II.

REFERENCE
A pneumothorax (noo-mo-THOR-acks) is a collapsed lung. Pneumothorax occurs when air
leaks into the space between your lungs and chest wall. This air pushes on the outside o your
lung and makes it collapse. !n most cases" only a portion o the lung collapses.
# pneumothorax can be caused by a blunt or penetrating chest in$ury" certain medical
procedures in%ol%ing your lungs" or damage rom underlying lung disease. Or it may occur
or no ob%ious reason. &ymptoms usually include sudden chest pain and shortness o breath.
CAUSES
The lungs normally inlate by increasing the si'e o the chest ca%ity" resulting in a negati%e
(%acuum) pressure in the pleural space (the area within the chest ca%ity but outside the lungs).
! air enters the pleural space either by a hole in the lung or the chest wall" the pressure in the
pleural space e(uals the pressure outside the body. Thus" the %acuum is lost and the lung
collapses.
&pontaneous pneumothorax is caused by a rupture o a cyst or a small sac (bleb) on the
surace o the lung. Pneumothorax may also occur ollowing an in$ury to the chest wall such
as a ractured rib" any penetrating in$ury (gun shot or stabbing)" surgical in%asion o the chest"
or may be deliberately induced in order to collapse the lung. # pneumothorax can also
de%elop as a result o underlying lung diseases" including cystic ibrosis" chronic obstructi%e
pulmonary disease ()OP*)" lung cancer" asthma" and inections o the lungs.
Pneumothorax can be caused by+
• Chest injuries. #ny blunt or penetrating in$ury to your chest can cause lung collapse.
&ome in$uries may happen during physical assaults or car crashes" while others may
inad%ertently occur during medical procedures that in%ol%e the insertion o a needle
into the chest.
• Underlying lung diseases. *amaged lung tissue is more likely to collapse. ,ung
damage can be caused by many types o underlying diseases" including chronic
obstructi%e pulmonary disease ()OP*)" cystic ibrosis and pneumonia.
• Ruptured air blisters. &mall air blisters (blebs) can de%elop on the top o your lung.
-hile not considered to be a disease o the lungs" these blebs sometimes burst .
allowing air to leak into the space that surrounds the lungs.
• Mehanial !entilation. # se%ere type o pneumothorax can occur in people who
need mechanical assistance to breathe. The %entilator can create an imbalance o air
pressure within the chest. The lung may collapse completely and the heart may be
s(uee'ed to the point that it can/t work properly.
RIS" FAC#$RS
&pontaneous pneumothorax aects about 0"111 persons each year in the 2.&. who ha%e no
history o lung disease. This type o pneumothorax is most common in men between the ages
o 31 and 41" particularly in tall" thin men. &moking has been shown to increase the risk or
spontaneous pneumothorax.
Risk actors or pneumothorax include+
• %our sex. !n general" men are ar more likely to ha%e a pneumothorax than are
women.
• Smo&ing. The risk increases with the length o time and the number o cigarettes
smoked" e%en without emphysema.
• Age. The type o pneumothorax caused by ruptured air blisters is most likely to occur
in people between 31 and 41 years old" especially i the person is a %ery tall and
underweight man.
• 'enetis. )ertain types o pneumothorax appear to run in amilies.
• (ung disease. Ha%ing an underlying lung disease . especially chronic obstructi%e
pulmonary disease ()OP*) . makes a collapsed lung more likely.
• Mehanial !entilation. People who need mechanical %entilation to assist their
breathing are at higher risk o pneumothorax.
• A history o) pneumothorax. #nyone who has had one pneumothorax is at increased
risk o another" usually within one to two years o the irst episode.
SI'NS AN* S%M+#$MS
&ymptoms o a pneumothorax include chest pain that usually has a sudden onset. The pain is
sharp and may lead to eelings o tightness in the chest. &hortness o breath" rapid heart rate"
rapid breathing" cough" and atigue are other symptoms o pneumothorax. The skin may
de%elop a bluish color (termed cyanosis) due to decreases in blood oxygen le%els
# small" uncomplicated pneumothorax may (uickly heal on its own. -hen the pneumothorax
is larger" doctors usually insert a lexible tube or needle between your ribs to remo%e the
excess air.
#ES# AN* *IA'N$SE
# pneumothorax is generally diagnosed using a chest 5-ray. !n some cases" computeri'ed
tomography ()T) scan may be needed to pro%ide more detailed images. )T scanners combine
5-ray images taken rom many dierent directions to produce cross-sectional %iews o
internal structures.
#REA#MEN#
The goal in treating a pneumothorax is to relie%e the pressure on your lung" allowing it to re-
expand" and to pre%ent recurrences. The best method or achie%ing this depends on the
se%erity o the lung collapse and sometimes on your o%erall health.
