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In general, respiratory airways are as follows: from the anterior nares to the cavitas Nasalis,
choanae, nasopharynx, larynx, trachea, bronchus primarius, bronchus Secundus, Tertius bronchus,
bronchiolus, bronchiolus terminalis, bronchiolus respiratory, alveolaris ductus, atrial alveolaris,
sacculus alveolaris , and ends at the alveoli where the exchange of air.

Definition and Etiology

Tuberculosis caused by Mycobacterium tuberculosis. Rod-shaped bacteria, acid resistant in coloring,
referred to as acid resistant bacillus (BTA). These germs die in direct sunlight but can survive in the
dark and damp. The infection way through droplets (splash sputum). Germs can spread directly into
the surrounding tissue, lymphatics, and blood vessels .

1. Primary infection. The first infection occurs in the body that do not have a specific reaction to the
TB bacillus.
2. Post primary infection. Infections that occur after primary infection, usually after several months
or years. This infection reappears as decreased immunity, such as poor nutritional status, HIV
infection, and others (Amin, 1989; Reviono, 2008).

Clinical picture

Respiratory symptoms of cough for more than 3 weeks, haemoptysis, shortness of breath, chest
pain. Systemic symptoms of a weak body, appetite falls, weight loss (BB) down, malaise, night
sweats (Chandrasoma, 2006).


1. Anamnesis, namely about symptoms, disease history, history of exposure / contact with TB
2. Macroscopic examination of bacteria: how SPS, Ziehl Nellson painting methods, IUATLD scale
readings, Bronkhorst scale.
3. Radiologically. Active multiform lesions: infiltrates, consolidation, noduler, milier, cavitas, effusion.
Inactive lesions: fibrotik, calcification, Schwarte. Used to distinguish minimal lesions and large
4. Tuberculin test. Based on 4 types of hypersensitivity reactions, which produce tuberculoprotein
TB bacilli which will stimulate the emergence of these reactions.
5. Blood tests are used to determine disease activity (Reviono, 2008).

Respiration consists of two mechanisms, namely inspiration and expiration. At the moment of
inspiration costa attracted to the axis of the cranial articulatio costovertebrale, contraction of the
diaphragm down to the caudal, thus expanding the thorax cavity, and the air pressure in the
enlarged thorax cavity is lower than outside air pressure. While expiration is the opposite of

Definition etiology

Lung inflammation caused by microorganisms other than Mycobacterium tuberculosis, namely
bacteria, viruses, fungi, parasites. Based sources of bacteria: community acquired pneumonia in the
community, nosocomial pneumonia hospital-acquired, aspiration pneumonia, and pneumonia
imunocompromised. Based on the cause: pneumonia bacterial / typical (staphylococus,
streptococcus, hemofilus influenza, Klebsiella, Pseudomonas.), A typical pneumonia (Mycoplasma,
Legionella, chlamydia), pneumonia virus, and fungal pneumonia.

Pathogenesis and Pathology

In good health, did not happen the growth of microorganisms in the lungs, it is due to the activity of
lung defense mechanisms. If there is an imbalance between the immune system, microorganisms,
and the environment, the microorganisms can cause diseases multiply. How to microorganisms in
the respiratory tract by 4 ways: direct inoculation, spread through the blood vessels, inhalation
aerosol material, colonization of mucosal surfaces.

The bacteria that enter the alveoli lead to inflammation, edema around the alveoli, and the
infiltration of PMN cells. PMN cells to the surface of bacteria urged the alveoli and with the help of
others through lekosit cytoplasmic pseudopodosis around the bacteria and the phagocyte.

There are 4 zones in areas of inflammation reactions:
1. Outer zone: the alveoli are filled with bacteria and edema fluid.
2. The beginning of the consolidation zone: consisting of several PMN and red blood cells.
3. Outside the consolidation zone: the area where there is active phagocytosis by the number of
PMN that much.
4. Resolution zone: the area where the resolution occurs with many of the dead bacteria, leukocytes
and alveolar macrophages (Reviono, 2008).


