it 7 - pendekatan diagnostik limfadenopati limfadenitis - nd (1)

5/19/2018 IT 7 - Pendekatan Diagnostik Limfadenopati Limfadenitis - ND (1)

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Limfadenopati :

pendekatan diagnostik

Dr. Norman Djamaluddin, SpPD K- HOM

Su agian Hematologi Onkologi Medik

!agian Pen"akit Dalam #SMH Palemang

PendekatanDiagnostik

Limfadenopatidan Limfadenitis


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The Lymphatic System

The body has approximately 600 lymph nodes,but only those in the submandibular, axillary oringuinal regions may normally be palpable inhealthy people. Lymphadenopathy refers to

nodes that are abnormal in either si!e,consistency or number. There are "ariousclassi#cations of lymphadenopathy, but a simpleand clinically useful system is to classifylymphadenopathy as $generali!ed$ if lymph

nodes are enlarged in t%o or more noncontiguousareas or $locali!ed$ if only one area is in"ol"ed.


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Distinguishing bet%een locali!ed andgenerali!ed lymphadenopathy isimportant in formulating a

di&erential diagnosis.

'n primary care patients %ithunexplained lymphadenopathy,

approximately ()* of patients %illpresent %ith locali!edlymphadenopathy and )* %ith

generali!ed lymphadenopathy.


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Kelenjar geta$ ening le$er

!a%emore &'. P$"si(ian )**)+:)*-*


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Kelenjar geta$ ening aksila

!a%emore &'. P$"si(ian )**)+:)*-*


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Kelenjar geta$ ening inguinal

!a%emore &'. P$"si(ian )**)+:)*-*


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Le/el kelenjar geta$ ening le$er

#oins K0. &r($ Otolar"ngol Head Ne(k Surg. )**)+)1:23-1

Le/el : sumental dan

sumandiular

Le/el ) : upper jugularLe/el : middle jugular

Le/el 4 : lo5er jugular

Le/el 3 : posterior

triangle group

Le/el : anterior triangle

group


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Pendekatan diagnosis

limfadenopati

6

6

6

6

Definisi

Klasifikasi

7tiologi



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Definisi

Limfadenopati

Pembesaran kelen+ar getah bening denganukuran lebih besar dari cm.

errer -. m am Physician//123(2ataubnormalitas ukuran atau karakter kelen+argetah bening

4a!emore 5. Physician 0016630(70

Limfadenitis

-adang pada kelen+ar getah bening yang


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Klasifikasi

Limfadenopati

lokalisata

6 Limfadenopati

pada regio

Limfadenopati

generalisata

6 limfadenopati

pada ) atau lei$

regio anatomi

"ang ereda


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M8&M8

!a%emore &'. P$"si(ian )**)+:)*-*8atrogeni(

unusual (ondition

7tiologiMalignan(ies

8nfe(tions

&utoimmune


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7tiologi : Malignan(ies

6

6

6

6

6

Lekemia

Limfoma

Neoplasma kulit

Kaposi sarkoma

Metastase


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7tiologi : 8nfe(tious

6

66

6

6

66

6

6

6

6

6

6

!ru(ellosis

9at-s(rat($ disease

9M

H8, infeksi primer

Limfogranuloma /enerium

Mononukleosis

;aringitis

#uela

0uerkulosis


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7tiologi : &utoimun

6

66

6

Lupus eritematosis sistemik

&rtritis rematoid

Dermatomiositis

Sindroma Sjogren


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7tiologi :Mis(ellaneous


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7tiologi : SH&K

S

Sar(oidosis

Sili(osis

Storage disease

H

Hipertiroidisme

Histiositosis

Hipertrigliseridemia

!a%emore &'. P$"si(ian )**)+:)*-*


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7tiologi : 8atrogeni(

6 Serum si(kness

6 Oat =oatan :

&lopurinol

&tenolol

9aptopril

9arama%epineH"drala%ine

Penisilin

Pirimidone

Pirimetamine

Kuinidin

0rimetoprim sulfametoksa%oleSulinda(

;enitoin

!a%emore &'. P$"si(ian )**)+:)*-*


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limfadenopati

6

6

6

6

Definisi

Klasifikasi

7tiologi



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6 &namnesa

= >mur penderita dan laman"a

limfadenopati

)1 penderita, pen"ea enign dan self

limiting :

= 2?@ penderita erusia kurang dari

* ta$un

= 3?@ penderita antara -3* ta$un

= ?@ penderita di atas 3* ta$un.