$bser!ation
! only a small portion o your lung is collapsed" your doctor may simply monitor your
condition with a series o chest 5-rays until the air is completely absorbed and your lung has
re-expanded. 6ormally this takes a week or two. &upplemental oxygen can speed the
absorption process.
Needle or hest tube insertion
! a larger area o your lung has collapsed" it/s likely that a needle or chest tube will be used to
remo%e the air. The hollow needle or tube is inserted between the ribs into the air-illed space
that is pressing on the collapsed lung. -ith the needle" a syringe is attached so that the doctor
can pull out the excess air . $ust like a syringe is used to pull blood rom a %ein. )hest tubes
are oten attached to a suction de%ice that continuously remo%es air rom the chest ca%ity.
Surgery
! a chest tube doesn/t resol%e your problem" surgery may be necessary to close the air leak.
!n most cases" the surgery can be perormed through small incisions" using a tiny iber-optic
camera and narrow" long-handled surgical tools. The surgeon will look or the leaking bleb
and sew it closed. !n some cases" a substance like talc may be blown in through the tube to
irritate the tissues around the lung so that they/ll stick together and seal any leaks. Rarely" the
surgeon will ha%e to make a larger incision between the ribs to get better access to multiple or
larger air leaks.
#U,ERCU($SIS
T7 is a inection disease that caused o mycobacterium tuberculosis. The spots o T7
inection germ are respiratory tracts" absorption tracts and opened in$ury in skin. 8ost o T7
inection occur pass through air " by means o droplet inhalation that consist o basil which
come rom person who inected. The spreading capacity rom a suerer is depended on the
number o germ that issued rom the lung.someone might be inected by T7 rom the droplet
concentration in the air" and how long they breath that air.
T7 is a disease that controlled by imunity response inse(uenced cell. 9ector cells are
macroag and limosit ( usually T cell ). They are imunoresponsi%e cells. This type usually
local" in%ol%ing macroag which acti%ed in inection spot by limosit and it:s limokin. The
response is called as hypersensiti%ity cellular reaction ( slow reaction )
C(ASSIFICA#I$N $F #,C ,ASE $N #-E -IS#$R%
.. +rimary #,C
it:s happen when someone attack primarly by T7) germ. The inection started when
the T7) germ replicated successully in the lung. That:s cause the inlammation. ,ime
tractus will carry T7) germ into lime gland around lung hilus and it.s called as primary
complexs.
Time between inection happens until primary complexs orm are around 4 ; < weeks.
The inection cold be pro%en by by the occur o tuberculin reaction that changes rom
negati%e into positi%e. The incubation period is time needed rom inected till become
sick" approximated or about < month.
/. A)ter +rimary #,C
2sually happen ater se%eral month or year. #ter primary inection" or example
because o the descent body deense in conse(uence inected by H!= or malnutrient
status. The main characteristic or ater primary T7) is the broadening lung damage in
occurring ca%ity or pleural eusion.
+rimary +rogressi!e #uberulosis
#cti%e tuberculosis de%elops in only >? to @1? o persons exposed to M tuberculosis. -hen
a patient progresses to acti%e tuberculosis" early signs and symptoms are oten nonspeciic.
8aniestations oten include progressi%e atigue" malaise" weight loss" and a low-grade e%er
accompanied by chills and night sweats.
33
-asting" a classic eature o tuberculosis" is due to
the lack o appetite and the altered metabolism associated with the inlammatory and immune
responses. -asting in%ol%es the loss o both at and lean tissueA the decreased muscle mass
contributes to the atigue.
3B
Cinger clubbing" a late sign o poor oxygenation" may occurA
howe%er" it does not indicate the extent o disease.
34
# cough e%entually de%elops in most
patients. #lthough the cough may initially be nonproducti%e" it ad%ances to a producti%e
cough o purulent sputum. The sputum may also be streaked with blood. Hemoptysis can be
due to destruction o a patent %essel located in the wall o the ca%ity" the rupture o a dilated
%essel in a ca%ity" or the ormation o an aspergilloma in an old ca%ity. The inlamed
parenchyma may cause pleuritic chest pain. 9xtensi%e disease may lead to dyspnea or
orthopnea because the increased interstitial %olume leads to a decrease in lung diusion
capacity. #lthough many patients with acti%e disease ha%e ew physical indings" rales may
be detected o%er in%ol%ed areas during inspiration" particularly ater a cough. Hematologic
studies might re%eal anemia" which is the cause o the weakness and atigue. ,eukocytosis
may also occur because o the large increase in the number o leukocytes" or white blood
cells" in response to the inection.
