RISNA HALIM

BAGIAN ILMU PENYAKIT DALAM

UNIVERSITAS HASANUDDIN

Function
Protection
Humidification
Filtration

Structures

Nasopharynx
Oropharynx
Tongue
Epiglottis
Larynx

Trachea & bronchi:

C-shaped cartilage
(posterior open)
Potential for airway
obstruction

Function
Filtration
Transmission of air

Structures

Trachea
Mainstem bronchi
Bronchioles
Terminal bronchioles

cough is a sudden and often repetitively

occurring reflex which helps to clear the large
breathing passages from secretions, irritants,
foreign particles and microbes.
The cough reflex consists of three phases: an
inhalation, a forced exhalation against a closed
glottis, and a violent release of air from the lungs
following opening of the glottis, usually
accompanied by a distinctive sound.
Coughing can happen voluntarily as well as
involuntarily.

Frequent coughing usually indicates the presence

of a disease.
Many viruses and bacteria benefit evolutionarily by
causing the host to cough, which helps to spread
the disease to new hosts.
Most of the time, coughing is caused by a
respiratory
tract
infection,
smoking,
air
pollution,asthma, gastroesophageal reflux disease,
post-nasal drip, chronic bronchitis, lung tumors,
heart failure and medications such as ACE
inhibitors.

 Treatment

should target the cause; for

example, smoking cessation or stop ACE-I
Cough suppressants such as codeine or
dextromethorphan are frequently prescribed,
Other treatment options may target airway
inflammation or mucus expectoration
As it is a natural protective reflex,
suppressing the cough reflex might have
deleterious effects, especially if the cough is
productive mucus retention obstruction
of airway

A cough can be classified :

The duration can be either acute (of sudden
onset) if it is present less than three weeks,
subacute if it is present between three and
eight weeks
chronic when lasting longer than eight
weeks
A cough can be dry or productive,
depending on whether sputum is coughed
up.

MEKANIK BATUK

Secara mekanis batuk tdd 4 fase:

1. Fase iritasi
2. Fase inspirasi
3. Fase kompresi
4. Fase ekspulsi

Fase iritasi : rangsangan reseptor oleh

berbagai stimulus.

Fase inspirasi : glotis secara refleks

terbuka akibat kontraksi m. abduktor
kartilago aritenoidea.

Volume paru besar efisiensi mekanis

lebih baik regangan otot ekspirasi me
elastisitas paru dan aktivasi slow adapting
pulmonary stretch receptor pe usaha
ekspirasi.
Fase kompresi : menutupnya glotis
otot-otot abdominal & intercostal
kontraksi tek. intrapleural & tek.
alveolar (300 mmHg).

BATUK + SPUTUM YANG KELUAR

- WARNA KUNING/HIJAU biasanya
karena infeksi.( PURULEN )
- DARAH (HEMOPTISIS),kapiler
sal.napas pecah karena infeksi,tu
mor paru, trauma toraks,bendungan ( STENOSIS MITRALIS atau
GAGAL JANTUNG )
- MUKOID ( asma, bronkitis kronis )

III. BRONKITIS KRONIS

- Infeksi
- Polusi lingkungan
- Asap rokok
- Tumor
Polusi
Alegen

Asap rokok Bronkitis yg berulang

-Uap kimia
-S02

Alergi

Iritasi

Metaplasi epitel
Epitel berbulu getar >>
rusak

Stimulasi sekret

Hiperplasia. Kel
Bronkitis
Kronis

Retensi sekret

Pertumbuhan
Bakteri

NYERI DADA
- Stimulasi serabut-serabut nyeri nn.

interkostakis dinding dada/pleura parietalis.

-Nyeri biasanya menusuk,bertambah

berat inspirasi/batuk. Berkurang ber-

baring pada posisi yang terserang

- NYERI PLEURITIK

SIANOSIS
Kulit kebiru-Biruan
* Bibir
* Pangkal Kuku
* Daun Telinga
Disebabkan Reduced HB (Deoxygenated)
derajat sianosis TGT :
* Kwalitas pigmen kulit
* Warna plasma darah
* Tebalnya kulit
* Keadaan kapiler kulit

HIPOKSIA
Jaringan kekurangan O2
O2 Atmosfir difusi memb alveolar
Hb O2 jaringan
1. Hipoksik Hipoksia
2. Anemik Hipoksia

3. Sirkulatorik Hipoksia
4. Histotoksik Hipoksia

1. Hipoksik Hipoksia
O2 dalam darah kurang OK
a. Gangguan Pertukaran Gas
* Kel paru / jantung
* Hipoventilasi
* Gangguan Ventilasi / Perfusi
* Gangguan difusi
* Shunt
b. O2 dalam udara kurang ( dataran tggi)
2. Anemik Hipoksia
* Jumlah HB
* CO Hb - Meth. Hb

3. Sirkulatorik Hipoksia
* kegagalan sirkulasi
* Syok
* Gagal jantung
* Kebutuhan jaringan
* Olah raga berat
* Tirotoksikosis
4. Histotoksik Hipoksia
* Keracunan sianida
* Jar tdk mampu menggunakan O2 yg
ada

KOMPENSASI TUBUH OK HIPOKSIA

GINJAL ERITROPOEIN
RS. SS. TULANG
ERITROSIT (Hb)

Penanggulangan
Tergantung Tipe Hipoksia
O2 diberikan bila ada :
* Hipoksik Hipoksia * Anemik Hipoksia ata* Sirkulatorik Hipoksia si anemi---R/ O2

HIPERKAPNIA & HIPOKAPNIA

Ventilasi adekwat Pa CO2 40 mm Hg

Hiperkapnia Pa Co2 > 44 mm Hg

Hipokapnia Pa CO2 < 36 mmHg

HIPERKAPNIA TERJADI KARENA RETENSI CO2
* Alveolar Hipoventilasi
* Obtruksi sal nafas
* Depresi pusat pernapasan akibat obat-obat
* Paralisis otot pernapasan

TANDA-TANDA KLINIK
* Ggn mental koma
* Flapping Tremor
* Volume Nadi lebih besar

* Extremitas berkeringat vasodilatasi perifer

(perabaan hangat)
Contoh * Hiperkapnia kronik
- Penderita PPOK
(rangsang Pusat Pernapasan akibat
Hopksia)

PaO2

SaO2 (%)

Normal

97

97

Kisaran normal

80

95

Hipoksemia

< 80

< 75

Ringan

60 79

90 94

Sedang

40 59

75 89

Berat

<40

< 75

-Emfisema
-Eksisi paru
-Aplasia/oklusi

Vasokonstriksi arteriol difus akibat hipoksia

Pengurangan vaskularisasi
paru-paru

Peningkatan viskositas
darah/eritrositosis

Peningkatan resistensi
vaskuler paru

Hipertensi pulmonal

Peningkatan aliran darah:

-peningkatan curah jantung
-peningkatan aliran kolateral

Kor pulmonal kronik

Gagal jantung kanan

Perubahan
anatomi
arteriol difus

Coba renungkan berapa banyak waktu kita habis

untuk tertawa, bermain, nonton, jalan jalan,
pacaran, maksiat, dosa??
Bandingkan dengan waktu kita shalat, kalau
sehari kita shalat 5x10 menit = 50 menit x 30
hari = 25 jam x 12 bulan = 300jam =12,5 hari
saja
Bila umur kita = 65 tahun
Maka total shalat kita Cuma 65- 15 tahun (usia
akil baliq) = 50 tahun x 12,5 hari = 625 hari =
1,7 tahun