Professional Documents
Culture Documents
ERWIN ARIEF
bronkia
(bronchial,
tubes), ek (out),
and tasis
(stretching)
Bronchiectasis
literally mean
the
outstretching of
the bronchi
Bronchiectasis is an uncommon disease
with irreversible abnormal dilatation of the
bronchi due to the destruction of elastic
and muscular components of the bronchial
wall.
PREVALENCE
The true
prevalence of
United States
bronchiectasis is
52 cases per
unknown for
100,000 adults
most regions of
the world.
PREVALENCE
• Trachea
• Right and left bronchi
• Lobar bronchi
• Segmentalis bronchi.
• Terminal bronchioles,
• Acini comprising:
respiratory bronchioles,
alveolar ducts and alveolar
sakkus terminalis
III. CLASSIFICATION OF
BRONCHIECTASIS
Saccular or
cystic
bronchiectasis
Classification
Varicose
of
bronchiectasis
bronchiectasis
Cylindrical
bronchiectasis
IV. Etiology
Impaired ciliary
function
Inflamatory
INFECTION response
Loss of
Tissue
Acumulation of ciliated cell
damage
mucus
• Chronic cough
• Dyspnea
• Hemoptysis
History and • Whezing
physical • Pleuritic chest pain
examination
• Fever
• Weight loss
• Thorax photo
• Bronchography
DIAGNOSI • CT-Scan thorax
S
Thorax photo
Bronchography
CT-Scan of thorax
Figure A Figure B
Figure C Figure D
• Analysis of sputum
• Quantitative
immunoglobulin
Examination levels
to identify the • Serum alpha-1 anti-
underlying trypsin
disease • Total serum IgG
level
• Autoimmune
screening tests
VII. MANAGEMENT
• The goal of therapy in patients with
bronchiectasis is to improve symptoms,
reduce complications, control of
exacerbations and reduce morbidity and
mortality and improve quality of life.
MANAGEMENT
• Early recognition of the underlying causes of
bronchiectasis was necessary to treatment
• The use of drugs and chest
physiotherapy have been done to
mobilize secretions.
• Chest physiotherapy in the form of
postural drainage, active breathing
techniques, therapies lid positive
Improve drainage expiratory pressure, positive expiratory
of bronchial pressure with high frequency chest
secretions wall vibration.
• Mucolytics to reduce the viscosity of
secretions and inhalation of hypertonic
saline or mannitol inhalation to reduce
the osmolarity of secretions is also an
adjunct therapy to improve mucus
clearance
Antibiotics
Early recognition and adequate treatment can help control and reduce
the symptoms of bronchiectasis.
Awareness of the need for life long treatment can allow people with
bronchiectasis to minimize complications and maximize the life
expectancy.
Onset : akut
Indeks oksigenasi (PaO2/FiO2) < 200
mmHg
Foto toraks : infiltrat alveolar bilateral
PAWP < 18 mmHg atau tidak ada bukti
klinis HT atrium kiri
PENYEBAB ARDS
I . LANGSUNG
II. TIDAK LANGSUNG
Langsung
Aspirasi
Tenggelam
Inhalasiasap atau bahan
kimia toksik
Kontusio paru
Keracunan oksigen
Pneumonia
Tidak langsung :
Syok berat
Sepsis
Pankreatitis
Emboli lemak
Transfusi berlebihan
membran alveolo-kapiler
permeabilitas
edema
Patogenesis ARDS secara
umum:
1. Edema paru
2. Shunting dalam darah paru
Kapiler Kapiler
sistemik pulmonal
Efusi
Tek koloid Pleura Tek koloid
osmotik osmotik
(cm H2O) (cm H2O)
Tek negatif
intrapleura
Tek
Tek
hidrostatik
hidrostatik
(cm H2O)
(cm H2O)
Pleura Pleura
parietalis viseralis
CXR
Arah cairan dalam
kavitas pleura
Fluid direction,
posteroinferior
posteroinferior
CT-Scan
Pleural effusion: Classification
• Purulent → Empyema
• Blood → Hemothorax
• Milky → Chylothorax
Pleural Effusion fluid
Tests Transudate Exudates Exudates
(tubercular) (Empyema)
Physical appearance Clear Straw coloured Cloudy /
Turbid
Microscopy <1000 >1000 >5000 PMNs
Lympho/M Lymphocytes Pus cells
Associated with
• Acute bacterial infections
• Tuberculosis
• Connective tissue disorders- rheumatic fever
Dry pleurisy: Pathology
• Infections of lungs
• Inflammatory conditions of mediastinum
• Less commonly with- SLE, RF, neoplasms
Serofibrinous pleurisy: Clinical features