tag:blogger.com,1999:blog-58533673472017391752024-03-14T09:13:24.116-07:00asro medikadibuat untuk berbagi..Anonymoushttp://www.blogger.com/profile/06590633769759394496noreply@blogger.comBlogger262125tag:blogger.com,1999:blog-5853367347201739175.post-20161865462771204632013-09-05T20:39:00.000-07:002013-09-05T20:39:03.810-07:00Diagram Sebab-Akibat (Cause Effect Diagram)/Diagram Tulang Ikan (Fishbone Diagram)/Diagram IshikawaDiagram ini adalah diagram yang menggambarkan hubungan antara karakteristik kualitas/ akibat dengan faktor-faktor penyebabnya sehingga didapatkan suatu hubungan sebab akibat untuk mencari akar dari suatu pokok permasalahan ditinjau dari berbagai faktor yang ada.1,2 Diagram ini digunakan sebagai grafik alat bantu manajemen mutu yang memaparkan dan menggambarkan sumber-sumber penyebab variasi suatu proses. Penyusunan diagram ini bertujuan untuk mencari dan menemukan beberapa sumber masalah yang menjadi kunci penyebab suatu masalah. <br /><br />Tujuan utama dari diagram tulang ikan adalah untuk menggambarkan hubungan antara outcome dan faktor-faktor yang mempengaruhi outcome. Sasaran utama dari penggunaan diagram ini adalah: <br /><br />- Menentukan akar masalah-masalah<br /><br /> -Memusatkan contoh masalah yang dianalisis dengan menggunakan teknik analisis sebab-akibat (cause effect diagram)/ tulang ikan (fishbone diagram)/ diagram Ishikawa <br /><br /><br />Reff: <br /><br />1. Ishikawa, Kaoru. 1986. Guide to Quality Control. Tokyo: Asian Productivity Organization. <br /><br /><br /><br /> Anonymoushttp://www.blogger.com/profile/06590633769759394496noreply@blogger.com1tag:blogger.com,1999:blog-5853367347201739175.post-42350509730669658922013-09-05T20:31:00.001-07:002013-09-05T20:31:55.646-07:00Transformasi ASKESProses Transformasi PT.ASKES <br /><br />• Menyusun sistem dan prosedur aspek strategik dan aspek operasional untuk operasionalisasi BPJS Kesehatan <br /><br />• Menyusun berbagai konsep untuk masukan dan usulan bagi penyusunan peraturan dan perundangan yang dibutuhkan dalam implementasi BPJS Kesehatan <br /><br />• Melakukan koordinasi dengan pihak-pihak terkait <br /><br />• Menyiapkan SDM yang handal untuk masa depan <br /><br /> <br /><br /> I. PERSIAPAN (25 November 2011 – 31 Desember 2013) <br /><br />1. Menyiapkan Operasional BPJS Kesehatan <br /><br />· Penyusunan sistem dan prosedur operasional BPJS <br /><br />· Sosialisasi JK kepada seluruh pemangku kepentingan <br /><br />· Penetapan manfaat program JK <br /><br />· Koordinasi dengan Kemenkes untuk pengalihan Jamkesmas <br /><br />· Koordinasi dengan Kemenhan, TNI, POLRI untuk pengalihan program yankes TNI, POLRI, PNS Kemenhan/ TNI/Polri <br /><br />· Koordinasi dengan PT Jamsostek untuk pengalihan JPK Jamsostek. <br /><br />2. Pengalihan Aset dan Liabilitas, Pegawai, Hak dan Kewajiban BPJS Kesehatan. <br /><br />· Menunjuk Kantor Akuntan Publik untuk melakukan audit: <br /><br />o Laporan Keuangan Penutupan PT Askes <br /><br />o Laporan Posisi Keuangan Pembukaan BPJS Kesehatan, dan <br /><br />o Laporan Posisi Keuangan Pembukaan Dana Jaminan Kesehatan <br /><br /> <br /><br />· Menyusun: <br /><br />o Laporan Keuangan Penutupan PT Askes <br /><br />o Laporan Posisi Keuangan Pembukaan BPJS Kesehatan, dan <br /><br />o Laporan Posisi Keuangan Pembukaan Dana Jaminan Kesehatan. 6 <br /><br /> <br /><br />Kesiapan operasional PT Askes (Persero) menuju BPJS Kesehatan : 2, <br /><br />1 Kepesertaan <br /><br />SAAT INI <br /><br />§ Aplikasi Manajemen Kepesertaan terintegrasi dalam Sistem Informasi Manajemen. <br /><br />§ Master File Nasional secara terpusat dan diakses dari seluruh Indonesia dengan pemanfaatan VPN. <br /><br />§ Penggunaan Nomor Identitas Tunggal <br /><br />§ Kepesertaan PNS, Penerima Pensiun, PJK MU <br /><br /> <br /><br />AKAN DATANG <br /><br />§ Pemantapan Aplikasi Manajemen Kepesertaan <br /><br />§ Penataan Master File Nasionalàmigrasi data dari institusi lain, peserta baru. <br /><br />§ Penggunaan Nomor Identitas Tunggal à dikaitkan dengan NIK <br /><br /> <br /><br />2 Pelayanan Kesehatan <br /><br />SAAT INI <br /><br />§ Aplikasi Manajemen Pelayanan Kesehatan terintegrasi dalam Sistem Informasi Manajemen <br /><br />§ Jaringan fasilitas kesehatan: Pemerintah, TNI/Polri, Swasta, <br /><br />§ Manfaat komprehensif, pelayanan berjenjang <br /><br />Standarisasi: obat <br /><br /> <br /><br />AKAN DATANG <br /><br />§ Pemantapan Aplikasi Manajemen Pelayanan Kesehatan. <br /><br />§ Pemantapan jaringan fasilitas kesehatan dan SDM. <br /><br />§ Manfaat komprehensif, pelayanan berjenjang. <br /><br />§ Standarisasi pelayanan medik, obat, alat kesehatan. <br /><br /> <br /><br />3 Pembiayaan <br /><br />SAAT INI <br /><br />§ Aplikasi Manajemen Keuangan terintegrasi dalam Sistem Informasi Manajemen. <br /><br />§ Iuran: % gaji pokok. <br /><br />§ Pembiayaan: kapitasi, tariff paket. <br /><br /> <br /><br />AKAN DATANG <br /><br />§ Pemantapan Aplikasi Manajemen Keuangan. <br /><br />§ Iuran: % gaji, nominal. <br /><br />§ Pembiayaan: kapitasi, pola tarip Askes, Ina-CBG. <br /><br /> <br /><br />4 Organisasi dan SDM <br /><br />SAAT INI <br /><br />§ Aplikasi Manajemen SDM. <br /><br />§ Jaringan organisasi Pusat sampai kabupaten / kota. <br /><br />§ SDM berbasis kompetensi. <br /><br /> <br /><br />AKAN DATANG <br /><br />§ Pemantapan jaringan organisasi: penambahan kantor. <br /><br />§ Pemantapan kompetensi SDM, penambahan SDM. <br /><br /> <br /><br />5 Teknologi Informasi <br /><br />SAAT INI <br /><br />§ Sistem Informasi Manajemen komprehensif Terpadu. <br /><br />§ Pusat Data Nasional. <br /><br />§ Jaringan VPN seluruh Indonesia: 686 titik. <br /><br /> <br /><br />AKAN DATANG <br /><br />§ Pemantapan Sistem Informasi Manajemen Terpadu. <br /><br />§ Pemantapan Pusat Data Nasional, <br /><br />§ Penambahan kapasitas jaringan VPN. <br /><br /> <br /><br /> II. BPJS KESEHATAN <br /><br />· PT ASKES Bubar TANPA likuidasi. <br /><br />· SEMUA Asset, liabilitas, hak & kewajiban hukum PT ASKES menjadi Asset & liabilitas hak dan kewajiban hukum BPJS KESEHATAN. <br /><br />· SEMUA Pegawai PT ASKES menjadi Pegawai BPJS KESEHATAN. <br /><br />· Menteri BUMN (RUPS) melakukan pengesahan laporan posisi keuangan penutup PT Askes (Persero) setelah diaudit oleh Akuntan Publik. <br /><br />· Menteri Keuangan melakukan pengesahan laporan posisi keuangan pembuka BPJS Kesehatan dan laporan keuangan pembuka dana JK. <br /><br />· Presiden Mengangkat Dewan Pengawas dan Direksi BPJS Kesehatan (untuk pertama kali Dewan Komisaris dan Direksi PT ASKES diangkat menjadi Dewan Pengawas dan Direksi BPJS Kesehatan untuk paling lama 2 tahun). <br /><br />· KEMENKES tidak lagi menyelenggarakan JAMKESMAS. <br /><br />· KEMENHAN, TNI, POLRI tidak lagi menyelenggarakan YanKes kecuali YanKes tertentu. <br /><br />· PT JAMSOSTEK tidak lagi menyelenggarakan JPK. <br /><br /> <br /><br />Reff: <br /><br />2. http: www.bpjs.info/, diakses pada tanggal 24 Agustus 2013. <br /><br />5. http: www.ilo.org/wcmsp5/.../wcms_170567.pdf <br /><br />6. http: datakesra.menkokesra.go.id/.../tahapan%20transforma, diakses pada tanggal 24 Agustus 2013. <br /><br /> <br /><br /> <br /><br /> <br /><br /> <br />Anonymoushttp://www.blogger.com/profile/06590633769759394496noreply@blogger.com0tag:blogger.com,1999:blog-5853367347201739175.post-9814271492281496192013-09-05T20:26:00.001-07:002013-09-05T20:26:20.912-07:00Transformasi BPJS <!--[if gte mso 9]><xml>
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<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman";">Transformasi
asuransi yang ada di Indonesia ke Badan Penyelenggara Jaminan Sosial Kesehatan
dijelaskan berikut : 5,6 <br />
<br />
1. PT ASKES <br />
<br />
Berubah menjadi BPJS Kesehatan dan mulai beroperasi menyelenggarakan program
jaminan kesehatan pada tanggal 1 Januari 2014 (Pasal 60 ayat (1) UU BPJS) <br />
<br />
2. PT JAMSOSTEK <br />
<br />
· Berubah menjadi BPJS Ketenagakerjaan pada tanggal 1 Januari 2014 (Pasal 62
ayat (1) UU BPJS) <br />
<br />
· BPJS Ketenagakerjaan paling lambat mulai beroperasi pada tanggal 1 Juli 2015,
termasuk menerima peserta baru (Pasal 60 ayat (2) UU BPJS) <br />
<br />
3. PT ASABRI <br />
<br />
Menyelesaikan pengalihan program ASABRI dan program pembayaran pensiun ke BPJS
Ketenagakerjaan paling lambat tahun 2029 (Pasal 65 ayat (1) UU BPJS) <br />
<br />
4. PT TASPEN <br />
<br />
Menyelesaikan pengalihan program THT dan program pembayaran pensiun ke BPJS
Ketenagakerjaan paling lambat tahun 2029 (Pasal 65 ayat (1) UU BPJS) <br />
<br />
Proses selanjutnya adalah pembubaran PT ASKES dan PT JAMSOSTEK tanpa likuidasi.
Sedangkan PT ASABRI dan PT TASPEN tidak secara tegas ditentukan dalam UU BPJS.
5,6 <br />
<br />
<br />
Hak dan Kewajiban <br />
<br />
Jaminan sosial merupakan salah satu bentuk pelayanan publik yang menjadi misi
Negara untuk melaksanakannnya. Pengembangan sistem jaminan sosial bagi seluruh
rakyat merupakan amanat konstitusi dalam rangka memenuhi hak rakyat atas
jaminan sosial yang dijamin dalam Pasal 28 H ayat (3) UUD Negara RI Tahun 1945.
6 <br />
<br />
Berdasarkan UU Nomor 24 Tahun 2011 tentang BPJS, dibentuk 2 Badan Penyelenggara
Jaminan Sosial, yaitu BPJS Kesehatan dan BPJS Ketenagakerjaan. BPJS Kesehatan
menyelenggarakan program JK dan BPJS Ketenagakerjaan menyelenggarakan JKK, JHT,
JP, dan JKM. 6 <br />
<br />
PT ASKES (Persero) berubah menjadi BPJS Kesehatan dan mulai beroperasi 1
Januari 2014, sedangkan BPJS Ketenagakerjaan mulai beroperasi menyelenggarakan
program JKK, JHT, JP, dan JKM bagi peserta selain peserta program yang dikelola
PT Taspen (Persero) dan PT Asabri (Persero) paling lambat 1 Juli 2015. PT
(Persero) JAMSOSTEK yang akan berubah menjadi BPJS Ketenagakerjaan pada tanggal
1 Januari 2014. UU BPJS memberikan hak dan kewajiban kepada BPJS dalam
melaksanakan kewenangan dan tugas yang ditentukan dalam UU BPJS. Berikut ini
akan di jabarkan tentang hak dan kewajiban BPJS. </span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman";">Hak BPJS : <br />
<br />
UU BPJS menentukan dalam melaksanakan kewenangannya, BPJS berhak: <br />
<br />
a. Memperoleh dana operasional untuk penyelenggaraan program yang bersumber
dari Dana Jaminan Sosial dan/atau sumber lainnya sesuai dengan ketentuan
peraturan perundang-undangan; <br />
<br />
b. Memperoleh hasil monitoring dan evaluasi penyelenggaraan program jaminan
sosial dari DJSN. <br />
<br />
Mengenai hak memperoleh hasil monitoring dan evaluasi penyelenggaraan program
jaminan sosial dari DJSN setiap 6 bulan, dimaksudkan agar BPJS memperoleh umpan
balik sebagai bahan untuk melakukan tindakan korektif memperbaiki
penyelenggaraan program jaminan sosial. Perbaikan penyelenggaraan program akan
memberikan dampak pada pelayanan yang semakin baik kepada peserta. 6 <br />
<br />
Kewajiban BPJS : <br />
<br />
UU BPJS menentukan bahwa untuk melaksanakan tugasnya, BPJS berkewajiban untuk: <br />
<br />
a. Memberikan nomor identitas tunggal kepada Peserta;<br />
Yang dimaksud dengan ”nomor identitas tunggal” adalah nomor yang diberikan
secara khusus oleh BPJS kepada setiap peserta untuk menjamin tertib
administrasi atas hak dan kewajiban setiap peserta. Nomor identitas tunggal
berlaku untuk semua program jaminan sosial. <br />
<br />
b. Mengembangkan asset Dana Jaminan Sosial dan asset BPJS untuk
sebesar-besarnya kepentingan peserta; <br />
<br />
c. Memberikan informasi melalui media massa cetak dan elektronik mengenai
kinerja, kondisi keuangan, serta kekayaan dan hasil pengembangannya;<br />
Informasi mengenai kinerja dan kondisi keuangan BPJS mencakup informasi
mengenai jumlah asset dan liabilitas, penerimaan, dan pengeluaran untuk setiap
Dana Jaminan Sosial, dan/atau jumlah asset dan liabilitas, penerimaan dan
pengeluaran BPJS. <br />
<br />
d. Memberikan manfaat kepada seluruh peserta sesuai dengan UU SJSN; <br />
<br />
e. Memberikan informasi kepada peserta mengenai hak dan kewajiban untuk
mengikuti ketentuan yang berlaku; <br />
<br />
f. Memberikan informasi kepada peserta mengenai prosedur untuk mendapatkan hak
dan memenuhi kewajiban; <br />
<br />
g. Memberikan informasi kepada peserta mengenai saldo JHT dan pengembangannya 1
kali dalam 1 tahun; <br />
<br />
h. Memberikan informasi kepada peserta mengenai besar hak pensiun 1 kali dalam
1 tahun; <br />
<br />
i. Membentuk cadangan teknis sesuai dengan standar praktik aktuaria yang lazim
dan berlaku umum; <br />
<br />
j. Melakukan pembukuan sesuai dengan standar akuntasi yang berlaku dalam
penyelenggaraan jaminan sosial; dan <br />
<br />
k. Melaporkan pelaksanaan setiap program, termasuk kondisi keuangan, secara
berkala 6 bulan sekali kepada Presiden dengan tembusan kepada DJSN. <br />
<br />
Jika dicermati ke 11 kewajiban BPJS tersebut berkaitan dengan governance BPJS
sebagai badan hukum publik. BPJS harus dikelolan sesuai dengan prinsip-prinsip
transparency, accountability and responsibility, responsiveness, independency,
dan fairness. Dari 11 kewajiban yang diatur dalam UU BPJS, 5 diantaranya
menyangkut kewajiban BPJS memberikan informasi. UU Nomor 14 Tahun 2008 tentang
Keterbukaan Informasi Publik memang mewajibkan badan publik untuk mengumumkan
informasi publik yang meliputi informasi yang berkaitan dengan badan publik,
informasi mengenai kegiatan dan kinerja badan publik, informasi mengenai
laporan keuangan, dan informasi lain yang diatur dalam peraturan
perundang-undangan. 6 <br />
<br />
Program <br />
<br />
Penyelenggaraaan jaminan sosial nasional yang adekuat merupakan salah satu
pilar untuk memajukan kesejahteraan umum sebagaimana diamanatkan dalam
Pembukaan UUD Negara RI Tahun 1945. UU Nomor 40 Tahun 2004 tentang SJSN
menentukan 5 jenis program jaminan sosial, yaitu program jaminan pemeliharaan
kesehatan (JPK), jaminan kecelakaan kerja (JKK), jaminan hari tua (JHT),
jaminan pensiun (JP) dan jaminan kematian (JK), yang diselenggarakan oleh Badan
penyelenggara Jaminan Sosial (BPJS) yang merupakan transformasi dari BUMN
penyelenggara jaminan sosial yang sekarang telah berjalan. Adapun program –
program BPJS antara lain : <br />
<br />
1. Jaminan Hari Tua (JHT) <br />
<br />
Program Jaminan Hari Tua ditujukan sebagai pengganti terputusnya penghasilan
tenaga kerja karena meninggal, cacat, atau hari tua dan diselenggarakan dengan
sistem tabungan hari tua. Program Jaminan Hari Tua memberikan kepastian
penerimaan penghasilan yang dibayarkan pada saat tenaga kerja mencapai usia 55 tahun
atau telah memenuhi persyaratan tertentu. <br />
<br />
Iuran Program Jaminan Hari Tua: <br />
<br />
§ Ditanggung Perusahaan = 3,7% <br />
<br />
§ Ditanggung Tenaga Kerja = 2% <br />
<br />
Kemanfaatan Jaminan Hari Tua adalah sebesar akumulasi iuran ditambah hasil
pengembangannya. Jaminan Hari Tua akan dikembalikan/dibayarkan sebesar iuran
yang terkumpul ditambah dengan hasil pengembangannya, apabila tenaga kerja: <br />
<br />
§ Mencapai umur 55 tahun atau meninggal dunia, atau cacat total tetap <br />
<br />
§ Mengalami PHK setelah menjadi peserta sekurang-kurangnya 5 tahun dengan masa
tunggu 1 bulan <br />
<br />
§ Pergi keluar negeri tidak kembali lagi, atau menjadi PNS/POLRI/ABRI <br />
<br />
2. Jaminan Pemeliharaan Kesehatan (JPK) <br />
<br />
Pemeliharaan kesehatan adalah hak tenaga kerja. JPK adalah salah satu program
Jamsostek yang membantu tenaga kerja dan keluarganya mengatasi masalah
kesehatan. Mulai dari pencegahan, pelayanan di klinik kesehatan, rumah sakit,
kebutuhan alat bantu peningkatan fungsi organ tubuh, dan pengobatan, secara
efektif dan efisien. Setiap tenaga kerja yang telah mengikuti program JPK akan
diberikan KPK (Kartu Pemeliharaan Kesehatan) sebagai bukti diri untuk
mendapatkan pelayanan kesehatan. Manfaat JPK bagi perusahaan yakni perusahaan
dapat memiliki tenaga kerja yang sehat, dapat konsentrasi dalam bekerja
sehingga lebih produktif. 6 <br />
<br />
Jumlah iuran yang harus dibayarkan: <br />
<br />
Iuran JPK dibayar oleh perusahaan sesuai dengan Peraturan Pemerintah No 53
Tahun 2012 tentang perubahan kedelapan atas Peraturan Pemeritah Nomor 14 Tahun
1993 tentang Penyelenggaraan Program Jaminan Sosial Tenaga Kerja, dengan
perhitungan sebagai berikut: <br />
<br />
§ Tiga persen (3%) dari upah tenaga kerja (maks Rp 3.080.000 ) untuk tenaga
kerja lajang. <br />
<br />
§ Enam persen (6%) dari upah tenaga kerja (maks Rp 3.080.000 ) untuk tenaga
kerja berkeluarga. <br />
<br />
§ Dasar perhitungan persentase iuran dari upah setinggi-tingginya Rp
3.080.000,- <br />
<br />
<br />
Cakupan Program <br />
<br />
Program JPK memberikan manfaat paripurna meliputi seluruh kebutuhan medis yang
diselenggarakan di setiap jenjang PPK dengan rincian cakupan pelayanan sebagai
berikut: <br />
<br />
1. Pelayanan Rawat Jalan Tingkat Pertama, adalah pelayanan kesehatan yang
dilakukan oleh dokter umum atau dokter gigi di Puskesmas, Klinik, Balai
Pengobatan atau Dokter praktek solo. <br />
<br />
2. Pelayanan Rawat Jalan tingkat II (lanjutan), adalah pemeriksaan dan
pengobatan yang dilakukan oleh dokter spesialis atas dasar rujukan dari dokter
PPK I sesuai dengan indikasi medis. <br />
<br />
3. Pelayanan Rawat Inap di Rumah Sakit, adalah pelayanan kesehatan yang
diberikan kepada peserta yang memerlukan perawatan di ruang rawat inap Rumah
Sakit. <br />
<br />
4. Pelayanan Persalinan, adalah pertolongan persalinan yang diberikan kepada
tenaga kerja wanita berkeluarga atau istri tenaga kerja peserta program JPK
maksimum sampai dengan persalinan ke 3 (tiga). <br />
<br />
5. Pelayanan Khusus, adalah pelayanan rehabilitasi, atau manfaat yang diberikan
untuk mengembalikan fungsi tubuh. <br />
<br />
6. Emergensi, merupakan suatu keadaan dimana peserta membutuhkan pertolongan
segera, yang bila tidak dilakukan dapat membahayakan jiwa. 6 <br />
<br />
Hak-hak Peserta Program JPK: <br />
<br />
1. Memperoleh kesempatan yang sama untuk mendapatkan pelayanan kesehatan yang
optimal dan menyeluruh, sesuai kebutuhan dengan standar pelayanan yang
ditetapkan, kecuali pelayanan khusus seperti kacamata, gigi palsu, mata palsu,
alat bantu dengar, alat Bantu gerak tangan dan kaki hanya diberikan kepada
tenaga kerja dan tidak diberikan kepada anggota keluarganya <br />
<br />
2. Bagi Tenaga Kerja berkeluarga peserta tanggungan yang diikutkan terdiri dari
suami/istri beserta 3 orang anak dengan usia maksimum 21 tahun dan belum
menikah. <br />
<br />
3. Memilih fasilitas kesehatan diutamakan dalam wilayah yang sesuai atau
mendekati dengan tempat tinggal. <br />
<br />
4. Dalam keadaan Emergensi peserta dapat langsung meminta pertolongan pada
Pelaksana Pelayanan Kesehatan (PPK) yang ditunjuk oleh PT Jamsostek (Persero)
ataupun tidak. <br />
<br />
5. Peserta berhak mengganti fasilitas kesehatan rawat jalan Tingkat I bila
dalam Kartu Pemeliharaan Kesehatan pilihan fasilitas kesehatan tidak sesuai
lagi dan hanya diizinkan setelah 6 (enam) bulan memilih fasilitas kesehatan
rawat jalan Tingkat I, kecuali pindah domisili. <br />
<br />
6. Peserta berhak menuliskan atau melaporkan keluhan bila tidak puas terhadap
penyelenggaraan JPK dengan memakai formulir JPK yang disediakan diperusahaan
tempat tenaga kerja bekerja, atau PT. JAMSOSTEK (Persero) setempat. <br />
<br />
7. Tenaga kerja/istri tenaga kerja berhak atas pertolongan persalinan kesatu,
kedua dan ketiga. <br />
<br />
8. Tenaga kerja yang sudah mempunyai 3 orang anak sebelum menjadi peserta
program JPK, tidak berhak lagi untuk mendapatkan pertolongan persalinan. 6 <br />
<br />
<br />
<br />
Kewajiban Peserta Program JPK <br />
<br />
1. Menyelesaikan Prosedur administrasi, antara lain mengisi formulir Daftar
Susunan Keluarga (Formulir Jamsostek 1a) <br />
<br />
2. Menandatangani Kartu Pemeliharaan Kesehatan (KPK). <br />
<br />
3. Memiliki Kartu Pemeliharaan Kesehatan (KPK) sebagai bukti diri untuk
mendapatkan pelayanan kesehatan. <br />
<br />
4. Mengikuti prosedur pelayanan kesehatan yang telah ditetapkan. <br />
<br />
5. Segera melaporkan kepada PT JAMSOSTEK (Persero) bilamana terjadi perubahan
anggota keluarga misalnya: status lajang menjadi kawin, penambahan anak, anak
sudah menikah dan atau anak berusia 21 tahun. Begitu pula sebaliknya apabila
status dari berkeluarga menjadi lajang. <br />
<br />
6. Segera melaporkan kepada Kantor PT JAMSOSTEK (Persero) apabila Kartu
Pemeliharaan Kesehatan (KPK) milik peserta hilang/rusak untuk mendapatkan
penggantian dengan membawa surat keterangan dari perusahaan atau bilamana masa
berlaku kartu sudah habis. <br />
<br />
7. Bila tidak menjadi peserta lagi maka KPK dikembalikan ke perusahaan. 6 <br />
<br />
<br />
<br />
Hal-hal yang tidak menjadi tanggung jawab badan penyelenggara (PT Jamsostek
(Persero)) <br />
<br />
1. Peserta <br />
<br />
§ Dalam hal tidak mentaati ketentuan yang berlaku yang telah ditetapkan oleh
Badan Penyelenggara <br />
<br />
§ Akibat langsung bencana alam, peperangan dan lain-lain <br />
<br />
§ Cidera yang diakibatkan oleh perbuatan sendiri, misalnya percobaan bunuh
diri, tindakan melawan hukum. <br />
<br />
§ Olah raga tertentu yang membahayakan seperti: terbang layang, menyelam, balap
mobil/motor, mendaki gunung, tinju, panjat tebing, arum jeram. <br />
<br />
§ Tenaga kerja yang pada permulaan kepesertaannya sudah mempunyai 3 (tiga) anak
atau lebih, tidak berhak mendapatkan pertolongan persalinan. 6 <br />
<br />
2. Pelayanan Kesehatan <br />
<br />
§ Pelayanan kesehatan diluar fasilitas yang ditunjuk oleh Badan Penyelenggara
JPK, kecuali kasus emergensi dan bila harus rawat inap, ditanggung maksimal 7
hari perawatan sesuai standar rawat inap yang telah ditetapkan. <br />
<br />
§ Imunisasi kecuali Imunisasi dasar pada bayi. <br />
<br />
§ General Check Up/Check Up/Regular Check Up (termasuk papsmear). <br />
<br />
§ Pemeriksaan, pengobatan, perawatan di luar negeri. <br />
<br />
§ Penyakit yang disebabkan oleh penggunaan alkohol/narkotik. <br />
<br />
§ Penyakit Kanker (terhitung sejak tegaknya diagnosa). <br />
<br />
§ Penyakit atau cidera yang timbul dari atau berhubungan dengan tugas pekerjaan
(Occupational diseases/accident). <br />
<br />
§ Sexual transmited diseases termasuk AIDS RELATED COMPLEX. <br />
<br />
§ Pengguguran kandungan tanpa indikasi medis termasuk kesengajaan. <br />
<br />
§ Kelainan congential/herediter/bawaan yang memerlukan pengobatan seumur hidup,
seperti: debil, embesil, mongoloid, cretinism, thalasemia, haemophilia,
retardasi mental, autis. <br />
<br />
§ Pelayanan untuk Persalinan ke 4 (empat) dan seterusnya termasuk segala
sesuatu yang berhubungan dengan proses kehamilan pada persalinan tersebut. <br />
<br />
§ Pelayanan khusus (Kacamata, gigi palsu, prothesa mata, alat bantu dengar,
prothesa anggota gerak) hilang/rusak sebelum waktunya tidak diganti. <br />
<br />
§ Khusus akibat kecelakaan kerja tidak menjadi tanggung jawab Penyelenggara
JPK. <br />
<br />
§ Haemodialisa termasuk tindakan penyambungan pembuluh darah untuk hemodialisa.
<br />
<br />
§ Operasi jantung berserta tindakan-tindakan termasuk pemasangan dan pengadaan
alat pacu jantung, kateterisasi jantung termasuk obat-obatan. <br />
<br />
§ Katerisasi jantung sebagai tindakan Therapeutik (pengobatan). <br />
<br />
§ Transpalantasi organ tubuh misalnya transplantasi sumsum tulang. <br />
<br />
§ Pemeriksaan-pemeriksaan dengan menggunakan peralatan canggih/baru yang belum
termasuk dalam daftar JPK, antara lain: MRI (Magnetic Resonance Immaging), DSA
(Digital Substraction Arteriography), TORCH (Toxoplasma, Rubella, CMV, Herpes).
<br />
<br />
§ Pemeriksaan dan tindakan untuk mendapatkan kesuburan termasuk bayi tabung. 6 <br />
<br />
3. Obat-obatan: <br />
<br />
§ Semua obat/vitamin yang tidak ada kaitannya dengan penyakit. <br />
<br />
§ Obat-obatan kosmetik untuk kecantikan termasuk operasi keloid yang bukan atas
indikasi medis. <br />
<br />
§ Obat-obatan berupa makanan seperti susu untuk bayi dan sebagainya. <br />
<br />
§ Obat-obatan gosok sepeti kayu putih dan sejenisnya. <br />
<br />
§ Obat-obatan lain seperti: verban, plester, gause stril. <br />
<br />
§ Pengobatan untuk mendapatkan kesuburan termasuk bayi tabung dan obat-obatan
kanker. <br />
<br />
4. Pembiayaan: 6 <br />
<br />
§ Biaya perjalanan dari dan ke tempat berobat. <br />
<br />
§ Biaya perjalanan untuk mengurus kelengkapan administrasi kepesertaan, jaminan
rawat dan klaim. <br />
<br />
§ Biaya perjalanan untuk memperoleh perawatan/pengobatan di Rumah sakit yang
ditunjuk. <br />
<br />
§ Biaya perawatan emergensi lebih dari 7 (hari) diluar fasilitas yang sudah
ditunjuk oleh Badan Penyelenggara JPK. <br />
<br />
§ Biaya Perawatan dan obat untuk penyakit lebih dari 60 hari/kasus/tahun sudah
termasuk perawatan khusus (ICU, ICCU, HCU, HCB, ICU, PICU) pada penyakit
tertentu sehingga memerlukan perawatan khusus lebih dari 20 hari/kasus/tahun. <br />
<br />
§ Biaya tindakan medik super spesialistik. <br />
<br />
§ Batas waktu pengajuan klaim paling lama 3 (tiga) bulan setelah perusahaan
melunasi tunggakan iuran, selebihnya akan ditolak. <br />
<br />
3. Jaminan Kecelakaan Kerja (JKK) <br />
<br />
Kecelakaan kerja termasuk penyakit akibat kerja merupakan risiko yang harus
dihadapi oleh tenaga kerja dalam melakukan pekerjaannya. Untuk menanggulangi
hilangnya sebagian atau seluruh penghasilan yang diakibatkan oleh adanya
risiko-risiko sosial seperti kematian atau cacat karena kecelakaan kerja baik
fisik maupun mental, maka diperlukan adanya jaminan kecelakaan kerja. Kesehatan
dan keselamatan tenaga kerja merupakan tanggung jawab pengusaha sehingga
pengusaha memiliki kewajiban untuk membayar iuran jaminan kecelakaan kerja yang
berkisar antara 0,24% - 1,74% sesuai kelompok jenis usaha. 6 <br />
<br />
Manfaat <br />
<br />
Jaminan Kecelakaan Kerja (JKK) memberikan kompensasi dan rehabilitasi bagi
tenaga kerja yang mengalami kecelakaan pada saat dimulai berangkat bekerja
sampai tiba kembali dirumah atau menderita penyakit akibat hubungan kerja.
Iuran untuk program JKK ini sepenuhnya dibayarkan oleh perusahaan. Perincian besarnya
iuran berdasarkan kelompok jenis usaha sebagaimana tercantum pada iuran. 6 <br />
<br />
1.Biaya Transport (Maksimum) <br />
<br />
Darat/sungai/danau Rp 750.000,- <br />
<br />
Laut Rp 1.000.000,- <br />
<br />
Udara Rp 2.000.000,- <br />
<br />
2.Sementara tidak mampu bekerja <br />
<br />
Empat (4) bulan pertama, 100% x upah sebulan <br />
<br />
Empat (4) bulan kedua, 75% x upah sebulan <br />
<br />
Seterusnya 50% x upah sebulan <br />
<br />
3.Biaya Pengobatan/Perawatan <br />
<br />
Rp 20.000.000,- (maksimum) dan Pergantian Gigi tiruan Rp. 2.000.000,-
(Maksimum) <br />
<br />
4.Santunan Cacat <br />
<br />
Sebagian-tetap: % tabel x 80 bulan upah <br />
<br />
Total-tetap: <br />
<br />
§ Sekaligus: 70% x 80 bulan upah <br />
<br />
§ Berkala (24 bulan) Rp 200.000,- per bulan* <br />
<br />
§ Kurang fungsi: % kurang fungsi x % tabel x 80 bulan upah <br />
<br />
5. Santunan Kematian <br />
<br />
Sekaligus 60% x 80 bulan upah <br />
<br />
Berkala (24 bulan) Rp. 200.000,- per bulan* <br />
<br />
Biaya pemakaman Rp 2.000.000,-* <br />
<br />
6. Biaya Rehabilitasi diberikan satu kali untuk setiap kasus dengan patokan
harga yang ditetapkan oleh Pusat Rehabilitasi RS Umum Pemerintah dan ditambah
40% dari harga tersebut, serta biaya rehabilitasi medik maksimum sebesar Rp
2.000.000,- <br />
<br />
7. Penyakit akibat kerja, besarnya santunan dan biaya pengobatan/biaya
perawatan sama dengan poin ke-2 dan ke-3. 6</span></div>
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4. Jaminan Kematian (JK) <br />
<br />
Jaminan Kematian diperuntukkan bagi ahli waris dari peserta program Jamsostek
yang meninggal bukan karena kecelakaan kerja. Jaminan Kematian diperlukan
sebagai upaya meringankan beban keluarga baik dalam bentuk biaya pemakaman
maupun santunan berupa uang. Pengusaha wajib menanggung iuran Program Jaminan
Kematian sebesar 0,3% dengan jaminan kematian yang diberikan adalah Rp
21.000.000,- terdiri dari Rp 14.200.000,- santunan kematian dan Rp 2 juta biaya
pemakaman* dan santunan berkala. <br />
<br />
Manfaat Program JK* <br />
<br />
Program ini memberikan manfaat kepada keluarga tenaga kerja seperti: <br />
<br />
1. Santunan Kematian: Rp 14.200.000,- <br />
<br />
2. Biaya Pemakaman: Rp 2.000.000,- <br />
<br />
3. Santunan Berkala: Rp 200.000,-/ bulan (selama 24 bulan) <br />
<br />
*) sesuai dengan PP Nomor 76 Tahun 2007 <br />
<br />
<br />
<br />
Tata Cara Pengajuan Jaminan Kematian <br />
<br />
Pengusaha/keluarga dari tenaga kerja yang meninggal dunia mengisi dan mengirim
form 4 kepada PT Jamsostek (Persero) disertai bukti-bukti: <br />
<br />
1. Surat keterangan kematian dari Rumah sakit/Kepolisian/Kelurahan. <br />
<br />
2. Salinan/Copy KTP/SIM dan Kartu Keluarga Tenaga Kerja bersangkutan yang masih
berlaku. <br />
<br />
3. Identitas ahli waris (photo copy KTP/SIM dan Kartu Keluarga). <br />
<br />
4. Surat Keterangan Ahli Waris dari Lurah/Kepala Desa setempat. <br />
<br />
5. Surat Kuasa bermeterai dan copy KTP yang diberi kuasa (apabila pengambilan
JKM ini dikuasakan). 6 <br />
<br />
<br />
5. Jaminan Pensiun (JP) <br />
<br />
Penyelenggaraan program pensiun sukarela oleh Asosiasi Dana Pensiun Indonesia
(ADPI) dan Asosiasi Dana Pensiun Lembaga Keuangan (ADPLK) hendaknya
dipertahankan untuk menjaga tingkat kesejahteraan pegawai setelah pensiun.
Program jaminan pensiun BPJS merupakan implementasi program jaminan sosial
dengan prinsip memberikan perlindungan dasar dan layak, yang dalam hal ini akan
mempunyai pola penyelenggaraan berbeda dengan pola pensiun DPPK/DPLK yang
mengedepankan manfaat maksimum (on top). Sehingga masyarakat yang membutuhkan
pelayanan dengan manfaat maksimum tetap akan menjadi peserta program yang
bersifat on top yang selama ini diselenggarakan oleh perusahaan asuransi.
6<br />
<br />
<br />
Reff: <br />
<br />
5. http: www.ilo.org/wcmsp5/.../wcms_170567.pdf <br />
<br />
6. http: datakesra.menkokesra.go.id/.../tahapan%20transforma, diakses pada
tanggal 24 Agustus 2013. <br />
<br />
<br style="mso-special-character: line-break;" />
<br style="mso-special-character: line-break;" />
</span></div>
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<![endif]-->Anonymoushttp://www.blogger.com/profile/06590633769759394496noreply@blogger.com1tag:blogger.com,1999:blog-5853367347201739175.post-14182462104845536242013-09-05T20:12:00.000-07:002013-09-05T20:12:27.475-07:00 Badan Penyelenggara Jaminan Sosial Kesehatan Definisi <br /><br />Berdasarkan UU No. 40 Tahun 2004 tentang SJSN, Badan Penyelenggara Jaminan Sosial (BPJS) adalah : <br /><br />1. Badan hukum yang dibentuk untuk menyelenggarakan program jaminan sosial (Pasal 1 angka 1) <br /><br />Badan Penyelenggara Jaminan Sosial yang selanjutnya disingkat BPJS adalah badan hukum yang dibentuk untuk menyelenggarakan program jaminan sosial.2,3 <br /><br />Jaminan Sosial adalah salah satu bentuk perlindungan sosial untuk menjamin seluruh rakyat agar dapat memenuhi kebutuhan dasar hidupnya yang layak. <br /><br />2. Badan hukum nirlaba (Pasal 4 dan Penjelasan Umum) <br /><br />BPJS menyelenggarakan sistem jaminan sosial nasional berdasarkan prinsip: <br /><br />a. kegotongroyongan; <br /><br />b. nirlaba; <br /><br />c. keterbukaan; <br /><br />d. kehati-hatian; <br /><br />e. akuntabilitas; <br /><br />f. portabilitas; <br /><br />g. kepesertaan bersifat wajib; <br /><br />h. dana amanat; dan <br /><br />i. hasil pengelolaan Dana Jaminan Sosial dipergunakan seluruhnya untuk pengembangan program dan untuk sebesar-besar kepentingan Peserta. <br /><br />3. Pembentukan dengan undang – undang (Pasal 5 ayat 1) <br /><br />(1) Berdasarkan Undang-Undang ini dibentuk BPJS. <br /><br />(2) BPJS sebagaimana dimaksud pada ayat (1) adalah: <br /><br />a. BPJS Kesehatan; dan <br /><br />b. BPJS Ketenagakerjaan. 2,3 <br /><br /> Pembentukan <br /><br />Berdasarkan ketentuan Pasal 52 ayat (2) UU No. 40 Tahun 2004, batas waktu paling lambat untuk penyesuaian semua ketentuan yang mengatur mengenai BPJS dengan UU No. 40 Tahun 2004 adalah tanggal 19 Oktober 2009, yaitu 5 tahun sejak UU No. 40 Tahun 2004 diundangkan. <br /><br />Batas waktu penetapan UU tentang BPJS yang ditentukan dalam UU No. 40 Tahun 2004 tidak dapat dipenuhi oleh Pemerintah. RUU tentang BPJS tidak selesai dirumuskan. DPR RI mengambil inisiatif menyelesaikan masalah ini melalui Program Legislasi Nasional 2010 untuk merancang RUU tentang BPJS. DPR telah menyampaikan RUU tentang BPJS kepada Pemerintah pada 8 Oktober 2010 untuk dibahas bersama Pemerintah. <br /><br />DPR RI dan pemerintah mengakhiri pembahasan RUU tentang BPJS pada Sidang Paripurna DPR RI tanggal 28 Oktober 2011. RUU tentang BPJS disetujui untuk disahkan menjadi Undang – Undang. DPR RI menyampaikan RUU tentang BPJS kepada Presiden pada tanggal 7 November 2011. Pemerintah mengundangkan UU No. 24 Tahun 2011 tentang BPJS pada tanggal 25 November 2011. 2,3 <br /><br />Petikan UU No. 24 Tahun 2011 tentang BPJS : <br /><br />Pasal 5 <br /><br />(1) Berdasarkan Undang-Undang ini dibentuk BPJS. <br /><br />(2) BPJS sebagaimana dimaksud pada ayat (1) adalah: <br /><br />a. BPJS Kesehatan; dan <br /><br />b. BPJS Ketenagakerjaan. <br /><br /> Pasal 6 <br /><br />(1) BPJS Kesehatan sebagaimana dimaksud dalam Pasal 5 ayat 2 huruf a menyelenggarakan program jaminan kesehatan <br /><br />(2) BPJS Ketenagakerjaan sebagaimana dimaksud dalam Pasal 5 ayat 2 huruf b menyelenggarakan program : <br /><br />· Jaminan kecelakaan kerja <br /><br />· Jaminan hari tua <br /><br />· Jaminan pensiun <br /><br />· Jaminan kematian <br />
<br />
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<cite><span style="background: white; color: black; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-themecolor: text1;">2. http:
</span></cite><cite><span lang="IN" style="background: white; color: black; font-size: 12.0pt; line-height: 150%; mso-themecolor: text1;">www.<span style="mso-bidi-font-weight: bold;">bpjs</span>.info/</span></cite><span lang="IN" style="background: white; color: black; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-themecolor: text1;"></span><span style="background: white; color: black; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-themecolor: text1;">, diakses pada tanggal 24 Agustus
2013.</span><span lang="IN" style="color: black; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-themecolor: text1;"></span></div>
Anonymoushttp://www.blogger.com/profile/06590633769759394496noreply@blogger.com1tag:blogger.com,1999:blog-5853367347201739175.post-11621153061260672172013-09-05T20:07:00.000-07:002013-09-05T20:07:00.921-07:00ASURANSI KESEHATAN<br />Definisi<br /><br />PT ASKES (Persero) merupakan Badan Usaha Milik Negara yang ditugaskan khusus oleh pemerintah untuk menyelenggarakan jaminan pemeliharaan kesehatan bagi Pegawai Negeri Sipil, Penerima Pensiun PNS dan TNI/POLRI, Veteran, Perintis Kemerdekaan beserta keluarganya dan Badan Usaha lainnya. 4 <br /><br />Visi Misi<br />
Visi : Menjadi spesialis dan pusat unggulan Asuransi Kesehatan di Indonesia <br /><br />Misi : <br /><br />Memberikan kepastian jaminan pemeliharaan kesehatan kepada peserta (masyarakat Indonesia) melalui sistem pengelolaan yang efektif dan efisien. <br /><br />Mengoptimalkan pengelolaan dana dan pengembangan sistem untuk memberikan pelayanan prima secara berkelanjutan kepada peserta. <br /><br />Mengembangkan pegawai untuk mencapai kinerja optimal dan menjadi salah satu keunggulan bersaing utama perusahaan. <br /><br /> Landasan Hukum <br /><br />PT ASKES (Persero) yang berkedudukan di Jakarta didirikan dengan Akte Notaris Muhani Salim, SH Nomor 104 tanggal 20 Agustus 1992 yang telah beberapa kali diubah terakhir dengan Akte Notaris NM Dipo Nusantara Pua Upa, SH Nomor 24 tanggal 13 Agustus 2012. 4 <br /><br />Tujuan <br /><br />Maksud dan tujuan perseroan ialah turut melaksanakan dan menunjang kebijakan dan program Pemerintah di bidang ekonomi dan pembangunan nasional pada umumnya, khusunya di bidang asuransi sosial melalui penyelenggaraan asuransi / jaminan kesehatan bagi pegawai negeri sipil, penerima pensiun, veteran, perintis kemerdekaan beserta keluarganya, dan masyarakat lainnya, serta optimalisasi pemanfaatan sumber daya Perseroan untuk menghasilkan jasa yang bermutu tinggi dan berdaya saing kuat, guna meningkatkan nilai manfaat bagi peserta dan nilai Perseroan dengan menerapkan prinsip – prinsip Perseroan Terbatas. 4 <br /><br />Untuk mencapai maksud dan tujuan tersebut diatas, Perseroan dapat melaksanakan kegiatan usaha sebagai berikut : <br /><br />Menyelenggarakan asuransi kesehatan yang bersifat menyeluruh (komprehensif) bagi Pegawai Negeri Sipil, Perintis Kemerdekaan, Penerima Pensiun, dan Veteran beserta keluarganya <br /><br />Menyelenggarakan asuransi kesehatan bagi Pegawai dan Penerima Badan Usaha dan Badan lainnya <br /><br />Menyelenggarakan jaminan kesehatan bagi masyarakat yang telah membayar iuran atau iurannya dibayar oleh pemerintah sesuai dengan prinsip penyelenggaraan Sistem Jaminan Sosial Nasional <br /><br />Melakukan kegiatan investasi dengan memperhatikan ketentuan peraturan perundang – undangan. 4 <br /><br /> Peserta ASKES <br /><br />Program Asuransi Kesehatan Sosial merupakan penugasan Pemerintah kepada PT ASKES (Persero) melalui Peraturan Pemerintah No. 69 tahun 1991. 4 <br /><br />Peserta Program ASKES adalah : <br /><br />Pegawai Negeri Sipil, Pejabat Negara, Penerima Pensiun (Pensiunan PNS, pensiunan TNI/Polri, Pensiunan Pejabat Negara), Veteran (Tuvet dan Non Tuvet) dan Perintis Kemerdekaan beserta anggota keluarga*) yang di tanggung <br /><br />Pegawai tidak tetap (Dokter/Dokter gigi/Bidan – PTT, melalui SK Menkes nomor 1540/MENKES/SK/XII/2002, tentang Penempatan Tenaga Medis Melalui Masa Bakti dan Cara Lain). 4 <br /><br />*) anggota keluarga adalah : <br /><br />Isteri / suami yang sah dari peserta yang mendapat tunjangan istri / suami (Daftar isteri / suami yang sah yang tercantum dalam daftar gaji / slip gaji, dan termasuk dalam daftar penerima pensiun) <br /><br />Anak (anak kandung / anak tiri / anak angkat) yang sah dari peserta yang mendapat tunjangan anak, yang tercantum dalam daftar gaji / slip gaji, dan termasuk dalam daftar penerima pensiun, belum berumur 21 tahun atau telah berumur 21 tahun sampai 25 tahun bagi anak yang masih melanjutkan pendidikan formal, dan tidak atau belum pernah kawin, tidak mempunyai penghasilan sendiri serta masih menjadi tanggungan peserta. Jumlah anak yang ditanggung maksimal 2 anak sesuai dengan urutan tanggal lahir. 4<br /><br />
Reff<br />4. http: <a href="http://www.ptaskes.com/">www.ptaskes.com/</a> ,diakses pada tanggal 24 Agustus 2013. <br /><br /><br /><br /><br /><br /> <br /><br /> <br />Anonymoushttp://www.blogger.com/profile/06590633769759394496noreply@blogger.com0tag:blogger.com,1999:blog-5853367347201739175.post-73207879955012505172013-09-05T19:55:00.002-07:002013-09-05T19:55:41.745-07:00Sistem Jaminan Sosial Nasional<!--[if gte mso 9]><xml>
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<b>
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<b>Substansi UU SJSN</b></div>
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Sistem Jaminan Sosial Nasional adalah suatu tatacara
penyelenggaraan program jaminan sosial oleh beberapa badan penyelenggara.
