tag:blogger.com,1999:blog-75146398709405738622024-03-12T16:25:30.971-07:00catatan kecil elitahanya sebuah catatan kecil agar semua ini tidak segera terlupa...Anonymoushttp://www.blogger.com/profile/17040699491469284898noreply@blogger.comBlogger22125tag:blogger.com,1999:blog-7514639870940573862.post-18784386422191873762012-11-28T07:10:00.000-08:002012-11-28T07:10:14.993-08:00GASTROESOPHAGEAL REFLUX
<b style="mso-bidi-font-weight: normal;"><u><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pendahuluan<o:p></o:p></span></u></b><br />
<br />
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<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Gastroesophageal reflux adalah aliran
isi lambung menuju esofagus, merupakan proses normal pada anak-anak dan bayi
yang sehat, namun dapat menimbulkan kekhawatiran pada pengasuh.
Gastroesophageal reflux disease adalah aliran isi lambung menuju esofagus yang
menimbulkan keluhan dan komplikasi pada anak-anak dan bayi maupuun pada
pengasuhnya. Regurgitasi adalah aliran isi lambung menuju faring dan mulut
tanpa usaha, sedangkan muntah adalah ekspulsi isi lambung dengan usaha.</span><a name='more'></a><o:p></o:p><br />
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p> </o:p></span><br />
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<b style="mso-bidi-font-weight: normal;"><u><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Epidemiologi<o:p></o:p></span></u></b></div>
<br />
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<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span style="mso-spacerun: yes;"> </span>GER merupakan hal yang wajar terjadi pada
anak-anak dan bayi normal, terutama setelah makan. Pada 50% bayi usia < 3
bulan dan 67% bayi usia 4 bulan akan mengalami regurgitasi minimal sekali
sehari. Setelah usia bayi mencapai 12 bulan hanya 5% yang masih mengalami
regurgitasi. Gejala refluks (meliputi heartburn, nyeri epigastrik dan
regurgitasi) dialami 7% anak usia sekolah dan 8% remaja. Beberapa populasi
pediatrik yang mempunyai risiko terjadinya GERD adalah anak dengan gangguan
neurologis, obesitas, penyakit paru-paru, atresia esofagus dan prematuritas.<o:p></o:p></span></div>
<br />
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<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p> </o:p></span></div>
<br />
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<b style="mso-bidi-font-weight: normal;"><u><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Patofisiologi<o:p></o:p></span></u></b></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">GER dihasilkan dari relaksasi lower
esophageal sphincter (LES). Pada anak-anak dan bayi yang sehat, relaksasi LES
terjadi secara transien. Pada bayi, distensi lambung karena volume makanan yang
besar akan memicu relaksasi LES menjadi lebih sering. Pengosongan lambung yang
lambat akan meningkatkan frekuensi relaksasi LES. Esophageal clearance dan
pertahanan mukosa (dengan sekresi) memainkan peran penting dalam mencegah terjadinya
esophagitis karena melindungi mukosa esofagus terhadap paparan asam lambung.<o:p></o:p></span></div>
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p> </o:p></span><br />
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<b style="mso-bidi-font-weight: normal;"><u><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tanda
dan Gejala<o:p></o:p></span></u></b></div>
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<b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><u><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Bayi<o:p></o:p></span></u></i></b></div>
<br />
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<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Regurgitasi merupakan manifestasi yang
paling sering dari GER infantil. Namun walaupun hanya sebagian kecil dari semua
kasus GER, bayi dapat mengalami GERD dengan komplikasi berupa failure to
thrive, kesulitan makan, nyeri punggung, rewel, dan hal ini biasanya dikeluhkan
oleh pengasuh. Gejala ekstraintestinal dapat berupa wheezing, batuk
kambuh-kambuhan, pneumonia aspirasi dan postur abnormal yang biasa disebut
sebagai sindrom Sandifer.<o:p></o:p></span></div>
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<b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><u><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Anak-anak<o:p></o:p></span></u></i></b></div>
<br />
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<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pada anak usia sekolah, regurgitasi,
muntah, nyeri perut dan kesulitan makan merupakan penampakan yang umum terjad
dari GERD. Tanda ekstraintestinal meliputi batuk kronis, pneumonia dan erosi
gigi. Pada anak yang lebih tua gejala GERD yang sering ditemui adalah
heartburn, regurgitasi, dan nyeri epigastrik. Bila terjadi inflamasi yang berat
dapat terjadi hematemesis dan anemia.<o:p></o:p></span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p> </o:p></span></div>
<br />
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<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pendekatan
Diagnosis pada GERD<o:p></o:p></span></b></div>
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<b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><u><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Anamnesis dan pemeriksaan Fisik<o:p></o:p></span></u></i></b></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Anamnesis dan pemeriksaan fisik
merupakan elemen yang sangat penting dalam mengevaluasi GERD dan kondisi lain
yang mungkin mirip dengan GERD. Anamnesis dan pemeriksaan fisik saja mungkin
sudah cukup untuk mendiagnosis GER benigna pada anak dan bayi normal. Namun
penting untuk mencari sumber muntah bila terdapat empedu atau darah pada
muntahan, jika anak menjadi rewel, jika muntah secara kuat dan proyektil atau
jika muntah berhubungan dengan gejala lain misalnya saja demam atau letargi.<o:p></o:p></span></div>
<br />
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<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Riwayat pemberian makan harus digali
dengan teliti meliputi volume dan frekuensi pemberian makan, jenis formula,
cara menyiapkan formula dan posisi bayi selama pemberian makan. Riwayat
disfagia, makan lambat, memotong makanan menjadi potongan kecil atau menolak
makanan tertentu mungkin menandakan eosinophilic esophagitis.<o:p></o:p></span></div>
<br />
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<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Riwayat penyakit dahulu meliputi
prematuritas, masalah neurologis, masalah tumbuh kembang, operasi atau mondok,
alergi (terutama terhhadap suatu makanan) dan penyakit psikologis. Review
sistem harus detail meliputi keluhan pada sistem respiratorius, gejala telinga
hidung dan tenggorok. Riwayat penyakit kelauarga meliputi penyakit
gastrointestinal, GERD dan penyakit atopik.<o:p></o:p></span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pemeriksaan fisik harus meliputi
penampakan umum pasien, pengukuran berat badan dan panjangg badan, paru-paru,
jantung, pemeriksaan abdomen ( terutama lihat apakah ada distensi abdmen, nyeri
tekan pada abdomen, suara usus, dan hepatosplenomegali) dan pemeriksaan
neurologis.<o:p></o:p></span></div>
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<b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><u><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pemeriksaan Penunjang<o:p></o:p></span></u></i></b></div>
<br />
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<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Untuk anak-anak dan bayi, anamnesis dan
pemeriksaan fisik sudah cukup sehingga pemeriksaan penunjang lainnya tidak
dibutuhkan untuk mendiagnosis GER. Pemeriksaan penunjang dilakukan jika pada
anak-anak atau bayi tersebut mengalami komplikasi yang berhubungan dengan GERD
dan mengevaluasi penyebab laindari muntah. Pemeriksaan penunjang didasarkan
hasil anamnesis dan pemeriksaan fisik.<o:p></o:p></span></div>
<br />
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<i style="mso-bidi-font-style: normal;"><u><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Trial penggunaan obat untuk
mengurangi keasaman lambung<o:p></o:p></span></u></i></div>
<br />
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<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pada
anak usia > 8 tahun dan remaja yang mempunyai keluhan GERD (heartburn,
regurgitasi dan nyeri epigastrik), respon positif pada trial obat yang
mengurangi produksi asam misalllnya Ppi dapat digunakan untuk menjadi dasar
penegakan diagnosis GERD. Durasi trial adalah selama 4 minggu, karena terapi
PPI selama 2 minggu tidak akan cukup untuk GERD.Namun tidaka ada evidence untuk
melakukan trial dengan menggunakan PPI untuk mendiagnosis GERD pada anak-anak
dan bayi.<i style="mso-bidi-font-style: normal;"><o:p></o:p></i></span></div>
<br />
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<i style="mso-bidi-font-style: normal;"><u><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Barium Contrast Radiography</span></u></i><i style="mso-bidi-font-style: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">.<o:p></o:p></span></i></div>
<br />
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<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pemeriksaan
fluoroskopi menggunakan barium untuk melihat upper GI tract. Pemeriksaan ini
baik digunakan untuk melihat anatomi dari upper GI tract (esofagus, lambung dan
duodenum). Pemeriksaan ini untuk menentukan adakan kelainan anatomi yang dapat
menimbulkan gejala menyerupai GERD meliputi striktura esofagus, achalasia,
hiatal hernia, gastric outlet obstruction dan malrotasi intestinal.<i style="mso-bidi-font-style: normal;"><o:p></o:p></i></span></div>
<br />
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<i style="mso-bidi-font-style: normal;"><u><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Monitoring pH Esofagus.<o:p></o:p></span></u></i></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Monitoring
pH pada esofagus dapat digunakan untuk mengukur pH pada isi lambung, frekuensi
dan durasi setiap episode refluks.<o:p></o:p></span></div>
<br />
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<i style="mso-bidi-font-style: normal;"><u><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Monometer Esofagus<o:p></o:p></span></u></i></div>
<br />
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<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Monometer
esofagus menilai fungsiesofagus dengan menili peristaltik esofagus dan upper
esophageal sphincter dan tekanan LES. Manometri berguna untuk mendiagnosis
gangguan motilitas esofagus seperti achalasia (suboptimal relaxation LES). Pada
kebanyakan anak yang mengalami GERD akan mempunyai hasil manometri yang
abnormal karena terjadinya kerusakan dan inflamasi pada esofagus. Namun
manometri tidak dapat digunakan untuk mendiagnosis GERD atau untuk memprediksi
keberhasilan terapi karena manometri tidak dapat menentukan apakat terjadi
refluks atau esofagitis.<o:p></o:p></span></div>
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<i style="mso-bidi-font-style: normal;"><u><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Endoskopi dengan biopsi<o:p></o:p></span></u></i></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Upper
intestinal endoscopy dengan biopsi dapat digunakan untuk peeriksaan histologis
pada esofagus, lambung dan duodenum.<o:p></o:p></span></div>
<br />
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<i style="mso-bidi-font-style: normal;"><u><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Scintigraphy<o:p></o:p></span></u></i></div>
<br />
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<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Dikenal
dengan gastric emptiying scan. Pemeriksaan ini menggunakan formula yang
dilabeli dengan technetium untuk menilai pengosongan lambung. Scan ini dapat
digunakan untuk mengidentifikasi adanya refluks dan aspirasi.<o:p></o:p></span></div>
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p> </o:p></span><br />
<br />
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<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Komplikasi
GERD<o:p></o:p></span></b></div>
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<b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><u><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Komplikasi Esofagus<o:p></o:p></span></u></i></b></div>
<br />
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<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Esofagitis, Barrett esophagus, striktur
dan adenokarsinoma dilaporkan sebagai konsekuensi dari GERD yang berat.
Esofagitis dapat muncul karena paparan asam lambung secara kronis dan harus
didiagnosis dengan upper endoscopy dan histologi.<o:p></o:p></span></div>
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<b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><u><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Gejala Respirasi<o:p></o:p></span></u></i></b></div>
<br />
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<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">GERD berhubungan dengan astma. Hal ini
berkaitan dengan aspirasi isi lambung yang menyebabkan hiperresponsif saluran
nafas dan inflamasi pada bronkus. Komplikasi lain dari refluks adalah pneumonia
yang disebabkan oleh aspirasi isi lambung.<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0pt; text-align: justify;">
<b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><u><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Gejala saluran nafas atas<o:p></o:p></span></u></i></b></div>
<br />
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<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Refluks berhubungan dengan serak, batuk
kronis dan juga penemuan pada pemeriksaan laringoskop berupa edema saluran
nafas atas, eritema.<o:p></o:p></span></div>
<br />
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<b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><u><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Karies gigi<o:p></o:p></span></u></i></b></div>
<br />
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<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">GERD berkaitan dengan karies gigi.
Selain itu GERD juga berkaitan dengan hilangnya enamel gigi.<o:p></o:p></span></div>
<br />
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<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Treatment<o:p></o:p></span></b></div>
<br />
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<b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><u><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Modifikasi Gaya Hidup<o:p></o:p></span></u></i></b></div>
<br />
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<i style="mso-bidi-font-style: normal;"><u><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Bayi<o:p></o:p></span></u></i></div>
<br />
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<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Modifikasi
gaya hidup meliputi perubahan makanan, latihan makan dan posisi. Volume makanan
yang besar akan memicu regurgitasi pada bayi karena distensi lambung dan
peningkatan relaksasi LES. Namun pembatasan volume makanan dapat menebabkan
intake energi yang tidak adekuat. Oleh sebab itu peningkatan konsentrasi atau
kepadatan makanan akan menurunkan volume makanan total sehingga menurunkan GER.
Alternatif lainnya adalah penambahan sereal pada susu formula atau ASI akan
mengurangi GER dengan pemadatan formula.<span style="mso-spacerun: yes;">
</span>Perubahan jenis formula tidak terlalu berefek pada gejala GER. Formula
casein hydrosylate atau asam amino akan mempunyai keuntungan apabila bayi
mempunyai alergi terhadap susu sapi atau protein kedelai.<o:p></o:p></span></div>
<br />
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<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Untuk
posisi, peningian kepala setelah minum atau makan akan memberikan keuntungan.
Selain itu dikatakan bahwa posisi tengkurap akan mengurangi angka kejadian GER,
namun posisi ini meningkatkan risiko suddent infant death syndrome.<o:p></o:p></span></div>
<br />
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<i style="mso-bidi-font-style: normal;"><u><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Anak-anak dan Remaja<o:p></o:p></span></u></i></div>
<br />
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<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Untuk
anak-anak dan remaja yang mempunyai gejala refluks yang ringan, perubahan gaya
hidup meliputi modifikasi diet (meliputi menghindari makanan tinggi lemak pada
makan malam) dan menghindari rokok dan alkohol. Untuk pasien dengan obesitas,
penurunan berat badan akan membantu.<o:p></o:p></span></div>
<br />
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<b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><u><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Terapi Farmakologi<o:p></o:p></span></u></i></b></div>
<br />
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<i style="mso-bidi-font-style: normal;"><u><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Antasida<o:p></o:p></span></u></i></div>
<br />
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<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Bekerja
dengan menetralkan isi lambung. Antasida berguna untuk anak dan remaja untuk
menghilangkan gejala secara cepat. Untuk meningkatkan efeknya, antasida baik
diminum setelah makan.<o:p></o:p></span></div>
<br />
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<i style="mso-bidi-font-style: normal;"><u><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Histamine-2 Receptor Antagonist<o:p></o:p></span></u></i></div>
<br />
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<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">H-2
antagonist akan menurunkan produksi asam. Contoh jenis obat ini adalah
ranitidin, cimetidin, dan famotidin. Ranitidin akan mencapai kadar puncak pada
plasma setelah 2,5 jam dan mempunyai t ½ yaitu 6 jam. H-2 antagonist aman untuk
anak-anak dan digunakan sebagai lini pertama terapi pada bayi.<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0pt 14.2pt; text-align: justify;">
<i style="mso-bidi-font-style: normal;"><u><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Proton Pump Inhibitor<o:p></o:p></span></u></i></div>
<br />
<div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0pt 14.2pt; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">PPI
menghambat produksi asam dengan memblok H+ K+ ATPase. PPI lebih efektif
daripada H-2 antagonist dalam menghambat produksi asam. Contoh obatnya adalah
omeprazole, lansoprazole. Namun PPI tidak dapat digunakan pada pasien dibawah 1
tahun.<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0pt 14.2pt; text-align: justify;">
<i style="mso-bidi-font-style: normal;"><u><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Agen Prokinetik<o:p></o:p></span></u></i></div>
<br />
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<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Secara
teori agen prokinetik akan bermanfaat pada GER dengan mempercepat pengosongan
lambung. Metoklopamid merupakan agen prokinetik yang efektif, akan tetapi
mempunyai efek samping berupa reaksi distonia, letargi, iritabilitas, ginekomastia
dan tardive dyskinesia.<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0pt 14.2pt; text-align: justify;">
<i style="mso-bidi-font-style: normal;"><u><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Surface Agent<o:p></o:p></span></u></i></div>
<br />
<div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0pt 14.2pt; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Salah
satunya adalah sukralfat. Sukralfat akan melndungi mukosa terhadap paparan isi
lambung yang bersifat asam.<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0pt; text-align: justify;">
<b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><u><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Terapi Bedah<o:p></o:p></span></u></i></b></div>
<br />
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<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Fundoplikasi akan menurunkan GER dengan
meningkatkan tekanan LES dan meningkatkan panjang esofagus intaabdomen. Teknik
fundoplikasi dengan laparoskopi lebih menguntungkan daripada dengan laparotomi.<o:p></o:p></span></div>
<br />
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<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p> </o:p></span></div>
</div>
Anonymoushttp://www.blogger.com/profile/17040699491469284898noreply@blogger.com0tag:blogger.com,1999:blog-7514639870940573862.post-77231816837464659312012-06-28T18:38:00.001-07:002012-06-28T18:38:14.378-07:00Appendicitis<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhr8t7eP0YjrIaMemy-0C7tvWo8-R3FpV_yHYCVjpFwXnpveVqP6qt8x4Jw8qpzGd-AXKSsF06231e51frZwlgqIr5sdsZN7fglV2weikIoZK00gqRjosDlcKKpD0AodBP0sPUnxJXy5x_Z/s1600/si1787.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="142" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhr8t7eP0YjrIaMemy-0C7tvWo8-R3FpV_yHYCVjpFwXnpveVqP6qt8x4Jw8qpzGd-AXKSsF06231e51frZwlgqIr5sdsZN7fglV2weikIoZK00gqRjosDlcKKpD0AodBP0sPUnxJXy5x_Z/s200/si1787.jpg" width="200" /></a></div>
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<b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Pendahuluan</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 12pt; letter-spacing: 1.5pt; line-height: 115%; mso-fareast-language: IN;">Apendiks disebut oleh masyarakat </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%; mso-fareast-language: IN;">sebagai usus buntu. Peradangan akut apendiks
memerlukan tindakan bedah segera untuk mencegah komplikasi yang umumnya
berbahaya.<o:p></o:p></span></div>
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<b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Anatomi</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%; mso-fareast-language: IN;">Apendiks merupakan organ berbentuk tabung, panjang ± 10 cm ( antara
3-15cm), dan berpangkal di sekum. Lumennya sempit di bagian proksimal dan
melebar di<span style="letter-spacing: 2.25pt;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">bagian
distal. Sedangkan pada bayi, apendiks berbentuk kerucut, lebar pada pangkalnya
dan menyempit ke arah ujungnya (hal ini mungkin menjadi sebab</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; letter-spacing: 2.25pt; line-height: 115%; mso-fareast-language: IN;"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%; mso-fareast-language: IN;">rendahnya insidens apendisitis pada usia ini). </span></div>
<a name='more'></a><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">U</span><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: SV;">jung dari apendiks bisa ditemukan pada posisi retrosekal,
pelvikal, subsekal, preileal atau parakolika kanan. Posisi apendiks retrosekal
paling banyak ditemukan yaitu 64% kasus. </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%; mso-fareast-language: IN;">Gejala klinis apendisitis ditentukan oleh letak apendiks. <span style="letter-spacing: 0.75pt;">Persarafan parasimpatis berasal dari cabang nervus
vagus yang mengikuti a.</span>mesenterika superior dan a. apendikularis,
sedangkan persarafan simpatis berasal dari </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">n. torakalis X (oleh
karena itu nyeri viseral pada apendisitis bermula di sekitar umbilikus).</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%; mso-fareast-language: IN;"> Pendarahan apendiks berasal dari a. Apendikularis
(arteri tanpa kolateral). Jika arteri ini tersumbat misalnya karena trombosis
pada infeksi, apendiks akan mengalami gangren.<o:p></o:p></span><br />
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<b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Apendisitis
Akut<o:p></o:p></span></b></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Appendisitis
akut merupakan penyebab acute abdomen yang paling umum pada dewasa muda. Diagnosis
appendisitis akut seringkali berdasarkan pada presentasi klinis yaitu dengan
anamnesis dan pemeriksaan fisik. <o:p></o:p></span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>
<br />
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<b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; letter-spacing: -0.75pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Epidemiologi</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%; mso-fareast-language: IN;">Appendisitis merupakan kasus emergensi abdomen yang paling banyak terjadi. Kasusnya
mencapai >40.000 per tahun pada seluruh RS di Inggris. Appendisitis paling
sering terjadi pada usia 10-20 tahun, namun tetap dapat terjadi pada segala
usia. Rasio antara laki-laki dan perempuan adalah 1,4 : 1. Di United State
lifetime risk appendisitis pada laki-laki adalah 8,6 % sedangkan pada perempuan
6,7 %. <o:p></o:p></span></div>
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<b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; letter-spacing: -0.75pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Etiologi</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%; mso-fareast-language: IN;">Penyebab<span style="mso-spacerun: yes;"> </span>appendisitis akut belum
diketahui secara pasti, kemungkinan multifaktorial yaitu: obstruksi lumen, pola
diet dan faktor familial. <o:p></o:p></span></div>
<br />
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<span style="font-family: "Times New Roman","serif"; font-size: 12pt; letter-spacing: 0.75pt; line-height: 115%; mso-fareast-language: IN;">Apendisitis akut merupakan infeksi bakteri. Berbagai
hal berperan sebagai faktor pencetusnya antara lain sumbatan lumen apendiks
(hiperplasi jaringan limfe, fekalit, tumor apendiks dan cacing askariasis).
Penyebab lain yaitu erosi mukosa </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%; mso-fareast-language: IN;">apendiks karena parasit seperti Entamoeba hystolitica. <span style="letter-spacing: 1.5pt;">Penelitian epidemiologi menunjukkan peran
kebiasaan makan makanan </span>rendah serat dan pengaruh konstipasi terhadap
timbulnya apendisitis. Konstipasi akan <span style="letter-spacing: 1.5pt;">menaikkan
tekanan intrasekal, yang berakibat timbulnya sumbatan fungsional </span><span style="letter-spacing: 0.75pt;">apendiks dan meningkatnya pertumbuhan kuman flora
kolon biasa. Semuanya ini</span>akan mempermudah timbulnya apendisitis akut.<o:p></o:p></span></div>
<br />
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<b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; letter-spacing: -0.75pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Patologi</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>
<br />
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<span style="font-family: "Times New Roman","serif"; font-size: 12pt; letter-spacing: 0.75pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Apendisitis dapat mulai di mukosa dan kemudian melibatkan seluruh lapisan dinding
apendiks dalam waktu 24-48 jam pertama. Usaha pertahanan tubuh adalah </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">membatasi
proses radang dengan menutup apendiks dengan omentum, usus halus atau adneksa
sehingga terbentuk massa periapendikuler yang secara salah dikenal dengan <span style="letter-spacing: 0.75pt;">istilah infiltrat apendiks. Di dalamnya dapat
terjadi nekrosis jaringan berupa abses </span>yang dapat mengalami perforasi. <o:p></o:p></span></div>
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<br /></div>
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt; text-align: justify;">
<b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; letter-spacing: -0.75pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Gambaran Klinik </span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; letter-spacing: 0.75pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Abdominal pain </span><span style="font-family: Wingdings; font-size: 12pt; letter-spacing: 0.75pt; line-height: 115%; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-char-type: symbol; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Wingdings;"><span style="mso-char-type: symbol; mso-symbol-font-family: Wingdings;">à</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; letter-spacing: 0.75pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> periumbilical
colicky pain diikuti dengan mual dan muntah </span><span style="font-family: Wingdings; font-size: 12pt; letter-spacing: 0.75pt; line-height: 115%; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-char-type: symbol; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Wingdings;"><span style="mso-char-type: symbol; mso-symbol-font-family: Wingdings;">à</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; letter-spacing: 0.75pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> migrasi ke right iliac fossa. <o:p></o:p></span></div>
<br />
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<span style="font-family: "Times New Roman","serif"; font-size: 12pt; letter-spacing: 0.75pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Nyeri yang awal muncul adalah nyeri viseral sesuai dengan inervasi midgut.
Kemudian nyeri bermigrasi karena proses inflamasi pada peritoneum parietal. <o:p></o:p></span></div>
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<br /></div>
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt; text-align: justify;">
<b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; letter-spacing: -0.75pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Pemeriksaan</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>
<br />
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<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Pasien
sering mengalami demam ringan hingga 38°C dengan takikardia.<o:p></o:p></span></div>
<br />
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<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Pemeriksaan
abdomen</span><span style="font-family: Wingdings; font-size: 12pt; line-height: 115%; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-char-type: symbol; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Wingdings;"><span style="mso-char-type: symbol; mso-symbol-font-family: Wingdings;">à</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> nyeri tekan
dan rigiditas muskular yang bersifat lokal apabila nyeri telah bermigrasi RLQ. Rebound
tenderness (+). Nyeri paling berat dirasakan pada Mc Burney’s point.<o:p></o:p></span></div>
<br />
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<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Rectal Toucer
</span><span style="font-family: Wingdings; font-size: 12pt; line-height: 115%; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-char-type: symbol; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Wingdings;"><span style="mso-char-type: symbol; mso-symbol-font-family: Wingdings;">à</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> nyeri tekan
pada bagian kanan (pelvic appendix).<o:p></o:p></span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Rovsig’s
sign (+), psoas sign (+), obturator sign (+). Uji psoas dilakukan dengan
rangsangan<span style="letter-spacing: 0.75pt;">otot psoas lewat hiperekstensi
sendi panggul kanan atau fleksi aktif sendi panggul</span>kanan, kemudian paha
kanan ditahan. Bila apendiks yang meradang menempel di m.<span style="letter-spacing: 0.75pt;"> psoas mayor, tindakan tersebut akan menimbulkan
nyeri. Uji obturator digunakanuntuk melihat apakah apendiks yang meradang
kontak dengan m. obturator internus</span>yang merupakan dinding panggul kecil.
Gerakan fleksi dan endorotasi sendi panggul pada posisi terlentang akan
menimbulkan nyeri pada apendisitis pelvika.<o:p></o:p></span></div>
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<b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Diagnosis</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Diagnosis
klinis apendisitis akut masih mungkin salah ( 15%-20%), kesalahan </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">diagnosis
lebih sering pada perempuan dibanding laki-laki. Hal ini karena pada</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> perempuan
terutama yang masih muda sering timbul gangguan yang mirip apendisitis akut.
Keluhan itu berasal dari genitalian interna karena ovulasi, menstruasi, radang
di pelvis, atau penyakit ginekologik lain. <b><span style="letter-spacing: -0.75pt;"><o:p></o:p></span></b></span></div>
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<b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Penatalaksanaan</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 12pt; letter-spacing: 0.75pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Bila diagnosis klinis sudah jelas, tindakan paling tepat dan merupakan
satu-satunya pilihan yang baik adalah apendektomi. </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Apendektomi
dapat dilakukan secara terbuka atau dengan laparaskopi. Bila apendektomi
terbuka insisi McBurney paling banyak dipilih oleh para ahli bedah. Pada
penderita yang diagnosisnya tidak jelas sebaiknya dilakukan observasi dulu. Pemeriksaan
laboratorium dan USG dapat dilakukan bila dalam observasi masih terdapat
keraguan. Bila tersedia laparoskop, tindakan laparoskopi diagnostik</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; letter-spacing: 0.75pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> pada </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">kasus meragukan dapat segera menentukan akan dilakukan operasi atau tidak.<o:p></o:p></span></div>
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<b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; letter-spacing: -0.75pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Komplikasi</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 12pt; letter-spacing: 0.75pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Komplikasi yang paling sering adalah perforasi, baik berupa perforasi bebas
maupun perforasi yang telah mengalami pendinginan sehingga berupa massa yang </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">terdiri atas
kumpulan apendiks, sekum, dan lekuk usus halus.<o:p></o:p></span></div>
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<b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; letter-spacing: -0.75pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Massa periapendikuler</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 12pt; letter-spacing: 0.75pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Massa apendiks terjadi bila apendisitis gangrenosa atau mikroperforasi diselubungi</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> oleh
omentum dan atau usus halus. </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Pada massa apendikuler yang penenangannya
belum sempurna dapat terjadi penyebaran pus ke seluruh rongga peritoneum jika
perforasi diikuti oleh peritonitis purulenta generalisata. Oleh sebab itu massa
periapendikuler yang masih bebas disarankan segera</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> dioperasi
untuk mencegah hal tersebut. </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Apendektomi direncanakan pada
infiltrat periapendikuler tanpa pus yang telah ditenangkan. Sebelumnya pasien
diberikan antibiotika kombinasi yang sensitif terhadap kuman aerob dan anaerob.
Baru setelah keadaan tenang, sekitar 6-8 minggu dilakukan apendektomi.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; letter-spacing: 0.75pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> </span><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; letter-spacing: -0.75pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></b></div>
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<b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; letter-spacing: -0.75pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Apendisitis perforata</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Adanya
fekalit, umur, dan keterlambatan diagnosis merupakan faktor yang yang berperanan
dalam terjadinya perforasi apendiks. Dilaporkan insidens perforasi 60% pada
penderita diatas usia 60 tahun. Faktor yang mempengaruhi tingginya insiden
perforasi pada orang tua adalah gejalanya yang samar, keterlambatan berobat,
adanya perubahan anatomi berupa penyempitan apendiks,arteriosklerosis. </span><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: SV;">Pada anak-anak apendiks lebih panjang dan lebih tipis
daripada dewasa oleh karena itu pada peradangan akan lebih mudah mengalami
perforasi.</span><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt; letter-spacing: 1.5pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Perforasi apendiks
akan mengakibatkan peritonitis purulenta yang ditandai dengan demam tinggi,
nyeri makin hebat yang meliputi seluruh perut, perut menjaddi tegang dan kembung,
nyeri tekan dan defans muskuler di seluruh perut mungkin dengan punctum
maksimum diregio iliaka kanan, peritalsis usus menurun sampai menghilang karena
ileus paralitik. <o:p></o:p></span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Perbaikan
keadaan umum dengan infus, pemberian antibiotik untuk kuman gram <span style="letter-spacing: 0.75pt;">negatif dan positif serta kuman anaerob, dan
pemasangan pipa nasogastrik perlu </span>dilakukan sebelum pembedahan. </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Perlu
dilakukan laparotomi dengan insisi yang panjang, supaya dapat dilakukan
pencucian rongga peritoneum dari pus maupun pengeluaran fibrin yang adekuat secara
mudah. </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Rongga
abdomen dapat dibilas dengan mudah. </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Karena ada kemungkinan
terjadi infeksi luka operasi, perlu dianjurkan</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> pemasangan drainage subfacia, kulit
dibiarkan terbuka untuk kemudian </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">dijahit bila sudah
dipastikan tidak ada infeksi. Pada anak tidak usah dipasang drainage intraperitoneal
karena justru akan menyebabkan komplikasi infeksi lebih sering.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> <o:p></o:p></span></div>Anonymoushttp://www.blogger.com/profile/17040699491469284898noreply@blogger.com0tag:blogger.com,1999:blog-7514639870940573862.post-90739464027441536242012-06-28T18:31:00.000-07:002012-06-28T18:31:05.027-07:00FRAKTUR FEMUR<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgIQ4Is6kx_RH8bbCaa6HmEg-QAWdQIwqnD_83qXktFxSdR0_TU8GSQu_XjMjd_JPosCFN5sMZ0BoCS9Hlf462y9Bln1QLDKjEW1WmJzX4nRqsDuQ9NgR-zUIc7hSoF0_9iP-WPriS_7_kk/s1600/1-0.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgIQ4Is6kx_RH8bbCaa6HmEg-QAWdQIwqnD_83qXktFxSdR0_TU8GSQu_XjMjd_JPosCFN5sMZ0BoCS9Hlf462y9Bln1QLDKjEW1WmJzX4nRqsDuQ9NgR-zUIc7hSoF0_9iP-WPriS_7_kk/s200/1-0.jpg" width="134" /></a></div>
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<b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">DEFINISI</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 12pt; letter-spacing: -0.75pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Fraktur adalah suatu diskontinuitas
struktur tulang. Diskontinuitas dapat berupa suatu retakan bahkan sampai suatu patahan
yang komplit dan terjadi pergeseran tulang. Apabila tidak ada luka yang
menghubungkan fraktur dengan udara luar atau kulit diatasnya masih utuh ini
disebut fraktur tertutup, sedangkan bila terdapat luka yang menghubungkan
tulang yang fraktur dengan udara luar atau kulit tidak intak disebut fraktur
terbuka. Diskontinuitas tulang femur dapat disebabkan oleh trauma langsung,
kelelahan otot, kondisi-kondisi tertentu seperti degenerasi tulang /
osteoporosis.</span></div>
<a name='more'></a><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span><br />
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<b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">EPIDEMIOLOGI<o:p></o:p></span></b></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 12pt; letter-spacing: -0.75pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Fraktur collum femur dan fraktur
subtrochanter banyak terjadi pada wanita tua dengan usia lebih dari 60 tahun dimana
tulang sudah mengalami osteoporotik, trauma yang dialami oleh wanita tua, biasanya
ringan sedangkan pada penderita muda ditemukan riwayat mengalami kecelakaan.
