il
•
G"$"l n""s "5u4 "%" $"$"l n""s 5#&nis
Pe,e#i5s""n EKG
Menu#u4 M&seni9"# ,"ni9es4"si PPOK 5e s.s4e, 5"#%i&:"s5ul"# %""4 4i,-ul "5i-"4 enu#un"n 5e,",u"n #e6&il "l:e&li
11
-e#u-un$"n %en$"n %e#"8"4 i&5se,i"( S4u%i l"in 8u$" ,el""n :"#i"si in4e#:"l R;R 8u$" %""4 ,en$in%i5"si5"n $"n$$u"n i#"," 8"n4un$ "5i-"4 $"n$$u"n si,"4is ."n$ -i"s"n." ,un6ul "%" "sien PPOK( Sel"in i4u 8u$" "%"n." e,-es"#"n "4#iu, 5"n"n < Right
,trium
$nlargement-R,$)
ie#4#&9i
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5"n"n
< Right
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H%pertroph%-R&H) -l&5 -e#5"s se#"-u4 5"n"n (Right Bundle Branch Bloc-RBBB=' %"n %e:i"si "5sis 5e 5i#i (e/t ,xis De0iation-,D=( Pe,e#i5s""n L"-"4iu, %"#" <$",-"#"n leu5&si4&sis=
2./ Pen#%#l#$s#n##n
Tu8u"n en"4"l"5s"n""n "%" PPOK "%"l" un4u5 ,en$u#"n$i $e8"l"' ,en6e$" e5s"se#-"si' ,e,e#-"i5i %"n ,en6e$" enu#un"n 9""l "#u se#4" ,enin$5"45"n 5u"li4"s i%u( A%"un ,&%"li4"s 4e#"i ."n$ %""4 %i-e#i5"n see#4i e%u5"si' &-"4;&-"4"n' &5si$en' :en4il"si' nu4#isi %"n #e"-ili4"si( "( E%u5"si1 Tu8u"n %"#i e%u5"si "%"l" ,en.esu"i5"n 5e4e#-"4"s"n "54i:i4"s %"n ,en6e$" 5e6e"4"n e#-u#u55"n 9un$si "#u( Pe,-e#i"n e%u5"si %isesu"i5"n %en$"n %e#"8"4 en."5i4 1( Rin$"n ; Pe,-e#i"n en8el"s"n en.e-"- %"n &l" en."5i4 PPOK ."n$ i#e:e#si-el ; Men6e$" en."5i4 ,en8"%i -e#"4 %en$"n ,en$in%"#i en6e4us' "n4"#" l"in -e#en4i ,e#&5&5 ; Se$e#" -e#&-"4 -il" 4i,-ul $e8"l" 2( Se%"n$
12
; Men$$un"5"n &-"4 ."n$ %i-e#i5"n %en$"n 4e"4 ; Men$en"l %"n ,en$"4"si e5s"se#-"si %ini ; P#&$#", l"4i"n 9isi5 %"n e#n"9"s"n *( Be#"4 ; Pe,-e#i"n in9,"si 4en4"n$ 5&,li5"si ."n$ %""4 4e#8"%i ; Pen.esu"i"n "54i:i4"s %en$"n 5e4e#-"4"s"n ."n$ %i"l",i ; Pen$$un""n &5si$en %i #u," -( Te#"i e5s"se#-"si "5u4 %en$"n &-"4;&-"4"n( O-"4 &-"4"n ."n$ %i-e#i5"n see#4i !1 1( B#&n5&%il"4 D""4 %i-e#i5"n se6"#" 4un$$"l "4"u 5&,-in"si %"#i 5e4i$" 8enis -#&n5&%il"4 %"n %isesu"i5"n %en$"n 5l"si9i5"si %e#"8"4 en."5i4( Pe,ili"n -en4u5 &-"4 ."n$ %iu4","5"n ."i4u in"l"si( P"%" %e#"8"4 -e#"4 %iu4","5"n e,-e#i"n &-"4 le"s l",-"4 < slow response) "4"u &-"4 %en$"n e9e5 8"n$5" "n8"n$
1*
Pe,-e#i"n &5si$en "%" PPOK %il"5u5"n un4u5 ,e,e#4""n5"n &5si$en"si selule# %"n ,en6e$" 5e#us"5"n sel -"i5 %i &4&4 ,"uun %i $"n;$"n l"inn."(
BAB III
1>
LAPORAN KASUS I. ANA0NESIS I.
II.
Iden%i%#s P#sien
N","
! Tn(SG
U,u#
! + 4"un
enis Kel",in
! L"5i;l"5i
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A$","
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Al","4
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T"n$$"l M"su5
! 2) "nu"#i 2017
N& RM
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Kel,#n U%#m#
Ses"5 n"9"s III.
Ri#3#% Pen3#$i% Se$#n
Pen%e#i4" %"4"n$ %en$"n 5elu"n ses"5 n"9"s ."n$ 4el" %i%e#i4" se8"5 > "#i se-elu, ,"su5 #u," s"5i4' ses"5 n"9"s %i#"s" ,e,-e#"4 4e#u4"," se4el" -e#"54i:i4"s' "5"n se%i5i4 -e#5u#"n$ -il" "sien -e#is4i#""4( %"n "sien se#in$ 4e#-"n$un "%" ,"l", "#i 5"#en" ses"5( P"sien 4i%u# le-i n.","n %en$"n * -"n4"l( Ses"5 n"9"s %ii5u4i %en$"n 5elu"n -"4u5 %en$"n %""5 ."n$ suli4 %i5elu"#5"n' %"n 8i5" 5elu"# %""5 -e#"#n" 5unin$' %e,",' 4i%"5 "%" enu#un"n -e#"4 -"%"n ' n"9su ,"5"n ,enu#un' 5e#in$"4 ,"l", <;=' n.e#i %"%" = s""4 -"4u5( BAK %"n BAB 4i%"5 "%" 5el"in"n( D"l", 1 -ul"n ini' ses"5 %i#"s"5"n &le "sien su%" * 5u,"4( N",un' se5"#"n$ ses"5 n"9"s en%e#i4" ,ul"i -e#5u#"n$' en%e#i4" su%" -is" -i6"#" e#5"li,"4' 4i%"5 see#4i "%" ""l ,"su5' ."n$ 4e#en$";en$" 5e4i5" -e#-i6"#"( B"4u5 8u$" su%" -e#5u#"n$( I4.
Ri#3#% Pen3#$i% D#,l,
Ri"."4 DM
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22
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DA"TAR PUSTAKA
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