Sistem jaminan sosial nasional pada dasarnya merupakan program Negara yang
bertujuan memberikan kepastian perlindungan dan kesejahteraan sosial bagi
seluruh rakyat Indonesia. 1 </div>
<div class="MsoNormal">
Jaminan sosial adalah salah satu bentuk perlindungan sosial
untuk menjamin agar setiap rakyat dapat memenuhi kebutuhan dasar hidup yang
layak. Kebutuhan dasar hidup yang layak demi terwujudnya kesejahteraan
sosial bagi seluruh rakyat Indonesia. 1</div>
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<br /></div>
<b>
</b><div class="MsoNormal">
<b> Azas, Tujuan dan Prinsip Penyelenggaraan</b></div>
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Sistem jaminan sosial diselenggarakan berdasarkan asas
kemanusiaan, asas manfaat dan asas keadilan sosial bagi seluruh rakyat
Indonesia. Asas kemanusiaan berkaitan dengan penghargaan terhadap martabat
manusia. Asas manfaat merupakan asas yang bersifat operasional menggambarkan
pengelolaan yang efisien dan efektif. Asas keadilan merupakan asas yang bersifat
ideal, ketiga asas tersebut dimaksudkan untuk menjamin kelangsungan program dan
hak peserta. 1</div>
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<br /></div>
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<b> 9 prinsip
Sistem Jaminan Sosial Nasional </b></div>
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1. Prinsip kegotong-royongan</div>
<div class="MsoNormal">
2. Prinsip Nirlaba</div>
<div class="MsoNormal">
3. Prinsip Keterbukaan</div>
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4. Prinsip Kehati-hatian</div>
<div class="MsoNormal">
5. Prinsip Akuntabilitas</div>
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6. Prinsip Portabilitas</div>
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7. Prinsip Kepesertaan
Bersifat Wajib</div>
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8. Prinsip Dana Amanat</div>
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9. Prinsip Hasil Pengelolaan
Dana Jaminan Sosial Nasional1</div>
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<br /></div>
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Penanggung Jawab SJSN</div>
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Untuk Penyelenggaraan Sistem Jaminan Sosial Nasional
dibentuk Dewan Jaminan Sosial Nasional. Dewan Jaminan Sosial Nasional (DJSN)
bertanggung jawab langsung kepada Presiden. DJSN berfungsi merumuskan kebijakan
umum dan sinkronisasi penyelenggaraan sistem jaminan sosial nasional. 1</div>
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<br /></div>
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<br /></div>
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1. http: www.jamsosindonesia.com/sjsn/bpjs<span style="font-family: "Arial","sans-serif";"></span>, download:
buku_reformasi_sjsn_ind, diakses pada tanggal 24 Agustus 2013. </div>
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</div>
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<br /></div>
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</div>
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<br /></div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
I.<span style="mso-spacerun: yes;"> </span>Anatomi</div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
Retina merupakan reseptor permukaan untuk informasi visual.
Sebagaimana halnya nervus optikus, retina merupakan bagian dari otak meskipun
secara fisik terletak di perifer dari sistem saraf pusat (SSP). Komponen yang
paling utama dari retina adalah sel-sel reseptor sensoris atau fotoreseptor dan
beberapa jenis neuron dari jaras penglihatan. Lapisan terdalam neuron pertama)
retina mengandung fotoreseptor (sel batang dan sel kerucut) dan dua lapisan
yang lebih superfisial mengandung neuron bipolar (lapisan neuron kedua) serta
sel-sel ganglion (lapisan neuron ketiga). Sekitar satu juta akson dari sel-sel
ganglion ini berjalan pada lapisan serat retina ke papila atau kaput nervus optikus.
Pada bagian tengah kaput nervus optikus tersebut keluar cabang-cabang dari
arteri centralis retina yang merupakan cabang dari a. Oftalmika4,5.</div>
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</div>
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<br /></div>
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</div>
<div class="MsoNormal" style="text-align: justify;">
Nervus kranialis II merupakan indera khusus untuk
penglihatan. Cahaya dideteksi oleh sel batang dan sel kerucut di retina, yang
dapat dianggap sebagai end organ sensorik khusus untuk penglihatan. Badan sel
dari reseptor reseptor ini mengeluarkan tonjolan (prosesus) yang bersinaps
dengan sel bipolar, neuron kedua di jaras penglihatan. Sel-sel bipolar kemudian
bersinaps dengan sel-sel retina membentuk nervus optikus. Saraf keluar dari
bagian belakang bola mata dan berjalan posterior di dalam kerucut otot untuk
masuk ke dalam rongga tengkorak melalui kanalis optikus.</div>
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</div>
<div class="MsoNormal" style="text-align: justify;">
Di dalam tengkorak, dua nervus optikus menyatu membentuk
diskus optikus. Di kiasma, lebih dari separuh serabut (yang berasal dari
separuh retina bagian nasal) mengalami dekusasi dan menyatu dengan
serabut-serabut temporal yang tidak menyilang dari nervus optikus kontralateral
untuk membentuk traktus optikus. Masing-masing nervus optikus berjalan
mengelilingi pedunculus serebri menuju nukleus genikulatus lateralis, tempat
nervus optikus bersinaps. Semua serabut yang menerima impuls dari separuh kanan
lapangan pandang tiap-tiap mata membentuk membentuk traktus optikus kiri dan
berproyeksi pada hemisfer serebrum kiri. Demikian juga, separuh kiri lapangan
pandang berproyeksi pada hemisfer serebrum kanan.</div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
Nervus optikus memasuki ruang intrakranial melalui foramen
optikum. Di depan tuber sinerium (tangkai hipofisis) nervus optikus kiri dan
kanan bergabung menjadi satu berkas membentuk kiasma optikum. Di depan tuber
sinerium nervus optikus kanan dan kiri bergabung menjadi satu berkas membentuk
kiasma optikum, dimana serabut bagian nasal dari masing-masing mata akan
bersilangan dan kemudian menyatu dengan serabut temporal mata yang lain
membentuk traktus optikus dan melanjutkan perjalanan untuk ke korpus
genikulatum lateral dan kolikulus superior. Kiasma optikum terletak di tengah
anterior dari sirkulus Willisi. Serabut saraf yang bersinaps di korpus
genikulatum lateral merupakan jaras visual sedangkan serabut saraf<span style="mso-spacerun: yes;"> </span>yang<span style="mso-spacerun: yes;">
</span>berakhir<span style="mso-spacerun: yes;"> </span>di<span style="mso-spacerun: yes;"> </span>kolikulus<span style="mso-spacerun: yes;">
</span>superior menghantarkan<span style="mso-spacerun: yes;">
</span>impuls<span style="mso-spacerun: yes;"> </span>visual<span style="mso-spacerun: yes;"> </span>yang membangkitkan refleks opsomatik seperti
refleks pupil. </div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
Setelah<span style="mso-spacerun: yes;"> </span>sampai <span style="mso-spacerun: yes;"> </span>di<span style="mso-spacerun: yes;">
</span>korpus<span style="mso-spacerun: yes;"> </span>genikulatum<span style="mso-spacerun: yes;"> </span>lateral,<span style="mso-spacerun: yes;">
</span>serabut<span style="mso-spacerun: yes;"> </span>saraf<span style="mso-spacerun: yes;"> </span>yang<span style="mso-spacerun: yes;">
</span>membawa<span style="mso-spacerun: yes;"> </span>impuls penglihatan<span style="mso-spacerun: yes;"> </span>akan<span style="mso-spacerun: yes;">
</span>berlanjut<span style="mso-spacerun: yes;"> </span>melalui<span style="mso-spacerun: yes;"> </span>radiatio<span style="mso-spacerun: yes;">
</span>optika<span style="mso-spacerun: yes;"> </span>(optic<span style="mso-spacerun: yes;"> </span>radiation)<span style="mso-spacerun: yes;">
</span>atau<span style="mso-spacerun: yes;"> </span>traktus genikulokalkarina ke
korteks penglihatan primer di girus kalkarina. Korteks penglihatan primer
tersebut<span style="mso-spacerun: yes;"> </span>mendapat<span style="mso-spacerun: yes;"> </span>vaskularisasi<span style="mso-spacerun: yes;">
</span>dari<span style="mso-spacerun: yes;"> </span>a.<span style="mso-spacerun: yes;"> </span>kalkarina<span style="mso-spacerun: yes;">
</span>yang<span style="mso-spacerun: yes;"> </span>merupakan<span style="mso-spacerun: yes;"> </span>cabang<span style="mso-spacerun: yes;">
</span>dari<span style="mso-spacerun: yes;"> </span>a.<span style="mso-spacerun: yes;"> </span>serebri posterior. Serabut yang berasal dari
bagian medial korpus genikulatum lateral membawa impuls lapang pandang bawah
sedangkan serabut yang berasal dari lateral membawa impuls dari lapang pandang
atas (gambar 3)4.Pada refleks pupil, setelah serabut saraf berlanjut ke arah
kolikulus superior, saraf akan berakhir pada nukleus area pretektal. Neuron
interkalasi yang berhubungan dengan nukleus<span style="mso-spacerun: yes;">
</span>Eidinger-Westphal (parasimpatik) dari kedua sisi menyebabkan refleks
cahaya menjadi bersifat konsensual. Saraf eferen motorik berasal dari nukleus
Eidinger-Westphal dan menyertai nervus okulomotorius (N.III) ke dalam rongga
orbita untuk<span style="mso-spacerun: yes;"> </span>mengkonstriksikan otot
sfingter<span style="mso-spacerun: yes;"> </span>pupil (gambar 4)4,1.</div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
Gambar 4. Jaras Refleks Pupil1</div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
<span style="mso-spacerun: yes;"> </span>II. Pemeriksaan
Sistem Visual </div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
Pemeriksaan yang dapat dilakukan pada sistem visual antara
lain: </div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
1.<span style="mso-spacerun: yes;"> </span>Pemeriksaan visus </div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
2.<span style="mso-spacerun: yes;"> </span>Pemeriksaan
refleks pupil </div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
3.<span style="mso-spacerun: yes;"> </span>Pemeriksaan lapang
pandang </div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
4.<span style="mso-spacerun: yes;"> </span>Pemeriksaan
funduskopi </div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
Pemeriksaan visus dilakukan dengan membaca kartu Snellen
pada jarak 6 meter. Masing-masing mata diperiksa secara terpisah, diikuti
dengan pemeriksaan menggunakan pinhole untuk menyingkirkan kelainan visus
akibat gangguan refraksi. Penilaian diukur dari barisan terkecil yang masih
dapat dibaca oleh pasien dengan benar, dengan nilai normal visus adalah 6/6.
Apabila pasien hanya bisa membedakan gerakan tangan pemeriksa maka visusnya 5
adalah 1/300, <a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="_GoBack"></a>sedangkan apabila pasien hanya dapat
membedakan kesan gelap terang (cahaya) maka visusnya 1/∞.6</div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
Pemeriksaan refleks pupil atau refleks cahaya terdiri dari
reaksi cahaya langsung dan tidak langsung (konsensual). Refleks cahaya langsung
maksudnya adalah mengecilnya pupil (miosis) pada mata yang disinari cahaya. Sedangkan<span style="mso-spacerun: yes;"> </span>refleks cahaya tidak langsung atau konsensual
adalah mengecilnya pupil pada mata yang tidak disinari cahaya6,7.</div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
Pemeriksaan lapang pandang bertujuan untuk memeriksa batas
perifer penglihatan, yaitu batas dimana benda dapat dilihat bila mata difiksasi
pada satu titik. Lapang pandang yang normal mempunyai bentuk tertentu dan tidak
sama ke<span style="mso-spacerun: yes;"> </span>semua jurusan, misalnya ke
lateral kita dapat melihat 90 – 100° dari titik fiksasi, ke medial 60°, ke atas
50 – 60° dan ke bawah 60 – 75°. Terdapat dua jenis pemeriksaan lapang pandang
yaitu pemeriksaan secara kasar (tes konfrontasi) dan pemeriksaan yang lebih
teliti dengan menggunakan kampimeter atau perimeter.6</div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
Pemeriksaan funduskopi di bidang neurologi bertujuan untuk
menilai keadaan fundus okuli terutama retina dan papil nervus optikus.
Pemeriksaan dilakukan dengan menggunakan alat berupa oftalmoskop. Papil normal
berbentuk lonjong, warna jingga muda, di bagian temporal sedikit pucat, batas
dengan sekitarnya tegas, hanya di bagian nasal agak kabur. Selain itu juga
terdapat lekukan fisiologis. Pembuluh darah muncul di bagian tengah, bercabang
keatas. Jalannya arteri agak lurus, sedangkan vena berkelok-kelok. Perbandingan
besar vena : arteri adalah 5:4 sampai 3:2.6</div>
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</div>
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<br /></div>
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</div>
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III. Gangguan Pada Nervus Optikus </div>
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</div>
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3.1. Kelainan pada pemeriksaan refleks pupil</div>
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</div>
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Reaksi pupil terhadap cahaya dapat menghilang atau berkurang
jika terdapat lesi yang mengenai jaras penglihatan pada lintasan saraf yang
berperan pada refleks pupil atau refleks cahaya tersebut. Kelainan tersebut termasuk
diataranya10:</div>
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</div>
<div class="MsoNormal" style="text-align: justify;">
1. Kegagalan cahaya untuk
mencapai retina, misalnya akibat katarak dan kekeruhan cairan vitreus pada
pasien diabetes melitus.</div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
2. Penyakit pada retina,
seperti retinitis pigmentosa, perdarahan makula, atau scar.</div>
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</div>
<div class="MsoNormal" style="text-align: justify;">
3. Penyakit atau kelainan pada
nervus optikus seperti<span style="mso-spacerun: yes;"> </span>neuritis optik,
neuritis retrobulbar, dan atrofi nervus optikus.</div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
4. Kelainan yang mengenai
traktus optikus dan hubungannya dengan batang otak.</div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
5. Penyakit atau kelainan pada
batang otak.</div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
6. Penyakit atau kelainan pada
nervus okulomotorius atau ganglion siliare4</div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
3.2. Kelainan pada pemeriksaan lapang pandang </div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
Jika terdapat lesi di sepanjang lintasan nervus optikus
(N.II) hingga korteks sensorik, akan menunjukkan gejala gangguan penglihatan yaitu<span style="mso-spacerun: yes;"> </span>pada lapang pandang atau medan penglihatan.
Lokasi lesi di jaras penglihatan ditentukan dengan pemeriksaan lapangan pandang
sentral dan perifer. Lesi di sebelah anterior kiasma (retina atau nervus
optikus) menyebabkan defek lapang pandang unilateral; lesi di mana saja yang
terletak di jaras penglihatan posterior terhadap kiasma menyebabkan defek
homonim kontralateral. Lesi di kiasma biasanya menyebabkan defek temporal.</div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
Tampilan klinis khas yang mengisyaratkan adanya penyakit
nervus optikus adalah defek pupil aferen, penglihatan warna yang buruk, dan
perubahan-perubahan pada diskus optikus.</div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
Lesi pada bagian medial kiasma akan menghilangkan medan
penglihatan temporal yang disebut hemianopsia bitemporal, sedangkan lesi pada
kedua bagian lateralnya akan menimbulkan hemianopsia binasal. Lesi pada
traktus<span style="mso-spacerun: yes;"> </span>optikus akan menyebabkan
hemianopsia homonim kontralateral. Lesi pada radiasio optika bagian medial akan
menyebabkan quadroanopsia inferior homonim kontralateral, sedangkan lesi pada
serabut lateralnya akan menyebabkan quadroanopsia superior homonim
kontralateral7.</div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
3. 3. Kelainan pada pemeriksaan funduskopi </div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
Kelainan papil nervus optikus yang perlu diperhatikan adalah
papil yang mengalami atrofi dan sembab atau papiledema.<span style="mso-spacerun: yes;"> </span>Pada papil yang mengalami atrofi, warna papil
menjadi pucat, batasnya tegas dan pembuluh darah berkurang.</div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
Papiledema dapat disebabkan oleh radang aktif ataupun
bendungan. Bila oleh radang aktif hal ini disebut papilitis atau neuritis optik
yang biasanya disertai perburukan visus yang hebat. Bila di bagian distal N.II
yang mengalami inflamasi, sedangkan papilnya normal, hal ini disebut neuritis
retrobulbar.8</div>
<div style="text-align: justify;">
</div>
<div style="text-align: justify;">
</div>
<h3 class="MsoNormal" style="text-align: justify;">
Neuritis Optik </h3>
<div style="text-align: justify;">
</div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
3.1<span style="mso-spacerun: yes;"> </span>Definisi</div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
Neuritis optik merupakan gangguan penglihatan yang disebabkan
oleh inflamasi dan demyelinisasi pada nervus optikus akibat reaksi autoimun.
Pada neuritis optikus, serabut saraf menjadi bengkak dan tak berfungsi
sebagaimana mestinya. Penglihatan dapat saja normal atau berkurang, tergantung
pada jumlah saraf yang mengalami peradangan9.</div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
Neuritis optik terdiri atas tiga jenis, yaitu:</div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
1. Retrobulbar
neuritis : menunjuk kepada lesi saraf yang akut dan tidak ditemukan adanya
gambaran fundus yang abnormal.</div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
2. Papilitis
: mengarah kepada lesi anterior diamana diskus menjadi membengkak dan
hiperemis.</div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
3. Neurorenitinitis
: memiliki konotasi yang sama dengan papilitis tetapi ditujukan kepada suatu
proses yang lebih lanjut menuju daerah dekat retina dan uvea.9</div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
3.2<span style="mso-spacerun: yes;"> </span>Epidemiologi</div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
Insiden dan prevalensi dari optic neuritis di amerika
serikat adalah 5 per 100.000 penduduk. Pada ras kaukasian, wanita dan orang
yang hidup di dataran tinggi lebih banyak terkena penyakit ini. Pada umumnya
terjadi pada usia antara 15-49 tahun (usia rata-rata 30-35 tahun).16</div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
3.3 Etiologi</div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
Optik Neuritis (ON) mungkin berhubungan dengan demyelinisasi
(disertai dengan Multipel Sclerosis lebih dari 50%), infeksi, parainfeksi atau
autoimmune disease. Pada orang dewasa, demyelinisasi adalah penyebab yang
tersering dimana penyebab demyelinisasi sendiri tidak diketahui. ON yang
disebabkan infeksi sangat jarang terjadi, meskipun begitu yang paling sering
menyebabkan ON adalah virus herpes, Cytomegalovirus, lyme disease, TB dan
fungi. Para infeksi yang dapat menyebabkan ON adalah sinus disease, vaksinasi
dan enchepalitis. SLE, sjogren syndrome, ankylosing spondylitis dan sarcoidosis
telah dilaporkan sebagai penyakit autoimun yang juga dapat menyebabkan ON.17</div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
3.4 Patofisiologi</div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
Hingga saat ini reaksi autoimun merupakan teori yang masih
dipegang dalam patofisiologi neuritis optik. Dalam reaksi ini myelin nervus
optikus mengalami destruksi sehingga akson hanya dapat memberikan impuls
listrik dalam jumlah yang sangat kecil. Bila keadaan ini terus menerus terjadi,
maka sel ganglion retina aka mengalami kerusakan ireversibel. Setelah destruksi
myelin berlangsung, axon dari sel ganglion retina akan mulai berdegenerasi.
Monosit melokalisir daerah tersebut diikuti oleh makrofag untuk memfagosit myelin.
Antrosit kemudian berproliferasi dengan diikuti deposisi jaringan sel glia.
Daerah gliotik (sklerotik) dapat berambah jumlahnya dan meluas ke otak dan
medulla spinalis (multipel sklerosis).12</div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
Inflamasi pada endotel pembuluh darah retina dapat mendahului
demielinisasi dan terkadang terlihat sebagai retinal vein sheathing.<span style="mso-spacerun: yes;"> </span>Kehilangan mielin dapat melebihi hilangnya
akson. </div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
Dipercaya bahwa demielinisasi yang terjadi pada Neuritis
optikus diperantarai oleh imun, tetapi mekanisme spesifik dan antigen targetnya
belum diketahui. Aktivasi sistemik sel T diidentifikasi pada awal gejala dan
mendahului perubahan yang terjadi didalam cairan serebrospinal. Perubahan
sistemik kembali menjadi normal mendahului perubahan sentral (dalam 2-4
minggu). Aktivasi sel T menyebabkan pelepasan sitokin dan agen-agen inflamasi
yang lain. Aktivasi sel B melawan protein dasar mielin tidak terlihat di darah
perifer namun dapat terlihat di cairan serebrospinal pasien dengan Neuritis
optikus. Neuritis optikus juga berkaitan dengan kerentanan genetik, sama
seperti MS. Terdapat ekspresi tipe HLA tertentu diantara pasien Neuritis
optikus.13 </div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
3.5 Manifestasi Klinik</div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
Riwayat dan pemeriksaan merupakan dasar dari diagnosis optic
neuritis.<span style="mso-spacerun: yes;"> </span>Pasien dewasa dengan ON sering
ditandai dengan penurunan penglihatan yang unilateral. Bilateral juga dapat
terjadi, tetapi ini lebih sering terjadi pada anak-anak atau populasi Asia dan
disebut sebagai 'optospinal MS'. Persepsi penglihatan terhadap warna biasanya juga
terpengaruh, dengan warna-warna seperti efek washed out sebelum penurunan
penglihatan terjadi. Nyeri orbital di dalam atau di sekitar mata.17</div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
Manifestasi klinis biasanya ditandai dengan nyeri subakut
unilateral disertai kehilangan penglihatan yang progresif selama beberapa hari
sampai 2 minggu. Kehilangan penglihatan mulai dari kabur hingga tidak respon
terhadap cahaya. Kilatan cahaya dapat terlihat saat penderita menggerakkan bola
matanya. Pada penderita juga terjadi penurunan penglihatan setelah berolahraga
atau saat suhu tubuh meningkat (uhthoff phenomenon).</div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
Tanda dari terjadinya optic neuritis ialah abnormallitas
penglihatan terhadap warna, menurunnya kontras dari penglihatan, defek lapangan
pandang dan reflek pupil aferen defek positif.19</div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
a. Tajam penglihatan</div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
Dalam praktek umum, tanda-tanda disfungsi saraf optik dapat
diperoleh dari pengujian visual acuity menggunakan grafik Snellen untuk
menentukan derajat kehilangan penglihatan. ketajaman visual pada penderita
Optic neuritis dapat berkisar mulai dari 6/6 hingga no light perception. Hilangnya
visus dapat : ringan (≥ 20 / 30), sedang (≥ 20 / 60), berat (≤ 20 / 70)</div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
Pemeriksaan penglihatan warna sangat penting dan ini dapat
dideteksi dengan menggunakan ishihara test. Pola yang paling umum didapatkan pada
penderita ON adalah redgreen confusion. Defek relatif aferen pupil merupakan
tanda klinis dari ON dan sangat penting bahwa tes ini dilakukan dengan benar.
Perlakuan percobaan neuritis optik (ONTT) menunjukkan bahwa sekitar 48% pasien
dengan ON pada satu mata memiliki optik neuropati pada mata kontralateralnya.
Pada anak-anak, ON cukup sering bilateral dan berulang. Penurunan subjektif
pada kontras penglihatan adalah indikator lain dari disfungsi nervus optikus.17</div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
Uhthoff’s phenomenon merupakan hilangnya visus sementara
waktu yang terjadi secara intermiten yang terjadi di Multiple sclerosis dan
optic neuropati. Syndrome ini juga dapat dicetuskan oleh stress emosional,
perubahan cuaca, menstruasi, cahaya, makanan, merokok. Patofisiologi dari
Unthoff’s syndrome belum diketahui, walaupun adanya hambatan hantaran hingga
peningkatan pada suhu tubuh atau perubahan pada kadar elektrolit darah dapat
dipercaya memegang peranan.</div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
b. Gangguan lapangan pandang</div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
Depresi secara keseluruhan dari lapangan pandang adalah tipe
defek visual yang sering ditemukan. Banyak tipe kehilangan lapangan pandang
dilaporkan, termasuk skotoma centrocecal, setelah 7 bulan, 51 % kasus memiliki
lapangan pandang yang normal.</div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
c. Ukuran pupil</div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
Ukuran pupil sama dengan optik neuritis yang unilateral
walaupun mata tersebut buta. Umumnya, bagaimanapun defek/kerusakan afferent
pupil di karakteristikan dengan susahnya atau hilangnya konstriksi pada
penyinaran langsung, hal ini didapati pada mata yang ipsilateral. Tes dengan
lampu senter yang berayun adalah metode sederhana untuk mendeteksi hal ini.</div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
OPTHALMOSKOPI </div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
a. Perubahan
awal11</div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
Papilitis dapat ditemukan dalam 38 % kasus. Diskus optikus
normal dalam 44 % kasus. Pucatnya bagian temporal menunjukkan adanya lesi optik
neuritis yang berat pada mata yang sama, hal ini dijumpai pada 18 % dari pasien
yang menjalani pemeriksaan. Papilitis tahap awal di karakteristikkan dengan
adanya batas diskus yang mengabur dan sedikit hiperemis.</div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
Edema dari diskus optikus (1:3) dengan atau tanpa peripapillary
flame-shaped hemorrhages (papillitis lebih sering terjadi pada anak-anak dan
dewasa muda) atau normasl diskus (2:3) retrobulbar ON lebih sering pada dewasa.
(willeye)</div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
b. Papilitis yang mencapai perkembangan yang lengkap </div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
Adanya papiledema pada opthalmoskopi tidak memungkinkan
untuk menyatakan hal ini, ditandai dengan adanya pembengkakan, hilangnya
fisiologis cup, hiperemis dan perdarahan yang terpisah. Pembungkus vena
biasanya jarang terlihat. Pemeriksaan dengan split lamp untuk melihat adanya
sel pada vitreous adalah hal yang sangat penting.</div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
c. Perubahan lanjut </div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
Pada retrobulbar optik neuritis, diskus yang normal dapat
dijumpai selama 4-6 minggu, saat dimana pucat dijumpai. Papilitis yang
berlanjut kadang-kadangdidapati gambaran optik atropi sekunder. Pada keadaan
ini batas diskus dapat mengabur, mungkin terdapat jaringan glial pada diskus,
dan pucatnya diskus bagian stadium akhir optik neuritis. Pada stadium ini,
serabut saraf atropi dapat diamati pada retina dengan berangkat lampu hijau
merah.</div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
3.6 Penegakan Diagnosis</div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
Ø Anamnesa</div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
Riwayat </div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
· Pasien
dengan sklerosis multipel dapat mempunyai riwayat neuritis optik yang berulang,
dapat ditanyakan apakah pernah terjadi sebelumnya keluhan yang sama.</div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
Pada anamnesa akan didapatkan gejala subjektif:</div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
1. Penglihatan turun mendadak
dalam beberapa jam sampai hari yang mengenai satu atau kedua mata. Kurang lebih
sepertiga pasien memiliki visus lebih baik dari 20/40 pada serangan pertama,
sepertiga lagi juga dapat memiliki visus lebih buruk dari 20/200.</div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
2. Penglihatan warna
terganggu.</div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
3. Rasa sakit bila mata
bergerak dan ditekan, dapat terjadi sebelum atau bersamaan dengan berkurangnya
tajam penglihatan. Bola mata terasa berat di bagian belakang bila digerakkan.</div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
4. Adanya defek lapang
pandang.</div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
5. Pasien mengeluh penglihatan
menurun setelah olahraga atau suhu tubuh naik (tanda Uhthoff).</div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
6. Beberapa pasien mengeluh
objek yang bergerak lurus terlihat mempunyai lintasan melengkung (Pulfrich
phenomenon), kemungkinan dikarenakan konduksi yang asimetris antara nervus
optikus.</div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
Ø Pemeriksaan</div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
Dilakukan pemeriksaan untuk melihat gejala objektif.</div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
Langkah-langkah pemeriksaan:</div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
1. Pemeriksaan visus</div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
Didapatkan penurunan visus yang bervariasi mulai dari ringan
sampai kehilangan total penglihatan.</div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
2. Pemeriksaan segmen anterior</div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
Pada pemeriksaan segmen anterior, palpebra, konjungtiva,
maupun kornea dalam keadaan wajar. Refleks pupil menurun pada mata yang terkena
dan defek pupil aferen relatif atau Marcus Gunn pupil umumnya ditemukan. Pada
kasus yang bilateral, defek ini bisa tidak ditemukan.16,2</div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
3. Pemeriksaan segmen
posterior</div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
Pada neuritis optik akut sebanyak dua pertiga dari kasus
merupakan bentuk retrobulbar, maka papil tampak normal, dengan berjalannya
waktu, nervus optikus dapat menjadi pucat akibat atrofi. Pada kasus neuritis
optik bentuk papilitis akan tampak edema diskus yang hiperemis dan difus,
dengan perubahan pada pembuluh darah retina, arteri menciut dan vena melebar.
Jika ditemukan gambaran eksudat star figure, mengarahkan diagnosa kepada
neuroretinitis.14,2</div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
Ø Pemeriksaan Tambahan</div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
- Tes
konfrontasi</div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
- Tes
ishihara untuk melihat adanya penglihatan warna yang terganggu, umumnya warna
merah yang terganggu.2</div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
Ø Pemeriksaan Anjuran</div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
- Untuk
membantu mencari penyebab neuritis optik biasanya dilakukan pemeriksaan foto
sinar X kanal optik, sela tursika, atau dilakukan pemeriksaan CT orbita dan
kepala.</div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
- Dengan
MRI dapat dilihat tanda-tanda sklerosis multipel.2</div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
3.8 Penatalaksanaan</div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
Terapi Jangka Pendek</div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
Dalam ONTT, pada pasien yang diberi perlakuan dalam 8 hari
setelah onset gejala untuk menerima prednison oral (1 mg per kilogram berat
badan per hari selama 14 hari, dengan selanjutnya tapering-off selama 4 hari),
dan pasien yang menerima intravena metilprednisolon (250 mg setiap 6 jam selama
3 hari) diikuti dengan prednison oral mg (1 per kilogram per hari selama 11
hari, dengan selanjutnya tapering-off selama 4 hari), atau oral placebo.
Pengobatan dengan metilprednisolon intravena ternyata menghasilkan pemulihan
visus yang lebih cepat. Angka kejadian multiple sclerosis dua tahun setelah
pengobatan dengan infus metilprednisolon sebesar 7,5 persen, dibandingkan
dengan 14,7 persen di antara pasien yang menerima prednisone dan 16,7 persen
placebo.18</div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
Menurut Wills Eye Manual, terapi terhadap neuritis optik
adalah sebagai berikut13:</div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
Pasien tanpa riwayat Multiple Sclerosis atau Neuritis
optikus :</div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
1. Dari hasil MRI bila
terdapat minimum 1<span style="mso-spacerun: yes;"> </span>lesi demielinasi
tipikal :</div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
<span style="mso-tab-count: 1;"> </span>Regimen
selama 2 minggu : <span style="mso-tab-count: 1;"> </span></div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
a. 3 hari pertama diberikan
Methylprednisolone 1kg/kg/hari<span style="mso-spacerun: yes;"> </span>i.v</div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
b. 11 hari setelahnya
dilanjutkan dengan Prednisolone 1mg/kg/hari oral</div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
c. Tapering off dengan cara 20
mg prednisone oral untuk hari pertama ( hari ke 15<span style="mso-spacerun: yes;"> </span>sejak pemberian obat ) dan 10 mg prednisone
oral pada hari ke 2 sampai ke 4 </div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
d. Dapat diberikan Ranitidine 150 mg
oral untuk profilaksis gastritis </div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
Menurut Neuritis optikus Treatment Trial (ONTT) pengobatan
dengan steroid dapat menurunkan progresivitas Multiple sclerosis selama 3
tahun. Terapi steroid hanya mempercepatkan pemulihan visual tapi tidak
meningkatkan hasil pemulihan pandangan visual.</div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
2. Dari hasil MRI bila 2 atau
lebih lesi demielinasi :</div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
a. Menggunakan regimen yang sama dengan
yang di atas</div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
b. Merujukan pasien ke spesialis neurologi
untuk terapi interferon β-1α selama 28 hari </div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
c. Tidak menggunakan oral prednisolone
sebagai terapi primer karena dapat meningkatkan resiko rekuren atau kekambuhan</div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
3. Dengan tidak ada lesi
demielinasi dari hasil MRI :</div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
a. Risiko terjadi MS
rendah, kemungkinan terjadi sekitar 22% setelah 10 tahun kemudian</div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
b. Intravena steroid dapat
digunakan untuk mempercepatkan pemulihan visual </div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
c. Biasanya tidak
dianjurkan untuk terapi kecuali muncul gangguan visual pada mata kontralateral </div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
d. MRI lagi dalam 1 tahun
kemudian </div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
Pasien dengan riwayat Multiple sclerosis atau Neuritis
optikus :</div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
1. Observasi</div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
2. Memeriksa pasien pada
minggu ke 4-6 setelah muncul gejala dan pemeriksaan ulang tiap 3-6 bulan
kemudian</div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
3. Pasien yang berisiko tinggi
MS atau demielinisasi sistem saraf pusat dari hasil MRI sebaiknya dirujuk ke
spesialis neurologi untuk evaluasi dan terapi lanjutan.</div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
Terapi jangka panjang</div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
Interferon beta-1a dan interferon beta-1b telah terbukti
dapat<span style="mso-spacerun: yes;"> </span>mengurangi angka kejadian multipel
sklerosis pada pasien dengan demielinasi akut optik neuritis dan dua atau lebih
karakteristik dari lesi demielinisasi pada MRI. Controlled high-risk Subjects
Avonex Multiple Sclerosis Prevention Study (CHAMPS) termasuk 383 pasien dengan
neuritis optik akut atau demielinasi lainnya yang berada pada resiko tinggi
untuk terkena multiple sclerosis berdasar bukti MRI (dua atau lebih whitematter
lesion). Semua pasien menerima 1 g per hari intravena metilprednisolon selama 3
hari; 193 pasien secara acak diberikan suntikan intramuskular 30 mg interferon
beta-1a (Avonex) selama 27 hari dan 190 secara acak untuk suntikan mingguan
plasebo. pasien yang diobati dengan interferon beta-1a memiliki angka
probabilitas lebih rendah untuk terjadinya multiple sklerosi selama 3 dibandingkan
dengan mereka yang menerima placebo. 18</div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
3.9 Prognosis</div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
<span style="mso-tab-count: 1;"> </span>Perbaikan<span style="mso-spacerun: yes;"> </span>visual yang terjadi pada penderita ON ini
cukup cepat, bertahap dan berlangsung hingga 1 tahun setelah serangan. Ketajaman
visual yang diperoleh rata-rata 1 tahun setelah serangan neuritis optik adalah
20/15, dan kurang dari 10% pasien memiliki ketajaman visual tetap kurang dari
20/40. Parameter lain dari fungsi visual, termasuk sensitivitas kontras,
persepsi warna, dan lapang pandang, meningkat seiring dengan peningkatan
ketajaman visual. Kebanyakan<span style="mso-spacerun: yes;"> </span>dari
pasien, yang mengalami serangan neuritis optic lebih dari sekali, dapat
mempertahankan visus yang sangat baik selama minimal 15 tahun setelah serangan
neuritis optic pertama.16</div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
Meskipun prognosis keseluruhan untuk ketajaman visual
setelah serangan neuritis optik akut sangat baik, beberapa dari pasien
mengalami hilangnya penglihatan cukup parah yang menetap setelah satu kali
serangan. Lebih jauh lagi, bahkan pasien dengan peningkatan fungsi visual untuk
"normal" mungkin mengeluh photopsias atau kehilangan visual sementara
akibat overheat atau setelah olahraga (Uhthoff phenomenon). Dua hipotesis utama
tentang gejala Uhthoff adalah bahwa (1) peningkatan suhu tubuh dapat mengganggu
konduksi dari akson n. optic (2) olahraga dapat mempengaruhi lingkungan
metabolic disekitar n. optic yang juga dapat mengganggu konduksi dari akson.</div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
Sekitar 25% pasien yang mengalami serangan neuritis optik
akut akan mengalami serangan kedua pada mata yang sakit atau serangan baru pada
mata yang sebelumnya tidak terkena. Resiko kambuhnya atau serangan baru secara
substansial lebih tinggi pada pasien yang diobati dengan dosis rendah prednison
oral dibandingkan pasien yang tidak mendapat perawatan atau yang dirawat dengan
3-hari dosis tinggi (1 g / hari) intravena metilprednisolon diikuti dengan
2-minggu dosis rendah (1 mg / kg / hari) prednison.16</div>
<div style="text-align: justify;">
</div>
<div style="text-align: justify;">
</div>
<h3 class="MsoNormal" style="text-align: justify;">
DAFTAR PUSTAKA</h3>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
1. Guyton AC, Hall JE.
Neurofisiologi Penglihatan Sentral. Dalam : Buku Ajar Fisiologi Kedokteran.
Edisi 9. 1997. Jakarta : EGC. hal 825.</div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
2. American academy of
ophthalmology. Section 5 Neuro-Opthalmology. San Fransisco : LEO. 2008-2009. Hal.
144.</div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
3. Ropper, A. Adams and
Victor’s Principles of Neurology. Edisi 8. New York: McGraw-Hill. Hal.213</div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
4. A.K. Kurana. Comprehensive
Ophthalmology 4th Edition dalam Chapter 12– New Age International 2007. P
288-96.</div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
5. Froetscher M & Baehr M.
Duus. Topical Diagnosis in Neurology. 4<span style="mso-spacerun: yes;">
</span>edition. 2005. Stuttgart: Thieme. p 130 – 137.</div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
6. Lumbantobing S. Neurologi
Klinik Pemeriksaan Fisik dan Mental. Jakarta : Balai Penerbit FKUI. 2006. p 25
– 46.</div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
7. Ilyas Sidharta. Pemeriksaan
Pupil. Dalam : Ilmu Penyakit Mata. Edisi Ketiga. Jakarta : Balai Penerbit FKUI.
p 31 – 33.</div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
8. Gilroy Jhon. Abnormalities
of Pupillary Light Reflex. In : Basic Neurology. Third edition.</div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
9. Siregar, N. Papilitis.
2003. USU Digital Library</div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
10. Chu, E. R. 2009. Optic neuritis – more than a loss
of vision. Australian Family physician Vol. 38, No. 10, October 2009.</div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
11. Schiefer, U. 2007. Clinical Neuro-Ophthalmology.
Nw York: Springer.</div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
12. <a href="http://eyewiki.aao.org/User:Guy.V.Jirawuthiworavong.CMT" title="User:Guy.V.Jirawuthiworavong.CMT">Guy V. Jirawuthiworavong</a>. 2010.
Demyelinating Optic Neuritis. Article (<a href="http://eyewiki.aao.demyelinating_optic_neuritis/">http://eyewiki.aao.demyelinating_optic_neuritis</a>,
Diakses 23 Maret 2012)</div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
13. Osborne B, Balcer LJ. <span style="mso-spacerun: yes;"> </span>Optic neuritis: Pathophysiology, clinical
features, and diagnosis. Disitasi pada tangal 29 Maret 2011. Dapat diperoleh
dari URL: <a href="http://www.uptodate.com/opticneuritis">http://www.uptodate.com/opticneuritis</a>.</div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
14. Riordan-Eva, Paul, FRCS, FRCOphth dan John P.
Whitcher, MD, MPH. 2008. Vaughan & Asbury’s General Ophthalmology. New
York: The McGraw-Hill Companies, Inc.</div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
15. The Wilis Eye Manual : Office and Emergency Room
Diagnosis and Treatment of Eye Disease. 2008. P 250-52.</div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
Optic neuritis : diagnosis, treatment and prognosis. Dapat
diunduh dari<span style="mso-spacerun: yes;"> </span>URL : <a href="http://www.osbbd.com/pdf/Optic%20Neuritis%20CME.pdf">http://www.osbbd.com/pdf/Optic%20Neuritis%20CME.pdf</a>
(tanggal diunduh : 4 Juni 2012)</div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
PN, shams. 2009. Optic neuritis : Review. The National
Hospital for Neurology & Neurosurgery, London, UK. Dapat diunduh dari URL :
<a href="http://www.msforum.net/journal/download/20091682.pdf">http://www.msforum.net/journal/download/20091682.pdf</a>
(tanggal diunduh : 4 Juni 2012)</div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
Balcer, Laura J. 2006. Optic neuritis. Dapat diunduh dari
URL : <a href="http://www.nejm.org/">http://www.nejm.org</a> (tanggal diunduh :
4 Juni 2012)</div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
S J Hickman, C M Dalton. 2002. Management of acute optic neuritis.
Neuro-Ophthalmology Department, Moorfields Eye Hospital, London. Dapat diunduh
dari URL : <a href="http://www.ncbi.nlm.nih.gov/pubmed/12493277">http://www.ncbi.nlm.nih.gov/pubmed/12493277</a>
(diunduh pada tanggal : 4 Juni 2012)</div>
<div style="text-align: justify;">
</div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
Anonymoushttp://www.blogger.com/profile/06590633769759394496noreply@blogger.com0tag:blogger.com,1999:blog-5853367347201739175.post-33853897454814184912013-01-28T10:22:00.003-08:002013-01-28T10:22:40.126-08:00Hiperbilirubinemia<!--[if gte mso 9]><xml>
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<div class="Section1">
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<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">2.1.1
Definisi</span></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">
Istilah “ikterus” berasal dari bahasa Yunani icteros atau istilah “jaundice”
berasal dari bahasa Perancis jaune yang berarti “kuning”.1 Ikterus adalah
gambaran klinis berupa pewarnaan kuning pada kulit, sklera atau membran mukosa
karena adanya deposisi produk akhir katabolisme heme yaitu bilirubin.1 </span></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">
Ikterus neonatorum adalah keadaan klinis pada bayi yang ditandai oleh pewarnaan
ikterus pada kulit dan skelera akibat akumulasi bilirubin tak terkonjugasi yang
berlebih. 9 Secara klinis akan mulai tampak pada bayi baru lahir bila kadar
bilirubin darah 5-7 mg/dl. 9 Hiperbilirubinemia adalah terjadinya peningkatan
kadar plasma bilirubin 2 standar deviasi atau lebih dari kadar yang diharapkan
berdasarkan umur bayi atau lebih dari persentil 90.9 Hiperbilirubinemia adalah
suatu keadaan dimana kadar bilirubin total sewaktu >12mg/dL dan >15mg/dL
pada bayi aterm; ikterus yang terjadi pada hari pertama kehidupan; peningkatan
kadar bilirubin >5mg%/24jam; peningkatan kadar bilirubin direk >1,5-2mg%;
ikterus berlangsung > 2minggu.2</span></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">2.1.2
Etiologi</span></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">Peningkatan kadar
bilirubin umum terjadi pada setiap bayi baru lahir, ± 60% neonatus
(ikterus fisiologis), disebabkan: 5-8</span></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">Bilirubin selama masa
janin diekskresi melalui plasenta ibu sekarang harus diekskresi bayi sendiri</span></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">2.
Jumlah eritrosit dan hemolisisnya lebih banyak pada neonatus </span></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">3.
Lama hidup eritrosit pada neonatus lebih singkat (70-90 hari)</span></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">4.
Jumlah albumin untuk mengikat bilirubin pada bayi prematur atau bayi yang
mengalami gangguan pertumbuhan intra-uterin kurang </span></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">Fungsi hepar yang belum
sempurna (jumlah dan fungsi enzim glukuronil transferase, uridine diphosphate
glukoronil transferase dan ligand dalam protein belum adekuat) atau penurunan
ambilan bilirubin oleh hepatosit dan konjugasi.</span></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">Sirkulus enterohepatik
meningkat karena masih berfungsinya enzim β- glukuronidase di usus dan belum
ada nutrien</span></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">Peningkatan kadar
bilirubin yang berlebihan (ikterus patologis):1,2, 5-8</span></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">Hari 1: - Hemolisis
akibat inkompatibilitas ABO atau isoimunisasi Rhesus</span></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">
- Infeksi intrauterin TORCH</span></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">Hari 2-5: -
Prematuritas
- Infeksi</span></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">- Ikterus fisiologis
- RDS </span></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">-
Polisitemia
- Kongenital spherositosis</span></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">-
Sepsis
- Perdarahan Ekstravaskular</span></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">- Defisiensi
G6PD - Breast feeding
jaundice</span></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">Hari 5-10: -
Sepsis</span></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">- Breast milk jaundice </span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">- Galaktosemia</span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">- Hipotiroidisme</span></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">- Obat-obatan
(sulfonamid, furosemid, thiazide, cephalosporine dll)</span></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">Hari
>10: - Sepsis </span></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">- Neonatal hepatitis</span></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">- Atresia biliaris</span></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">- Peningkatan sirkulasi
enterohepatik (stenosis pilorik, obstruksi usus)</span></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">2.1.3
Metabolisme Bilirubin1-4</span></div>
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<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">Bilirubin merupakan
produk yang toksik dan harus dikeluarkan oleh tubuh.4 Bilirubin berasal dari
proses eritropoesis yang tidak efektif dan hasil pemecahan heme dalam sel
retikuloendotelial limpa dan hati. Produk akhir jaras metabolisme ini adalah
bilirubin indirek (bilirubin bebas/ bilirubin IX alfa) yang tidak larut dalam
air, terikat pada albumin dalam sirkulasi. Setelah sampai hepar, terjadi
mekanisme ambilan dan bilirubin terikat oleh reseptor membran sel hati. Dalam
sel hati, terjadi persenyawaan dengan ligandin (protein Y) dan protein Z dan
glutation lain yang membawanya ke retikulum endoplasma hati, tempat terjadinya
konjugasi. Bilirubin indirek ini kemudian oleh enzim glukoronil transferase
dimetabolisme menjadi bilirubin direk. Bilirubin direk akan disekresikan ke
dalam sistem bilier oleh transporter spesifik. 9</span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">Setelah disekresi oleh
hati, disimpan dalam kandung empedu sampai proses makan akan merangsang
pengeluaran empedu ke dalam duodenum. Bilirubin direk tidak dapat direabsorpsi
oleh epitel usus, tetapi dipecah oleh flora usus menjadi sterkobilin dan
urobilinogen yang kemudian dikeluarkan melalui tinja. Sebagian kecil bilirubin
direk akan didekonjugasi oleh enzim β-glukoronidase yang terdapat pada epitel
usus dan bilirubin indirek yang dihasilkan ini akan direabsorpsi ke dalam
sirkulasi dan kembali ke hati, yang dikenal sebagai sirkulasi enterohepatik. 9</span></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">Berdasarkan metabolisme
normal bilirubin tersebut, mekanisme terjadinya ikterus berkaitan dengan:
produksi bilirubin, ambilan bilirubin oleh hepatosit, ikatan bilirubin
intrahepatosit, konjugasi, sekresi, dan ekskresi bilirubin. Pada sebagian
kasus, lebih dari satu mekanisme yang terlibat. 9</span></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">2.1.4
Diagnosis9</span></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">
Anamnesis, mencari berbagai faktor resiko yang dapat meningkatkan kejadian
hiperbilirubinemia, pemeriksaan fisik harus dilakukan dalam ruangan dengan
pencahayaan yang baik, dan dengan menekan kulit dengan tekanan yang ringan
untuk melihat warna kulit dan jaringan subkutan. Ikterus pada kulit bayi tidak
terperhatikan pada kadar bilirubin kurang dari 4 mg/dl. Pemeriksaan fisik harus
difokuskan pada identifikasi dari salah satu penyebab ikterus patologis.