Sedangkan fraktur batang femur, fraktur supracondyler, frakturintercondyler,
fraktur condyler femur banyak terjadi pada penderita laki</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">–<span style="letter-spacing: -0.75pt;">laki dewasa karena kecelakaan ataupun jatuh dari
ketinggian. Sedangkan fraktur batang femur pada anak terjadi karena jatuh waktu
bermain dirumah atau disekolah.</span><o:p></o:p></span></div>
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<b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">ETIOLOGI</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Bila terkena kekuatan langsung <span style="letter-spacing: -0.75pt;">tulang dapat patah pada tempat yang terkena; jaringan lunak juga pasti
rusak. Pemukulan (pukulan sementara) biasanya menyebabkan fraktur melintang dan
kerusakan pada kulit diatasnya; penghancuran kemungkinan akan menyebabkan
fraktur komunitif disertai kerusakan jaringan lunak yang luas.</span> Bila
terkena kekuatan tak langsung <span style="letter-spacing: -0.75pt;">tulang dapat
mengalami fraktur pada tempat yang jauh dari tempat yang terkena kekuatan itu;
kerusakan jaringan lunak di tempat fraktur mungkin tidak ada.</span><o:p></o:p></span></div>
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<div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin: 0cm 0cm 0pt 14.2pt; mso-add-space: auto; mso-list: l3 level1 lfo1; text-align: justify; text-indent: -14.2pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; letter-spacing: -0.75pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><span style="mso-list: Ignore;">-<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Fraktur akibat peristiwa trauma tunggal. <span style="letter-spacing: -0.75pt;">Kekuatan dapat berupa :<o:p></o:p></span></span></div>
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<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0pt 1cm; mso-add-space: auto; mso-list: l8 level1 lfo2; text-align: justify; text-indent: -14.15pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><span style="mso-list: Ignore;">1.<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; letter-spacing: -0.75pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Pemuntiran (rotasi), yang
menyebabkan fraktur spiral</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0pt 1cm; mso-add-space: auto; mso-list: l8 level1 lfo2; text-align: justify; text-indent: -14.15pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><span style="mso-list: Ignore;">2.<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; letter-spacing: -0.75pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Penekukan (trauma angulasi atau
langsung) yang menyebabkan fraktur melintang</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0pt 1cm; mso-add-space: auto; mso-list: l8 level1 lfo2; text-align: justify; text-indent: -14.15pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><span style="mso-list: Ignore;">3.<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; letter-spacing: -0.75pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Penekukan dan Penekanan, yang
mengakibatkan fraktur sebagian melintang tetapi disertai fragmen kupu</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">– <span style="letter-spacing: -0.75pt;">kupu berbentuk segitiga yang terpisah</span><o:p></o:p></span></div>
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<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0pt 1cm; mso-add-space: auto; mso-list: l8 level1 lfo2; text-align: justify; text-indent: -14.15pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><span style="mso-list: Ignore;">4.<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; letter-spacing: -0.75pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Kombinasi dari pemuntiran,
penekukan dan penekanan yang menyebabkan fraktur obliq pendek</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0pt 1cm; mso-add-space: auto; mso-list: l8 level1 lfo2; text-align: justify; text-indent: -14.15pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><span style="mso-list: Ignore;">5.<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; letter-spacing: -0.75pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Penatikan dimana tendon atau
ligamen benar</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">– <span style="letter-spacing: -0.75pt;">benar menarik tulang sampai terpisah</span><o:p></o:p></span></div>
<br />
<div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin: 0cm 0cm 0pt 14.2pt; mso-add-space: auto; mso-list: l3 level1 lfo1; text-align: justify; text-indent: -14.2pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><span style="mso-list: Ignore;">-<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Tekanan yang berulang-ulang<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0pt 18pt; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; letter-spacing: -0.75pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Retak dapat terjadi pada tulang, seperti halnya pada logam dan benda lain,
akibat tekanan berulang</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">– <span style="letter-spacing: -0.75pt;">ulang.</span><o:p></o:p></span></div>
<br />
<div class="MsoListParagraph" style="line-height: 150%; margin: 0cm 0cm 0pt 14.2pt; mso-add-space: auto; mso-list: l3 level1 lfo1; text-align: justify; text-indent: -14.2pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><span style="mso-list: Ignore;">-<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Kelemahan abnormal pada tulang<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0pt 14.2pt; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; letter-spacing: -0.75pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Fraktur dapat terjadi oleh tekanan yang normal kalau tulang itu lemah
(misalnya oleh tumor) atau kalau tulang itu sangat rapuh (misalnya pada
penyakit paget).</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0pt; text-align: justify;">
<b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">KLASIFIKASI</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0pt; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; letter-spacing: -0.75pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Klasifikasi fraktur femur dapat
dibagi dalam :<o:p></o:p></span></div>
<br />
<div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin: 0cm 0cm 0pt 14.2pt; mso-add-space: auto; mso-list: l2 level1 lfo3; tab-stops: 14.2pt; text-align: justify; text-indent: -14.2pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><span style="mso-list: Ignore;">a.<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; letter-spacing: -0.75pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Fraktur collum femur : Fraktur collum femur dapat disebabkan oleh trauma
langsung yaitu misalnya penderita jatuh dengan posisi miring dimana daerah
trochanter mayor langsung terbentur dengan benda keras (jalanan) ataupun
disebabkan oleh trauma tidak langsung yaitu karena gerakan eksorotasi yang
mendadak dari tungkai bawah, dibagi dalam :</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0pt 72pt; mso-add-space: auto; mso-list: l5 level1 lfo4; text-align: justify; text-indent: -18pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><span style="mso-list: Ignore;">1.<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; letter-spacing: -0.75pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Fraktur intrakapsuler (Fraktur
collum femur)</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0pt 72pt; mso-add-space: auto; mso-list: l5 level1 lfo4; text-align: justify; text-indent: -18pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><span style="mso-list: Ignore;">2.<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; letter-spacing: -0.75pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Fraktur extrakapsuler (Fraktur
intertrochanter femur)</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0pt 14.2pt; mso-add-space: auto; mso-list: l2 level1 lfo3; text-align: justify; text-indent: -14.2pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><span style="mso-list: Ignore;">b.<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; letter-spacing: -0.75pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Fraktur subtrochanter femur : Fraktur
dimana garis patahnya berada 5 cm distal dari trochanter minor, dibagi dalam
beberapa klasifikasi tetapi yang lebih sederhana dan mudah dipahami adalah klasifikasi
Fielding & Magliato, yaitu :</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0pt 14.2pt; mso-add-space: auto; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; letter-spacing: -0.75pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">tipe 1 : garis fraktur satu
level dengan trochanter minortipe <o:p></o:p></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0pt 14.2pt; mso-add-space: auto; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; letter-spacing: -0.75pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">tipe 2 : garis patah berada 1 -2
inch di bawah dari batas atas trochanter minortipe <o:p></o:p></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0pt 14.2pt; mso-add-space: auto; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; letter-spacing: -0.75pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">tipe 3 : garis patah berada 2 -3
inch di distal dari batas atas trochanterminor<o:p></o:p></span></div>
<br />
<div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin: 0cm 0cm 0pt 14.2pt; mso-add-space: auto; mso-list: l2 level1 lfo3; text-align: justify; text-indent: -14.2pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><span style="mso-list: Ignore;">c.<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; letter-spacing: -0.75pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Fraktur batang femur (dewasa)</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0pt 14.2pt; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; letter-spacing: -0.75pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Fraktur batang femur biasanya terjadi karena trauma langsung akibat
kecelakaan lalu lintas dikota kota besar atau jatuh dari ketinggian, patah pada
daerah ini dapat menimbulkan perdarahan yang cukup banyak, mengakibatkan
penderita jatuh dalam shock. Salah satu klasifikasi fraktur batang femur dibagi
berdasarkan adanya luka yang berhubungan dengan daerah yang patah. Dibagi
menjadi :<o:p></o:p></span></div>
<br />
<div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin: 0cm 0cm 0pt 1cm; mso-add-space: auto; mso-list: l3 level1 lfo1; text-align: justify; text-indent: -14.15pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><span style="mso-list: Ignore;">-<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; letter-spacing: -0.75pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Tertutup </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0pt 1cm; mso-add-space: auto; mso-list: l3 level1 lfo1; text-align: justify; text-indent: -14.15pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><span style="mso-list: Ignore;">-<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; letter-spacing: -0.75pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Terbuka</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0pt 1cm; mso-add-space: auto; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; letter-spacing: -0.75pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">ketentuan fraktur femur terbuka
bila terdapat hubungan antara tulang patah dengan dunia luar, dibagi dalam tiga
derajat, yaitu ;<o:p></o:p></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0pt 3cm; mso-add-space: auto; text-align: justify; text-indent: -2cm;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; letter-spacing: -0.75pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Derajat I<span style="mso-tab-count: 1;"> </span>: Bila terdapat hubungan dengan dunia
luar timbul luka kecil, biasanya diakibatkan tusukan fragmen tulang dari dalam
menembus keluar.<o:p></o:p></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0pt 3cm; mso-add-space: auto; text-align: justify; text-indent: -2cm;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; letter-spacing: -0.75pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Derajat II<span style="mso-tab-count: 1;"> </span>: <span style="mso-spacerun: yes;"> </span>Lukanya
lebih besar (>1cm) luka ini disebabkan karena benturan dari luar.<o:p></o:p></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0pt 3cm; mso-add-space: auto; text-align: justify; text-indent: -2cm;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; letter-spacing: -0.75pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Derajat III <span style="mso-tab-count: 1;"> </span>: Lukanya lebih luas dari derajat II, lebih
kotor, jaringan lunak banyak yang ikut rusak (otot, saraf, pembuluh darah)<o:p></o:p></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0pt 14.2pt; mso-add-space: auto; mso-list: l2 level1 lfo3; text-align: justify; text-indent: -14.2pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><span style="mso-list: Ignore;">d.<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; letter-spacing: -0.75pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Fraktur supracondyler femur : Fraktur
supracondyler fragment bagian distal selalu terjadi dislokasi ke posterior, hal
ini biasanya disebabkan karena adanya tarikan dari otot</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">– <span style="letter-spacing: -0.75pt;">otot gastrocnemius, biasanya fraktur
supracondyler ini disebabkan oleh trauma langsung karena kecepatan tinggi sehingga
terjadi gaya axial dan stress valgus atau varus dan disertai gaya rotasi.</span><o:p></o:p></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0pt 14.2pt; mso-add-space: auto; mso-list: l2 level1 lfo3; text-align: justify; text-indent: -14.2pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><span style="mso-list: Ignore;">e.<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; letter-spacing: -0.75pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Fraktur intercondyler femur : Fraktur
intercondular diikuti oleh fraktur supracondular, sehingga umumnya terjadi
bentuk T fraktur atau Y fraktur.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0pt 14.2pt; mso-add-space: auto; mso-list: l2 level1 lfo3; text-align: justify; text-indent: -14.2pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><span style="mso-list: Ignore;">f.<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; letter-spacing: -0.75pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Fraktur condyler femur : Mekanisme
traumanya biasa kombinasi dari gaya hiperabduksi dan adduksi disertai dengan
tekanan pada sumbu femur keatas.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>
<br />
<div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin: 0cm 0cm 0pt 14.2pt; mso-add-space: auto; text-align: justify;">
<br /></div>
<br />
<div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0pt; text-align: justify;">
<b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">GAMBARAN KLINIK</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0pt; text-align: justify;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; letter-spacing: -0.75pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Riwayat<o:p></o:p></span></b></div>
<br />
<div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0pt; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; letter-spacing: -0.75pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Biasanya terdapat riwayat
cedera, diikuti dengan ketidakmampuan menggunakan tungkai yang mengalami
cedera, fraktur tidak selalu dari tempat yang cedera suatu pukulan dapat menyebebkan
fraktur pada kondilus femur, batang femur, pattela, ataupun acetabulum. Umur pasien
dan mekanisme cedera itu penting, kalau fraktur terjadi akibat cedera yang
ringan curigailah lesi patologik; nyeri, memar dan pembengkakan adalah gejala
yang sering ditemukan, tetapi gejala itu tidak membedakan fraktur dari cedera
jaringan lunak, deformitas jauh lebih mendukung.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0pt; text-align: justify;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Tanda– tanda
lokalis :<o:p></o:p></span></b></div>
<br />
<div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin: 0cm 0cm 0pt 14.2pt; mso-add-space: auto; mso-list: l10 level1 lfo5; text-align: justify; text-indent: -14.2pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><span style="mso-list: Ignore;">a)<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Look : </span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; letter-spacing: -0.75pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Pembengkakan,
memar dan deformitas (penonjolan yang abnormal, angulasi, rotasi, pemendekan)
mungkin terlihat jelas, tetapi hal yang penting adalah apakah kulit itu utuh;
kalau kulit robek dan luka memiliki hubungan dengan fraktur.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0pt 14.2pt; mso-add-space: auto; mso-list: l10 level1 lfo5; text-align: justify; text-indent: -14.2pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><span style="mso-list: Ignore;">b)<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Feel : </span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; letter-spacing: -0.75pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Terdapat nyeri
tekan setempat, tetapi perlu juga memeriksa bagian distal dari fraktur untuk
merasakan nadi dan untuk menguji sensasi. Cedera pembuluh darah adalah keadaan
darurat yang memerlukan pembedahan.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0pt 14.2pt; mso-add-space: auto; mso-list: l10 level1 lfo5; text-align: justify; text-indent: -14.2pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><span style="mso-list: Ignore;">c)<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Movement : </span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; letter-spacing: -0.75pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Krepitasi dan
gerakan abnormal dapat ditemukan, tetapi lebih penting untuk menanyakan apakah
pasien dapat menggerakan sendi</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">– <span style="letter-spacing: -0.75pt;">sendi dibagian
distal cedera.</span><o:p></o:p></span></div>
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<br /></div>
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<div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0pt; text-align: justify;">
<b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">PENATALAKSANAAN</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>
<br />
<div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin: 0cm 0cm 0pt 14.2pt; mso-add-space: auto; mso-list: l1 level1 lfo6; text-align: justify; text-indent: -14.2pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><span style="mso-list: Ignore;">1.<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; letter-spacing: -0.75pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Terapi konservatif :</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0pt 1cm; mso-add-space: auto; mso-list: l9 level1 lfo7; text-align: justify; text-indent: -14.15pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><span style="mso-list: Ignore;">-<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; letter-spacing: -0.75pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Proteksi</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0pt 1cm; mso-add-space: auto; mso-list: l9 level1 lfo7; text-align: justify; text-indent: -14.15pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><span style="mso-list: Ignore;">-<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; letter-spacing: -0.75pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Immobilisasi saja tanpa reposisi</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0pt 1cm; mso-add-space: auto; mso-list: l9 level1 lfo7; text-align: justify; text-indent: -14.15pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><span style="mso-list: Ignore;">-<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; letter-spacing: -0.75pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Reposisi tertutup dan fiksasi
dengan gips</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>
<br />
<div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin: 0cm 0cm 0pt 1cm; mso-add-space: auto; mso-list: l9 level1 lfo7; text-align: justify; text-indent: -14.15pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><span style="mso-list: Ignore;">-<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; letter-spacing: -0.75pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Traksi</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0pt; text-align: justify; text-indent: 14.2pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; letter-spacing: -0.75pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Metode
Pemasangan traksi:</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>
<br />
<div class="MsoListParagraph" style="line-height: 150%; margin: 0cm 0cm 0pt 1cm; mso-add-space: auto; mso-list: l6 level1 lfo8; text-align: justify; text-indent: -14.15pt;">
<span style="font-family: Symbol; font-size: 12pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; mso-fareast-language: IN;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Traksi Manual<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0pt 1cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; letter-spacing: -0.75pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Tujuan : perbaikan dislokasi, mengurangi fraktur, pada keadaan emergency dilakukan
dengan menarik bagian tubuh.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>
<br />
<div class="MsoListParagraph" style="line-height: 150%; margin: 0cm 0cm 0pt 1cm; mso-add-space: auto; mso-list: l6 level1 lfo8; text-align: justify; text-indent: -14.15pt;">
<span style="font-family: Symbol; font-size: 12pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; mso-fareast-language: IN;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Traksi Mekanik <o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0pt 1cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; letter-spacing: -0.75pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Ada dua macam, yaitu :</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0pt 1cm; text-align: justify;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; letter-spacing: -0.75pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Traksi Kulit</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; letter-spacing: -0.75pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> </span><span style="font-family: Wingdings; font-size: 12pt; letter-spacing: -0.75pt; line-height: 150%; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-char-type: symbol; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Wingdings;"><span style="mso-char-type: symbol; mso-symbol-font-family: Wingdings;">à</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; letter-spacing: -0.75pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> Dipasang pada dasar sistem skeletal untuk struktur yang lain, misalnya:
otot. Traksi kulit terbatas untuk 4 minggu dan beban < 5 kg. Untuk anak-anak
waktu beban tersebut mencukupi untuk dipakai sebagai fraksi definitif, bila tidak
diteruskan dengan pemasangan gips.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0pt 1cm; text-align: justify;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; letter-spacing: -0.75pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Traksi Skeletal</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; letter-spacing: -0.75pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> </span><span style="font-family: Wingdings; font-size: 12pt; letter-spacing: -0.75pt; line-height: 150%; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-char-type: symbol; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Wingdings;"><span style="mso-char-type: symbol; mso-symbol-font-family: Wingdings;">à</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; letter-spacing: -0.75pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> Merupakan traksi definitif pada orang dewasa yang merupakan balanced
traction. Dilakukan untuk menyempurnakan luka operasi dengan kawat metal atau
penjepit melalui tulang/jaringan metal. Kegunaan pemasangan :</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>
<br />
<div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin: 0cm 0cm 0pt 54pt; mso-add-space: auto; mso-list: l7 level1 lfo9; text-align: justify; text-indent: -18pt;">
<span style="font-family: Wingdings; font-size: 12pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings; mso-fareast-language: IN;"><span style="mso-list: Ignore;">ü<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; letter-spacing: -0.75pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Mengurangi nyeri akibat spasme otot</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0pt 54pt; mso-add-space: auto; mso-list: l7 level1 lfo9; text-align: justify; text-indent: -18pt;">
<span style="font-family: Wingdings; font-size: 12pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings; mso-fareast-language: IN;"><span style="mso-list: Ignore;">ü<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; letter-spacing: -0.75pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Memperbaiki dan mencegah deformitas</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0pt 54pt; mso-add-space: auto; mso-list: l7 level1 lfo9; text-align: justify; text-indent: -18pt;">
<span style="font-family: Wingdings; font-size: 12pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings; mso-fareast-language: IN;"><span style="mso-list: Ignore;">ü<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; letter-spacing: -0.75pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Immobilisasi</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0pt 54pt; mso-add-space: auto; mso-list: l7 level1 lfo9; text-align: justify; text-indent: -18pt;">
<span style="font-family: Wingdings; font-size: 12pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings; mso-fareast-language: IN;"><span style="mso-list: Ignore;">ü<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; letter-spacing: -0.75pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Difraksi penyakit (dengan penekanan untuk nyeri tulang sendi).</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0pt 54pt; mso-add-space: auto; mso-list: l7 level1 lfo9; text-align: justify; text-indent: -18pt;">
<span style="font-family: Wingdings; font-size: 12pt; letter-spacing: -0.75pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings; mso-fareast-language: IN;"><span style="mso-list: Ignore;">ü<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; letter-spacing: -0.75pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Mengencangkan pada
perlekatannya.<o:p></o:p></span></div>
<br />
<div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin: 0cm 0cm 0pt 14.2pt; mso-add-space: auto; mso-list: l1 level1 lfo6; text-align: justify; text-indent: -14.2pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><span style="mso-list: Ignore;">2.<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; letter-spacing: -0.75pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Terapi operatif </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0pt 14.2pt; text-align: justify;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; letter-spacing: -0.75pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">ORIF (Open Reduction internal
fixation)<o:p></o:p></span></b></div>
<br />
<div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0pt 14.2pt; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; letter-spacing: -0.75pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Indikasi ORIF :</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>
<br />
<div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin: 0cm 0cm 0pt 1cm; mso-add-space: auto; mso-list: l4 level1 lfo10; text-align: justify; text-indent: -14.15pt;">
<span style="font-family: Symbol; font-size: 12pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; mso-fareast-language: IN;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; letter-spacing: -0.75pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Fraktur yang tidak bisa sembuh
atau bahaya avascular nekrosis tinggi</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0pt 1cm; mso-add-space: auto; mso-list: l4 level1 lfo10; text-align: justify; text-indent: -14.15pt;">
<span style="font-family: Symbol; font-size: 12pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; mso-fareast-language: IN;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; letter-spacing: -0.75pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Fraktur yang tidak bisa
direposisi tertutup</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0pt 1cm; mso-add-space: auto; mso-list: l4 level1 lfo10; text-align: justify; text-indent: -14.15pt;">
<span style="font-family: Symbol; font-size: 12pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; mso-fareast-language: IN;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; letter-spacing: -0.75pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Fraktur yang dapat direposisi
tetapi sulit dipertahankan</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>
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<span style="font-family: Symbol; font-size: 12pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; mso-fareast-language: IN;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; letter-spacing: -0.75pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Fraktur yang berdasarkan
pengalaman memberi hasil yang lebih baik dengan operasi</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>
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<br /></div>
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<b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">KOMPLIKASI</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>
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<div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0pt; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; letter-spacing: -0.75pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Early :</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>
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<div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin: 0cm 0cm 0pt 14.2pt; mso-add-space: auto; mso-list: l11 level1 lfo11; text-align: justify; text-indent: -14.2pt;">
<span style="font-family: Symbol; font-size: 12pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; mso-fareast-language: IN;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; letter-spacing: -0.75pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Lokal :</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>
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<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0pt 14.2pt; mso-add-space: auto; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; letter-spacing: -0.75pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Vaskuler : compartement syndrome<o:p></o:p></span></div>
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<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0pt 14.2pt; mso-add-space: auto; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; letter-spacing: -0.75pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Trauma vaskuler<o:p></o:p></span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 12pt; letter-spacing: -0.75pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Neurologis : lesi medulla
spinalis atau saraf perifer</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>
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<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0pt 14.2pt; mso-add-space: auto; mso-list: l11 level1 lfo11; text-align: justify; text-indent: -14.2pt;">
<span style="font-family: Symbol; font-size: 12pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; mso-fareast-language: IN;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; letter-spacing: -0.75pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Sistemik : emboli lemak </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>
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<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0pt 14.2pt; mso-add-space: auto; mso-list: l11 level1 lfo11; text-align: justify; text-indent: -14.2pt;">
<span style="font-family: Symbol; font-size: 12pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; mso-fareast-language: IN;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; letter-spacing: -0.75pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Crush syndrome</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>
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<div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin: 0cm 0cm 0pt 14.2pt; mso-add-space: auto; mso-list: l11 level1 lfo11; text-align: justify; text-indent: -14.2pt;">
<span style="font-family: Symbol; font-size: 12pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; mso-fareast-language: IN;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; letter-spacing: -0.75pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Emboli paru dan emboli lemak </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>
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<div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0pt; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; letter-spacing: -0.75pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Late :</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>
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<div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin: 0cm 0cm 0pt 14.2pt; mso-add-space: auto; mso-list: l0 level1 lfo12; text-align: justify; text-indent: -14.2pt;">
<span style="font-family: Symbol; font-size: 12pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; mso-fareast-language: IN;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; letter-spacing: -0.75pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Malunion : Bila tulang sembuh
dengan fungsi anatomis abnormal (angulasi, perpendekan, atau rotasi) dalam
waktu yang normal</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>
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<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0pt 14.2pt; mso-add-space: auto; mso-list: l0 level1 lfo12; text-indent: -14.2pt;">
<span style="font-family: Symbol; font-size: 12pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; mso-fareast-language: IN;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; letter-spacing: -0.75pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Delayed union : Fraktur sembuh
dalam jangka waktu yang lebih dari normal</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>
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<div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin: 0cm 0cm 0pt 14.2pt; mso-add-space: auto; mso-list: l0 level1 lfo12; text-indent: -14.2pt;">
<span style="font-family: Symbol; font-size: 12pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; mso-fareast-language: IN;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; letter-spacing: -0.75pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Nonunion : Fraktur yang tidak
menyambung dalam 20 minggu</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>Anonymoushttp://www.blogger.com/profile/17040699491469284898noreply@blogger.com0tag:blogger.com,1999:blog-7514639870940573862.post-90695696923646484492012-06-20T04:43:00.000-07:002012-06-20T04:43:00.900-07:00Dermatitis Kontak Iritan<div class="separator" style="clear: both; text-align: center;">
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhvt5d3bAB9O9M8XepEgYyoDSR72bNoj39vEetnyJquNpxuqCcBQc4ao4v28wDQ99sM3ZGCTA51n3wA2Tr5ZO36BHt8ZGfsXEcR6S2OtakPDGAv3c7V3T9Y1jRRBIw_pYY0jhyphenhyphen9Pk_1ptyE/s1600/derma3.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="150" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhvt5d3bAB9O9M8XepEgYyoDSR72bNoj39vEetnyJquNpxuqCcBQc4ao4v28wDQ99sM3ZGCTA51n3wA2Tr5ZO36BHt8ZGfsXEcR6S2OtakPDGAv3c7V3T9Y1jRRBIw_pYY0jhyphenhyphen9Pk_1ptyE/s200/derma3.jpg" width="200" /></a></div>
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">I.<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span></b><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">PENDAHULUAN<o:p></o:p></span></b><br />
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<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Dermatitis
merupakan reaksi inflamasi terhadap berbagai faktor eksogen maupun endogen,
menimbulkan klinis yang polimorfik (eritema, edema, papula, vesikel, skuama,
likenifikasi) dan keluhan gatal, yang melibatkan epidermis dan dermis.
Dermatitis kontak adalah inflamasi akut maupun kronik yang disebabkan oleh bahan/substansi
yang menempel pada kulit. Dikenal dua macam dermatitis kontak yaitu dermatitis
kontak alergik (DKA) dan dermatitis kontak iritan (DKI). DKA adalah suatu
dermatitis kontak yang terjadi pada seseorang yang telah mengalami sensitisasi
terhadap suatu alergen. Sedangkan DKI merupakan reaksi inflamasi kulit
non-imunologik, sehingga kerusakan kulit terjadi langsung tanpa proses
sensitisasi. Menurut penelitian yang dilakukan di RSCM Jakarta prevalensi
dermatitis kontak adalah 3,07% dan jumlah kasus DKI lebih besar daripada DKA.</span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Jumlah
penderita DKI diperkirakan cukup banyak terutama yang berhubungan dengan
pekerjaan (DKI akibat kerja). DKI merupakan penyakit kulit yang berhubungan
dengan pekerjaan yang paling sering terjadi mencapai ±80% dari semua kasus.
Beberapa pekerjaan yang mempunyai resiko tinggi terjadinya DKI adalah petani,
tukang cuci, pekerja mebel, tukang kayu, pekerja bangunan, tukang las, salon
dan pemotong rambut. Pekerjaan-pekerjaan tersebut berkaitan erat dengan
penggunaan bahan-bahan kimia. Namun seiring berkembangnya zaman, penggunaan
bahan-bahan kimia semakin marak pada kehidupan sehari-hari. Sehingga DKI dapat
terjadi pada pada siapa saja yang sering terpapar dengan bahan yang bersifat
iritan. Banyak bahan-bahan kimia yang digunakan sehari-hari yang mempunyai
sifat iritan walaupun hanya lemah. Namun jika digunakan secara berulang-ulang
maka dapat menimbulkan DKI yang kronis/kumulatif. Contoh bahan yang bersifat
iritan lemah misalnya saja detergen, sabun, pelarut dan sebagainya.<o:p></o:p></span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pada
DKI kelainan kulit ditentukan oleh berbagai faktor yaitu ukuran molekul, daya
larut, konsentrasi bahan, dan vehikulum juga dipengaruhi oleh faktor lain.
Faktor tersebut adalah lama kontak, frekuensi yang berulang, adanya oklusi,
gesekan dan trauma fisik, suhu, kelembaban dan lingkungan. Faktor individu juga
berpengaruh pada DKI misalnya perbedaan permeabilitas, ras, jenis kelamin,
riwayat atopik.<o:p></o:p></span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Penggalian
informasi untuk mendiagnosis DKI serta penggalian informasi terhadap
bahan-bahan iritan pada penderita DKI serta faktor-faktor yang berpengaruh
terhadap terjadinya DKI penting dilakukan untuk upaya penyembuhan dan
pencegahan kekambuhan dari DKI. Oleh sebab itu dalam makalah ini akan dibahas tentang
DKI karena banyaknya kasus DKI yang terjadi pada masyarakat umum dengan semakin
maraknya penggunaan bahan-bahan kimia, apakah cara diagnosis sudah tepat serta
faktor-faktor yang berpengaruh terhadap terjadinya DKI pada salah satu kasus
DKI yang terjadi pada seorang pasien di RSUD Wonosari.<o:p></o:p></span></div>
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<br /></div>
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: IN; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><br clear="all" style="mso-special-character: line-break; page-break-before: always;" />
</span>
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<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">II.<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span></b><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">KASUS<o:p></o:p></span></b></div>
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<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0pt 35.45pt; mso-add-space: auto; mso-list: l4 level1 lfo2; text-align: justify; text-indent: -21.25pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">A.<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Identitas<o:p></o:p></span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Nama<span style="mso-tab-count: 2;"> </span>:N.K.<o:p></o:p></span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Usia<span style="mso-tab-count: 2;"> </span>:14 tahun<o:p></o:p></span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Jenis Kelamin<span style="mso-tab-count: 1;"> </span>:Perempuan<o:p></o:p></span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pekerjaan<span style="mso-tab-count: 1;"> </span>:Pelajar<o:p></o:p></span></div>
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<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0pt 35.45pt; mso-add-space: auto; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Alamat<span style="mso-tab-count: 2;"> </span>:Semanu<o:p></o:p></span></div>
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<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0pt 35.45pt; mso-add-space: auto; mso-list: l4 level1 lfo2; text-align: justify; text-indent: -21.25pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">B.<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Anamnesis<o:p></o:p></span></div>
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<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0pt 2cm; mso-add-space: auto; mso-list: l6 level1 lfo3; text-align: justify; text-indent: -21.25pt;">
<a href="" name="_GoBack"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">1.<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">KU<span style="mso-tab-count: 1;"> </span>:Jari
telunjuk tangan kanan gatal dan panas<o:p></o:p></span></a></div>
<span style="mso-bookmark: _GoBack;"></span>
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<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">2.<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">RPS<span style="mso-tab-count: 1;"> </span>:Pasien
datang dengan keluhan pada jari telunjuk tangan kanan terasa panas dan gatal
sejak 3 bulan yang lalu. Awalnya jari telunjuk hanya terasa gatal, kemudian
lama-lama menjadi panas, kemerahan lalu kulitnya mengelupas sehingga menjadi
kasar dan tampak bersisik. Bila digunakan mencuci akan terasa sangat gatal,
perih dan keluhan menjadi lebih berat. Pasien sering mencuci menggunakan
detergen. Bila pasien frekuensi mencuci berkurang keluhan diakui berkurang.<o:p></o:p></span></div>
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<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0pt 2cm; mso-add-space: auto; mso-list: l6 level1 lfo3; text-align: justify; text-indent: -21.25pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">3.<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">RPD<span style="mso-tab-count: 1;"> </span>:Pasien
pernah mengalami keluhan serupa ± 1 tahun yang lalu. Diobati dengan menggunakan
salep lalu membaik. Pasien lupa nama salep tersebut. Riwayat alergi, astma,
bersin-bersin dipagi hari disangkal.<o:p></o:p></span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">4.<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">RPK<span style="mso-tab-count: 1;"> </span>:Keluhan
serupa pada keluarga disangkal.<o:p></o:p></span></div>
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<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0pt 35.45pt; mso-add-space: auto; mso-list: l4 level1 lfo2; text-align: justify; text-indent: -21.25pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">C.<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pemeriksaan
Fisik<o:p></o:p></span></div>
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<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0pt 35.45pt; mso-add-space: auto; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Lesi tampak pada jari telunjuk
tangan kanan. Terdapat plak eritem, hampir mengenai seluruh permukaan telunjuk,
bentuk tidak teratur, batas tidak tegas, tepi ileguler, ditutupi oleh skuama
diatasnya. Skuama berwarna putih. Xerotic (+), fisura (+).<o:p></o:p></span></div>
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<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0pt 35.45pt; mso-add-space: auto; mso-list: l4 level1 lfo2; text-align: justify; text-indent: -21.25pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">D.<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Diagnosis
Banding<o:p></o:p></span></div>
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<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0pt 53.45pt; mso-add-space: auto; mso-list: l1 level1 lfo7; text-align: justify; text-indent: -18pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">1.<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Dermatitis
kontak iritan<o:p></o:p></span></div>
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<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0pt 53.45pt; mso-add-space: auto; mso-list: l1 level1 lfo7; text-align: justify; text-indent: -18pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">2.<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Dermatitis
kontak alergi<o:p></o:p></span></div>
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<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0pt 53.45pt; mso-add-space: auto; mso-list: l1 level1 lfo7; text-align: justify; text-indent: -18pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">3.<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Dermatitis
atopik<o:p></o:p></span></div>
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<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0pt 35.45pt; mso-add-space: auto; mso-list: l4 level1 lfo2; text-align: justify; text-indent: -21.25pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">E.<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pemeriksaan
Laboratorium<o:p></o:p></span></div>
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<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0pt 35.45pt; mso-add-space: auto; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tidak dilakukan<o:p></o:p></span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">F.<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Diagnosis<o:p></o:p></span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Dermatitis kontak iritan e.c.
detergen<o:p></o:p></span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">G.<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Terapi<o:p></o:p></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0pt 35.45pt; mso-add-space: auto; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Acid salicylic 3%<o:p></o:p></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0pt 35.45pt; mso-add-space: auto; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Inerson oint gr 15<o:p></o:p></span></div>
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<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0pt 35.45pt; mso-add-space: auto; mso-list: l4 level1 lfo2; text-align: justify; text-indent: -21.25pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">H.<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Saran<o:p></o:p></span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Hindari kontak dengan iritan yaitu detergen.
