tbc lecture.ppt

7/21/2019 TBC LECTURE.ppt

http://slidepdf.com/reader/full/tbc-lectureppt 1/27

H. Oma Rosmayudi dr. Sp.A(K)



Hasil %$m$riksaan T tidak tampak sakit,

!i*i "aik, dil$h$r t$rdapat 1 "$n&olan

diam$t$r +mm, "ulat padat mudah

di!$rakkan. antun! paru normal H" 1 !r /, 0$kosit +mm, 034 115 T$st

tu"$rkulin +mm Sinar-6- Thora7

m$nun&ukkan !am"aran "ronkhitis.

Apakah T TB 8



PENYAKIT TBC PADA

ANAK

SA9A 4:; 3T'O0O:' TB-43<ASA 9=OBAT3R'>9 T>B3R>0OS'S

O9%036 9. T>B3R>0OS'S, 9. BO?'S, 9. 9'ROT',9. A;3TT', 9. A@R'A;>9

OB0':AT3 A3ROB

;O;-9OT'03, ;O;-S%OR3@OR9';: >K>RA; (1-1)7(,2-,+)m TAHA; ASA9, T>9B>H 0A9BAT

ETIOLOGI

:



930A0>' 4RO%03T-';@3T'O;C

%3R'KA; 0>4AH D1m =A;:

93;=39B>R 4:; BAT>K, B3RS';%3;43R'TA TB-%AR>-43<ASA 4:;

BTA %OS'T'@ %A4A S%>T>9;=A.

ARA;: S3KA0' 930A0>' '>9A;

ATA> KO;TAK S3KR3T.

PENULARAN



SUMBER PENULARAN %3;43R'TA TB %AR> 43<ASA 43;:A;

S%>T>9 BTA (E), KA?3R;OS>S A;AK 4:; TB %AR> (usia D F thn )

B'ASA;=A T'4AK 93;>0AR, K3>A0' G TB BRO;K>S

G TB KA?3R;OS>S

KAR3;A - S%>T>9 S34'K'T

- S%>T>9 4'T30A;

- S%>T>9 T'4AKHA;=A S34'K'T93;:A;4>;: 9.TB



%3;>0ARA; B'ASA;=A T3RA4' A%AB'0A

KO;TAK 3RAT (S3R>9AH, S3R';:

K3T39>, 4'R>A;:A; T3RT>T>%, 4ST)

B3RHA4A%-HA4A%A; %A4A <AKT>

%3;43R'TA BAT>K

A4A 9.TB =: SA9%A' K3 A0?3O0'

(T3RBA<A %ART'K30 >K>RA; D 5m)



B'0A A4A 1-2 9.TB =: SA9%A' 4' A0?3O0',S30A;>T;=A A4A K39>;:K';A; =:T3RA4' I 9.TB 3%AT 4'B>;>H 4A; 4'B>A;: 4'B3RS'HKA;

4AR' AR';:A; %AR>

I ';@3KS' 0AT3; (ATA> KRO;'K)I A;AK 93;43R'TA TB %R'93R =: K39>4'A; S39B>H ATA> %RO:R3S'?3 4A0A9 T39%O 3%AT

I 93;43R'TA SAK'T B3B3RA%A TAH>; K39>4'A;KAR3;A R3AKT'?AS' ';@3KS' 0AT3;T

B'0A T'4AK A4A 9ASA0AH K3S3HATA; (A'4S,:'J' K>RA;:,4ST), HA;=A 5-1/ A;AK=A;: T3RK3;A ';@3KS' AKA; 93;43R'TA%3;=AK'T TB

PATOGENESIS



A%AB'0A 9.TB T'4AK 4%T 4'B>;>H O03H9AKRO@A: A0?3O0AR 9.TB 939B'AK4'4A0A9 9AKRO@A:, 4A; 939B>;>H

9AKRO@A: TSB.9AKRO@A: =: T3R';@3KS' (93;A;:KA%)9.TB 939%RO4>KS' S'TOK'; 4A;H39OK'; =: AKA; 93;AR'K S30

@A:OS'T (9O;OS'T, 9AKRO@A: A0?3O0AR0A';, ;3>TRO@'0 =: 939B3;T>K;O4>0AR :RA;>0O9ATO>S STR>T>R3C=: 4'S3B>T TUBERKEL)



S3B30>9 300 934'AT34 '99>;3 (9')CT3RB3;T>K (B'ASA;=A 2-12, RATA-RATA +-F9';::> S3T30AH 9.TB 9AS>K), 9.TB939B'AK (939B30AH 4'R') T3R>S KAR3;A

>90AH;=A 939B0>4AK, A4A S3BA:'A; =:T3RBA<A A0'RA; 4ARAH (TRA;S'3;TBAT3R'39'A) K3 OR:A; T>B>H 4'0>AR%AR>, T3R>TA9A =: KA=A %39B>0>H 4ARAH,S3%3RT' OTAK, %3R'KAR4'>9, :';A0, T>0A;:

S3;4' 4ST.9.TB =: T3RSA;:K>T 4' OR:A; =BS939B3;T>K T>B3RK30 4'SA;A 93;A4''KA0 BAKA0 %3;=AK'T TB 4' OR:A; =BS.