Kondisi bayi yang diperiksa; apakah ada pucat, petekie, ekstravasasi darah,
memar, kulit yang berlebihan, hepatosplenomegali, kehilangan berat badan, dan
bukti adanya dehidrasi. Pemeriksaan terhadap kadar bilirubin total dan indirek
untuk menegakkan diagnosis, serta mencari faktor penyebab yang berhubungan
dengan hiperbilirubinemia yang berat.</span></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">2.1.5 Penatalaksanaan2,
9</span></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">
Tujuan penatalaksanaan ikterus pada neonatus adalah untuk mengendalikan agar
kadar bilirubin serum tidak mencapai nilai yang dapat menimbulkan kern ikterus,
serta mengobati penyebab langsung ikterus. Pengendalian kadar bilirubin dapat
dilakukan dengan mengusahakan agar konjugasi bilirubin lebih cepat terjadi
dengan memberikan luminal atau agar yang dapat merangsang terbentuknya enzim
glukoronil transferase. Pemberian substrat yang dapat menghambat metabolisme
bilirubin (plasma, albumin), mengurangi sirkulasi enterohepatik (pemberian
kolestiramin), terapi sinar atau transfusi tukar dapat juga dilakukan untuk
mengendalikan kenaikan kadar bilirubin.4 Dikemukakan pula bahwa obat-obatan
(IVIG: Intra Venous Immuno Globulin dan Metalloporphyrins) dipakai dengan
maksud menghambat hemolisis, meningkatkan konjugasi dan ekskresi bilirubin.6</span></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">Terapi Sinar9</span></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">Bilirubin indirek tidak
larut dalam air. Cara kerja terapi sinar adalah dengan mengubah bilirubin
menjadi bentuk yang larut dalam air untuk dieksresikan melalui empedu atau
urin. Ketika bilirubin mengabsorbsi sinar, terjadi reaksi fotokimia yaitu
isomerisasi (80%). Juga terdapat konversi ireversibel menjadi isomer kimia
lainnya yaitu lumirubin yang dengan cepat dibersihkan dari plasma (tanpa konjugasi)
melalui empedu. Lumirubin adalah produk terbanyak degradasi bilirubin akibat
terapi sinar pada manusia. Sejumlah kecil bilirubin plasma tak terkonjugasi
diubah oleh cahaya (foto oksidasi, 20%) menjadi dipyrole yang diekskresikan
melalui urin. Foto isomer bilirubin lebih polar dibandingkan bentuk asalnya dan
secara langsung bisa dieksreksikan melalui empedu. Hanya produk foto oksidan
saja yang bisa diekskresikan lewat urin. </span></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">Pada terapi sinar,
panjang gelombang lampu yang digunakan 425-475 nm dengan intensitas cahaya 6-12
μwatt/cm2 per nm. Cahaya diberikan pada jarak 35-50 cm di atas bayi. Jumlah
bola lampu yang digunakan berkisar antara 6-8 buah, terdiri dari biru (F20T12),
cahaya biru khusus (F20T12/BB) atau daylight fluorescent tubes. </span></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">Tabel 2.2 Komplikasi
terapi sinar umumnya ringan, sangat jarang </span></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">terjadi dan reversibel.</span></div>
<table border="1" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border-collapse: collapse; border: none; mso-border-bottom-alt: solid gray 1.5pt; mso-padding-alt: 0in 5.4pt 0in 5.4pt; mso-yfti-tbllook: 480;">
<tbody>
<tr style="mso-yfti-firstrow: yes; mso-yfti-irow: 0;">
<td style="background: #008078; border-bottom: solid black 1.0pt; border: none; mso-border-bottom-alt: solid black .75pt; mso-pattern: gray-75 teal; mso-shading: green; padding: 0in 5.4pt 0in 5.4pt; width: 1.75in;" valign="top" width="168">
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">Komplikasi</span></div>
</td>
<td style="background: #008078; border-bottom: solid black 1.0pt; border: none; mso-border-bottom-alt: solid black .75pt; mso-pattern: gray-75 teal; mso-shading: green; padding: 0in 5.4pt 0in 5.4pt; width: 297.0pt;" valign="top" width="396">
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">Mekanisme yang
mungkin terjadi</span></div>
</td>
</tr>
<tr style="height: 16.05pt; mso-yfti-irow: 1;">
<td style="background: #EFFFEF; border: none; height: 16.05pt; mso-pattern: gray-20 lime; mso-shading: white; padding: 0in 5.4pt 0in 5.4pt; width: 1.75in;" valign="top" width="168">
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">Bronze baby
syndrome </span></div>
</td>
<td style="background: #EFFFEF; border: none; height: 16.05pt; mso-pattern: gray-20 lime; mso-shading: white; padding: 0in 5.4pt 0in 5.4pt; width: 297.0pt;" valign="top" width="396">
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">Berkurangnya ekskresi
hepatik hasil penyinaran bilirubin</span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 2;">
<td style="background: #EFFFEF; border: none; mso-pattern: gray-20 lime; mso-shading: white; padding: 0in 5.4pt 0in 5.4pt; width: 1.75in;" valign="top" width="168">
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">Diare</span></div>
</td>
<td style="background: #EFFFEF; border: none; mso-pattern: gray-20 lime; mso-shading: white; padding: 0in 5.4pt 0in 5.4pt; width: 297.0pt;" valign="top" width="396">
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">Bilirubin indirek
menghambat laktase</span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 3;">
<td style="border: none; padding: 0in 5.4pt 0in 5.4pt; width: 1.75in;" valign="top" width="168">
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">Hemolisis</span></div>
</td>
<td style="border: none; padding: 0in 5.4pt 0in 5.4pt; width: 297.0pt;" valign="top" width="396">
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">Fotosensitivitas
mengganggu sirkulasi eritrosit</span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 4;">
<td style="border: none; padding: 0in 5.4pt 0in 5.4pt; width: 1.75in;" valign="top" width="168">
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">Dehidrasi</span></div>
</td>
<td style="border: none; padding: 0in 5.4pt 0in 5.4pt; width: 297.0pt;" valign="top" width="396">
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">IWL ↑ (30-100%)
karena menyerap energi foton</span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 5; mso-yfti-lastrow: yes;">
<td style="border-bottom: solid gray 1.5pt; border-left: none; border-right: none; border-top: solid black 1.0pt; mso-border-bottom-alt: solid gray 1.5pt; mso-border-top-alt: solid black .75pt; padding: 0in 5.4pt 0in 5.4pt; width: 1.75in;" valign="top" width="168">
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">Ruam kulit</span></div>
</td>
<td style="border-bottom: solid gray 1.5pt; border-left: none; border-right: none; border-top: solid black 1.0pt; mso-border-bottom-alt: solid gray 1.5pt; mso-border-top-alt: solid black .75pt; padding: 0in 5.4pt 0in 5.4pt; width: 297.0pt;" valign="top" width="396">
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">Gangguan
fotosensitasi terhadap sel mast kulit dengan pelepasan histamin</span></div>
</td>
</tr>
</tbody></table>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">
</span></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">Faktor-faktor yang
mempengaruhi efektivitas terapi adalah intensitas radiasi, kurva spektrum
emisi, luas tubuh bayi yang terpapar, usia bayi, umur gestasi, berat badan dan
etiologi ikterus. Terapi sinar paling efektif untuk bayi prematur yang sangat
kecil dan paling tidak efektif untuk bayi matur yang sangat kecil (gangguan
pertumbuhan yang sangat berat) dengan peningkatan hematokrit. Selain itu, makin
tinggi kadar bilirubin pada saat memulai fototerapi, makin efektif.</span></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">Transfusi Tukar 9 </span></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">
</span></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">Merupakan suatu tindakan
pengambilan sejumlah kecil darah yang dilanjutkan dengan pengembalian darah
dari donor dalam jumlah yang sama yang dilakukan berulang-ulang sampai sebagian
besar darah penderita tertukar. Transfusi tukar ini bertujuan mencegah
terjadinya ensefalopati bilirubin dengan cara mengeluarkan bilirubin indirek
dari sirkulasi, membantu mengeluarkan antibodi maternal dari sirkulasi bayi,
mengganti RBC yang sensitized dengan RBC yang tak dapat dihemolise, memperbaiki
volume darah dan mengoreksi anemia, memberi albumin, dan membuang zat toksik
dan koreksi imbalans elektrolit.</span></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">Tabel 2.4 Transfusi
Tukar Pada Bayi Kurang Bulan</span></div>
<table border="1" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border-collapse: collapse; border: none; mso-border-left-alt: solid black 1.5pt; mso-border-right-alt: solid black 1.5pt; mso-padding-alt: 0in 5.4pt 0in 5.4pt; mso-yfti-tbllook: 480;">
<tbody>
<tr style="mso-yfti-firstrow: yes; mso-yfti-irow: 0;">
<td style="background: #FFFFCA; border-bottom: solid black 1.0pt; border-left: solid black 1.5pt; border-right: solid black 1.0pt; border-top: none; mso-border-bottom-alt: solid black .75pt; mso-border-left-alt: solid black 1.5pt; mso-border-right-alt: solid black .75pt; mso-pattern: gray-30 yellow; mso-shading: white; padding: 0in 5.4pt 0in 5.4pt; width: 104.2pt;" valign="top" width="139">
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">Usia (jam)</span></div>
</td>
<td style="background: #FFFFCA; border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-bottom-alt: solid black .75pt; mso-border-left-alt: solid black .75pt; mso-border-left-alt: solid black .75pt; mso-border-right-alt: solid black .75pt; mso-pattern: gray-30 yellow; mso-shading: white; padding: 0in 5.4pt 0in 5.4pt; width: 109.6pt;" valign="top" width="146">
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">BB < 1500gr </span></div>
</td>
<td style="background: #FFFFCA; border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-bottom-alt: solid black .75pt; mso-border-left-alt: solid black .75pt; mso-border-left-alt: solid black .75pt; mso-border-right-alt: solid black .75pt; mso-pattern: gray-30 yellow; mso-shading: white; padding: 0in 5.4pt 0in 5.4pt; width: 109.65pt;" valign="top" width="146">
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">BB 1500– 2000 gr</span></div>
</td>
<td style="background: #FFFFCA; border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.5pt; border-top: none; mso-border-bottom-alt: solid black .75pt; mso-border-left-alt: solid black .75pt; mso-border-left-alt: solid black .75pt; mso-border-right-alt: solid black 1.5pt; mso-pattern: gray-30 yellow; mso-shading: white; padding: 0in 5.4pt 0in 5.4pt; width: 99.55pt;" valign="top" width="133">
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">BB > 2000 gr</span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 1;">
<td style="border-bottom: solid black 1.0pt; border-left: solid black 1.5pt; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .75pt; mso-border-left-alt: solid black 1.5pt; mso-border-top-alt: solid black .75pt; padding: 0in 5.4pt 0in 5.4pt; width: 104.2pt;" valign="top" width="139">
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">< 24</span></div>
</td>
<td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .75pt; mso-border-left-alt: solid black .75pt; mso-border-top-alt: solid black .75pt; padding: 0in 5.4pt 0in 5.4pt; width: 109.6pt;" valign="top" width="146">
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">> 10-15 mg/dL</span></div>
</td>
<td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .75pt; mso-border-left-alt: solid black .75pt; mso-border-top-alt: solid black .75pt; padding: 0in 5.4pt 0in 5.4pt; width: 109.65pt;" valign="top" width="146">
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">>15 mg/dL</span></div>
</td>
<td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.5pt; border-top: none; mso-border-alt: solid black .75pt; mso-border-left-alt: solid black .75pt; mso-border-right-alt: solid black 1.5pt; mso-border-top-alt: solid black .75pt; padding: 0in 5.4pt 0in 5.4pt; width: 99.55pt;" valign="top" width="133">
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">> 16 mg/dL</span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 2;">
<td style="border-bottom: solid black 1.0pt; border-left: solid black 1.5pt; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .75pt; mso-border-left-alt: solid black 1.5pt; mso-border-top-alt: solid black .75pt; padding: 0in 5.4pt 0in 5.4pt; width: 104.2pt;" valign="top" width="139">
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">25-48</span></div>
</td>
<td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .75pt; mso-border-left-alt: solid black .75pt; mso-border-top-alt: solid black .75pt; padding: 0in 5.4pt 0in 5.4pt; width: 109.6pt;" valign="top" width="146">
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">> 10-15 mg/dL</span></div>
</td>
<td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .75pt; mso-border-left-alt: solid black .75pt; mso-border-top-alt: solid black .75pt; padding: 0in 5.4pt 0in 5.4pt; width: 109.65pt;" valign="top" width="146">
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">>15 mg/dL</span></div>
</td>
<td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.5pt; border-top: none; mso-border-alt: solid black .75pt; mso-border-left-alt: solid black .75pt; mso-border-right-alt: solid black 1.5pt; mso-border-top-alt: solid black .75pt; padding: 0in 5.4pt 0in 5.4pt; width: 99.55pt;" valign="top" width="133">
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">> 20 mg/dL</span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 3;">
<td style="border-bottom: solid black 1.0pt; border-left: solid black 1.5pt; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .75pt; mso-border-left-alt: solid black 1.5pt; mso-border-top-alt: solid black .75pt; padding: 0in 5.4pt 0in 5.4pt; width: 104.2pt;" valign="top" width="139">
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">49-72</span></div>
</td>
<td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .75pt; mso-border-left-alt: solid black .75pt; mso-border-top-alt: solid black .75pt; padding: 0in 5.4pt 0in 5.4pt; width: 109.6pt;" valign="top" width="146">
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">>10-15 mg/dL</span></div>
</td>
<td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .75pt; mso-border-left-alt: solid black .75pt; mso-border-top-alt: solid black .75pt; padding: 0in 5.4pt 0in 5.4pt; width: 109.65pt;" valign="top" width="146">
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">>15 mg/dL</span></div>
</td>
<td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.5pt; border-top: none; mso-border-alt: solid black .75pt; mso-border-left-alt: solid black .75pt; mso-border-right-alt: solid black 1.5pt; mso-border-top-alt: solid black .75pt; padding: 0in 5.4pt 0in 5.4pt; width: 99.55pt;" valign="top" width="133">
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">> 17 mg/dL</span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 4; mso-yfti-lastrow: yes;">
<td style="background: #FFFFCA; border-bottom: none; border-left: solid black 1.5pt; border-right: solid black 1.0pt; border-top: none; mso-border-left-alt: solid black 1.5pt; mso-border-right-alt: solid black .75pt; mso-border-top-alt: solid black .75pt; mso-border-top-alt: solid black .75pt; mso-pattern: gray-30 yellow; mso-shading: white; padding: 0in 5.4pt 0in 5.4pt; width: 104.2pt;" valign="top" width="139">
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">> 72</span></div>
</td>
<td style="background: #FFFFCA; border-right: solid black 1.0pt; border: none; mso-border-left-alt: solid black .75pt; mso-border-left-alt: solid black .75pt; mso-border-right-alt: solid black .75pt; mso-border-top-alt: solid black .75pt; mso-border-top-alt: solid black .75pt; mso-pattern: gray-30 yellow; mso-shading: white; padding: 0in 5.4pt 0in 5.4pt; width: 109.6pt;" valign="top" width="146">
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">>15 mg/dL</span></div>
</td>
<td style="background: #FFFFCA; border-right: solid black 1.0pt; border: none; mso-border-left-alt: solid black .75pt; mso-border-left-alt: solid black .75pt; mso-border-right-alt: solid black .75pt; mso-border-top-alt: solid black .75pt; mso-border-top-alt: solid black .75pt; mso-pattern: gray-30 yellow; mso-shading: white; padding: 0in 5.4pt 0in 5.4pt; width: 109.65pt;" valign="top" width="146">
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">>17 mg/dL</span></div>
</td>
<td style="background: #FFFFCA; border: none; mso-border-left-alt: solid black .75pt; mso-border-top-alt: solid black .75pt; mso-pattern: gray-30 yellow; mso-shading: white; padding: 0in 5.4pt 0in 5.4pt; width: 99.55pt;" valign="top" width="133">
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">> 18 mg/dL</span></div>
</td>
</tr>
</tbody></table>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">Pada penyakit hemolitik
segera dilakukan tranfusi tukar apabila ada indikasi:</span></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">1. Kadar
bilirubin tali pusat > 4,5 mg/dL dan kadar Hb < 10 gr/dL</span></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">2. Kadar
bilirubin meningkat > 6 mg/dL/12jam walaupun sedang mendapatkan terapi sinar</span></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">3. Anemia dengan early
jaundice dengan kadar Hb 10–13gr/dL dan kecepatan peningkatan bilirubin
0,5mg/dL/jam </span></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">4. Anemia yang
progresif pada waktu pengobatan hiperbilirubinemia</span></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">5. Bayi menunjukkan
tanda-tanda ensephalopati bilirubin akut (hipotoni, kaki melengkung,
retrocolis, panas, tangis melengking tinggi)</span></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">6. Kadar
bilirubin total >25mg/dL</span></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">Transfusi tukar harus
dihentikan apabila terjadi:</span></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;"> *
Emboli (emboli, bekuan darah), trombosis</span></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;"> *
Hiperkalemia, hipernatremia, hipokalsemia, asidosis, hipoglikemia</span></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;"> *
Gangguan pembekuan karena pemakaian heparin</span></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;"> *
Perforasi pembuluh darah</span></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">Komplikasi tranfusi
tukar: 9</span></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;"> *
Vaskular: emboli udara atau trombus, trombosis</span></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;"> *
Kelainan jantung: aritmia, overload, henti jantung</span></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;"> *
Gangguan elektrolit: hipo/hiperkalsemia, hipernatremia, asidosis</span></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;"> *
Koagulasi: trombositopenia, heparinisasi berlebih</span></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;"> *
Infeksi: bakteremia, hepatitis virus, sitomegalik, enterokolitis nekrotikan</span></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;"> *
Lain-lain: hipotermia, hipoglikemia</span></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">6. Prognosis</span></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">
Hiperbilirubinemia prognosisnya akan buruk apabila bilirubin indirek telah
melalui sawar darah otak, artinya penderita telah menderita kern ikterus atau
ensephalopati biliaris. Sebaliknya apabila tidak terjadi kern ikterus,
prognosanya baik. 9</span></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">DAFTAR PUSTAKA</span></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">1.
Hadinegoro SR, Prawitasari T, dkk. Diagnosis dan Tatalaksana Penyakit Anak
dengan Gejala Kuning. Jakarta: Departemen Ilmu Kesehatan Anak FKUI-RSCM. 2007.</span></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">2.
Staf Pengajar FK Unsri. Hiperbilirubinemia Neonatal. Buku Standar Profesi Ilmu
Kesehatan Anak. Palembang: FK Universitas Sriwijaya. 2005.</span></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">3.
Sastroasmono S, dkk. Ikterus Neonatorum. Diambil dari:
http//www.yanmedik-depkes.net .</span></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">4.
Markum AH. Buku Ajar Ilmu Kesehatan Anak. Jakarta: FKUI. 1991</span></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">5.
Sylviati M. Damanik. Hiperbilirubinemia. Diambil dari: http//www.pediatrik.com.
</span></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">6.
Etika R, Harianto A, Indarso F, Damanik MS. Hiperbilirubinemia pada Neonatus.
Divisi Neonatologi Bagian Ilmu Kesehatan Anak. Surabaya: FK Unair/Dr. Soetomo.</span></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">7.
Staf Pengajar FK Unsri. Sepsis Neonatorum. Buku Standar Profesi Ilmu Kesehatan
Anak. Palembang: FK Universitas Sriwijaya. 2005</span></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">8.
Quagliarello, Vincent J., Scheld W. 1997. Treatment of Bacterial Meningitis. The
New England Journal of Medicine. 336 : 708-16 Diambil dari URL : <a href="http://content.nejm.org/cgi/reprint/336/10/708.pdf">http://content.nejm.org/cgi/reprint/336/10/708.pdf</a></span></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">9.
Sholeh Kosim M, dkk. Buku Ajar Neonatologi; edisi pertama. Ikatan Dokter Anak
Indonesia. 2010</span></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
</div>
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: EN-US; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><br clear="all" style="mso-break-type: section-break; page-break-before: always;" />
</span>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
Anonymoushttp://www.blogger.com/profile/06590633769759394496noreply@blogger.com0tag:blogger.com,1999:blog-5853367347201739175.post-66537237561271787162012-08-06T00:08:00.000-07:002012-08-06T00:08:34.447-07:00What is vestibulitis? How is it managed?
<div class="MsoNormal" style="text-align: justify;">
<span style="font-size: 12.0pt; line-height: 115%;">Vestibulitis is defined as a constellation of symptoms and
signs, including entry dyspareunia, vestibular erythema, and vestibular
tenderness in the absence of an active dermatosis or disorder that would
otherwise explain the findings. Management includes symptomatic relief with 5%
lidocaine ointment; tricyclic antidepressants may be helpful. Surgical
treatment should only be considered in severe cases that are refractory to
medical management.</span></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
Anonymoushttp://www.blogger.com/profile/06590633769759394496noreply@blogger.com2tag:blogger.com,1999:blog-5853367347201739175.post-20689060938551059542012-08-05T23:55:00.001-07:002012-08-05T23:56:27.476-07:00Benign Lessions of the vulva and vagina<a class="breadcrumb" href="http://www.blogger.com/bookcontent.cfm@id=s1.htm" target="content" title="Go to I. GENERAL GYNECOLOGY AND INFERTILITY"> <b>Reff: GENERAL GYNECOLOGY AND INFERTILITY</b></a><b> > 1 BENIGN LESIONS OF THE VULVA AND
VAGINA</b><br />
<br />
<b>What is the vulva composed of?</b><br />
The vulva is composed of the labia majora, labia minora, mons pubis, clitoris,
vestibule, urinary meatus, vaginal orifice, hymen, Bartholin's glands, Skene's
ducts, and vestibulovaginal bulbs.<br />
<br />
<b>Name the five disorders in which infectious agents cause lesions of the vulva.</b><br />
<ul>
<li>Chancroid (<i>Haemophilus ducreyi</i>)
</li>
<li>Syphilis (<i>Treponema pallidum</i>)
</li>
<li>Lymphogranuloma venereum (<i>Chlamydia trachomatis</i> serovar)
</li>
<li>Human papillomavirus
</li>
<li>Genital herpes </li>
</ul>
<b> Describe the clinical features and treatment of each disorder listed in question
2.</b><br />
<br />
<table border="0" cellpadding="0" cellspacing="0" width="100%">
<tbody>
<tr>
<td bgcolor="#ffffff" class="PA" width="100%"><a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="P001003"></a><b>Chancroid:</b>
Sexually transmitted with an incubation period of 3-10 days. Presents as small,
tender papules that soon break down to form ragged, tender, nonindurated ulcers
usually located on the labia, fourchette, perineum, and perianal areas. May be
single, but are more often multiple.▪ Treatment-current drug of choice is
<b>erythromycin.</b></td></tr>
</tbody></table>
<table border="0" cellpadding="0" cellspacing="0" width="100%">
<tbody>
<tr>
<td bgcolor="#ffffff" class="PA" width="100%"><br />
<b>Syphilis:</b>
Sexually transmitted with an incubation period of about 2 weeks. The first
lesion is a macule, which soon becomes papular, then ulcerates to form a primary
chancre. Classic description of the primary chancre is an indurated, painless
ulcer with a dull red base. If untreated, primary stage typically lasts 3-8
weeks and then the ulcer spontaneously heals. In <b>secondary syphilis</b>, skin
rashes may be macular, papular, papulosquamous, or pustular, and any of these
may occur on the vulva. <i>Condyloma lata</i> are seen in secondary syphilis and
are characterized by confluent, spongy, gray masses with flat tops and broad
bases located at the periphery of the vulva. In <b>late syphilis,</b> vulvar
lesions termed <i>gummas</i> appear as squamous lesions or subcutaneous nodules
that sometimes ulcerate.▪ Treatment-remains <b>penicillin</b> for all stages.
</td></tr>
</tbody></table>
<table border="0" cellpadding="0" cellspacing="0" width="100%">
<tbody>
<tr>
<td bgcolor="#ffffff" class="PA" width="100%"><br />
<b>Lymphogranuloma
venereum (LGV):</b> Rare in temperate climates. Incubation period is between 3
days and 3 weeks. The primary lesion is a small, painless papule, vesicle, or
ulcer, typically located on the fourchette but may also occur on the labia or
cervix. The secondary stage is characterized by enlargement of the inguinal
glands to form a painful mass, which tends to suppurate and form sinuses.▪
Treatment-early LGV responds to <b>tetracycline</b>. Prolonged treatment may be
necessary. </td><td bgcolor="#ffffff" class="PA" width="100%"></td></tr>
</tbody></table>
<table border="0" cellpadding="0" cellspacing="0" width="100%">
<tbody>
<tr>
<td bgcolor="#ffffff" class="PA" width="100%"><br />
<b>Human
papillomavirus:</b> Sexually transmitted with incubation periods ranging from 3
weeks to 8 months. Manifest on the vulva as genital warts. Commonly are papular,
appearing as small, raised, rounded lesions, usually multiple. However, may
present as <i>condylomata acuminata</i>, which are irregular, fleshy, vascular
tumors affecting any part of the vulva.▪ Treatment-repeat application of
<b>trichloroacetic acid, podophyllin, topical imiquimod (Aldara)</b>,
<b>cryotherapy,</b> or <b>laser surgery.</b></td></tr>
</tbody></table>
<table border="0" cellpadding="0" cellspacing="0" width="100%">
<tbody>
<tr>
</tr>
</tbody></table>
<table border="0" cellpadding="0" cellspacing="0" width="100%"><tbody>
<tr><td align="right" class="PB" width="100%"></td></tr>
<tr></tr>
</tbody></table>
<table border="0" cellpadding="0" cellspacing="0" width="100%"><tbody>
<tr><td align="right" bgcolor="#eeeeee" class="PB" width="100%"></td></tr>
<tr><td align="right" class="PB" width="100%"><br /></td></tr>
</tbody></table>
<table border="0" cellpadding="0" cellspacing="0" width="100%">
<tbody>
<tr>
<td bgcolor="#ffffff" class="PA" width="100%"><a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="P001007"></a><b>Genital herpes
virus:</b> Sexually transmitted with incubation period of first attack usually
2-10 days. Lesions are initially vesicular, but rupture to form single,
multiple, or grouped shallow, tender, ulcers, 1-2 mm in diameter. Lesions are
most common on the labia majora and minora, clitoris, perineum, and perianal
areas. </td></tr>
</tbody></table>
<table border="0" cellpadding="0" cellspacing="0" width="100%">
<tbody>
<tr>
<td bgcolor="#ffffff" class="PA" width="100%"><a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="P001008"></a>Treatment-<b>acyclovir</b> is the drug of choice for the
treatment of outbreaks. However, it does not influence the rate of recurrence.<br />
<br />
<b>List the common cystic lesions of the vulva and vagina</b><br />
<br />
<table border="0" cellpadding="0" cellspacing="0" width="100%">
<tbody>
<tr>
<td bgcolor="#ffffff" class="PA" width="100%"><a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="P001016"></a><b>Cysts of
epidermal origin:</b> sebaceous cysts, epidermal inclusion cysts, hidradenoma
</td></tr>
</tbody></table>
<table border="0" cellpadding="0" cellspacing="0" width="100%">
<tbody>
<tr>
</tr>
</tbody></table>
<table border="0" cellpadding="0" cellspacing="0" width="100%"><tbody>
<tr><td align="right" class="PB" width="100%"></td></tr>
<tr></tr>
</tbody></table>
<table border="0" cellpadding="0" cellspacing="0" width="100%"><tbody>
<tr><td align="right" bgcolor="#eeeeee" class="PB" width="100%"></td></tr>
<tr>
<td align="right" class="PB" width="100%"><br /></td></tr>
</tbody></table>
<table border="0" cellpadding="0" cellspacing="0" width="100%">
<tbody>
<tr>
<td bgcolor="#ffffff" class="PA" width="100%"><a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="P001017"></a><b>Cysts of
embryonic origin:</b> Gartner's duct cysts (arise from vestigial remnants of the
vaginal portion of the Wolffian ducts) </td></tr>
</tbody></table>
<table border="0" cellpadding="0" cellspacing="0" width="100%">
<tbody>
<tr>
<td bgcolor="#ffffff" class="PA" width="100%"><br />
<b>Duct cysts:</b>
Bartholin's gland </td></tr>
</tbody></table>
<table border="0" cellpadding="0" cellspacing="0" width="100%">
<tbody>
<tr>
<td bgcolor="#ffffff" class="PA" width="100%"><br />
<b>Cysts of
urethral and paraurethral origin:</b> Skene's duct cysts, urethral or
suburethral diverticulum </td></tr>
</tbody></table>
</td><td bgcolor="#ffffff" class="PA" width="100%"></td><td bgcolor="#ffffff" class="PA" width="100%"></td><td bgcolor="#ffffff" class="PA" width="100%">.</td></tr>
</tbody></table>Anonymoushttp://www.blogger.com/profile/06590633769759394496noreply@blogger.com0tag:blogger.com,1999:blog-5853367347201739175.post-12945318083695644452012-08-02T23:42:00.002-07:002012-08-02T23:42:17.948-07:00FERTILIZATION AND EARLY CLEAVAGE<div class="MsoNormal" style="text-align: justify;">
<b style="mso-bidi-font-weight: normal;"><span style="font-size: 12.0pt; line-height: 115%;">Reff :<span style="mso-spacerun: yes;"> </span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-font-kerning: 18.0pt;">Katz: Comprehensive Gynecology, 5th
ed.</span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
In most mammals, including humans, the egg is
released from the ovary in the metaphase II stage. When the egg enters the
fallopian tube, it is surrounded by a cumulus of granulosa cells (cumulus
oophorus) and intimately surrounded by a clear zona pellucida. Within the zona
pellucida are both the egg and the first polar body. Meanwhile, spermatozoa are
transported through the cervical mucus and the uterus and into the fallopian
tubes. During this transport period the sperm undergo two changes: capacitation
and acrosome reaction. These changes activate enzyme systems within the sperm
head and make it possible for the sperm to transgress the cumulus oophorus and
the zona pellucida.</div>
<div style="text-align: justify;">
The sperm are attracted to an egg through the
process known as chemotaxis, which is related to capacitation of the sperm. The
process is aided by the binding of progesterone to a surface receptor on the sperm.
This allows an increase in intracellular calcium ion concentration, which
increases sperm motility (chemokinesis). Once the sperm has passed the barrier
of the zona pellucida, it attaches to the cell membrane of the egg and enters
the cytoplasm. When the sperm enters the cytoplasm, intracytoplasmic
structures, the coronal granules, arrange themselves in an orderly fashion
around the outermost portion of the cytoplasm just beneath the cytoplasmic
membrane, and the sperm head swells and gives rise to the male pronucleus. The
egg completes its second meiotic division, casting off the second polar body to
a position also beneath the zona pellucida. <a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="4-u1.0-B978-0-323-02951-3..50004-2--p6"></a>The female pronucleus swells as
well. In most mammals the male pronucleus can be recognized as the larger of the
two. The pronuclei, which contain the haploid sets of chromosomes of maternal
and paternal origin, do not fuse in mammals. How-ever, the nuclear membranes
surrounding them disappear, and the chromosomes contained within each membrane
arrange themselves on the developing spindle of the first mitotic division. In
this way the diploid complement of chromosomes is reestablished, completing the
process of fertilization.</div>
<div style="text-align: justify;">
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="4-u1.0-B978-0-323-02951-3..50004-2--para"></a> Cell
division (cleavage) then occurs, giving rise to the two-cell embryo. The first division takes about 20 hours to complete, and the actual phase of
fertilization generally occurs in the ampulla of the fallopian tube. A
significant number of fertilized ova do not complete cleavage for a number of
reasons, including failure of appropriate chromosome arrangement on the
spindle, specific gene defects that prevent the formation of the spindle, and
environmental factors. Importantly, teratogens acting at this point are usually
either completely destructive <a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="4-u1.0-B978-0-323-02951-3..50004-2--p7"></a>or
cause little or no effect. Twinning may occur by the separation of the two
cells produced by cleavage, each of which has the potential to develop into a
separate embryo. Twinning may occur at any stage until the formation of the
blastula, since each cell is totipotential. Both genetic and environmental
factors are probably involved in the causation of twinning.</div>
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<br /></div>Anonymoushttp://www.blogger.com/profile/06590633769759394496noreply@blogger.com1tag:blogger.com,1999:blog-5853367347201739175.post-36567381903898926542012-07-28T02:46:00.000-07:002012-07-28T02:46:01.601-07:00Maternal Anatomy<!--[if gte mso 9]><xml>
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<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman";">Reff:</span><b>
</b><b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman";">Williams Obstetrics</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman";"> > Section II.
Anatomy and Physiology > Chapter 2. Maternal Anatomy ></span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Introduction</span></div>
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<br /></div>
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<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="724958"></a><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">The organs of reproduction of women are classified as
either external or internal. There may be marked variation in anatomical structures
in a given woman, and this is especially true for major blood vessels and
nerves.</span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">External
Generative Organs</span></div>
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<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="724962"></a><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">The <i>pudenda</i>—commonly designated the <i>vulva</i>—includes
all structures visible externally from the pubis to the perineum, that is,
the mons pubis, labia majora and minora, clitoris, hymen, vestibule, urethral
opening, and various glandular and vascular structures . </span></div>
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Mons Pubis </div>
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<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="724964"></a>The mons
pubis, or mons veneris, is the fat-filled cushion that lies over the symphysis
pubis. After puberty, the skin of the mons pubis is covered by curly hair that
forms the escutcheon. In women, it is distributed in a triangular area, the
base of which is formed by the upper margin of the symphysis. In men, the
escutcheon is not so well circumscribed.</div>
<div class="contentbody" style="text-align: justify;">
<br /></div>
<div class="contenthead3" style="text-align: justify;">
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="724965"></a>Labia
Majora</div>
<div class="contentbody" style="text-align: justify;">
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="724966"></a>These
structures vary somewhat in appearance, principally according to the amount of
fat that is contained within the tissues. Embryologically, the labia majora are
homologous with the male scrotum. The round ligaments terminate at the upper
borders. After repeated childbearing, the labia majora are less prominent. They
are 7 to 8 cm in length, 2 to 3 cm in width, and 1 to 1.5 cm in thickness, and
are somewhat tapered at the lower extremities. In children and nulliparous
women, the labia majora usually lie in close apposition, whereas in multiparous
women, they may gape widely. They are continuous directly with the mons pubis
above and merge into the perineum posteriorly at a site where they are joined
medially to form the <i>posterior commissure.</i></div>
<div class="contentbody" style="text-align: justify;">
<br /></div>
<div class="contentbody" style="text-align: justify;">
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="724967"></a>Before
puberty, the outer surface of the labia is similar to that of the adjacent
skin, but after puberty the labia are covered with hair. In nulliparous women,
the inner surface is moist and resembles a mucous membrane, whereas in
multiparous women, the inner surface becomes more skinlike. The labia majora
are richly supplied with sebaceous glands. Beneath the skin, there is a layer
of dense connective tissue that is rich in elastic fibers and adipose tissue
but is nearly void of muscular elements. Unlike the squamous epithelium of the
vagina and cervix, there are epithelial appendages in parts of the vulvar skin.
A mass of fat beneath the skin provides the bulk of the volume of the labium,
and this tissue is supplied with a rich plexus of veins.</div>
<div class="contentbody" style="text-align: justify;">
<br /></div>
<div class="contenthead3" style="text-align: justify;">
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="724970"></a>Labia
Minora</div>
<div class="contentbody" style="text-align: justify;">
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="724971"></a>The labia minora
vary greatly in size and shape. In nulliparous women, they usually are not
visible behind the nonseparated labia majora. In multiparas, it is common for
the labia minora to project beyond the labia majora.</div>
<div class="contentbody" style="text-align: justify;">
<br /></div>
<div class="contentbody" style="text-align: justify;">
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="724972"></a>Each labium
minus is a thin fold of tissue that is moist and reddish, similar in appearance
to a mucous membrane. The labia minora are covered by stratified squamous
epithelium. Although there are no hair follicles in the labia minora, there are
many sebaceous follicles and, occasionally, a few sweat glands. The interior of
the labial folds is composed of connective tissue with many vessels and some
smooth muscular fibers. They are supplied with a variety of nerve endings and
are extremely sensitive. The tissues of the labia minora converge superiorly,
where each is divided into two lamellae; the lower pair fuse to form the <i>frenulum
of the clitoris</i>, and the upper pair merge to form the <i>prepuce.</i>
Inferiorly, the labia minora extend to approach the midline as low ridges of
tissue that fuse to form the <i>fourchette</i>.</div>
<div class="contentbody" style="text-align: justify;">
<br /></div>
<div class="contenthead3" style="text-align: justify;">
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="724973"></a>Clitoris</div>
<div class="contentbody" style="text-align: justify;">
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="724974"></a>The clitoris
is the principal female erogenous organ. It is the homologue of the penis and
is located near the superior extremity of the vulva. This erectile organ
projects downward between the branched extremities of the labia minora. The
clitoris is composed of a glans, a corpus, and two crura. The glans is made up
of spindle-shaped cells, and in the body there are two corpora cavernosa, in
the walls of which are smooth muscle fibers. The long, narrow crura arise from
the inferior surface of the ischiopubic rami and fuse just below the middle of
the pubic arch to form the corpus.</div>
<div class="contentbody" style="text-align: justify;">
<br /></div>
<div class="contentbody" style="text-align: justify;">
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="724975"></a>The clitoris
rarely exceeds 2 cm in length. Its free end is pointed downward and inward
toward the vaginal opening. The glans is usually less than 0.5 cm in diameter
and is covered by stratified squamous epithelium that is richly supplied with
nerve endings. The vessels of the erectile clitoris are connected with the
vestibular bulbs.</div>
<div class="contentbody" style="text-align: justify;">
<br /></div>
<div class="contentbody" style="text-align: justify;">
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="724976"></a>There is a
delicate network of free nerve endings in the labia majora, labia minora, and
clitoris (Krantz, 1958). Tactile discs are found in abundance in these areas.
Genital corpuscles, which are mediators of erotic sensation, vary considerably
in number. These structures are abundant in the labia minora and in the skin
that overlies the glans clitoris.</div>
<div class="contentbody" style="text-align: justify;">
<br /></div>
<div class="contenthead3" style="text-align: justify;">
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="724977"></a>Vestibule</div>
<div class="contentbody" style="text-align: justify;">
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="724978"></a>The
vestibule is an almond-shaped area that is enclosed by the labia minora
laterally and extends from the clitoris to the fourchette. The vestibule is the
functionally mature female structure of the urogenital sinus of the embryo. In
the mature state, the vestibule usually is perforated by six openings: the
urethra, the vagina, the two ducts of the Bartholin glands, and, at times, the
two ducts of the paraurethral glands, also called the <i>Skene ducts and glands</i>.
The posterior portion of the vestibule between the fourchette and the vaginal
opening is called the <i>fossa navicularis,</i> and it is usually observed only
in nulliparous women</div>
<div class="contentbody" style="text-align: justify;">
<br /></div>
<div class="contentbody" style="text-align: justify;">
The pair of <i>Bartholin glands</i>
are about 0.5 to 1 cm in diameter, and each is situated beneath the vestibule
on either side of the vaginal opening. They are the <i>major vestibular glands,</i>
and the ducts are 1.5 to 2 cm long and open on the sides of the vestibule just
outside the lateral margin of the vaginal orifice. At times of sexual arousal,
they secrete mucoid material. These glands may harbor <i>Neisseria gonorrhoeae</i>
or other bacteria, which in turn may cause infection and a Bartholin gland
abscess.</div>
<div class="contentbody" style="text-align: justify;">
<br /></div>
<div class="contenthead5" style="text-align: justify;">
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="724980"></a>Urethral
Opening</div>
<div class="contentbody" style="text-align: justify;">
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="724981"></a>The lower
two thirds of the urethra lies immediately above the anterior vaginal wall. The
urethral opening or meatus is in the midline of the vestibule, 1 to 1.5 cm
below the pubic arch, and a short distance above the vaginal opening.
Ordinarily, the <i>paraurethral ducts,</i> also known as the <i>Skene ducts,</i>
open onto the vestibule on either side of the urethra. The ducts occasionally
open on the posterior wall of the urethra just inside the meatus.</div>
<div class="contentbody" style="text-align: justify;">
<br /></div>
<div class="contenthead5" style="text-align: justify;">
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="724982"></a>Vestibular
Bulbs</div>
<div class="contentbody" style="text-align: justify;">
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="724983"></a>Embryologically,
the vestibular bulbs correspond to the anlage of the corpus spongiosum of the
penis. These are almond-shaped aggregations of veins, 3 to 4 cm long, 1 to 2 cm
wide, and 0.5 to 1 cm thick, that lie beneath the mucous membrane on either
side of the vestibule. They are in close apposition to the ischiopubic rami and
are partially covered by the ischiocavernosus and constrictor vaginae muscles.
The vestibular bulbs terminate interiorly at about the middle of the vaginal
opening and extend upward toward the clitoris. During childbirth, they may be
injured and may even rupture to form a vulvar hematoma.</div>
<div class="contentbody" style="text-align: justify;">
<br /></div>
<div class="contenthead5" style="text-align: justify;">
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="724984"></a>Vaginal
Opening and Hymen</div>
<div class="contentbody" style="text-align: justify;">
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="724985"></a>In most
virginal women, the vaginal opening most often is hidden by the overlapping
labia minora. There are marked differences in shape and consistency of the
hymen, which is composed mainly of elastic and collagenous connective tissue.
Both the outer and inner surfaces are covered by stratified squamous
epithelium. The hymen has no glandular or muscular elements, and it is not
richly supplied with nerve fibers.</div>
<div class="contentbody" style="text-align: justify;">
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="724986"></a>In the newborn,
the hymen is very vascular and redundant. In pregnant women, its epithelium is
thick, and the tissue is rich in glycogen. After menopause, the epithelium is
thin, and focal cornification may develop. In adult women, the hymen is a
membrane of various thickness that surrounds the vaginal opening more or less
completely. Its aperture varies in diameter from pinpoint size to one that
admits the tip of one or even two fingers.</div>
<div class="contentbody" style="text-align: justify;">
<br /></div>
<div class="contentbody" style="text-align: justify;">
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="724989"></a>The
appearance of the hymen cannot be used to determine whether a woman has begun
sexual activity. A fimbriated type of hymen in virginal women may be
indistinguishable from one that has been penetrated during intercourse. As a
rule, however, it is torn at several sites during first coitus, usually in the
posterior portion. Identical tears may occur by other penetration, for example,
tampons used during menstruation. The edges of the torn tissue soon cicatrize,
and the hymen becomes divided permanently into two or more portions that are
separated by narrow sulci. Occasionally with hymenal rupture, there may be
profuse bleeding.</div>
<div class="contentbody" style="text-align: justify;">
<br /></div>
<div class="contentbody" style="text-align: justify;">
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="724990"></a>Changes
produced in the hymen by childbirth are usually readily recognizable. Over
time, the hymen consists of several cicatrized nodules of various sizes. <i>Imperforate
hymen</i> is a rare lesion in which the vaginal orifice is occluded completely,
causing retention of menstrual blood </div>
<div class="contentbody" style="text-align: justify;">
<br /></div>
<div class="contenthead3" style="text-align: justify;">
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="724991"></a>Vagina</div>
<div class="contentbody" style="text-align: justify;">
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="724992"></a>This
musculomembranous structure extends from the vulva to the uterus and is
interposed anteriorly and posteriorly between the urinary bladder and the
rectum . The upper portion of the vagina arises from the müllerian ducts, and
the lower portion is formed from the urogenital sinus. Anteriorly, the vagina
is separated from the bladder and urethra by connective tissue, often referred
to as the <i>vesicovaginal septum.</i> Posteriorly, between the lower portion
of the vagina and the rectum, there are similar tissues that together form the <i>rectovaginal
septum.</i> The upper fourth of the vagina is separated from the rectum by the <i>rectouterine
pouch,</i> also called the <i>cul-de-sac of Douglas.</i> Normally, the anterior
and posterior vaginal walls lie in contact, with only a slight space
intervening between the lateral margins. Vaginal length varies considerably,
but commonly, the anterior and posterior vaginal walls are, respectively, 6 to
8 cm and 7 to 10 cm in length. The upper end of the vaginal vault is subdivided
into the anterior, posterior, and two lateral fornices by the uterine cervix.
These are of considerable clinical importance because the internal pelvic
organs usually can be palpated through their thin walls. Moreover, the
posterior fornix provides surgical access to the peritoneal cavity.</div>
<div class="contentbody" style="text-align: justify;">
<br /></div>
<div class="contentbody" style="text-align: justify;">
Prominent midline longitudinal
ridges project into the vaginal lumen from the anterior and posterior walls. In
nulliparous women, numerous transverse ridges, or <i>rugae,</i> extend outward
from and almost at right angles to the longitudinal ridges. In postmenopausal
multiparous women, the vaginal walls often are smooth.</div>
<div class="contentbody" style="text-align: justify;">
<br /></div>
<div class="contentbody" style="text-align: justify;">
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="724994"></a>The vaginal
mucosa is composed of noncornified stratified squamous epithelium. Beneath the
epithelium is a thin fibromuscular coat, usually consisting of an inner
circular layer and an outer longitudinal layer of smooth muscle. A thin layer
of connective tissue beneath the mucosa and the muscularis is rich in blood
vessels. It is controversial whether this connective tissue—often referred to
as <i>perivaginal endopelvic fascia—</i>is a definite fascial plane in the
strict anatomical sense.</div>
<div class="contentbody" style="text-align: justify;">
<br /></div>
<div class="contentbody" style="text-align: justify;">
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="724995"></a>There are no
vaginal glands. After giving birth, fragments of stratified epithelium
occasionally are embedded in the vaginal connective tissue. They may form <i>vaginal
inclusion cysts,</i> which are not true glands. In the absence of glands, the
vagina is kept moist by a small amount of secretion from the cervix. During
pregnancy, there is copious, acidic vaginal secretion, which normally consists
of a curdlike product of exfoliated epithelium and bacteria. <i>Lactobacillus</i>
species are also recovered in higher concentrations than in nonpregnant women
(Larsen and Galask, 1980; McGregor and French, 2000).</div>
<div class="contentbody" style="text-align: justify;">
<br /></div>
<div class="contentbody" style="text-align: justify;">
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="724996"></a>The vagina
has an abundant vascular supply. The upper third is supplied by the
cervicovaginal branches of the uterine arteries, the middle third by the
inferior vesical arteries, and the lower third by the middle rectal and
internal pudendal arteries. The vaginal artery may branch directly from the
internal iliac artery. An extensive venous plexus immediately surrounds the
vagina and follows the course of the arteries. Lymphatics from the lower third
of the vagina, along with those of the vulva, drain primarily into the inguinal
lymph nodes. Those from the middle third drain into the internal iliac nodes,
and those from the upper third drain into the iliac nodes.</div>
<div class="contentbody" style="text-align: justify;">
<br /></div>
<div class="contenthead3" style="text-align: justify;">
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="725003"></a>Perineum</div>
<div class="contentbody" style="text-align: justify;">
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="725004"></a>The many
structures that make up the perineum. Most of the support of the perineum is provided
by the pelvic and urogenital diaphragms. The <i>pelvic diaphragm</i> consists
of the levator ani muscles plus the coccygeus muscles posteriorly. The levator
ani muscles form a broad muscular sling that originates from the posterior
surface of the superior pubic rami, from the inner surface of the ischial
spine, and between these two sites, from the obturator fascia. Some of these
muscle fibers are inserted around the vagina and rectum to form efficient
functional sphincters. In a recent study utilizing magnetic resonance imaging,
Tunn (2003) and Hoyte (2004) and their colleagues used magnetic-resonance
imaging and reported significant variation in the levator ani muscle,
endopelvic fascia, and urethral support in nulliparous women. The <i>urogenital
diaphragm</i> is external to the pelvic diaphragm and includes the triangular
area between the ischial tuberosities and the symphysis. The urogenital
diaphragm is made up of the deep transverse perineal muscles, the constrictor
of the urethra, and the internal and external fascial coverings.</div>
<div class="contentbody" style="text-align: justify;">
<br /></div>
<table border="0" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="mso-cellspacing: 0in; mso-padding-alt: 0in 0in 0in 0in; mso-yfti-tbllook: 1184;">
<tbody>
<tr style="mso-yfti-firstrow: yes; mso-yfti-irow: 0; mso-yfti-lastrow: yes;">
<td style="background: white; padding: 0in 0in 0in 0in;" valign="top">
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">The
major blood supply to the perineum is via the internal pudendal artery and
its branches. These include the inferior rectal artery and posterior labial
artery. The innervation of the perineum is primarily via the pudendal nerve
and its branches. The pudendal nerve originates from the S2, S3, and S4 level
of the spinal cord.</span></div>
<div class="MsoNormal" style="line-height: normal; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify;">
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="725009"></a><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Perineal Body</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify;">
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="725010"></a><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">The median raphe of the levator ani, between the anus and
the vagina, is reinforced by the central tendon of the perineum. The
bulbocavernosus, superficial transverse perineal, and external anal sphincter
muscles also converge on the central tendon. Thus, these structures
contribute to the perineal body, which provides much of the support for the
perineum.</span></div>
<div class="MsoNormal" style="line-height: normal; text-align: justify;">
<br /></div>
</td>
</tr>
</tbody></table>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify;">
<br /></div>
<table border="0" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="mso-cellspacing: 0in; mso-padding-alt: 0in 0in 0in 0in; mso-yfti-tbllook: 1184;">
<tbody>
<tr style="mso-yfti-firstrow: yes; mso-yfti-irow: 0; mso-yfti-lastrow: yes;">
<td style="background: white; padding: 0in 0in 0in 0in;" valign="top">
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Internal
Generative Organs</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify;">
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="725012"></a><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Uterus</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify;">
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="725013"></a><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">The nonpregnant uterus is situated in the pelvic cavity
between the bladder anteriorly and the rectum posteriorly. Almost the entire
posterior wall of the uterus is covered by serosa, or peritoneum, the lower
portion of which forms the anterior boundary of the <i>recto-uterine
cul-de-sac,</i> or pouch of Douglas. Only the upper portion of the anterior
wall of the uterus is so covered. The lower portion is united to the
posterior wall of the bladder by a well-defined loose layer of connective
tissue.</span></div>
<div class="MsoNormal" style="line-height: normal; text-align: justify;">
<br /></div>
</td>
</tr>
</tbody></table>
<div class="contenthead5" style="text-align: justify;">
Size and Shape</div>
<div class="contentbody" style="text-align: justify;">
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="725015"></a>The uterus
resembles a flattened pear in shape. It consists of two major but unequal
parts: an upper triangular portion, the <i>body,</i> or corpus; and a lower,
cylindrical, or fusiform portion, the <i>cervix,</i> which projects into the
vagina. The <i>isthmus</i> is that portion of the uterus between the internal
cervical os and the endometrial cavity. It is of special obstetrical
significance because it forms the lower uterine segment during pregnancy. The
oviducts, or fallopian tubes, emerge from the <i>cornua</i> of the uterus at
the junction of the superior and lateral margins. The convex upper segment
between the points of insertion of the fallopian tubes is called the <i>fundus.</i>
The round ligaments insert below the tubes on the anterior side. They are
covered by a fold of peritoneum that extends to the pelvic sidewall. These
folds are called the <i>broad ligaments</i>, however, they do not constitute
the anatomical definition of a ligament.</div>
<div class="contentbody" style="text-align: justify;">
<br /></div>
<div class="contentbody" style="text-align: justify;">
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="725016"></a>The
prepubertal uterus varies in length from 2.5 to 3.5 cm (Orsini and colleagues,
1984). The uterus of adult nulliparous women is from 6 to 8 cm in length as
compared with 9 to 10 cm in multiparous women. Uteri of nonparous women average
50 to 70 g, and those of parous women average 80 g or more (Langlois, 1970). In
the premenarchal girl, the body of the uterus is only half as long as the
cervix. In nulliparous women, the two are about equal in length. In multiparous
women, the cervix is only a little more than a third of the total length of the
organ. After menopause, uterine size decreases as a consequence of atrophy of
both myometrium and endometrium.</div>
<div class="contentbody" style="text-align: justify;">
<br /></div>
<div class="contentbody" style="text-align: justify;">
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="725017"></a>The bulk of
the body of the uterus, but not the cervix, is composed of muscle. The inner
surfaces of the anterior and posterior walls lie almost in contact, and the
cavity between these walls forms a mere slit. The cervical canal is fusiform
and is open at each end by small apertures, the <i>internal os</i> and the <i>external
os.</i></div>
<div class="contenthead5" style="text-align: justify;">
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="725018"></a><a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="725020"></a>Pregnancy-Induced Uterine Changes</div>
<div class="contenthead5" style="text-align: justify;">
<br /></div>
<div class="contentbody" style="text-align: justify;">
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="725021"></a>Pregnancy
stimulates remarkable uterine growth due to hypertrophy of muscle fibers. The
weight of the uterus increases from 70 g to about 1100 g at term. Its total
volume averages about 5 L. The uterine fundus, a previously flattened convexity
between tubal insertions, now becomes dome shaped. The round ligaments now
appear to insert at the junction of the middle and upper thirds of the organ.