Kurangi frekuensi paparan dengan detergen. Bila harus mencuci dengan detergen
gunakan sarung tangan atau bilas tangan hingga bersih sehingga tidak terdapat
sisa detergen pada jari.<o:p></o:p></span></div>
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: IN; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><br clear="all" style="mso-special-character: line-break; page-break-before: always;" />
</span>
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<div class="MsoNormal" style="margin: 0cm 0cm 10pt;">
<br /></div>
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<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">III.<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span></b><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">DISKUSI<o:p></o:p></span></b></div>
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<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0pt; mso-add-space: auto; text-align: justify; text-indent: 1cm;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pada
DKI, riwayat yang terperinci sangat dibutuhkan karena diagnosis dari DKI
tergantung pada adanya riwayat paparan iritan pada kulit tubuh. Diagnosis DKI
didasarkan anamnesis yang cermat dan pengamatan gambaran klinis. Tidak ada uji
diagnostik untuk DKI. Diagnosis berdasarkan ekslusi penyakit kulit lainnya
(khususnya DKA) dan berdasarkan pada penampakan klinis dermatitis pada tempat
yang terpapar secara cukup oleh iritan yang diketahui.<o:p></o:p></span></div>
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<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0pt; mso-add-space: auto; text-align: justify; text-indent: 1cm;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">DKI
merupakan reaksi peradangan kulit nonimunologik, dimana kerusakan kulit terjadi
langsung tanpa didahului proses sensitisasi. Dermatitis pada tangan pekerja 80%
karena iritan. Pekerjaan yang berisiko tinggi adalah pekerjaan yang berkaitan
dengan cuci tangan berulang seperti tukang cuci, tukang bersih-bersih dan
tukang masak. DKI lebih sering terjadi pada perempuan dibanding laki-laki. Hal
ini ditemukan dalam kasus diatas yaitu DKI terjadi pada perempuan yang sering
terpapar dengan deterjen karena diakui bahwa pasien sering mencuci dengan
detergen.<o:p></o:p></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0pt; mso-add-space: auto; text-align: justify; text-indent: 1cm;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">DKI
dipengaruhi oleh berbagai faktor yaitu faktor zat iritan, faktor lingkungan dan
faktor individu. Dari anamnesis dikatakan keluhan muncul sejak 3 bulan yang
lalu. Pasien sendiri merupakan seorang pelajar yang tinggal diasrama sehingga sering
mencuci sendiri dengan detergen bahkan hampir setiap hari. Pasien juga mengatakan
bahwa keluhan makin berat saat pasien mencuci dengan detergen. Bila pasien
mengurangi kegiatan mencuci dengan detergen diakui keluhan berkurang. Sehingga
dari anamnesis tersebut kemungkinan bahan iritan yang mengenai pasien adalah
detergen. <o:p></o:p></span></div>
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<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0pt; mso-add-space: auto; text-align: justify; text-indent: 1cm;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Faktor
lingkungan, aktivitas mencuci dengan tangan yang sering setiap harinya pada
pasien merupakan aktivitas yang melibatkan gesekan dan berisiko terjadinya trauma
mikro. Selain itu saat mencuci tangan akan terus menerus terendam dalam air
sehingga akan menyebabkan tangan menjadi <span style="mso-spacerun: yes;"> </span>lebih lembab sehingga bahan iritan dapat lebih
mudah penetrasi pada lapisan kulit. Selain itu kebiasaan mencuci dengan
detergen diakui pasien sudah dilakukan sejak bertahun-tahun yang lalu. Dan
kebiasaan tersebut makin sering dilakukan sejak pasien tinggal diasrama. Dari
kondisi tersebut dapat dilihat adanya faktor lama dan frekuensi paparan yakni
adanya paparan yang berulang tapi ringan pada pasien. Hal ini menyebabkan munculnya
DKI yang bersifat kronis/kumulatif. DKI ini disebabkan oleh bahan yang bersifat
iritan lemah namun terpapar secara berulang-ulang. Kebiasaan pasien tidak
mencuci tangan dengan bersih setelah terpapar detergen sehingga terdapat sisa
detergen yang melekat ditangan dalam jangka waktu yang lama juga mempengaruhi. <o:p></o:p></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0pt; mso-add-space: auto; text-align: justify; text-indent: 1cm;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Dari
faktor individu, keluhan yang pernah terjadi sebelumnya dan muncul kembali dan serta
makin bertambah berat terjadi akibat belum pulihnya sawar kulit dengan baik
namun sudah disusul oleh kontak iritan berikutnya sehingga menimbulkan kelainan
kulit. Selain itu jenis kelamin pasien adalah perempuan, dimana dilaporkan
bahwa insidensi DKI lebih banyak pada perempuan.<o:p></o:p></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0pt; mso-add-space: auto; text-align: justify; text-indent: 1cm;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Secara
klinis kasus diatas dapat digolongkan menjadi DKI kronis. Hal ini sesuai karakteristik
DKI kronis karena penyebabnya adalah iritan lemah, onset berminggu-minggu bulan
sampai tahun, kulit tampak kering, eritema, skuama, hiperkeratosis, bila
terus-terusan dapat retak atau fisura, adanya riwayat kontak berulang-ulang dan
berhubungan dengan pekerjaan. Dari anamnesis pasien diketahui bahwa onset
keluhan sejak 3 bulan yang lalu, pasien mengeluhkan kulit mengelupas, tebal dan
perih; paparannya adalah iritan lemah yaitu detergen; dan pasien sering mencuci
dengan tangan menggunakan detergen. Pada pemeriksaan fisik juga ditemukan plak
eritem dengan skuama serta terdapat fisura. Maka anamnesis dan pemeriksaan
fisik sesuai dengan karakteristik DKI kronis.<o:p></o:p></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0pt; mso-add-space: auto; text-align: justify; text-indent: 1cm;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Menurut
Standar Pelayanan Medis RSUP Sardjito pengelolaan untuk DKI adalah sebagai berikut:<o:p></o:p></span></div>
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<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0pt 1cm; mso-add-space: auto; mso-list: l0 level1 lfo4; text-align: justify; text-indent: -1cm;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">a.<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Hentikan kontak dengan bahan penyebab
atau yang dicurigai.<o:p></o:p></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0pt 1cm; mso-add-space: auto; mso-list: l0 level1 lfo4; text-align: justify; text-indent: -1cm;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">b.<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Bersihkan dari bahan-bahan iritan (baik
bahan yang dicurigai sebagai penyebab maupun bahan lain yang dapat mengganggu
penyembuhan).<o:p></o:p></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0pt 1cm; mso-add-space: auto; mso-list: l0 level1 lfo4; text-align: justify; text-indent: -1cm;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">c.<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Dilakukan pengelolaan dermatitis secara
umum:<o:p></o:p></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0pt 42.55pt; mso-add-space: auto; mso-list: l2 level1 lfo5; text-align: justify; text-indent: -14.2pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">1.<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Topikal<o:p></o:p></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0pt 60.55pt; mso-add-space: auto; mso-list: l3 level1 lfo6; text-align: justify; text-indent: -18pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">-<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Dermatitis akut membasah : kompres untuk
pembersihan dan pengeringan dengan obat kompres yang tidak iritatif sampai
lesinya tidak produktif, kemudian dilanjutkan dengan jenis lain yang sesuai.<o:p></o:p></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0pt 60.55pt; mso-add-space: auto; mso-list: l3 level1 lfo6; text-align: justify; text-indent: -18pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">-<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Dermatitis akut tidak membasah : krim
kortikosteroid lemah 2 kali sehari.<o:p></o:p></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0pt 60.55pt; mso-add-space: auto; mso-list: l3 level1 lfo6; text-align: justify; text-indent: -18pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">-<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Dermatitis subakut : krim kortikosteroid
lemah 2 kali sehari.<o:p></o:p></span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">-<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Dermatitis kronis : salep kortikosteroid
sedang/kuat, jika ada penebalan dicampur dengan asam salisilat 5-10%.<o:p></o:p></span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">2.<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sistemik<o:p></o:p></span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Dikerjakan untuk:<o:p></o:p></span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">-<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Menekan peradangan yang berat, jika
peradangan telah berkurang dan dapat diatasi secara topikal, penggunaan secara
sistemik dapat dihentikan secara bertahap. Jika tidak ada kontraindikasi dapat
digunakan prednison 15-30 mg/hari atau lainnya yang setara.<o:p></o:p></span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">-<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Membantu mengurangi gejala gatal. Dapat
digunakan antihistamin, dengan memanfaatkan efek sedatifnya atau
antipruritusnya.<o:p></o:p></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0pt 1cm; mso-add-space: auto; mso-list: l0 level1 lfo4; text-align: justify; text-indent: -1cm;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">d.<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pencegahan selanjutnya dengan mencegah
kontak dengan iritan penyebab:<o:p></o:p></span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">-<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Hindari
sama sekali bahan tersebut.<o:p></o:p></span></div>
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<div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin: 0cm 0cm 0pt 42.55pt; mso-add-space: auto; mso-list: l3 level1 lfo6; text-align: justify; text-indent: -14.2pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">-<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Hindari
bahan tersebut dengan konsentrasi iritatif, sedangkan konsentrasi rendah
non-iritatif perhatikan kemungkinan terjadinya kumulatif pada penggunaan yang
lama.<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 10pt; text-align: justify; text-indent: 1cm;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sehingga
pada pasien ini hal yang paling penting dilakukan adalah usaha untuk
menghindari atau mengurangi paparan dengan bahan iritan. Selain itu juga
kurangi lama dan frekuensi paparan dengan bahan iritan. Bila perlu gunakan
sarung tangan pelindung. Untuk keluhan diberikan asam salisilat 3% dan Salep
Inerson 0,25% 5 gram. Asam salisilat 3% mempunyai daya antipruritus untuk
mengurangi keluhan gatal pada pasien. Inerson 0,25% mengandung desoksimetason merupakan
steroid topikal yang bersifat kuat. Hal ini digunakan karena pada dermatitis
kronis dibutuhkan steroid kuat untuk mengatasi inflamasi. Sedangkan pemilihan
bentuk salep karena pada dermatitis kronis lesi kulit bersifat kering.<o:p></o:p></span></div>
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<div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 10pt; text-align: justify; text-indent: 1cm;">
<br /></div>
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<div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 10pt; text-align: justify; text-indent: 1cm;">
<br /></div>
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<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">IV.<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span></b><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">KESIMPULAN<o:p></o:p></span></b></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">DKI dipengaruhi
oleh berbagai faktor yaitu faktor zat iritan, faktor lingkungan dan faktor
individu. Pada kasus ini faktor iritan adalah detergen yang merupakan bahan
yang bersifat iritan lemah. Faktor lingkungannya adalah aktivitas mencuci yang
berkaitan dengan gesekan, mikro trauma dan merupakan kegiatan dengan kelembaban
tinggi. Faktor individu meliputi jenis kelamin perempuan dan riwayat penyakit
serupa yang pernah dialami.<o:p></o:p></span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Secara klinis
kasus diatas dapat digolongkan menjadi DKI kronis karena sesuai dengan
karakteristiknya yaitu penyebabnya adalah iritan lemah, onset lama, kulit
tampak kering, eritema, skuama, hiperkeratosis, fisura, adanya riwayat kontak
berulang-ulang dan berhubungan dengan pekerjaan.<o:p></o:p></span></div>
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<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0pt 14.2pt; mso-add-space: auto; text-align: justify; text-indent: 21.8pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Untuk pengobatan
yang paling penting adalah menghindari bahan iritan. Kemudian diberikan juga
steroid topikal kuat dan antipruritus.<o:p></o:p></span></div>
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<br /></div>
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<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">V.<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span></b><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">DAFTAR
PUSTAKA<o:p></o:p></span></b></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0pt 14.2pt; mso-add-space: auto; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Budimulja, U., 2008. <i style="mso-bidi-font-style: normal;">Ilmu Penyakit Kelamin Edisi Kelima</i>.
Fakultas Kedokteran Universitas Indonesia, Jakarta.<o:p></o:p></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0pt 14.2pt; mso-add-space: auto; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Marks, J. G., Miller,
J. J., 2006. <i style="mso-bidi-font-style: normal;">Lookingbill and Marks’
Principles of Dermatology Fourth Edition</i>. Elvesier Saunders, India.<o:p></o:p></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0pt 14.2pt; mso-add-space: auto; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Wolf, K., Johnson, R.
A., 2009. <i style="mso-bidi-font-style: normal;">Fitzpatrick’s Color Atlas and
Synopsis of Clinical Dermatology Sixth Edition</i>. Mc Graw Hill, New York.<o:p></o:p></span></div>
<br />
<div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin: 0cm 0cm 0pt 14.2pt; mso-add-space: auto; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Etnawati dan Soedarmadi. 1990. <i style="mso-bidi-font-style: normal;">Pengobatan Penyakit Kulit dan Kelamin</i>.
Laboratorium Ilmu Penyakit Kulit dan Kelamin FK UGM.<o:p></o:p></span></div>Anonymoushttp://www.blogger.com/profile/17040699491469284898noreply@blogger.com0tag:blogger.com,1999:blog-7514639870940573862.post-54624774227092278552012-06-20T04:35:00.001-07:002012-06-20T04:35:48.149-07:00Scabies<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg6syIGqwzLM91bOb5Z0f-T4AkG3oa1BdZCh11h8nVHNF5RETGv0-Gi9M69bV3lJfRHCZ0LZQy9OcmpugdpP2EyL24_FCYhWZdjsF9DF7bOuWT-Dx5igZnM5lNAWebJKZnv1COAoAcC_ibI/s1600/scabies_hand07.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="132" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg6syIGqwzLM91bOb5Z0f-T4AkG3oa1BdZCh11h8nVHNF5RETGv0-Gi9M69bV3lJfRHCZ0LZQy9OcmpugdpP2EyL24_FCYhWZdjsF9DF7bOuWT-Dx5igZnM5lNAWebJKZnv1COAoAcC_ibI/s200/scabies_hand07.jpg" width="200" /></a></div>
Dalam bahasa jawa skabies disebut juga dengan "gudikan". <span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Skabies merupakan penyakit kulit yang
disebabkan oleh infestasi dan sensitisasi terhadap <i style="mso-bidi-font-style: normal;">Sarcoptes scabiei</i>. <o:p></o:p></span><br />
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<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">I.<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span></b><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Epidemiologi
dan Etiologi<o:p></o:p></span></b></div>
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<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Onset penyakit</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">
biasanya pada anak-anak < 5 tahun, dewasa muda yang mendapatkan infeksi <i style="mso-bidi-font-style: normal;">S. scabiei </i>dari kontak tubuh.<o:p></o:p></span></div>
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<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Etiologi</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">
dari penyakit ini adalah <i style="mso-bidi-font-style: normal;">Sarcoptes
scabiei varian hominis</i>. Tumbuh dan berkembang pada kulit manusia. <i style="mso-bidi-font-style: normal;">S. scabiei </i>dalam segala siklus kehidupan
akan membentuk terowongan dalam epidermis sesaat setelah kontak, terowongan
yang dibuat lebih dangkal dari stratum granulosum, <i style="mso-bidi-font-style: normal;">S. scabiei</i> juga akan menyimpan kotorannya dalam terowongan. <i style="mso-bidi-font-style: normal;">S. scabiei</i> betina akan meletakkan telurnya
dalama terowongan saat siang hari sedangkan malam hari akan membuat terowongan
dengan kecepatan 2-3 mm dalam sehari. Telur menetas dalam 72-96 jam.</span></div>
<a name='more'></a><o:p></o:p><br />
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<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Insidensi</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">
dari skabies diperkirakan 300 juta kasus per tahun diseluruh dunia. <o:p></o:p></span></div>
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<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Transmisi </span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">dari
<i style="mso-bidi-font-style: normal;">S. scabiei </i>adalah melalui kontak
kulit ke-kulit saat kontak seksual, saat anak kecil bermain atau pada petugas
kesehatan. <i style="mso-bidi-font-style: normal;">S. scabiei</i> juga dapat
bertahan hidup lebih dari 2 hari dalam pakaian, tempat tidur, sprei dan handuk,
sehingga penyebarannya tidak hanya dari kontak kulit ke-kulit tapi dapat juga
penggunaan barang pribadi bergantian dengan individu yang terinfeksi <i style="mso-bidi-font-style: normal;">S. scabiei</i>.<o:p></o:p></span></div>
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<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">II.<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span></b><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Patogenesis<o:p></o:p></span></b></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kelainan kulit tidak hanya disebabkan
oleh <i style="mso-bidi-font-style: normal;">S. scabiei</i> tetapi juga oleh
pasien sendiri akibat garukan. Gatal disebabkan oleh sensitisasi terhadap
sekret dari <i style="mso-bidi-font-style: normal;">S.scabiei</i> yang memerlukan
waktu kira-kira 1 bulan setelah infestasi parasit. Pada awalnya lesi kulit
menyerupai dermatitis yaitu munculnya papula, vesikel, urtika, dan lain-lain.
Dengan garukan dapat timbul erosi, ekskoriasi, krusta, dan infeksi sekunder.<o:p></o:p></span></div>
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<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">III.<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span></b><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Gejala
Klinis<o:p></o:p></span></b></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Ada 4 tanda kardinal dari skabies
yaitu:<o:p></o:p></span></div>
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<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0pt 32.2pt; mso-add-space: auto; mso-list: l2 level1 lfo2; text-align: justify; text-indent: -18pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">1.<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pruritus
nokturnal : gatal pada malam hari. Hal ini disebabkan aktivitas <i style="mso-bidi-font-style: normal;">S. scabiei </i>saat malam hari lebih tinggi.<o:p></o:p></span></div>
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<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0pt 32.2pt; mso-add-space: auto; mso-list: l2 level1 lfo2; text-align: justify; text-indent: -18pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">2.<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Penyakit
ini <b style="mso-bidi-font-weight: normal;">menyerang manusia secara berkelompok</b>,
misalnya dalam suatu keluarga biasanya seluruh keluarga terkena infeksi. Begitu
pula dalam perkampungan padat, kos-kosan atau asrama.<o:p></o:p></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0pt 32.2pt; mso-add-space: auto; mso-list: l2 level1 lfo2; text-align: justify; text-indent: -18pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">3.<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Adanya
<b style="mso-bidi-font-weight: normal;">terowongan atau kunikulus</b> pada
tempat presileksi yang berwarna putih keabuan, membentuk garis lurus, berkelok,
panjang rata-rata 1 cm dengan ujungnya adalah papula atau vesikel. Jika
terdapat infeksi sekunder dapat terjadi pustula atau ekskoriasi. Tempat
predileksi biasanya adalah tempat yang stratum korneumnya tipis yaitu pada
sela-sela jari, pergelangan tangan bagian volar, siku bagian luar, lipat ketiak
bagian depan, areola mamae, umbilikus, bokong, genitalia eksterna terutama
penis dan skrotum, dan perut bagian bawah.<o:p></o:p></span></div>
<br />
<div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin: 0cm 0cm 0pt 32.2pt; mso-add-space: auto; mso-list: l2 level1 lfo2; text-align: justify; text-indent: -18pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">4.<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";"> </span></span></span><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Menemukan S. scabiei</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">,
merupakan baku emas diagnostik skabies.<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0pt 14.2pt; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Diagnosis
ditegakkan jika menemukan 2 dari 4 tanda kardinal tersebut.<o:p></o:p></span></div>
<br />
<div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin: 0cm 0cm 0pt 1cm; mso-add-space: auto; mso-list: l0 level1 lfo1; text-align: justify; text-indent: -1cm;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">IV.<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span></b><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pemeriksaan
Laboratorium<o:p></o:p></span></b></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0pt 14.2pt; mso-add-space: auto; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pemeriksaan menggunakan lup,
mencari kunikulus yang dibentuk oleh <i style="mso-bidi-font-style: normal;">S.
scabieis</i>. Pengamatan ini dapat dibantu dengan menggunakan tinta sehingga
diamati adanya kunikulus berisi tinta. Selain itu dapat dilakukan kerokan pada
papula atau vesikel kemudian diberikan KOH 30% dan diamati dengan mikroskop
untuk menemukan<i style="mso-bidi-font-style: normal;"> Sarcoptes scabiei.</i><o:p></o:p></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0pt 1cm; mso-add-space: auto; mso-list: l0 level1 lfo1; text-align: justify; text-indent: -1cm;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">V.<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span></b><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Diagnosis
Banding<o:p></o:p></span></b></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0pt 14.2pt; mso-add-space: auto; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pedikulosis korporis<o:p></o:p></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0pt 14.2pt; mso-add-space: auto; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Prurigo<o:p></o:p></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0pt 14.2pt; mso-add-space: auto; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Papular urtikaria<o:p></o:p></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0pt 14.2pt; mso-add-space: auto; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Folikulitis<o:p></o:p></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0pt 1cm; mso-add-space: auto; mso-list: l0 level1 lfo1; text-align: justify; text-indent: -1cm;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">VI.<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span></b><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Manajemen<o:p></o:p></span></b></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0pt 14.2pt; mso-add-space: auto; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Syarat obat yang ideal adalah:<o:p></o:p></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0pt 32.2pt; mso-add-space: auto; mso-list: l3 level1 lfo3; text-align: justify; text-indent: -18pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">1.<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Harus
efektif untuk semua stadium<o:p></o:p></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0pt 32.2pt; mso-add-space: auto; mso-list: l3 level1 lfo3; text-align: justify; text-indent: -18pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">2.<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tidak
menimbulkan iritasi dan toksik<o:p></o:p></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0pt 32.2pt; mso-add-space: auto; mso-list: l3 level1 lfo3; text-align: justify; text-indent: -18pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">3.<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tidak
berbau atau kotor serta tidak merusak pakaian<o:p></o:p></span></div>
<br />
<div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin: 0cm 0cm 0pt 32.2pt; mso-add-space: auto; mso-list: l3 level1 lfo3; text-align: justify; text-indent: -18pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">4.<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Mudah
diperoleh dan harganya murah<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0pt 14.2pt; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Cara
pengobatannya adalah seluruh anggota keluarga harus diobati secara bersamaan.<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0pt 14.2pt; text-align: justify;">
<br /></div>
<br />
<div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0pt 14.2pt; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Jenis
obat topikal:<o:p></o:p></span></div>
<br />
<div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin: 0cm 0cm 0pt 32.2pt; mso-add-space: auto; mso-list: l1 level1 lfo4; text-align: justify; text-indent: -18pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">-<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Belerang endap (sulfur presipitatum)
dengan kadar 4-20% dalam bentuk salep atau krim. Tidak efektif untuk stadium
telur, sehingga penggunaan harus lebih dari 3 hari.<o:p></o:p></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0pt 32.2pt; mso-add-space: auto; mso-list: l1 level1 lfo4; text-align: justify; text-indent: -18pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">-<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Emulsi benzil benzoat (20-25%), efektif
terhadap semua stadium, diberikan setiap malam selama 3 hari.<o:p></o:p></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0pt 32.2pt; mso-add-space: auto; mso-list: l1 level1 lfo4; text-align: justify; text-indent: -18pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">-<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Gama Benzena Heksa Klorida (Gameksan)
kadarnya 1% dalam krim atau losio, efektif terhadap semua stadium, mudah
digunakan, jarang menimbulkan iritasi. Tidak dianjurkan untuk anak <6 tahun
dan wanita hamil karena toksik terhadap SSP.<o:p></o:p></span></div>
<br />
<div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin: 0cm 0cm 0pt 32.2pt; mso-add-space: auto; mso-list: l1 level1 lfo4; text-align: justify; text-indent: -18pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">-<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Permetrin dengan kadar 5% dalam krim,
kurang toksik dibanding gameksan, efektivitasnya sama, aplikasi hanya 1 kali
dihapus setelah 10 jam. Bila belum sembuh diulangi 1 minggu kemudian.<o:p></o:p></span></div>Anonymoushttp://www.blogger.com/profile/17040699491469284898noreply@blogger.com0tag:blogger.com,1999:blog-7514639870940573862.post-85702862394196457492012-06-20T04:28:00.001-07:002012-06-20T04:28:46.182-07:00Cutaneus Larva Migran<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiXLQJwI2HCm1WbTrd28_mfSJiwfpZ2uo1-c6Bor3oY62R3hSrUTBoVEN04jmLY1ZWBMQWW_Arm5GG4VdlT7Qm-qep4psDskwBmAZA8ibzMw8XgUGz7VFYia_kVCdke4Th-HM4JwKluHAsg/s1600/037_02.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="133" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiXLQJwI2HCm1WbTrd28_mfSJiwfpZ2uo1-c6Bor3oY62R3hSrUTBoVEN04jmLY1ZWBMQWW_Arm5GG4VdlT7Qm-qep4psDskwBmAZA8ibzMw8XgUGz7VFYia_kVCdke4Th-HM4JwKluHAsg/s200/037_02.jpg" width="200" /></a></div>
<br />
<div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 10pt; text-align: justify; text-indent: 1cm;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Cutaneus
larva migran disebut juga dengan creeping eruption, dermatosis linearis migrans
dan sandworm disease. Istilah ini digunakan untuk kelainan kulit yang merupakan
peradangan berbentuk linear atau berkelok-kelok, menimbul dan progresif, yang
disebabkan oleh invasi cacing tambang yang berasal dari anjing atau kucing.<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 10pt; text-align: justify; text-indent: 1cm;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Penyakit
ini sering terjadi pada anak-anak terutama yang sering berjalan tanpa alas
kaki, atau yang sering berhubungan dengan tanah dan pasir. Penyakit ini banyak
terjadi didaerah tropis dan subtropis yang hangat dan lembab. Di Indonesia ini
masih banyak ditemukan kelainan kulit ini. </span></div>
<a name='more'></a><o:p></o:p><br />
<br />
<div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 10pt; text-align: justify;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Etiopatogenesis<o:p></o:p></span></b></div>
<br />
<div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 10pt; text-align: justify; text-indent: 1cm;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Penyebab
utama adalah larva yang berasal dari cacing tambang binatang anjing atau kucing
yaitu Ancylostoma braziliense dan Ancylostoma canicum. Nematoda (cacing dewasa)
hidup dalam hospes, kemudian ovum akan keluar bersama dengan feses. Dalam
keadaan hangat dan lembab maka ovum akan menetas menjadi larva. Larva ini mampu
melakukan penetrasi kedalam kulit manusia. Larva akan berjalan dilapisan kulit
dermoepidermal, yang kemudian akan menimbulkan manifestasi klinis.<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 10pt; text-align: justify;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Gejala klinis<o:p></o:p></span></b></div>
<br />
<div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 10pt; text-align: justify; text-indent: 1cm;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Masuknya
larva kedalam kulit akan menimbulkan rasa panas dan gatal. Awalnya akan tampak
papula, kemudian diikuti bentuk khas yaitu lesi berbentuk linear yang
berkelok-kelok, serpiginosa (seperti ular) berwarna kemerahan. Lesi kulit
berupa papula menunjukkan bahwa larva telah ada dalam kulit selama beberapa
jam-hari.<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 10pt; text-align: justify; text-indent: 1cm;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Papula
merah ini kemudian akan berkembang menjalar seperti benang berkelok-kelok, serpiginosa,
menimbul, dan membentuk kanalikuli mencapai panjang beberapa cm. Rasa gatal
akan lebih dirasakan saat malam hari. Tempat predileksi adalah ditungkai,
plantar, tangan, anus, bokong dan paha.<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 10pt; text-align: justify;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Diagnosis<o:p></o:p></span></b></div>
<br />
<div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 10pt; text-align: justify; text-indent: 1cm;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Diagnosis
berdasarkan bentuk yang khas yaitu terdapat kelainan seperti benang
berkelok-kelok, serpiginosa menimbul, serta terdapat papula atau vesikel
diatasnya.<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 10pt; text-align: justify;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Penatalaksanaan<o:p></o:p></span></b></div>
<br />
<div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 10pt; text-align: justify; text-indent: 1cm;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Antihelmintes
berspektrum luas diketahui efektif untuk cutaneus larva migran, misalnya
tiabendazole dengan dosis 50 mg/KgBB/hari sehari 2 kali diberikan
berturut-turut selama 2 hari. Obat tersebut sukar didapat dan efek sampingnya
mual,dan muntah. Pengobatan dengan tiabendazole topikal ternyata efektif. Obat
lain adalah albendazole, dosis sehari 400 mg sebagai dosis tunggal, diberikan 3
hari berturut-turut. Cara terapi lain adalah dengan cryotherapy yaitu
menggunakan CO2 snow (dry ice). Pengobatan ini bila terlalu lama digunakan
dapat merusak jaringan.<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 10pt; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pembahasan<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 10pt; text-align: justify; text-indent: 1cm;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pada
pasien ini keluhan utama yang membawa pasien datang ke Rumah Sakit adalah gatal
pada punggung kaki. Dari anamnesis didapatkan keluhan dirasakan sejak 3 hari
yang lalu, gatal terutama malam hari, awalnya muncul plenting-plenting yang
kemudian tampak garis merah yang berkelok-kelok. Garis tersebut makin panjang
dan dapat berpindah tempat. Diketahui bahwa faktor risiko yang ada pada pasien
adalah pasien sering bermain dipasir yang ada pada depan rumah tanpa
menggunakan alas kaki. Selain itu keluhan yang serupa juga dirasakan oleh kakak
pasien yang juga sering bermain bersama. Dari pemeriksaan fisik tampak pada
dorsum kaki dekstra papula eritem dengan susunan linear berkelok-kelok,
serpiginosa dan tampak ekskoriasi pada daerah sekitar lesi. Dengan data
tersebut dapat ditegakkan diagnosis berupa cutaneus larva migran. Terapi yang
digunakan adalah antihelmintes topikal yaitu albendazole cream digunakan 2 kali
sehari. Dan hal yang harus diperhatikan adalah menghindari faktor risiko yaitu
selalu gunakan alas kaki.<o:p></o:p></span></div>Anonymoushttp://www.blogger.com/profile/17040699491469284898noreply@blogger.com1tag:blogger.com,1999:blog-7514639870940573862.post-25748277910682655602012-06-19T06:44:00.001-07:002012-06-19T07:32:19.721-07:00Batu Saluran Kencing<br />
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<span style="font-family: "Times New Roman","serif";">Batu
saluran kencing terbentuk oleh pengendapan berbagaimacam larutan dalam saluran
kencing. Batu tersebut mengandung calcium oxalate (60%), triple phosphate stone
(campuran kalsium, phosphate dan ammonium) (30%), asam urat (5%) dan sistein
(1%).</span></div>
<a name='more'></a><o:p></o:p><br />
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<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif";">Epidemiologi<o:p></o:p></span></b></div>
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<span style="font-family: "Times New Roman","serif";">Laki-laki
lebih banyak terkena batu saluran kencing daripada perempuan. Prevalensiya ±3%.<o:p></o:p></span></div>
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<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif";">Patogenesis<o:p></o:p></span></b></div>
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<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><span style="font-family: "Times New Roman","serif";">Hipelkalsiuria
: 65% pasien mempunyai hiperkalsiuria idiopatik.<o:p></o:p></span></div>
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</span></span></span><span style="font-family: "Times New Roman","serif";">Teori
nukleasi : sebuah kristal atau benda asing sebagai nukleus dalam proses
kristalisasi pada urin yang mengalami supersaturasi.<o:p></o:p></span></div>
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</span></span></span><span style="font-family: "Times New Roman","serif";">Teori
matriks batu : protein matriks yang disekresikan oleh sel tubular bekerja
sebagai pemacu kristalisasi pada urin yang mengalami supersaturasi.<o:p></o:p></span></div>
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</span></span></span><span style="font-family: "Times New Roman","serif";">Dehidrasi<o:p></o:p></span></div>
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</span></span></span><span style="font-family: "Times New Roman","serif";">Infeksi
: batu staghorn<span style="mso-spacerun: yes;"> </span>triple phosphate
dibentuk oleh aksi organisme yang memproduksi urease (Proteus, Klebsiella),
yang memproduksi ammonia sehingga urin menjadi basa. Schistomiasis merupakan
predisposisi batu vesica urinaria dan juga kanker.<o:p></o:p></span></div>
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<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif";">Patologi<o:p></o:p></span></b></div>
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<span style="font-family: "Times New Roman","serif";">Batu
staghorn berukuran besar, mengisi pelviks dan kaliks renalis dan menyebabkan
pyelonefritis yang kambuh-kambuhan dan kerusakan parenkim ginjal.<o:p></o:p></span></div>
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<span style="font-family: "Times New Roman","serif";">Batu
jenis lain yang lebih kecil bervariasi ukurannya mulai dari 1-2 cm. Batu
tersebut menyebabakan obstruksi saluran kencing biasanya adalah ureter. Batu
pada kaliksbiasanya<span style="mso-spacerun: yes;"> </span>menyebabkan
hematuria, batu pada vesica menyebabkan menyebabkan infeksi.<o:p></o:p></span></div>
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<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif";">Manifestasi Klinis<o:p></o:p></span></b></div>
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<span style="font-family: "Times New Roman","serif";">Batu
kaliks biasanya asimptomatik.<o:p></o:p></span></div>
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<span style="font-family: "Times New Roman","serif";">Batu
staghorn menyebabkan nyeri pada regio flank dan saluran kencing bagian atas.<o:p></o:p></span></div>
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<span style="font-family: "Times New Roman","serif";">Batu
ureter menyebabkan nyeri kolik yang menjalar dari loin ke groin dan kescrotum
atau labia dengan hematuria makro ataupun mikro.<o:p></o:p></span></div>
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<span style="font-family: "Times New Roman","serif";">Batu
vesica muncul dengan sumbatan aliran urin yang tiba-tiba, nyeri perineal dan
nyeri pada ujung penis.<o:p></o:p></span></div>
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<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif";">Pemeriksaan Penunjang<o:p></o:p></span></b></div>
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</span></span></span><span style="font-family: "Times New Roman","serif";">Darah
rutin, urin rutin, creatinin serum, kalsium, fosfat, asam urat<o:p></o:p></span></div>
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</span></span></span><span style="font-family: "Times New Roman","serif";">Urinalisis<o:p></o:p></span></div>
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</span></span></span><span style="font-family: "Times New Roman","serif";">Kultur
urin<o:p></o:p></span></div>
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</span></span></span><span style="font-family: "Times New Roman","serif";">Foto
polos abdomen<o:p></o:p></span></div>
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</span></span></span><span style="font-family: "Times New Roman","serif";">IVP<o:p></o:p></span></div>
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</span></span></span><span style="font-family: "Times New Roman","serif";">Renografi<o:p></o:p></span></div>
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<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif";">Penatalaksanaan<o:p></o:p></span></b></div>
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<span style="font-family: "Times New Roman","serif";">Hal
yang paling penting dalam penatalaksanaan batu saluran kencing adalah:<o:p></o:p></span></div>
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<span style="font-family: "Times New Roman","serif";">Antinyeri
untuk nyeri kolik.<o:p></o:p></span></div>
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<span style="font-family: "Times New Roman","serif";">Intake
cairan yang tinggi.<o:p></o:p></span></div>
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<span style="font-family: "Times New Roman","serif";">80%
batu akan keluar secara spontan. Batu berukuran <4mm akan lolos sedangkan
batu >6mm tidak dapat keluar.<o:p></o:p></span></div>
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<span style="font-family: "Times New Roman","serif";">Indikasi
untuk intervensi adalah: <o:p></o:p></span></div>
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<span style="mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;"><span style="mso-list: Ignore;"><span style="font-family: Calibri;">-</span><span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><span style="font-family: "Times New Roman","serif";">batu
ginjal: simptomatik, obstruksi, obstruksi, staghorn<o:p></o:p></span></div>
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<span style="mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;"><span style="mso-list: Ignore;"><span style="font-family: Calibri;">-</span><span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><span style="font-family: "Times New Roman","serif";">batu
ureter: gagal untuk keluar, batu yang ukurannya besar, obstruksi, infeksi<o:p></o:p></span></div>
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<span style="mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;"><span style="mso-list: Ignore;"><span style="font-family: Calibri;">-</span><span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><span style="font-family: "Times New Roman","serif";">batu
vesica: untuk mencegah komplikasi<o:p></o:p></span></div>
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<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif";">Prosedur intervensi:<o:p></o:p></span></b></div>
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</span></span></span><span style="font-family: "Times New Roman","serif";">ESWL
untuk batu yang ukuran kecil atau medium<o:p></o:p></span></div>
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</span></span></span><span style="font-family: "Times New Roman","serif";">Percutaneus
nephrolithotomy untuk batu ureter bagian proksimal<o:p></o:p></span></div>
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</span></span></span><span style="font-family: "Times New Roman","serif";">Contact
lithotrypsy<o:p></o:p></span></div>
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<span style="mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;"><span style="mso-list: Ignore;"><span style="font-family: Calibri;">-</span><span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><span style="font-family: "Times New Roman","serif";">Open
surgery : ureterolithotomy, nephrolithotomy<o:p></o:p></span></div>
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</span></span></span><span style="font-family: "Times New Roman","serif";">Mechanical
lithotrypsy<o:p></o:p></span></div>Anonymoushttp://www.blogger.com/profile/17040699491469284898noreply@blogger.com0tag:blogger.com,1999:blog-7514639870940573862.post-11853866027340617692012-06-19T06:38:00.001-07:002012-06-19T07:33:23.233-07:00Trauma Inhalasi<b style="mso-bidi-font-weight: normal;"><u><span style="font-family: "Times New Roman","serif";">Etiologi<o:p></o:p></span></u></b><br />
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<div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0pt; text-align: justify; text-indent: 18pt;">
<span style="font-family: "Times New Roman","serif";">Kebanyakan
trauma inhalasi terjadi akibat kerusakan langsung pada permukaaan epitel yang
dapat menyebabkan iritasi dan inflamasi pada saluran pernafasan. Trauma
inhalasi disebabkan oleh berbagai inhalan. Inhalan dibedakan atas 4 macam
yaitu:</span></div>
<a name='more'></a><o:p></o:p><br />
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<span style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">1.<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><span style="font-family: "Times New Roman","serif";">Gas
iritan<o:p></o:p></span></div>
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<span style="font-family: "Times New Roman","serif";">Bekerja
dengan melapisi mukosa saluran pernafasan dan menyebabkan reaksi inflamasi.