D
+A#$'ENENC%
The risk actor are +
@. must ha%e inection sorce
3. the number o bacillus as an inection cause must be suicient
B. the high %irulence o T7) bacillus
4. The descent o body deense make the bacillus reproduce
)linic illustration +
@. The main symptom
)ontinous cough withEwithout sputum during B weeks or more
3. #dditional symptom
- &putum mixed with blood
- Haemoptoe
- *yspnea and chest pain
- -eakness
- 6ight sweat
- *ecrease weight
- Ce%erish e%er more than @ month
*IA'N$SIS
,ung T7) diagnosis can be stood at by 7T# inding in sputum inspection microscopicly. The
inspection result tangibled positi%e i at least 3 rom B &P& specimen must be positi%e.
! only @ specimen which positi%e" so it:s needed a urther check up" that is chest x-ray photo
or &P& sputum check up repeated.
a. ! the x-ray result supports T7)" so the patient is diagnosed as T7) 7T# suerer
positi%e
b. ! the x-ray result unsupports T7)" so the sputum check up repeated
! three sputum specimen are negati%e" gi%e an extensi%e spectrum antibiotic during @-3
weeks. ! the condition still bad" do &P& sputum check up repeated.
a. ! the &P& result are positi%e" diagnosed as inection T7) 7T# inected
b. ! the &P& result are still negati%e" do thr chest 5-ray check up.
• ! the 5-ray result supports T7)" diagnosed as negati%e 7T# patient but the
5-ray positi%e
• ! the 5-ray result not supports T7)" the patient is not T7).
ME*ICA( #REA#MEN#
Purpose +
@. )ure the patient
3. Pre%ent death
B. Pre%ent relapse
4. *ecreasing the le%el o spreading
Category . 0/-R1E23-4R45 6
• 6ew patient lung T7) positi%e 7T#
• Patient lung T7) negati%e 7T#" 5-ray positi%e who got serious illness
• Patient hea%y extra lung T7)
!ntensi%e stage consist o !soniasid(H)" Riampicin(R)" Pira'inamid(F)" dan 9tambutol(9).
Those medicine are gi%en e%eryday during two (3) month (3HRF9). Then continued by next
stage" that consists o !soniasid(H)" and Riampicin(R). Gi%en three times a week during our
month (4HBRB).
Category / 0/-R1ES2-R1E27-4R4E45 6
• Relaps patient
• Cailure patient
• #ter deault patient
!ntensi%e stage are gi%en or three month consists o HRF9& during 3 month gi%en
e%eryday (3HRF9&)" continued by HRF9 during @ month gi%en e%ery day (HRF9). Then
continued by next stage that consists o HR9 during > month gi%en B times a week.
Category 4 0/-R1ES23-4R45 6
• 6ew patient 7T# negati%e and 5-ray positi%e" light ill.
• Patient extra light lung" it is T7) limadenitis" pleuritis eksudati%a unilateral" skin
T7)" bone T7) (except backbone)" $oint T7) and adrenal gland.
!ntensi%e stage consist o HRF" gi%en e%eryday during 3 month(3HRF)" continued by se(uel
stage that consist o HR during 4 month gi%en B times a week(4HBRB). One packet o
)ombipac B
rd
category contents o @@4 daily blister that consist o <1 blister HRF or the
intensi%e stage and >4 blister HR or the se(uel stage each packed in a small doss and
bounded in a big doss.
Implied $A# 0-R1E5
! the end o intensi%e treatment o new patient 7T# positi%e in @
st
category or patient 7T#
positi%e retreatment by category 3
nd
" sputum check up result still 7T# positi%e (positi%e
7T#)" gi%en medical implied (HRF9) e%eryday during @ month.
C$M+(ICA#I$N $F #U,ERCU($SIS
-ithout treatment" tuberculosis can be atal. 2ntreated acti%e disease typically aects your
lungs" but it can spread to other parts o the body through your bloodstream. 9xamples
include+
• ,ones. &pinal pain and $oint destruction may result rom T7 that inects your bones. !n
many cases" the ribs are aected.
• ,rain. Tuberculosis in your brain can cause meningitis" a sometimes atal swelling o the
membranes that co%er your brain and spinal cord.
• (i!er or &idneys. Hour li%er and kidneys help ilter waste and impurities rom your
bloodstream. These unctions become impaired i the li%er or kidneys are aected by
tuberculosis.
• -eart. Tuberculosis can inect the tissues that surround your heart" causing inlammation
and luid collections that may interere with your heart/s ability to pump eecti%ely. This
condition" called cardiac tamponade" can be atal.