The fallopian tubes elongate, but the ovaries grossly appear unchanged.</div>
<div class="contentbody" style="text-align: justify;">
<br /></div>
<div class="contenthead5" style="text-align: justify;">
Cervix</div>
<div class="contentbody" style="text-align: justify;">
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="725023"></a>Anteriorly,
the upper boundary of the cervix is the internal os, which corresponds to the
level at which the peritoneum is reflected upon the bladder. The supravaginal
segment is covered by peritoneum on its posterior surface. This segment is
attached to the cardinal ligaments anteriorly, and it is separated from the
overlying bladder by loose connective tissue. The other segment is the lower
vaginal portion of the cervix, also called the <i>portio vaginalis.</i></div>
<div class="contentbody" style="text-align: justify;">
<br /></div>
<div class="contentbody" style="text-align: justify;">
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="725026"></a>Before
childbirth, the external cervical os is a small, regular, oval opening. After
childbirth, the orifice is converted into a transverse slit that is divided
such that there are the so-called anterior and posterior lips of the cervix. If
torn deeply during delivery, it might heal in such a manner that it appears to
be irregular, nodular, or stellate. These changes are sufficiently
characteristic to permit an examiner to ascertain with some certainty whether a
given woman has borne children by vaginal delivery.</div>
<div class="contentbody" style="text-align: justify;">
<br /></div>
<div class="contentbody" style="text-align: justify;">
The mucosa of the cervical
canal is composed of a single layer of very high ciliated columnar epithelium
that rests on a thin basement membrane. Numerous cervical glands extend from the
surface of the endocervical mucosa directly into the subjacent connective
tissue. These glands furnish the thick, tenacious cervical secretions. If the
ducts of the cervical glands are occluded, retention cysts, known as <i>nabothian
cysts,</i> are formed.</div>
<div class="contentbody" style="text-align: justify;">
<br /></div>
<div class="contenthead5" style="text-align: justify;">
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="725028"></a>Body of the
Uterus</div>
<div class="contentbody" style="text-align: justify;">
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="725029"></a>The wall of
the body of the uterus is composed of serosal, muscular, and mucosal layers.
The serosal layer is formed by the peritoneum that covers the uterus. It is
firmly adherent except at sites just above the bladder and at the lateral margins,
where the peritoneum is deflected to form the broad ligaments.</div>
<div class="contentbody" style="text-align: justify;">
<br /></div>
<div class="contenthead8" style="text-align: justify;">
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="725030"></a>Endometrium</div>
<div class="contentbody" style="text-align: justify;">
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="725031"></a>This mucosal
layer lines the uterine cavity in nonpregnant women. It is a thin, pink,
velvet-like membrane that on close examination is found to be perforated by a
large number of minute ostia of the uterine glands. The endometrium normally
varies greatly in thickness, and measures from 0.5 mm to as much as 5 mm. It is
composed of surface epithelium, glands, and interglandular mesenchymal tissue
in which there are numerous blood vessels.</div>
<div class="contentbody" style="text-align: justify;">
<br /></div>
<div class="contentbody" style="text-align: justify;">
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="725034"></a>The
epithelium of the endometrial surface is made up of a single layer of closely
packed, high columnar, ciliated cells. The tubular <i>uterine glands</i> are
invaginations of the epithelium. The glands extend through the entire thickness
of the endometrium to the myometrium, which is occasionally penetrated for a
short distance. Histologically, the inner glands resemble the epithelium of the
surface and are lined by a single layer of columnar, partially ciliated
epithelium that rests on a thin basement membrane. The glands secrete a thin,
alkaline fluid. The connective tissue of the endometrium, between the surface
epithelium and the myometrium, is a mesenchymal stroma. Histologically, the
stroma varies remarkably throughout the ovarian cycle.</div>
<div class="contentbody" style="text-align: justify;">
<br /></div>
<div class="contentbody" style="text-align: justify;">
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="725037"></a>After menopause,
the endometrium is atrophic and the epithelium flattens. The glands gradually
disappear, and the interglandular tissue becomes more fibrous.</div>
<div class="contentbody" style="text-align: justify;">
<br /></div>
<div class="contentbody" style="text-align: justify;">
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="725038"></a>The vascular
architecture of the uterus and the endometrium is of signal importance in
pregnancy. The uterine and ovarian arteries branch and penetrate the uterine
wall obliquely inward and reach its middle third. They then ramify in a plane
that is parallel to the surface and are therefore named the <i>arcuate arteries</i>
(DuBose and colleagues, 1985). Radial branches extend from the arcuate arteries
at right angles and enter the endometrium to become <i>coiled or spiral
arteries.</i> Also from the radial arteries, <i>basal arteries</i> branch at a
sharp angle. The coiled arteries supply most of the midportion and all of the
superficial third of the endometrium. The walls of these vessels are responsive
(sensitive) to the action of a number of hormones, especially by
vasoconstriction, and thus probably serve an important role in the mechanism(s)
of menstruation. The straight basal endometrial arteries extend only into the
basal layer of the endometrium and are not responsive to hormonal action.</div>
<div class="contentbody" style="text-align: justify;">
<br /></div>
<div class="contenthead8" style="text-align: justify;">
Myometrium</div>
<div class="contentbody" style="text-align: justify;">
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="725040"></a>The
myometrium makes up the major portion of the uterus. It is composed of bundles
of smooth muscle united by connective tissue in which there are many elastic
fibers. According to Schwalm and Dubrauszky (1966), the number of muscle fibers
of the uterus progressively diminishes caudally such that, in the cervix,
muscle comprises only 10 percent of the tissue mass. In the inner wall of the
body of the uterus, there is relatively more muscle than in the outer layers;
and in the anterior and posterior walls, there is more muscle than in the lateral
walls. During pregnancy, the upper myometrium undergoes marked hypertrophy, but
there is no significant change in cervical muscle content.</div>
<div class="contentbody" style="text-align: justify;">
<br /></div>
<div class="contenthead8" style="text-align: justify;">
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="725041"></a>Ligaments</div>
<div class="contentbody" style="text-align: justify;">
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="725042"></a>The <i>broad
ligaments</i> are made up of two winglike structures that extend from the
lateral margins of the uterus to the pelvic walls. They divide the pelvic
cavity into anterior and posterior compartments. Each broad ligament consists
of a fold of peritoneum. The inner two thirds of the superior margin form the <i>mesosalpinx,</i>
to which the fallopian tubes are attached. The outer third of the superior
margin, which extends from the fimbriated end of the oviduct to the pelvic
wall, forms the <i>infundibulopelvic ligament</i> or <i>suspensory ligament of
the ovary,</i> through which the ovarian vessels traverse.</div>
<div class="contentbody" style="text-align: justify;">
<br /></div>
<div class="contentbody" style="text-align: justify;">
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="725043"></a>At the
lateral margin of each broad ligament, the peritoneum is reflected onto the
side of the pelvis. The thick base of the broad ligament is continuous with the
connective tissue of the pelvic floor. The densest portion is usually referred
to as the <i>cardinal ligament—</i>also called the <i>transverse cervical
ligament</i> or the <i>Mackenrodt ligament</i>—and is composed of connective
tissue that medially is united firmly to the supravaginal portion of the
cervix.</div>
<div class="contentbody" style="text-align: justify;">
<br /></div>
<div class="contentbody" style="text-align: justify;">
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="725044"></a>A vertical
section through the uterine end of the broad ligament is triangular, and the
uterine vessels and ureter are found within its broad base. In its lower part,
it is widely attached to the connective tissues that are adjacent to the
cervix, that is, the <i>parametrium.</i> The upper part is made up of three
folds that nearly cover the oviduct, the utero-ovarian ligament, and the round
ligament.</div>
<div class="contentbody" style="text-align: justify;">
<br /></div>
<div class="contentbody" style="text-align: justify;">
The <i>round ligaments</i>
extend from the lateral portion of the uterus, arising somewhat below and
anterior to the origin of the oviducts. Each round ligament is located in a
fold of peritoneum that is continuous with the broad ligament and extends
outward and downward to the inguinal canal, through which it passes to
terminate in the upper portion of the labium majus. In nonpregnant women, the
round ligament varies from 3 to 5 mm in diameter, and is composed of smooth
muscle cells. The round ligament corresponds embryologically to the
gubernaculum testis of men. During pregnancy, the round ligaments undergo
considerable hypertrophy and increase appreciably in both length and diameter.</div>
<div class="contentbody" style="text-align: justify;">
<br /></div>
<div class="contentbody" style="text-align: justify;">
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="725046"></a>Each <i>uterosacral
ligament</i> extends from an attachment posterolaterally to the supravaginal
portion of the cervix to encircle the rectum and inserts into the fascia over
the sacrum. Umek and colleagues (2004) used MR-imaging to describe anatomical
variations of these ligaments. The ligaments are composed of connective tissue
and some smooth muscle and are covered by peritoneum. They form the lateral
boundaries of the pouch of Douglas.</div>
<div class="contentbody" style="text-align: justify;">
<br /></div>
<div class="contenthead8" style="text-align: justify;">
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="725049"></a>Blood
Vessels</div>
<div class="contentbody" style="text-align: justify;">
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="725050"></a>The vascular
supply of the uterus is derived principally from the uterine and ovarian
arteries. The uterine artery, a main branch of the internal iliac
artery—referred to in the past as the hypogastric artery—enters the base of the
broad ligament and makes its way medially to the side of the uterus.
Immediately adjacent to the supravaginal portion of the cervix, the uterine
artery divides. The smaller cervicovaginal artery supplies blood to the lower
cervix and upper vagina. The main branch turns abruptly upward and extends as a
highly convoluted vessel that traverses along the margin of the uterus. A
branch of considerable size extends to the upper portion of the cervix, and
numerous other branches penetrate the body of the uterus. Just before the main
branch of the uterine artery reaches the oviduct, it divides into three terminal
branches. The ovarian branch of the uterine artery anastomoses with the
terminal branch of the ovarian artery; the tubal branch makes its way through
the mesosalpinx and supplies part of the oviduct; and the fundal branch is
distributed to the uppermost uterus.</div>
<div class="contentbody" style="text-align: justify;">
<br /></div>
<div class="contentbody" style="text-align: justify;">
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="725051"></a>About 2 cm
lateral to the cervix, the uterine artery crosses over the ureter . The
proximity of the uterine artery and vein to the ureter at this point is of
great surgical significance. Because of their close proximity, the ureter may
be injured or ligated during a hysterectomy when the vessels are clamped and
ligated.</div>
<div class="contentbody" style="text-align: justify;">
<br /></div>
<div class="contentbody" style="text-align: justify;">
The <i>ovarian artery</i> is a
direct branch of the aorta. It enters the broad ligament through the
infundibulopelvic ligament. At the ovarian hilum, it divides into a number of
smaller branches that enter the ovary. Its main stem, however, traverses the
entire length of the broad ligament very near the mesosalpinx and makes its way
to the upper lateral portion of the uterus. Here it anastomoses with the
ovarian branch of the uterine artery. There are numerous additional
communications among the arteries on both sides of the uterus.</div>
<div class="contentbody" style="text-align: justify;">
<br /></div>
<div class="contentbody" style="text-align: justify;">
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="725057"></a>When the
uterus is in a contracted state, its numerous venous lumens are collapsed,
however, in injected specimens the greater part of the uterine wall appears to
be occupied by dilated venous sinuses. On either side, the arcuate veins unite
to form the <i>uterine vein,</i> which empties into the internal iliac vein and
thence into the common iliac vein. Some of the blood from the upper uterus, the
ovary, and the upper part of the broad ligament is collected by several veins.
Within the broad ligament, these veins form the large <i>pampiniform plexus</i>
that terminates in the ovarian vein. The right ovarian vein empties into the
vena cava, whereas the left ovarian vein empties into the left renal vein.
During pregnancy, there is marked hypertrophy of the blood supply to the
uterus.</div>
<div class="contentbody" style="text-align: justify;">
<br /></div>
<div class="contenthead8" style="text-align: justify;">
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="725060"></a>Lymphatics</div>
<div class="contentbody" style="text-align: justify;">
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="725061"></a>The
endometrium is abundantly supplied with true lymphatic vessels that are
confined largely to the basal layer. The lymphatics of the underlying
myometrium are increased in number toward the serosal surface and form an
abundant lymphatic plexus just beneath it. Lymphatics from the cervix terminate
mainly in the hypogastric nodes, which are situated near the bifurcation of the
common iliac vessels. The lymphatics from the body of the uterus are
distributed to two groups of nodes. One set of vessels drains into the internal
iliac nodes. The other set, after joining certain lymphatics from the ovarian
region, terminates in the periaortic lymph nodes.</div>
<div class="contentbody" style="text-align: justify;">
<br /></div>
<div class="contenthead8" style="text-align: justify;">
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="725062"></a>Innervation</div>
<div class="contentbody" style="text-align: justify;">
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="725063"></a>The nerve
supply to the pelvic area is derived principally from the sympathetic nervous
system, but also partly from the cerebrospinal and parasympathetic systems. The
parasympathetic system is represented on either side by the pelvic nerve, which
is made up of a few fibers that are derived from the second, third, and fourth
sacral nerves. It loses its identity in the <i>cervical ganglion of
Frankenhäuser.</i> The sympathetic system enters the pelvis by way of the
internal iliac plexus that arises from the aortic plexus just below the
promontory of the sacrum. After descending on either side, it also enters the
uterovaginal plexus of Frankenhäuser, which is made up of ganglia of various
sizes, but particularly of a large ganglionic plate that is situated on either
side of the cervix and just above the posterior fornix in front of the rectum.</div>
<div class="contentbody" style="text-align: justify;">
<br /></div>
<div class="contentbody" style="text-align: justify;">
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="725064"></a>Branches
from these plexuses supply the uterus, bladder, and upper vagina. In the 11th
and 12th thoracic nerve roots, there are sensory fibers from the uterus that
transmit the painful stimuli of contractions to the central nervous system. The
sensory nerves from the cervix and upper part of the birth canal pass through
the pelvic nerves to the second, third, and fourth sacral nerves, whereas those
from the lower portion of the birth canal pass primarily through the pudendal
nerve. Knowledge of the innervation of dermatomes and its clinical application
to providing epidural or spinal analgesia for labor and vaginal or cesarean
delivery.</div>
<div class="contentbody" style="text-align: justify;">
<br /></div>
<div class="contenthead3" style="text-align: justify;">
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="725067"></a>Oviducts</div>
<div class="contentbody" style="text-align: justify;">
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="725068"></a>More
commonly called the <i>fallopian tubes,</i> the oviducts vary in length from 8
to 14 cm. They are covered by peritoneum, and their lumen is lined by mucous
membrane. Each tube is divided into an <i>interstitial portion, isthmus,
ampulla,</i> and <i>infundibulum.</i> The interstitial portion is embodied
within the muscular wall of the uterus. The isthmus, or the narrow portion of
the tube that adjoins the uterus, passes gradually into the wider, lateral
portion, or <i>ampulla.</i> The <i>infundibulum,</i> or fimbriated extremity,
is the funnel-shaped opening of the distal end of the fallopian tube. The
oviduct varies considerably in thickness; the narrowest portion of the isthmus
measures from 2 to 3 mm in diameter, and the widest portion of the ampulla
measures from 5 to 8 mm. The fimbriated end of the infundibulum opens into the
abdominal cavity. One projection, the <i>fimbria ovarica,</i> which is
considerably longer than the other fimbriae, forms a shallow gutter that
approaches or reaches the ovary.</div>
<div class="contentbody" style="text-align: justify;">
<br /></div>
<div class="contentbody" style="text-align: justify;">
The musculature of the
fallopian tube is arranged in an inner circular and an outer longitudinal
layer. In the distal portion, the two layers are less distinct and, near the
fimbriated extremity, are replaced by an interlacing network of muscular
fibers. The tubal musculature undergoes rhythmic contractions constantly, the
rate of which varies with the hormonal changes of the ovarian cycle. The
greatest frequency and intensity of contractions is reached during transport of
ova.</div>
<div class="contentbody" style="text-align: justify;">
<br /></div>
<div class="contentbody" style="text-align: justify;">
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="725070"></a>The oviducts
are lined by a single layer of columnar cells, some of them ciliated and others
secretory. The ciliated cells are most abundant at the fimbriated extremity,
elsewhere, they are found in discrete patches. There are differences in the
proportions of these two types of cells in different phases of the ovarian
cycle. Because there is no submucosa, the epithelium is in close contact with
the underlying muscle. In the tubal mucosa, there are cyclical histological
changes similar to those of the endometrium, but much less striking. The mucosa
is arranged in longitudinal folds that are more complex toward the fimbriated
end. On cross sections through the uterine portion, four simple folds are found
that form a figure that resembles a Maltese cross. The isthmus has a more
complex pattern. In the ampulla, the lumen is occupied almost completely by the
arborescent mucosa, which consists of very complicated folds. The current
produced by the tubal cilia is such that the direction of flow is toward the
uterine cavity. Tubal peristalsis is believed to be an extraordinarily
important factor in transport of the ovum.</div>
<div class="contentbody" style="text-align: justify;">
<br /></div>
<div class="contentbody" style="text-align: justify;">
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="725071"></a>The tubes
are supplied richly with elastic tissue, blood vessels, and lymphatics.
Sympathetic innervation of the tubes is extensive, in contrast to their
parasympathetic innervation.</div>
<div class="contentbody" style="text-align: justify;">
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="725072"></a><i>Diverticula</i>
may extend occasionally from the lumen of the tube for a variable distance into
the muscular wall and reach almost to the serosa. </div>
<div class="contentbody" style="text-align: justify;">
<br /></div>
<div class="contenthead5" style="text-align: justify;">
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="725073"></a>Embryological
Development of the Uterus and Oviducts</div>
<div class="contentbody" style="text-align: justify;">
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="725074"></a>The uterus
and tubes arise from the müllerian ducts, which first appear near the upper
pole of the urogenital ridge in the fifth week of embryonic development. This
ridge is composed of the mesonephros, gonad, and associated ducts. The first
indication of the development of the müllerian duct is a thickening of the
coelomic epithelium at about the level of the fourth thoracic segment. This
thickening becomes the fimbriated extremity of the fallopian tube, which
invaginates and grows caudally to form a slender tube at the lateral edge of
the urogenital ridge. In the sixth week of embryonic life, the growing tips of
the two müllerian ducts approach each other in the midline; they reach the
urogenital sinus 1 week later. At that time, a fusion of the two müllerian
ducts to form a single canal is begun at the level of the inguinal crest, that
is, the gubernaculum (primordium of the round ligament). Thus, the upper ends
of the müllerian ducts produce the oviducts and the fused parts give rise to
the uterus. The vaginal canal is not patent throughout its entire length until
the sixth month of fetal life (Koff, 1933). Because of the clinical importance
of anomalies that arise from abnormal fusion and dysgenesis of these
structures.</div>
<div class="contentbody" style="text-align: justify;">
<br /></div>
<div class="contenthead3" style="text-align: justify;">
Ovaries</div>
<div class="contentbody" style="text-align: justify;">
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="725076"></a>Compared
with each other, as well as between women, the ovaries vary considerably in
size. During childbearing years, they are from 2.5 to 5 cm in length, 1.5 to 3
cm in breadth, and 0.6 to 1.5 cm in thickness. After menopause, ovarian size
diminishes remarkably. The position of the ovaries also varies, but they
usually are situated in the upper part of the pelvic cavity and rest in a slight
depression on the lateral wall of the pelvis between the divergent external and
internal iliac vessels—the <i>ovarian fossa of Waldeyer.</i> The ovary is
attached to the broad ligament by the <i>mesovarium.</i> The <i>utero-ovarian
ligament</i> extends from the lateral and posterior portion of the uterus, just
beneath the tubal insertion, to the uterine pole of the ovary. Usually, it is
several centimeters long and 3 to 4 mm in diameter. It is covered by peritoneum
and is made up of muscle and connective tissue fibers. The <i>infundibulopelvic</i>
or <i>suspensory ligament of the ovary</i> extends from the upper or tubal pole
to the pelvic wall; through it course the ovarian vessels and nerves.</div>
<div class="contentbody" style="text-align: justify;">
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="725077"></a>In young
women, the exterior surface of the ovary is smooth, with a dull white surface
through which glisten several small, clear follicles. As the woman ages, the
ovaries become more corrugated, and in elderly women, the exterior surfaces may
be convoluted markedly.</div>
<div class="contentbody" style="text-align: justify;">
<br /></div>
<div class="contentbody" style="text-align: justify;">
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="725080"></a>The ovary
consists of two portions, the cortex and medulla. The cortex is the outer
layer, which varies in thickness with age and becomes thinner with advancing
years. It is in this layer that the ova and graafian follicles are located. The
cortex is composed of spindle-shaped connective tissue cells and fibers, among
which are scattered primordial and graafian follicles in various stages of
development. As the woman ages, the follicles become less numerous. The
outermost portion of the cortex, which is dull and whitish, is designated the <i>tunica
albuginea.</i> On its surface, there is a single layer of cuboidal epithelium,
the <i>germinal epithelium of Waldeyer.</i></div>
<div class="contentbody" style="text-align: justify;">
<br /></div>
<div class="contentbody" style="text-align: justify;">
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="725081"></a>The medulla
is the central portion, which is composed of loose connective tissue that is
continuous with that of the mesovarium. There are a large number of arteries
and veins in the medulla and a small number of smooth muscle fibers that are
continuous with those in the suspensory ligament.</div>
<div class="contentbody" style="text-align: justify;">
<br /></div>
<div class="contentbody" style="text-align: justify;">
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="725082"></a>The ovaries
are supplied with both sympathetic and parasympathetic nerves. The sympathetic
nerves are derived primarily from the ovarian plexus that accompanies the
ovarian vessels. Others are derived from the plexus that surrounds the ovarian
branch of the uterine artery. The ovary is richly supplied with nonmyelinated
nerve fibers, which for the most part accompany the blood vessels. These are
merely vascular nerves, whereas others form wreaths around normal and atretic
follicles, and these give off many minute branches that have been traced up to,
but not through, the membrana granulosa.</div>
<div class="contentbody" style="text-align: justify;">
<br /></div>
<div class="contenthead5" style="text-align: justify;">
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="725083"></a>Embryology</div>
<div class="contentbody" style="text-align: justify;">
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="725084"></a>The earliest
sign of a gonad is one that appears on the ventral surface of the embryonic
kidney at a site between the eighth thoracic and fourth lumbar segments at
about 4 weeks. The coelomic epithelium is thickened, and clumps of cells are
seen to bud off into the underlying mesenchyme. This circumscribed area of the
coelomic epithelium is called the <i>germinal epithelium.</i> By the fourth to
sixth week, however, there are many large ameboid cells in this region that
have migrated into the body of the embryo from the yolk sac. These <i>primordial
germ cells</i> are distinguishable by their large size and certain
morphological and cytochemical features.</div>
<div class="contentbody" style="text-align: justify;">
<br /></div>
<div class="contentbody" style="text-align: justify;">
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="725085"></a>When the
primordial germ cells reach the genital area, some enter the germinal
epithelium and others mingle with the groups of cells that proliferate from it
or lie in the mesenchyme. By the end of the fifth week, rapid division of all
these types of cells results in development of a prominent <i>genital ridge.</i>
The ridge projects into the body cavity medially to a fold in which there are
the mesonephric (wolffian) and the müllerian ducts. By the seventh week, it is
separated from the mesonephros except at the narrow central zone, the future
hilum, where the blood vessels enter. At this time, the sexes can be
distinguished, because the testes can be recognized by well-defined radiating
strands of cells (sex cords). These cords are separated from the germinal
epithelium by mesenchyme that is to become the tunica albuginea. The sex cords,
which consist of large germ cells and smaller epithelioid cells derived from
the germinal epithelium, develop into the seminiferous tubules and tubuli rete.
The latter establishes connection with the mesonephric tubules that develop
into the epididymis. The mesonephric ducts become the vas deferens.</div>
<div class="contentbody" style="text-align: justify;">
<br /></div>
<div class="contentbody" style="text-align: justify;">
In the female embryo, the
germinal epithelium continues to proliferate for a much longer time. The groups
of cells thus formed lie at first in the region of the hilum. As connective
tissue develops between them, these appear as sex cords. These cords give rise
to the medullary cords and persist for variable times (Forbes, 1942). By the
third month, medulla and cortex are defined (see Fig. 2–15). The bulk of the
organ is made up of cortex, a mass of crowded germ and epithelioid cells that
show some signs of grouping, but there are no distinct cords as in the testis.
Strands of cells extend from the germinal epithelium into the cortical mass,
and mitoses are numerous. The rapid succession of mitoses soon reduces the size
of the germ cells to the extent that these no longer are differentiated clearly
from the neighboring cells. These germ cells are now called <i>oogonia.</i></div>
<div class="contentbody" style="text-align: justify;">
<br /></div>
<div class="contentbody" style="text-align: justify;">
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="725087"></a>By the
fourth month, some germ cells in the medullary region begin to enlarge. These
are called <i>primary oocytes</i> at the beginning of the phase of growth that
continues until maturity is reached. During this period of cell growth, many
oocytes undergo degeneration, both before and after birth. A single layer of
flattened follicular cells that were derived originally from the germinal
epithelium soon surrounds the primary oocytes. These structures are now called <i>primordial
follicles</i> and are seen first in the medulla and later in the cortex. Some
follicles begin to grow even before birth, and some are believed to persist in
the cortex almost unchanged until menopause.</div>
<div class="contentbody" style="text-align: justify;">
<br /></div>
<div class="contentbody" style="text-align: justify;">
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="725088"></a>By 8 months,
the ovary has become a long, narrow, lobulated structure that is attached to
the body wall along the line of the hilum by the <i>mesovarium,</i> in which
lies the <i>epoöphoron.</i> The germinal epithelium has been separated for the
most part from the cortex by a band of connective tissue—<i>tunica albuginea</i>—which
is absent in many small areas where strands of cells, usually referred to as <i>cords
of Pflüger,</i> are in contact with the germinal epithelium. Among these cords
are cells believed by many investigators to be oogonia that have come to resemble
the other epithelial cells as a result of repeated mitoses. In the underlying
cortex, there are two distinct zones. Superficially, there are nests of germ
cells in synapsis, interspersed with Pflüger cords and strands of connective
tissue. In the deeper zone, there are many groups of germ cells in synapsis, as
well as primary oocytes, prospective follicular cells, and a few primordial
follicles.</div>
<div class="contentbody" style="text-align: justify;">
<br /></div>
<div class="contentbody" style="text-align: justify;">
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="725089"></a>At term, the
various types of ovarian cells in the human female fetus may still be found.</div>
<div class="contenthead5" style="text-align: justify;">
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="725090"></a>Histology</div>
<div class="contentbody" style="text-align: justify;">
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="725091"></a>From the
first stages of its development until after the menopause, the ovary undergoes
constant change. The number of oocytes at the onset of puberty has been
estimated variously at 200,000 to 400,000. Because only one ovum ordinarily is
cast off during each ovarian cycle, it is evident that a few hundred ova
suffice for purposes of reproduction.</div>
<div class="contentbody" style="text-align: justify;">
<br /></div>
<div class="contentbody" style="text-align: justify;">
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="725092"></a>The
glandular elements of ovaries of adult women include interstitial, thecal, and
luteal cells. The interstitial glandular elements are formed from cells of the
theca interna of degenerating or atretic follicles; the thecal glandular cells
are formed from the theca interna of ripening follicles; and the true luteal
cells are derived from the granulosa cells of ovulated follicles and from the
undifferentiated stroma that surround them.</div>
<div class="contentbody" style="text-align: justify;">
<br /></div>
<div class="contentbody" style="text-align: justify;">
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="725093"></a>The huge
store of primordial follicles at birth is exhausted gradually after sexual
maturation and through the reproductive span. Block (1952) found that there is
a gradual decline from a mean of 439,000 oocytes in girls younger than 15 years
to a mean of 34,000 in women older than 36 years. In young girls, the greater
portion of the ovary is composed of the cortex, which is filled with large
numbers of closely packed primordial follicles. In young women, the cortex is
relatively thinner but still contains a large number of primordial follicles.
Each primordial follicle is made up of an oocyte and its surrounding single
layer of epithelial cells, which are small and flattened, spindle-shaped, and
somewhat sharply differentiated from the still smaller and spindly cells of the
surrounding stroma.</div>
<div class="contentbody" style="text-align: justify;">
<br /></div>
<div class="contentbody" style="text-align: justify;">
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="725094"></a>The oocyte
is a large, spherical cell in which there is clear cytoplasm and a relatively
large nucleus located near the center of the ovum. In the nucleus, there are
one large and several smaller nucleoli, and numerous masses of chromatin. </div>
<div class="contentbody" style="text-align: justify;">
<br /></div>
<div class="contenthead3" style="text-align: justify;">
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="725095"></a>Embryological
Remnants</div>
<div class="contentbody" style="text-align: justify;">
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="725096"></a>There are a
number of vestigial wolffian structures that are identified after embryogenesis
of the female reproductive system. Some of these occasionally cause clinical
concerns. The <i>parovarium</i> can be found in the scant loose connective
tissue within the broad ligament in the vicinity of the mesosalpinx. It
comprises a number of narrow vertical tubules that are lined by ciliated
epithelium. These tubules connect at the upper ends with a longitudinal duct
that extends just below the oviduct to the lateral margin of the uterus, where
it ends blindly near the internal os. This canal is the remnant of the wolffian
(mesonephric) duct in women and is called the <i>Gartner duct.</i> The
parovarium, also a remnant of the wolffian duct, is homologous embryologically
with the caput epididymis in men. The cranial portion of the parovarium is the <i>epoöphoron,</i>
or <i>organ of Rosenmüller;</i> the caudal portion, or <i>paroöphoron,</i> is a
group of vestigial mesonephric tubules that lie in or around the broad
ligament. It is homologous embryologically with the paradidymis of men. The
paroöphoron in adult women usually disappears.</div>
<div class="contentbody" style="text-align: justify;">
<br /></div>
<div class="contenthead3" style="text-align: justify;">
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="725097"></a>Pelvic
Anatomy</div>
<div class="contentbody" style="text-align: justify;">
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="725102"></a>The false
pelvis lies above the linea terminalis and the true pelvis below this anatomical
boundary.The false pelvis is bounded posteriorly by the lumbar vertebra and
laterally by the iliac fossa. In front, the boundary is formed by the lower
portion of the anterior abdominal wall.</div>
<div class="contentbody" style="text-align: justify;">
<br /></div>
<div class="contentbody" style="text-align: justify;">
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="725103"></a>The true
pelvis is the portion important in childbearing. It is bounded above by the
promontory and alae of the sacrum, the linea terminalis, and the upper margins
of the pubic bones, and below by the pelvic outlet. The cavity of the true
pelvis can be described as an obliquely truncated, bent cylinder with its greatest
height posteriorly. Its anterior wall at the symphysis pubis measures about 5
cm, and its posterior wall, about 10 cm.</div>
<div class="contentbody" style="text-align: justify;">
<br /></div>
<div class="contentbody" style="text-align: justify;">
The walls of the true pelvis
are partly bony and partly ligamentous. The posterior boundary is the anterior
surface of the sacrum, and the lateral limits are formed by the inner surface
of the ischial bones and the sacrosciatic notches and ligaments. In front, the
true pelvis is bounded by the pubic bones, the ascending superior rami of the
ischial bones, and the obturator foramen.</div>
<div class="contentbody" style="text-align: justify;">
<br /></div>
<div class="contentbody" style="text-align: justify;">
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="725105"></a>The sidewalls
of the true pelvis of an adult woman converge somewhat. Extending from the
middle of the posterior margin of each ischium are the ischial spines. These
are of great obstetrical importance because the distance between them usually
represents the shortest diameter of the pelvic cavity. They also serve as
valuable landmarks in assessing the level to which the presenting part of the
fetus has descended into the true pelvis. The sacrum forms the posterior wall
of the pelvic cavity. Its upper anterior margin corresponds to the promontory
that may be felt during bimanual pelvic examination in women with a small
pelvis. It can provide a landmark for clinical pelvimetry. Normally the sacrum
has a marked vertical and a less pronounced horizontal concavity, which in
abnormal pelves may undergo important variations. A straight line drawn from
the promontory to the tip of the sacrum usually measures 10 cm, whereas the
distance along the concavity averages 12 cm.</div>
<div class="contentbody" style="text-align: justify;">
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="725106"></a>The
descending inferior rami of the pubic bones unite at an angle of 90 to 100
degrees to form a rounded arch under which the fetal head must pass.</div>
<div class="contentbody" style="text-align: justify;">
<br /></div>
<div class="contenthead3" style="text-align: justify;">
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="725107"></a>Pelvic
Joints</div>
<div class="contenthead5" style="text-align: justify;">
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="725108"></a>Symphysis
Pubis</div>
<div class="contentbody" style="text-align: justify;">
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="725109"></a>Anteriorly,
the pelvic bones are joined together by the symphysis pubis. This structure
consists of fibrocartilage and the superior and inferior pubic ligaments; the
latter are frequently designated the <i>arcuate ligament of the pubis</i>.</div>
<div class="contentbody" style="text-align: justify;">
<br /></div>
<div class="contenthead5" style="text-align: justify;">
Sacroiliac Joints</div>
<div class="contentbody" style="text-align: justify;">
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="725113"></a>Posteriorly,
the pelvic bones are joined by the articulations between the sacrum and the
iliac portion of the innominate bones to form the sacroiliac joints. These
joints also have a certain degree of mobility.</div>
<div class="contentbody" style="text-align: justify;">
<br /></div>
<div class="contenthead5" style="text-align: justify;">
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="725122"></a>Relaxation
of the Pelvic Joints</div>
<div class="contentbody" style="text-align: justify;">
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="725123"></a>During
pregnancy, relaxation of these joints likely results from hormonal changes.
Abramson and co-workers (1934) observed that relaxation of the symphysis pubis
commenced in women in the first half of pregnancy and increased during the last
3 months. They also observed that this laxity began to regress immediately
after parturition and that regression was completed within 3 to 5 months. The
symphysis pubis also increases in width during pregnancy—more so in multiparas
than in primigravidas—and returns to normal soon after delivery.</div>
<div class="contentbody" style="text-align: justify;">
<br /></div>
<div class="contentbody" style="text-align: justify;">
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="725124"></a>There are
important changes in sacroiliac joint mobility. Borell and Fernstrom (1957)
demonstrated that the rather marked mobility of the pelvis at term was caused
by an upward gliding movement of the sacroiliac joint. The displacement, which
is greatest in the dorsal lithotomy position, may increase the diameter of the
outlet by 1.5 to 2.0 cm. <b>This is the main justification for placing a woman
in this position for a vaginal delivery.</b> The increase in the diameter of
the pelvic outlet, however, occurs only if the sacrum is allowed to rotate
posteriorly, that is, only if the sacrum is not forced anteriorly by the weight
of the maternal pelvis against the delivery table or bed (Russell, 1969, 1982).
Sacroiliac joint mobility is also the likely reason that the McRoberts maneuver
often is successful in releasing an obstructed shoulder in a case of shoulder
dystocia (see Chap. 20, Shoulder Dystocia). These changes have also been
attributed to the success of the modified squatting position to hasten
second-stage labor (Gardosi and co-workers, 1989). The squatting position may
increase the interspinous diameter and the diameter of the pelvic outlet
(Russell, 1969, 1982). These latter observations are unconfirmed, but this
position is assumed for birth in many primitive societies.</div>
<div class="contentbody" style="text-align: justify;">
<br /></div>
<div class="contenthead3" style="text-align: justify;">
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="725125"></a>Planes and
Diameters of the Pelvis</div>
<div class="contentbody" style="text-align: justify;">
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="725126"></a>The pelvis
is described as having four imaginary planes.</div>
<div class="font12" style="margin-left: .5in; mso-list: l0 level1 lfo1; tab-stops: list .5in; text-align: justify; text-indent: -.25in;">
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="725127"></a><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span>The plane of the pelvic inlet—the superior strait.</div>
<div class="font12" style="margin-left: .5in; mso-list: l0 level1 lfo1; tab-stops: list .5in; text-align: justify; text-indent: -.25in;">
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="725128"></a><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span>The plane of the pelvic outlet—the inferior strait.</div>
<div class="font12" style="margin-left: .5in; mso-list: l0 level1 lfo1; tab-stops: list .5in; text-align: justify; text-indent: -.25in;">
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="725129"></a><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";">
</span></span>The plane of the midpelvis—the least pelvic dimensions.</div>
<div class="font12" style="margin-left: .5in; mso-list: l0 level1 lfo1; tab-stops: list .5in; text-align: justify; text-indent: -.25in;">
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="725130"></a><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";">
</span></span>The plane of greatest pelvic dimension—of no
obstetrical significance.</div>
<div class="font12" style="margin-left: 0.5in; text-align: justify; text-indent: -0.25in;">
<br /></div>
<div class="contenthead5" style="text-align: justify;">
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="725133"></a>Pelvic
Inlet</div>
<div class="contentbody" style="text-align: justify;">
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="725134"></a>The pelvic
inlet (superior strait) is bounded posteriorly by the promontory and alae of
the sacrum, laterally by the linea terminalis, and anteriorly by the horizontal
pubic rami and the symphysis pubis. The inlet of the female pelvis typically is
more nearly round than ovoid. Caldwell and co-workers (1934) identified
radiographically a nearly round or <i>gynecoid</i> pelvic inlet in
approximately 50 percent of white women.</div>
<div class="contentbody" style="text-align: justify;">
Four diameters of the pelvic
inlet are usually described: anteroposterior, transverse, and two obliques. The
obstetrically important anteroposterior diameter is the shortest distance
between the promontory of the sacrum and the symphysis pubis, and is designated
the <i>obstetrical conjugate</i>. Normally, this measures 10 cm or more.</div>
<div class="contentbody" style="text-align: justify;">
<br /></div>
<div class="contentbody" style="text-align: justify;">
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="725136"></a>The
transverse diameter is constructed at right angles to the obstetrical conjugate
and represents the greatest distance between the linea terminalis on either
side. It usually intersects the obstetrical conjugate at a point about 4 cm in
front of the promontory. The segment of the obstetrical conjugate from the
intersection of these two lines to the promontory is designated the <i>posterior
sagittal diameter</i> of the inlet.</div>
<div class="contentbody" style="text-align: justify;">
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="725137"></a>Each of the
two oblique diameters extends from one of the sacroiliac synchondroses to the
iliopectineal eminence on the opposite side. They average less than 13 cm.</div>
<div class="contentbody" style="text-align: justify;">
<br /></div>
<div class="contentbody" style="text-align: justify;">
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="725140"></a>The
anteroposterior diameter of the pelvic inlet that has been identified as the <i>true
conjugate</i> does not represent the shortest distance between the promontory
of the sacrum and the symphysis pubis. The shortest distance is the obstetrical
conjugate, which is the shortest anteroposterior diameter through which the
head must pass in descending through the pelvic inlet. Obstetrical conjugate
cannot be measured directly with the examining fingers. For clinical purposes,
the obstetrical conjugate is estimated indirectly by subtracting 1.5 to 2 cm
from the diagonal conjugate. The latter is determined by measuring the distance
from the lower margin of the symphysis to the promontory of the sacrum.</div>
<div class="contentbody" style="text-align: justify;">
<br /></div>
<div class="contenthead5" style="text-align: justify;">
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="725145"></a>Midpelvis</div>
<div class="contentbody" style="text-align: justify;">
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="725146"></a>The
midpelvis is measured at the level of the ischial spines—the midplane, or plane
of least pelvic dimensions. It is of particular importance following engagement
of the fetal head in obstructed labor. The interspinous diameter, 10 cm or
somewhat more, is usually the smallest diameter of the pelvis. The
anteroposterior diameter through the level of the ischial spines normally
measures at least 11.5 cm. Its posterior component (posterior sagittal
diameter), between the sacrum and the line created by the interspinous
diameter, is usually at least 4.5 cm.</div>
<div class="contentbody" style="text-align: justify;">
<br /></div>
<div class="contenthead5" style="text-align: justify;">
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="725151"></a>Pelvic
Outlet</div>
<div class="contentbody" style="text-align: justify;">
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="725152"></a>The pelvic
outlet consists of two approximately triangular areas that are not in the same
plane. They have a common base, which is a line drawn between the two ischial
tuberosities . The apex of the posterior triangle is at the tip of the sacrum,
and the lateral boundaries are the sacrosciatic ligaments and the ischial
tuberosities. The anterior triangle is formed by the area under the pubic arch.
Three diameters of the pelvic outlet usually are described: the anteroposterior,
transverse, and posterior sagittal.</div>
<div class="contentbody" style="text-align: justify;">
<br /></div>
<div class="contenthead3" style="text-align: justify;">
Pelvic Shapes</div>
<div class="contentbody" style="text-align: justify;">
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="725154"></a>In the past,
x-ray pelvimetry was used frequently in women with suspected cephalopelvic
disproportion or fetal malpresentation. Caldwell and Moloy (1933, 1934)
developed a classification of the pelvis that is still used. The classification
is based on the shape of the pelvis, and its familiarity helps the clinician
understand better the mechanisms of labor.</div>
<div class="contentbody" style="text-align: justify;">
<br /></div>
<div class="contentbody" style="text-align: justify;">
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="725155"></a>The <i>Caldwell–Moloy
classification</i> is based on measurement of the greatest transverse diameter
of the inlet and its division into anterior and posterior segments. The shapes
of these are used to classify the pelvis as gynecoid, anthropoid, android, or
platypelloid. The character of the posterior segment determines the type of
pelvis, and the character of the anterior segment determines the tendency.
These are both determined because many pelves are not pure but are mixed types;
for example, a gynecoid pelvis with an android tendency means that the
posterior pelvis is gynecoid and the anterior pelvis is android in shape.</div>
<div class="contentbody" style="text-align: justify;">
<br /></div>
<div class="contentbody" style="text-align: justify;">
From viewing the four basic
types, the configuration of the gynecoid pelvis would intuitively seem suited
for delivery of most fetuses. Indeed, Caldwell and co-workers (1939) reported
that the gynecoid pelvis was found in almost 50 percent of women. In contrast,
in the android pelvis, the posterior sagittal diameter at the inlet is much
shorter than the anterior sagittal diameter, limiting the use of the posterior
space by the fetal head. Moreover, the anterior portion is narrow and triangular.