Amonia, klorin lebih larut air sehingga menyebabkan luka bakar saluran nafas
atas dan menyebabkan iritasi. Gas iritan lain sulfur dioksida dan nitrogen
dioksida kurang larut air sehingga menyebabkan trauma paru dan distress nafas.<o:p></o:p></span></div>
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<span style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">2.<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><span style="font-family: "Times New Roman","serif";">Gas
asfiksian<o:p></o:p></span></div>
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<span style="font-family: "Times New Roman","serif";">Karbon
dioksida, gas dari bahan bakar (metana, etena, propane) mengikat udara dan
oksigen sehingga menyebabkan asfiksia.<o:p></o:p></span></div>
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<span style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">3.<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><span style="font-family: "Times New Roman","serif";">Gas
yang bersifat toksik sistemik<o:p></o:p></span></div>
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<span style="font-family: "Times New Roman","serif";">CO
yang merupakan komponen terbesar asap , berhubungan dengan pengangkutan oksigen
untuk produksi energi bagi sel.<o:p></o:p></span></div>
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<span style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">4.<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><span style="font-family: "Times New Roman","serif";">Gas
yang menyebabkan alergi<o:p></o:p></span></div>
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<span style="font-family: "Times New Roman","serif";">Gas
ini menyebabkan bronkospasme dan edema meyerupai asma.<o:p></o:p></span></div>
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<br /></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0pt; mso-add-space: auto; text-align: justify;">
<b style="mso-bidi-font-weight: normal;"><u><span style="font-family: "Times New Roman","serif";">Patofisiologi<o:p></o:p></span></u></b></div>
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<span style="font-family: "Times New Roman","serif";">Trauma inhalasi terjadi melalui
kombinasi kerusakan epitel jalan nafas oleh panas dan zat kimia. <span class="a">Hasil
dari pembakaran tidak hanya terdiri dari udara saja, tetapi merupakan campuran
dari udara, partikel padat yang terurai di udara (melalui suatu efek iritasi
dan sitotoksik). Aerosol daricairan yang bersifat iritasi dan sitotoksik serta
gas toksik dimana gabungan tersebut bekerja sistemik. Partikel padat yang
ukurannya lebih dari 10 mikrometer tertahan di hidung dan nasofaring. Partikel
yang berukuran 3-10 mikrometer tertahan pada cabang trakeobronkial,<span style="letter-spacing: -0.75pt;">sedangkan partikel berukuran 1-2 mikrometer dapat
mencapai alveoli.<o:p></o:p></span></span></span></div>
<br />
<div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0pt; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; letter-spacing: -0.75pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Trauma inhalasi diklasifikasikan menjadi 3, antara lain :</span><span style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>
<br />
<div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin: 0cm 0cm 0pt 14.2pt; mso-add-space: auto; mso-list: l2 level1 lfo2; text-align: justify; text-indent: -14.2pt;">
<span style="font-family: "Times New Roman","serif"; letter-spacing: -0.75pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><span style="mso-list: Ignore;">1.<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><span style="font-family: "Times New Roman","serif"; letter-spacing: -0.75pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Trauma pada saluran nafas bagian atas ( trauma supraglotis)<o:p></o:p></span></div>
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<span style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Trauma
saluran nafas atas dapat menyebabkan ancaman hidup melalui obstruksi jalan nafas
sesaat setelah trauma. Jika proses ini ditangani secara benar, edema saluran <span style="letter-spacing: -0.75pt;">nafas dapat hilang tanpa sekuele beberapa hari.<o:p></o:p></span></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0pt 14.2pt; mso-add-space: auto; mso-list: l2 level1 lfo2; text-align: justify; text-indent: -14.2pt;">
<span style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><span style="mso-list: Ignore;">2.<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; letter-spacing: -0.75pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Trauma pada saluran nafas bawah
dan parenkim paru (trauma subglotis)</span><span style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>
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<span style="font-family: "Times New Roman","serif"; letter-spacing: -0.75pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Trauma ini dapat menyebabkan lebih banyak perubahan signifikan dalam fungsi
paru </span><span style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">dan mungkin akan susah ditangani.
Trauma subglotis merupakan trauma kimia yang disebabkan akibat inhalasi
hasil-hasil pembakaran yang bersifat toksik pada luka bakar. Asap memiliki
kapasitas membawa panas yang rendah, sehingga jarang <span style="letter-spacing: -0.75pt;">didapatkan trauma termal langsung pada jalan nafas bagian bawah dan
parenkim paru,</span>trauma ini terjadi bila seseorang terpapar uap yang sangat
panas.<o:p></o:p></span></div>
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<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0pt 14.2pt; mso-add-space: auto; mso-list: l2 level1 lfo2; text-align: justify; text-indent: -14.2pt;">
<span style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><span style="mso-list: Ignore;">3.<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Toksisitas sistemik akibat inhalasi gas toksik seperti
karbon monoksida (CO) dan <span style="letter-spacing: -0.75pt;">sianida.</span><o:p></o:p></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0pt 14.2pt; mso-add-space: auto; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; letter-spacing: -0.75pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Inhalasi dari gas toksik merupakan penyebab utama kematian cepat akibat
api,</span><span style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">meskipun biasanya trauma
supraglotis, subglotis dan toksisitas sistemik terjadi bersamaan. Intoksikasi
CO terjadi jika afinitas CO terhadap hemoglobin lebih besar dari afinitas
oksigen terhadap hemoglobin, sehingga ikatan CO dan hemoglobin <span style="letter-spacing: -0.75pt;">membentuk suatu karboksihemoglobin dan
menyebabkan hipoksia.</span><o:p></o:p></span></div>
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<br /></div>
<br />
<div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0pt; text-align: justify;">
<b style="mso-bidi-font-weight: normal;"><u><span style="font-family: "Times New Roman","serif";">Gambaran klinis<o:p></o:p></span></u></b></div>
<br />
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<span style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Oleh karena
onset terjadinya sering tidak ditangani sesegera <span style="letter-spacing: -0.75pt;">mungkin, maka <span style="mso-spacerun: yes;"> </span>perlu diketahui
tanda-tanda yang dapat <span style="mso-spacerun: yes;"> </span>mengarahkan <span style="mso-spacerun: yes;"> </span>kita untuk bertindak </span>dan harus
mencurigai bahwa seseorang telah mengalami trauma inhalasi antara lain :<o:p></o:p></span></div>
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<span style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><span style="mso-list: Ignore;">-<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><span style="font-family: "Times New Roman","serif"; letter-spacing: -0.75pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Luka bakar pada wajah</span><span style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>
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<span style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><span style="mso-list: Ignore;">-<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><span style="font-family: "Times New Roman","serif"; letter-spacing: -0.75pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Alis mata dan bulu hidung hangus</span><span style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0pt 36pt; mso-add-space: auto; mso-list: l3 level1 lfo3; text-align: justify; text-indent: -18pt;">
<span style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><span style="mso-list: Ignore;">-<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><span style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Adanya
timbunan karbon dan tanda-tanda inflamasi akut di dalam orofaring<o:p></o:p></span></div>
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<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0pt 36pt; mso-add-space: auto; mso-list: l3 level1 lfo3; text-align: justify; text-indent: -18pt;">
<span style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><span style="mso-list: Ignore;">-<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><span style="font-family: "Times New Roman","serif"; letter-spacing: -0.75pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Sputum yang mengandung arang atau karbon (berwarna hitam)</span><span style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0pt 36pt; mso-add-space: auto; mso-list: l3 level1 lfo3; text-align: justify; text-indent: -18pt;">
<span style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><span style="mso-list: Ignore;">-<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><span style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Wheezing,
sesak dan suara serak<o:p></o:p></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0pt 36pt; mso-add-space: auto; mso-list: l3 level1 lfo3; text-align: justify; text-indent: -18pt;">
<span style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><span style="mso-list: Ignore;">-<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><span style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Adanya
riwayat terkurung dalam kepungan api<o:p></o:p></span></div>
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<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0pt 36pt; mso-add-space: auto; mso-list: l3 level1 lfo3; text-align: justify; text-indent: -18pt;">
<span style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><span style="mso-list: Ignore;">-<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><span style="font-family: "Times New Roman","serif"; letter-spacing: -0.75pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Ledakan yang menyebabkan trauma bakar pada kepala dan badan</span><span style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0pt 36pt; mso-add-space: auto; mso-list: l3 level1 lfo3; text-align: justify; text-indent: -18pt;">
<span style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><span style="mso-list: Ignore;">-<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><span style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Tanda-tanda
keracunan CO (karboksihemoglobin lebih dari 10% setelah berada dalam lingkungan
api) seperti kulit berwarna pink sampai merah, takikardi, takipnea, sakit<span style="letter-spacing: -0.75pt;">kepala, mual, pusing, pandangan kabur,
halusinasi, ataksia, kolaps sampai koma.</span><o:p></o:p></span></div>
<br />
<div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin: 0cm 0cm 0pt 36pt; mso-add-space: auto; text-align: justify;">
<br /></div>
<br />
<div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0pt; text-align: justify;">
<b><u><span style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Penatalaksanaan<o:p></o:p></span></u></b></div>
<br />
<div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0pt; text-align: justify; text-indent: 21.3pt;">
<span style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Diagnosis
yang cepat terhadap trauma inhalasi adalah penting untuk penanganan cepat agar
terhindar dari gagal nafas yang berakibat kematian. Pengobatan untuk trauma inhalasi
adalah bersifat suportif.<o:p></o:p></span></div>
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<div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin: 0cm 0cm 0pt 14.2pt; mso-add-space: auto; mso-list: l0 level1 lfo4; text-align: justify; text-indent: -14.2pt;">
<span style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><span style="mso-list: Ignore;">1.<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Airway<o:p></o:p></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0pt 14.2pt; mso-add-space: auto; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; letter-spacing: -0.75pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Jika dicurigai seseorang dengan trauma inhalasi maka sebelum dikirim ke
pusat luka</span><span style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> bakar sebaiknya dilakukan intubasi
cepat untuk melindungi jalan nafas sebelum terjadi pembengkakan wajah dan
faring yang biasanya terjadi 24-48 jam setelah kejadian, dimana jika terjadi
edema maka yang diperlukan adalah trakeostomi atau krikotiroidotomi jika
intubasi oral tidak dapat dilakukan.<o:p></o:p></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0pt 14.2pt; mso-add-space: auto; mso-list: l0 level1 lfo4; text-align: justify; text-indent: -14.2pt;">
<span style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><span style="mso-list: Ignore;">2.<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Breathing<o:p></o:p></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0pt 14.2pt; mso-add-space: auto; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Jika
didapatkan tanda-tanda insufisiensi pernapasan, susah bernapas, stridor,
batuk,retraksi suara nafas bilateral atau tanda-tanda keracunan CO maka
dibutuhkan oksigen100% atau oksigen tekanan tinggi yang akan menurunkan waktu
paruh dari CO dalam <span style="letter-spacing: -0.75pt;">darah.</span><o:p></o:p></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0pt 14.2pt; mso-add-space: auto; mso-list: l0 level1 lfo4; text-align: justify; text-indent: -14.2pt;">
<span style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><span style="mso-list: Ignore;">3.<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Circulation<o:p></o:p></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0pt 14.2pt; mso-add-space: auto; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Pengukuran
tekanan darah dan nadi untuk mengetahui stabilitas hemodinamik. Untuk mencegah
syok hipovolemik diperlukan resusitasi cairan intravena. Pada pasien dengan
trauma inhalasi biasanya dalam 24 jam pertama digunakan cairan kristaloid <span style="letter-spacing: -0.75pt;">40-75% <span style="mso-spacerun: yes;"> </span>lebih banyak dibandingkan pasien yang hanya
luka bakar saja.</span><o:p></o:p></span></div>
<br />
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<span style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><span style="mso-list: Ignore;">4.<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Neurologik <o:p></o:p></span></div>
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<span style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Pasien yang
berespon/sadar membantu untuk mengetahui kemampuan mereka untuk <span style="letter-spacing: -0.75pt;">melindungi <span style="mso-spacerun: yes;"> </span>jalan nafas <span style="mso-spacerun: yes;"> </span>dan <span style="mso-spacerun: yes;"> </span>merupakan
indikator yang baik untuk mengukur </span>kesuksesan resusitasi. Pasien dengan
kelainan neurologik seringkali memerlukan <span style="letter-spacing: -0.75pt;">analgetik
<span style="mso-spacerun: yes;"> </span>poten.</span><o:p></o:p></span></div>
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<span style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><span style="mso-list: Ignore;">5.<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; letter-spacing: -0.75pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Luka bakar </span><span style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>
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<span style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Periksa
seluruh tubuh untuk mengetahui adanya trauma lain dan luka bakar. Cuci<span style="letter-spacing: -0.75pt;"> NaCl kulit yang <span style="mso-spacerun: yes;"> </span>tidak terbakar untuk menghindari sisa zat
toksik yang bermakna.</span><o:p></o:p></span></div>
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<span style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><span style="mso-list: Ignore;">6.<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Medikasi<o:p></o:p></span></div>
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<span style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><span style="mso-list: Ignore;">-<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><span style="font-family: "Times New Roman","serif"; letter-spacing: -0.75pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Kortikosteroid : digunakan untuk menekan inflamasi dan menurunkan edema</span><span style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>
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<span style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><span style="mso-list: Ignore;">-<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><span style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Antibiotik :
Mengobati infeksi sekunder yang biasanya disebabkan oleh Staphylococcus Aureus
dan Pseudomonas Aeruginosa pada pasien-pasien<span style="letter-spacing: -0.75pt;">dengan
kerusakan paru</span><o:p></o:p></span></div>
<br />
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<span style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><span style="mso-list: Ignore;">-<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><span style="font-family: "Times New Roman","serif"; letter-spacing: -0.75pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Amyl dan Sodium Nitrit untuk <span style="mso-spacerun: yes;"> </span>mengobati <span style="mso-spacerun: yes;"> </span>keracunan sianida tetapi harus</span><span style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> berhati-hati jika ditemukan pula tanda-tanda
keracunan CO karena obat inidapat menyebabkan methahemoglobinemia. Oksigen dan
Sodium tiosulfat juga dapat sebagai antidotum sianida, antidotum yang lain
adalah hidroksikobalamin dan EDTA.<o:p></o:p></span></div>
<br />
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<span style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><span style="mso-list: Ignore;">-<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><span style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Bronkodilator
untuk pasien-pasien dengan bronkokonstriksi. Pada kasus-kasus berat
bronkodilator digunakan secara intavena.<o:p></o:p></span></div>
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<br /></div>
<br />
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<b><u><span style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Komplikasi<o:p></o:p></span></u></b></div>
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<span style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><span style="mso-list: Ignore;">1.<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Trauma paru berat, edema, dan ketidakmampuan untuk
oksigenasi atau ventilasi yang<span style="letter-spacing: -0.75pt;">adekuat dapat
menyebabkan kematian</span><o:p></o:p></span></div>
<br />
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<span style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><span style="mso-list: Ignore;">2.<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Keracunan CO dan inhalasi dari hasil pembakaran yang
lain secara bersamaan dapat<span style="letter-spacing: -0.75pt;">menyebabkan
hipoksemia, trauma organ dan morbiditas.</span><o:p></o:p></span></div>
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<br /></div>
<br />
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<b><u><span style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Prognosis<o:p></o:p></span></u></b></div>
<br />
<div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0pt; text-align: justify; text-indent: 21.3pt;">
<span style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Pada trauma
inhalasi ringan biasanya self limited dalam 48-72 jam. Berat ringannya <span style="letter-spacing: -0.75pt;">trauma langsung <span style="mso-spacerun: yes;"> </span>pada <span style="mso-spacerun: yes;"> </span>parenkim paru <span style="mso-spacerun: yes;"> </span>tergantung <span style="mso-spacerun: yes;"> </span>pada luas dan lamanya paparan serta jenis </span>inhalan
yang diproduksi secara bersamaan.<o:p></o:p></span></div>Anonymoushttp://www.blogger.com/profile/17040699491469284898noreply@blogger.com0tag:blogger.com,1999:blog-7514639870940573862.post-85167677885708936082012-06-19T06:34:00.000-07:002012-06-19T06:34:26.084-07:00Terapi non-farmakologi Diabetes Mellitus<br />
<div class="MsoNormal" style="line-height: 150%; margin-bottom: 0pt; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Selain dengan obat-obatan, penanganan Diabetes mellitus atau penyakit gula membutuhkan pendekatan dari sisi lain yaitu dari gaya hidup meliputi perencanaan makan dan latihan jasmani.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: 0pt; text-align: justify;">
<b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Perencanaan Makan</span></b></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: 0pt; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Standar yang dianjurkan untuk penderita Diabetes Mellitus adalah makanan dengan komposisi:</span></div>
<div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: 0pt; text-align: justify; text-indent: -18pt;">
<span style="font-size: 12pt; line-height: 150%;">-<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Karbohidrat 60-70%</span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 0pt; text-align: justify; text-indent: -18pt;">
<span style="font-size: 12pt; line-height: 150%;">-<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Protein 10-15%</span></div>
<div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: 0pt; text-align: justify; text-indent: -18pt;">
<span style="font-size: 12pt; line-height: 150%;">-<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Lemak 20-25%</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: 0pt; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Jumlah kandungan kolesterol dianjurkan <300 mg/hari> Diusahakan lemak berasal dari sumber asam lemak tidak jenuh (MUFA= Mono Unsaturated Fatty Acid), dan membatasi PUFA (Poly Unsaturated Fatty Acid) dan lemak jenuh. Jumlah kandungan serat kurang lebih 25 gram terutama serat yang larut.</span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Jumlah Kalori basal per hari:</span></div>
<div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: 0pt; text-align: justify; text-indent: -18pt;">
<span style="font-size: 12pt; line-height: 150%;">-<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Laki-laki : 30 kal/kg BB ideal</span></div>
<div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: 0pt; text-align: justify; text-indent: -18pt;">
<span style="font-size: 12pt; line-height: 150%;">-<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Perempuan : 25 kal/kg BB ideal</span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Penyesuaian (terhadap kalori basal per hari) :</span></div>
<div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: 0pt; text-align: justify; text-indent: -18pt;">
<span style="font-size: 12pt; line-height: 150%;">-<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Status Gizi :</span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0pt 72pt; text-align: justify; text-indent: -18pt;">
<span style="font-family: Symbol; font-size: 12pt; line-height: 150%;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">BB gemuk : -20%</span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0pt 72pt; text-align: justify; text-indent: -18pt;">
<span style="font-family: Symbol; font-size: 12pt; line-height: 150%;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">BB lebih : -10%</span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0pt 72pt; text-align: justify; text-indent: -18pt;">
<span style="font-family: Symbol; font-size: 12pt; line-height: 150%;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">BB kurang : +20%</span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 0pt; text-align: justify; text-indent: -18pt;">
<span style="font-size: 12pt; line-height: 150%;">-<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Umur >40 tahun : -5%</span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 0pt; text-align: justify; text-indent: -18pt;">
<span style="font-size: 12pt; line-height: 150%;">-<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Stres metabolik : + (10-30%)</span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 0pt; text-align: justify; text-indent: -18pt;">
<span style="font-size: 12pt; line-height: 150%;">-<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Aktivitas :</span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0pt 72pt; text-align: justify; text-indent: -18pt;">
<span style="font-family: Symbol; font-size: 12pt; line-height: 150%;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Ringan : +10%</span></div>
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<span style="font-family: Symbol; font-size: 12pt; line-height: 150%;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sedang : +20%</span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0pt 72pt; text-align: justify; text-indent: -18pt;">
<span style="font-family: Symbol; font-size: 12pt; line-height: 150%;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Berat : +30%</span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 0pt; text-align: justify; text-indent: -18pt;">
<span style="font-size: 12pt; line-height: 150%;">-<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Hamil :</span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0pt 72pt; text-align: justify; text-indent: -18pt;">
<span style="font-family: Symbol; font-size: 12pt; line-height: 150%;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Trimester I,II : +300 kal</span></div>
<div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin: 0cm 0cm 0pt 72pt; text-align: justify; text-indent: -18pt;">
<span style="font-family: Symbol; font-size: 12pt; line-height: 150%;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Trimester III/laktasi : +500 kal</span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Penentuan Berat Badan (rumus Broca):</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: 0pt; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">BB ideal = (tinggi badan-100)-10% *</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: 0pt; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">*) pada pria <160 cm dan wanita < 150 cm tidak perlu dikurangi 10%</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: 0pt; text-align: justify;">
<span style="font-family: Wingdings; font-size: 12pt; line-height: 150%;">à</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> BB kurang : <90% BB ideal</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: 0pt; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> BB normal : 90-110% BB ideal</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: 0pt; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> BB lebih : 110-120% BB ideal</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: 0pt; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Gemuk : >120 BB ideal</span></div>
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<b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Latihan Jasmani</span></b></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kegiatan jasmani sehari-hari dan latihan teratur (3-4 kali seminggu selama kurang lebih 30 menit).</span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Prinsip latihan adalah :</span></div>
<div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: 0pt; text-align: justify; text-indent: -18pt;">
<span style="font-size: 12pt; line-height: 150%;">-<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Continuous</span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 0pt; text-align: justify; text-indent: -18pt;">
<span style="font-size: 12pt; line-height: 150%;">-<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rythmical</span></div>
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<span style="font-size: 12pt; line-height: 150%;">-<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Interval</span></div>
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<span style="font-size: 12pt; line-height: 150%;">-<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Progressive</span></div>
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<span style="font-size: 12pt; line-height: 150%;">-<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Endurance</span></div>Anonymoushttp://www.blogger.com/profile/17040699491469284898noreply@blogger.com0tag:blogger.com,1999:blog-7514639870940573862.post-9068982181546120452012-06-19T06:32:00.004-07:002012-06-30T03:55:27.307-07:00FIBROADENOMA MAMMAE<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><span style="mso-list: Ignore;">I.<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span></b><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">D<span style="mso-bidi-font-style: italic; mso-bidi-font-weight: bold;">efinisi </span><o:p></o:p></span></b><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh3bE_yoFMIYSBTFdRlj7oBmGaL9PpkP5y5fnqsqfCuWPKA85pfYDxtGyW1J6utoJ-6brFJWTwab4GUfgFmhLD6LPtGDKvAyoFA4yLWVdNApqlaxoy1CN_YT9KJqNfl_mMiIel-c1FberDx/s1600/tumor-payudara-(aidforwomen)-200.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh3bE_yoFMIYSBTFdRlj7oBmGaL9PpkP5y5fnqsqfCuWPKA85pfYDxtGyW1J6utoJ-6brFJWTwab4GUfgFmhLD6LPtGDKvAyoFA4yLWVdNApqlaxoy1CN_YT9KJqNfl_mMiIel-c1FberDx/s200/tumor-payudara-(aidforwomen)-200.jpg" width="200" /></a></div>
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<span style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Fibroadenoma
mammae adalah suatu neoplasma jinak yang berbatas tegas, padat, berkapsul.