'KA R3%0'KAS' 9.TB 4' @OK>S %R'93R

T'4AK T3RK3;4A0' T>B3RK30

9393B3SAR, 4A; 9.TB T3RBA<A A0'RA; 0'9@3 SA9%A' 4' K303;AR

0'9@3 R3:'O;A0 KO9%03KS %R'93R

(:HO; O9%036) TB %AR>

%R'93R.



A%AB'0A R3%0'KAS' 9.TB T'4AKT3RK3;4A0' (KR; KO;4'S' HOS%3S 039AH AK'BAT A'4S, :'J' B>R>K, 4ST), S3T30AH9' T3RB3;T>K%>; 4A%AT T3RA4'

%3;=3BARA; H39ATO:3; TB 9'0'3R 4'%AR> (%ada Sinar 6 %aru tampak "intik-"intik y!t$rs$"ar dis$luruh paru), H3%AR, OTAK, 4ST.

4'0>AR %3;=3BARA; H39ATO:3;, 4A%AT>:A T4 KO9%0'KAS' KAR3;A K303;AR

0'9@3 4' H'0' 93;3KA; 4';4';: BRO;K>S %3;=39%'TA; 0>93; BRO;K>S KR;T3KA;A; 4AR' 0>AR <H33J';:%3RS'ST3;.



S30A'; 93;=3BABKA; OBSTR>KS',

T3KA;A; %A4A 4';4';: 4%T

93;=3BABKA; 3ROS' 4';4';:

AR';:A; KAS3O>S, S30 9AT', 4A;'S' K303;AR 0'9@3 0A'; 9AS>K K3

0>93; BRO;K>S 93;=>9BAT

ATA> T3R4ORO;: K3 4'STA0

%;3>9O;'A.



'. TB-%AR> '.1 TB %R'93R (TA;%A KO9%0'KAS')- @OK>S %R'93R 4' %3R'@3R %AR>

- 0'9@A;:'T'S

- 0'9@A43;'T'S 4' H'0>S ATA> %ARATRAK3A0

'.2 TB-%R'93R %RO:R3SS'@4'S3B>T S>B-%R'93R KO9%0'KAS' TB %R'93R

- %3;=3BARA; @OK>S %R'93R O'; SHA4O<

- %3;=3BARA; H39ATO:3;

TB 9'0'3R %03>R'T'S 3KS>4AT'?A- %3;=3BARA; BRO;KO:3;'K %;3>9O;'A, AT303KTAS'S,

39@'S39A

TBC PADA ANAK



TB-3KSTRA %AR> AK'BAT %3;=3BARA; TRA;S'3;T

BAT3R'39'AC danatau TB 9'0'3R

93;';:O3;S3@A0'T'S,%OTTLS 4'S3AS3,O6'T'S, %3R'AR4'T'S, TB AB4O93;,

0'9@A43;'T'S O00', :';A0, 4ST.

<A00:R3;LS T'93 TAB03 TB 9'0'3R

93;';:'T'S + B0; ', TB %03>RA 12 B0; ',

:';A0 M TH; ?.



S3BA:'A; B3SAR KAS>S TB A;AK AS=9%TO9AT'C

S3BA:'A; B3SAR 4AR' =A;: S=9%TO9AT'C,

:3A0A;=A HA;=A :3A0A >9>9 %3;>R>;A; ;A@S>

9AKA;, %3;>R>;A; B3RAT BA4A; :A;::>A;

%3RT>9B>HA;, 439A9

BAT>K B>KA; :3A0A %ATO:;O9O;'S, HA;=A

4'>9%A' B'0A BRO;K>S T3RT3KA; ATA>

BRO;KO:3;'K (T3R9AS>K %;3>9O;'A TB)

:3A0A KHAS O;>;:T'?'T'S %H0=T3;>0AR'S,3R=TH39A ;O4>S>9, SRO%H>0O43R9A, %OTTLS

4'S3AS3, O6'T'S, K30A';A; %03>RA

S3R3BROS%';A0'S

GEJALA/TANDA KLINIS



03B'H S>0'T 4AR' 4'A:;OS'S TB 43<ASA

BAK> 39AS 4'A:;OS'S TB (=A'T>

4'T39>KA;;=A 9.TB %A4A AR';:A; ATA>

S3KR3T -S%>T>9-) S>0'T 4A; BA;=AK @A0S;3:AT'%;=A

:3A0ATA;4A K0';'S,0AB.R>T';, :A9BARA;

S';AR-6 TORAK T'4AK A4A =: %ATO:;O9O;'S

HAS'0 T3ST T>B3RK>0'; %OS'T'% HA;=A

93;>;>KKA; %3R;AH K3;A ';@3KS' (B>KA;

%3;=AK'T) 9.TB

DIAGNOSIS



PEMERIKSAAN SPUTUM (SEKRETPARENKIM-DINDING BRONKI YG TERKENA

PENYAKIT TBC)