Anamnesis, found symptoms of fever chills, increased body temperature, purulent sputum,
shortness of breath, sometimes chest pain, coughing up blood can be a bit much.
Physical examination, depending on the area of lesions. Inspection: left diseased part, palpation:
fremitus can harden, percussion dim. Auscultation: basic voice bronchial until bronkovesikuler
,additional sound stage wet ronki resolution.
Radiological picture: picture infiltrates until consolidation (cloudy) water can be accompanied by

The laboratory, an increase lekosit 10.000/ul-30.000/ul. To be able to know the aetiology of sputum
examination, culture and serology. Blood gas analysis showed hipoksemia, at an advanced stage
respiratory acidosis.


Consists of antibiotics and supportive treatment. Antibiotics should be based on micro data and
sensitivity test results (Reviono, 2008).


Histologically, composed of airway epithelial goblet cells, glands, cartilage, smooth muscle, and
elastin. Epithelium of the fossa Nasalis to multilevel thoracic bronchus is bersilia, was afterwards
bersilia is a layer of cabbage. Tues goblet fossa are common in large Nasalis until the bronchus, was
later slightly until no. Tracheal cartilage in the horseshoe, on bronchial not found and there is much

Is all malignancies in the lung disease include malignancy originating from the lungs or from
metastases. There are several groups who have a high risk of lung cancer : male higher, above the
age of 40 years, smokers, exposure to the industry, women as passive smokers (Rima, 2008).

Clinical picture

Divided into two groups: typical symptoms and not typical. Typical symptoms: shortness of breath,
difficult / pain swallowing, lump in the base of the neck, puffy face and neck, coughing with or
without sputum, haemoptysis, chest pain. The symptoms are not typical: weight loss, loss of
appetite, intermittent fever (Amin, 1989; Chandrasoma, 2006).


Anamnesis, in the form of symptoms, disease history, family history of disease, risk factors.
Physical examination, depending on the location of large tumors. When a small tumor and the
location of the peripheral, showed a normal picture. Tumor size, location in the central, and when
accompanied by atelectasis will occur withdrawal or oesofagus trachea.
Radiologically. Solitary nodule appeared sirkumskripta or coin lession in radigram chest is an early
clue to detect carcinoma bronkogenik, though can also be found in many other circumstances. CT
scans may be able to provide further assistance in distinguishing lesions of the suspect.

Bronchoscopy, has several functions: to take the material or tissue, to determine bronchial mucosal
abnormalities, to assess the state of the branching bronchus.
Special examination include: sputum cytology, biopsy trans torakal (TTB) for peripheral lesions
located, trans bronchial lung biopsy (TBLB), torakoskopi, mediastinoskopi, and Thoracotomy
exploration as a last resort (Rima, 2008).


Primary lung cancer is usually classified according to type histologinya:
Small cell carcinoma
Non-small cell carcinoma include: squamous carcinoma, large cell carcinoma, adenocarcinoma (Price
and Wilson, 2006).


Penderajatan lung cancer according to the International Staging System for Lung Cancer TNM system
(tumor, lymph nodes, metastase). Stage IA: T1N0M0. Stage IB: T2N0M0. Stage IIA: T1N1M0. Stage
IIB: T2N1M0. Stage IIIA: T1N2M0, T2N2M0, T3N1M0, T3N2M0. Stage IIIB: any T N3M0, T4 any N M0.
Stage IV: any TN M1 (Price and Wilson, 2006).


Surgery (operations), indicated on the cell type non-small cell carcinoma of stage I and II. Stage IIIA
should be given chemotherapy first to reduce the staging.
Radiotherapy as a curative and palliative therapy.
Chemotherapy (Rima, 2008).


Coughing blood 2.3% and 15.4% pneumotorak (Rima, 2008).

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