Merupakan lesi payudara paling umum pada wanita berusia dibawah 25 tahun,
sebagian besar (80%) bersifat tunggal. Biasanya bentuk neoplasma ini tampil
sebagai massa payudara yang bersifat mobile, tidak nyeri, kenyal seperti karet
berukuran 1-4cm. </span></div>
<a name='more'></a>Benjolan dapat dipengaruhi oleh hormon dan dapat berfluktuasi
dalam diameter yaitu ± 1 cm dibawah pengaruh estrogen pada saat menstruasi normal,
kehamilan, laktasi atau penggunaan kontrasepsi oral. Pertumbuhan dapat jelas
terlihat selama kehamilan atau laktasi. Terapi FAM dengan cara biopsi eksisi
dan jarang regresi involusional. Penampilan makroskopik berbeda dari tumor payudara
lainnya, pada FAM tepi benjolan tajam dan permukaan potongannya putih
keabu-abuan sampai merah muda dan homogen. Secara histologi ada susunan lobus
perikanalikuler yang mengandung stroma padat dan epitel proliferatif. Varian
FAM bisa memperlihatkan proliferasi epitel yang jelas dari kelenjar dan epitel
sekresi.<o:p></o:p><br />
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<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><span style="mso-list: Ignore;">II.<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span></b><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">E<span style="mso-bidi-font-style: italic; mso-bidi-font-weight: bold;">tiologi dan Faktor Predis</span>p<span style="mso-bidi-font-style: italic; mso-bidi-font-weight: bold;">osisi </span><o:p></o:p></span></b></div>
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<span style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">FAM merupakan
penyakit payudara tersering kedua yang menyebabkan benjolan di payudara. Muncul
paling sering pada usia antara 20-35 tahun, fibroadenoma mammae jarang terdapat
pada pada wanita setelah menopause. Lesi-lesi ini dapat tumbuh lambat selama
kehamilan.<o:p></o:p></span></div>
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<span style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><span style="mso-list: Ignore;">III.<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><b><span style="font-family: "Times New Roman","serif"; mso-bidi-font-style: italic; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Patogenesis</span></b><span style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>
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<span style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Belum ada
patogenesis yang pasti dari fibroadenoma tetapi dapat dikaitkan dengan rangsangan
hormon estrogen yang tinggi. Pada masa remaja, fibroadenoma mammae bisa terdapat
dalam ukuran yang besar. Pertumbuhan bisa cepat sekali selama kehamilan dan
laktasi atau menjelang menopause, saat rangsang estrogen yang tinggi.<o:p></o:p></span></div>
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<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><span style="mso-list: Ignore;">IV.<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span></b><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">M<span style="mso-bidi-font-style: italic; mso-bidi-font-weight: bold;">anifestasi Klinis</span><o:p></o:p></span></b></div>
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<span style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Fibroadenoma
mammae biasanya tidak menimbulkan gejala dan ditemukan secara kebetulan. Pada
10-15% kasus, fibroadenoma mammae bersifat majemuk. Benjolannya bersifat keras,
kenyal, dan tidak nyeri tekan, bulat, berbatas tegas dan pada palpasi terkesan mobile.
Pemikiran kita yang pertama, adalah untuk membedakan fibroadenoma dengan
kanker. Diperlukan eksisi tumor, atau memastikan diagnosa dengan aspirasi jarum
halus. Resiko utama adalah, bila fibroadenoma yang tidak tereksisi bertumbuh
dan menimbulkan nyeri, khususnya selama kehamilan. Umumnya tidak ditemukan
adanya kanker yang tumbuh menginvasi fibroadenoma, dan pula sangat jarang (satu
per seribu) untuk menemukan kanker yang berasal dari jaringan fibroid (sebagian
besar karena kanker in situ). Karena resiko kanker meningkat menjadi 1 dalam
30, kemungkinan adanya kanker pada fibroadenoma menjadi lebihsedikit, dari pada
tidak adanya fibroadenoma.<o:p></o:p></span></div>
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<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><span style="mso-list: Ignore;">V.<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span></b><b><span style="font-family: "Times New Roman","serif"; mso-bidi-font-style: italic; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Penegakan</span></b><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> D<span style="mso-bidi-font-style: italic; mso-bidi-font-weight: bold;">iagnosis</span><o:p></o:p></span></b></div>
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<span style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Fibroadenoma
dapat didiagnosis dengan tiga cara, yaitu dengan pemeriksaan fisik, dengan
mammography atau USG, dengan Fine Needle Aspiration Cytology (FNAC). <o:p></o:p></span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pada pemeriksaan fisik
diperiksa benjolan yang ada dengan inspeksi pada saat berbaring, duduk, dan
membungkuk apakah terlihat benjolan, kerutan pada kulit payudara (peau
d’orange), dan dengan palpasi pada daerah tersebut, dari palpasi itu dapat
diketahui ukurannya, jumlahnya, apakah mobil atau tidak, kenyal atau keras,
bernodul atau tidak, dan mengeluarkan cairan dari putting susu atau tidak</span><span style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">. <o:p></o:p></span></div>
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Mammography digunakan untuk membantu
diagnosis, mammography sangat berguna untuk mendiagnosis wanita dengan usia tua
sekitar 60 atau 70 tahun, sedangkan pada wanita usia muda tidak digunakan
mammography, sebagai gantinya digunakan USG, hal ini karena fibroadenoma pada
wanita muda tebal, sehingga tidak terlihat dengan baik bila menggunakan mammography.
</div>
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Mammography merupakan s<span lang="SV" style="mso-ansi-language: SV;">uatu teknik pemeriksaan soft tissue. Adanya proses
keganasan akan memberikan tanda-tanda primer dan sekunder. Tanda primer </span>yaitu
jaringan <span lang="SV" style="mso-ansi-language: SV;">berfibrosis reaktif, comet
sign, adanya perbedaan yang nyata ukuran VE dan rontgenologik dan adanya
mikrokalsifikasi. Tanda-tanda sekunder berupa retraksi, penebalan kulit,
bertambahnya vaskularisasi, perubahan posisi palpila dan areola adanya bridge
of tumor, keadaan daerah dan jaringan fibroglanduler tidak teratur, infiltrasi
dalam jaringan lunak di belakang mammae dan adanya metastis ke kelenjar.
Mammografi ini dapat mendeteksi tumor-tumor yang secara palpasi tidak teraba,
jadi sangat baik untuk diagnosis dini dan screening. Hanya saja untuk </span>skrining
masal<span lang="SV" style="mso-ansi-language: SV;"> cara ini adalah cara yang
mahal dan dianjurkan digunakan secara selektif saja misalnya pada wanita dengan
adanya faktor resiko. </span>K<span lang="SV" style="mso-ansi-language: SV;">etetapan
83-95%, tergantung dari teknis dan ahli radiologinya.</span></div>
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<span lang="SV" style="mso-ansi-language: SV;">Dengan
pemeriksaan </span>USG<span lang="SV" style="mso-ansi-language: SV;"> hanya dapat
dibedakan lesi solid dan kistik pemeriksaan lain dapat berupa: termografi,
xerografi. </span><span lang="FI" style="mso-ansi-language: FI;">Dilakukan untuk
mencari jauhnya ekstensi tumor atau mencari metastasis jauh. Pemeriksaan ini
umumnya hanya dilakukan apabila diperlukan (atas indikasi) pemeriksaan
laboratorium untuk melihat toleransi penderita, juga dapat melihat kemungkinan
adanya metastasis misalnya alkali fosfatase.</span></div>
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<span style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Pada FNAC
kita akan mengambil sel dari fibroadenoma dengan menggunakan penghisap berupa
sebuah jarum yang dimasukkan pada suntikan. Dari alat tersebut kita dapat
memperoleh sel yang terdapat pada fibroadenoma, lalu hasil pengambilan tersebut
dikirim ke laboratorium patologi anatomi (PA) untuk diperiksa di bawah
mikroskop apakah terdapat sel-sel ganas atau tidak.<o:p></o:p></span></div>
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<span style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Dibawah
mikroskop tumor tersebut tampak seperti berikut :<o:p></o:p></span></div>
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<span style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><span style="mso-list: Ignore;">a.<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><span style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Tampak
jaringan tumor yang berasal dari mesenkim (jaringan ikat fibrosa) dan berasal
dari epitel (epitel kelenjar) yang berbentuk lobus-lobus<o:p></o:p></span></div>
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<span style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><span style="mso-list: Ignore;">b.<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><span style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Lobuli
terdiri atas jaringan ikat kolagen dan saluran kelenjar yang berbentuk bulat
(perikanalikuler) atau bercabang (intrakanalikuler)<o:p></o:p></span></div>
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<span style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><span style="mso-list: Ignore;">c.<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><span style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Saluran
tersebut dibatasi sel-sel yang berbentuk kuboid atau kolumnar pendek uniform<o:p></o:p></span></div>
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<span style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><span style="mso-list: Ignore;">VI.<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><b><span style="font-family: "Times New Roman","serif"; mso-bidi-font-style: italic; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Penatalaksanaan dan</span></b><span style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> <b><span style="mso-bidi-font-style: italic;">Prognosis</span></b><o:p></o:p></span></div>
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<span style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Terapi
fibroadenoma mammae adalah eksisi dengan anastesi lokal. Bila penderita muda
dengan lesi kecil, diagnosa dapat ditegakkan dengan aspirasi jarum halus, bila
penderita tidak menginginkan biopsi dengan eksisi. (samapai kini belum ada
publikasi ilmiah tentang penyelidikan terhadap fibroadenoma, yang tetap
dibiarkan tanpa tindakan, hal ini harus diberitahukan kepada penderita yang
menolak pembedahan). Fibroadenoma yang lebih besar (lebih dari 2 cm) harus diangkat,
karena dapat menyebabkan nyeri, dan dapat bertumbuh terus.<o:p></o:p></span></div>
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<span style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><span style="mso-spacerun: yes;"> </span>Prognosis dari fibroadenoma mammae adalah
baik, bila diangkat dengan sempurna, tetapi bila masih tertapat jaringan sisa pada
saat operasi dapat kambuh kembali.<o:p></o:p></span></div>
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<br /></div>Anonymoushttp://www.blogger.com/profile/17040699491469284898noreply@blogger.com13tag:blogger.com,1999:blog-7514639870940573862.post-50544645375414223522011-12-17T02:10:00.000-08:002012-06-19T06:53:57.947-07:00Acute Coronary Syndrome<div class="MsoNormal" style="margin: 0cm 0cm 10pt; text-align: justify;">
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgS1iGkI6TS4CybwCTiAjzmHW3sebped0zw8AOvjF3cUOhOi4x1TV9QA0S4I_FA9A-jkFfyMMMxMj0dEW5HZ5D7wehk1U0gRcYW6ls8GTZ3Q0S-ucBmQYbemjFVw8tAEN0zDOT08ShjrB_X/s1600/cardiac-muscle-damage-illustration-PU.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="198" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgS1iGkI6TS4CybwCTiAjzmHW3sebped0zw8AOvjF3cUOhOi4x1TV9QA0S4I_FA9A-jkFfyMMMxMj0dEW5HZ5D7wehk1U0gRcYW6ls8GTZ3Q0S-ucBmQYbemjFVw8tAEN0zDOT08ShjrB_X/s320/cardiac-muscle-damage-illustration-PU.jpg" width="320" /></a></div>
<span style="font-family: Calibri;">Atherosclerosis merupakan proses yang terus menerus berjalan selama hidup. Plak atherosclerosis yang stabil dapat mengganggu lumen arteri dan menyebabkan iskemia kronis yang dapat menimbulkan stable angina. Sedangkan plak atherosclerosis yang tidak stabil dapat ruptur dan menyebabkan terbentuknya thrombus yang kaya akan platelet, yang menyumbat arteri secara parsial maupun total sehingga dapat menyebabkan gejala iskemia akut.</span></div>
<div class="MsoNormal" style="margin: 0cm 0cm 10pt; text-align: justify;">
<span style="font-family: Calibri;">Plak atherosclerosis disebut stabil bila risiko terjadinya ruptur adalah rendah. Plak yang stabil umumnya adalah:</span></div>
<div class="MsoListParagraphCxSpFirst" style="margin: 0cm 0cm 0pt 36pt; mso-list: l0 level1 lfo1; text-align: justify; text-indent: -18pt;">
<span style="mso-bidi-font-family: Calibri;"><span style="mso-list: Ignore;"><span style="font-family: Calibri;">-</span><span style="font-family: "Times New Roman";"> </span></span></span><span style="font-family: Calibri;">mempunyai fibrous cap yang tebal dan kepadatannya merata sehingga secara mekanik lebih stabil.</span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 36pt; mso-list: l0 level1 lfo1; text-align: justify; text-indent: -18pt;">
<span style="mso-bidi-font-family: Calibri;"><span style="mso-list: Ignore;"><span style="font-family: Calibri;">-</span><span style="font-family: "Times New Roman";"> </span></span></span><span style="font-family: Calibri;">fibrous cap mengandung lebih banyak VSMC (vascular smooth muscle cell) dan kolagen.</span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 36pt; mso-list: l0 level1 lfo1; text-align: justify; text-indent: -18pt;">
<span style="mso-bidi-font-family: Calibri;"><span style="mso-list: Ignore;"><span style="font-family: Calibri;">-</span><span style="font-family: "Times New Roman";"> </span></span></span><span style="font-family: Calibri;">lipid-rich core kurang dari 40% volume total plak.</span></div>
<div class="MsoListParagraphCxSpLast" style="margin: 0cm 0cm 10pt 36pt; mso-list: l0 level1 lfo1; text-align: justify; text-indent: -18pt;">
<span style="mso-bidi-font-family: Calibri;"><span style="mso-list: Ignore;"><span style="font-family: Calibri;">-</span><span style="font-family: "Times New Roman";"> </span></span></span><span style="font-family: Calibri;">sedikit infiltrasi sel inflamasi (makrofag dan limfosit-T).</span></div>
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<span style="font-family: Calibri;">Terdapat 6 stage perkembangan atherosclerosis:</span></div>
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<span style="font-family: Calibri;">Stage I-IV : akumulasi lipid yang awalnya adalah intraseluler kemudian ekstraseluler sehingga terbentuk lipid core.</span></div>
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<span style="font-family: Calibri;">Stage V : terbentuk fibrosis disekeliling lipid core sehingga terbentuklah plak atherosclerosis.</span></div>
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<span style="font-family: Calibri;">Stage VI : komplikasi plak yaitu plak mengalami ruptur dan thrombosis</span><span style="font-family: Wingdings; mso-ascii-font-family: Calibri; mso-char-type: symbol; mso-hansi-font-family: Calibri; mso-symbol-font-family: Wingdings;"><span style="mso-char-type: symbol; mso-symbol-font-family: Wingdings;">à</span></span><span style="font-family: Calibri;"> atherothrombosis</span><span style="font-family: Wingdings; mso-ascii-font-family: Calibri; mso-char-type: symbol; mso-hansi-font-family: Calibri; mso-symbol-font-family: Wingdings;"><span style="mso-char-type: symbol; mso-symbol-font-family: Wingdings;">à</span></span><span style="font-family: Calibri;"> clinical event.</span></div>
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<span style="font-family: Calibri;">Pada saat plak mengalami ruptur maka akan terjadi thrombosis yang menyebabkan oklusi arteri. Oklusi arteri parsial akan menimbulkan UAP atau NSTEMI sedangkan oklusi total akan menimbulkan STEMI. </span></div>
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<span style="font-family: Calibri;">ACUTE CORONARY SYNDROME</span></div>
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<span style="font-family: Calibri;">ACS<span style="mso-spacerun: yes;"> </span>merupakan keadaan gawat darurat jantung dengan menifestasi klinis berupa perasaan tidak enak didada akibat iskemia miokardiaum. ACS mencakup STEMI, NSTEMI, dan Unstable Angina Pectoris. ACS mempunyai hubungan yang erat dengan rupturnya plak atherosclerosis yang menyebabkan oklusi baik parsial maupun total arteri tersebut oleh pembentukan thrombosis.</span><br />
<span style="font-family: Calibri;"><a name='more'></a></span></div>
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<span style="font-family: Calibri;">Etiologi:</span></div>
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<span style="font-family: Calibri;">ACS umumnya disebabkan oleh atherosclerosis. Sebagian besar kasus ACS terjadi dari gangguan pada plak atherosclerosis yang rentan mengalami ruptur. Plak ini mempunyai ciri khas yaitu mengandung banyak lipid pool, banyak sel inflamasi dan pelindung jaringan fibrotik (fibrous cap) yang tipis.</span></div>
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<span style="font-family: Calibri;">ACS dapat timbul apabila terdapat ketidak seimbangan kebutuhan dan suplai oksigen dan nutrisi pada myocardial karena adanya obstruksi. Hal ini dapat terjadi saat myocard mengalami peningkatan kebutuhan oksigen dan nutrisi seperti yang dihasilkan<span style="mso-spacerun: yes;"> </span>dari olahraga, stress emosional, atau stress fisiologis (dehidrasi, blood loss, hipotensi, infeksi, dll).</span></div>
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<span style="font-family: Calibri;">Patofisiologi ACS</span></div>
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<span style="font-family: Calibri;">Keluhan utama pada ACS umumnya berupa nyeri dada yang timbul karena iskemia miokardium. Biasanya mempunyai karakteristik berupa:</span></div>
<div class="MsoListParagraphCxSpFirst" style="margin: 0cm 0cm 0pt 36pt; mso-list: l0 level1 lfo1; text-align: justify; text-indent: -18pt;">
<span style="mso-bidi-font-family: Calibri;"><span style="mso-list: Ignore;"><span style="font-family: Calibri;">-</span><span style="font-family: "Times New Roman";"> </span></span></span><span style="font-family: Calibri;">Lokasi biasanya didada, substernal, retrosternal, prekordial dengan penjalaran ke leher, rahang, bahu kiri sampai dengan lengan dan jari bagian ulnar, punggung/pundak kiri.</span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 36pt; mso-list: l0 level1 lfo1; text-align: justify; text-indent: -18pt;">
<span style="mso-bidi-font-family: Calibri;"><span style="mso-list: Ignore;"><span style="font-family: Calibri;">-</span><span style="font-family: "Times New Roman";"> </span></span></span><span style="font-family: Calibri;">Kualitas nyeri berupa nyeri yang tumpul seperti rasa tertindih/tertekan benda berat, rasa terbakar, seperti ditusuk, diperas, dipelintir didada.</span></div>
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<span style="font-family: Calibri;">Nyeri berhubungan ditimbulkan oleh aktivitas, latihan fisik, stress emosi, udara dingin; hilang dengan istirahat atau obat nitrat.</span></div>
<div class="MsoListParagraphCxSpLast" style="margin: 0cm 0cm 10pt 36pt; mso-list: l0 level1 lfo1; text-align: justify; text-indent: -18pt;">
<span style="mso-bidi-font-family: Calibri;"><span style="mso-list: Ignore;"><span style="font-family: Calibri;">-</span><span style="font-family: "Times New Roman";"> </span></span></span><span style="font-family: Calibri;">Dapat disertai dengan gejala berupa mual, muntah, sulit bernafas, keringat dingin dan lemas.</span></div>
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<span style="font-family: Calibri;">Manajemen Awal ACS</span></div>
<div class="MsoListParagraphCxSpFirst" style="margin: 0cm 0cm 0pt 36pt; mso-list: l0 level1 lfo1; text-indent: -18pt;">
<span style="mso-bidi-font-family: Calibri;"><span style="mso-list: Ignore;"><span style="font-family: Calibri;">-</span><span style="font-family: "Times New Roman";"> </span></span></span><span style="font-family: Calibri;">Anamnesis</span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 36pt; mso-list: l0 level1 lfo1; text-indent: -18pt;">
<span style="mso-bidi-font-family: Calibri;"><span style="mso-list: Ignore;"><span style="font-family: Calibri;">-</span><span style="font-family: "Times New Roman";"> </span></span></span><span style="font-family: Calibri;">Pemeriksaan Fisik</span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 36pt; mso-list: l0 level1 lfo1; text-indent: -18pt;">
<span style="mso-bidi-font-family: Calibri;"><span style="mso-list: Ignore;"><span style="font-family: Calibri;">-</span><span style="font-family: "Times New Roman";"> </span></span></span><span style="font-family: Calibri;">EKG</span></div>
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<span style="mso-bidi-font-family: Calibri;"><span style="mso-list: Ignore;"><span style="font-family: Calibri;">-</span><span style="font-family: "Times New Roman";"> </span></span></span><span style="font-family: Calibri;">Cardiac biomarker</span></div>
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<span style="font-family: Calibri;">Dilakukan dalam 10 menit !!!!!</span></div>
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<br /></div>
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<span style="font-family: Calibri;">Pemeriksaan Fisik :</span></div>
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<span style="mso-bidi-font-family: Calibri;"><span style="mso-list: Ignore;"><span style="font-family: Calibri;">-</span><span style="font-family: "Times New Roman";"> </span></span></span><span style="font-family: Calibri;">tanda vital dan kardiovaskular</span><span style="font-family: Wingdings; mso-ascii-font-family: Calibri; mso-char-type: symbol; mso-hansi-font-family: Calibri; mso-symbol-font-family: Wingdings;"><span style="mso-char-type: symbol; mso-symbol-font-family: Wingdings;">à</span></span><span style="font-family: Calibri;"> biasanya normal</span></div>
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<span style="mso-bidi-font-family: Calibri;"><span style="mso-list: Ignore;"><span style="font-family: Calibri;">-</span><span style="font-family: "Times New Roman";"> </span></span></span><span style="font-family: Calibri;">tanda gagal jantung dan syok kardiogenik</span></div>
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<span style="mso-bidi-font-family: Calibri;"><span style="mso-list: Ignore;"><span style="font-family: Calibri;">-</span><span style="font-family: "Times New Roman";"> </span></span></span><span style="font-family: Calibri;">komplikasi</span><span style="font-family: Wingdings; mso-ascii-font-family: Calibri; mso-char-type: symbol; mso-hansi-font-family: Calibri; mso-symbol-font-family: Wingdings;"><span style="mso-char-type: symbol; mso-symbol-font-family: Wingdings;">à</span></span><span style="font-family: Calibri;"> acute mitral regurgitation</span></div>
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<span style="mso-bidi-font-family: Calibri;"><span style="mso-list: Ignore;"><span style="font-family: Calibri;">-</span><span style="font-family: "Times New Roman";"> </span></span></span><span style="font-family: Calibri;">klasifikasi Killip (risiko mortalitas)</span></div>
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<span style="font-family: Calibri;">Klas I<span style="mso-tab-count: 1;"> </span>tak ada tanda gagal jantung kongestif<span style="mso-tab-count: 2;"> </span>mortalitas 6 %</span></div>
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<span style="font-family: Calibri;">Klas II<span style="mso-tab-count: 1;"> </span>+S3 dan/atau ronki basah<span style="mso-tab-count: 3;"> </span>17%</span></div>
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<span style="font-family: Calibri;">Klas III<span style="mso-tab-count: 1;"> </span>edema paru<span style="mso-tab-count: 5;"> </span>30-40%</span></div>
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<span style="font-family: Calibri;">Klas IV<span style="mso-tab-count: 1;"> </span>syok kardiogenik<span style="mso-tab-count: 4;"> </span>60-80%</span></div>
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<span style="font-family: Calibri;">EKG</span></div>
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<span style="font-family: Calibri;">UAP : depresi segmen ST dengan atau tanpa inversi gelombang T</span></div>
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<span style="font-family: Calibri;">NSTEMI : depresi ST, inversi gelombang T dalam (>0,2 mv) yang simetris 2 lead yg bersebelahan</span></div>
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<span style="font-family: Calibri;">STEMI : elevasi segmen ST<span style="mso-tab-count: 1;"> </span>>1 mv dari 2 lead pada lead II, III, aVF, aVL (ekstremitas)</span></div>
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<span style="font-family: Calibri;">>2 mv di lead V1-V6 (prekordial)</span></div>
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<br /></div>
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<span style="font-family: Calibri;">Terapi</span></div>
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<span style="mso-bidi-font-family: Calibri;"><span style="mso-list: Ignore;"><span style="font-family: Calibri;">-</span><span style="font-family: "Times New Roman";"> </span></span></span><span style="font-family: Calibri;">tirah baring di ICCU</span></div>
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<span style="mso-bidi-font-family: Calibri;"><span style="mso-list: Ignore;"><span style="font-family: Calibri;">-</span><span style="font-family: "Times New Roman";"> </span></span></span><span style="font-family: Calibri;">Pasang infus IV dengan Nacl 0,9% atau D5</span></div>
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<span style="mso-bidi-font-family: Calibri;"><span style="mso-list: Ignore;"><span style="font-family: Calibri;">-</span><span style="font-family: "Times New Roman";"> </span></span></span><span style="font-family: Calibri;">O2 dimulai 2 liter/mnt 2-3 jam</span></div>
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<span style="mso-bidi-font-family: Calibri;"><span style="mso-list: Ignore;"><span style="font-family: Calibri;">-</span><span style="font-family: "Times New Roman";"> </span></span></span><span style="font-family: Calibri;">pasang EKG secara kontinu</span></div>
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<span style="font-family: Calibri;">Atasi nyeri dengan:</span></div>
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<span style="mso-bidi-font-family: Calibri;"><span style="mso-list: Ignore;"><span style="font-family: Calibri;">-</span><span style="font-family: "Times New Roman";"> </span></span></span><span style="font-family: Calibri;">nitrat sublingual</span></div>
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<span style="mso-bidi-font-family: Calibri;"><span style="mso-list: Ignore;"><span style="font-family: Calibri;">-</span><span style="font-family: "Times New Roman";"> </span></span></span><span style="font-family: Calibri;">morfin 2,5 mg IV atau petidin 25-50 mg IV atau tramadol 25-50 mg IV</span></div>
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<span style="font-family: Calibri;">Antitrombotik</span></div>
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<span style="mso-bidi-font-family: Calibri;"><span style="mso-list: Ignore;"><span style="font-family: Calibri;">-</span><span style="font-family: "Times New Roman";"> </span></span></span><span style="font-family: Calibri;">Aspirin (160-345 mg)</span></div>
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<span style="font-family: Calibri;">Trombolitik</span></div>
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<span style="mso-bidi-font-family: Calibri;"><span style="mso-list: Ignore;"><span style="font-family: Calibri;">-</span><span style="font-family: "Times New Roman";"> </span></span></span><span style="font-family: Calibri;">streptokinase 1,5 juta U</span></div>
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<span style="mso-bidi-font-family: Calibri;"><span style="mso-list: Ignore;"><span style="font-family: Calibri;">-</span><span style="font-family: "Times New Roman";"> </span></span></span><span style="font-family: Calibri;">aktivator plasminogen jaringan bolus 15 mg</span></div>
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<span style="font-family: Calibri;">Antikoagulan</span></div>
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<span style="mso-bidi-font-family: Calibri;"><span style="mso-list: Ignore;"><span style="font-family: Calibri;">-</span><span style="font-family: "Times New Roman";"> </span></span></span><span style="font-family: Calibri;">Heparin</span></div>Anonymoushttp://www.blogger.com/profile/17040699491469284898noreply@blogger.com0tag:blogger.com,1999:blog-7514639870940573862.post-19352665566449639622011-10-23T05:41:00.000-07:002011-10-23T05:41:10.505-07:00Metabolisme Tubuh<div class="MsoListParagraph" style="line-height: 200%; margin: 0cm 0cm 0pt; mso-add-space: auto;"><span style="font-family: "Courier New"; font-size: 12pt; line-height: 200%;">A.1 <u>Metabolisme bahan bakar tubuh</u></span></div><div class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 0pt; text-align: justify;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Courier New"; font-size: 12pt; line-height: 200%;"><span style="mso-spacerun: yes;"> </span></span></b><span style="font-family: "Courier New"; font-size: 12pt; line-height: 200%;">Metabolisme yaitu semua reaksi kimia yang berlangsung didalam sel tubuh. Reaksi-reaksi yang melibatkan molekul organik kaya energi yaitu karbohidrat, lemak dan protein dikenal sebagai metabolisme bahan bakar (Sherwood, 2001). Lintasan metabolisme dapat digolongkan dalam 3 kategori yaitu: (1) Lintasan anabolik merupakan lintasan yang digunakan untuk sintesis senyawa misalnya protein, TAG (<i style="mso-bidi-font-style: normal;">triacylglycerol</i>), dan glikogen. Lintasan anabolik merupakan reaksi yang membutuhkan energi. (2) Lintasan katabolik meliputi pemecahan molekul besar, biasanya meliputi reaksi oksidatif yang melepaskan energi dalam bentuk fosfat energi tinggi. Pada proses ini terjadi pemecahan karbohidrat, lemak, dan protein menjadi bentuk yang lebih sederhana yaitu laktat, gliserol, dan asam amino. (3) Lintasan amfibolik bekerja sebagai penghubung antara lintasan anabolik dan lintasan katabolik, misalnya siklus asam sitrat (Mayes dan Bender, 2003).</span></div><div class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 0pt; text-align: justify;"><span style="font-family: "Courier New"; font-size: 12pt; line-height: 200%;"><span style="mso-spacerun: yes;"> </span><u>Metabolisme glukosa.</u> Glukosa dimetabolisme menjadi piruvat melalui lintasan glikolisis. Glikolisis dapat terjadi dalam keadaan anaerob dan produk akhirnya berupa laktat. Dalam keadaan aerob, piruvat dimetabolisme menjadi asetil-KoA yang kemudian masuk kedalam siklus asam sitrat untuk menjalani proses oksidasi sempurna menjadi CO<sub>2</sub> dan H<sub>2</sub>O dengan pelepasan ATP pada proses fosforilasi oksidatif sehingga glukosa menjadi bahan bakar utama pada sebagian besar jaringan tubuh. Glukosa juga ikut serta dalam proses lain, misalnya: </span></div><a name='more'></a><div class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 0pt; text-align: justify;">(1) konversi menjadi glikogen (glikogenesis) di otot rangka dan hepar. (2) Lintasan pentosa fosfat merupakan lintasan alternatif dari glikolisis, lintasan ini merupakan sumber NADPH dan ribosa. (3) Triosa fosfat menghasilkan TGA. (4) Piruvat dan intermediet pada siklus asam sitrat menyediakan kerangka karbon sintesis asam amino, serta asetil-KoA merupakan prekursor asam lemak dan kolesterol (Mayes dan Bender, 2003). Glikogen merupakan bentuk polimer besar dari glukosa. Semua sel tubuh mampu menyimpan glikogen, namun penyimpanan dalam jumlah besar dapat dilakukan oleh sel hepar dan sel otot. Penyimpanan dalam bentuk glikogen ini memungkinkan penyimpanan karbohidrat dalam jumlah besar tanpa mengganggu tekanan osmotik cairan intraseluler (Guyton and Hall, 2006).</div><div class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 0pt; text-align: justify;"><span style="font-family: "Courier New"; font-size: 12pt; line-height: 200%;"><span style="mso-spacerun: yes;"> </span><u>Metabolisme asam lemak dan kolesterol</u>. Asam lemak rantai panjang berasal dari lipid dalam makanan dan dari sintesis de novo dari asetil-KoA. Asam lemak dioksidasi menjadi asetil-KoA (β-oksidasi) atau diesterifikasi dengan gliserol menjadi TAG sebagai simpanan utama bahan bakar tubuh. Asetil-KoA dapat teroksidasi sempurna menjadi CO<sub>2</sub> dan H<sub>2</sub>O melalui siklus asam sitrat, menjadi prekursor sintesis kolesterol dan steroid, serta membentuk badan keton di hepar sebagai sumber energi dalam keadaan kelaparan yang berkepanjangan (Mayes dan Bender, 2003).</span></div><div class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 0pt; text-align: justify;"><span style="font-family: "Courier New"; font-size: 12pt; line-height: 200%;"><span style="mso-spacerun: yes;"> </span><u>Metabolisme asam amino.</u> Asam amino sangat penting dalam sintesis protein. Asam amino berasal dari derivat protein yang dikonsumsi dan dari pemecahan protein endogen (Ganong, 2005). Asam amino terdiri dari asam amino esensial yaitu asam amino yang harus dipasok dari makanan karena tidak dapat disintesis oleh tubuh dan asam amino non-esensial yaitu asam amino yang dapat disintesis sendiri oleh tubuh melalui proses transaminasi menggunakan nitrogen amino dari asam amino lain. Nitrogen amino setelah proses deaminasi akan menjadi urea, sedangkan kerangka karbon yang tersisa setelah transaminasi akan digunakan untuk membentuk glukosa (glukoneogenesis), membentuk badan keton, dan dioksidasi melalui siklus asam sitrat (Mayes dan Bender, 2003).</span></div><div class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 0pt; text-align: justify;"><span style="font-family: "Courier New"; font-size: 12pt; line-height: 200%;">A.2. <u>Pengaturan metabolisme bahan bakar tubuh</u></span></div><div class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 0pt; text-align: justify;"><span style="font-family: "Courier New"; font-size: 12pt; line-height: 200%;"><span style="mso-spacerun: yes;"> </span>Dalam mengatur metabolisme bahan bakar diperlukan peranan berbagai macam hormon. Hormon-hormon yang berperan antara lain insulin, glukagon, epinefrin, kortisol, dan hormon pertumbuhan (GH). Hormon yang paling dominan dalam mengatur perubahan metabolisme dari lintasan anabolisme ke lintasan katabolisme atau sebaliknya dan dalam menghemat glukosa adalah hormon pankreas yaitu insulin dan glukagon (Sherwood, 2001).</span></div><div class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 0pt; text-align: justify;"><span style="font-family: "Courier New"; font-size: 12pt; line-height: 200%;"><span style="mso-spacerun: yes;"> </span>Pankreas adalah organ yang terdiri dari jaringan eksokrin dan endokrin. Jaringan eksokrin menghasilkan enzim-enzim pencernaan yang dialirkan ke saluran pencernaan melalui duktus pankreatikus. Jaringan endokrin tersusun atas kumpulan sel-sel endokrin yang membentuk pulau-pulau langerhans. Sel-sel endokrin terdiri atas sel α , sel β, sel δ, dan sel F. Sel α menhasilkan glukagon, sel β menghasilkan insulin, sel δ menghasilkan somatostatin dan sel F meghasilkan polipeptida pankreas (Rhoades and Bell, 2009).</span></div><div class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 0pt; text-align: justify;"><span style="font-family: "Courier New"; font-size: 12pt; line-height: 200%;"><span style="mso-spacerun: yes;"> </span>Insulin mempunyai peranan penting dalam metabolisme karbohidrat, lemak dan protein. Insulin akan menurunkan kadar glukosa dan meningkatkan penyimpanan glukosa dengan cara mempermudah masuknya glukosa kedalam sel, merangsang glikogenesis, menghambat pemecahan glikogen (glikogenolisis), menghambat pembentukan glukosa oleh hati dengan menghambat glukoneogenesis (Sherwood, 2001).</span></div><div class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 0pt; text-align: justify;"><span style="font-family: "Courier New"; font-size: 12pt; line-height: 200%;"><span style="mso-spacerun: yes;"> </span>Glukagon mempunyai efek yang berlawanan dengan efek insulin. Glukagon bekerja di hepar dan akan menimbulkan efek pada metabolisme karbohidrat, lemak, dan protein. Pada metabolisme karbohidrat, glukagon bekerja dengan menurunkan sintesis glikogen, meningkatkan glikogenolisis dan merangsang glukoneogenesis. Pada metabolisme lemak, glukagon bekerja dengan meningkatkan pembentukan badan keton yang berasal dari asam lemak. Pada metabolisme protein, glukagon menghambat sintesis protein dan meningkatkan penguraian protein dihepar (Sherwood, 2010). Glukagon juga meningkatkan kadar kalsium intraseluler yang akan memperkuat glikogenolisis (Goodman, 2009).</span></div>Anonymoushttp://www.blogger.com/profile/17040699491469284898noreply@blogger.com0tag:blogger.com,1999:blog-7514639870940573862.post-66122128306687132972011-10-23T05:34:00.000-07:002011-10-23T05:34:40.558-07:00Pengaturan Kadar Glukosa Darah<div class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 0pt; text-align: justify;"><span style="font-family: "Courier New";"><span style="mso-spacerun: yes;"> </span>Sumber utama glukosa plasma menurut Mayes dan Bender (2003) adalah absorpsi glukosa oleh usus yang berasal dari pemecahan makanan, glukoneogenesis (pembentukan glukosa dari prekursor non-glukosa) dan glikogenolisis (pemecahan simpanan glikogen menjadi glukosa).</span></div><div class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 0pt; text-align: justify;"><span style="font-family: "Courier New";"><span style="mso-spacerun: yes;"> </span>Proses pengaturan kadar glukosa plasma merupakan mekanisme homeostasis yang diatur sedemikian rupa dalam rentang yang sempit dan diatur dengan halus (Mayes dan Bender, 2003; Guyton dan hall, 2006). Kadar glukosa plasma tidak boleh menurun terlalu rendah karena glukosa merupakan satu-satunya sumber energi yang dapat digunakan oleh otak dan eritrosit (Mayes , 2003). Kadar glukosa plasma juga tidak boleh meningkat terlalu tinggi karena dapat mempengaruhi tekanan osmotik dan bila kadar glukosa plasma sangat tinggi akan menyebabkan dehidrasi seluler (Guyton dan Hall, 2006).</span></div><a name='more'></a><div class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 0pt; text-align: justify;"></div><div class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 0pt; text-align: justify;"><span style="font-family: "Courier New";"><span style="mso-spacerun: yes;"> </span>Pengaturan kadar glukosa plasma melibatkan hepar, jaringan ekstrahepatik dan beberapa hormon. Sel-sel hepar dapat dilewati glukosa dengan bebas melalui transporter GLUT 2, sedangkan pada jaringan ekstrahepatik glukosa memerlukan transporter yang diatur oleh insulin untuk dapat masuk kedalam sel (Mayes dan Bender, 2003). Dalam pengaturan kadar glukosa plasma, selain insulin juga dibutuhkan peranan dari glukagon. Kedua hormon tersebut merupakan hormon yang disekresikan oleh sel pankreas. Sel β pankreas mensekresikan insulin dan sel α pankreas mensekresikan glukagon. </span></div><div class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 0pt; text-align: justify;"><span style="font-family: "Courier New";"><span style="mso-spacerun: yes;"> </span>Insulin bekerja untuk menurunkan kadar glukosa plasma dengan cara meningkatkan ambilan glukosa oleh jaringan lemak dan otot melalui transporter GLUT 4. Insulin juga akan mengaktivasi enzim glikogen sintase dan menghambat enzim fosforilase. (Mayes dan Bender, 2003; Ganong, 2005). Glikogen sintase merupakan enzim yang bertanggung jawab dalam polimerisasi monosakarida membentuk glikogen, sedangkan fosforilase merupakan enzim yang bertanggung jawab dalam pemecahan glikogen menjadi glukosa. Dengan demikian insulin akan menyebabkan peningkatan glikogenesis dan menghambat glikogenolisis (Guyton dan Hall, 2006).</span></div><div class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 0pt; text-align: justify;"><span style="font-family: "Courier New";"><span style="mso-spacerun: yes;"> </span>Glukagon menyebabkan peningkatan glikogenolisis dan glukoneogenesis. Glukagon meningkatkan glikogenesis dengan cara mengaktivasi adenil siklase dan meningkatkan cAMP intraseluler pada hepar. Hal ini akan mengaktivasi fosforilase melalui protein kinase sehingga terjadi pemecahan glikogen. Dengan adanya glukagon maka glukoneogenesis juga akan meningkat (Ganong, 2005).</span></div><div class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 0pt; text-align: justify;"><span style="font-family: "Courier New";"><span style="mso-spacerun: yes;"> </span>Pada keadaan puasa, sebagian besar glukosa tubuh berada pada <i style="mso-bidi-font-style: normal;">insulin-independent tissue</i> yaitu 50% berada pada jaringan otak, 25% berada pada hepar dan saluran pencernaan, sedangkan 25% berada pada <i style="mso-bidi-font-style: normal;">insulin-dependent tissue</i> yaitu otot dan jaringan lemak (DeFronzo, 2004). Kadar glukosa plasma akan menurun karena pasokan sumber glukosa yang berasal dari absorbsi usus terhenti. Namun hal ini akan segera direspon oleh tubuh. Terjadinya penurunan kadar glukosa plasma akan merangsang sel α pankreas untuk merespon dengan mensekresikan glukagon (Mayes and Bender, 2003). Seperti yang telah dijelaskan diatas glukagon bekerja dengan meningkatkan glikogenolisis dan glukoneogenesis sehingga meningkatkan kadar glukosa plasma (Goodman, 2009).</span></div><div class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 0pt; text-align: justify;"><span style="font-family: "Courier New";"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>Pada beberapa jam puasa tubuh mulai menggunakan energi yang berasal dari simpanan energi. Sekitar 75% glukosa yang disekresikan oleh hepar berasal dari pemecahan glikogen. Dalam keadaan ini kadar glukosa plasma masih konstan (Goodman, 2009). Hal ini akan menjaga kadar glukosa plasma untuk utilisasi organ seperti otak (Duez dan Lewis, 2008). Namun cadangan glikogen dalam hepar hanya terbatas dan lama-kelamaan akan menipis. Menurut Mayes (2003) setelah seseorang puasa selama 8-12 jam maka hampir seluruh simpanan glikogen dalam hati akan terkuras. Oleh karena itu di dalam hepar mulai dilakukan proses glukoneogenesis (Goodman, 2009).