;errer #. &m ;am P$"si(ian ??1+31:3

!a%emore &'. P$"si(ian )**)+:)*-*

.


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6 &namnesa

=>mur penderita dan laman"a

limfadenopati :

6 #isiko keganasan seagaipen"ea limfadenopati :

usia 4* ta$un atau lei$ : 4@

usia di a5a$ 4* ta$un : *,4@.


!a%emore &'. P$"si(ian )**)+:)*-*


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6 &namnesa

=>mur penderita dan laman"a

limfadenopati

limfadenopati "ang erlangsungkurang dari ) minggu atau lei$ dari

ta$un tanpa progresi/itas ukuran

mempun"ai kemungkinan sangat ke(il

diseakan keganasan


!a%emore &'. P$"si(ian )**)+:)*-*


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6 &namnesa :

6 Paparan

6 Simptom "ang men"ertai


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:istory

First,are there locali!ing symptoms or signs tosuggest infection or neoplasm in a speci#c site;

Second, are there constitutional symptoms suchas fe"er, %eight loss, fatigue or night s%eats tosuggest disorders such as tuberculosis,lymphoma, collagen "ascular diseases,unrecogni!ed infection or malignancy;


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:istory

Third,are there epidemiologic clues such asoccupational exposures, recent tra"el or high7riskbeha"iors that suggest speci#c disorders;

Fourth,is the patient taking a medication thatmay cause lymphadenopathy; Some medicationsare kno%n to speci#cally cause lymphadenopathy


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6 Pemeriksaan fisik

= Karakter dan ukuran kelenjar geta$ ening

6 ) penderita de5asa , dengan ukuran

kelenjar :

=di a5a$ (m : tidak ada keganasan

=-),)3 (m : keganasan : 1@

=di atas ),)3 (m : keganasan : 1 @


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6 Pemeriksaan fisik

=Karakter dan ukuran kelenjar geta$

ening :

ukuran kelenjar maksimum ) (m dan ,3

(m merupakan atas ukuran "angmemerlukan e/aluasi lei$ lanjut untuk

menentukan adan"a keganasan dan

pen"akit granulomatous


!a%emore &'. P$"si(ian )**)+:)*-*


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Physical 9xamination

Size.

Pain/Tenderness:The presence or absence of tendernessdoes not reliably di&erentiate benign from malignant nodes.

Consistency:Stony7hard nodes are typically a sign ofcancer, usually metastatic. >ery #rm, rubbery nodes

suggest lymphoma. Softer nodes are the result of infectionsor in8ammatory conditions. Suppurant nodes may be8uctuant. The term $shotty$ refers to small nodes that feellike buckshot under the skin, as found in the cer"ical nodesof children %ith "iral illnesses.


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Matting :can be either benign


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Pemeriksaan fisik

6 Pemeriksaan fisik=Lokasi limfadenopati :

6 Limfadenopati daera$ kepala dan

le$er

6 Limfadenopati epitro$lear

6 limfadenopati aksila

6 Limfadenopati suprakla/ikula

6 Limfadenopati inguinal

6 Limfadenopati generalisata


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Supracla"icular lymphadenopathy has the highest risk ofmalignancy, estimated as /0 percent in patients older than*0 years and 2 percent in those younger than age.

Lymphadenopathy of the right supracla"icular node isassociated %ith cancer in the mediastinum, lungs or

esophagus. The left supracla"icular ircho%?s= node recei"es lymphatic

8o% from the thorax and abdomen, and may signalpathology in the testis, o"aries, kidneys, pancreas,prostate, stomach or gallbladder. lthough rarely present


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&lgoritme e/aluasi limfadenopati

&namnesa, pemeriksaan fisikAinak, self

limited

&utoimun

it 7 - pendekatan diagnostik limfadenopati limfadenitis - nd (1)

Documents

pendekatan diagnostikdr

ed lymphadenopathy isimportant

leel kelenjar geta

ed andgenerali

ithunexplained lymphadenopathy

cations of lymphadenopathy

n locali

ening aksila