The extreme android pelvis presages a poor prognosis for vaginal delivery. In
the anthropoid pelvis, the anteroposterior diameter of the inlet is greater
than the transverse. This results in an oval anteroposteriorly, with the
anterior segment somewhat narrow and pointed. Variations of anthropoid-type
pelves are found in about one third of women. The <i>platypelloid pelvis</i>
has a flattened gynecoid shape with short anteroposterior and wide transverse
diameters. Pure varieties are found in fewer than 3 percent of women.</div>
<div class="contentbody" style="text-align: justify;">
<br /></div>
<div class="contenthead3" style="text-align: justify;">
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="725159"></a>Pelvic Size
and Its Clinical Estimation</div>
<div class="contenthead5" style="text-align: justify;">
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="725160"></a>Pelvic
Inlet Measurements</div>
<div class="contentbody" style="text-align: justify;">
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="725161"></a>In many
abnormal pelves, the anteroposterior diameter of the pelvic inlet—the
obstetrical conjugate—is considerably shortened. The diagonal conjugate is
clinically estimated by measuring the distance from the sacral promontory to
the lower margin of the symphysis pubis. Two fingers of the dominant hand are
introduced into the vagina. The mobility of the coccyx is first evaluated. The
anterior surface of the sacrum is next palpated from below upward and its
vertical and lateral curvatures noted. In normal pelves, only the last three
sacral vertebrae can be felt without indenting the perineum. Conversely, in
markedly contracted pelves, the entire anterior surface of the sacrum usually
is readily palpable. Next, in order to reach the sacral promontory, the
examiner's elbow must be flexed and the perineum forcibly indented by the
knuckles of the third and fourth fingers. The index and the second fingers are
carried up and over the anterior surface of the sacrum. By deeply inserting the
wrist, the promontory may be felt by the tip of the second finger as a
projecting bony margin. With the finger closely applied to the most prominent
portion of the upper sacrum, the vaginal hand is elevated until it contacts the
pubic arch. The immediately adjacent point on the index finger is marked. The
distance between the mark and the tip of the second finger is the diagonal
conjugate. The obstetrical conjugate is computed by subtracting 1.5 to 2.0 cm,
depending on the height and inclination of the symphysis pubis. If the diagonal
conjugate is greater than 11.5 cm, it is justifiable to assume that the pelvic
inlet is of adequate size for vaginal delivery of a normal-sized fetus.</div>
<div class="contentbody" style="text-align: justify;">
<br /></div>
<div class="contenthead5" style="text-align: justify;">
Engagement</div>
<div class="contentbody" style="text-align: justify;">
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="725164"></a>Descent of
the biparietal plane of the fetal head to a level below that of the pelvic
inlet is termed <i>engagement</i>. When the biparietal—the largest—diameter of
the normally flexed fetal head has passed through the inlet, the head is
engaged. Although engagement usually is regarded as a phenomenon of labor, in
nulliparas it may occur during the last few weeks of pregnancy. When it does
so, it is confirmatory evidence that the pelvic inlet is adequate for that
fetal head. <b>With engagement, the fetal head serves as an internal pelvimeter
to demonstrate that the pelvic inlet is ample for that fetus.</b></div>
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<br /></div>
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Engagement is ascertained by
vaginal examination or by abdominal palpation. With vaginal examination, the
station of the lowermost part of the fetal head in relation to the level of the
ischial spines is determined. If the lowest part of the occiput is at or below
the level of the spines, the head usually, but not always, is engaged. The
distance from the plane of the pelvic inlet to the level of the ischial spines
is approximately 5 cm in most pelves. Although the distance from the biparietal
plane of the unmolded fetal head to the vertex is usually only 3 to 4 cm,
accurate determination of engagement may be difficult if there is considerable
elongation of the fetal head from molding or formation of a <i>caput
succedaneum.</i></div>
<div class="contentbody" style="text-align: justify;">
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="725166"></a>Abdominal
examination is a less satisfactory method to determine engagement. If the
biparietal plane of a term-sized infant has descended through the inlet, the
examining fingers cannot reach the lowermost part of the head. Thus, when
pushed downward over the lower abdomen, the examining fingers will slide over
that portion of the head proximal to the biparietal plane (nape of the neck)
and diverge. Conversely, if the head is not engaged, the examining fingers can
easily palpate the lower part of the head and will converge.</div>
<div class="contentbody" style="text-align: justify;">
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="725167"></a><i>Fixation</i>
of the fetal head occurs when descent proceeds to a depth that prevents its
free movement when pushed right and then left by both hands placed over the
lower abdomen. Fixation is not necessarily synonymous with engagement. Although
a head that is freely movable on abdominal examination cannot be engaged,
fixation of the head is sometimes seen when the biparietal plane is still 1 cm
or more above the pelvic inlet, especially if the head is molded appreciably.</div>
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<br /></div>
<div class="contenthead5" style="text-align: justify;">
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="725168"></a>Pelvic
Outlet Measurements</div>
<div class="contentbody" style="text-align: justify;">
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="725169"></a>An important
dimension of the pelvic outlet that is accessible for clinical measurement is
the diameter between the ischial tuberosities, variously called the <i>biischial
diameter, intertuberous diameter,</i> and <i>transverse diameter of the outlet.</i>
A measurement of more than 8 cm is considered normal. The measurement of the
transverse diameter of the outlet can be estimated by placing a closed fist
against the perineum between the ischial tuberosities. Usually the closed fist
is wider than 8 cm. The shape of the subpubic arch also can be evaluated at the
same time by palpating the pubic rami from the subpubic region toward the
ischial tuberosities.</div>
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<br /></div>
<div class="contenthead5" style="text-align: justify;">
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="725170"></a>Midpelvis
Estimation</div>
<div class="contentbody" style="text-align: justify;">
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="725171"></a>Clinical
estimation of midpelvic capacity by any direct form of measurement is not
possible. If the ischial spines are quite prominent, the sidewalls are felt to
converge, and the concavity of the sacrum is very shallow, then suspicion of a
contraction is aroused.</div>
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<br /></div>
Anonymoushttp://www.blogger.com/profile/06590633769759394496noreply@blogger.com0tag:blogger.com,1999:blog-5853367347201739175.post-18082430661985345912012-06-10T04:43:00.003-07:002012-06-10T04:43:18.482-07:00RINITIS ALERGI<br />
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<b style="text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;">Mahyudin</span></b></div>
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<b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;"> 04081001038<o:p></o:p></span></b></div>
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<br /></div>
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<b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;">Definisi</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;"><o:p></o:p></span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;"> Kelainan
pada hidung dengan gejala bersin-bersin, rinore, rasa gatal dan tersumbat
setelah mukosa hidung terpapar alergen yang diperantai IgE.<o:p></o:p></span></div>
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<br /></div>
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<b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;">Etiologi<o:p></o:p></span></b></div>
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<b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;"> </span></b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;">Rinitis
alergi merupakan suatu penyakit inflamasi yang diawali dengan tahap sensitisasi
dan diikuti dengan tahap provokasi/reaksi alergi. Ada 2 fase reaksi alergi:
fase cepat (RAFC) dan fase lambat (RAFL).<o:p></o:p></span></div>
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<br /></div>
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<b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;">Patofisiologi<o:p></o:p></span></b></div>
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<b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;"> </span></b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;">Kontak
pertama dengan allergen</span><span style="font-family: Wingdings; font-size: 12.0pt; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-size: 11.0pt; mso-char-type: symbol; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Wingdings;">à</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;"> ditangkap oleh makrofag (APC) </span><span style="font-family: Wingdings; font-size: 12.0pt; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-size: 11.0pt; mso-char-type: symbol; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Wingdings;">à</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;">
antigen membentuk fragmen peptide + HLA kelas 2 </span><span style="font-family: Wingdings; font-size: 12.0pt; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-size: 11.0pt; mso-char-type: symbol; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Wingdings;">à</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;">
komplek peptide MHC kelas 2 </span><span style="font-family: Wingdings; font-size: 12.0pt; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-size: 11.0pt; mso-char-type: symbol; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Wingdings;">à</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;"> APC
melepaskan sitokin </span><span style="font-family: Wingdings; font-size: 12.0pt; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-size: 11.0pt; mso-char-type: symbol; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Wingdings;">à</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;">
mengaktifkan Th0 untuk berploriferasi menjadi Th1 dan Th2.<o:p></o:p></span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;"> Th2
memproduksi sitokin IL 3, <b>IL 4</b>, IL
5, <b>IL 13</b> </span><span style="font-family: Wingdings; font-size: 12.0pt; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-size: 11.0pt; mso-char-type: symbol; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Wingdings;">à</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;">
mengaktifkan sel limfosit B</span><span style="font-family: Wingdings; font-size: 12.0pt; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-size: 11.0pt; mso-char-type: symbol; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Wingdings;">à</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;">
menghasilkan IgE </span><span style="font-family: Wingdings; font-size: 12.0pt; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-size: 11.0pt; mso-char-type: symbol; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Wingdings;">à</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;"> menuju sirkulasi darah dan
jaringan </span><span style="font-family: Wingdings; font-size: 12.0pt; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-size: 11.0pt; mso-char-type: symbol; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Wingdings;">à</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;">IgE berikatan dengan sel mastosit
basophil </span><span style="font-family: Wingdings; font-size: 12.0pt; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-size: 11.0pt; mso-char-type: symbol; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Wingdings;">à</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;"> sel mediator jadi aktif<o:p></o:p></span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;"> Terpapar
alergen yang sama</span><span style="font-family: Wingdings; font-size: 12.0pt; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-size: 11.0pt; mso-char-type: symbol; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Wingdings;">à</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;"> kedua rantai IgE mengikat
allergen</span><span style="font-family: Wingdings; font-size: 12.0pt; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-size: 11.0pt; mso-char-type: symbol; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Wingdings;">à</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;"> degranulasi dinding sel basophil
dan mastosit</span><span style="font-family: Wingdings; font-size: 12.0pt; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-size: 11.0pt; mso-char-type: symbol; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Wingdings;">à</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;"> terlepasnya mediator kima</span><span style="font-family: Wingdings; font-size: 12.0pt; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-size: 11.0pt; mso-char-type: symbol; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Wingdings;">à</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;">Histamin
(preformed mediators) dan prostaglandin, leukotrin, dll (newly formed
mediators). </span><span style="font-family: Wingdings; font-size: 12.0pt; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-size: 11.0pt; mso-char-type: symbol; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Wingdings;">à</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;">bersin-bersin, rinore, hidung
tersumbat, gatal-gatal pada hidung.<o:p></o:p></span></div>
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<br /></div>
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<b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;">Klasifikasi<o:p></o:p></span></b></div>
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<b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;"> </span></b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;">Berdasarkan
<b>WHO ARIA</b> </span><span style="font-family: Wingdings; font-size: 12.0pt; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-size: 11.0pt; mso-char-type: symbol; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Wingdings;">à</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;">
(1) Intermiten ringan, (2)Intermiten sedang-berat, (3) Persisten ringan, (4) Persisten
sedang-berat<o:p></o:p></span></div>
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<br /></div>
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<b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;">Diagnosis<o:p></o:p></span></b></div>
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<b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;"> Anamnesis</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;">
</span><span style="font-family: Wingdings; font-size: 12.0pt; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-size: 11.0pt; mso-char-type: symbol; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Wingdings;">à</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;">
bersin berulang, rinore, hidung tersumbat, hidung dan mata gatal, kadang-kadang
hiperlakrimasi.<o:p></o:p></span></div>
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<b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;"> Pem Fisik</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;">
</span><span style="font-family: Wingdings; font-size: 12.0pt; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-size: 11.0pt; mso-char-type: symbol; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Wingdings;">à</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;">
<b>Inspeksi</b> : allergic shiner, allergic
salute, allergic crease, facies adenoid, cobblestone appearance, geographic tounge.<o:p></o:p></span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;"> <b>
Rhinoskopi anterior</b> : mukosa edema, basah, berwarna pucat/livid,
secret encer dan banyak, bila persisten</span><span style="font-family: Wingdings; font-size: 12.0pt; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-size: 11.0pt; mso-char-type: symbol; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Wingdings;">à</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;">mukosa
inferior tampak hipertrofi.<o:p></o:p></span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;"> <b>Pem Penunjang</b> </span><span style="font-family: Wingdings; font-size: 12.0pt; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-size: 11.0pt; mso-char-type: symbol; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Wingdings;">à</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;">
hitung eosinophil bisa N/tinggi, tes cukit kulit, SET (skin end-point titration), Intracutaneus
provocative dilutional food test, challenge test, sitology hidung, hitung
basophil dan PMN, <b><i><u>pemeriksanan penunjang lain</u></i></b></span><span style="font-family: Wingdings; font-size: 12.0pt; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-size: 11.0pt; mso-char-type: symbol; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Wingdings;">à</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;">IgE
total dan Spesifik.<o:p></o:p></span></div>
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<b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;">Tatalaksana<o:p></o:p></span></b></div>
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<b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;"> </span></b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;">Sesuai
Algoritma rhinitis Alergi ARIA,<o:p></o:p></span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;">Namun secara umum</span><span style="font-family: Wingdings; font-size: 12.0pt; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-size: 11.0pt; mso-char-type: symbol; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Wingdings;">à</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;">
menghindari kontak dengan allergen penyebabnya, antihistamin (generasi 2 lebih
disukai: loratadin) bisa dikombinasikan dengan dekongestan peroral. Bila berat </span><span style="font-family: Wingdings; font-size: 12.0pt; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-size: 11.0pt; mso-char-type: symbol; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Wingdings;">à</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;">
kortikosteroid topikal dan oral, Na-kromoglikat, gagal</span><span style="font-family: Wingdings; font-size: 12.0pt; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-size: 11.0pt; mso-char-type: symbol; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Wingdings;">à</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;">kaustik
konka/konkotomi.<o:p></o:p></span></div>
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<b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;">Prognosis</span></b><span style="font-family: Wingdings; font-size: 12.0pt; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-size: 11.0pt; mso-char-type: symbol; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Wingdings;">à</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;">
sesuai klasifikasi rhinitis alergi<o:p></o:p></span></div>
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<b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;">Komplikasi</span></b><b><span style="font-family: Wingdings; font-size: 12.0pt; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-size: 11.0pt; mso-char-type: symbol; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Wingdings;">à</span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;"> </span></b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;">Rinitis
Hipertrofi<b>, </b>Polip Hidung, OME Residif,
Infeksi SPN. <o:p></o:p></span></div>Anonymoushttp://www.blogger.com/profile/06590633769759394496noreply@blogger.com0tag:blogger.com,1999:blog-5853367347201739175.post-86642631600144712272012-06-10T04:42:00.002-07:002012-06-10T04:42:39.917-07:00RINITIS ATROFI<br />
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<b style="text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;"> Mahyudin</span></b></div>
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<b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;"> 04081001038<o:p></o:p></span></b></div>
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<br /></div>
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<b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;">Definisi<o:p></o:p></span></b></div>
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<b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;"> </span></b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;">Merupakan
infeksi hidung kronis, yang ditandai oleh adanya atrofi progresif pada mukosa
dan tulang konka.<o:p></o:p></span></div>
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<br /></div>
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<b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;">Etiologi
<o:p></o:p></span></b></div>
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<b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;"> </span></b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;">Infeksi
oleh kuman spesifik (Klebsiella, Streptokokus, Pseudomonas), (2) Defisiensi FE,
(3) Defisiensi Vit. A, (4) Sinusitis Kronik, (5) Kelainan hormonal, (6)
Penyakit kolagen.<o:p></o:p></span></div>
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<br /></div>
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<b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;">Patofisiologi<o:p></o:p></span></b></div>
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<b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;"> </span></b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;">Tergantung
etiologi awal (bisa dari kombinasi beberpa factor penyebab) </span><span style="font-family: Wingdings; font-size: 12.0pt; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-size: 11.0pt; mso-char-type: symbol; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Wingdings;">à</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;">infeksi
yg kronik menyebabkan mukosa dan tulang
konka mengalami atrofi yang bersifat progresif</span><span style="font-family: Wingdings; font-size: 12.0pt; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-size: 11.0pt; mso-char-type: symbol; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Wingdings;">à</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;">menghasilkan
sekret yang kental dan cepat mongering (berbentuk krusta yang berbau busuk).<o:p></o:p></span></div>
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<b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;">Klasifikasi
<o:p></o:p></span></b></div>
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<b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;">(-)</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;"><o:p></o:p></span></div>
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<b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;"> </span></b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;"><o:p></o:p></span></div>
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<b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;">Diagnosis<o:p></o:p></span></b></div>
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<b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;"> Anamnesis</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;">
</span><span style="font-family: Wingdings; font-size: 12.0pt; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-size: 11.0pt; mso-char-type: symbol; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Wingdings;">à</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;">.adanya
riwayat infeksi kronis (tergantung etiologi), adanya gangguan penghidu, sakit
kepala dan hidung merasa tersumbat.<o:p></o:p></span></div>
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<br /></div>
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<b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;"> Pem Fisik</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;">
</span><span style="font-family: Wingdings; font-size: 12.0pt; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-size: 11.0pt; mso-char-type: symbol; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Wingdings;">à</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;">
<b>Inspeksi</b> : napas berbau, ada ingus
kental berwarna hijau, kerak (krusta) hijau, <o:p></o:p></span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;"> <b> Rhinoskopi anterior</b></span><span style="font-family: Wingdings; font-size: 12.0pt; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-size: 11.0pt; mso-char-type: symbol; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Wingdings;">à</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;">rongga
hidung sangat lapang, konka inferior dan media menjadi hipotrofi atau atrofi, ada
sekret purulen dan krusta berwarna hijau.<o:p></o:p></span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;"> <o:p></o:p></span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;"> <b>Pem.
Penunjang</b> </span><span style="font-family: Wingdings; font-size: 12.0pt; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-size: 11.0pt; mso-char-type: symbol; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Wingdings;">à</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;"> Histopatologik (biopsy konka
media)</span><span style="font-family: Wingdings; font-size: 12.0pt; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-size: 11.0pt; mso-char-type: symbol; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Wingdings;">à</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;">metaplasia epitel torak bersilia
menjadi epitel kubik atau epitel gepeng berlapis, silia menghilang, lapisan submukosa
menjadi lebih tipis, kelenjar-kelenjar berdegenerasi atau atrofi.<o:p></o:p></span></div>
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<br /></div>
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<b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;">Tatalaksana<o:p></o:p></span></b></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;"> <i><u>Belum ada yang baku, tujuannya mengatasi
etiologi dan menghilangkan gejala.<o:p></o:p></u></i></span></div>
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<br /></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;"> <b>Konservatif</b></span><span style="font-family: Wingdings; font-size: 12.0pt; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-size: 11.0pt; mso-char-type: symbol; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Wingdings;">à</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;">Antibiotik
spectrum luas</span><span style="font-family: Wingdings; font-size: 12.0pt; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-size: 11.0pt; mso-char-type: symbol; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Wingdings;">à</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;">sesuai dengan uji resistensi
kuman, obat cuci hidung (larutan hipertonik atau 100 cc air + 1 cth betadin)</span><span style="font-family: Wingdings; font-size: 12.0pt; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-size: 11.0pt; mso-char-type: symbol; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Wingdings;">à</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;">
untuk menghilangkan bau busuk di hidung, Vit A (3 x 50.000 unit) dan prefarat
Fe dapat diberikan selama 2 minggu.<o:p></o:p></span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;"> <b>Operatif</b></span><span style="font-family: Wingdings; font-size: 12.0pt; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-size: 11.0pt; mso-char-type: symbol; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Wingdings;">à</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;">
gagal konservatif </span><span style="font-family: Wingdings; font-size: 12.0pt; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-size: 11.0pt; mso-char-type: symbol; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Wingdings;">à</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;"> implantasi/ jabir osteo
periosteal,</span><span style="font-family: Wingdings; font-size: 12.0pt; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-size: 11.0pt; mso-char-type: symbol; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Wingdings;">à</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;">mengurangi turbulensi udara dan
pengeringan sekret, Bedah sinus endoskopik fungsional (BSEF)</span><span style="font-family: Wingdings; font-size: 12.0pt; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-size: 11.0pt; mso-char-type: symbol; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Wingdings;">à</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;">eradikasi
infeksi, perbaikan fungsi ventilasi dan drainase sinus</span><span style="font-family: Wingdings; font-size: 12.0pt; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-size: 11.0pt; mso-char-type: symbol; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Wingdings;">à</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;">regenerasi
mukosa.<o:p></o:p></span></div>
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<br /></div>
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<b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;">Prognosis</span></b><span style="font-family: Wingdings; font-size: 12.0pt; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-size: 11.0pt; mso-char-type: symbol; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Wingdings;">à</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;">
dubia <o:p></o:p></span></div>
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<br /></div>
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<b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;">Komplikasi</span></b><b><span style="font-family: Wingdings; font-size: 12.0pt; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-size: 11.0pt; mso-char-type: symbol; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Wingdings;">à</span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;"> </span></b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;">infeksi
SPN<o:p></o:p></span></div>Anonymoushttp://www.blogger.com/profile/06590633769759394496noreply@blogger.com0tag:blogger.com,1999:blog-5853367347201739175.post-55713975442800878822012-06-10T04:41:00.003-07:002012-06-10T04:41:47.876-07:00RINITIS VASOMOTOR<br />
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<span style="font-family: 'Times New Roman', serif;"><b><br /></b></span></div>
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<b style="text-align: left;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;"> Mahyudin</span></b></div>
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<b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;"> 04081001038<o:p></o:p></span></b></div>
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<br /></div>
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<b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;">Definisi<o:p></o:p></span></b></div>
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<b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;"> </span></b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;">Suatu
keadaan idiopatik yang didiagnosis tanpa adanya infeksi, alergi, eosinophilia,
perubahan hormonal (hamil, hipertiroid) dan pajanan obat (kontrasepsi oral,
antihipertensi, B-bloker, aspirin, klorpromazin dan obat topikal hidung
dekongestan).<o:p></o:p></span></div>
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<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify;">
<b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;">Etiologi
dan Patofisiologi<o:p></o:p></span></b></div>
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<span style="font-family: Wingdings; font-size: 12.0pt; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-size: 11.0pt; mso-char-type: symbol; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Wingdings;">à</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;">Belum
jelas diketahui, masih berupa hipotesis,<o:p></o:p></span></div>
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<b><u><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;">Neurogenik</span></u></b><span style="font-family: Wingdings; font-size: 12.0pt; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-size: 11.0pt; mso-char-type: symbol; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Wingdings;">à</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;">
ketidakseimbangan impuls saraf otonom di mukosa hidung berupa bertambahnya
aktivitas sistem parasimpatis</span><span style="font-family: Wingdings; font-size: 12.0pt; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-size: 11.0pt; mso-char-type: symbol; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Wingdings;">à</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;">nukleus
salivatori superior</span><span style="font-family: Wingdings; font-size: 12.0pt; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-size: 11.0pt; mso-char-type: symbol; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Wingdings;">à</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;">
ganglion sfenopalatina</span><span style="font-family: Wingdings; font-size: 12.0pt; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-size: 11.0pt; mso-char-type: symbol; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Wingdings;">à</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;"> n.
vidianus</span><span style="font-family: Wingdings; font-size: 12.0pt; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-size: 11.0pt; mso-char-type: symbol; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Wingdings;">à</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;"> pelepasan ko-transmiter
asetilkolin, vasoaktif internal peptide</span><span style="font-family: Wingdings; font-size: 12.0pt; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-size: 11.0pt; mso-char-type: symbol; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Wingdings;">à</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;">
vasodilatasi dan peningkatan sekresi hidung</span><span style="font-family: Wingdings; font-size: 12.0pt; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-size: 11.0pt; mso-char-type: symbol; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Wingdings;">à</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;">
kongesti hidung<o:p></o:p></span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;"> <b><u>Neuropeptida</u></b></span><span style="font-family: Wingdings; font-size: 12.0pt; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-size: 11.0pt; mso-char-type: symbol; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Wingdings;">à</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;">peningkatan
rangsangan terhadap saraf sensoris serabut C di hidung </span><span style="font-family: Wingdings; font-size: 12.0pt; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-size: 11.0pt; mso-char-type: symbol; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Wingdings;">à</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;">
pelepasan neuropeptida-</span><span style="font-family: Wingdings; font-size: 12.0pt; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-size: 11.0pt; mso-char-type: symbol; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Wingdings;">à</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;">
substansi P dan calsitonin gene related protein</span><span style="font-family: Wingdings; font-size: 12.0pt; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-size: 11.0pt; mso-char-type: symbol; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Wingdings;">à</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;">
meningkatkan permeabilitas vascular dan sekresi kelenjar</span><span style="font-family: Wingdings; font-size: 12.0pt; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-size: 11.0pt; mso-char-type: symbol; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Wingdings;">à</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;">
peningkatan respon pada hiperaktivitas hidung.<o:p></o:p></span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;"> <b><u>NO</u></b></span><span style="font-family: Wingdings; font-size: 12.0pt; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-size: 11.0pt; mso-char-type: symbol; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Wingdings;">à</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;">
peningkatan NO pada lapisan epitel hidung</span><span style="font-family: Wingdings; font-size: 12.0pt; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-size: 11.0pt; mso-char-type: symbol; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Wingdings;">à</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;">
kerusakan dan nekrosis epitel</span><span style="font-family: Wingdings; font-size: 12.0pt; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-size: 11.0pt; mso-char-type: symbol; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Wingdings;">à</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;">
akibatnya setiap ada rangsang non-spesifik langsung ke sub-epitel</span><span style="font-family: Wingdings; font-size: 12.0pt; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-size: 11.0pt; mso-char-type: symbol; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Wingdings;">à</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;">peningkatan
reaktivitas serabut trigeminal dan recruitmen reflex vascular dan kelenjar
mukosa hidung.<o:p></o:p></span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;"> <b><u>Trauma</u></b></span><span style="font-family: Wingdings; font-size: 12.0pt; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-size: 11.0pt; mso-char-type: symbol; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Wingdings;">à</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;">
yang dapat menyebabkan mekanisme neurogenic dan neuropeptida<o:p></o:p></span></div>
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<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify;">
<b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;">Klasifikasi
</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;">(berdasarkan gejala yang menonjol)<o:p></o:p></span></div>
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<b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;"> </span></b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;">Golongan
bersin (sneezers), golongan rinore (runners), golongan tersumbat (blockers).<o:p></o:p></span></div>
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<b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;"> </span></b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;"><o:p></o:p></span></div>
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<b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;">Diagnosis<o:p></o:p></span></b></div>
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<b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;"> Anamnesis</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;">
</span><span style="font-family: Wingdings; font-size: 12.0pt; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-size: 11.0pt; mso-char-type: symbol; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Wingdings;">à</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;">
mencari faktor yang mempengaruhi timbulnya gejala, (umumnya non-spesifik; udara
dingin, rokok, bau yg menyengat, stress, kelelahan, dll). Gejala
dominan--.hidung tersumbat, bergantian kiri dan kanan, terdapat rinore mukoid
atau serous, jarang disertai gatal pada mata.<o:p></o:p></span></div>
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<br /></div>
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<b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;"> Pem Fisik</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;">
</span><span style="font-family: Wingdings; font-size: 12.0pt; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-size: 11.0pt; mso-char-type: symbol; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Wingdings;">à</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;">
<b>Inspeksi</b> : tidak ada patognomonik.<o:p></o:p></span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;"> <b> Rhinoskopi anterior</b></span><span style="font-family: Wingdings; font-size: 12.0pt; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-size: 11.0pt; mso-char-type: symbol; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Wingdings;">à</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;">edema
mukosa hidung, konka berwarna merah gelap atau merah tua, tetapi dapat pula
pucat. Permukaan konka licin,
berbenjol-benjol (hipertrofi), sekret hidung bersifat mukoid dan sedikit, pada
golongan rinore</span><span style="font-family: Wingdings; font-size: 12.0pt; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-size: 11.0pt; mso-char-type: symbol; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Wingdings;">à</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;">sekret bersifat serous dan
banyak.<o:p></o:p></span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;"> <b>Pem Penunjang</b> </span><span style="font-family: Wingdings; font-size: 12.0pt; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-size: 11.0pt; mso-char-type: symbol; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Wingdings;">à</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;"> dilakukan
untuk menyingkirkan rinitis alergi. Eosinophil biasanya sedikit, tes cukit
kulit (-), kadar IgE spesifik tidak meningkat.<o:p></o:p></span></div>
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<br /></div>
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<b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;">Tatalaksana<o:p></o:p></span></b></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;"> Menghindari
stimulus/faktor pencetus, simtomatis--. Dekongestan oral + antihistamin, cuci
hidung larutan garam fisiologis, berat</span><span style="font-family: Wingdings; font-size: 12.0pt; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-size: 11.0pt; mso-char-type: symbol; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Wingdings;">à</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;">
kortikosteroid topical; flutikason propionate, ipatrium bromide
(antikolinergik). Gagal</span><span style="font-family: Wingdings; font-size: 12.0pt; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-size: 11.0pt; mso-char-type: symbol; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Wingdings;">à</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;">kauterisasi,
konkotomi, neurektomi<o:p></o:p></span></div>
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<br /></div>
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<b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;">Prognosis</span></b><span style="font-family: Wingdings; font-size: 12.0pt; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-size: 11.0pt; mso-char-type: symbol; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Wingdings;">à</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;">
golongan obstruksi lebih baik daripada rinore.<o:p></o:p></span></div>
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<b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;">Komplikasi</span></b><b><span style="font-family: Wingdings; font-size: 12.0pt; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-size: 11.0pt; mso-char-type: symbol; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Wingdings;">à</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;">Rinitis
Hipertrofi, Infeksi SPN, Polip Hidung.<o:p></o:p></span></div>
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<br /></div>Anonymoushttp://www.blogger.com/profile/06590633769759394496noreply@blogger.com0tag:blogger.com,1999:blog-5853367347201739175.post-27952116152206364082012-06-09T00:43:00.007-07:002012-06-09T00:46:10.416-07:00Hemangiomas of Infancy & Vascular Malformations: Introduction<b>REFF--- Current
Otolaryngology > II. Face > Chapter 6. Hemangiomas of Infancy &
Vascular Malformations ></b><br />
<br />
<br />
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Hemangiomas are true tumors with pathologic endothelial
cell proliferation; vascular malformations are distinguished by this distinct
absence.</div>
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Hemangioma of Infancy</div>
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="2824193"></a>
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<div class="contentHead3">
Essentials of Diagnosis</div>
<ul>
<li class="font12List">Absent at birth or history of small premonitory mark at
birth.
</li>
<li class="font12List">Rapid neonatal growth of the lesion.
</li>
<li class="font12List">Cutaneous lesions develop either a typical "strawberry"
appearance or a bluish hue ("deep bruise" appearance).
</li>
<li class="font12List">Magnetic resonance imaging (MRI) is diagnostic when the
diagnosis is uncertain or when serial exam is not possible.
</li>
<li class="font12List">Visceral involvement is suspected if there are more than
three cutaneous lesions.
</li>
<li class="font12List">Progressive stridor in the appropriate age group (2–9
months) is suspicious for airway hemangioma.</li>
</ul>
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<br />
<div class="contentHead5">
<b>General Considerations</b></div>
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="2824195"></a>
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<div class="contentBody">
Hemangiomas are the most common tumors of infancy. They are
more common in females than in males (3:1), in white populations, and in
premature infants. Most of these neoplasms are located in the head and neck. In
addition, most are single lesions; however, about 20% of patients have multiple
lesions. Hemangiomas exhibit a period of rapid postnatal growth. The duration of
the proliferative period is variable, but is usually confined to the first year
of life. The proliferative period rarely extends to 18 months. The involutional
phase is also variable, occurring over a period of 2 to 9 years. After complete
involution, normal skin is restored in about 50% of patients. In other patients,
the skin has evidence of telangiectasia, yellowish hypoelastic patches, sagging
or fibrofatty patches, and scarring if the lesion has ulcerated.</div>
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="2824196"></a>
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<div class="contentBody">
Hemangiomas can be classified as superficial (Figure 6–1),
deep (Figure 6–2) or combined. The term <i>superficial hemangioma</i> replaces
the older terms <i>capillary hemangioma</i> and <i>"strawberry" hemangioma</i>
and refers to hemangiomas located in the papillary dermis. The deep hemangioma,
often slightly blue in color, originates from the reticular dermis or the
subcutaneous space and in the past was referred to as a <i>cavernous
hemangioma</i>. The combined hemangioma has elements of both the superficial and
the deep hemangioma.</div>
<div class="contentBody">
<br /></div>
<div class="contentBody">
</div>
<div class="contentHead5">
<b>Pathogenesis</b></div>
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="2824200"></a>
<br />
<div class="contentBody">
Proliferative hemangiomas have been shown to express high
levels of indolamine 2,3-dioxygenase (IDO), basic fibroblast growth factors
(<img border="0" src="" />-fgf),
proliferating cell nuclear antigen, type IV collagenase, urokinase, and, most
recently, insulin-like growth factor 2. Involuting hemangiomas have been
characterized by exhibition of tissue inhibitor of metalloproteinase 1 (TIMP1),
thrombospondin, interferon-<img border="0" src="" />,
and decreased levels of other factors seen in the proliferative
hemangioma.</div>
<div class="contentBody">
<br /></div>
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<br />
<div class="contentBody">
In addition, it has recently been shown that endothelial
cells are of clonal origin and the defect that leads to tumor growth and the
altered expression of growth factors is intrinsic to the endothelial cell. These
clonal endothelial cells have also been shown to have characteristics similar to
placental endothelial cells, which may suggest that hemangiomas are of placental
origin. A higher rate of hemangioma is found in children whose mother underwent
chorionic villus sampling, which gives additional weight to placental origin
theories.</div>
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<br />
<div class="contentBody">
Recently, the primary clonal cell of the hemangioma has
been shown to have characteristics of a myeloid cell, demonstrating that it is
not a typical endothelial cell.</div>
<div class="contentBody">
<br /></div>
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<br />
<div class="contentHead5">
<b>Clinical Findings</b></div>
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="2824204"></a>
<br />
<div class="contentBody">
Most commonly, the diagnosis of hemangioma is determined by
the history and physical examination. The history typically reveals that more
than 50% of hemangiomas are seen at birth as a prominent cutaneous mark. This
mark may manifest as a whitish patch, an anemic nevus, a faint telangiectasia,
or a blue spot. The rapid proliferation of this initial lesion is highly
suggestive of a hemangioma. A superficial hemangioma assumes the typical
"strawberry" appearance, making the diagnosis obvious. In a subcutaneous,
intramuscular, or visceral tumor, the diagnosis may be uncertain. In these
instances, various radiologic modalities can be very helpful. MRI is the most
informative of the available modalities.</div>
<div class="contentBody">
<br /></div>
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="2824205"></a>
<br />
<div class="contentBody">
When an infant age 2–9 months presents with progressive
stridor or persistent crouplike symptoms, consideration should be given to the
possibility of a subglottic hemangioma. This neoplasm is said to be more common
in children with a cutaneous hemangioma in a facial or "beard" distribution. The
diagnosis of a subglottic hemangioma should be made with a direct laryngoscopy
and a bronchoscopy.</div>
<div class="contentBody">
<br /></div>
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="2824206"></a>
<br />
<div class="contentBody">
Special consideration should be given to the child with
three or more hemangiomas. In these children, abdominal ultrasounds should be
obtained to evaluate for visceral hemangiomas, especially hepatic hemangiomas.
If the screening ultrasound is positive, MRI of the entire body is indicated to
detect other internal hemangiomas.</div>
<div class="contentBody">
<br /></div>
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="2824207"></a>
<br />
<div class="contentBody">
Another special diagnostic situation arises when a child
presents with extensive facial hemangiomas, sometimes referred to as
<i>segmental hemangiomas.</i> The term segmental hemangioma relates to the
approximate distribution that may correspond to sensory innervation patterns.
The acronym PHACE can help the clinician recall the findings seen in these
children, which include the following:</div>
<dl class="font12">
<dd class="font12List"><b>P</b>osterior fossa malformations
</dd><dd class="font12List"><b>H</b>emangiomas
</dd><dd class="font12List"><b>A</b>rterial anomalies
</dd><dd class="font12List"><b>C</b>oarctation of the aorta and cardiac defects
</dd><dd class="font12List"><b>E</b>ye abnormalities</dd></dl>
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="2824208"></a>
<br />
<div class="contentHead5">
<b>Differential Diagnosis</b></div>
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="2824209"></a>
<br />
<div class="contentBody">
<b>Congenital hemangiomas</b> are rare vascular tumors that
are fully developed at birth and in that way are distinguished from the more
typical hemangioma of infancy. There are two types of congenital hemangiomas.
One type does not involute—the noninvoluting congenital hemangi oma (NICH). The
other type involutes quickly—rapidly involuting congenital hemangioma (RICH).
These tumors are also pathologically distinguishable from the hemangioma of
infancy in that they are glucose transporter-1 protein(glut-1)–negative.</div>
<div class="contentBody">
<br /></div>
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="2824212"></a>
<br />
<div class="contentBody">
A <b>pyogenic granuloma</b> is often confused with a
hemangioma. A pyogenic granuloma is often the result of a minor trauma. The
lesion is usually sessile and as it grows it becomes pedicled, often bleeding
impressively. The treatment is surgical excision.</div>
<div class="contentBody">
<br /></div>
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="2824213"></a>
<br />
<div class="contentBody">
A <b>vascular malformation </b>is another typical
diagnostic alternative to consider when attempting to diagnose a potential
hemangioma. However, the natural history of the hemangioma (not present at birth
with rapid growth in the first months of life) is usually adequate evidence to
support a confident diagnosis.</div>
<div class="contentBody">
<br /></div>
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="2824214"></a>
<br />
<div class="contentBody">
<b>Kaposiform hemangioendothelioma (KHE)</b> is a rare
vascular tumor closely associated with Kasabach-Merritt syndrome.
Differentiation from hemangioma of infancy is typically based on recognition of
aggressive behavior such as compression and invasion of surrounding tissue.
These are large abnormal vascular tumors, and early recognition and treatment
can be life saving.</div>
<div class="contentBody">
<br /></div>
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="2824215"></a>
<br />
<div class="contentBody">
<b>Tufted angiomas </b>(known in Japanese literature as
angioblastoma of Nakagawa) are benign erythematous plaques that grow slowly over
several years. They often stabilize after the slow growth period. A pathologic
specimen is usually diagnostic.</div>
<div class="contentBody">
<br /></div>
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="2824216"></a>
<br />
<div class="contentBody">
MRI with contrast is the most useful of all radiologic
evaluations of hemangiomas. MRI can differentiate a hemangioma from a vascular
malformation. A discussion of clinical suspicions with the radiologist may help
determine the need for concomitant magnetic resonance angiography, which is
especially helpful in locating feeder vessels of high-flow arteriovenous
malformations.</div>
<div class="contentBody">
<br /></div>
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="2824217"></a>
<br />
<div class="contentBody">
The ultimate method of differentiating all diagnostic
possibilities is with a histologic study of the tissue. A biopsy should be done
whenever there is a possibility that the lesion in question is a <b>malignant
tumor;</b> however, a biopsy is rarely necessary because there is usually ample
epidemiologic, clinical, and radiologic information that can facilitate a
reliable diagnosis.</div>
<div class="contentBody">
<br /></div>
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="2824218"></a>
<br />
<div class="contentHead5">
<b>Complications</b></div>
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="2824219"></a>
<br />
<div class="contentBody">
Although rare, the complications of hemangiomas dictate a
need for treatment. These complications include:</div>
<dl class="font12">
<dd class="font12List">(1) Ulceration (most common in the perineum and
lip/perioral area).
</dd><dd class="font12List">(2) Airway obstruction.
</dd><dd class="font12List">(3) Visual loss. Obstruction of the visual axis for 1 week
in the first year of life can cause permanent amblyopia.
</dd><dd class="font12List">(4) External auditory canal obstruction.
</dd><dd class="font12List">(5) Bleeding. Bleeding is usually low flow and therefore
can be managed simply with pressure.
</dd><dd class="font12List">(6) Heart failure. This complication is managed with
medical therapy (usually by a cardiologist) and with attempts to control the
growth of the hemangioma. Steroids should be the initial medical therapy, with
vincristine and other chemotherapies used for steroid failures. Surgical therapy
combined with embolization would be a second tier of therapy if medical
treatment is not effective and the problem becomes life threatening.</dd></dl>
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="2824220"></a>
<br />
<div class="contentHead5">
<b>Treatment</b></div>
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="2824221"></a>
<br />
<div class="contentBody">
The decision to intervene and attempt to treat the patient
without an active or inevitable complication from hemangioma must be weighed
against the fact that most hemangiomas resolve completely or with minimal
long-term sequelae. For hemangiomas with active or inevitable complications,
multiple treatment options exist. The most appropriate treatment depends on the
location and the nature of the impending complication as well as the child's
specific medical and social situation. For example, if follow-up is not
possible, early definitive surgical management may be more strongly
considered.</div>
<div class="contentBody">
<br /></div>
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="2824222"></a>
<br />
<div class="contentHead8">
<b>Steroids</b></div>
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="2824223"></a>
<br />
<div class="contentBody">
Steroids are the usual first line of treatment. Typical
initial doses are 2–5 mg/kg/d of prednisolone or prednisone. Steroids are best
administered in a single morning dose. This initial therapy is usually used for
4–12 weeks, then tapered over the next several months according to what the
patient can tolerate. Rebound growth may necessitate a second course of therapy.
Alternate-day dosing or rest periods of several weeks may lessen troublesome
side effects such as cushingoid appearance, growth retardation, decreased
appetite, and susceptibility to infection. Monitoring of blood glucose and blood
pressure are recommended. Adrenal suppression can be a result of therapy.
Concomitant use of a proton pump inhibitor is also suggested.</div>
<div class="contentBody">
<br /></div>
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="2824224"></a>
<br />
<div class="contentBody">
Intralesional steroid injections may be used as an initial
therapy, especially for orbital or periorbital lesions, tumors of the nasal tip,
and globular tumors of the lips, ears, and cheeks and parotid hemangiomas. A 1:1
ratio of long-acting steroids (eg, triamcinolone 40 mg/mL) and short-acting
steroids (eg, betamethasone 6 mg/mL) yields the best results. Three injections
of triamcinolone, at doses of 3–5 mg/kg per procedure mixed with an equal volume
of betamethsone spaced 4–6 weeks apart, are the suggested course. Injections of
long-acting corticosteroids in a suspension in the periorbital tissues can
result in blindness. Great caution is needed in this area, especially in the
upper lid. Low-pressure injection technique is thought to decrease the risk of
embolization. When effective, injection therapy usually leads to a dramatic
reduction in the size of the lesion within 1 week. In general, steroid therapy
(systemic or intralesional) can be extremely effective in one third of patients,
partially effective in another third, and ineffective for the final third of
patients.</div>
<div class="contentBody">
<br /></div>
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="2824225"></a>
<br />
<div class="contentHead8">
<b>Interferon</b></div>
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="2824226"></a>
<br />
<div class="contentBody">
Interferon alfa-2a is a comparatively new agent for the
treatment of hemangiomas. Although it is effective in most cases, its use is
limited because of cost, route of administration, and potential side effects.
The treatment is generally reserved for pulmonary hemangioma, life-threatening
hemangioma, and diffuse neonatal hemangioma. Transient side effects include
fever, elevated liver enzymes, and neutropenia. Spastic diplegia and other
permanent neurologic complications associated with the use of interferon alfa-2a
have resulted in the cautious application of this therapy. The typical dose is 3
million units/m<sup>2</sup> injected subcutaneously daily. The therapy is
generally administered for 6–12 months.</div>
<div class="contentBody">
<br /></div>
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="2824227"></a>
<br />
<div class="contentHead8">
<b>Vincristine</b></div>
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="2824228"></a>
<br />
<div class="contentBody">
Vincristine is gaining popularity as another efficacious
treatment for complicated or refractory hemangiomas. There are relatively few
side effects compared with interferon. The therapy should be coordinated by a
clinician experienced in using the medication. One drawback of the therapy is
the need for central venous access for up to 12 weeks.</div>
<div class="contentBody">
<br /></div>
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="2824229"></a>
<br />
<div class="contentHead8">
<b>Laser</b></div>
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="2824230"></a>
<br />
<div class="contentBody">
Laser therapy for hemangiomas is becoming widely practiced
to combat mucosal lesions and cutaneous lesions with or without ulceration. In
the United States, laser debulking of mucosal lesions is the typical treatment
of obstructing lesions such as subglottic hemangiomas. The goal is to reduce the
lesion size to allow for an adequate airway. Recurrence is anticipated and the
treatment is repeated until the hemangioma stops proliferating and involutes.