</span></div><div class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 0pt; text-align: justify;"><span style="font-family: "Courier New";"><span style="mso-spacerun: yes;"> </span>Glukoneogenesis merupakan pembentukan glukosa dari senyawa non-karbohidrat. Prekursor glukoneogenesis ini merupakan produk akhir dari metabolisme karbohidrat (piruvat, laktat), lemak (gliserol) dan protein (asam amino). Mekanisme glukoneogenesis ini juga merupakan cara untuk membersihkan produk metabolisme jaringan dari dalam darah seperti laktat yang dihasilkan oleh otot dan eritrosit serta gliserol yang dihasilkan oleh jaringan lemak (Mayes dan Bender, 2003; Hatta, 2006). </span></div><div class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 0pt; text-align: justify;"><span style="font-family: "Courier New";"><span style="mso-spacerun: yes;"> </span>Sesaat setelah makan, kadar glukosa plasma akan meningkat dan mencapai puncak sekitar 60 menit setelah makan, jarang melebihi 140 mg/dl dan kembali pada kadar sebelum makan setelah 2-3 jam (Raghavan and Garber, 2008). Peningkatan kadar glukosa plasma ini akan menstimulasi sekresi insulin oleh sel β pankreas (Goodman, 2009). Sekresi insulin, selain distimulasi oleh peningkatan kadar glukosa darah, juga distimulasi oleh produksi hormon inkretin oleh usus (Raghavan dan Garber, 2008). Insulin akan meningkatkan penyimpanan glukosa, menghambat pembentukan glukosa oleh hepar dan meningkatkan ambilan glukosa oleh sel otot dan lemak sehingga menyebabkan penurunan kadar glukosa plasma (Goodman, 2009). Kombinasi dari hiperinsulinemia dan hiperglikemia ini akan menstimulasi ambilan glukosa oleh jaringan perifer dan jaringan <i style="mso-bidi-font-style: normal;">splanchnic</i> yaitu hepar dan usus (DeFronzo, 2004), penyimpanan glukosa dalam bentuk glikogen oleh hepar (Mayes and Bender, 2003) dan pembentukan triaselgliserol oleh asam lemak (Gastaldelli, 2009).</span></div>Anonymoushttp://www.blogger.com/profile/17040699491469284898noreply@blogger.com0tag:blogger.com,1999:blog-7514639870940573862.post-29128822647346724952011-10-23T05:21:00.000-07:002011-10-23T08:23:15.880-07:00Diabetes Mellitus<div class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 0pt; text-align: justify;"><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi_5t0LcuD_S2GPdzZQV1E4ozeACL4fwbHfmmfUMPeg3629dgvkFK_Cf_WdeYLXxDZlFCIzqdRwoaqhZ8pLBENxQSeMdO6fHDbShiMZLsHMaZI9G1YEBXhPXNFK0Agl6-UUkcTmhsmxyn2M/s1600/Diabetes-mellitus.jpg" imageanchor="1" style="clear: left; cssfloat: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="213" rda="true" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi_5t0LcuD_S2GPdzZQV1E4ozeACL4fwbHfmmfUMPeg3629dgvkFK_Cf_WdeYLXxDZlFCIzqdRwoaqhZ8pLBENxQSeMdO6fHDbShiMZLsHMaZI9G1YEBXhPXNFK0Agl6-UUkcTmhsmxyn2M/s320/Diabetes-mellitus.jpg" width="320" /></a></div><span style="font-family: "Courier New";"><span style="mso-spacerun: yes;"> </span>Diabetes mellitus (DM) adalah gangguan metabolik yang mempunyai karakteristik berupa hiperglikemia kronik dengan gangguan metabolisme karbohidrat, lemak dan protein yang dihasilkan dari gangguan sekresi insulin, kerja insulin, atau keduanya (WHO, 1999).</span></div><div class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 0pt; text-align: justify;"><span style="font-family: "Courier New";"><span style="mso-spacerun: yes;"> </span>Menurut ADA (2010) DM diklasifikasikan menjadi 4 kelompok berdasarkan etiologinya, yaitu:</span></div><div class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 0pt 21.3pt; mso-list: l1 level1 lfo1; text-align: justify; text-indent: -21.3pt;"><span style="font-family: "Courier New"; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">1.<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Courier New";">Diabetes mellitus tipe 1<u></u></span></div><div class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 0pt 21.3pt; text-align: justify;"><span style="font-family: "Courier New";">Diabetes mellitus tipe 1 terjadi karena adanya kerusakan sel β pankreas. Kerusakan sel β pankreas disebabkan oleh proses autoimun yang dapat dideteksi dengan adanya autoantibodi terhadap sel β pankreas dan autoantibodi terhadap insulin. <u></u></span></div><div class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 0pt 21.3pt; mso-list: l1 level1 lfo1; text-align: justify; text-indent: -21.3pt;"><span style="font-family: "Courier New"; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">2.<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Courier New";">Diabetes mellitus tipe 2<u></u></span></div><div class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 0pt 21.3pt; text-align: justify;"><span style="font-family: "Courier New";">Diabetes mellitus tipe 2 merupakan bentuk paling umum dari DM. Karakteristik dari DM tipe 2 yaitu adanya gangguan pada kerja insulin dan sekresi insulin.<u></u></span></div><div class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 0pt 21.3pt; mso-list: l1 level1 lfo1; text-align: justify; text-indent: -21.3pt;"><span style="font-family: "Courier New"; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">3.<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Courier New";">Diabetes mellitus tipe spesifik<u></u></span></div><div class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 0pt 21.3pt; text-align: justify;"><span style="font-family: "Courier New";">Diabetes mellitus tipe spesifik merupakan bentuk DM yang jarang terjadi. Hal ini disebabkan oleh kerusakan genetik dari fungsi sel β pankreas, kerusakan genetik pada kerja insulin, penyakit pada pankreas, endokrinopati, induksi obat atau bahan kimia, infeksi pada tubuh dan sindrom genetik lainnya.</span></div><div class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 0pt 21.3pt; mso-list: l1 level1 lfo1; text-align: justify; text-indent: -21.3pt;"><span style="font-family: "Courier New"; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">4.<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Courier New";">Diabetes mellitus gestational<u></u></span></div><div class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 0pt 21.3pt; text-align: justify;"><span style="font-family: "Courier New";">Diabetes mellitus gestational merupakan intoleransi glukosa yang muncul pertama kali saat mengalami kehamilan. Keadaan ini dapat sembuh atau menetap setelah melahirkan.</span></div><div class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 0pt 2cm; text-align: justify; text-indent: -2cm;"><span style="font-family: "Courier New";">II.1.2. <u>Diabetes Mellitus Tipe 2</u></span></div><div class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 0pt; text-align: justify;"><span style="font-family: "Courier New";"><span style="mso-spacerun: yes;"> </span>Diabetes Mellitus tipe 2 merupakan bentuk DM yang paling sering terjadi pada masyarakat. ADA (2010) menyebutkan bahwa dari semua kasus diabetes, 90-95% adalah DM tipe 2.<span style="mso-spacerun: yes;"> </span>Menurut Cheng dan Fantus (2005) DM tipe 2 merupakan kelainan metabolik yang dihasilkan dari interaksi berbagai macam faktor dan mempunyai 2 karakteristik mayor yaitu penurunan sekresi insulin oleh pankreas dan resistensi insulin pada berbagai jaringan tubuh seperti otot, hepar dan adiposit sehingga terjadi gangguan pada ambilan (<i style="mso-bidi-font-style: normal;">uptake</i>) glukosa.</span></div><div class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 0pt; text-align: justify;"><span style="font-family: "Courier New";"><span style="mso-spacerun: yes;"> </span>Menurut PERKENI tahun 2006 diagnosis DM tipe 2 dapat ditegakkan jika terdapat salah satu kriteria sebagai berikut:</span></div><a name='more'></a><div class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 0pt; text-align: justify;"></div><div class="MsoListParagraphCxSpFirst" style="line-height: 200%; margin: 0cm 0cm 0pt 21.3pt; mso-add-space: auto; mso-list: l0 level1 lfo2; tab-stops: 21.3pt; text-align: justify; text-indent: -21.3pt;"><span style="font-family: "Courier New"; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">1.<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Courier New";">Gejala klasik DM tipe 2 (sering kencing/poliuri, cepat lapar/polifagi, sering haus/polidipsi, berat badan menurun cepat tanpa penyebab yang jelas) dengan kadar glukosa plasma sewaktu ≥200 mg/dl. Kadar glukosa plasma sewaktu merupakan hasil pemeriksaan sesaat pada suatu hari tanpa memperhatikan waktu makan terakhir.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 200%; margin: 0cm 0cm 0pt 21.3pt; mso-add-space: auto; mso-list: l0 level1 lfo2; tab-stops: 21.3pt; text-align: justify; text-indent: -21.3pt;"><span style="font-family: "Courier New"; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">2.<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Courier New";">Gejala klasik DM tipe 2 dengan kadar glukosa plasma puasa ≥126 mg/dl. Puasa diartikan pasien tidak mendapat kalori tambahan sedikitnya 8 jam.</span></div><div class="MsoListParagraphCxSpLast" style="line-height: 200%; margin: 0cm 0cm 0pt 21.3pt; mso-add-space: auto; mso-list: l0 level1 lfo2; tab-stops: 21.3pt; text-align: justify; text-indent: -21.3pt;"><span style="font-family: "Courier New"; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">3.<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Courier New";">Pada tes toleransi glukosa oral (TTGO) didapatkan hasil pemeriksaan kadar glukosa plasma 2 jam sesudah pemberian beban glukosa 75 gram ≥200 mg/dl.</span></div><div class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 0pt; text-align: justify;"><span style="font-family: "Courier New";"><span style="mso-spacerun: yes;"> </span>Karakteristik utama dari DM tipe 2 adalah adanya penurunan sekresi insulin oleh pankreas dan resistensi insulin pada berbagai jaringan tubuh (Cheng dan Fantus, 2005). Resistensi insulin merupakan penurunan kemampuan insulin untuk bekerja secara efektif pada sel target khususnya pada otot, hepar dan jaringan lemak (Fauci <i style="mso-bidi-font-style: normal;">et al</i>., 2008). </span></div><div class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 0pt; text-align: justify;"><span style="font-family: "Courier New";"><span style="mso-spacerun: yes;"> </span>Resistensi insulin merupakan hasil kombinasi dari berbagai faktor yaitu faktor genetik, umur, asupan energi yang berlebihan, obesitas dan kurangnya aktivitas fisik (Cheng dan Fantus, 2005; DeFronzo, 2009). Resistensi insulin akan mengganggu ambilan glukosa oleh otot dan jaringan lemak serta meningkatkan produksi glukosa oleh hepar. Kedua hal ini akan menyebabkan munculnya hiperglikemia. Penurunan ambilan glukosa oleh otot dan jaringan lemak dapat dilihat dengan adanya hiperglikemia postprandial, sedangkan peningkatan produksi glukosa oleh hepar dapat dilihat dengan adanya hiperglikemia puasa (Fauci <i style="mso-bidi-font-style: normal;">et al</i>., 2008). </span></div><div class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 0pt; text-align: justify;"><span style="font-family: "Courier New";"><span style="mso-spacerun: yes;"> </span>Resistensi insulin dapat terjadi tanpa adanya manifestasi gangguan homeostasis glukosa selama sel β pankreas masih dapat melakukan kompensasi dengan mensekresikan insulin dalam jumlah yang lebih banyak sehingga toleransi glukosa masih normal (DeFonzo, 2009). DeFronzo (2009) menyebutkan bahwa pada fase <i style="mso-bidi-font-style: normal;">impaired glucose tolerance</i> (IGT), fase sebelum terjadinya DM tipe 2, fungsi sel β pankreas sudah mengalami penurunan hingga 80%. </span></div><div class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 0pt; text-align: justify;"><span style="font-family: "Courier New";"><span style="mso-spacerun: yes;"> </span>Penurunan fungsi sel β pankreas dipengaruhi oleh berbagai faktor yaitu peningkatan umur, riwayat genetis, resistensi insulin, lipotoksisitas dan glukotoksisitas (DeFronzo, 2009). Lingkungan metabolik dalam tubuh penderita DM tipe 2 juga sangat berpengaruh pada kerusakan fungsi sel β pankreas (Fauci <i style="mso-bidi-font-style: normal;">et al.,</i> 2008). Lingkungan metabolik tersebut misalnya keadaan hiperglikemia kronik yang akan mengganggu fungsi sel β pankreas (glukotoksisitas) dan akan memperparah keadaan hiperglikemia, begitu juga dengan peningkatan kadar asam lemak bebas yang sering terjadi pada penderita DM tipe 2 karena peningkatan lipolisis juga akan memperparah kerusakan fungsi sel β pankreas (lipotoksisitas).</span></div><div class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 0pt; text-align: justify;"><span style="font-family: "Courier New";"><span style="mso-spacerun: yes;"> </span>Menurut DeFronzo (2009) saat ini berkembang pemahaman baru tentang patogenesis DM tipe 2. Patogenesis DM tipe 2 tidak hanya dipengaruhi oleh otot, hepar dan sel β pankreas tetapi juga dipengaruhi oleh jaringan lemak, saluran gastrointestinal, sel α pankreas, ginjal dan sistem saraf pusat. Sehingga terdapat 8 komponen yang berperan dalam patogenesis DM tipe 2 sehingga disebut <i style="mso-bidi-font-style: normal;">the ominous octet</i>. Peran masing-masing komponen dalam patogenesis DM tipe 2 yaitu penurunan ambilan glukosa oleh otot dan hepar karena adanya resistensi insulin, penurunan sekresi insulin oleh sel β pankreas, peningkatan lipolisis oleh sel lemak, defisiensi inkretin pada saluran gastrointestinal, peningkatan sekresi glukagon oleh sel α pankreas, peningkatan reabsorpsi glukosa oleh ginjal dan resistensi insulin pada sistem saraf pusat. Semua komponen tersebut berperan penting dalam perkembangan intoleransi glukosa pada pasien Diabetes mellitus tipe 2 (DeFronzo, 2009).</span></div><div class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 0pt 2cm; text-align: justify; text-indent: -2cm;"><span style="font-family: "Courier New";">II.1.3. <u>Perkembangan Penyakit Diabetes Mellitus Tipe 2</u></span></div><div class="MsoListParagraph" style="line-height: 200%; margin: 0cm 0cm 0pt; mso-add-space: auto; text-align: justify;"><span style="font-family: "Courier New";"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>Pada DM tipe 2 pasien akan mengalami proses perkembangan penyakit yang berkelanjutan mulai dari <i style="mso-bidi-font-style: normal;">normal glucose tolerance</i> (NGT) menjadi <i style="mso-bidi-font-style: normal;">impaired glucose tolerance </i>(IGT) dan kemudian berubah menjadi DM tipe 2 (DeFronzo, 2004). Pada fase awal DM tipe 2, toleransi glukosa mendekati normal walaupun telah terjadi resistensi insulin. Hal ini disebabkan adanya kompensasi sel β pankreas dengan meningkatkan sekresi insulin. Resistensi insulin dan hiperinsulinemia akan semakin berkembang, sedangkan pankreas tidak mampu lagi mempertahankan keadaan hiperinsulinemia sehingga sekresi insulin akan menurun. Hal ini menyebabkan munculnya gangguan toleransi glukosa yang ditandai dengan peningkatan kadar glukosa postprandial. Sekresi insulin akan semakin menurun sedangkan produksi glukosa hepar akan meningkat sehingga menimbulkan hiperglikemia puasa. Dan pada akhirnya sel β pankreas akan mengalami kerusakan (Fauci <i style="mso-bidi-font-style: normal;">et al</i>., 2008).</span></div>Anonymoushttp://www.blogger.com/profile/17040699491469284898noreply@blogger.com0tag:blogger.com,1999:blog-7514639870940573862.post-42386426397630893612011-10-20T22:41:00.000-07:002011-10-20T22:58:38.025-07:00Berteman dengan Hipertensi<div class="MsoNormal" style="text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 115%;">Apa yang dimaksud dengan Hipertensi itu?</span></b></div><div class="MsoNormal" style="text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Hipertensi adalah tekanan darah sistolik (batas atas) yang lebih besar atau sama dengan 140 mmHgatau tekanan darah diastolik (batas bawah) yang lebih besar atau sama dengan 90 mmHg.</span></div><div class="MsoNormal" style="text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Hipertensi dibagi menjadi dua:</span></div><ol><li><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Hipertensi Primer : Hipertensi yang penyebabnya tidak diketahui.</span></li>
<li><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"><span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Hipertensi Sekunder : Hipertensi yang disebabkan oleh penyakit lain misalnya saja penyakit ginjal, faktor kehamilan, penyakit syaraf, pengaruh obat-obatan, dll.</span></li>
</ol><div class="MsoNormal" style="text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 115%;">Apa sajakah tanda-tanda hipertensi itu?</span></b></div><a name='more'></a><br />
<div class="MsoListParagraphCxSpFirst" style="text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">1.<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Sering merasa sakit pada kepala bagian belakang dan tengkuk terutama saat bangun tidur pagi hari dan saat mengalami ketegangan.</span></div><div class="MsoListParagraphCxSpMiddle" style="text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">2.<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Dada terasa berdebar-debar dan berat, sarta sesak saat beraktivitas berat.</span></div><div class="MsoListParagraphCxSpMiddle" style="text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">3.<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Penglihatan kabur</span></div><div class="MsoListParagraphCxSpLast" style="text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">4.<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Sering nyeri kepala sebelah atau pusing.</span></div><div class="MsoNormal" style="text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 115%;">Apakah Komplikasi dari hipertensi itu?</span></b></div><div class="MsoNormal" style="text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Hipertensi apabila tidak diobati dan tidak dikontrol dengan baik dapat menyebabkan komplikasi berupa penyakit-penyakit lain yang mematikan. Penyakit-penyakit tersebut adalah:</span></div><div class="MsoListParagraphCxSpFirst" style="text-align: justify; text-indent: -18pt;"><span style="font-size: 12pt; line-height: 115%;">-<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">penyakit jantung koroner</span></div><div class="MsoListParagraphCxSpMiddle" style="text-align: justify; text-indent: -18pt;"><span style="font-size: 12pt; line-height: 115%;">-<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"> stroke</span></div><div class="MsoListParagraphCxSpMiddle" style="text-align: justify; text-indent: -18pt;"><span style="font-size: 12pt; line-height: 115%;">-<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Penyakit ginjal (gagal ginjal)</span></div><div class="MsoListParagraphCxSpLast" style="text-align: justify; text-indent: -18pt;"><span style="font-size: 12pt; line-height: 115%;">-<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Penglihatan kabur (retinopati hipertensi)</span></div><div class="MsoNormal" style="text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 115%;">Apakah Hipertensi dapat disembuhkan?</span></b></div><div class="MsoNormal" style="text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Jawabanya adalah TIDAK. Hipertensi memang tidak dapat disembuhkan, namun hipertensi dapat dikontrol sehingga komplikasi dapat dicegah dan dihindari.</span></div><div class="MsoNormal" style="text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 115%;">Bagaimanakah caranya?</span></b></div><div class="MsoNormal" style="text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Caranya adalah Berteman dengan Hipertensi....</span></div><div class="MsoNormal" style="text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 115%;">H</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">indari makanan yang banyak mengandung garam</span></div><div class="MsoNormal" style="text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 115%;">I</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">stirahat yang cukup</span></div><div class="MsoNormal" style="text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 115%;">P</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">ikiran selalu positif</span></div><div class="MsoNormal" style="text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 115%;">E</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">nggan marah-marah</span></div><div class="MsoNormal" style="text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 115%;">R</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">ajin olahraga</span></div><div class="MsoNormal" style="text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 115%;">T</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">eratur minum obat</span></div><div class="MsoNormal" style="text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 115%;">E</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">nyahkan makanan berlemak tinggi</span></div><div class="MsoNormal" style="text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 115%;">N</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">gaji/Berdoa yang rajin</span></div><div class="MsoNormal" style="text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 115%;">S</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">ingkirkan rokok dan alkohol</span></div><div class="MsoNormal" style="text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 115%;">I</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">ngat untuk kontrol</span></div>Anonymoushttp://www.blogger.com/profile/17040699491469284898noreply@blogger.com0tag:blogger.com,1999:blog-7514639870940573862.post-49704328612525430442011-10-20T21:58:00.000-07:002011-10-20T21:58:08.691-07:00Hipertensi (Tekanan Darah Tinggi)<!--[if !mso]> <style>
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<div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">II.2.<span> </span>Tekanan Darah</span></b></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">II.2.1.<span> </span>Definisi Tekanan Darah</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 36pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tekanan darah adalah tekanan yang dik</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">erja</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">kan oleh darah </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">melawan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> dinding pembuluh darah (arteri) </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">pada saat</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> darah mengalir me</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">nuju</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> seluruh </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">tubuh</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">. Tekanan darah seseorang </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">dinyatakan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> dalam bentuk sistolik per diastoli</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">k</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> (mmHg). Tekanan darah sistolik adalah tekanan darah saat kontraksi ventrikel jantung </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">sedangkan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> tekanan darah diastoli</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">k</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">menunjukkan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> tekanan darah saat relaksasi ventrikel jantung</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">( WHO, 2011). Tekanan darah biasanya diukur pada arteri brakialis pada bagian dalam siku.</span></div><a name='more'></a><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span><br />
<div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Bunyi <i>Korotkoff</i> adalah suara dengan frekuensi rendah yang berasal dari pembuluh darah dalam konjungsi dengan turbulensi yang dihasilkan oleh terhambatnya sebagian arteri dengan manset tekanan darah. Tekanan sistolik dicatat saat bunyi <i>Korotkoff</i> terdengar menggunakan stetoskop (fase 1). Tekanan diastolik dicatat saat bunyi <i>Korotkoff</i><span> </span>menjadi sangat lemah (fase 4) atau menghilang (fase 5) (<i>Skills Laboratory-Faculty of Medicine Gadjah Mada University</i>, 2008).</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">II.2.2.<span> </span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Klasifikasi</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tekanan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">darah</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Menurut</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> <span lang="EN-US">klasifikasi JNC </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">VII tahun </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">2004, tekanan darah dibagikan </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">menjadi </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">4 kategori </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">yang dapat dilihat pada tabel 3.</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 36pt;"><br />
</div><div align="center" class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: center;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tabel 3. Klasifikasi Tekanan Darah berdasarkan kriteria JNC VII</span></div><div align="center"> <table border="1" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border-collapse: collapse; border: medium none; margin-left: 47.65pt; width: 558px;"><tbody>
<tr> <td style="border: 1pt solid black; padding: 0cm 5.4pt; width: 106.35pt;" width="142"> <div align="center" class="MsoListParagraph" style="line-height: 150%; margin: 0cm 0cm 0.0001pt; text-align: center; text-indent: 1cm;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kategori</span></b></div></td> <td style="-moz-border-bottom-colors: none; -moz-border-image: none; -moz-border-left-colors: none; -moz-border-right-colors: none; -moz-border-top-colors: none; border-color: black black black -moz-use-text-color; border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; padding: 0cm 5.4pt; width: 105.45pt;" width="141"> <div align="center" class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sistolik (mmHg)</span></b></div></td> <td style="-moz-border-bottom-colors: none; -moz-border-image: none; -moz-border-left-colors: none; -moz-border-right-colors: none; -moz-border-top-colors: none; border-color: black black black -moz-use-text-color; border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; padding: 0cm 5.4pt; width: 103.3pt;" valign="top" width="138"> <div align="center" class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin: 0cm 0cm 0.0001pt; text-align: center;"><br />
</div></td> <td style="-moz-border-bottom-colors: none; -moz-border-image: none; -moz-border-left-colors: none; -moz-border-right-colors: none; -moz-border-top-colors: none; border-color: black black black -moz-use-text-color; border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; padding: 0cm 5.4pt; width: 103.3pt;" width="138"> <div align="center" class="MsoListParagraphCxSpLast" style="line-height: 150%; margin: 0cm 0cm 0.0001pt; text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Diastolik (mmHg)</span></b></div></td> </tr>
<tr> <td style="-moz-border-bottom-colors: none; -moz-border-image: none; -moz-border-left-colors: none; -moz-border-right-colors: none; -moz-border-top-colors: none; border-color: -moz-use-text-color black black; border-right: 1pt solid black; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 106.35pt;" width="142"> <div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin: 0cm 0cm 0.0001pt;"><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Normal</span></i></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 105.45pt;" width="141"> <div align="center" class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt; text-align: center;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">< 120</span></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 103.3pt;" valign="top" width="138"> <div align="center" class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt; text-align: center;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">dan</span></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 103.3pt;" width="138"> <div align="center" class="MsoListParagraphCxSpLast" style="line-height: 150%; margin: 0cm 0cm 0.0001pt; text-align: center;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">< 80</span></div></td> </tr>
<tr> <td style="-moz-border-bottom-colors: none; -moz-border-image: none; -moz-border-left-colors: none; -moz-border-right-colors: none; -moz-border-top-colors: none; border-color: -moz-use-text-color black black; border-right: 1pt solid black; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 106.35pt;" width="142"> <div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin: 0cm 0cm 0.0001pt;"><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pre Hypertension</span></i></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 105.45pt;" width="141"> <div align="center" class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt; text-align: center;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">120-139</span></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 103.3pt;" valign="top" width="138"> <div align="center" class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt; text-align: center;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">atau</span></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 103.3pt;" width="138"> <div align="center" class="MsoListParagraphCxSpLast" style="line-height: 150%; margin: 0cm 0cm 0.0001pt; text-align: center;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">80-89</span></div></td> </tr>
<tr> <td style="-moz-border-bottom-colors: none; -moz-border-image: none; -moz-border-left-colors: none; -moz-border-right-colors: none; -moz-border-top-colors: none; border-color: -moz-use-text-color black black; border-right: 1pt solid black; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 106.35pt;" width="142"> <div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin: 0cm 0cm 0.0001pt;"><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Stage I Hypertension</span></i></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 105.45pt;" width="141"> <div align="center" class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt; text-align: center;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">140-159</span></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 103.3pt;" valign="top" width="138"> <div align="center" class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt; text-align: center;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">atau</span></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 103.3pt;" width="138"> <div align="center" class="MsoListParagraphCxSpLast" style="line-height: 150%; margin: 0cm 0cm 0.0001pt; text-align: center;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">90-99</span></div></td> </tr>
<tr> <td style="-moz-border-bottom-colors: none; -moz-border-image: none; -moz-border-left-colors: none; -moz-border-right-colors: none; -moz-border-top-colors: none; border-color: -moz-use-text-color black black; border-right: 1pt solid black; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 106.35pt;" width="142"> <div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin: 0cm 0cm 0.0001pt;"><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Stage II Hypertension</span></i></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 105.45pt;" width="141"> <div align="center" class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt; text-align: center;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">≥ 160</span></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 103.3pt;" valign="top" width="138"> <div align="center" class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt; text-align: center;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">atau</span></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 103.3pt;" width="138"> <div align="center" class="MsoListParagraphCxSpLast" style="line-height: 150%; margin: 0cm 0cm 0.0001pt; text-align: center;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">≥ 100</span></div></td> </tr>
</tbody></table></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 36pt;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Prehipertensi tidak dikategorikan sebagai penyakit, tetapi bertujuan untuk mengidentifikasi seseorang yang memiliki risiko tinggi mengalami hipertensi</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">. Mereka disarankan melakukan intervensi awal untuk menghindari penyakit hipertensi.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Seseorang</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> didiagnosa </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">hipertensi</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> apabila tekanan darahnya ≥140mmHg sistolik atau ≥90mmHg diastoli</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">k</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">. Untuk </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">hipertensi</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> stage 1 dan stage 2, JNC </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">VII </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">menyarankan perawatan medis dimula</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">i</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">. (JNC</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> VII</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">, 2004)</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 36pt;"><br />
</div><div class="MsoNormal"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">II.3.<span> </span>Hipertensi</span></b></div><div class="MsoNormal" style="margin-bottom: 0.0001pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">II.3.1.<span> </span>Definisi Hipertensi</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 36pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Hipertensi, atau</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">tekanan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">darah</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">tinggi, adalah</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">kondisi</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">medis</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">berupa</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">tekanan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">darah yang meningkat</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">secara</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">kronis.</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tekanan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">darah</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">kurang</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">dari 120/80 mmHg didefinisikan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">sebagai normal.</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Hipertensi</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">biasanya</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">terjadi</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">pada</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">tekanan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">darah</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">≥140/90 mmHg, diukur di kedua</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">lengan </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">2</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> kali dalam</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">jangka</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">beberapa</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">minggu.</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Satu</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">-</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">satunya</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">cara</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">untuk</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">mengetahui</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">tekanan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">darah</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">tinggi</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">adalah</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">dengan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">melakukan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">pengukuran</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">tekanan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">dar</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">a</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">h. Menurut <i>Joint National Committee</i></span><i><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span></i><i><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">on Prevention, Detection, Evaluation and Treatment of High Blood Pressure</span></i><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">, defin</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">i</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">s</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">i</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> hipertensi</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">adalah</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">tekanan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">darah</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">sistolik (TDS) ≥140 mmHg atau</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">tekanan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">darah diastoli</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">k</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> (TDD) ≥ 90mmHg (JNC VII, 2003).</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">II.3.2.<span> </span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Etiologi</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">dan</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> F</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">a</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">k</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">tor</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Risiko</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Hipertensi</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">primer tidak</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">disebabkan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">oleh</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">factor</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">tunggal</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">dan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">khusus.</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Hipertensi</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">ini</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">disebabkan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">berbagai</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">faktor yang saling</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">berkaitan.</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Hipertensi</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">sekunder</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">disebabkan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">oleh</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">berbagai</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">faktor primer yang diketahui</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">yaitu</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">seperti</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">kerusakan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">ginjal, gangguan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">endokrin,</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">penggunaan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">obat</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">tertentu,</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">stress</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">akut,</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">kerusakan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">vaskuler</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">dan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">lain-lain. </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Adapun</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">risiko</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">relative</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">hipertensi</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">tergantung</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">pada</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">jumlah</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">dan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">keparahan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">dari</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">factor</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">risiko yang dapat</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">dimodifikasi</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">dan yang tidak</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">dapat</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">dimodifikasi.</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Faktor</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">-</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">faktor</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">yang tidak</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">dapat</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">dimodifikasi</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">antara lain faktor geneti</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">k</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">, umur, jenis</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">kelamin, dan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">etnis. Sedangkan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">faktor yang dapat</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">dimodifikasi</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">meliputi stress, obesitas</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">dan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">nutrisi (Black et al., 1997)</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">.</span></div><div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 36pt; text-align: justify; text-indent: -36pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>a.