PENDERITA ANAK DEWASA

JENIS KELAINAN KEL.LYMF> KAVERNE

JUMLAH M.TBC SEDIKIT BANYAK

HUB. DG. BRONKI (-) (+)

JUMLAH SPUTUMSEDIKIT &DITELAN

BANYAK

BAHAN PEMERIKSAANCAIRAN

LAMBUNGSPUTUM

PENGAMBILAN BAHAN

SULITINVASIF

HARUS DI RS

LEBIH MUDAHNON INVASIF

DIRUMAH



SUSPECT

PROBABLE

CONFIRMED

KLASIFIKASI TBC MENURUTWHO



SISTEM SKORING DARIDEPKES

PARAMETER ! " #

KONTAK TB T’JELAS - LAP.KLRG BTA(+)

UJI TUBERKULIN NEGATIF - - > 10mm

ST.GI$I - BB/U<80% <60% -

DEMAM TAK JELAS - > m!! - -

BATUK KRONIK - > " m!! - -

KELENJAR - >1 #m > 1

- -

TULANG%SENDI - BENGKAK - -

FOTO TORAKS N$RAL/KEL.T’JLS

SUGESTIFTB&

- -



4ASAR T3OR'T'S R3AKS' H'%3RS3;S'T'?'TAS

9AS>K;=A A;T':3; (%%4) >;T>K K3S3K'A;

KA0';=A 93;:>;4A;: S30-S30 ';@0A9AS'K3T39%AT 9AS>K;=A A;T':3; %3;3BA0A;

(';4>RAS') K>0'T 4' T39%AT S>;T'KA; =:>K>RA; 9AKS'9A0;=A T4 %A4A F-N2 A9S3T30AH S>;T'KA;

HAS'0 4'BAA 4: 93RABA (%A0%AS') %AKA'TA;:A; ATA> BA00-%O';T (93TO4A SOKKA0)

TEST TUBERCULINE = TEST PPD (PURIFIED PROTEIN DERIVATIVES) = TEST MANTOUX



HAS'0 - mm ;3:AT'%

5- mm %OS'T'% 93RA:>KA;

KR; HT9,B:,

K3SA0AHA; T3K;'S,

ATA> K>A0'TAS %%4

M 1 mm %OS'T'%

ART' HAS'0 %OS'T'% %3R;AH K3;A ';@3KS'

TA;%A SAK'T, S34A;: SAK'T, %3R;AH SAK'T

TA%' S>4AH S39B>H, %3R;AH B:HT9.

ART' ;3:AT'% B30>9 ';@3KS', 9ASA

';K>BAS', A03R:'



1. 9ASA ';K>BAS'

2. %3;='9%A;A; %3;=>;T'KA; SA0AH

. ';T3R%R3TAS' SA0AH

. SAK'T TB B3RAT (TB 9'0'3R

93;';:'T'S)

5. SAK'T A9%AK, R>B300A, ?AR'300A,

';@0>3;JA, H'?A'4S+. '99>;OKO9%3T3;S' S30>0AR A.0. KR;

%39AKA'A; ST3RO'4

HASIL NEGATIP PALSU TESTMANTOUX



N. 43@'S'3;S' KO9%0393;

F. 439A9. 03KOS'TOS'S

1. 9A0;>TR'S'

11. SARKO'4OS'S12. %SOR'AS'S

1. 3>;O'03A0 B=%ASS

1. %%4 T3RK3;A S';AR >0TRA?'O03T

15. >R39'A

1+. 43@'S'3;S' %3R;'S'OSA



1. H39O%RO@'0AKS'S 4: ';H 1 m!k!hr (4OS'S

T>;::A0) S30A9A + B>0A; >;T>K

1.1 K3;A ';@3KS' TA;%A SAK'T

1.2 B30>9 K3;A ';@3KS' TA%' 4A0A9 K3A4AA;

T3RA;A9 T3R';@3KS' (A4A KO;TAK 3RAT)

2. T3RA%' OAT >;T>K =: S>4AH SAK'T A4A 2 @AS3

2.1 @AS3 ';T3;S'@ (2 B0; 4: RHJ)

2.2 @AS3 %3930'HARAA; ( B0; 4: RH)

PENGOBATAN TBC PADA ANAK



DOSIS OAT

DOSIS HARIAN('%K'BB%H*)

DOSIS MAKSIMAL('%H*)

'SO;'AJ'4 (H) 5-15

R'@A9%'S'; (R) 1-2 +

%'RAJ';A9'4 (J) 15- 2

3THA9B>TO0 (3) 15-2 125

STR3%TO9'S'; (S) 15- 1



H H$patitis, n$uritis p$riP$r, hip$rs$nsitiQitas.

R :astroint$stinal, r$aksi kulit, h$patitis,

throm"ositop$nia, p$nin!katan $n*im hati.J Toksisitas hati, artal!ia, !astroint$stinal

3 ;$uritis optik

S Ototoksik, ;$Protoksik

EFEK SAMPING OAT

tbc lecture.ppt

Documents