Various laser therapies are used, but all share the drawback of causing a
mucosal ulceration in the airway.</div>
<div class="contentBody">
<br /></div>
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="2824231"></a>
<br />
<div class="contentBody">
Ulceration is a controversial indication for cutaneous
laser therapy. The yellow light emitted by pulsed dye lasers is selectively
absorbed by hemoglobin and melanin. In an ulcerated hemangioma, the laser light
does not need to pass through the skin and the melanin within the skin to reach
the hemangioma; therefore, the risks of scarring due to absorption by melanin
are considered lessened. Recent advances in the flashlamp pulsed dye laser
include longer wavelengths, longer pulse durations, and the very important
dynamic cooling of the surface tissues. These advances have allowed for higher
energy treatments, deeper penetration, fewer complications, and better overall
responses. They have in turn led to increased confidence is using flashlamp
pulsed-dye laser for the treatment of select nonulcerated cutaneous lesions. The
KTP and Nd:YAG lasers have been used for intralesional therapy by using bare
fibers to deliver high energies to the deep components of the lesions. The use
of these laser technologies, although gaining in acceptance and recognition of
their usefulness, is not standardized and is limited by the experience of the
practitioner.</div>
<div class="contentBody">
<br /></div>
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="2824232"></a>
<br />
<div class="contentHead8">
<b>Excision</b></div>
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="2824233"></a>
<br />
<div class="contentBody">
It is common to consider excision in a completely involuted
lesion when the residuum causes a functional or esthetic problem. </div>
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="2824234"></a>
<br />
<div class="contentBody">
Baggy fibrofatty tissue is recontoured for improved
cosmesis.</div>
<div class="contentBody">
<br /></div>
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="2824235"></a>
<br />
<div class="contentBody">
The early surgical excision of an actively proliferating
lesion is appropriate in an area (eg, the glabella, eyelid, airway, the nasal
wall) that will certainly lead to complications or impaired function. This may
also prevent the need for protracted systemic therapy and spare the child and
family the anticipated psychosocial difficulty.</div>
<div class="contentBody">
<br /></div>
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="2824236"></a>
<br />
<div class="contentBody">
Some surgeons also advocate surgical intervention of
lesions that have stopped proliferating rather than waiting for a protracted
involution phase. Physicians who advocate earlier removal do so with the hope of
diminishing psychosocial stress. This technique also takes advantage of the
natural tissue expansion of the surrounding skin and soft tissue, which occurs
in the proliferative phase.</div>
<div class="contentBody">
<br /></div>
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="2824237"></a>
<br />
<div class="contentBody">
Regardless of the timing, the procedures are typically
accomplished using routine techniques. Special preoperative planning and imaging
should be carried out when operating on actively proliferating or recently
quiescent lesions to minimize blood loss. In addition to standard techniques,
circular excision with purse-string closure and subsequent lenticular removal of
scarring as needed has been advocated. This technique may lead to smaller
eventual scarring.</div>
<div class="contentBody">
<br /></div>
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="2824238"></a>
<br />
<div class="contentHead8">
<b>Treatment of Ulceration</b></div>
<a href="http://www.blogger.com/blogger.g?blogID=5853367347201739175" name="2824239"></a>
<br />
<div class="contentBody">
Local wound care consisting of topical and oral
antibiotics, topical steroids, barrier creams, and wound dressings are the
mainstay of treatment. Treatment to minimize the ongoing proliferation of the
hemangioma remains necessary. Management of pain is also very important. Reports
of the use of topical recombinant platelet-derived growth factor (Regranex) are
new and promising.</div>
</td></tr>
</tbody></table>Anonymoushttp://www.blogger.com/profile/06590633769759394496noreply@blogger.com0tag:blogger.com,1999:blog-5853367347201739175.post-33934316357897224512012-06-09T00:35:00.001-07:002012-06-09T00:35:22.908-07:00Hipospadia<br />
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<span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-no-proof: yes;">Pekerjaan </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-no-proof: yes;"> </span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-no-proof: yes;">: </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-no-proof: yes;">Pelajar<o:p></o:p></span></div>
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<span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-no-proof: yes;">Status </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-no-proof: yes;"> </span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-no-proof: yes;">: </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-no-proof: yes;">Belum
Menikah<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 27.0pt; mso-add-space: auto; text-align: justify;">
<span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-no-proof: yes;">MRS </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-no-proof: yes;"> </span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-no-proof: yes;">: </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-no-proof: yes;">14
Maret 2009<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: .25in; mso-add-space: auto; text-align: justify;">
<br /></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 27.0pt; mso-add-space: auto; mso-list: l0 level2 lfo3; text-align: justify; text-indent: -27.0pt;">
<!--[if !supportLists]--><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman"; mso-no-proof: yes;">1.2<span style="font-family: 'Times New Roman'; font-size: 7pt; font-weight: normal; line-height: normal;">
</span></span></b><!--[endif]--><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-no-proof: yes;">Anamnesis<o:p></o:p></span></b></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 27.0pt; mso-add-space: auto; text-align: justify;">
<b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-no-proof: yes;">Keluhan Utama:</span></b><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: FI; mso-no-proof: yes;"> </span></b><span lang="FI" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: FI; mso-no-proof: yes;">Bak dari pangkal kemaluan.</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-no-proof: yes;"> <o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 27.0pt; mso-add-space: auto; text-align: justify;">
<br /></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 27.0pt; mso-add-space: auto; text-align: justify;">
<b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-no-proof: yes;">Riwayat Perjalanan Penyakit:</span></b><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: FI; mso-no-proof: yes;"> </span></b><span lang="FI" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: FI; mso-no-proof: yes;">Bak dari pangkal kemaluan sejak lahir, pancaran kencing tidak jauh (+). </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-no-proof: yes;">Operasi meluruskan kemaluan 6 bulan yang lalu.<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 27.0pt; mso-add-space: auto; text-align: justify;">
<br /></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 27.0pt; mso-add-space: auto; mso-list: l0 level2 lfo3; text-align: justify; text-indent: -27.0pt;">
<!--[if !supportLists]--><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman"; mso-no-proof: yes;">1.3<span style="font-family: 'Times New Roman'; font-size: 7pt; font-weight: normal; line-height: normal;">
</span></span></b><!--[endif]--><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-no-proof: yes;">Pemeriksaan Fisik<o:p></o:p></span></b></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 27.0pt; mso-add-space: auto; text-align: justify;">
<b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-no-proof: yes;">Status Generalis<o:p></o:p></span></b></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 27.0pt; mso-add-space: auto; text-align: justify;">
<span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-no-proof: yes;">Keadaan Umum </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-no-proof: yes;"> </span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-no-proof: yes;">: baik<o:p></o:p></span></div>
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<span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-no-proof: yes;">Kesadaran :
</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-no-proof: yes;">K</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-no-proof: yes;">ompos mentis<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 27.0pt; mso-add-space: auto; text-align: justify;">
<span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-no-proof: yes;">TB :
</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-no-proof: yes;">120 </span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-no-proof: yes;">cm<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 27.0pt; mso-add-space: auto; text-align: justify;">
<span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-no-proof: yes;">BB :
</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-no-proof: yes;">24 </span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-no-proof: yes;">kg<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 27.0pt; mso-add-space: auto; text-align: justify;">
<span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-no-proof: yes;">Gizi </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-no-proof: yes;"> </span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-no-proof: yes;">: </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-no-proof: yes;">cukup<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 27.0pt; mso-add-space: auto; text-align: justify;">
<span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-no-proof: yes;">Tekanan Darah </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-no-proof: yes;"> </span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-no-proof: yes;">: 1</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-no-proof: yes;">1</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-no-proof: yes;">/</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-no-proof: yes;">8</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-no-proof: yes;">0 mmHg<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 27.0pt; mso-add-space: auto; text-align: justify;">
<span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-no-proof: yes;">Nadi </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-no-proof: yes;"> </span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-no-proof: yes;">: </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-no-proof: yes;">106 x</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-no-proof: yes;">/menit<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 27.0pt; mso-add-space: auto; text-align: justify;">
<span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-no-proof: yes;">Pernapasan </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-no-proof: yes;"> </span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-no-proof: yes;">: </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-no-proof: yes;">24 x</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-no-proof: yes;">/menit<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 27.0pt; mso-add-space: auto; text-align: justify;">
<span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-no-proof: yes;">Temperatur </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-no-proof: yes;"> </span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-no-proof: yes;">: </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-no-proof: yes;">36,7</span><sup><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-no-proof: yes;">0</span></sup><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-no-proof: yes;">C<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 27.0pt; mso-add-space: auto; text-align: justify;">
<span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-no-proof: yes;">Kepala </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-no-proof: yes;"> </span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-no-proof: yes;">: konjuntiva palpebra pucat </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-no-proof: yes;">-</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-no-proof: yes;">/</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-no-proof: yes;">-</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-no-proof: yes;">, sclera ikterik -/-</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-no-proof: yes;"><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 27.0pt; mso-add-space: auto; text-align: justify;">
<span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-no-proof: yes;">Pupil </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-no-proof: yes;"> </span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-no-proof: yes;">: isokor, reflex cahaya +/+<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 27.0pt; mso-add-space: auto; text-align: justify;">
<span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-no-proof: yes;">Leher </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-no-proof: yes;"> </span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-no-proof: yes;">: tidak ada kelainan<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 27.0pt; mso-add-space: auto; text-align: justify;">
<span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-no-proof: yes;">KGB </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-no-proof: yes;"> </span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-no-proof: yes;">: tidak ada pembesaran<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 27.0pt; mso-add-space: auto; text-align: justify;">
<span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-no-proof: yes;">Dada </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-no-proof: yes;"> </span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-no-proof: yes;">: tidak ada kelainan<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 27.0pt; mso-add-space: auto; text-align: justify;">
<span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-no-proof: yes;">Paru </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-no-proof: yes;"> </span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-no-proof: yes;">: tidak ada kelainan<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 27.0pt; mso-add-space: auto; text-align: justify;">
<span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-no-proof: yes;">Jantung </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-no-proof: yes;"> </span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-no-proof: yes;">: tidak ada kelainan<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 27.0pt; mso-add-space: auto; text-align: justify;">
<span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-no-proof: yes;">Perut </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-no-proof: yes;"> </span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-no-proof: yes;">: tidak ada kelainan<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 27.0pt; mso-add-space: auto; text-align: justify;">
<span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-no-proof: yes;">Hati </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-no-proof: yes;"> </span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-no-proof: yes;">: tidak ada kelainan<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 27.0pt; mso-add-space: auto; text-align: justify;">
<span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-no-proof: yes;">Kemaluan :
</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-no-proof: yes;">Lihat status lokalis<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 27.0pt; mso-add-space: auto; text-align: justify;">
<span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-no-proof: yes;">Ekstremitas superior</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-no-proof: yes;"> </span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-no-proof: yes;">: tidak ada kelainan<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 27.0pt; mso-add-space: auto; text-align: justify;">
<span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-no-proof: yes;">Ekstremitas inferior </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-no-proof: yes;"> </span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-no-proof: yes;">:</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-no-proof: yes;"> Tidak ada kelainan</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-no-proof: yes;"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-no-proof: yes;"><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 27.0pt; mso-add-space: auto; text-align: justify;">
<br /></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 27.0pt; mso-add-space: auto; text-align: justify;">
<b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-no-proof: yes;">Status Lokalis<o:p></o:p></span></b></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 27.0pt; mso-add-space: auto; text-align: justify;">
<span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-no-proof: yes;">Regio </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-no-proof: yes;">genitalia eksterna<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-left: 27.0pt; mso-add-space: auto; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-no-proof: yes;">Inspeksi</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-no-proof: yes;"> :</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-no-proof: yes;"> </span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-no-proof: yes;"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-no-proof: yes;">Tampak
adanya lubang pada pangkal penis<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-left: .25in; mso-add-space: auto; text-align: justify;">
<br /></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 27.0pt; mso-add-space: auto; mso-list: l0 level2 lfo3; text-align: justify; text-indent: -27.0pt;">
<!--[if !supportLists]--><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman"; mso-no-proof: yes;">1.4<span style="font-family: 'Times New Roman'; font-size: 7pt; font-weight: normal; line-height: normal;">
</span></span></b><!--[endif]--><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-no-proof: yes;">Pemeriksaan Penunjang<o:p></o:p></span></b></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: .25in; mso-add-space: auto; text-align: justify;">
<br /></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 27.0pt; mso-add-space: auto; text-align: justify;">
<b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-no-proof: yes;">Pemeriksaan Laboratorium:<o:p></o:p></span></b></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 27.0pt; mso-add-space: auto; text-align: justify;">
<span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-no-proof: yes;">Darah Rutin</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-no-proof: yes;"> (18-02-2009)</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-no-proof: yes;"> <o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 27.0pt; mso-add-space: auto; text-align: justify;">
<span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-no-proof: yes;">Hb :
</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-no-proof: yes;">12,4</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-no-proof: yes;"> g/dL (N: 14-18
g/dL) <o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 27.0pt; mso-add-space: auto; text-align: justify;">
<span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-no-proof: yes;">Ht :
3</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-no-proof: yes;">7</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-no-proof: yes;"> vol% (N: 40-48
vol%) <o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 27.0pt; mso-add-space: auto; text-align: justify;">
<span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-no-proof: yes;">Leukosit </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-no-proof: yes;"> </span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-no-proof: yes;">: </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-no-proof: yes;">76</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-no-proof: yes;">00/mm<sup>3</sup> (N: 5000-10000/mm<sup>3</sup>) <o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 27.0pt; mso-add-space: auto; text-align: justify;">
<span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-no-proof: yes;">Trombosit : </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-no-proof: yes;">357</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-no-proof: yes;">.000/mm<sup>3</sup> (N:
200000-500000/mm<sup>3</sup>) </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-no-proof: yes;"><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 27.0pt; mso-add-space: auto; text-align: justify;">
<br /></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 27.0pt; mso-add-space: auto; text-align: justify;">
<span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-no-proof: yes;">Kimia Klinik<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 27.0pt; mso-add-space: auto; text-align: justify;">
<span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-no-proof: yes;">BSS : </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-no-proof: yes;">80</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-no-proof: yes;"> mg/dL<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: .25in; mso-add-space: auto; text-align: justify;">
<br /></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 27.0pt; mso-add-space: auto; mso-list: l0 level2 lfo3; text-align: justify; text-indent: -27.0pt;">
<!--[if !supportLists]--><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman"; mso-no-proof: yes;">1.5<span style="font-family: 'Times New Roman'; font-size: 7pt; font-weight: normal; line-height: normal;">
</span></span></b><!--[endif]--><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-no-proof: yes;">Diagnosis Kerja<o:p></o:p></span></b></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 27.0pt; mso-add-space: auto; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-no-proof: yes;">Post
chordectomy Hipospadia pro uretroplasty <o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: .25in; mso-add-space: auto; text-align: justify;">
<br /></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 27.0pt; mso-add-space: auto; mso-list: l0 level2 lfo3; text-align: justify; text-indent: -27.0pt;">
<!--[if !supportLists]--><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman"; mso-no-proof: yes;">1.6<span style="font-family: 'Times New Roman'; font-size: 7pt; font-weight: normal; line-height: normal;">
</span></span></b><!--[endif]--><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-no-proof: yes;">Penatalaksanaan<o:p></o:p></span></b></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 27.0pt; mso-add-space: auto; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-no-proof: yes;">Uretroplasty</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-no-proof: yes;"><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 27.0pt; mso-add-space: auto; mso-list: l0 level2 lfo3; text-align: justify; text-indent: -27.0pt;">
<!--[if !supportLists]--><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman"; mso-no-proof: yes;">1.7<span style="font-family: 'Times New Roman'; font-size: 7pt; font-weight: normal; line-height: normal;">
</span></span></b><!--[endif]--><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-no-proof: yes;">Prognosis<o:p></o:p></span></b></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 27.0pt; mso-add-space: auto; text-align: justify;">
<span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-no-proof: yes;">Quo ad vitam :
bonam<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-left: 27.0pt; mso-add-space: auto; text-align: justify;">
<span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-no-proof: yes;">Quo ad functionam :
</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-no-proof: yes;">bonam</span><span style="font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 200%; text-align: center;"> </span></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 200%;">BAB
II<o:p></o:p></span></b></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 200%;">TINJAUAN
PUSTAKA<o:p></o:p></span></b></div>
<div class="MsoListParagraph" style="margin-left: 58.5pt; mso-add-space: auto; mso-list: l2 level1 lfo1; text-indent: -.25in;">
<!--[if !supportLists]--><b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 200%; mso-fareast-font-family: "Times New Roman";">A.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-weight: normal; line-height: normal;">
</span></span></b><!--[endif]--><b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 200%;">Definisi<o:p></o:p></span></b></div>
<div class="MsoNormal" style="margin-left: .5in; text-align: justify; text-indent: .5in;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 200%;">Hipospadia
merupakan suatu kelainan bawaan dimana meatus uretra eksternus terletak dipermukaan
ventral penis dan lebih proksimal dari tempatnya yang normal pada ujung glans
penis. Istilah hipospadia berasal dari bahasa Yunani, yaitu Hypo (below) dan
spaden (opening).<sup><o:p></o:p></sup></span></div>
<div class="MsoNormal" style="margin-left: .5in; text-align: justify; text-indent: .5in;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 200%;">Hipospadia
dapat timbul tanpa chordee dan chordee dapat pula timbul tanpa adanya
hipospadia. Chordee merupakan jaringan fibrosa yang menyebar mulai dari meatus
yang letaknya abnormal ke glans penis. Adanya chordee ini menyebabkan penis
melengkung kearah bawah yang tampak jelas pada keadaaan ereksi. Dengan penis
yang bengkok maka akan timbul kesulitan dalam proses reproduksi dari penis yang
hipospadia tersebut.<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 58.5pt; mso-add-space: auto; mso-list: l2 level1 lfo1; text-align: justify; text-indent: -.25in;">
<!--[if !supportLists]--><b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 200%; mso-fareast-font-family: "Times New Roman";">B.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-weight: normal; line-height: normal;">
</span></span></b><!--[endif]--><b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 200%;">Insidens.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="margin-left: .5in; text-align: justify; text-indent: .5in;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 200%;">Hipospadia
terjadi pada setiap 350 kelahiran bayi laki-laki hidup. Makin proksimal letak
meatus, makin berat kelainan nya dan makin jarang frekuensinya. Klasifikasi
dari hipospadiyang sering dipakai adalah glandular, distal penile, penile,
penoskrotal, scrotal, dan perineal. </span><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 200%; mso-ansi-language: SV;">Yang
distal frekuensinya sampai 90% sedang yang penile, skotal, dan perineal hanya
10%. </span></div>
<div class="MsoNormal" style="margin-left: .5in; text-align: justify; text-indent: .5in;">
<span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 200%; mso-ansi-language: SV;">Di Amerika Serikat angka kejadian sekitar 3-8 diantara
1000 kelahiran bayi laki-laki dan angkanya meningkat 2 kali lipat dari tahun
1970 hingga tahun 1993. Sedangkan sejak tahun 1998-2004 jumlah pasien yang
telah di tangani Profesor Chaula sebanyak 350 orang. Di Indonesia juga terjadi peningkatan
insidens hipospadia, dari yang ada pada <span class="bodytext01">hahun 2006,
Rumah Sakit Umum (RSU) Dr Kariadi Semarang rata-rata menangani enam pasien
hipospadia dalam sebulan atau lebih banyak dibanding tahun sebelumnya yang rata-rata
empat pasien perbulan.<o:p></o:p></span></span></div>
<div class="MsoNormal" style="margin-left: .5in; text-align: justify; text-indent: .5in;">
<br /></div>
<div class="MsoListParagraphCxSpFirst" style="margin-left: 58.5pt; mso-add-space: auto; mso-list: l2 level1 lfo1; text-align: justify; text-indent: -.25in;">
<!--[if !supportLists]--><span class="bodytext01"><b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 200%; mso-fareast-font-family: "Times New Roman";">C.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-weight: normal; line-height: normal;">
</span></span></b></span><!--[endif]--><span class="bodytext01"><b><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 200%; mso-ansi-language: SV;"> </span></b></span><span class="bodytext01"><b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 200%;">Embriologi <o:p></o:p></span></b></span></div>
<div class="MsoListParagraphCxSpMiddle" style="text-align: justify; text-indent: .5in;">
<span class="bodytext01"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 200%;">Jenis kelamin pada embrio ditentukan pada saat
konsepsi oleh kromosom pada spermatozoa yang membuahi ovum.Sperma yang
mengandung kromosom X akan membentuk individu XX (wanita) sedangkan kromosom Y
pada spermatozoa akan membentuk XY ( laki-laki). <o:p></o:p></span></span></div>
<div class="MsoListParagraphCxSpMiddle" style="text-align: justify; text-indent: .5in;">
<span class="bodytext01"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 200%;">Pada embrio berumur 2 minggu baru terdapat dua
lapisan yaitu ectoderm dan endoderm. Baru kemudian terbentuk lekukan ditengah-tengah
yaitu mesoderm yang kemudian bermigrasi ke perifer, memisahkan ectoderm dan
endoderm.</span></span></div>
<div class="MsoListParagraphCxSpMiddle" style="text-align: justify; text-indent: .5in;">
<span class="bodytext01"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 200%;">Di bagan kaudal ectoderm dan endoderm tetap bersatu
membenuk membrane kloaka. Pada permulaan minngu ke enam, terbentuk tonjolan
antara umbilical cord dan tail yang disebut genital turbecle. Dibawahnya pada
garis tengah terbentuk lekukan dimana dibagian lateralnya ada 2 lipatan
memanjang yang disebut genital fold. Selama minggu ke 7, genital turbekel akan
memanjang dan membentuk glans. </span></span><span class="bodytext01"><span lang="IT" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 200%; mso-ansi-language: IT;">Ini adalah bentuk primordial dari penis bila embrio
adalah laki-laki. Bila wanita akan menjadi klitoris.</span></span></div>
<div class="MsoListParagraphCxSpMiddle" style="text-align: justify; text-indent: .5in;">
<span class="bodytext01"><span lang="IT" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 200%; mso-ansi-language: IT;">Bila terjadi
agenesis dari mesoderm maka tubercle tak
terbentuk sehingga penis juga tidak terbentuk. Bagian anterior dari membrane
kloaka, yaitu membrane urogenitalia akan ruptur dan membentuk sinus. Sementara
itu sepasang lipatan yang disebut genital fold akan membentuk sisi-sisi dari sinus
urogenitalia.<o:p></o:p></span></span></div>
<div class="MsoListParagraphCxSpMiddle" style="text-align: justify; text-indent: .5in;">
<span class="bodytext01"><span lang="IT" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 200%; mso-ansi-language: IT;">Bila genital fold
gagal bersatu diatas sinus urogenitalia maka akan timbul hipospadi. </span></span><span class="bodytext01"><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 200%; mso-ansi-language: SV;">Selama periode ini
juga, terbentuk genital swelling di bagian lateral kiri dan kanan. </span></span><span class="bodytext01"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 200%;">Hipospadi yang terberat yaitu jenis penoskrotal,
skotal dan perineal, terjadi kegagalan genital fold dan genital swelling untuk
bersatu. <o:p></o:p></span></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: .75in; mso-add-space: auto; text-align: justify; text-indent: .25in;">
<br /></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 58.5pt; mso-add-space: auto; mso-list: l2 level1 lfo1; text-align: justify; text-indent: -.25in;">
<a href="" name="IntroductionPathophysiology"></a><!--[if !supportLists]--><span class="bodytext01"><b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 200%; mso-fareast-font-family: "Times New Roman";">D.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-weight: normal; line-height: normal;">
</span></span></b></span><!--[endif]--><span class="bodytext01"><b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 200%;">Etiologi<o:p></o:p></span></b></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: .75in; mso-add-space: auto; text-align: justify;">
<span class="bodytext01"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Beberapa
etiologi untuk hipospadia yaitu genetik, endocrine dan faktor lingkungan.<a href="" name="ClinicalCauses"></a><o:p></o:p></span></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 1.0in; mso-add-space: auto; mso-list: l1 level2 lfo2; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 1.0in; text-align: justify; text-indent: -.25in;">
<!--[if !supportLists]--><span class="bodytext01"><span style="font-family: "Courier New"; font-size: 10.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Courier New";">o<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span></span><!--[endif]--><span class="bodytext01"><b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Faktor genetik</span></b></span><span class="bodytext01"><b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></b></span></div>
<div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-left: 1.0in; mso-add-space: auto; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Faktor predisposisi genetik telah
dibuktikan melalui 8-fold meningkatkan insidens hypospadia diantara kembar
monozigot dengan singletons. Penemuan ini berhubungan dengan kebutuhan 2 fetus
terhadap HCG yang dihasilkan oleh satu plasenta yang tidak cukup pada periode
kritis perkembangan urethra. <o:p></o:p></span></div>
<ul type="disc">
<ul type="circle">
<li class="MsoNormal" style="line-height: 150%; mso-list: l1 level2 lfo2; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 1.0in; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Penyakit
keluarga menjadi perhatian. Ayah
Penderita hipospadia juga menderita hipospadia pada 8% pasien dan saudara laki-laki penderita hipospadia
juga hipospadia didapatkan pada 14% pasien.<o:p></o:p></span></li>
</ul>
</ul>
<div class="MsoNormal" style="line-height: 150%; margin-left: .5in; mso-list: l1 level1 lfo2; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 1.0in; text-align: justify; text-indent: .25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 10.0pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Faktor endokrin<o:p></o:p></span></b></div>
<ul type="disc">
<ul type="circle">
<li class="MsoNormal" style="line-height: 150%; mso-list: l1 level2 lfo2; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 1.0in; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Penurunan
ketersediaan androgen atau ketidakmampuan untuk menggunakan Androgen
secara tepat dapat menimbulkan hipospadia. Pada tahun 1997 dilaporkan oleh Aoronson
dkk. 66% laki-laki dengan hipospadia ringan dan 40% dengan hipospadia
berat ditemukan mempunyai defek pada biosintesis testicular testoteron. Mutasi pada
enzim 5-alpha reductase yang mengubah testosterone menjadi dihydrotestosterone (DHT), dihubungkan
dengan hypospadias. Pada 1999 dilaporkan
oleh silver dkk. Bahwa 10% anak laki-laki dengan hipospadia empunyai
sedikitnya satu alel dengan mutasi 5-alpha reductase mutation. Meskipun
defisit reseptor androgen secara kuantitatif maupun kualitatif telah
dibuktikan menyebabkan hypospadia. Akan tetapi hal ini tidak selalu
terjadi karena ada faktor lain
yang mempengaruhi. <o:p></o:p></span></li>
</ul>
</ul>
<div class="MsoNormal" style="line-height: 150%; margin-left: .5in; mso-list: l1 level1 lfo2; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 1.0in; text-indent: .25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 10.0pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Faktor lingkungan.<o:p></o:p></span></b></div>
<div class="MsoListParagraphCxSpFirst">
<br /></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 58.5pt; mso-add-space: auto; mso-list: l2 level1 lfo1; text-indent: -.25in;">
<!--[if !supportLists]--><b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 200%; mso-fareast-font-family: "Times New Roman";">E.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-weight: normal; line-height: normal;">
</span></span></b><!--[endif]--><b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 200%;">Patologi
Anatomi<o:p></o:p></span></b></div>
<div class="MsoListParagraphCxSpMiddle" style="text-align: justify; text-indent: .5in;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 200%;">Glans
penis pada hipospadi bentuknya lebih datar dan ada lekukan yang dangkal
dibagian ventral. Prepusium tidak ada dibagan ventral. JaringanAbnormal yang
menimbulkan chordee adalah jaringan fibrosa yang mengelilingi meatus dan
membentang ke distal sampai basis dari glans penis. Kulit penis dibagian
ventral distal dari meatus sangat tipis.
Tunika dartos, fascia buch, dan kospus spongiosum tidak ada. <o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 200%;"> Bila meatus letaknya di skrotum atau
perineum maka terdapat scrotum bifida dimana ada lekukan yang tak rambut. Raphe
penis yang biasanya terdapat dibagian tengah akan berpindah kesalah satu sisi
sesuai dengan adanya torsi dari kulit penis.<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 200%;"> Kadang-kadang terdapat saluran
uretra yang buntu dibagian distal dari meatus. Juga dilaporkan adanya fistula
uretra congenital yang timbul bersama-sama hipospadi. Sering skrotum letaknya
lebih ke anterior dari basis penis (engulfment). Selain itu kadang-kadang
ditemukan penis yang kecil sehingga pada keadaan seperti ini diperlukan
pemeriksaan kromatin seks untuk identifikasi jenis kelamin.<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="text-align: justify;">
<br /></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 58.5pt; mso-add-space: auto; mso-list: l2 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: -.25in;">
<!--[if !supportLists]--><b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">F.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-weight: normal; line-height: normal;">
</span></span></b><!--[endif]--><b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Gegala Hipospadia<o:p></o:p></span></b></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 1.0in; mso-add-space: auto; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Gejala klinis yang ditimbulkan pada
hipospadia yaitu :<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 76.5pt; mso-add-space: auto; mso-list: l1 level3 lfo2; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">1.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Lubang penis tidak terdapat di ujung
penis, tetapi berada di bawah penis <o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 76.5pt; mso-add-space: auto; mso-list: l1 level3 lfo2; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: -.25in;">
<!--[if !supportLists]--><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: SV; mso-fareast-font-family: "Times New Roman";">2.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: SV; mso-fareast-font-family: "Times New Roman";">Penis melengkung ke bawah<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 76.5pt; mso-add-space: auto; mso-list: l1 level3 lfo2; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: -.25in;">
<!--[if !supportLists]--><span lang="FI" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: FI; mso-fareast-font-family: "Times New Roman";">3.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="FI" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: FI; mso-fareast-font-family: "Times New Roman";">Penis tampak seperti berkerudung karena
kelainan pada kulit depan penis<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 76.5pt; mso-add-space: auto; mso-list: l1 level3 lfo2; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: -.25in;">
<!--[if !supportLists]--><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: SV; mso-fareast-font-family: "Times New Roman";">4.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: SV; mso-fareast-font-family: "Times New Roman";">Jika BAK anak harus duduk<span style="color: #333333;">.</span></span><span lang="SV"> </span><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: SV; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 76.5pt; mso-add-space: auto; mso-list: l1 level3 lfo2; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: -.25in;">
<!--[if !supportLists]--><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: SV; mso-fareast-font-family: "Times New Roman";">5.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: SV; mso-fareast-font-family: "Times New Roman";">Glans penis bentuknya lebih datar dan
ada lekukan yang dangkal di bagian bawah penis yang menyerupai meatus uretra
eksternus <o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 76.5pt; mso-add-space: auto; mso-list: l1 level3 lfo2; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: -.25in;">
<!--[if !supportLists]--><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: SV; mso-fareast-font-family: "Times New Roman";">6.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: SV; mso-fareast-font-family: "Times New Roman";"> Adanya chordee, yaitu jaringan fibrosa yang
mengelilingi meatus dan membentang hingga ke glans penis, teraba lebih keras
dari jaringan sekitar.<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 76.5pt; mso-add-space: auto; mso-list: l1 level3 lfo2; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: -.25in;">
<!--[if !supportLists]--><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: SV; mso-fareast-font-family: "Times New Roman";">7.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: SV; mso-fareast-font-family: "Times New Roman";"> Glans penis bentuknya lebih datar dan ada
lekukan yang dangkal di bagian bawah penis yang menyerupai meatus uretra
eksternus .<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 76.5pt; mso-add-space: auto; mso-list: l1 level3 lfo2; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: -.25in;">
<!--[if !supportLists]--><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: SV; mso-fareast-font-family: "Times New Roman";">8.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: SV; mso-fareast-font-family: "Times New Roman";"> Adanya chordee, yaitu jaringan fibrosa yang
mengelilingi meatus dan membentang hingga ke glans penis, teraba lebih keras
dari jaringan sekitar<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 76.5pt; mso-add-space: auto;">
<br /></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 58.5pt; mso-add-space: auto; mso-list: l2 level1 lfo1; text-indent: -.25in;">
<!--[if !supportLists]--><b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 200%; mso-fareast-font-family: "Times New Roman";">G.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-weight: normal; line-height: normal;">
</span></span></b><!--[endif]--><b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 200%;">Diagnosis<o:p></o:p></span></b></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 45.0pt; mso-add-space: auto; text-indent: 27.0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 200%;">Meskipun
dapat di diagnosis dengan menggunakan prenatal fetal ultrasonography,
Hipospadia biasanya di diagnosis pada saat bayi baru lahir dengan pemeriksaan
fisik. Pada pemeriksaan fisik didapatkan meatus urethra externus terletak lebih
proksimal, kadang-kadang disetai dengan atau tanpa chordee. Bila tidak terdapat
chordee maka pengobatan dapat ditangguhkan sampai umur 3-4 tahun untuk
memastikan bahwa betul-betul tidak ada chordee yang terjadi. Bila pada umur 4
tahun tak ada chordee, maka anak tersebut dapat di sirkumsisi.<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="text-indent: .5in;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 200%;">Beberapa
pemeriksaan penunjang yang dapat dilakukan yaitu <i>urethtroscopy</i> dan <i>cystoscopy
</i>untuk memastikan organ-organ seks internal terbentuk secara normal. <i>Excretory
urography</i> dilakukan untuk mendeteksi ada tidaknya abnormalitas kongenital
pada ginjal dan ureter.<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="text-indent: .5in;">
<br /></div>
<div class="MsoListParagraphCxSpLast" style="margin-left: 58.5pt; mso-add-space: auto; mso-list: l2 level1 lfo1; text-indent: -.25in;">
<!--[if !supportLists]--><b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 200%; mso-fareast-font-family: "Times New Roman";">H.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-weight: normal; line-height: normal;">
</span></span></b><!--[endif]--><b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 200%;">Pengobatan<o:p></o:p></span></b></div>
<div class="MsoNormal" style="margin-left: .5in; text-align: justify; text-indent: 22.5pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 200%;">Hipospadia
dapat di obati dengan cara pembedahan yang bertujuan utuk memperbaiki fungsi
dan kosmetik. Usia ideal untuk dilakukan pembedahan adalah usia 1,5 – 3 tahun
atau pada sebelum usia sekolah saat anak belum mengerti sehingga akan
mengurangi efek psikologis anak tersebut. Pada usia bayi biasanya dilakukan
kordektomi untuk meluruskan penis. Sedangkan pasca usia 2-4 tahun dilakukan
rekonstrusksi tahap kedua yang terdiri dari rekonstruksi uretra.Meskipun pada kepustakaan
disebutkan ada lebih dari 200 teknik operasi untuk hopospadia tapi yang palin
popular adalah teknik dari Thiersch-duplay, Dennis Brown, Cecil culp, dan
lain-lain.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 40.5pt; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 200%;"> </span><span lang="FI" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 200%; mso-ansi-language: FI;">Pada semua teknik operasi tersebut pada tahap pertama
dilakukan eksisi dari chordee. </span><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 200%; mso-ansi-language: SV;">Penutupan
luka operasi dilakukandengan menggunakan preputium bagian dorsal dan kulit
penis. </span><span lang="FI" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 200%; mso-ansi-language: FI;">Tahap pertama ini
dilakukan pada usia 1,5-2 tahun bila ukuran penis sesuai untuk usianya. Setelah
eksis chordee maka penis akan menjadi lurus, tapi meatus masih pada tempatnya
yang abnormal. Pada tahap kedua dilakukan uretroplasti yang dikerjakan 6 bulan
setelah tahap pertama.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 40.5pt; text-align: justify; text-indent: .5in;">
<span lang="FI" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 200%; mso-ansi-language: FI;">Pada tahap kedua ini dibuat insisi parallel pada tiap
sisi uretra sampai glans, lalu dibuat pipa dari kulit dibagian tengah ini untuk
membentuk urethra. </span><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 200%; mso-ansi-language: SV;">Setelah
urethra terbentuk luka operasi ditutup dengan flap dari kulit dari prepusium di
bagian lateral yang ditarik ke ventral dan dipertemukan pada garis median..<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 40.5pt; text-align: justify; text-indent: 31.5pt;">
<span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 200%; mso-ansi-language: SV;">Pada teknik Thiersch- Duplay (Byars) dilakukan operasi
pada 2 tahap. Cecil Culp melakukan teknik 3 tahap dimana pada tahap kedua,
penis diletakkan pada skrotum. Baru pada tahap ketiga dilakukan pemisahan penis
dan skrotum.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 40.5pt; text-align: justify;">
<span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 200%; mso-ansi-language: SV;"> Pada
tahun 1959 horton dan devine memprkenalkan teknik satu tahap untuk
penangulangan hipospadia teknik satu tahaap ini dilakuakan pada anak yang lebih
besar dengan penis yang sudah cukup besar dan dengan kelainan hipospadia jenis
yang distal.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 40.5pt; text-align: justify;">
<span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 200%; mso-ansi-language: SV;"> Pada penanggulangan hipospadia, jelas
diperlukan prepusium, Karena itu hipospadia merupakan kontraindikasi yang absolute
untuk sirkumsisi. Diharapkan semua tahapan ini dapat selesai sebelum anak masuk
sekolah.</span></div>
<div align="center" class="MsoNormal" style="margin-left: .75in; text-align: center;">
<b><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 200%; mso-ansi-language: SV;">BAB
III<o:p></o:p></span></b></div>
<div align="center" class="MsoNormal" style="margin-left: .75in; text-align: center;">
<b><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 200%; mso-ansi-language: SV;">ANALISIS
KASUS<o:p></o:p></span></b></div>
<div align="center" class="MsoNormal" style="margin-left: .75in; text-align: center;">
<br /></div>
<div class="MsoNormal" style="margin-left: 4.5pt; text-indent: 58.5pt;">
<span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 200%; mso-ansi-language: SV;">Seorang anak laki-laki usia 9 tahun datang kerumah sakit dengan keluhan utama
buang air kecil dari pangkal penis. Dari ananmnesis diketahui bahwa BAK tidak
memancar jauh dan pada 6 bulan sebelum masuk rumah sakit telah dilakkan operasi
untuk meluruskan penis.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 4.5pt; text-indent: 58.5pt;">
<span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 200%; mso-ansi-language: IN; mso-no-proof: yes;">Dari pemeriksaan fisik didapatkan vital
sign dalam batas normal, gizi </span><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 200%; mso-ansi-language: SV; mso-no-proof: yes;">cukup</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 200%; mso-ansi-language: IN; mso-no-proof: yes;">, dan </span><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 200%; mso-ansi-language: SV; mso-no-proof: yes;">dan
pada organ lain dalam batas normal. Namun pada regio genitalia eksterna
ditemukan kelainan meatus urinarius
eksternus terdapat pada scrotum.</span><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 200%; mso-ansi-language: SV;"><o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify; text-indent: .5in;">
<span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 200%; mso-ansi-language: SV;">Dari anamnesis dan pemeriksaan fisik diagnosis yang dapat
ditegakan pada pasien ini adalah hipospadia tipe scrotal. Yang di tatalaksana
dengan pembedahan yang dilakukan dalam dua tahapan. Operasi ini bertujuan untuk
merekonstruksi penis agar lurus dengan
orifisium uretra pada tempat yang normal atau diusahakan untuk senormal mungkin.
</span><span lang="FI" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 200%; mso-ansi-language: FI;">Pada semua teknik operasi tersebut pada tahap pertama
dilakukan eksisi dari chordee. </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 200%;">Sedangkan operasi tahap kedua
adalah uretroplasty.<o:p></o:p></span></div>
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<br /></div>Anonymoushttp://www.blogger.com/profile/06590633769759394496noreply@blogger.com0tag:blogger.com,1999:blog-5853367347201739175.post-41798083692103181362012-06-07T23:56:00.001-07:002012-06-07T23:56:44.078-07:00Anatomi Hidung<br />
<div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in;">
<span lang="IN"> Hidung luar (piramid)<o:p></o:p></span></div>
<div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: .25in; margin-right: 0in; margin-top: 0in; text-align: justify; text-indent: .25in;">
<span lang="IN">Bagian hidung yang paling menonjol
keanterior, yang merupakan puncak dari piramid, disebut apex nasi. Bagian
hidung yang berjalan kurang lebih lurus disini kearah dorso cranial sampai
tepat ke bawah arah dahi disebut dorsum nasi. Tempat pertemuan dorsum nasi
dengan dahi disebut radix nasi. Bagian hidung yang berjalan ke dorsal mulai
dari apex nasi sampai bagian tengah dari bibir atas disebut columela. Tempat
pertemuan columela dengan bibir atas disebut basis nasi.</span><o:p></o:p></div>
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<span lang="IN">Dikanan dan kiri columela terdapat lubang
yang disebut nares, yang dibatasi dilaterosuperior oleh alae nasi dan bagian
inferior oleh dasar cavum nasi.Tegaknya hidung didukung oleh rangka hidung yang
terdiri dari os nasale kanan dan kiri, prosesus frontalis kanan dan kiri,
cartilago alaris nasi kanan dan kiri, kartilago alaris nasi kanan dan kiri dan
septum nasi.</span><o:p></o:p></div>
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<!--[if !supportLists]--><span lang="IN">2.<span style="font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="IN">Cavum
nasi<o:p></o:p></span></div>
<div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: .25in; margin-right: 0in; margin-top: 0in; text-indent: .25in;">
<span lang="IN">Rongga hidung dibagi 2 bagian, kanan dan kiri
digaris median oleh septum nasi yang sekaligus menjadi dinding medial dari
cavum nasi dan dibentuk oleh :</span><o:p></o:p></div>
<div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: .5in; margin-right: 0in; margin-top: 0in; mso-list: l0 level1 lfo2; text-indent: -.25in;">
<!--[if !supportLists]--><span lang="IN">a.<span style="font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="IN">Lamina perpendikularis ossis et
ethmoidalis<o:p></o:p></span></div>
<div style="line-height: 150%; margin-bottom: 5.95pt; margin-left: .5in; margin-right: 0in; margin-top: 0in;">
<span lang="IN">Lamina
perpendikularis ossis et Ethmoidalis membentuk septum nasi dibagian superior
yang bagian bawahnya bertumpu pada os vomer.<sup>(2)</sup></span><o:p></o:p></div>
<div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: .5in; margin-right: 0in; margin-top: 0in; mso-list: l0 level1 lfo2; text-indent: -.25in;">
<!--[if !supportLists]--><span lang="IN">b.<span style="font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="IN"> Cartilago septi nasi atau cartilago
quadrankularis<o:p></o:p></span></div>
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<span lang="IN">Cartilago septum nasi adalah sekeping tulang rawan
tunggal yang berbentuk quadri lateral, yang merupakan bagian anterior inferior
septum nasi, yang merupakan bagian anterior inferior septum nasi. Dibelakang
bersatu dengan bagian tulang septum dan lamina perpendukalaris os ethmoidalis,
bagian bawah-nya bertumpu pada lekukan osvomer, crista maksila dan spina
maksila.</span><o:p></o:p></div>
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<!--[if !supportLists]--><span lang="IN">c.<span style="font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="IN">Vomer<o:p></o:p></span></div>
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<span lang="IN">Bagian ini membentuk septum nasi di bagian
posterior dimana terdapat bagian yang terletak antara os vomer dan lamina
perpendikularis, yang disebut sebagai processus sfenioid.</span><o:p></o:p></div>
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<span lang="IN"><br /></span></div>
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<span lang="IN">Daftar Pustaka</span></div>
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<span lang="IN"></span></div>
<div class="MsoBodyTextIndent" style="margin-left: .25in; mso-list: l0 level1 lfo1; tab-stops: list .25in; text-indent: -.25in;">
<!--[if !supportLists]-->1.<span style="font-size: 7pt; line-height: normal;">
</span><!--[endif]-->Adams GL. Boies LR, Jr. Highler PA. Boies Buku Ajar
THT. <span lang="IT">Edisi 6. Effendi H. Santoso
RAK. </span>Editor. Penerbit Buku Kedokteran EGC. 1993. 174-175.<o:p></o:p></div>
<br />
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<span lang="IN"><br /></span></div>Anonymoushttp://www.blogger.com/profile/06590633769759394496noreply@blogger.com0tag:blogger.com,1999:blog-5853367347201739175.post-9358658525878777062012-06-07T23:49:00.000-07:002012-06-07T23:49:09.377-07:00Abses Septum<br />
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Abses
septum adalah salah satu kelainan septum yang sering ditemukan selain deviasi
septum dan hematoma. Abses akut pada septum jarang terjadi, dapat disebabkan
oleh trauma paska bedah atau sebagai komplikasi penyakit infeksi, seperti thypoid,
influenza, sinus supurativ, smallpox, dan tuberkulosis. Kebanyakan juga
disebabkan karena trauma yang tidak disadari pasien.<o:p></o:p></div>
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Septum dibentuk oleh tulang dan
tulang rawan. Bagian tulang dari septum terdiri dari lamina perpendikularis
tulang etmoidalis disebelah atas, vomer dan rostrum sfenoid di posterior dan
suatu krista di sebelah bawah, terdiri dari krista maksial dan krista palatina.
Sedangkan bagian tulang rawan terdiri dari kartilago septum (kuadrangularis) di
sebelah anterior dan kolumela.<o:p></o:p></div>
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Patofisiologi abses septum nasi
tergantung pada penyebab abses. Terdapat beberapa mekanisme terbentuknya abses
septum nasi, yaitu penyebaran langsung sepanjang jaringan lunak misalnya pada
sinusitis, infeksi pada hematom septum nasi, infeksi pada gigi, dan p<span lang="FR">enyebaran melalui pembuluh vena yang
berasal dari sinus kavernosus<o:p></o:p></span></div>
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Abses septum nasal merupakan perkembangan dari hematom nasi. Biasanya
dipicu oleh trauma yang menyebabkan terjadinya ruptur pembuluh darah kecil yang
menyuplai septum nasi sehingga terbentuklah hematom yang memisahkan
mukoperikondrium dari tulang rawan septum. Destruksi tulang rawan merupakan
akibat dari iskemik dan nekrosis karena tekanan. Darah yang statis merupakan
media yang baik untuk pertumbuhan bakteri sehingga terbentuklah abses. Proses
peradangan diperberat oleh kematian sel serta pelepasan enzim proteolitik dan
kolagenase.<o:p></o:p></div>
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<!--[if !supportLists]--><b><span lang="IN">a.<span style="font-size: 7pt; font-weight: normal; line-height: normal;">
</span></span></b><!--[endif]--><b><span lang="IN">Definisi</span></b><span lang="IN"><o:p></o:p></span></div>
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<span lang="IN">Abses septum nasi
adalah kumpulan pus yang terdapat antara tulang rawan atau tulang pada septum
nasi dengan mukoperikondrium atau muko periosteum.</span><o:p></o:p></div>
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<!--[if !supportLists]--><b><span lang="IN">b.<span style="font-size: 7pt; font-weight: normal; line-height: normal;">
</span></span></b><!--[endif]--><b><span lang="IN">Etiologi<o:p></o:p></span></b></div>
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<span lang="IN">Terjadinya abses
septum nasi paling sering ditemukan akibat trauma pada hidung (75%). Trauma ini
dapat terjadi akibat kecelakaan, perkelahian maupun olahraga.</span><sup><span lang="IN"> </span></sup><span lang="IN">Selain trauma,
abses septum nasi juga dapat terjadi akibat komplikasi dari operasi hidung.
Penyebab lain adalah akibat penyebaran dari sinusitis etmoid dan sinusitis
sfenoid. Di samping itu abses septum nasi dapat juga terjadi akibat penyebaran
dari infeksi gigi. Organisme patogenik yang biasa menyebabkan abses septum nasi
adalah <i>Staphylococcus aureus</i>. Pada
beberapa kasus ditemukan pula adanya infeksi <i>Pneumococcus pneumoniae, Streptococcus β hemolyticus, Haemophilus
influenzae, </i>dan organisme anaerob.<o:p></o:p></span></div>
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<!--[if !supportLists]--><b><span lang="IN">c.<span style="font-size: 7pt; font-weight: normal; line-height: normal;"> </span></span></b><!--[endif]--><b><span lang="IN">Epidemiologi<o:p></o:p></span></b></div>
<div class="MsoNormal" style="line-height: 150%; text-indent: 27pt;">
<span lang="IN">Abses septum nasi jarang
ditemui dan biasanya terjadi pada laki-laki. Sebanyak 74% mengenai umur di
bawah 31 tahun dan 42% mengenai umur antara 3-14 tahun. Lokasi yang paling sering
ditemukan adalah pada bagian anterior tulang rawan septum. Eavey menemukan tiga
kasus abses septum nasi pada penelitian selama 10 tahun di rumah sakit anak di
Los Angeles. Rumah sakit Royal Children di Melbourne, Australia melaporkan
sebanyak 20 pasien abses septum selama 18 tahun dan di RS Ciptomangunkusumo
didapati 9 kasus abses septum selama 5 tahun (1989-1994). Di bagian THT FK
USU/RSUP H. Adam Malik Medan selama tahun 1999-2004 terdapat 5 kasus abses
septum nasi.<o:p></o:p></span></div>
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<!--[if !supportLists]--><b><span lang="IN">d.<span style="font-size: 7pt; font-weight: normal; line-height: normal;"> </span></span></b><!--[endif]--><b><span lang="IN">Patogenesis<o:p></o:p></span></b></div>
<div class="MsoNormal" style="line-height: 150%; text-indent: 27pt;">
<span lang="IN">Patogenesis abses septum
biasanya tergantung dari penyebabnya. Penyebab paling sering adalah trauma yang
akan menyebabkan timbulnya hematoma septum. Trauma pada septum nasi dapat
menyebabkan pembuluh darah di sekitar tulang rawan pecah. Darah terkumpul di
ruang antar tulang rawan dan mukoperikondrium yang melapisinya, sehingga
menyebabkan tulang rawan tersebut mengalami penekanan, dan menjadi iskemik
serta nekrosis, akibatnya tulang rawan mengalami destruksi. Darah yang
terkumpul merupakan media pertumbuhan bakteri dan selanjutnya terbentuk abses.
Bila terdapat daerah yang fraktur atau nekrosis pada tulang rawan, maka darah
akan merembes ke sisi yang lain dan menyebabkan hematoma bilateral. Hematoma
yang besar akan menyebabkan obstruksi pada kedua sisi rongga hidung. Kemudian
hematoma ini terinfeksi kuman dan menjadi abses septum. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; text-indent: 27pt;">
<span lang="IN">Abses septum nasi dapat
mengakibatkan nekrosis tulang rawan septum oleh karena menghalangi suplai darah
ke tulang rawan septum nasi. Nekrosis tersebut akan menyebabkan terjadinya
perforasi, sehingga proses supurasi yang semula unilateral menjadi bilateral.
Destruktif tulang membentuk cavitas yang akan diisi oleh jaringan ikat.
Hilangnya sebagian besar jaringan penyokong bagian bawah hidung dan adanya
retraksi jaringan parut, akan menyebabkan terjadinya deformitas hidung berupa
hidung pelana dan retraksi columela.</span><o:p></o:p></div>
<div class="MsoNormal" style="line-height: 150%; text-indent: 27pt;">
<span lang="IN">Selain dari trauma ada
beberapa mekanisme yang dapat menyebabkan timbulnya abses septum, yaitu
penyebaran langsung dari jaringan lunak yang berasal dari infeksi sinus. Di
samping itu penyebaran infeksi dapat juga dari gigi dan daerah orbita atau
sinus kavernosus. Pada beberapa kondisi, abses septum bisa diakibatkan oleh
trauma pada saat operasi hidung.<o:p></o:p></span></div>
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<!--[if !supportLists]--><b><span lang="IN">e.<span style="font-size: 7pt; font-weight: normal; line-height: normal;"> </span></span></b><!--[endif]--><b><span lang="IN">Gejala klinik<o:p></o:p></span></b></div>
<div style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 0in; margin-right: 0in; margin-top: 0in; text-indent: 27pt;">
<span lang="IN">Gejala abses
septum nasi adalah hidung tersumbat progresif disertai dengan rasa nyeri hebat,
terutama terasa di puncak hidung. Juga tedapat keluhan demam dan sakit kepala.</span><sup><o:p></o:p></sup></div>
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<span lang="IN">Obstruksi umumnya
satu sisi setelah beberapa hari karena nekrose kartigalo pus mengalir ke sisi
lain menyebabkan obstruksi nasi bilateral dan total. Dengan adanya proses
supurasi tersebut akan terjadi penumpukan pus yang semakin lama semakin
bertambah banyak sehingga mengakibatkan terjadinya pembengkakan septum yang
bertambah besar. Biasanya pasien mengeluh hidungnya bertambah besar.</span><sup><o:p></o:p></sup></div>
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<!--[if !supportLists]--><b>f.<span style="font-size: 7pt; font-weight: normal; line-height: normal;"> </span></b><!--[endif]--><b><span lang="IN">Pemeriksaan</span><o:p></o:p></b></div>
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<!--[if !supportLists]--><span lang="IN">1.<span style="font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="IN">Inspeksi<o:p></o:p></span></div>
<div style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 0.25in; margin-right: 0in; margin-top: 0in;">
<span lang="IN">Tampak hidung bagian luar (apex nasi) yang
hiperemi, oedem, dan kulit mengkilat.<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="IN">2.<span style="font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="IN">Palpasi<o:p></o:p></span></div>
<div style="line-height: 150%; margin-bottom: .0001pt; margin: 0in; text-indent: .25in;">
<span lang="IN">Didapatkan nyeri pada sentuhan<o:p></o:p></span></div>
<div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: .25in; margin-right: 0in; margin-top: 0in; mso-list: l1 level1 lfo1; tab-stops: list .25in; text-indent: -.25in;">
<!--[if !supportLists]--><span lang="IN">3.<span style="font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="IN">Rhinoskopi
anterior<o:p></o:p></span></div>
<div style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 0.25in; margin-right: 0in; margin-top: 0in;">
<span lang="IN">Pembengkakan pada septum nasi berwarna merah
keabu-abuan berbentuk bulat pada satu atau kedua rongga hidung, terutama
mengenai bagian paling depan tulang rawan septum. Ppada perabaan terdapat nyeri
tekan, terasa lunak, dan pada pemberian kapas yang dibasahi dengan solutio
tetrakain efedrin 1%, pembengkakan tersebut tidak mengempis.<o:p></o:p></span></div>
<div style="line-height: 150%; margin-bottom: .0001pt; margin: 0in;">
<br /></div>
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<!--[if !supportLists]--><span lang="IN">4.<span style="font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="IN">Pungsi
dan aspirasi<o:p></o:p></span></div>
<div style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 0.25in; margin-right: 0in; margin-top: 0in;">
<span lang="IN">Tindakan ini berguna untuk membantu menegakkan
diagnosis, pemeriksaan kultur, selain itu juga dapat mengurangi tekanan dalam
abses dan mencegah terjadinya infeksi intrakranial.</span><o:p></o:p></div>
<div style="line-height: 150%; margin-bottom: .0001pt; margin: 0in;">
<br /></div>
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<!--[if !supportLists]--><b><span lang="IN">g.<span style="font-size: 7pt; font-weight: normal; line-height: normal;"> </span></span></b><!--[endif]--><b><span lang="IN">Pemeriksaan penunjang<o:p></o:p></span></b></div>
<div style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 0in; margin-right: 0in; margin-top: 0in; text-indent: 27pt;">
<span lang="IN"><br />Abses septum nasi memiliki penampakan yang khas
pada pemeriksaan CT-Scan sebagai akumulasi cairan dengan peninggian pinggiran
yang tipis yang melibatkan septum nasi. Hasil pemeriksaan CT-scan pada abses
septum nasi adalah kumpulan cairan yang berdinding tipis dengan perubahan
peradangan di daerah sekitarnya, sama dengan yang terlihat pada abses di bagian
tubuh yang lain.<o:p></o:p></span></div>
<div align="center" style="line-height: 150%; margin-bottom: .0001pt; margin: 0in; text-align: center;">
<b><br /></b></div>
<div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: .5in; margin-right: 0in; margin-top: 0in; mso-list: l5 level1 lfo6; text-indent: -.25in;">
<!--[if !supportLists]--><b><span lang="IN">h.<span style="font-size: 7pt; font-weight: normal; line-height: normal;"> </span></span></b><!--[endif]--><b><span lang="IN">Penegakan diagnosis<o:p></o:p></span></b></div>
<div style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 0in; margin-right: 0in; margin-top: 0in; text-indent: 27pt;">
<span lang="IN">Diagnosis abses septum ditegakkan apabila terdapat riwayat trauma,
riwayat operasi atau infeksi intranasal. Kebanyakan abses septum disebabkan
oleh trauma yang kadang-kadang tidak disadari oleh penderita.2,6 Diagnosa abses
septum dapat ditegakkan berdasarkan gejala dan tanda klinis berupa obstruksi
nasi bilateral yang parah dengan rasa nyeri di hidung. Pada pasien juga dapat
ditemukan adanya demam dan menggigil serta nyeri kepala di bagian frontal.