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Faktor</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">genetik</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 36pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Adanya</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">factor</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">genetic</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">pada</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">keluarga</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">tertentu</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">akan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">menyebabkan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">keluarga</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">itu</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">mempunyai</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">risiko</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">menderita</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">hipertensi. Hal ini</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">berhubungan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">dengan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">peningkatan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">kadar sodium intraseluler</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">dan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">rendahnya</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">rasio</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">antara</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">potassium</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">terhadap sodium, </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">orang yang mempunyai riwayat</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> orang tua</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">dengan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">hipertensi</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">mempunyai</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">risiko</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">dua kali lebih</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">besar</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">untuk</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">menderita</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">hipertensi</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">daripada</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">or</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">an</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">g yang tidak</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">mempunyai</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">keluarga</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">dengan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">riwayat</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">hipertensi (Black et al., 1997). Orang normotensi yang memiliki orang tua</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">hipertensi</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">memiliki</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">reaktivitas</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">vaskuler yang lebih</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">tinggi</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">terhadap stress mental maupun</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">fisik</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">dibandingkan orang normotensi</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">dengan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">orangtua yang juga</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">normotensi. Hal ini</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">berkaitan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">dengan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">kemungkinan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">timbulnya</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">hipertensi</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">dikemudian</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">hari (Soesanto</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">et al., 2001).</span></div><div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 36pt; text-align: justify; text-indent: -36pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>b.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Umur</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 36pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Insidensi</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">hipertensi</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">meningkat</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">seiring</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">dengan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">pertambahan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">usia. </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Orang</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> yang berumur</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">diatas 60 tahun, 50-60% mempunyai</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">tekanan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">darah</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">lebih</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">besar</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">atau</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">sama</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">dengan l40/90 mmHg. </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Dinyatakan pula bahwa </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">lebih daripada 50% mereka yang berusia 60-69 tahun dan 75% mereka yang berusia ≥70 tahun mempunyai hipertensi. (Burt <i>et al., </i>1995)</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">.</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Studi juga menunjukkan bahawa untuk mereka yang normotensi pada usia 55</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">-</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">65 tahun mempunyai <i>lifetime risk </i>± 90% untuk </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">menderita</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> penyakit hipertensi.( Vasan <i>et al., </i>2002).</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Hal itu</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">merupakan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">pengaruh</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">degenerasi yang terjadi</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">pada</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">orang yang bertambah</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">usianya (Black et al.,1997).</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span></div><div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 36pt; text-align: justify; text-indent: -36pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>c.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Jenis</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">kelamin</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 36pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Laki-laki</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">mempunyai</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">risiko</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">lebih</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">tinggi</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">untuk</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">menderita</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">hipertensi</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">lebih</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">awal.</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Laki-laki</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">juga</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">mempunyai</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">risiko yang lebih</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">besar</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">terhadap</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">morbiditas</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">dan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">mortalitas</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">kardiovaskuler.</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sedangkan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">diatas</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">umur 50 tahun</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">hipertensi</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">lebih</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">banyak</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">terjadi</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">pada</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">wanita (Black et al.,1997).</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 36pt; text-align: justify; text-indent: -36pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>d.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Etnis</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 36pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Hipertensi</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">lebih</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">banyak</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">terjadi</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">pada orang berkulit</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">hitam</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">daripada yang berkulit</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">putih.</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Belum</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">diketahui</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">secara</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">pasti</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">penyebabnya.</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Namun</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">dalam orang kulit</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">hitam</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">ditemukan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">kadar rennin yang lebih</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">rendah</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">dan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">sensitifitas</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">terhadap vasopressin lebih</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">besar (Black et al.,1997).</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 36pt; text-align: justify; text-indent: -36pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>e.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Stress</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 36pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Stress akan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">meningkatkan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">resistensi</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">pembuluh</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">darah</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">perifer</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">dan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">curah</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">jantung</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">sehingga</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">akan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">menstimulasi</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">aktivitas</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">saraf</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">simpatetik. Adapun stress ini</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">dapat</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">berhubungan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">dengan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">pekerjaan, kelas</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">sosial, ekonomi, dan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">karakteristik personal (Black et a1</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">.</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">,1997).</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 36pt; text-align: justify; text-indent: -36pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>f.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Obesitas</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">P</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">enelitian</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">epidemiologi</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">menyebutkan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">adanya</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">hubungan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">antara</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">berat</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">badan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">dengan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">tekanan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">darah</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">baik</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">pada</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">pasien</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">hipertensi</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">maupun</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">normotensi. Pada</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">populasi</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">yang tidak</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">ada</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">peningkatan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">berat</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">badan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">seiring</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">peningkatan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">umur, tidak</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">dijumpai</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">peningkatan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">tekanan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">darah</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">sesuai</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">peningkatan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">umur.</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Obesitas</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">terutama</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">pada</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">tubuh</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">bagian</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">atas</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">dengan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">peningkatan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">jumlah</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">lemak</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">pada</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">bagian</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">perut (Black et a1.,1997).</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 36pt; text-align: justify; text-indent: -36pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>g.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Nutrisi</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sodium adalah</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">penyebab</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">penting</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">dari</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">hipertensi</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">essensial, asupan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">garam yang tinggi</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">akan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">menyebabkan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">pengeluaran</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">ber</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">l</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">ebihan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">dari</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">hormone</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">natriouretik yang secara</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">tidak</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">langsung</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">akan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">meningkatkan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">tekanan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">darah. Sodium seca</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">ra </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">eksperimental</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">menunjukkan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">kemampuan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">untuk</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">menstimulasi</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">mekanisme vasopressor pada</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">susunan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">saraf</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">pusat.</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Defisiensi potassium akan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">berimplikasi</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">terhadap</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">terjadinya</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">hipertensi (Black et aL.,1997).</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">II.3.3</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Patofisiologi</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 36pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Penelitian</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">menunjukkan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">bahwa</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">factor</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">yang bertanggung</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">jawab</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">terhadap</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">mekanisme</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">terjadinya</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">hipertensi</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">bukanlah</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">fa</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">k</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">tor</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">tunggal.</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Berbagai</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">fa</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">k</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">tor</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">i</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">k</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">ut</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">berperan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">baik</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">fa</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">k</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">tor</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">geneti</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">k </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">maupun</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">fa</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">k</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">tor</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">lingkungan.</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Mekanisme</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">terjadinya</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">hipertensi</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">essensial</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">atau primer yang meliputi 95% jumlah</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">kasus</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">merupakan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">kombinasi</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">ekspresi gen mayor pada</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">individu yang mempunyai</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">pengaruh</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">luas</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">pada</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">tekanan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">darah</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">dengan</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> banyak </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">gen yang mempunyai</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">kon</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">tr</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">ibusi</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">kecil</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">dan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">interaksi</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">dengan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">fa</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">k</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">tor</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">lingkungan. Pada</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">beberapa</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">individu, hipertensi</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">dapat</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">terjadi</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">dengan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">adanya</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">satu</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">fa</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">k</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">tor</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">lingkungan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">ditambah</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">fa</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">k</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">tor</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">predisposisi</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">genetik, sedangkan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">pada</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">individu</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">yang lain membutuhkan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">akumulasi</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">dari</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">pengaruh</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">beberapa</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">fa</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">k</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">tor</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">lingkungan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">untuk</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">menjadi</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">hipertensi. Tekanan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">darah</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">merupakan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">hasil</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">perkalian</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">antara</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">curah</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">jan</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">tu</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">ng</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">dengan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">resistensi</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">perifer, sehingga</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">semua</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">fa</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">k</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">tor</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">yang mempengaruhi</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">curah</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">jantung</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">dan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">resistensi</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">perifer</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">dapat</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">meningkatkan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">tekanan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">darah (Weder cit. Prodjosudjadi, 2000).</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 36pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kaplan cit. Prodjosudjadi (2000) menyatakan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">berbagai</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">keadaan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">seperti</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">asupan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">garam yang berlebih, retensi sodium oleh</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">ginjal, jumlah</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">nefron yang kurang</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">dan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">faktor yang berasal</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">dari</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">endotel</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">mempunyai</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">peranan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">terhadap</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">mekanisme</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">terjadinya</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">hipertensi.</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Aktivitas</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">saraf</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">simpatetik yang</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">berlebih, </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">system</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">vaskuler, dan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">sistem renin-angiotensin juga</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">berperan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">terhadap</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">hipertensi.</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sistem renin angiotensin adalah</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">sistem hormonal enzimatik yang kompleks, berperan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">dalam</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">pengaturan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">tekanan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">darah</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">sistemik, kesei</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">m</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">bangan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">cairan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">dan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">elektrolit. </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Renin disintesis</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">oleh</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">apparatus juxtaglumerolus di ginjal</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">akibatberbagai</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">rangsangan, antara lain</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">kehilangan sodium, menurunnya</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">tekanan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">perfusi</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">ginjal, dan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">restriksi sodium. Renin mengubah angiotensinogen yang diproduksi</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">terutama</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">oleh</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">hati</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">menjadi angiotensin I, suatu</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">dekapeptidase</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">inaktif, Angiotensin I dengan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">bantuan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">enzim</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">konversi</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">angiotensin diubah</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">menjadi angiotensin II, suatu</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">vasokonstriktor</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">kuat. Bauer</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">, </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Reams dan Kang ci</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">t</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">.</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Prodjosudjadi (2000) menyatakan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">bahwa angiotensin II akan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">berikatan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">dengan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">reseptor yang terdapat</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">pada</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">membrane</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">sel</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">berbagai organ seperti</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">ginjal, kelenjar adrenal, jantung, pembuluh</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">darah, dan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">otak</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">sehingga</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">menyebabkan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">vasokonstriksi, retensi</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">natrium</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">dan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">cairan, hipertrofi</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">jantung, dan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">pembuluh</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">darah. Keadaan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">ini</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">merupakan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">factor</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">penting</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">pada</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">pathogenesis</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">dan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">patofisiologi</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">hipertensi,</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">gagal</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">jantung, </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">dan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">penyakit</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">ginjal</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">progresif (Prodjosudjadi, 2000).</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 36pt;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">II.3.4.<span> </span>Diagnosis</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Penegakan diagnosis dapat dilakukan dengan pengukuran tekanan darah menggunakan sphygmomanometer raksa sebanyak 2 kali dalam waktu yang berbeda. Ada beberapa syarat yang harus dipenuhi, yaitu:</span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">30 menit sebelum dilakukannya pemeriksaan pasien tidak boleh mengkonsumsi rokok ataupun kopi.</span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pasien harus dalam posisi duduk dengan punggung bersandar selama 5 menit dan tangan diposisikan bersandar pada meja periksa setinggi jantung.</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">II.3.5.<span> </span>Pengobatan</span></div><div class="MsoListParagraph" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 1cm; text-align: justify; text-indent: -14.15pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>a.<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tujuan pengobatan</span></div><div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 1cm; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tujuan pengobatan adalah untuk menurunkan tekanan darah pasien, target tekanan darah yang diharapkan adalah:</span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 2cm; text-align: justify; text-indent: -14.15pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1)<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">140/90 mmHg pada pasien hipertensi tanpa penyulit</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 2cm; text-align: justify; text-indent: -14.15pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2)<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">130/80 mmHg pada pasien dengan penyulit (diabetes mellitus dan penyakit ginjal)</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 1cm; text-indent: -14.15pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>b.<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Jenis Pengobatan</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 1cm; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Terdapat 2 cara pendekatan pengobatan pada pasien hipertensi, yaitu tanpa obat dan dengan obat. Pendekatan tanpa obat adalah pengobatan dengan cara mengubah gaya hidup pasien yang mencakup makanan, olahraga dan berat badan (lihat tabel 4). </span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 1cm; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 1cm; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 1cm; text-align: justify;"><br />
</div><div align="center" class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Tabel<span> </span>4. Modifikasi Gaya Hidup</span></div><div align="center"> <table border="1" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border-collapse: collapse; border: medium none;"><tbody>
<tr style="height: 34.6pt;"> <td style="border: 1pt solid black; height: 34.6pt; padding: 0cm 5.4pt;" valign="top"> <div align="center" class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Modifikasi</span></b></div></td> <td style="-moz-border-bottom-colors: none; -moz-border-image: none; -moz-border-left-colors: none; -moz-border-right-colors: none; -moz-border-top-colors: none; border-color: black black black -moz-use-text-color; border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; height: 34.6pt; padding: 0cm 5.4pt;" valign="top"> <div align="center" class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Rekomendasi</span></b></div></td> <td style="-moz-border-bottom-colors: none; -moz-border-image: none; -moz-border-left-colors: none; -moz-border-right-colors: none; -moz-border-top-colors: none; border-color: black black black -moz-use-text-color; border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; height: 34.6pt; padding: 0cm 5.4pt;" valign="top"> <div align="center" class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Perkiraan Penurunan Tekanan Darah Sistolik</span></b></div></td> </tr>
<tr style="height: 40pt;"> <td style="-moz-border-bottom-colors: none; -moz-border-image: none; -moz-border-left-colors: none; -moz-border-right-colors: none; -moz-border-top-colors: none; border-color: -moz-use-text-color black black; border-right: 1pt solid black; border-style: none solid solid; border-width: medium 1pt 1pt; height: 40pt; padding: 0cm 5.4pt;" valign="top"> <div align="center" class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Penurunan berat badan</span></b></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 40pt; padding: 0cm 5.4pt;" valign="top"> <div align="center" class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Mempertahankan berat badan normal (BMI 18,5-24,9 kg/m<sup>2</sup>)</span></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 40pt; padding: 0cm 5.4pt;" valign="top"> <div align="center" class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">5-20 mmHg / 10 Kg</span></div></td> </tr>
<tr style="height: 34.6pt;"> <td style="-moz-border-bottom-colors: none; -moz-border-image: none; -moz-border-left-colors: none; -moz-border-right-colors: none; -moz-border-top-colors: none; border-color: -moz-use-text-color black black; border-right: 1pt solid black; border-style: none solid solid; border-width: medium 1pt 1pt; height: 34.6pt; padding: 0cm 5.4pt;" valign="top"> <div align="center" class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Mengadopsi pola makan DASH</span></b></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 34.6pt; padding: 0cm 5.4pt;" valign="top"> <div align="center" class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Makan banyak buah, sayuran dan produk susu rendah lemak</span></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 34.6pt; padding: 0cm 5.4pt;" valign="top"> <div align="center" class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">8-14 mmHg</span></div></td> </tr>
<tr style="height: 40pt;"> <td style="-moz-border-bottom-colors: none; -moz-border-image: none; -moz-border-left-colors: none; -moz-border-right-colors: none; -moz-border-top-colors: none; border-color: -moz-use-text-color black black; border-right: 1pt solid black; border-style: none solid solid; border-width: medium 1pt 1pt; height: 40pt; padding: 0cm 5.4pt;" valign="top"> <div align="center" class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Mengurangi intake sodium</span></b></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 40pt; padding: 0cm 5.4pt;" valign="top"> <div align="center" class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Mengurangi asupan garam tidak lebih dari 2,4g / hari</span></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 40pt; padding: 0cm 5.4pt;" valign="top"> <div align="center" class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">2-8 mmHg</span></div></td> </tr>
<tr style="height: 35.5pt;"> <td style="-moz-border-bottom-colors: none; -moz-border-image: none; -moz-border-left-colors: none; -moz-border-right-colors: none; -moz-border-top-colors: none; border-color: -moz-use-text-color black black; border-right: 1pt solid black; border-style: none solid solid; border-width: medium 1pt 1pt; height: 35.5pt; padding: 0cm 5.4pt;" valign="top"> <div align="center" class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Aktivitas fisik</span></b></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 35.5pt; padding: 0cm 5.4pt;" valign="top"> <div align="center" class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Melakukan olahraga aerob yang berkelanjutan (30 menit per hari sebanyak 4-5x per minggu)</span></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 35.5pt; padding: 0cm 5.4pt;" valign="top"> <div align="center" class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">4-9 mmHg</span></div></td> </tr>
<tr style="height: 35.5pt;"> <td style="-moz-border-bottom-colors: none; -moz-border-image: none; -moz-border-left-colors: none; -moz-border-right-colors: none; -moz-border-top-colors: none; border-color: -moz-use-text-color black black; border-right: 1pt solid black; border-style: none solid solid; border-width: medium 1pt 1pt; height: 35.5pt; padding: 0cm 5.4pt;" valign="top"> <div align="center" class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Mengurangi konsumsi alkohol</span></b></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 35.5pt; padding: 0cm 5.4pt;" valign="top"> <div align="center" class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Maksimal 2 kali minum per hari, Bir 24 oz, Anggur 10 oz, Wishkey 2 oz</span></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 35.5pt; padding: 0cm 5.4pt;" valign="top"> <div align="center" class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">2-4 mmHg</span></div></td> </tr>
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</div><div class="MsoListParagraph" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 1cm; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pendekatan dengan obat adalah dengan cara memberikan obat oral yang berfungsi untuk menurunkan tekanan darah. Untuk tercapainya target tekanan darah yang diinginkan makan kedua cara pendekatan tersebut harus diterapkan secara bersama-sama. (lihat gambar 8.) Sedangkan untuk pemilihan obat pada hipertensi dengan penyakit pemberat dapat dilihat pada tabel 5.</span></div><div class="MsoNormal" style="margin-bottom: 0.0001pt;"><br />
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</div><br clear="ALL" /> <div class="MsoNormal"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Gambar 8. Algoritma Penanganan Hipertensi</span></div><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><br clear="all" style="page-break-before: always;" /> </span> <div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin: 0cm 0cm 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tabel 5. Pilihan Obat Oral Pada Pasien dengan Indikasi pemberat</span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin: 0cm 0cm 0.0001pt; text-align: justify;"><br />
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<tr> <td rowspan="2" style="border: 1pt solid black; padding: 0cm 5.4pt; width: 4cm;" valign="top" width="151"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><b><span style="font-family: "Times New Roman","serif";">Indikasi Pemberat</span></b></div></td> <td colspan="6" style="-moz-border-bottom-colors: none; -moz-border-image: none; -moz-border-left-colors: none; -moz-border-right-colors: none; -moz-border-top-colors: none; border-color: black black black -moz-use-text-color; border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; padding: 0cm 5.4pt; width: 288.9pt;" valign="top" width="385"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><b><span style="font-family: "Times New Roman","serif";">Obat Rekomendasi</span></b></div></td> </tr>
