+fisis diagnostik paru
DESCRIPTION
INTERNATRANSCRIPT
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FISIS DIAGNOSTIK FISIS DIAGNOSTIK PARUPARU
M.JUNUS PATAUM.JUNUS PATAUSUB-BAGIAN PULMONOLOGI BAG.PENY.DALAM FK SUB-BAGIAN PULMONOLOGI BAG.PENY.DALAM FK
UNHASUNHAS
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Cardinal Chief Cardinal Chief ComplaintsComplaints
DyspneaDyspnea CoughCough HemoptysisHemoptysis WheezingWheezing Chest painChest pain Voice changeVoice change Ankle swellingAnkle swelling
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FISIS DIAGNOSTIK PARU
1. ANAMNESIS
2. INSPEKSI
3. PALPASI
4. PERKUSI
5. AUSKULTASI
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1.ANAMNESIS
. Keluhan utama penderita
. Anamnesis terpimpin sesuai KU
. Anamnesis sistemik yang ada hubu-
ngan dengan KU
. Anamnesis keluarga, pekerjaan,pe-
nyakit sebelumnya,obat-obatan.
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Barrel chestBarrel chest
What causes this?What causes this? CharacteristicsCharacteristics Clinical usefulnessClinical usefulness
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FISIS DIAGNOSTIK PARU
1. ANAMNESIS
2. INSPEKSI
3. PALPASI
4. PERKUSI
5. AUSKULTASI
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1.ANAMNESIS
. Keluhan utama penderita
. Anamnesis terpimpin sesuai KU
. Anamnesis sistemik yang ada hubu-
ngan dengan KU
. Anamnesis keluarga, pekerjaan,pe-
nyakit sebelumnya,obat-obatan.
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INSPEKSI :
. Inspeksi umum (keadaan umum yg tampak)
. Inspeksi khusus: - kecepatan dan dalamnya
- bentuk dada; Barrel chest (empisema-
tous), Pectus carinatum(pigeon chest)
Kifoskoliosis, Pectus excavatum
( funnel chest ), dada tidak simetris, tipe
pernapasan torakal,abdominal,paradoxal
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Barrel chestBarrel chest
What causes this?What causes this? CharacteristicsCharacteristics Clinical usefulnessClinical usefulness
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What causes this?What causes this? CharacteristicsCharacteristics Clinical usefulnessClinical usefulness
ClubbingClubbing
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Signs of Steroid UseSigns of Steroid Use
What causes this?What causes this? CharacteristicsCharacteristics Clinical usefulnessClinical usefulness
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PALPASI:
- Dipakai untuk menetapkan ekspansi dada,
posisi apeks jantung. Perobahan posisi
apeks jantung karena pendorngan mediasti-
num, efusi pleura; penarikan o/k fibrosis
paru atau karena fibrosis pleura.
- Tactile fremitus; meingkat( infiltrat,konsoli-
dasi ), menurun ( efusi pl, pnthorax, tumor)
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PalpationPalpation
Chest wall Chest wall excursionexcursion
SymmetrySymmetry Subcutaneous Subcutaneous
emphysemaemphysema CrepitusCrepitus
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PERKUSI :
-Perkusi perbandingan paru kanan dan kiri
-Perkusi batas paru hepar dan batas jantung
-Suara perkusi normal sonor.
-Suara perkusi abnormal : redup,pekak, tim-
pani dan hipersonor menandakan adanya
kelainan paru atau pleura
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AUSKULTASI:
Suara napas utama ; bronkial, bronkovesi-
kuler, vesikuler.
Suara napas tambahan :
a. kontinu – ronki kering nada tingggi
( wheezes), nada rendah (sonorous).
b. diskontinu- ronki basah (crackles)
r.basah kasar,sedang dan halus.
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Normal Breath SoundsNormal Breath Sounds
BronchialBronchial Vesicular Vesicular BronchovesicularBronchovesicular
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Lower AirwaysLower Airways
FunctionFunction FiltrationFiltration Transmission of airTransmission of air
StructuresStructures TracheaTrachea Mainstem bronchiMainstem bronchi BronchiolesBronchioles Terminal Terminal
bronchiolesbronchioles
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Anterior LocationsAnterior Locations
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Breath SoundsBreath Sounds
Where to listen?Where to listen? Upper lobesUpper lobes Major airwaysMajor airways Lower lobesLower lobes
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Posterior LocationsPosterior Locations
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Anterior LocationsAnterior Locations
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AUSKULTASI sambungan
- ronki kering -- obstruksi sal.napas akibat
spasme , edema,sekret/mukus bronkus
terutama terdengar waktu ekspirasi,bila
terdengar waktu inspirasi ---obstruksi sal.
napas atas ( stridor inspiratoir ).
- ronki kering nada tinggi=mengik ;asma
(wheezing ).
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Abnormal Breath SoundsAbnormal Breath Sounds
WheezesWheezes Rales/cracklesRales/crackles Rhonchi/low Rhonchi/low
wheezeswheezes Pleural friction rubPleural friction rub StridorStridor AbsentAbsent
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AUSKULTASI sambungan
-Ronki basah kasar terdengar pd permulaan
inspirasi; R.b sedang pd pertengahan inspsi;
R.b halus pd akhir inspirasi.
- Suara napas vesikuler yang melemah ok han-
taran udara ke dinding dada tarhalang –efusi
pleura,pn.toraks,atelektasis,fibrosis,emfisema
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AUSKULTASI sambungan.
- Ronki basah kasar : terdengar di sal.napas besar
karena gelembung udara besar pecah (kesadaran
menurun)
- Ronki basah sedang: terdengar di sal.n.sedang,
karena gel.udara kecil pecah(bronkiektasis,br.pn)
- Ronki basah halus: karena acinus terbuka,edema
paru,pneumonia.Terdengar seperti gesekan
rambut dan jari ( crackles )
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AUSKULTASI sambungan
Fremitus vokal ; penderita disuruh mengu-
capkan satu kata kemudian didengarkan me-
lalui stetoskop di dada , bila suara yg dihan-
tarkan melalui bronkus terdengar jelas ----
bronkofoni menunjukkan konsolidasi paru
Bila suara yang terdengar sengau (s.nasal)----
egofoni ( atelektasis kompresif ok ef.pleura).
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AUSKULTASI sambungan.
* Whispered pectoriloquy penderita disu-
ruh mengucapkan suara bisik 77, 99
bila dapat didengar dengan jelas menandakan
proses infiltrat,konsolidasi,atelektasis.
*Pleural friction rub ( bunyi gesekan pleura )
Tedengar pada akhir inspirasi dan permulaan
ekspirasi ok adanya proses peradangan pleura.