Diagnosis pasti adalah dijumpai adanya nanah pada aspirasi abses.<o:p></o:p></span></div>
<div style="line-height: 150%; margin-bottom: .0001pt; margin: 0in;">
<br /></div>
<div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: .5in; margin-right: 0in; margin-top: 0in; mso-list: l5 level1 lfo6; text-indent: -.25in;">
<!--[if !supportLists]--><b><span lang="IN">i.<span style="font-size: 7pt; font-weight: normal; line-height: normal;">
</span></span></b><!--[endif]--><b><span lang="IN">Diagnosis banding<o:p></o:p></span></b></div>
<div style="line-height: 150%; margin-bottom: .0001pt; margin: 0in;">
<span lang="IN">Hematoma septum, Septum
deviasi, Furunkulosis dan Vestibulitis</span></div>
<div style="line-height: 150%; margin-bottom: .0001pt; margin: 0in;">
<span lang="IN"><br /></span></div>
<div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: .5in; margin-right: 0in; margin-top: 0in; mso-list: l5 level1 lfo6; text-indent: -.25in;">
<!--[if !supportLists]--><b><span lang="IN">j.<span style="font-size: 7pt; font-weight: normal; line-height: normal;">
</span></span></b><!--[endif]--><b><span lang="IN">Penatalaksanaan</span></b><span lang="IN"><o:p></o:p></span></div>
<div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: .5in; margin-right: 0in; margin-top: 0in; mso-list: l2 level2 lfo2; tab-stops: list .5in; text-indent: -.25in;">
<!--[if !supportLists]--><span lang="IN">1.<span style="font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="IN">Insisi<o:p></o:p></span></div>
<div style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 0.25in; margin-right: 0in; margin-top: 0in; text-indent: 0.25in;">
<span lang="IN">Insisi dapat dilakukan dengan anestasi
lokal atau anestasi umum. Incisi di buat vertikal pada daerah yang paling
berfluktuasi. Incisi abses dapat unilateral atau bilateral, kemudian dilakukan
evakuasi pus, bekuan darah, jaringan nekrotik dan jaringan granulasi sampai
bersih, kemudian dilanjutkan dengan pemasangan drain. Drain dipertahankan
sampai 2-3 hari, jika drain masih diperlukan dapat dipertahankan.</span><o:p></o:p></div>
<div style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 0.25in; margin-right: 0in; margin-top: 0in; text-indent: 0.25in;">
<br /></div>
<div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: .5in; margin-right: 0in; margin-top: 0in; mso-list: l4 level2 lfo3; tab-stops: list .5in; text-indent: -.25in;">
<!--[if !supportLists]--><span lang="IN">2.<span style="font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="IN">Dipasang
Tampon<o:p></o:p></span></div>
<div style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 0.25in; margin-right: 0in; margin-top: 0in; text-indent: 0.25in;">
<span lang="IN">Pada kedua rongga hidung dipasang tampon
anterior setelah dilakukan incisi dan pemasangan drain, tampon anterior tiap
hari diganti, dan dipertahankan selama 2 sampai 3 hari. Bila pus masih ada luka
dibuka lagi.</span><o:p></o:p></div>
<div style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 0.25in; margin-right: 0in; margin-top: 0in; text-indent: 0.25in;">
<br /></div>
<div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: .5in; margin-right: 0in; margin-top: 0in; mso-list: l0 level2 lfo4; tab-stops: list .5in; text-indent: -.25in;">
<!--[if !supportLists]--><span lang="IN">3.<span style="font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="IN">Pemberian
Antibiotik<o:p></o:p></span></div>
<div style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 0.25in; margin-right: 0in; margin-top: 0in; text-indent: 0.25in;">
<span lang="IN">Antibiotik spektrum
luas untuk gram positif dan gram negatif, serta kuman anaerob dapat diberikan
secara parenteral. Sebelum diperoleh hasil kultur dan tes resistensi dianjurkan
untuk pemberian preparat penicillin IV dan kloramfenikol IV, serta terapi
terhadap kuman anaerob. Pada kasus tanpa komplikasi, terapi antibiotik
parenteral diberikan selama 3 sampai 5 hari dan dilanjutkan dengan pemberian
oral selama 7-10 hari kemudian.</span><o:p></o:p></div>
<div style="line-height: 150%; margin-bottom: .0001pt; margin: 0in;">
<br /></div>
<div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: .5in; margin-right: 0in; margin-top: 0in; mso-list: l5 level1 lfo6; text-indent: -.25in;">
<!--[if !supportLists]--><b><span lang="IN">k.<span style="font-size: 7pt; font-weight: normal; line-height: normal;"> </span></span></b><!--[endif]--><b><span lang="IN">Komplikasi<o:p></o:p></span></b></div>
<div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: .25in; margin-right: 0in; margin-top: 0in; mso-list: l3 level1 lfo5; tab-stops: list .25in; text-indent: -.25in;">
<!--[if !supportLists]--><span lang="IN">1.<span style="font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="IN"> </span><span lang="IN">Nekrosis Kartilago<o:p></o:p></span></div>
<div style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 22.5pt; margin-right: 0in; margin-top: 0in;">
<span lang="IN">Abses septum nasi dapat menyebabkan komplikasi
estetis berupa deformitas hidung (lorgnet nose) yang disebabkan oleh karena
nekrose kartilago sehingga terjadi kerusakan sebagian besar jaringan penyokong
bagian bawah hidung.</span><o:p></o:p></div>
<div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: .25in; margin-right: 0in; margin-top: 0in; mso-list: l3 level1 lfo5; tab-stops: list .25in; text-indent: -.25in;">
<!--[if !supportLists]--><span lang="IN">2.<span style="font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--> <span lang="IN">Perforasi septum nasi<o:p></o:p></span></div>
<div style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 22.5pt; margin-right: 0in; margin-top: 0in;">
<span lang="IN">Perforasi septum nasi yang disebabkan oleh karena
abses dapat menyebabkan terjadinya kavitas yang kemudian diisi jaringan ikat
sehingga menyebabkan terjadinya retraksi, jaringan parut, yang kemudian
menyebabkan terjadinya retraksi columela.</span><sup><o:p></o:p></sup></div>
<div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: .25in; margin-right: 0in; margin-top: 0in; mso-list: l3 level1 lfo5; tab-stops: list .25in; text-indent: -.25in;">
<!--[if !supportLists]--><span lang="IN">3.<span style="font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="IN">Infeksi
Intrakranial <o:p></o:p></span></div>
<div style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 0.25in; margin-right: 0in; margin-top: 0in;">
<span lang="IN">Komplikasi Intrakranial dapat berlangsung melalui
berbagai jalan yakni melalui saluran limfatik memasuki sirkulasi sistemik dan
kemudian masuk ke meningen ataupun melalui seluruh perineural pada lamina cribosa
dan area olfaktori sehingga menyebabkan komplikasi meningitis. Selain itu dapat
timbul pula trombosis sinus kavernosus dan sepsis.<o:p></o:p></span></div>
<div style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 0.25in; margin-right: 0in; margin-top: 0in;">
<span lang="IN"><br /></span></div>
<div style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 0.25in; margin-right: 0in; margin-top: 0in;">
<span lang="IN"></span></div>
<div align="center" class="MsoBodyText" style="line-height: 150%; text-align: center;">
<b>DAFTAR
PUSTAKA<o:p></o:p></b></div>
<div align="center" class="MsoBodyText" style="line-height: 150%; text-align: center;">
<br /></div>
<div class="MsoBodyTextIndent" style="margin-left: .25in; mso-list: l0 level1 lfo1; tab-stops: list .25in; text-indent: -.25in;">
<!--[if !supportLists]-->1.<span style="font-size: 7pt; line-height: normal;">
</span><!--[endif]-->Soepardi EA. Iskandar HN. Editor. Buku ajar ilmu
kesehatan telinga-hidung-tenggorok. Edisi 5. Penerbit Fakultas Kedokteran <st1:place w:st="on"><st1:country-region w:st="on">Indonesia</st1:country-region></st1:place>.
2005. 100-101<o:p></o:p></div>
<div class="MsoBodyTextIndent" style="margin-left: .25in; mso-list: l0 level1 lfo1; tab-stops: list .25in; text-indent: -.25in;">
<!--[if !supportLists]-->2.<span style="font-size: 7pt; line-height: normal;">
</span><!--[endif]-->Adams GL. Boies LR, Jr. Highler PA. Boies Buku Ajar
THT. <span lang="IT">Edisi 6. Effendi H. Santoso
RAK. </span>Editor. Penerbit Buku Kedokteran EGC. 1993. 174-175.<o:p></o:p></div>
<div class="MsoBodyTextIndent" style="margin-left: .25in; mso-list: l0 level1 lfo1; tab-stops: list .25in; text-indent: -.25in;">
<!--[if !supportLists]-->3.<span style="font-size: 7pt; line-height: normal;">
</span><!--[endif]-->Becker W. Clinical Aspects of Diseases of The Nose. In:
Ear, Nose and Throat Diseases, A Pocket Reference. 2<span style="font-size: 7.0pt; line-height: 150%;">nd </span>Ed. New York: Thieme Medical Pub Inc., 1994<o:p></o:p></div>
<div class="MsoBodyTextIndent" style="margin-left: .25in; mso-list: l0 level1 lfo1; tab-stops: list .25in; text-indent: -.25in;">
<!--[if !supportLists]-->4.<span style="font-size: 7pt; line-height: normal;">
</span><!--[endif]-->Collman BH. Diseases of the Nasal Septum. In: Hall and
Colman’s, Diseases of The Nose, Throat and Ear, and Head and Neck. 14<span style="font-size: 7.0pt; line-height: 150%;">th </span>Ed. Singapore: ELBS with
Churchill Livingstone, 1992: 19-20.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<br />
<div style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 0.25in; margin-right: 0in; margin-top: 0in;">
<span lang="IN"><br /></span></div>
<br />Anonymoushttp://www.blogger.com/profile/06590633769759394496noreply@blogger.com0tag:blogger.com,1999:blog-5853367347201739175.post-15739861914744182592012-06-07T23:42:00.002-07:002012-06-07T23:42:38.787-07:00Tatalaksana Serumen Plug<br />
<div align="center" class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; text-align: center;">
<b><span style="font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 150%;">BAHAN 1</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;"><o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify;">
<span style="background: white; color: #29303b; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Penatalaksanaan
disesuaikan dengan konsistensi serumen. <o:p></o:p></span></div>
<div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: .25in; margin-right: 0in; margin-top: 0in; mso-add-space: auto; mso-list: l1 level1 lfo1; text-align: justify; text-indent: -.25in;">
<!--[if !supportLists]--><span style="color: #29303b; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">1.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span style="background: white; color: #29303b; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Jika
serumen lembek hanya dibersihkan dengan kapas yang dililitkan pada aplikator.
Serumen yang sudah keras dikeluarkan dengan cara dikait dengan alat pengait. <o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: .25in; margin-right: 0in; margin-top: 0in; mso-add-space: auto; mso-list: l1 level1 lfo1; text-align: justify; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">2.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="background: white; color: #29303b; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Serumen yang terlalu dalam (mendekati membran
timpani), dikeluarkan dengan cara mengirigasi liang telinga.<sup> </sup>Pada
serumen yang keras membatu sebelum dikeluarkan harus dilembekkan terlebih
dahulu dengan karbol gliserin 10% tiga kali tiga tetes sehari, selama tiga
sampai lima hari, setelah itu dikait dengan alat pengait atau diirigasi jika
serumen telah terdorong jauh kedalam liang telinga.</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;"><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: .25in; margin-right: 0in; margin-top: 0in; mso-add-space: auto; text-align: justify;">
<br /></div>
<div align="center" class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; text-align: center;">
<b><span style="font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 150%;">BAHAN 2</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;"><o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify;">
<b><span style="color: #222222; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Penatalaksanaan</span></b><span style="color: #222222; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 150%; margin-bottom: .0001pt; margin: 0in; mso-list: l3 level1 lfo2; tab-stops: list .5in; text-align: justify; text-indent: 0in;">
<!--[if !supportLists]--><span style="color: #222222; font-family: Symbol; font-size: 10.0pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><b><span style="color: #222222; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Serumen cair</span></b><span style="color: #222222; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">. Bila serumen sedikit, bersihkan dengan kapas yang
dililitkan pada pelilit kapas atau disedot dengan pompa penghisap.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 150%; margin-bottom: .0001pt; margin: 0in; mso-list: l3 level1 lfo2; tab-stops: list .5in; text-align: justify; text-indent: 0in;">
<!--[if !supportLists]--><span style="color: #222222; font-family: Symbol; font-size: 10.0pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><b><span style="color: #222222; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Serumen lunak</span></b><span style="color: #222222; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">. Bila serumen banyak dan tidak ada
riwayat perforasi membran timpani, lakukan irigasi liang telinga dengan larutan
permanganat 1/1000 suhu larutan sesuai suhu tubuh. Bila ada riwayat
perforasi membran timpani, maka tidak dapat dilakukan irigasi. Bersihkan
serumen dengan kapas yang dililitkan pada pelilit kapas.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 150%; margin-bottom: .0001pt; margin: 0in; mso-list: l3 level1 lfo2; tab-stops: list .5in; text-align: justify; text-indent: 0in;">
<!--[if !supportLists]--><span style="color: #222222; font-family: Symbol; font-size: 10.0pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><b><span style="color: #222222; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Serumen liat</span></b><span style="color: #222222; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">. Dikait dengan pengit serumen, apabila tidak berhasil
lakukan irigasi dengan syarat tidak ada perforasi membrana timpani.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 150%; margin-bottom: .0001pt; margin: 0in; mso-list: l3 level1 lfo2; tab-stops: list .5in; text-align: justify; text-indent: 0in;">
<!--[if !supportLists]--><span style="color: #222222; font-family: Symbol; font-size: 10.0pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><b><span style="color: #222222; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Serumen keras dan padat</span></b><span style="color: #222222; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">. Apabila serumen berukuran besar dan
menyumbat liang telinga, lunakkan terlebih dahulu dengan meneteskan
karboliserin 10% selama 3 hari, kemudian keluarkan dengan pengait atau
dilakukan irigasi.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify;">
<br /></div>
<div align="center" class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; text-align: center;">
<b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">BAHAN
3<o:p></o:p></span></b></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in;">
<b><span style="background: white; color: #333333; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Penatalaksanaan<o:p></o:p></span></b></div>
<div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; mso-add-space: auto; mso-list: l2 level1 lfo4; text-indent: -.25in;">
<!--[if !supportLists]--><span style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">1.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span style="background: white; color: #333333; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Serumen
yang masih lunak, dapat dibersihkan dengan kapas yang dililitkan oleh aplikator
(pelilit).<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; mso-add-space: auto; mso-list: l2 level1 lfo4; text-indent: -.25in;">
<!--[if !supportLists]--><span style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">2.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span style="background: white; color: #333333; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Serumen
yang sudah agak mengeras dikait dan dibersihkan dengan alat pengait.<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; mso-add-space: auto; mso-list: l2 level1 lfo4; text-indent: -.25in;">
<!--[if !supportLists]--><span style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">3.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span style="background: white; color: #333333; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Serumen
yang lembek dan letaknya terlalu dalam, sehingga mendekati mebran timpani,
dapat dikeluarkan dengan mengirigasi liang telinga (spooling).<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; mso-add-space: auto; mso-list: l2 level1 lfo4; text-indent: -.25in;">
<!--[if !supportLists]--><span style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">4.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span style="background: white; color: #333333; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Serumen
yang telah keras membatu, harus dilembekkan terlebih dahulu dengan karbol
gliserin 10 %, 3 kali 3 tetes sehari, selama 2-5 hari (tergantung keperluan),
setelah itu dibersihkan dengan alat pengait atau diirigasi (spooling).<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in;">
<b><span style="background: white; color: #333333; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Teknik Irigasi Liang Telinga</span></b><span style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;"><br />
<span style="background: white;">Dalam melakukan tindakan irigasi liang telinga
(spooling) ada beberapa hal yang harus diketahui dan diperhatikan oleh tenaga
medis sebelum melakukan tindakan tersebut, antara lain :</span><br />
<span style="background: white;">• Pasien tidak mempunyai riwayat sakit telinga
yang menyebabkan rupture gendang telinga, <o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="background: white; color: #333333; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;"> seperti
riwayat congekan (OMSK), maupun riwayat trauma gendang telinga.</span><span style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;"><br />
<span style="background: white;">• Pasien tidak sedang mengalami sakit telinga
luar (otitis eksterna).<o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in;">
<b><span style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;"><br />
<span style="background: white;">Prosedur Tindakan Spooling (Irigasi) telinga
adalah :</span></span></b><span style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;"><br />
<b><span style="background: white;">A.
Persiapan Alat :</span></b><br />
<span style="background: white;">1. Alat Spooling atau Spuit 20 cc.</span><br />
<span style="background: white;">2. Kom berisi air hangat kuku secukupnya.</span><br />
<span style="background: white;">3. Bak Bengkok untuk menampung kotoran telinga.</span><br />
<span style="background: white;">4. Handuk sebagai alas pelindung .</span><br />
<span style="background: white;">5. Sarung tangan disposable.</span><br />
<span style="background: white;">6. Otoscope</span><br />
<span style="background: white;">7. Cotton bud secukupnya.</span><br />
<span style="background: white;">8. Cairan NaCl hangat atau air hangat.</span><br />
<span style="background: white;">9. Cairan H2O2 3 % dalam tempatnya.</span><br />
<b><span style="background: white;">B.
Persiapan pasien :</span></b><br />
<span style="background: white;">1. Jelaskan kepada pasien mengenai tindakan yang
akan dilakukan (inform consent), dan minta <o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="background: white; color: #333333; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;"> kepada
pasien agar bersikap kooperatif.</span><span style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;"><br />
<span style="background: white;">2. Posisikan pasien dengan terlentang dan kepala
miring ke sisi berlawanan dengan telinga yang <o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="background: white; color: #333333; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;"> akan
dibersihkan.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="background: white; color: #333333; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;"> </span><span style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;"><br />
<b><span style="background: white;">3.
Tindakan</span></b><br />
<span style="background: white;">a. Tetesi telinga pasien dengan H2O2 3 % (jika
masih ada yang keras), tunggu sampai kotoran <o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="background: white; color: #333333; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;"> hancur
atau larut kira-kira 10 – 15 menit.</span><span style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;"><br />
<span style="background: white;">b. Tempatkan bak bengkok dibawah telinga yang
dibersihkan, dan beri alas handuk untuk <o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="background: white; color: #333333; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;"> mencegah
tetesan air mengenai pasien.</span><span style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;"><br />
<span style="background: white;">c. Perintahkan pasien agar bangun dan duduk
tegak</span><br />
<span style="background: white;">d. Semprot telinga pasien dengan Cairan NaCl
hangat secara perlahan sampai telinga bersih.</span><br />
<span style="background: white;">e. Eksplorasi dengan otoscope.<o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in;">
<b><span style="background: white; color: #333333; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Pustaka</span></b><span style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;"><o:p></o:p></span></div>
<div class="MsoListParagraph" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 22.5pt; margin-right: 0in; margin-top: 0in; mso-add-space: auto; mso-list: l0 level1 lfo3; text-indent: -.25in;">
<!--[if !supportLists]--><b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">1.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-weight: normal; line-height: normal;">
</span></span></b><!--[endif]--><span style="background: white; color: #333333; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Iskandar,
H. Nurbaiti. Sumbatan Seruman. Dalam: Soepardi, dr. Efiaty Arsyad; Hadjzt, dr.
Fachri; Iskandar, prof. dr. Nurbaiti (editor). Penatalaksanaan penyakit dan
kelainan Telinga Hidung Tenggorok. Edisi ketiga. Jakarta, Balai penerbit FKUI,
2003: 33-34.</span><b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;"><o:p></o:p></span></b></div>Anonymoushttp://www.blogger.com/profile/06590633769759394496noreply@blogger.com0tag:blogger.com,1999:blog-5853367347201739175.post-67562008059928877822012-06-07T23:40:00.001-07:002012-06-07T23:40:24.830-07:00KARSINOMA NASOFARING (KNF)<br />
<div class="WordSection1">
<div align="center" class="MsoNormal" style="margin-bottom: 6pt; text-align: center;">
<span style="font-family: 'Times New Roman', serif;"><br /></span></div>
<div align="right" class="MsoNormal" style="margin-bottom: 6pt; text-align: right;">
<span style="font-family: "Times New Roman","serif"; mso-bidi-font-size: 12.0pt;">Ashadi
Oktavian S,Ked<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 6pt; text-align: justify;">
<br /></div>
<div class="MsoListParagraphCxSpFirst" style="margin-bottom: 6pt; text-align: justify; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: "Times New Roman","serif"; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">1.<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; mso-bidi-font-size: 12.0pt;">DEFINISI<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-bottom: 6pt; text-align: justify; text-indent: 0.5in;">
<span style="font-family: "Times New Roman","serif"; mso-bidi-font-size: 12.0pt;">Karsinoma
adalah pertumbuhan baru yang ganas terdiri dari sel-sel epithelial yang
cenderung menginfiltrasi jaringan sekitarnya dan menimbulkan metastasis.<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-bottom: 6pt; text-align: justify; text-indent: 0.5in;">
<span style="font-family: "Times New Roman","serif"; mso-bidi-font-size: 12.0pt;">Karsinoma
Nasofaring (KNF) merupakan tumor ganas yang timbul pada epithelial pelapis
ruangan dibelakang hidung (nasofaring).<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-bottom: 6pt; text-align: justify; text-indent: 0.5in;">
<span style="font-family: "Times New Roman","serif"; mso-bidi-font-size: 12.0pt;">KNF
meningkat setelah umur 30 tahun, dan puncaknya pada umur 40-59 tahun. pria
disbanding wanita dengan rasio 2-3:1<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-bottom: 6pt; text-align: justify; text-indent: 0.5in;">
<span style="font-family: "Times New Roman","serif"; mso-bidi-font-size: 12.0pt; mso-no-proof: yes;"><v:shapetype coordsize="21600,21600" filled="f" id="_x0000_t75" o:preferrelative="t" o:spt="75" path="m@4@5l@4@11@9@11@9@5xe" stroked="f">
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</v:imagedata></v:shape></span><span style="font-family: "Times New Roman","serif"; mso-bidi-font-size: 12.0pt;"><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-bottom: 6pt; text-align: justify; text-indent: 0.5in;">
<br /></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-bottom: 6pt; text-align: justify; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: "Times New Roman","serif"; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">2.<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman","serif"; mso-ansi-language: IN; mso-bidi-font-size: 12.0pt;">ETIOLOGI</span><span style="font-family: "Times New Roman","serif"; mso-bidi-font-size: 12.0pt;"><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-bottom: 6pt; margin-left: 0.75in; margin-right: 0in; margin-top: 0in; text-align: justify; text-indent: -0.25in;">
<!--[if !supportLists]-->a.<span style="font-size: 7pt;">
</span><!--[endif]--><span style="font-family: "Times New Roman","serif"; mso-bidi-font-size: 12.0pt;">Infeksi EBV (Virus Epstein-Barr)<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-bottom: 6pt; margin-left: 0.75in; margin-right: 0in; margin-top: 0in; text-align: justify; text-indent: -0.25in;">
<!--[if !supportLists]-->b.<span style="font-size: 7pt;">
</span><!--[endif]--><span style="font-family: "Times New Roman","serif"; mso-bidi-font-size: 12.0pt;">Faktor lingkungan </span><span style="font-family: Wingdings; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-size: 12.0pt; mso-char-type: symbol; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Wingdings;">à</span><span style="font-family: "Times New Roman","serif"; mso-bidi-font-size: 12.0pt;"> asap
kayu, kadar nikel dalam air minum<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-bottom: 6pt; margin-left: 0.75in; margin-right: 0in; margin-top: 0in; text-align: justify; text-indent: -0.25in;">
<!--[if !supportLists]-->c.<span style="font-size: 7pt;">
</span><!--[endif]--><span style="font-family: "Times New Roman","serif"; mso-bidi-font-size: 12.0pt;">Genetik </span><span style="font-family: Wingdings; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-size: 12.0pt; mso-char-type: symbol; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Wingdings;">à</span><span style="font-family: "Times New Roman","serif"; mso-bidi-font-size: 12.0pt;"> ras mogoloid<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-bottom: 6pt; margin-left: 0.75in; margin-right: 0in; margin-top: 0in; text-align: justify; text-indent: -0.25in;">
<!--[if !supportLists]-->d.<span style="font-size: 7pt;">
</span><!--[endif]--><span style="font-family: "Times New Roman","serif"; mso-bidi-font-size: 12.0pt;">Bahan pengawet </span><span style="font-family: Wingdings; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-size: 12.0pt; mso-char-type: symbol; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Wingdings;">à</span><span style="font-family: "Times New Roman","serif"; mso-bidi-font-size: 12.0pt;">
nitrosamin<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-bottom: 6pt; margin-left: 0.75in; margin-right: 0in; margin-top: 0in; text-align: justify; text-indent: -0.25in;">
<!--[if !supportLists]-->e.<span style="font-size: 7pt;">
</span><!--[endif]--><span style="font-family: "Times New Roman","serif"; mso-bidi-font-size: 12.0pt;">Jenis kelamin </span><span style="font-family: Wingdings; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-size: 12.0pt; mso-char-type: symbol; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Wingdings;">à</span><span style="font-family: "Times New Roman","serif"; mso-bidi-font-size: 12.0pt;"> laki-laki</span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-bottom: 6pt; margin-left: 0.75in; margin-right: 0in; margin-top: 0in; text-align: justify; text-indent: -0.25in;">
<span style="font-family: "Times New Roman","serif"; mso-bidi-font-size: 12.0pt;"><br /></span></div>
<div class="MsoListParagraphCxSpFirst" style="margin-bottom: 6pt; text-align: justify; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: "Times New Roman","serif"; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">4.<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; mso-bidi-font-size: 12.0pt;">KLASIFIKASI<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpLast" style="margin-bottom: 6pt; text-align: justify; text-indent: 0.25in;">
<!--[if !supportLists]--><span style="font-family: "Times New Roman","serif"; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">a.<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; mso-bidi-font-size: 12.0pt;">Bentuk ulseratif<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 6pt; margin-left: 0.5in; margin-right: 0in; margin-top: 0in; text-align: justify; text-indent: 0.5in;">
<span style="font-family: "Times New Roman","serif"; mso-bidi-font-size: 12.0pt;">Bentuk
ini paling sering terdapat pada dinding posterior dan di daerah sekitar fosa
rosenmulleri. Juga dapat ditemukan pada dinding lateral didepan tuba eustachius
dan pada bagian atap nasofaring. Lesi ini biasanya lebih kecil disertai dengan
jaringan yang nekrotik dan sangat mudah mengadakan infiltrasi ke jaringan sekitarnya.
Gambaran histopatologik bentuk ini adalah karsinoma sel skuamosa deengan
diferensiasi baik.<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-bottom: 6pt; text-align: justify; text-indent: 0.25in;">
<!--[if !supportLists]--><span style="font-family: "Times New Roman","serif"; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">b.<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; mso-bidi-font-size: 12.0pt;">Bentuk
noduler/lubuler/proliferative <o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 6pt; margin-left: 0.5in; margin-right: 0in; margin-top: 0in; text-align: justify; text-indent: 0.5in;">
<span style="font-family: "Times New Roman","serif"; mso-bidi-font-size: 12.0pt;">Bentuk
noduler atau lobuler sangat sering dijumpai pada daerah sekitar muara tuba eustachius.
Tumor jenis ini berbentuk seperti buah angguratau polipoid jarang, dijumpai adanya
ulserasi, namun kadang-kadang dijumpai ulserasi kecil. Gambaran histopatologik bentuk
ini biasanya karsinoma tanpa diferensiasi.<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-bottom: 6pt; text-align: justify; text-indent: 0.25in;">
<!--[if !supportLists]--><span style="font-family: "Times New Roman","serif"; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">c.<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; mso-bidi-font-size: 12.0pt;">Bentuk
eksofitik<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 6pt; margin-left: 0.5in; margin-right: 0in; margin-top: 0in; text-align: justify; text-indent: 0.5in;">
<span style="font-family: "Times New Roman","serif"; mso-bidi-font-size: 12.0pt;">Bentuk
eksofitik biasanya tumbuh pada satu sisi nasofaring, tidak dijumpai adanya ulserasi,
kadang-kadang bertangkai dan prmukaannya licin. Tumor jenis ini biasanya tumbuh
dari atap nasofaring dan dapat mengisi seluruh rongga nasofaring. Tumor ini dapat
mendorong palatum mole ke bawah dan tumbuh kearah koana dan masuk ke dalam rongga
hidung. Gambaran histopatologik berupa limfasarkoma<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpFirst" style="margin-bottom: 6pt; text-align: justify;">
<br /></div>
<div class="MsoListParagraphCxSpLast" style="margin-bottom: 6pt; text-align: justify; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: "Times New Roman","serif"; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">5.<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; mso-bidi-font-size: 12.0pt;">DIAGNOSIS<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 6pt; text-align: justify; text-indent: 0.5in;">
<span style="font-family: "Times New Roman","serif"; mso-bidi-font-size: 12.0pt;">Trias KNF<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpFirst" style="margin-bottom: 6pt; margin-left: 0.75in; margin-right: 0in; margin-top: 0in; text-align: justify; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: "Times New Roman","serif"; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">a.<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; mso-bidi-font-size: 12.0pt;">Tumor colli </span><span style="font-family: Wingdings; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-size: 12.0pt; mso-char-type: symbol; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Wingdings;">à</span><span style="font-family: "Times New Roman","serif"; mso-bidi-font-size: 12.0pt;">
benjolan di leher<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-bottom: 6pt; margin-left: 0.75in; margin-right: 0in; margin-top: 0in; text-align: justify; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: "Times New Roman","serif"; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">b.<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; mso-bidi-font-size: 12.0pt;">Gangguan Telinga </span><span style="font-family: Wingdings; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-size: 12.0pt; mso-char-type: symbol; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Wingdings;">à</span><span style="font-family: "Times New Roman","serif"; mso-bidi-font-size: 12.0pt;">
tinnitus, sakit telinga, gangguan pendengaran<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpLast" style="margin-bottom: 6pt; margin-left: 0.75in; margin-right: 0in; margin-top: 0in; text-align: justify; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: "Times New Roman","serif"; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">c.<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; mso-bidi-font-size: 12.0pt;">Gangguan Hidung </span><span style="font-family: Wingdings; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-size: 12.0pt; mso-char-type: symbol; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Wingdings;">à</span><span style="font-family: "Times New Roman","serif"; mso-bidi-font-size: 12.0pt;">
Epistaksis, hidung tersumbat<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 6pt; text-align: justify; text-indent: 27pt;">
<span style="font-family: "Times New Roman","serif"; mso-bidi-font-size: 12.0pt;">Jadi, Anamnesis KNF:<o:p></o:p></span></div>
</div>
<span style="font-family: "Times New Roman","serif"; font-size: 11.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-fareast;"><br clear="all" style="mso-break-type: section-break; page-break-before: auto;" />
</span>
<div class="WordSection2">
<div class="MsoNormal" style="margin-bottom: 6pt; margin-left: 9pt; margin-right: 0in; margin-top: 0in; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; mso-bidi-font-size: 12.0pt;">Mimisan,
Hidung tersumbat, Kuping berdenging, Sakit telinga, Pendengaran berkurang, Penglihatan
ganda, Sakit kepala, Mual muntah, Kejang, Demam<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpFirst" style="margin-bottom: 6pt; margin-left: 27pt; margin-right: 0in; margin-top: 0in; text-align: justify; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; mso-bidi-font-size: 12.0pt;">BB ↓<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-bottom: 6pt; margin-left: 27pt; margin-right: 0in; margin-top: 0in; text-align: justify; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; mso-bidi-font-size: 12.0pt;">Sakit menelan<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpLast" style="margin-bottom: 6pt; margin-left: 27pt; margin-right: 0in; margin-top: 0in; text-align: justify; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; mso-bidi-font-size: 12.0pt;">Nyeri di wajah<o:p></o:p></span></div>
</div>
<span style="font-family: "Times New Roman","serif"; font-size: 11.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-fareast;"><br clear="all" style="mso-break-type: section-break; page-break-before: auto;" />
</span>
<div class="WordSection3">
</div>
<span style="font-family: "Times New Roman","serif"; font-size: 11.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-fareast;"><br clear="all" style="mso-break-type: section-break; page-break-before: auto;" />
</span>
<div class="MsoNormal" style="margin-bottom: 6pt; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; mso-bidi-font-size: 12.0pt;">
Pemeriksaan Fisik </span><span style="font-family: Wingdings; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-size: 12.0pt; mso-char-type: symbol; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Wingdings;">à</span><span style="font-family: "Times New Roman","serif"; mso-bidi-font-size: 12.0pt;"> Rhinoskopi posterior </span><span style="font-family: Wingdings; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-size: 12.0pt; mso-char-type: symbol; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Wingdings;">à</span><span style="font-family: "Times New Roman","serif"; mso-bidi-font-size: 12.0pt;"> Tampak massa tumor<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 6pt; margin-left: 27pt; margin-right: 0in; margin-top: 0in; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; mso-bidi-font-size: 12.0pt;">Penunjang
</span><span style="font-family: Wingdings; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-size: 12.0pt; mso-char-type: symbol; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Wingdings;">à</span><span style="font-family: "Times New Roman","serif"; mso-bidi-font-size: 12.0pt;"> Biopsi
dan Patologi Anatomi<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 6pt; margin-left: 27pt; margin-right: 0in; margin-top: 0in; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; mso-bidi-font-size: 12.0pt;">Radiologi
</span><span style="font-family: Wingdings; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-size: 12.0pt; mso-char-type: symbol; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Wingdings;">à</span><span style="font-family: "Times New Roman","serif"; mso-bidi-font-size: 12.0pt;">
CT-scan nasofaring, Ro Thorax, USG Abdomen, Bone survey<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; mso-bidi-font-size: 12.0pt;">Penentuan stadium yang terbaru berdasarkan atas
kesepakatan antara UICC (Union Internationale Contre Cancer) pada tahun 2002
adalah sebagai berikut :<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; mso-bidi-font-size: 12.0pt;">T = Tumor, menggambarkan keadaan tumor primer, besar
dan perluasannya.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt; margin-left: 22.5pt; margin-right: 0in; margin-top: 0in; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; mso-bidi-font-size: 12.0pt;">T0 :
Tidak tampak tumor<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt; margin-left: 22.5pt; margin-right: 0in; margin-top: 0in; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; mso-bidi-font-size: 12.0pt;">T1 :
Tumor terbatas pada 1 lokasi di nasofaring<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt; margin-left: 22.5pt; margin-right: 0in; margin-top: 0in; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; mso-bidi-font-size: 12.0pt;">T2 :
Tumor meluas lebih dari 1 lokasi, tetapi masih di dalam rongga nasofaring<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt; margin-left: 22.5pt; margin-right: 0in; margin-top: 0in; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; mso-bidi-font-size: 12.0pt;">T3 :
Tumor meluas ke kavum nasi dan / atau orofaring<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt; margin-left: 22.5pt; margin-right: 0in; margin-top: 0in; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; mso-bidi-font-size: 12.0pt;">T4 :
Tumor meluas ke tengkorak dan / sudah mengenai saraf otak<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; mso-bidi-font-size: 12.0pt;">N = Nodul, menggambarkan keadaan kelenjar limfe
regional<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt; margin-left: 22.5pt; margin-right: 0in; margin-top: 0in; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; mso-bidi-font-size: 12.0pt;">N0 :
Tidak ada pembesaran kelenjar<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt; margin-left: 22.5pt; margin-right: 0in; margin-top: 0in; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; mso-bidi-font-size: 12.0pt;">N1 :
Terdapat pembesaran kelenjar homolateral yang masih dapat digerakkan<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt; margin-left: 22.5pt; margin-right: 0in; margin-top: 0in; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; mso-bidi-font-size: 12.0pt;">N2 :
Terdapat pembesaran kelenjar kontralateral / bilateral yang masih dapat
digerakkan<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt; margin-left: 22.5pt; margin-right: 0in; margin-top: 0in; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; mso-bidi-font-size: 12.0pt;">N3 :Terdapat
pembesaran kelenjar baik homolateral, kontralateral atau bilateral, yang sudah melekat
pada jaringan sekitar.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; mso-bidi-font-size: 12.0pt;">M = Metastase, menggambarkan metastase jauh<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt; margin-left: 22.5pt; margin-right: 0in; margin-top: 0in; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; mso-bidi-font-size: 12.0pt;">M0 :
Tidak ada metastase jauh<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt; margin-left: 22.5pt; margin-right: 0in; margin-top: 0in; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; mso-bidi-font-size: 12.0pt;">M1 : Metastase jauh<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpFirst" style="margin-bottom: 6pt; text-align: justify; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: "Times New Roman","serif"; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">6.<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; mso-bidi-font-size: 12.0pt;">TATALAKSANA<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-bottom: 6pt; margin-left: 0.75in; margin-right: 0in; margin-top: 0in; text-align: justify; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: "Times New Roman","serif"; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">a.<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; mso-bidi-font-size: 12.0pt;">Rujuk ke Sp.THT-KL<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-bottom: 6pt; margin-left: 0.75in; margin-right: 0in; margin-top: 0in; text-align: justify; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: "Times New Roman","serif"; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">b.<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; mso-bidi-font-size: 12.0pt;">Terapi sesuai stadium<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-bottom: 6pt; margin-left: 67.5pt; margin-right: 0in; margin-top: 0in; text-align: justify; text-indent: -67.5pt;">
<!--[if !supportLists]--><span style="font-family: "Times New Roman","serif"; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"><span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span>i.<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; mso-bidi-font-size: 12.0pt;">Stadium I </span><span style="font-family: Wingdings; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-size: 12.0pt; mso-char-type: symbol; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Wingdings;">à</span><span style="font-family: "Times New Roman","serif"; mso-bidi-font-size: 12.0pt;"> Radioterapi<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-bottom: 6pt; margin-left: 67.5pt; margin-right: 0in; margin-top: 0in; text-align: justify; text-indent: -67.5pt;">
<!--[if !supportLists]--><span style="font-family: "Times New Roman","serif"; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"><span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span>ii.<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; mso-bidi-font-size: 12.0pt;">Stadium II dan III </span><span style="font-family: Wingdings; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-size: 12.0pt; mso-char-type: symbol; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Wingdings;">à</span><span style="font-family: "Times New Roman","serif"; mso-bidi-font-size: 12.0pt;">
Qemoterapi<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-bottom: 6pt; margin-left: 67.5pt; margin-right: 0in; margin-top: 0in; text-align: justify; text-indent: -67.5pt;">
<!--[if !supportLists]--><span style="font-family: "Times New Roman","serif"; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"><span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span>iii.<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; mso-bidi-font-size: 12.0pt;">Stadium IV </span><span style="font-family: Wingdings; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-size: 12.0pt; mso-char-type: symbol; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Wingdings;">à</span><span style="font-family: "Times New Roman","serif"; mso-bidi-font-size: 12.0pt;"> < 6
cm Qemoterapi, > 6 cm Qemoterapi full dose di lanjutkan Qemoradiasi <o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-bottom: 6pt; margin-left: 0.75in; margin-right: 0in; margin-top: 0in; text-align: justify; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: "Times New Roman","serif"; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">c.<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; mso-bidi-font-size: 12.0pt;">Operasi<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-bottom: 6pt; margin-left: 0.75in; margin-right: 0in; margin-top: 0in; text-align: justify;">
<br /></div>
<div class="MsoListParagraphCxSpLast" style="margin-bottom: 6pt; text-align: justify; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: "Times New Roman","serif"; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">7.<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; mso-bidi-font-size: 12.0pt;">PROGNOSIS<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 6pt; margin-left: 0.5in; margin-right: 0in; margin-top: 0in; text-align: justify; text-indent: 0.5in;">
<span style="font-family: "Times New Roman","serif"; mso-bidi-font-size: 12.0pt;">Secara
keseluruhan, angka bertahan hidup 5 tahun adalah 45 %. Prognosis diperburuk
oleh beberapa faktor, seperti :<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 6pt; margin-left: 0.5in; margin-right: 0in; margin-top: 0in; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; mso-bidi-font-size: 12.0pt;">· Stadium yang lebih lanjut.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 6pt; margin-left: 0.5in; margin-right: 0in; margin-top: 0in; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; mso-bidi-font-size: 12.0pt;">· Usia lebih dari 40 tahun<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 6pt; margin-left: 0.5in; margin-right: 0in; margin-top: 0in; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; mso-bidi-font-size: 12.0pt;">· Laki-laki dari pada perempuan<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 6pt; margin-left: 0.5in; margin-right: 0in; margin-top: 0in; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; mso-bidi-font-size: 12.0pt;">· Ras Cina dari pada ras kulit
putih<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 6pt; margin-left: 0.5in; margin-right: 0in; margin-top: 0in; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; mso-bidi-font-size: 12.0pt;">· Adanya pembesaran kelenjar
leher<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 6pt; margin-left: 0.5in; margin-right: 0in; margin-top: 0in; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; mso-bidi-font-size: 12.0pt;">· Adanya kelumpuhan saraf otak
adanya kerusakan tulang tengkorak<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 6pt; margin-left: 0.5in; margin-right: 0in; margin-top: 0in; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; mso-bidi-font-size: 12.0pt;">· Adanya metastasis jauh<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 6pt; margin-left: 0.5in; margin-right: 0in; margin-top: 0in; text-align: justify;">
<br /></div>
<div class="MsoListParagraphCxSpFirst" style="margin-bottom: 6pt; text-align: justify; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: "Times New Roman","serif"; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">8.<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; mso-bidi-font-size: 12.0pt;">KOMPLIKASI<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-bottom: 6pt; margin-left: 0.75in; margin-right: 0in; margin-top: 0in; text-align: justify; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: "Times New Roman","serif"; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">a.<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; mso-bidi-font-size: 12.0pt;">Metastasis </span><span style="font-family: Wingdings; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-size: 12.0pt; mso-char-type: symbol; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Wingdings;">à</span><span style="font-family: "Times New Roman","serif"; mso-bidi-font-size: 12.0pt;"> </span><span lang="IN" style="font-family: "Times New Roman","serif"; mso-ansi-language: IN; mso-bidi-font-size: 12.0pt;">P</span><span style="font-family: "Times New Roman","serif"; mso-bidi-font-size: 12.0pt;">aru, Hepar, Tulang<o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-family: "Times New Roman","serif"; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">b.<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; mso-bidi-font-size: 12.0pt;">Penekanan nn. Craniales </span><span style="font-family: Wingdings; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-size: 12.0pt; mso-char-type: symbol; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Wingdings;">à</span><span style="font-family: "Times New Roman","serif"; mso-bidi-font-size: 12.0pt;">
sindrom unilateral<o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-family: "Times New Roman","serif"; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">c.<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; mso-bidi-font-size: 12.0pt;">Intracranial </span><span style="font-family: Wingdings; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-size: 12.0pt; mso-char-type: symbol; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Wingdings;">à</span><span style="font-family: "Times New Roman","serif"; mso-bidi-font-size: 12.0pt;">
cepalgia<o:p></o:p></span></div>Anonymoushttp://www.blogger.com/profile/06590633769759394496noreply@blogger.com1tag:blogger.com,1999:blog-5853367347201739175.post-1796707991597891092012-06-07T23:36:00.003-07:002012-06-07T23:36:42.133-07:00Manifestasi Sumbatan Benda Asing Jalan Nafas<br />
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<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-size: 9.0pt; mso-fareast-font-family: "Times New Roman";">Gejala sumbatan benda asing di dalam
saluran napas tergantung pada lokasi benda asing, derajat sumbatan (total atau
sebagian), sifat, bentuk dan ukuran benda asing. Benda asing yang masuk melalui
hidung dapat tersangkut di hidung, nasofaring, laring, trakea dan bronkus.
Benda yang masuk melalui mulut dapat tersangkut di orofaring, hipofaring,
tonsil, dasar lidah, sinus piriformis, esofagus atau dapat juga tersedak masuk
ke dalam laring, trakea dan bronkus. <o:p></o:p></span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-size: 9.0pt; mso-fareast-font-family: "Times New Roman";"> Gejala
yang timbul bervariasi, dari tanpa gejala hingga kematian sebelum diberikan
pertolongan akibat sumbatan total. Seseorang yang mengalami aspirasi benda
asing saluran napas akan mengalami 3 stadium. Stadium pertama merupakan gejala
permulaan yaitu batuk-batuk hebat secara tiba-tiba (violent paroxysms of
coughing), rasa tercekik (choking), rasa tersumbat di tenggorok (gagging) dan
obstruksi jalan napas yang terjadi dengan segera. Pada stadium kedua, gejala
stadium permulaan diikuti oleh interval asimtomatis. Hal ini karena benda asing
tersebut tersangkut, refleks-refleks akan melemah dan gejala rangsangan akut
menghilang. Stadium ini berbahaya, sering menyebabkan keterlambatan diagnosis
atau cenderung mengabaikan kemungkinan aspirasi benda asing karena gejala dan
tanda yang tidak jelas. Pada stadium ketiga, telah terjadi gejala komplikasi
dengan obstruksi, erosi atau infeksi sebagai akibat reaksi terhadap benda
asing, sehingga timbul batuk-batuk, hemoptisis, pneumonia dan abses paru.</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"> <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; mso-layout-grid-align: none; mso-pagination: none; tab-stops: 28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 3.5in 280.0pt 308.0pt 336.0pt; text-align: justify; text-autospace: none;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-size: 9.0pt; mso-fareast-font-family: "Times New Roman";">Benda
asing di laring dapat menutup laring, tersangkut di antara pita suara atau
berada di subglotis. Gejala sumbatan laring tergantung pada besar, bentuk dan
letak (posisi) benda asing.</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">
</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-size: 9.0pt; mso-fareast-font-family: "Times New Roman";">Sumbatan
total di laring akan menimbulkan keadaan yang gawat biasanya kematian mendadak
karena terjadi asfiksia dalam waktu singkat. Hal ini disebabkan oleh timbulnya
spasme laring dengan gejala antara lain disfonia sampai afonia, apnea dan
sianosis. Sumbatan tidak total di laring dapat menyebabkan disfonia sampai
afonia, batuk yang disertai serak (croupy cough), odinofagia, mengi, sianosis,
hemoptisis, dan rasa subjektif dari
benda asing (penderita akan menunjuk lehernya sesuai dengan letak benda asing
tersebut tersangkut) dan dispnea dengan derajat bervariasi. Gejala ini jelas
bila benda asing masih tersangkut di laring, dapat juga benda asing sudah turun
ke trakea, tetapi masih menyisakan reaksi laring oleh karena adanya edema.</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></div>
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<b><span style="font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 150%;">DAFTAR PUSTAKA<o:p></o:p></span></b></div>
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<br /></div>
<div class="MsoListParagraphCxSpFirst" style="line-height: 150%; mso-list: l0 level1 lfo1; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: "Times New Roman";">1.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-size: 11.0pt;">Merchant SN, Kirtane MV, Shah KL, Karnk PP. Foreign
bodies in the bronchi (a 10 years review of 132 cases). Journal of
Postgraduate Medicine 1984; 30(4):219-23 or Available at
http://www.jpgmonline.com/article.asp?issn=0022-3859;year=1984;volume=30;issue=4;spage=219;epage=23;aulast=Merchant;type=0<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; mso-list: l0 level1 lfo1; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: "Times New Roman";">2.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-size: 11.0pt;">Callender T. Laryngo-tracheo-bronchial foreign
bodies, 1992. Available at http://www.bcm.edu/oto/grand/2192.html<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpLast" style="line-height: 150%; mso-list: l0 level1 lfo1; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: "Times New Roman";">3.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-size: 11.0pt;">Stewart C. Foreign bodies of the airway: recognition
and emergency management. 2002. Available at http://www.strosmith.netcom<o:p></o:p></span></div>Anonymoushttp://www.blogger.com/profile/06590633769759394496noreply@blogger.com0tag:blogger.com,1999:blog-5853367347201739175.post-14811496145311934562012-04-24T09:42:00.002-07:002012-04-24T09:42:59.326-07:00BLEFARITIS<br />
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<span style="font-family: 'Times New Roman', serif;"><span style="line-height: 18px;"><br /></span></span></div>
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<!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman";">1.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">PENDAHULUAN<o:p></o:p></span></div>
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<span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">Blefaritis adalah
radang pada kelopak mata. Radang yang sering terjadi pada kelopak merupakan
radang kelopak dan tepi kelopak. Radang bertukak atau tidak pada tepi kelopak
bisanya melibatkan folikel dan kelenjar rambut. Blefaritis ditandai dengan
pembentukan minyak berlebihan di dalam kelenjar di dekat kelopak mata yang
merupakan lingkungan yang disukai oleh bakteri yang dalam keadaan normal
ditemukan di kulit. Blefaritis dapat disebabkan infeksi dan alergi yang
biasanya berjalan kronis atau menahun. Blefaritis alergi dapat terjadi akibat
debu, asap, bahan kimia, iritatif, dan bahan kosmetik. Infeksi kelopak dapat
disebabkan kuman streptococcus alfa atau beta, pneumococcus, dan pseudomonas.
