TUBERCULOSIS 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 . Classification 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). Diagnosis 1. Anamnesis, namely about symptoms, disease history, history of exposure / contact with TB patients. 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 lesions. 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). PNEUMONIA 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 inspiration 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). Diagnosis 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 bronchogram. 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. Medical Consists of antibiotics and supportive treatment. Antibiotics should be based on micro data and sensitivity test results (Reviono, 2008). LUNG CANCER 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 elastin 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). Diagnosis 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). Pathology 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). Staging 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). Medical 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). Complications Coughing blood 2.3% and 15.4% pneumotorak (Rima, 2008).