Di kenal bentuk blefaritis skuamosa, blefaritis ulseratif, dan blefaritis
angularis. Gejala umum pada blefaritis adalah kelopak mata merah, bengkak,
sakit, eksudat lengket dan epiforia. Blefaritis sering disertai dengan
konjungtivitis dan keratitis. Biasanya blefaritis sebelum diobati dibersihkan dengan
garam fisiologik hangat, dan kemudian diberikan antibiotik yang sesuai.
Penyulit blefaritis yang dapat timbul adalah konjungtivitis, keratitis, hordeolum,
kalazoin, dan madarosis.<o:p></o:p></span></div>
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<br /></div>
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<!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman";">2.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">PATOFISIOLOGI<o:p></o:p></span></div>
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<span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">Patofisiologi
blefaritis biasanya terjadi kolonisasi bakteri pada mata. Hal ini mengakibatkan
invasi mikrobakteri secara langsung pada jaringan ,kerusakan sistem imun atau
kerusakan yang disebabkan oleh produksi toksin bakteri , sisa buangan dan
enzim. Kolonisasi dari tepi kelopak mata dapat ditingkatkan dengan adanya
dermatitis seboroik dan kelainan fungsi kelenjar meibom.<o:p></o:p></span></div>
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<br /></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 28.35pt; mso-add-space: auto; mso-list: l0 level1 lfo1; text-align: justify; text-indent: -28.35pt;">
<!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman";">3.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">ANATOMI<o:p></o:p></span></div>
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<span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">Kelopak atau palpebra
mempunyai fungsi melindungi bola mata, serta mengeluarkan sekresi kelenjarnya
yang membentuk film air mata di depan kornea. Palpebra merupakan alat penutup
mata yang berguna untukmelindungi bola mata terhapat trauma, trauma sinar dan
pengeringan mata. Kelopak mempunyai lapisan kulit yang tipis pada bagian depan
sedang di bagian belakang ditutupi selaput lendir tarsus yang disebut
konjungtiva tarsal. Pada kelopak terdapat bagian-bagian :<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 28.35pt; mso-add-space: auto; mso-list: l2 level1 lfo2; text-align: justify; text-indent: -14.15pt;">
<!--[if !supportLists]--><span lang="IN" style="font-family: Symbol; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">Kelenjar
seperti kelenjar sebasea, kelenjar moll atau kelenjar keringat, kelenjar zeis
pada pangkal rambut, dan kelenjar meibom pada tarsus.<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 28.35pt; mso-add-space: auto; mso-list: l2 level1 lfo2; text-align: justify; text-indent: -14.15pt;">
<!--[if !supportLists]--><span lang="IN" style="font-family: Symbol; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">Otot
seperti : M. Orbikularis okuli yang berjalan melingkar di dalam kelopak atas
dan bawah, dan terletak di bawah kulit kelopak. M. Orbikularis berfungsi
menutup bola mata yang dipersarafi N. fasial. M. Levator palpebra berfungsi
untuk mengangkat kelopak mata atau membuka mata.<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 28.35pt; mso-add-space: auto; mso-list: l2 level1 lfo2; text-align: justify; text-indent: -14.15pt;">
<!--[if !supportLists]--><span lang="IN" style="font-family: Symbol; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">Di
dalam kelopak terdapak tarsus yang merupakan jaringan ikat dengan kelenjar di
dalamnya atau kelenjar Meibom yang bermuara pada margo palpebra.<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 28.35pt; mso-add-space: auto; mso-list: l2 level1 lfo2; text-align: justify; text-indent: -14.15pt;">
<!--[if !supportLists]--><span lang="IN" style="font-family: Symbol; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">Septum
orbita yang merupakan jaringan fibrosa berasal dari rima orbita merupakan
pembatas isi orbita dengan kelopak depan.<o:p></o:p></span></div>
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<br /></div>
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<br /></div>
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<!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman";">4.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">ETIOLOGI<o:p></o:p></span></div>
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<span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">Terdapat 2 jenis blefaritis, yaitu
:<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman";">1.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">Blefaritis anterior :
mengenai kelopak mata bagian luar depan (tempat melekatnya bulu mata).
Penyebabnya adalah bakteri stafilokokus dan seborrheik. Blefaritis stafilokok
dapat disebabkan infeksi dengan Staphylococcus aureus, yang sering ulseratif,
atau Staphylococcus epidermidis atau stafilokok koagulase-negatif. Blefaritis
seboroik(non-ulseratif) umumnya bersamaan dengan adanya Pityrosporum ovale.<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 49.65pt; mso-add-space: auto; mso-list: l1 level1 lfo3; text-align: justify; text-indent: -21.3pt;">
<!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman";">2.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">Blefaritis posterior :
mengenai kelopak mata bagian dalam (bagian kelopak mata yang lembab, yang
bersentuhan dengan mata). Penyebabnya adalah kelainan pada kelenjar minyak. Dua
penyakit kulit yang bisa menyebabkan blefaritis posterior adalah rosasea dan
ketombe pada kulit kepala (dermatitis seboreik).<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 49.65pt; mso-add-space: auto; text-align: justify;">
<br /></div>
<div class="MsoListParagraphCxSpLast" style="margin-left: 28.35pt; mso-add-space: auto; mso-list: l0 level2 lfo1; text-align: justify; text-indent: -28.35pt;">
<!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman";">4.1<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">Blefaritis Anterior<o:p></o:p></span></div>
<div class="MsoNormalCxSpFirst" style="text-align: justify; text-indent: 28.35pt;">
<span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">Blefaritis
anterior merupakan radang bilateral kronik yang umum di tepi palpebra. Ada dua
jenis utamanya: stafilokokok dan seborreik. Blefaritis stafilokok dapat
disebabkan oleh infeksi <i>Staphylococcus
aureus,</i> yang sering ulseratif, atau <i>Staphylococcus
epidermidis </i>(stafilokok koagulase-negatif). Blefaritis seborreik
(non-ulseratif) umumnya berkaitan dengan keberadaan <i>Pytirosporum ovale</i> meskipun organisme ini belum terbukti menjadi
penyebabnya. Seringkali kledua jenis blefaritis timbul scara bersamaan (infeksi
campur). Seborrea kulit kepala, alis, dan telinga sering menyertai blefaritis
seborreik.<o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="text-align: justify; text-indent: 28.35pt;">
<span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">Gejala
utamanya adalah iritasi, rasa terbakar, dan gatal pada tepi palpebra. Mata yang
terkena “bertepi merah”. Banyak sisik atau “granulasi” terlihat menggantung di
bulu mata palpebra superior maupun inferior. Pada tipe stafilokok, sisinya
kering, palpebra merah, terdapat ulkus-ulkus kecil di tepi palpebra, dan bulu
mata cenderung rontok. Pada tipe seborreik, sisik berminyak, tidak terjadi
ulserasi, dan tepian palpebra tidak begitu merah. Pada tipe campuran yang lebih
umum, kedua sisik ada, tepian palpebra merah dan mungkin berulkus. <i>S. Aureus </i>dan <i>P. Ovale </i>mungkin muncul bersamaan atau sendiri-sendiri pada pulasan
materi kerokan dari tepi palpebra.<o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="text-align: justify; text-indent: 28.35pt;">
<br /></div>
<div class="MsoNormalCxSpMiddle" style="text-align: justify; text-indent: 28.35pt;">
<br /></div>
<div class="MsoNormalCxSpMiddle" style="text-align: justify; text-indent: 28.35pt;">
<span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">Blefaritis
Stafilokok dapat disertai komplikasi hordeolum, kalazion, keratitis
epitelsepertiga bawah kornea, dan infiltrat kornea marginal. Kedua bentuk
blefaritis anterior merupakan predisposisi terjadinya konjungtivitis berulang.<o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="text-align: justify; text-indent: 28.35pt;">
<span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">Kulit
kepala, alis mata, dan tepi palpebra harus selalu dibersihkan, terutama pada
blefaritis tipe seborreik, dengan memakai sabun dan shampo. Sisik-sisik harus
dibersihkan dari tepi palpebra dengan kain basah dan shampo setiap hari.<o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="text-align: justify; text-indent: 28.35pt;">
<span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">Blefaritis
stafilokok diobati dengan antibiotik antistafilokok atau pemberian salep mata
sulfonamide dengan aplikator kapas sekali sehari pada tepian palpebra.<o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="text-align: justify; text-indent: 28.35pt;">
<span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">Tipe
seborreik dan stafilokok umumnya bercampur dan menjadi kronik selang beberapa
bulan atau tahun jika tidak diobati dengan memadai; konjungtivitis atau
keratitis stafilokok penyerta umumnya cepat teratasi setelah pengobatan
antistafilokok lokal.<o:p></o:p></span></div>
<div class="MsoNormalCxSpLast" style="text-align: justify;">
<br /></div>
<div class="MsoListParagraphCxSpFirst" style="margin-left: 28.35pt; mso-add-space: auto; mso-list: l0 level2 lfo1; text-align: justify; text-indent: -28.35pt;">
<!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman";">4.2<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">Blefaritis Posterior<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpLast" style="margin-left: 0in; mso-add-space: auto; text-align: justify; text-indent: 28.35pt;">
<span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">Blefaritis posterior
adalah peradangan palpebra akibat disfungsi kelenjar meibom. Seperti blefaritis
anterior, kelainan ini terjadi secara kronik dan bilateral. Blefaritis anterior
dan posterior dapat timbul secara bersamaan. Dermatitis seborreik umumnya disertai
dengan disfungsi kelenjar meibom. Kolonisasi atau infeksi strain stafilokok
dalam jumlah memadai sering disertai dengan penyakit kelenjar meibom dan dapat
menjadi salah satu penyebab gangguan fungsi kelenjar meibom. Lipase bakteri
dapat menimulkan peradangan pada kelenjar meibom dan konjungtiva serta
menyebabkan terganggunya film air mata.<o:p></o:p></span></div>
<div class="MsoNormalCxSpFirst" style="text-align: justify; text-indent: 28.35pt;">
<br /></div>
<div class="MsoNormalCxSpMiddle" style="text-align: justify; text-indent: 28.35pt;">
<span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">Blefaritis
posterior bermanifestasi dalam bermacam gejala yang mengenai palpebra, air
mata, konjungtiva, dan kornea. Perubahan pada kelenjar meibom mencakup
peradangan muara meibom (meibominanitis), sumbatan muara kelenjar oleh sekret
yang kental, pelebaran kelenjar meibom dalam kelenjar tarsus, dan keluarnya
sekret kuning kental seperti keju bila kelenjar itu dipencet. Dapat juga timbul
hordeolum dan kalazion. Tepi palpebra tampak hiperemis dan telangiektasia.
Palpebra juga membulat dan menggulung ke dalam sebagai akibat parut pada
konjungtiva tarsal; membentuk hubungan yang abnormal antara film airmata
prakornea dan muara-muara kelenjar meibom. Air mata mungkin berbusa atau sangat
berlemak. Hipersensitivitas terhadap stafilokok mungkin menyebabkan keratitis
epitelial. Kornea juga bisa membentuk vaskularisasi perifer dan menjadi tipis,
terutama di bagian inferior, terkadang dengan infiltrat marginal yang jelas.
Perubahan-perubahan makroskopik pada blefaritis posterior identik dengan
kelainan-kelainan mata yag ditemukan pada acne rosacea.<o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="text-align: justify; text-indent: 28.35pt;">
<span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">Terapi
blefaritis posterior tergantung pada perubahan-perubahan di konjungtiva dan
kornea terkait. Peradangan yang jelas pada struktur-struktur ini mengharuskan
pengobatan aktif, termasuk terapi antibiotiksistemik dosis rendah jangka
panjang, biasanya doxycycline (100 mg dua kali sehari) atau erythromycin (250
mg tiga kali sehari), tetapi juga berpedoman pada hasil biakan bakteri dari
tepi palpebra dan steroid topikal dengan antibiotik atau substitusi air mata
umumnya tidak perlu dan dapat berakibat bertambah rusaknnya film air mata atau
reaksi toksik terhadap bahan pengawetnya.<o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="text-align: justify; text-indent: 28.35pt;">
<span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">Pengeluaran
isi kelenjar meibom secara periodik bisa membantu, khususnya pada pasien dengan
penyakit ringan yang tidak memerlukan terapi antibiotik oral atau steroid
topikal jangka panjang. Hordeolum dan kalazion yang dapat menjadi komplikasi
hendaknya diterapi dengan baik.<o:p></o:p></span></div>Anonymoushttp://www.blogger.com/profile/06590633769759394496noreply@blogger.com0tag:blogger.com,1999:blog-5853367347201739175.post-26176992878259391902012-04-24T09:41:00.003-07:002012-04-24T09:41:54.206-07:00NEUROPATI OPTIK<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div align="center" class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center;">
<span style="font-family: 'Times New Roman', serif;"><span style="font-size: 19px; line-height: 28px;"><b><br /></b></span></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Neuropati optik merupakan gangguan
fungsional atau perubahan patologis pada nervus optikus, kadang terbatas hanya
pada lesi non-inflamatorik, berlawanan dengan neuritis. Klasifikasi neuropati
optic berdasarkan manifestasi klinik terdiri atas pola lapangan pandang,
neuropati optic anterior, Neuropati optic posterior, dan Atropi optic.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify;">
<br /></div>
<div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: .25in; margin-right: 0in; margin-top: 0in; mso-add-space: auto; mso-list: l3 level1 lfo1; text-align: justify; text-indent: -.25in;">
<!--[if !supportLists]--><b><span style="font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">1.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-weight: normal; line-height: normal;">
</span></span></b><!--[endif]--><b><span style="font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt;">Pola Lapangan Pandang <o:p></o:p></span></b></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: .25in; margin-right: 0in; margin-top: 0in; mso-add-space: auto; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Serabut saraf retina yang menuju
nervus optikus dibagi atas 3 kelompok besar </span><span style="font-family: Wingdings; font-size: 12.0pt; line-height: 150%; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-char-type: symbol; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Wingdings;">à</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;"> lesi pada 3
kelompok besar tersebut:<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 31.5pt; margin-right: 0in; margin-top: 0in; mso-add-space: auto; mso-layout-grid-align: none; mso-list: l4 level1 lfo3; tab-stops: 1.25in; text-align: justify; text-autospace: none; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "Times New Roman","serif"; font-size: 10.5pt; line-height: 150%; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">a.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><i><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">papillomacular fibers: </span></i><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">cecocentral
scotoma, paracentral scotoma, dan central scotoma.<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 31.5pt; margin-right: 0in; margin-top: 0in; mso-add-space: auto; mso-layout-grid-align: none; mso-list: l4 level1 lfo3; tab-stops: 1.25in; text-align: justify; text-autospace: none; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "Times New Roman","serif"; font-size: 10.5pt; line-height: 150%; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">b.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><i><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">arcuate fibers: </span></i><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">arcuate
scotoma (defek nerve fiber bundle), broad (altitudinal) defect (broader region
of arcuate fibers) <o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 31.5pt; margin-right: 0in; margin-top: 0in; mso-add-space: auto; mso-layout-grid-align: none; mso-list: l4 level1 lfo3; tab-stops: 1.25in; text-align: justify; text-autospace: none; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "Times New Roman","serif"; font-size: 10.5pt; line-height: 150%; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">c.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><i><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">nasal radiating fibers:</span></i><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-style: italic;">defek pada<i> </i></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">temporal.<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 31.5pt; margin-right: 0in; margin-top: 0in; mso-add-space: auto; mso-layout-grid-align: none; tab-stops: 1.25in; text-align: justify; text-autospace: none;">
<br /></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: .25in; margin-right: 0in; margin-top: 0in; mso-add-space: auto; mso-list: l3 level1 lfo1; text-align: justify; text-indent: -.25in;">
<!--[if !supportLists]--><b><span style="font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">2.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-weight: normal; line-height: normal;">
</span></span></b><!--[endif]--><b><span style="font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt;">Neuropati optic anterior <o:p></o:p></span></b></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: .25in; margin-right: 0in; margin-top: 0in; mso-add-space: auto; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Neuropati optic iskemik anterior
(NOIA) merupakan peyakit yang berupa infark pada diskus optikus dan tidak
berhubungan dengan inflamasi, demielinasi, infiltrasi neural, ataupun
metastasis. NOIA sering dijumpai dan menyebabkan hilangnya visus mendadak, dan
sering terjadi pada usia lanjut. NOIA dapat dibagi menjadi 2 yaitu arteritik
(lebih jarag, 5-10% kasus NOIA) dan nonarteritik, yang dibedakan dalam tabel
berikut.<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: .25in; margin-right: 0in; margin-top: 0in; mso-add-space: auto; text-align: justify;">
<br /></div>
<div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: .25in; margin-right: 0in; margin-top: 0in; mso-add-space: auto; mso-list: l0 level1 lfo2; text-align: justify; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Wingdings; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">v<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Patofisiologi</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;"><o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: .25in; margin-right: 0in; margin-top: 0in; text-align: justify; text-indent: .5in;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">NOIA merupakan proses iskemik pada serabut saraf
optic. Pembuluh darah utama yang menyuplai papil optic berasal dari arteri
siliaris posterior, sehingga NOIA merupakan manifestasi dari kelainan iskemik
dari sirkulasi arteri siliaris posterior pada optic nerve head. Pola aliran dan
suplai darah pada optic nerve head bervariasi tiap individu sehingga
berpengaruh pada anifestasi klinik.<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 1.0in; margin-right: 0in; margin-top: 0in; mso-add-space: auto; mso-list: l2 level1 lfo4; text-align: justify; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">a.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Trombosis
(lebih sering) dan emboli (jarang) a. siliaris posterior<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 1.0in; margin-right: 0in; margin-top: 0in; mso-add-space: auto; mso-list: l2 level1 lfo4; text-align: justify; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">b.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Sirkulasi
buruk atau tidak ada pada optic nerve head. Faktor risiko dibagi menjadi 3
kategori mayor penyakit menurut Ichemic Optic Neuropathy Decompresion Trial
(IONDT), yaitu : (1) Penyakit sistemik: Hipertensi, DM; (2) Penyakit yang
berhubungan tetapi tidak langsung sebagai penyebab: oklusi pembuluh darah kecil cerebrovaskular;
(3) Kelainan yang tidak mempunyai hubungan patogenik pada sebagian kecil
pasien.<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: .25in; margin-right: 0in; margin-top: 0in; mso-add-space: auto; mso-list: l0 level1 lfo2; text-align: justify; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Wingdings; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">v<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Penatalaksanaan</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;"><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; mso-add-space: auto; mso-list: l1 level1 lfo5; text-align: justify; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">a.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">NOIA Arteritik: steroid sistemik
prednisone 40-60 mg/hari. Bila dimulai dengan dosis 60 mg/hari selama 2-4
minggu, tapering 10 mg tiap 2 minggu sampai 40 mg, kemudian dikurangi 5 mg tiap
1-2 minggu. Jika sudah 10 mg/hari dikurangi 1 mg tiap bulan.<o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">b.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">NOIA Nonarteritik: tidak terbukti
steroid sistemik. Hiperbarik oksigen pada 2 atm 2x1 hari selama 10 hari.
Pemberian steroid sistemik masih dianjurkan, metilprednisolon 1g/hari IV,
tapering lambat. Setelah 1 bulan pasien mengalami perbaikan visus 6/9.<o:p></o:p></span></div>
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<br /></div>
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<br /></div>
<div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: .25in; margin-right: 0in; margin-top: 0in; mso-add-space: auto; mso-list: l3 level1 lfo1; text-align: justify; text-indent: -.25in;">
<!--[if !supportLists]--><b><span style="font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">3.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-weight: normal; line-height: normal;">
</span></span></b><!--[endif]--><b><span style="font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt;">Neuropati optic iskemik posterior<o:p></o:p></span></b></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin: 0in; mso-add-space: auto; text-align: justify; text-indent: .5in;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Merupakan
kerusakan iskemia akut pada nervus optikus retrobulbar, RAPD (<i>relative afferent puilaary defect)</i>, diskus
optikus normal. NOIP jarang dan didiagnosis eksklusi (sebaiknya tidak diajukan
sebelum penyebab-penyebab lain, terutama lesi komprehensif telah dieksklusi). <o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 22.5pt; margin-right: 0in; margin-top: 0in; mso-add-space: auto; mso-list: l0 level1 lfo2; text-align: justify; text-indent: -22.5pt;">
<!--[if !supportLists]--><span style="font-family: Wingdings; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">v<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Patofisiologi</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;"><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 4.5pt; margin-right: 0in; margin-top: 0in; mso-add-space: auto; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">NOIP terjadi pada 3 kejadian
berbeda, yaitu: (1) perioperatif (kepala, spine, leher), (2)
arteritik/vaskulitis, (3) Nonarteritik (klinik yang mirip pada NOIA
Nonarteritik). Pada perioperatif kehilangan visus lebih sering bilateral
daripada unilateral.<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 22.5pt; margin-right: 0in; margin-top: 0in; mso-add-space: auto; mso-list: l0 level1 lfo2; text-align: justify; text-indent: -22.5pt;">
<!--[if !supportLists]--><span style="font-family: Wingdings; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">v<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Penatalaksanaan</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;"><o:p></o:p></span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Kortikosteroid.<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 22.5pt; margin-right: 0in; margin-top: 0in; mso-add-space: auto; mso-list: l0 level1 lfo2; text-align: justify; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Wingdings; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">v<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Prognosis: </span></b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Buruk<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 1.0in; margin-right: 0in; margin-top: 0in; mso-add-space: auto; text-align: justify;">
<br /></div>
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<!--[if !supportLists]--><b><span style="font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">4.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-weight: normal; line-height: normal;">
</span></span></b><!--[endif]--><b><span style="font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt;">Atropi optic<o:p></o:p></span></b></div>
<div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: .25in; margin-right: 0in; margin-top: 0in; mso-add-space: auto; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Kombinasi dari hilangnya visus,
RAPD, dan atrofi optic adalah nonspesifik dan dapat ditemukan pada fase kronik
dari tiap neuropati optic yang diientifikasi aawal. Tingkatan fungsi nervus
optikus adaah berdasarkan <i>visual acuity,
color vision testing, </i>dan <i>quantitative
perimetry.</i> Derajat dan pola atropi dapat dilihat melalui foto fundus. </span><b><span style="font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt;"><o:p></o:p></span></b></div>Anonymoushttp://www.blogger.com/profile/06590633769759394496noreply@blogger.com0tag:blogger.com,1999:blog-5853367347201739175.post-62562366940017616282012-04-24T09:40:00.002-07:002012-04-24T09:40:55.402-07:00DISTROFI KORNEA<br />
<div align="center" class="MsoNormal" style="line-height: 150%; mso-layout-grid-align: none; text-align: center; text-autospace: none;">
<span style="font-family: 'Times New Roman', serif;"><br /></span></div>
<div class="MsoNormal" style="line-height: 150%; mso-layout-grid-align: none; text-align: justify; text-autospace: none; text-indent: .5in;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Distrofi kornea adalah
suatu kondisi bilateral simetrik dan diturunkan, yang sedikit berhubungan atau
tidak ada hubungannya dengan lingkungan atau faktor sistemik. Distrofi dimulai
pada awal kehidupan tetapi bisa tidak menimbulkan gejala klinis dikemudian
hari. Berkembang secara progresif lambat. Distrofi kornea dapat
diklasifikasikan menurut genetik, keparahan, gambaran karakteristik biokemis
atau lokasi anatomis. Skema anatomik yang mengklasifikasikan distrofi
tergantung pada level kornea yang terkena yaitu anterior distrofi, stromal
distrofi, posterior distrofi, dan ektatik distrofi.<o:p></o:p></span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Banyak manisfestasi
kornea dari penyakit sistemik mempengaruhi kejernihan kornea diakibatkan oleh
penumpukan abnormal substansi metabolik di epitel, stroma atau endotel.
Substansi abnormal secara tipikal menumpuk pada lisosom atau struktur
intrasitoplasmik seperti lisosom sebagai penyebab defek enzim tunggal.
Kebanyakan kelainan ini adalah autosomal resesif. Yang termasuk kelainan
metabolik ini adalah kelainan metabolism karbohidrat, lemak, asam amino,
protein, sintesa imunoglobulin, metabolisme nukleotida dan mineral.<o:p></o:p></span></div>
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<b><span style="color: #040404; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Stroma Kornea Dystrophies<o:p></o:p></span></b></div>
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<span style="color: #040404; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Kelompok
ini mencakup <i>macular corneal dystrophy (MCD), granular corneal<o:p></o:p></i></span></div>
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<i><span style="color: #040404; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">dystrophy (GCD) type I,
the lattice corneal dystrophies (LCD), Schnyder corneal dystrophy<o:p></o:p></span></i></div>
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<i><span style="color: #040404; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">(SCD), fleck corneal
dystrophy (FCD), congenital stromal corneal dystrophy (CSCD) and<o:p></o:p></span></i></div>
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<i><span style="color: #040404; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">posterior amorphous
corneal dystrophy (PACD)<o:p></o:p></span></i></div>
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<b><span style="color: #040404; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Deskripsi temuan klinis,
histopatologi, etiologi, manajemen<o:p></o:p></span></b></div>
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<!--[if !supportLists]--><b><span style="color: #040404; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">1.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-weight: normal; line-height: normal;">
</span></span></b><!--[endif]--><span style="font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 150%;"> </span><b><i><span style="color: #040404; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Macular
distrofi kornea (MCD, distrofi kornea Groenouw tipe II, Fehr distrofi</span></i></b><b><span style="color: #040404; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;"><o:p></o:p></span></b></div>
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<b><i><span style="color: #040404; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">kornea)<o:p></o:p></span></i></b></div>
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<span style="color: #040404; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Gambaran samar berbentuk
kabut biasanya muncul pertama kali dalam stroma kedua kornea selama masa
remaja, tetapi kekeruhan dapat menjadi jelas pada masa pertumbuhan atau bahkan
dalam dekade keenam.<o:p></o:p></span></div>
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<br /></div>
<div class="MsoNormal" style="line-height: 150%; mso-layout-grid-align: none; text-align: justify; text-autospace: none; text-indent: .5in;">
<span style="color: #040404; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Kekeruhan
kornea bilateral secara bertahap meluas ke seluruh stroma kornea sentral<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; mso-layout-grid-align: none; text-align: justify; text-autospace: none;">
<span style="color: #040404; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">dan perifer. Stroma kornea
lebih tipis dari normal. Kebanyakan pasien dengan MCD tidak memiliki keratan
sulfat dalam serum (MCD tipe I dan IA), tetapi beberapa tingkat keratin sulfat
antigen dalam serum normal (tipe II MCD). Immunophenotypes ini tidak dapat dibedakan
satu sama lain secara klinis dan tidak memiliki signifikansi klinis.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; mso-layout-grid-align: none; text-align: justify; text-autospace: none; text-indent: .5in;">
<span style="color: #040404; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">MCD telah
diidentifikasi terjadi di seluruh dunia, tetapi jarang di sebagian besar populasi.
Hal ini paling umum di India, Arab Saudi, Islandia dan bagian Amerika Serikat. Adanya
mutasi gen CHST6 bertanggung jawab untuk kebanyakan kasus MCD.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; mso-layout-grid-align: none; text-align: justify; text-autospace: none; text-indent: .5in;">
<span style="color: #040404; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Pada
kelainan ini, penglihatan dapat dikembalikan dengan transplantasi kornea, tapi<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; mso-layout-grid-align: none; text-align: justify; text-autospace: none;">
<span style="color: #040404; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">penyakit ini dapat kambuh
setelah bertahun-tahun walaupun sudah di transplantasi. Karena kondisi ini
mempengaruhi stroma kornea secara keseluruhan, membran Descemet dan endotel
kornea maka tindakan keratoplasti tidak mencakup semua jaringan patologis .<o:p></o:p></span></div>
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<!--[if !supportLists]--><b><i><span style="color: #040404; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">2.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-style: normal; font-weight: normal; line-height: normal;">
</span></span></i></b><!--[endif]--><span style="font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 150%;">.</span><b><i><span style="color: #040404; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Granular corneal dystrophy (GCD) type I (classic GCD, corneal
dystrophy<o:p></o:p></span></i></b></div>
<div class="MsoNormal" style="line-height: 150%; mso-layout-grid-align: none; text-align: justify; text-autospace: none;">
<b><i><span style="color: #040404; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Groenouw type I)<o:p></o:p></span></i></b></div>
<div class="MsoNormal" style="line-height: 150%; mso-layout-grid-align: none; text-align: justify; text-autospace: none; text-indent: .5in;">
<span style="color: #040404; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Berbentuk
bintik-bintik kecil putih multipel yang tidak beraturan yang menyerupai<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; mso-layout-grid-align: none; text-align: justify; text-autospace: none;">
<span style="color: #040404; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">serpihan roti atau salju.
Gambaran tersebut terlihat jelas di daerah membran Bowman dalam<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; mso-layout-grid-align: none; text-align: justify; text-autospace: none;">
<span style="color: #040404; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">stroma kornea sentral
superfisial.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; mso-layout-grid-align: none; text-align: justify; text-autospace: none;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; mso-layout-grid-align: none; text-align: justify; text-autospace: none; text-indent: .5in;">
<span style="color: #040404; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Muncul
pada dekade pertama kehidupan dan terlihat jelas pada umur 3 tahun. Awalnya
terlihat seperti titik kekurahan dan dengan seiring waktu mereka secara
bertahap membesar dan menjadi lebih banyak. Pada anak-anak terlihat permukaan
kornea halus, namun pada orang dewasa sering tidak merata. Ketajaman
penglihatan kurang lebih normal. Pada akhir dekade kedua, banyak kekeruhan
terdapat di kornea sentral dan superfisial, namun jarang di stroma bagian
dalam. Terdapat perbedaan klinis yang terlihat pada kekeruhan kornea antara 2
tipe GCD yaitu GCD tipe 1 dan GCD tipe 2.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; mso-layout-grid-align: none; text-align: justify; text-autospace: none; text-indent: .5in;">
<span style="color: #040404; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">GCD telah
dipelajari secara ekstensif di Denmark oleh Moller. GCD1 paling umum di<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; mso-layout-grid-align: none; text-align: justify; text-autospace: none;">
<span style="color: #040404; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Eropa, tetapi GCD2 lebih
umum di Jepang, Korea dan Amerika Serikat. Kekeruhan kornea pada GCD mudah
dilihat setelah kornea dipotong .<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; mso-layout-grid-align: none; text-align: justify; text-autospace: none; text-indent: .5in;">
<span style="color: #040404; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Sebuah
studi menunjukkan bahwa individu keluarga heterozigot dan homozigot untuk<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; mso-layout-grid-align: none; text-align: justify; text-autospace: none;">
<span style="color: #040404; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">gen TGFBI fenotip identik,
tetapi mutasi genetik telah dilakukan dalam kasus ini. Banyak mutasi TGFB1
ditemukan di fenotipe histopatologi dan klinis yang berbeda tetapi GCD² hasil
mutasi Arg555Trp, sementara GCD2 adalah efek dari mutasi Arg124His pada gen TGFBI
[6].Dalam kebanyakan kasus GCD, ketajaman visual tetap baik sampai akhir dalam perjalanan
penyakit. Setelah keratoplasti, biasanya tidak terjadi kekambuhan selama kurang<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; mso-layout-grid-align: none; text-align: justify; text-autospace: none;">
<span style="color: #040404; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">lebih 30 bulan, tetapi
kekeruhan dapat kambuh dalam setahun<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; mso-layout-grid-align: none; text-align: justify; text-autospace: none;">
<br /></div>
<div class="MsoListParagraph" style="line-height: 150%; mso-layout-grid-align: none; mso-list: l1 level1 lfo1; text-align: justify; text-autospace: none; text-indent: -.25in;">
<!--[if !supportLists]--><span style="color: #040404; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">3.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><b><span style="color: #040404; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Lattice corneal
dystrophies (LCD) type I (Biber-Haab-Dimmer dystrophy)</span></b><span style="color: #040404; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;"><o:p></o:p></span></div>
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<span style="color: #040404; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Sebuah jaringan filamen
bercabang kekeruhan kornea interdigitating halus dalam<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<span style="color: #040404; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">bentuk kelainan bawaan pada dua genetika yang berbeda.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
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<br /></div>
<div class="MsoNormal" style="line-height: 150%; mso-layout-grid-align: none; text-align: justify; text-autospace: none; text-indent: .5in;">
<span style="color: #040404; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Satu
tanpa manifestasi sistemik yang disebabkan oleh mutasi spesifik dalam gen TGFBI
(LCD tipe I dan variannya) (LCD1), yang lain dihasilkan dari mutasi pada gen
GSN (LCD tipe II) (LCD2) dan memiliki manifestasi sistemik. LCD1 biasanya
menjadi jelas pada kedua mata pada akhir dekade pertama kehidupan, tapi
kadang-kadang dimulai pada usia pertengahan dan jarang pada masa bayi.
Berbentuk garis buram dan lainnya menumpuk terutama dalam stroma kornea
sentral, sedangkan kornea perifer relatif transparan.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; mso-layout-grid-align: none; text-align: justify; text-autospace: none; text-indent: .5in;">
<span style="color: #040404; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Kelainan
kornea disertai dengan neuropati perifer dan kranial yang progresif, dysarthria,
kulit kering dan gatalpada kulit. Karakteristik ekspresi wajah "seperti
topeng", bibir menonjol dengan gerakan terganggu dan blepharochalasis juga
terlihat.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; mso-layout-grid-align: none; text-align: justify; text-autospace: none; text-indent: .5in;">
<span style="color: #040404; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Transplantasi
kornea mungkin diperlukan dalam LCD 1 pada usia 20 tahun, tetapi biasanya tidak
diindikasikan sampai setelah dekade keempat. Hasil dari PK adalah sangat baik,
tetapi deposit amiloid dapat terjadi pada 2-14 tahun kemudian. Lesi kornea pada
LCD2 jarang surat perintah keratoplasty menembus, tetapi ketika melakukan cacat
epitel neurotropik persisten dapat berkembang.<o:p></o:p></span></div>
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<br /></div>
<div class="MsoListParagraph" style="line-height: 150%; mso-layout-grid-align: none; mso-list: l1 level1 lfo1; text-align: justify; text-autospace: none; text-indent: -.25in;">
<!--[if !supportLists]--><b><i><span style="color: #040404; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">4.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-style: normal; font-weight: normal; line-height: normal;">
</span></span></i></b><!--[endif]--><b><i><span style="color: #040404; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Schnyder
corneal dystrophy (SCD, Schnyder crystalline corneal dystrophy,<o:p></o:p></span></i></b></div>
<div class="MsoNormal" style="line-height: 150%; mso-layout-grid-align: none; text-align: justify; text-autospace: none;">
<b><i><span style="color: #040404; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">crystalline stromal
dystrophy, Schnyder crystalline dystrophy sine crystals, hereditary<o:p></o:p></span></i></b></div>
<div class="MsoNormal" style="line-height: 150%; mso-layout-grid-align: none; text-align: justify; text-autospace: none;">
<b><i><span style="color: #040404; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">crystalline stromal
dystrophy of Schnyder)<o:p></o:p></span></i></b></div>
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<span style="color: #040404; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">SCD
biasanya menjadi jelas pada awal kehidupan dengan adanya kabut kristal di kornea
atau stroma kornea. Seiring waktu, sebuah stroma kornea awal biasa-biasa saja memperoleh
kekeruhan putih kecil dan menyebar kabut. SCD disebabkan oleh salah satu mutasi
gen UBIAD1.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; mso-layout-grid-align: none; text-align: justify; text-autospace: none;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; mso-layout-grid-align: none; text-align: justify; text-autospace: none;">
<span style="color: #040404; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Ketajaman penglihatan
umumnya baik dalam SCD dan secara umum setelah masa kanak-kanak. Tetapi
kekeruhan kornea dapat berubah dari waktu ke waktu dan membentuk kekeruhan
kornea sentral berbentuk cakram padat. Penglihatan scotopic sangat baik dan berlanjut
sampai usia pertengahan, namun mereka yang terkena dampak perlu keratoplasty penetrating
sebelum dekade ketujuh.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; mso-layout-grid-align: none; text-align: justify; text-autospace: none;">
<br /></div>
<div class="MsoListParagraph" style="line-height: 150%; mso-layout-grid-align: none; mso-list: l1 level1 lfo1; text-align: justify; text-autospace: none; text-indent: -.25in;">
<!--[if !supportLists]--><b><span style="color: #040404; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">5.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-weight: normal; line-height: normal;">
</span></span></b><!--[endif]--><b><span style="color: #040404; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Fleck corneal dystrophy
(FCD, Francois-Neetens speckled corneal dystrophy)<o:p></o:p></span></b></div>
<div class="MsoNormal" style="line-height: 150%; mso-layout-grid-align: none; text-align: justify; text-autospace: none; text-indent: .25in;">
<span style="color: #040404; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Karakteristik
FCD adalah asimtomatis, kekeruhan simetris yang non progresif di<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; mso-layout-grid-align: none; text-align: justify; text-autospace: none;">
<span style="color: #040404; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">seluruh stroma kornea.
Salah satu jenis kekeruhannya berbentuk oval banyak dan kecil, bulat,<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; mso-layout-grid-align: none; text-align: justify; text-autospace: none;">
<span style="color: #040404; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">seperti lingkaran atau setengah
lingkaran dengan batas yang berbeda ("spot") di kornea pusat<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; mso-layout-grid-align: none; text-align: justify; text-autospace: none;">
<span style="color: #040404; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">dan perifer. <o:p></o:p></span></div>
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<br /></div>
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<br /></div>
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<br /></div>
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<br /></div>
<div class="MsoNormal" style="line-height: 150%; mso-layout-grid-align: none; text-align: justify; text-autospace: none;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; mso-layout-grid-align: none; text-align: justify; text-autospace: none;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; mso-layout-grid-align: none; text-align: justify; text-autospace: none; text-indent: .5in;">
<span style="color: #040404; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Kekeruhan
lain menyerupai salju atau awan dan terdiri dari warna abu-abu kecil tanpa<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; mso-layout-grid-align: none; text-align: justify; text-autospace: none;">
<span style="color: #040404; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">batas yang jelas dan
terjadi terutama di tiga kornea sentral. Mereka berada di anterior dan perifer
stroma, terkadang lebih padat terdapat di stroma bagian dalam dekat dengan
membran<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; mso-layout-grid-align: none; text-align: justify; text-autospace: none;">
<span style="color: #040404; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Descement. FCD
mempengaruhi pria dan wanita adalah sama dan telah diamati sepanjang hidup dan
bahkan pada anak-anak usia 2 tahun. Epitel kornea, lapisan Bowman, dan membran
Descemet normal. Sensasi kornea biasanya normal. FCD disebabkan oleh mutasi<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; mso-layout-grid-align: none; text-align: justify; text-autospace: none;">
<span style="color: #040404; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">dari gen PIP5K3. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; mso-layout-grid-align: none; text-align: justify; text-autospace: none; text-indent: .5in;">
<span style="color: #040404; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">FCD
adalah non-progresif, tidak mempengaruhi penglihatan dan biasanya tanpa gejala
dan tidak memerlukan pengobatan, tetapi fotofobia ringan telah dilaporkan. Pada
satu<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; mso-layout-grid-align: none; text-align: justify; text-autospace: none;">
<span style="color: #040404; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">pasien yang menjalani
keratoplas penetrating, tidak ada bukti klinis rekurensi FCD pada jaringan
transplantasi setelah 10 tahun follow up.<o:p></o:p></span></div>
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<br /></div>
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<!--[if !supportLists]--><b><span style="color: #040404; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">6.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-weight: normal; line-height: normal;">
</span></span></b><!--[endif]--><b><span style="color: #040404; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Congenital stromal
corneal dystrophy (CSCD, congenital hereditary stromal<o:p></o:p></span></b></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<b><span style="color: #040404; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">dystrophy, Witschel dystrophy<o:p></o:p></span></b></div>
<div class="MsoNormal" style="line-height: 150%; mso-layout-grid-align: none; text-align: justify; text-autospace: none; text-indent: .5in;">
<span style="color: #040404; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">CSCD
adalah gangguan non-progresif yang ditandai dengan mengaburkan stabil atau<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; mso-layout-grid-align: none; text-align: justify; text-autospace: none;">
<span style="color: #040404; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">berbulu banyak stroma
kornea buram. Serpih dan tempat menjadi lebih banyak dengan usia<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<span style="color: #040404; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">dan akhirnya mencegah evaluasi klinis endothelium kornea.<o:p></o:p></span></div>
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<br /></div>
<div class="MsoNormal" style="line-height: 150%; mso-layout-grid-align: none; text-align: justify; text-autospace: none;">
<span style="color: #040404; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Erosi kornea,
vaskularisasi kornea dan fotofobia tidak hadir. Beberapa individu yang<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; mso-layout-grid-align: none; text-align: justify; text-autospace: none;">
<span style="color: #040404; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">terkena strabismus atau
primer sudut terbuka glaukoma. CSCD sangat jarang, hanya empat keluarga telah
dilaporkan. CSCD satu keluarga besar dikenal memiliki keturunan di Jerman<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; mso-layout-grid-align: none; text-align: justify; text-autospace: none;">
<span style="color: #040404; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">dan Perancis. Individu
dipengaruhi oleh CSCD telah dipelajari secara ekstensif dalam keluarga besar
Perancis dan Norwegia.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; mso-layout-grid-align: none; text-align: justify; text-autospace: none;">
<br /></div>
<div class="MsoListParagraph" style="line-height: 150%; mso-layout-grid-align: none; mso-list: l1 level1 lfo1; text-align: justify; text-autospace: none; text-indent: -.25in;">
<!--[if !supportLists]--><b><span style="color: #040404; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">7.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-weight: normal; line-height: normal;">
</span></span></b><!--[endif]--><b><span style="color: #040404; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Posterior amorphous
corneal dystrophy (PACD, posterior amorphous stromal<o:p></o:p></span></b></div>
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<b><span style="color: #040404; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">dystrophy)<o:p></o:p></span></b></div>
<div class="MsoNormal" style="line-height: 150%; mso-layout-grid-align: none; text-align: justify; text-autospace: none;">
<span style="color: #040404; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">PACD adalah gangguan
kornea tidak teratur ditandai secara klinis oleh lembar-seperti "amorf"
kekeruhan di dalam stroma kornea, terutama posterior, dan membran Descemet. Sesuai
dengan gagasan ini bahwa ini adalah gangguan perkembangan, kelainan telah
diamati<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; mso-layout-grid-align: none; text-align: justify; text-autospace: none;">
<span style="color: #040404; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">pada masa bayi dan masa
kanak-kanak, dan kontras dengan dystrophies kornea tradisional, non-kornea
manifestasi telah dilaporkan, termasuk kelainan dari adhesi iris (iridocorneal,<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; mso-layout-grid-align: none; text-align: justify; text-autospace: none;">
<span style="color: #040404; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">corectopia, dan pseudopolycoria
).<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; mso-layout-grid-align: none; text-align: justify; text-autospace: none; text-indent: .5in;">
<span style="color: #040404; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Stroma
kornea transparan mungkin ikut campur antara kekeruhan, yang kadangkadang indent
membran Descemet dan endotelium kornea, yang mungkin memiliki kelainan fokal.
Bentuk PACD Centroperipheral dan perangkat diakui. Jenis centroperipheral meluas
ke limbus corneoscleral dan disertai dengan penipisan kornea dan kelengkungan
kornea adalah datar. Ketajaman visual Gangguan biasanya minimal.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; mso-layout-grid-align: none; text-align: justify; text-autospace: none; text-indent: .5in;">
<span style="color: #040404; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">PACD
cenderung lambat progresif atau nonprogressive. Ketajaman visual biasanya<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; mso-layout-grid-align: none; text-align: justify; text-autospace: none;">
<span style="color: #040404; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">minimal terganggu, tetapi
dapat cukup parah untuk menjamin keratoplasty menembus.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; mso-layout-grid-align: none; text-align: justify; text-autospace: none;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; mso-layout-grid-align: none; text-align: justify; text-autospace: none;">
<b><span style="color: #040404; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Diagnosis Banding<o:p></o:p></span></b></div>
<div class="MsoNormal" style="line-height: 150%; mso-layout-grid-align: none; text-align: justify; text-autospace: none;">
<span style="color: #040404; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Anggota keluarga yang
terkena dengan LCD1 dapat mengembangkan fenotipe klinis menyerupai RBCDS. Fitur
klinis Kementerian telah dilaporkan dalam keluarga dengan LCD1, tapi studi ini
tidak menganalisis gen KRT3 dan KRT12. MCD harus dibedakan pada
mucopolysaccharidoses sistemik (MASC) (seperti IH jenis mucopolysaccharidosis
dan IS) dan mucolipidosis. Berbeda dengan deposito sistemik materi MASC
abnormal antara serat-serat kolagen dalam stroma kornea di MCD. GCD harus
dibedakan dari gammopathy monoklonal karena lesi histopatologi bisa sangat
mirip. SCD harus dibedakan dari lemak lain dan keratopathy lethithin khusus:
penyakit kolesterol acyltransferase (penyakit LCAT, penyakit Norum) dan penyakit
ikan mata disebabkan oleh mutasi yang berbeda pada gen LCAT.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; mso-layout-grid-align: none; text-align: justify; text-autospace: none;">
<b><span style="color: #040404; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Manajemen Pengobatan<o:p></o:p></span></b></div>
<div class="MsoNormal" style="line-height: 150%; mso-layout-grid-align: none; text-align: justify; text-autospace: none; text-indent: .5in;">
<span style="color: #040404; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Karena
stroma kornea dystrophies ekstensif atau sepenuhnya memperpanjang melalui stroma
kornea seluruh, sebuah keratoplasty menembus atau keratoplasty lamelar mungkin pada
akhirnya diperlukan bila visi menjadi gangguan signifikan. Sebagai tindakan
sementara ablasi kornea dangkal dapat praktis, terutama jika jaringan donor
tidak tersedia<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Kompetensi Dokter Umum<o:p></o:p></span></b></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<br /></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<br /></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<br /></div>
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<b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt;">Keterampilan Klinis Yang Harus Dimilki<o:p></o:p></span></b></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Tingkat
kemampuan 4 mampu melakukan secara mandiri<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Lulusan
dokter memiliki pengetahuan teoritis mengenai keterampilan ini (baik konsep,
teori, prinsip maupun indikasi, cara melakukan, komplikasi dan sebagainya)..
Keterampilan klinis tingkat 4 yang harus dimiliki untuk kasus stroma kornea distrofi antara lain :<o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Pemeriksaan
opthalmologis umum yang meliputi pemeriksaan visus, pemeriksaan refraksi
subjektif.<o:p></o:p></span></div>
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<br /></div>Anonymoushttp://www.blogger.com/profile/06590633769759394496noreply@blogger.com0