<tr> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 55.05pt;" valign="top" width="73"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><b><span style="font-family: "Times New Roman","serif";">Diuretik</span></b></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 43.95pt;" valign="top" width="59"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><b><span style="font-family: "Times New Roman","serif";">BB</span></b></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 45pt;" valign="top" width="60"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><b><span style="font-family: "Times New Roman","serif";">ACEi</span></b></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 45pt;" valign="top" width="60"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><b><span style="font-family: "Times New Roman","serif";">ARB</span></b></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 36.15pt;" valign="top" width="48"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><b><span style="font-family: "Times New Roman","serif";">CCB</span></b></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 63.75pt;" valign="top" width="85"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><b><span style="font-family: "Times New Roman","serif";">Aldosteron Antagonis</span></b></div></td> </tr>
<tr> <td style="-moz-border-bottom-colors: none; -moz-border-image: none; -moz-border-left-colors: none; -moz-border-right-colors: none; -moz-border-top-colors: none; border-color: -moz-use-text-color black black; border-right: 1pt solid black; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 4cm;" valign="top" width="151"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="font-family: "Times New Roman","serif";">Gagal Jantung</span></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 55.05pt;" valign="top" width="73"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="font-family: "Times New Roman","serif";">Ѵ</span></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 43.95pt;" valign="top" width="59"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="font-family: "Times New Roman","serif";">Ѵ</span></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 45pt;" valign="top" width="60"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="font-family: "Times New Roman","serif";">Ѵ</span></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 45pt;" valign="top" width="60"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="font-family: "Times New Roman","serif";">Ѵ</span></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 36.15pt;" valign="top" width="48"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 63.75pt;" valign="top" width="85"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="font-family: "Times New Roman","serif";">Ѵ</span></div></td> </tr>
<tr> <td style="-moz-border-bottom-colors: none; -moz-border-image: none; -moz-border-left-colors: none; -moz-border-right-colors: none; -moz-border-top-colors: none; border-color: -moz-use-text-color black black; border-right: 1pt solid black; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 4cm;" valign="top" width="151"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="font-family: "Times New Roman","serif";">Post. Infark Myokard</span></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 55.05pt;" valign="top" width="73"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 43.95pt;" valign="top" width="59"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="font-family: "Times New Roman","serif";">Ѵ</span></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 45pt;" valign="top" width="60"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="font-family: "Times New Roman","serif";">Ѵ</span></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 45pt;" valign="top" width="60"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 36.15pt;" valign="top" width="48"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 63.75pt;" valign="top" width="85"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="font-family: "Times New Roman","serif";">Ѵ</span></div></td> </tr>
<tr> <td style="-moz-border-bottom-colors: none; -moz-border-image: none; -moz-border-left-colors: none; -moz-border-right-colors: none; -moz-border-top-colors: none; border-color: -moz-use-text-color black black; border-right: 1pt solid black; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 4cm;" valign="top" width="151"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="font-family: "Times New Roman","serif";">Resiko Tinggi Penyakit Koroner</span></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 55.05pt;" valign="top" width="73"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="font-family: "Times New Roman","serif";">Ѵ</span></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 43.95pt;" valign="top" width="59"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="font-family: "Times New Roman","serif";">Ѵ</span></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 45pt;" valign="top" width="60"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="font-family: "Times New Roman","serif";">Ѵ</span></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 45pt;" valign="top" width="60"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 36.15pt;" valign="top" width="48"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="font-family: "Times New Roman","serif";">Ѵ</span></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 63.75pt;" valign="top" width="85"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><br />
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</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 43.95pt;" valign="top" width="59"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 45pt;" valign="top" width="60"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="font-family: "Times New Roman","serif";">Ѵ</span></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 45pt;" valign="top" width="60"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="font-family: "Times New Roman","serif";">Ѵ</span></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 36.15pt;" valign="top" width="48"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><br />
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<tr> <td style="-moz-border-bottom-colors: none; -moz-border-image: none; -moz-border-left-colors: none; -moz-border-right-colors: none; -moz-border-top-colors: none; border-color: -moz-use-text-color black black; border-right: 1pt solid black; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 4cm;" valign="top" width="151"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="font-family: "Times New Roman","serif";">Pencegahan Stroke Berulang</span></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 55.05pt;" valign="top" width="73"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="font-family: "Times New Roman","serif";">Ѵ</span></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 43.95pt;" valign="top" width="59"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 45pt;" valign="top" width="60"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="font-family: "Times New Roman","serif";">Ѵ</span></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 45pt;" valign="top" width="60"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><br />
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</div>Anonymoushttp://www.blogger.com/profile/17040699491469284898noreply@blogger.com0tag:blogger.com,1999:blog-7514639870940573862.post-12686550136757583372011-10-03T02:02:00.000-07:002011-10-03T02:04:41.525-07:00otomikosis<div class="MsoNormal" style="line-height: 150%; text-align: justify;"><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgEQA2TlvhiiG8TGMtL4Ae6xAF7Tb12p6bbuQw6j0_IazDzls6qzbn2XPaPA3DbysN3M1TsraHBIeFfqB31UtShYdN4BgUVb3lfj7iexbxpiu8k7FslLct7H8aFGA9sXTsKdzeZsrr7zxM5/s1600/Picture1.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="116" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgEQA2TlvhiiG8TGMtL4Ae6xAF7Tb12p6bbuQw6j0_IazDzls6qzbn2XPaPA3DbysN3M1TsraHBIeFfqB31UtShYdN4BgUVb3lfj7iexbxpiu8k7FslLct7H8aFGA9sXTsKdzeZsrr7zxM5/s200/Picture1.jpg" width="200" /></a></div> <span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Otomikosis merupakan infeksi jamur pada kanalis akustikus eksterna. Walaupun penyakit ini jarang menyebabkan kematian, namun membutuhkan terapi dan <i>follow-up</i> jangka panjang sehingga membutuhkan biaya yang tidak sedikit.</span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><u><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><br />
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<a name='more'></a><u><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Epidemiologi</span></u></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Dilaporkan dari semua kasus otitis eksterna, 9 % merupakan kasus otomikosis. 90% kasus otomikosis melibatkan <i>Aspergillus sp.</i> dan sisanya adalah <i>Candida sp</i>. Otomikosis lebih sering terjadi orang-orang yang tinggal pada daerah yang beriklim panas dan orang-orang yang sering berolahraga didalam air.</span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><u><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Faktor Predisposisi</span></u></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Faktor yang berpengaruh terhadap terjadinya otomikosis adalah ketiadaan serumen, pemakaian peralatan pada telinga (alat bantu dengar), kondisi <i>immunocompromized</i>, penggunaan antibiotik dan steroid topikal dalam jangka panjang, dan iklim yang panas dan lembab.</span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><u><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Etiologi</span></u></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Otomikosis merupakan infeksi akut, subakut, ataupun kronis yang dihasilakan oleh jamur yang berefek pada epitelium squamosum pada kanalis akustikus eksterna. Jamur yang menyebabkan otomikosis pada umumnya adalah spesies jamur saprofit yang banyak ditemukan dialam dan merupakan bagian dari flora normal pada kanalis akustikus eksterna. Jamur-jamur tersebut pada umumnya adalah <i>Aspergillus </i>dan<i> Candida</i>. <i>Aspergillus niger</i> merupakan agen yang predominan walaupun <i>A. Flavus, A. Fumigatus, A. Terreus, Candida albican </i>dan<i> C. Parapsilosis</i> juga umum ditemukan.</span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><u><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Patogenesis</span></u></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Secara umum, kanalis akustikus eksterna dilindungi oleh sistem imun tubuh, lapisan epitelium, dan sekresi yang dihasilkan oleh kanal yaitu serumen. Kanalis akustikus eksterna mempunyai pH normal berkisar antara 4-5. Hal ini dijaga oleh flora normal dan serumen. Kadar pH yang sedikit asam akan menekan pertumbuhan bakteri dan jamur, sehingga bersama-sama dengan sistem imun tubuh dan lapisan epitelium, akan menjaga kanalis akustikus eksterna dari serangan patogen.</span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Dalam keadaan tertentu seperti paparan air, penggunaan antibiotik dan steroid dalam jangka panjang, maka suasana sedikit asam tersebut akan berubah menjadi lebih basa. Hal ini akan menyebabkan pertumbuhan bakteri dan jamur sehingga terjadi infeksi pada kanalis akustikus eksterna. Keadaan akan diperburuk jika sistem imun dan lapisan epitelium juga mengalami gangguan. Jamur juga tumbuh dengan cepat dikarenakan kondisi kanalis akustikus yang lembab, hangat dan gelap, sehingga otomikosis terjadi.</span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><u><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tanda dan Gejala</span></u></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Gejala yang paling umum dirasakan adalah rasa gatal pada telinga bagian dalam. Rasa gatal ini sangat mengganggu, tidak tertahankan dan ingin selalu digaruk. Debris dari jamur juga dapat menumpuk pada kanalis akustikus eksterna sehingga dapat menimbulkan keluhan penurunan pendengaran dan telinga terasa penuh.</span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><u><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pemeriksaan Fisik</span></u></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Pada pemeriksaan dengan inspeksi dan palpasi akan ditemukan tanda-tanda inflamasi pada kanal disertai nyeri tekan pada tragus dan aurikula. Discharge dapat terlihat pada kanal. Pada pemeriksaan dengan otoskop dapat terlihat kanal yang hiperemis, sedikit edem dan tampak hifa berfilamen putih dengan titik-titik hitam yang tumbuh dari permukaan kulit.</span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><u><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pemeriksaan Penunjang</span></u></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Pemeriksaan yang dilakukan untuk membantu penegakan diagnosis adalah swab telinga dan pemeriksaan mikroskopis dengan KOH. Akan tampak hifa dan spora pada pemeriksaan mikroskopis. Sedangkan untuk menentukan spesies yang menginveksi dapat dilakukan kultur.</span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><u><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Terapi</span></u></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Terapi untuk otomikosis meliputi pembersihan kanalis akustikus eksterna dari material jamur dan discharge yang dihasilkan. Anti jamur yang spesifik dapat digunakan hingga 10-14 hari setelah keluhan menghilang untuk mencegah kekambuahn. Anti jamur yang dapat digunakan adalah clotrimazol krim, digunakan 2 kali sehari setelah kanal dibersihkan dengan aural toilet (dengan cotton bud hingga tidak basah). Telinga juga harus dijaga supaya tetap kering, jangan sampai kemasukan air.</span></div>Anonymoushttp://www.blogger.com/profile/17040699491469284898noreply@blogger.com0tag:blogger.com,1999:blog-7514639870940573862.post-63179064398297935972011-10-02T09:02:00.000-07:002011-10-02T09:06:00.235-07:00OMA (otitis media akut)<div class="MsoNormal" style="margin: 0cm 0cm 0pt; text-align: justify;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: Calibri;">Otitis Media Akut</span></b></div><div class="MsoListParagraphCxSpFirst" style="margin: 0cm 0cm 0pt 14.2pt; mso-add-space: auto; mso-list: l0 level1 lfo2; text-align: justify; text-indent: -14.2pt;"><span style="mso-bidi-font-family: Calibri;"><span style="mso-list: Ignore;"><span style="font-family: Calibri;">1.</span><span style="font-family: "Times New Roman";"> </span></span></span><span style="font-family: Calibri;">Definisi :</span></div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 14.2pt; mso-add-space: auto; text-align: justify;"><span style="font-family: Calibri;">radang akut telinga tengah yang terjadi terutama pada bayi atau anak yang biasanya didahului oleh infeksi saluran nafas bagian atas.</span></div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 14.2pt; mso-add-space: auto; mso-list: l0 level1 lfo2; text-align: justify; text-indent: -14.2pt;"><span style="mso-bidi-font-family: Calibri;"><span style="mso-list: Ignore;"><span style="font-family: Calibri;">2.</span><span style="font-family: "Times New Roman";"> </span></span></span><span style="font-family: Calibri;">Patogenesis</span></div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 14.2pt; mso-add-space: auto; text-align: justify;"><span style="font-family: Calibri;">Kuman penyebab OMA adalah bakteri pirogenik</span><span style="font-family: Wingdings; mso-ascii-font-family: Calibri; mso-char-type: symbol; mso-hansi-font-family: Calibri; mso-symbol-font-family: Wingdings;"><span style="mso-char-type: symbol; mso-symbol-font-family: Wingdings;">à</span></span><span style="font-family: Calibri;"> Streptococcus hemolitika, Pneumococcus dan H. influenzae</span><br />
<a name='more'></a><span style="font-family: Calibri;">Terdapat 5 stadium OMA yaitu: stadium oklusi tuba, stadium hiperemis, stadium supurasi, stadium perforasi, dan stadium resolusi</span></div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 14.2pt; mso-add-space: auto; mso-list: l0 level1 lfo2; text-align: justify; text-indent: -14.2pt;"><span style="mso-bidi-font-family: Calibri;"><span style="mso-list: Ignore;"><span style="font-family: Calibri;">3.</span><span style="font-family: "Times New Roman";"> </span></span></span><span style="font-family: Calibri;">Sign dan Simptom</span></div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 14.2pt; mso-add-space: auto; text-align: justify;"><span style="font-family: Calibri;">Gejala OMA adalah:</span></div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 14.2pt; mso-add-space: auto; text-align: justify;"><span style="font-family: Calibri;">anak gelisah atau ketika tidur tiba-tiba bangun, menjerit sambil pegang telinga</span></div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 14.2pt; mso-add-space: auto; text-align: justify;"><span style="font-family: Calibri;">demam dengan suhu yang tinggi, kadang sampai kejang</span></div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 14.2pt; mso-add-space: auto; text-align: justify;"><span style="font-family: Calibri;">bisa disertai muntah dan diare</span></div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 14.2pt; mso-add-space: auto; text-align: justify;"><span style="font-family: Calibri;">Tanda OMA tergantung stadiumnya:</span></div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 1cm; mso-add-space: auto; mso-list: l1 level1 lfo1; text-align: justify; text-indent: -14.15pt;"><span style="mso-bidi-font-family: Calibri;"><span style="mso-list: Ignore;"><span style="font-family: Calibri;">-</span><span style="font-family: "Times New Roman";"> </span></span></span><span style="font-family: Calibri;">stadium oklusi tuba</span></div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 1cm; mso-add-space: auto; text-align: justify;"><span style="font-family: Calibri;">membran timpani tampak suram, refleks cahaya memendek atau menghilang.</span></div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 1cm; mso-add-space: auto; mso-list: l1 level1 lfo1; text-align: justify; text-indent: -14.15pt;"><span style="mso-bidi-font-family: Calibri;"><span style="mso-list: Ignore;"><span style="font-family: Calibri;">-</span><span style="font-family: "Times New Roman";"> </span></span></span><span style="font-family: Calibri;">stadium hiperemis</span></div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 1cm; mso-add-space: auto; text-align: justify;"><span style="font-family: Calibri;">membran impani hiperemis dan edema, refleks cahaya menghilang</span></div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 1cm; mso-add-space: auto; mso-list: l1 level1 lfo1; text-align: justify; text-indent: -14.15pt;"><span style="mso-bidi-font-family: Calibri;"><span style="mso-list: Ignore;"><span style="font-family: Calibri;">-</span><span style="font-family: "Times New Roman";"> </span></span></span><span style="font-family: Calibri;">stadium supurasi</span></div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 1cm; mso-add-space: auto; text-align: justify;"><span style="font-family: Calibri;">keluhan dan gejala klinik menghebat</span></div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 1cm; mso-add-space: auto; text-align: justify;"><span style="font-family: Calibri;">membran timpani menonjol keluar (bulging) dan ada bagian berwarna kekuningan</span></div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 1cm; mso-add-space: auto; mso-list: l1 level1 lfo1; text-align: justify; text-indent: -14.15pt;"><span style="mso-bidi-font-family: Calibri;"><span style="mso-list: Ignore;"><span style="font-family: Calibri;">-</span><span style="font-family: "Times New Roman";"> </span></span></span><span style="font-family: Calibri;">stadium perforasi</span></div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 1cm; mso-add-space: auto; text-align: justify;"><span style="font-family: Calibri;">keluhan klinis berkurang</span></div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 1cm; mso-add-space: auto; text-align: justify;"><span style="font-family: Calibri;">tampak cairan diliang telinga dari telinga tengah, membran timpani mengalami perforasi</span></div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 1cm; mso-add-space: auto; mso-list: l1 level1 lfo1; text-align: justify; text-indent: -14.15pt;"><span style="mso-bidi-font-family: Calibri;"><span style="mso-list: Ignore;"><span style="font-family: Calibri;">-</span><span style="font-family: "Times New Roman";"> </span></span></span><span style="font-family: Calibri;">stadium resolusi</span></div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 1cm; mso-add-space: auto; text-align: justify;"><span style="font-family: Calibri;">tidak ada sekret/kering, membran timpani berangsur membaik</span></div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 14.2pt; mso-add-space: auto; mso-list: l0 level1 lfo2; text-align: justify; text-indent: -14.2pt;"><span style="mso-bidi-font-family: Calibri;"><span style="mso-list: Ignore;"><span style="font-family: Calibri;">4.</span><span style="font-family: "Times New Roman";"> </span></span></span><span style="font-family: Calibri;">Pemeriksaan Fisik</span><span style="font-family: Wingdings; mso-ascii-font-family: Calibri; mso-char-type: symbol; mso-hansi-font-family: Calibri; mso-symbol-font-family: Wingdings;"><span style="mso-char-type: symbol; mso-symbol-font-family: Wingdings;">à</span></span><span style="font-family: Calibri;"> liat tanda2</span></div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 14.2pt; mso-add-space: auto; mso-list: l0 level1 lfo2; text-align: justify; text-indent: -14.2pt;"><span style="mso-bidi-font-family: Calibri;"><span style="mso-list: Ignore;"><span style="font-family: Calibri;">5.</span><span style="font-family: "Times New Roman";"> </span></span></span><span style="font-family: Calibri;">Terapi</span></div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 1cm; mso-add-space: auto; mso-list: l1 level1 lfo1; text-align: justify; text-indent: -14.15pt;"><span style="mso-bidi-font-family: Calibri;"><span style="mso-list: Ignore;"><span style="font-family: Calibri;">-</span><span style="font-family: "Times New Roman";"> </span></span></span><span style="font-family: Calibri;">stadium oklusi tuba</span></div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 1cm; mso-add-space: auto; text-align: justify;"><span style="font-family: Calibri;">beri antibiotik selama 7 hari</span><span style="font-family: Wingdings; mso-ascii-font-family: Calibri; mso-char-type: symbol; mso-hansi-font-family: Calibri; mso-symbol-font-family: Wingdings;"><span style="mso-char-type: symbol; mso-symbol-font-family: Wingdings;">à</span></span><span style="font-family: Calibri;"> ampisilin 500 mg 4dd1 (anak 25mg/kg)</span></div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 6cm; mso-add-space: auto; text-align: justify;"><span style="font-family: Calibri;">amoksisilin 500 mg 3dd1 (anak 10mg/kg)</span></div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 6cm; mso-add-space: auto; text-align: justify;"><span style="font-family: Calibri;">eritromisin 500mg 4dd1 (anak 10mg/kg)</span></div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 1cm; mso-add-space: auto; text-align: justify;"><span style="font-family: Calibri;">obat tetes hidung dekongestan atau pseudoefedrin 60 mg</span></div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 1cm; mso-add-space: auto; text-align: justify;"><span style="font-family: Calibri;">antipiretik</span><span style="font-family: Wingdings; mso-ascii-font-family: Calibri; mso-char-type: symbol; mso-hansi-font-family: Calibri; mso-symbol-font-family: Wingdings;"><span style="mso-char-type: symbol; mso-symbol-font-family: Wingdings;">à</span></span><span style="font-family: Calibri;">parasetamol</span></div><div class="MsoListParagraphCxSpLast" style="margin: 0cm 0cm 0pt 1cm; mso-add-space: auto; mso-list: l1 level1 lfo1; text-align: justify; text-indent: -14.15pt;"><span style="mso-bidi-font-family: Calibri;"><span style="mso-list: Ignore;"><span style="font-family: Calibri;">-</span><span style="font-family: "Times New Roman";"> </span></span></span><span style="font-family: Calibri;">stadium hiperemis</span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 1cm; text-align: justify;"><span style="font-family: Calibri;">beri antibiotik selama 10-14<span style="mso-spacerun: yes;"> </span>hari</span><span style="font-family: Wingdings; mso-ascii-font-family: Calibri; mso-char-type: symbol; mso-hansi-font-family: Calibri; mso-symbol-font-family: Wingdings;"><span style="mso-char-type: symbol; mso-symbol-font-family: Wingdings;">à</span></span><span style="font-family: Calibri;"> ampisilin 500 mg 4dd1 (anak 25mg/kg)</span></div><div class="MsoListParagraphCxSpFirst" style="margin: 0cm 0cm 0pt 6cm; mso-add-space: auto; text-align: justify;"><span style="font-family: Calibri;">amoksisilin 500 mg 3dd1 (anak 10mg/kg)</span></div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 6cm; mso-add-space: auto; text-align: justify;"><span style="font-family: Calibri;">eritromisin 500mg 4dd1 (anak 10mg/kg)</span></div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 1cm; mso-add-space: auto; text-align: justify;"><span style="font-family: Calibri;">obat tetes hidung dekongestan atau pseudoefedrin 60 mg maksimal 5 hari</span></div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 1cm; mso-add-space: auto; text-align: justify;"><span style="font-family: Calibri;">antipiretik, analgetik</span><span style="font-family: Wingdings; mso-ascii-font-family: Calibri; mso-char-type: symbol; mso-hansi-font-family: Calibri; mso-symbol-font-family: Wingdings;"><span style="mso-char-type: symbol; mso-symbol-font-family: Wingdings;">à</span></span><span style="font-family: Calibri;">parasetamol</span></div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 1cm; mso-add-space: auto; mso-list: l1 level1 lfo1; text-align: justify; text-indent: -14.15pt;"><span style="mso-bidi-font-family: Calibri;"><span style="mso-list: Ignore;"><span style="font-family: Calibri;">-</span><span style="font-family: "Times New Roman";"> </span></span></span><span style="font-family: Calibri;">stadium supurasi</span></div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 1cm; mso-add-space: auto; text-align: justify;"><span style="font-family: Calibri;">segera rawat</span></div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 1cm; mso-add-space: auto; text-align: justify;"><span style="font-family: Calibri;">antibiotik ampisilin atau amoksisilin dosis tinggi parenteral selama 3 hari</span></div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 1cm; mso-add-space: auto; text-align: justify;"><span style="font-family: Calibri;">kalau tdk ada fasilitas perawatan rujuk dr THT</span></div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 1cm; mso-add-space: auto; mso-list: l1 level1 lfo1; text-align: justify; text-indent: -14.15pt;"><span style="mso-bidi-font-family: Calibri;"><span style="mso-list: Ignore;"><span style="font-family: Calibri;">-</span><span style="font-family: "Times New Roman";"> </span></span></span><span style="font-family: Calibri;">stadium perforasi</span></div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 1cm; mso-add-space: auto; text-align: justify;"><span style="font-family: Calibri;">beri antibiotik selama 14 hari</span></div><div class="MsoListParagraphCxSpLast" style="margin: 0cm 0cm 0pt 1cm; mso-add-space: auto; text-align: justify;"><span style="font-family: Calibri;">cairan dibersihkan dengan obat cuci telinga</span><span style="font-family: Wingdings; mso-ascii-font-family: Calibri; mso-char-type: symbol; mso-hansi-font-family: Calibri; mso-symbol-font-family: Wingdings;"><span style="mso-char-type: symbol; mso-symbol-font-family: Wingdings;">à</span></span><span style="font-family: Calibri;"> Solutio H2O2 sebanyak 2-3 kali.</span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt; text-align: justify;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt; text-align: justify;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt; text-align: justify;"><span style="font-family: Calibri;">Kalau pada stadium perforasi, membran timpani tidak menutup >2 bulan maka disebut Otitis Media Supuratif Kronik</span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt; text-align: justify;"><span style="font-family: Calibri;">Kuman yang paling banyak mengenai adalah Staphylococcus aureus</span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt; text-align: justify;"><span style="font-family: Calibri;">OMSK dibagi menjadi 2</span><span style="font-family: Wingdings; mso-ascii-font-family: Calibri; mso-char-type: symbol; mso-hansi-font-family: Calibri; mso-symbol-font-family: Wingdings;"><span style="mso-char-type: symbol; mso-symbol-font-family: Wingdings;">à</span></span><span style="font-family: Calibri;"> tipe benigna dan tipe maligna</span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt; text-align: justify;"><span style="font-family: Calibri;">Tipe benigna</span><span style="font-family: Wingdings; mso-ascii-font-family: Calibri; mso-char-type: symbol; mso-hansi-font-family: Calibri; mso-symbol-font-family: Wingdings;"><span style="mso-char-type: symbol; mso-symbol-font-family: Wingdings;">à</span></span><span style="font-family: Calibri;"> jika peradangan hanya mengenai mukosa saja</span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt; text-align: justify;"><span style="font-family: Calibri;">Tipe maligna</span><span style="font-family: Wingdings; mso-ascii-font-family: Calibri; mso-char-type: symbol; mso-hansi-font-family: Calibri; mso-symbol-font-family: Wingdings;"><span style="mso-char-type: symbol; mso-symbol-font-family: Wingdings;">à</span></span><span style="font-family: Calibri;"> jika peradangan terjadi pada tulang</span><span style="font-family: Wingdings; mso-ascii-font-family: Calibri; mso-char-type: symbol; mso-hansi-font-family: Calibri; mso-symbol-font-family: Wingdings;"><span style="mso-char-type: symbol; mso-symbol-font-family: Wingdings;">à</span></span><span style="font-family: Calibri;"> bisa komplikasi intrakranial.</span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt; text-align: justify;"><span style="font-family: Calibri;">Terapi untuk tipe benigna adalah cuci dengan solutio H2O2, antibiotik selama 7 hari, jangan berenang dan mengorek kuping, bila 2 bln tdk kering</span><span style="font-family: Wingdings; mso-ascii-font-family: Calibri; mso-char-type: symbol; mso-hansi-font-family: Calibri; mso-symbol-font-family: Wingdings;"><span style="mso-char-type: symbol; mso-symbol-font-family: Wingdings;">à</span></span><span style="font-family: Calibri;">rujuk</span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt; text-align: justify;"><span style="font-family: Calibri;">Terapi untuk tipe maligna adalah rujuk kedokter spesialis.</span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt; text-align: justify;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt; text-align: justify;"><br />
<span style="font-family: Calibri;">Bagaimana membedakan OE dan OMA dengan keluhan nyeri telinga?</span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt; text-align: justify;"><span style="font-family: Calibri;">Anamnesis</span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt; text-align: justify;"><span style="font-family: Calibri;">-Otitis eksterna</span><span style="font-family: Wingdings; mso-ascii-font-family: Calibri; mso-char-type: symbol; mso-hansi-font-family: Calibri; mso-symbol-font-family: Wingdings;"><span style="mso-char-type: symbol; mso-symbol-font-family: Wingdings;">à</span></span><span style="font-family: Calibri;">ada riwayat berenang, penggunaan cotton bud, trauma fisik</span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt; text-align: justify;"><span style="font-family: Calibri;">-Otitis media</span><span style="font-family: Wingdings; mso-ascii-font-family: Calibri; mso-char-type: symbol; mso-hansi-font-family: Calibri; mso-symbol-font-family: Wingdings;"><span style="mso-char-type: symbol; mso-symbol-font-family: Wingdings;">à</span></span><span style="font-family: Calibri;">riwayat infeksi saluran pernafasan bagian atas sebelumnya.</span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt; text-align: justify;"><span style="font-family: Calibri;">Pemeriksaan Fisik</span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt; text-align: justify;"><span style="font-family: Calibri;">-OE</span><span style="font-family: Wingdings; mso-ascii-font-family: Calibri; mso-char-type: symbol; mso-hansi-font-family: Calibri; mso-symbol-font-family: Wingdings;"><span style="mso-char-type: symbol; mso-symbol-font-family: Wingdings;">à</span></span><span style="font-family: Calibri;">kulit pada kanalis aurikularis eritema, membran timpani juga bisa eritem</span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt; text-align: justify;"><span style="font-family: Calibri;">-OM</span><span style="font-family: Wingdings; mso-ascii-font-family: Calibri; mso-char-type: symbol; mso-hansi-font-family: Calibri; mso-symbol-font-family: Wingdings;"><span style="mso-char-type: symbol; mso-symbol-font-family: Wingdings;">à</span></span><span style="font-family: Calibri;"> hanya membran timpani yang eritem</span></div>Anonymoushttp://www.blogger.com/profile/17040699491469284898noreply@blogger.com0tag:blogger.com,1999:blog-7514639870940573862.post-89167801089403861562011-10-02T09:00:00.000-07:002011-10-02T09:07:05.763-07:00penyakit telinga luar<div class="MsoNormal" style="margin: 0cm 0cm 0pt; text-align: justify;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: Calibri;">Penyakit pada Aurikula</span></b></div><div class="MsoListParagraphCxSpFirst" style="margin: 0cm 0cm 0pt 14.2pt; mso-add-space: auto; mso-list: l1 level1 lfo1; text-align: justify; text-indent: -14.2pt;"><span style="mso-bidi-font-family: Calibri;"><span style="mso-list: Ignore;"><span style="font-family: Calibri;">-</span><span style="font-family: "Times New Roman";"> </span></span></span><b style="mso-bidi-font-weight: normal;"><span style="font-family: Calibri;">Cerumen Impaction</span></b></div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 14.2pt; mso-add-space: auto; text-align: justify;"><span style="font-family: Calibri;">Serumen adalah produk yang disekresikan oleh bagian luar kanalis aurikularis. Pd sebagian besar orang biasanya bersih dengan sendirinya. Cara membersihkan yang direkomendasikan adalah</span><br />
<a name='more'></a> membersihkan dengan kain basah dengan jari telunjuk tanpa memasukkannya kekana, cukup bagian luar saja. </div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 14.2pt; mso-add-space: auto; text-align: justify;"><span style="font-family: Calibri;">Impaksi serumen biasanya diinduksi oleh cara pembersihan yang salah.</span></div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 14.2pt; mso-add-space: auto; text-align: justify;"><span style="font-family: Calibri;">Cara penanganan adalah dengan detergent ear drop (3% hidrogen peroksida, 6,5% carbamide peroksida), mechanical removal, suction, atau irigasi.</span></div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 14.2pt; mso-add-space: auto; text-align: justify;"><span style="font-family: Calibri;">Irigasi menggunakan air dengan suhu badan</span><span style="font-family: Wingdings; mso-ascii-font-family: Calibri; mso-char-type: symbol; mso-hansi-font-family: Calibri; mso-symbol-font-family: Wingdings;"><span style="mso-char-type: symbol; mso-symbol-font-family: Wingdings;">à</span></span><span style="font-family: Calibri;">mencegah vestibular coloric response, dan hanya bisa digunakan jika membran timpani masih intak.</span></div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 14.2pt; mso-add-space: auto; mso-list: l1 level1 lfo1; text-align: justify; text-indent: -14.2pt;"><span style="mso-bidi-font-family: Calibri;"><span style="mso-list: Ignore;"><span style="font-family: Calibri;">-</span><span style="font-family: "Times New Roman";"> </span></span></span><b style="mso-bidi-font-weight: normal;"><span style="font-family: Calibri;">Benda Asing</span></b></div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 14.2pt; mso-add-space: auto; text-align: justify;"><span style="font-family: Calibri;">Lebih sering pada anak kecil. Material yang kuat bisa dihilangkan dengan kait. Material organik jangan diirigasi dengan air karena dapat mengembang. Serangga yang hidup sebelum dihilangkan beri lidokain untuk immobilisasi.</span></div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 14.2pt; mso-add-space: auto; mso-list: l1 level1 lfo1; text-align: justify; text-indent: -14.2pt;"><span style="mso-bidi-font-family: Calibri;"><span style="mso-list: Ignore;"><span style="font-family: Calibri;">-</span><span style="font-family: "Times New Roman";"> </span></span></span><b style="mso-bidi-font-weight: normal;"><span style="font-family: Calibri;">Otitis Eksterna</span></b></div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 14.2pt; mso-add-space: auto; text-align: justify;"><span style="font-family: Calibri;">Keluhan utama: </span></div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 14.2pt; mso-add-space: auto; text-align: justify; text-indent: 14.15pt;"><span style="font-family: Calibri;">nyeri pada telinga (otalgia)</span></div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 1cm; mso-add-space: auto; text-align: justify;"><span style="font-family: Calibri;">Sering disertai dengan gatal/pruritus dan discharge purulen.</span></div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 1cm; mso-add-space: auto; text-align: justify;"><span style="font-family: Calibri;">Biasanya ada riwayat terpapar air atau trauma mekanik (penggunaan cotton bud).</span></div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 1cm; mso-add-space: auto; text-align: justify;"><span style="font-family: Calibri;">Biasa disebabkan oleh bakteri batang gram negatif (pseudomonas, proteus) atau jamur (aspergillus).</span></div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 14.2pt; mso-add-space: auto; text-align: justify;"><span style="font-family: Calibri;">Pemeriksaan Fisik: </span></div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 1cm; mso-add-space: auto; text-align: justify;"><span style="font-family: Calibri;">eritema dan edema pada kulit kanalis aurikularis</span></div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 1cm; mso-add-space: auto; text-align: justify;"><span style="font-family: Calibri;">sering ditemukan eksudat purulen</span></div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 1cm; mso-add-space: auto; text-align: justify;"><span style="font-family: Calibri;">manipulasi aurikula akan menyebabkan nyeri (nyeri tekan)</span></div><div class="MsoListParagraphCxSpLast" style="margin: 0cm 0cm 0pt 1cm; mso-add-space: auto; text-align: justify;"><span style="font-family: Calibri;">membran timpani eritematous</span><span style="font-family: Wingdings; mso-ascii-font-family: Calibri; mso-char-type: symbol; mso-hansi-font-family: Calibri; mso-symbol-font-family: Wingdings;"><span style="mso-char-type: symbol; mso-symbol-font-family: Wingdings;">à</span></span><span style="font-family: Calibri;">bila kulit pada kanalis aurikularis sangat edema tidak bisa dilihat</span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 14.2pt; text-align: justify;"><span style="font-family: Calibri;">Terapi:</span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 1cm; text-align: justify;"><span style="font-family: Calibri;">Intinya adl cegah telinga dari kelembaban tambahan dan hindari injuri mekanikal lebih lanjut dg penggarukan. </span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 1cm; text-align: justify;"><span style="font-family: Calibri;">Tetes telinga</span><span style="font-family: Wingdings; mso-ascii-font-family: Calibri; mso-char-type: symbol; mso-hansi-font-family: Calibri; mso-symbol-font-family: Wingdings;"><span style="mso-char-type: symbol; mso-symbol-font-family: Wingdings;">à</span></span><span style="font-family: Calibri;">campuran antibiotik aminoglikosida dan kortikosteroid anti inflamasi (neomycin sulfate, polymycin B sulfate, dan hydrocortisone)</span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 1cm; text-align: justify;"><span style="font-family: Calibri;">Sebelum diberikan obat topikal, debris pada kanal harus dibersihkan dulu.</span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 1cm; text-align: justify;"><span style="font-family: Calibri;">Tetesi 5 atau lebih tetesan 3-4 kali sehari</span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 1cm; text-align: justify;"><span style="font-family: Calibri;">Pada kasus yang susah dengan topikal bisa diberikan fluoroquinolon oral (ciprofloxacin 500 mg 2dd1 selama 1 minggu).</span></div>Anonymoushttp://www.blogger.com/profile/17040699491469284898noreply@blogger.com0tag:blogger.com,1999:blog-7514639870940573862.post-4280986456515895742011-10-02T08:54:00.000-07:002011-10-23T08:27:41.043-07:00gagal jantung (CHF)<div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: justify;"><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjULEs6_mbwrXsIk-vnpZkGbuByOiXbv-1q2cGZx1A8Xa_snItfaM03sctmcss__hsypoSGHzFy1MVh9MjRTyTsxugbSgR0fKa7dxAKVh5AisTp8l7GMps-f64wrZm_lGI9ADawrtTQWPUE/s1600/gagal-jantung.jpg" imageanchor="1" style="clear: left; cssfloat: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="320" rda="true" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjULEs6_mbwrXsIk-vnpZkGbuByOiXbv-1q2cGZx1A8Xa_snItfaM03sctmcss__hsypoSGHzFy1MVh9MjRTyTsxugbSgR0fKa7dxAKVh5AisTp8l7GMps-f64wrZm_lGI9ADawrtTQWPUE/s320/gagal-jantung.jpg" width="300" /></a></div></div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: justify; text-indent: 1cm;"><span style="font-size: 12pt; mso-bidi-font-family: Calibri;"><span style="font-family: Calibri;">Heart Failure/gagal jantung adalah sindrom klinis yang terjadi pada pasien karena abnormalitas pada struktur atau fungsi jantung yang menyebabkan munculnya gejala klinis (dyspnea dan kelelahan) dan tanda klinis (edema dan rales).</span></span></div><span style="font-size: 12pt; mso-bidi-font-family: Calibri;"><span style="font-family: Calibri;"></span></span><br />
<a name='more'></a><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: justify; text-indent: 1cm;"></div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: justify; text-indent: 1cm;"><span style="font-size: 12pt; mso-bidi-font-family: Calibri;"><span style="font-family: Calibri;">Ventrikel jantung kanan bekerja dengan memompa darah dari sirkulasi sistemik ke paru-paru. Ketika terjadi gagal jantung kanan maka akan terdapat akumulasi darah pada vena sistemik dan akan memunculkan manifestasi klinis berupa edema pada jaringan perifer dan kongesti pada organ abdomen.</span></span></div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: justify; text-indent: 1cm;"><span style="font-size: 12pt; mso-bidi-font-family: Calibri;"><span style="font-family: Calibri;">Ventrikel jantung kiri bekerja untuk memompa darah dari paru-paru ke sirkulasi sistemik. Dengan adanya kegagalan pada fungsi jantung kiri maka akan terjadi penurunan cardiac output dan kongesti pada paru-paru. Manifestasi klinis dari gagal jantung kiri adalah sesak nafas saat beraktivitas, orthopnea, cyanosis.</span></span></div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: justify; text-indent: 1cm;"><span style="font-size: 12pt; mso-bidi-font-family: Calibri;"><span style="font-family: Calibri;">Manifestasi CHF berupa dyspnea terjadi karena adanya edema paru dan hal ini merupakan salah satu manifestasi mayor dari gagal jantung kiri.</span></span></div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: justify;"><b style="mso-bidi-font-weight: normal;"><span style="font-size: 12pt; mso-bidi-font-family: Calibri;"><span style="font-family: Calibri;">Etiologi</span></span></b></div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: justify; text-indent: 1cm;"><span style="font-size: 12pt; mso-bidi-font-family: Calibri;"><span style="font-family: Calibri;">Coronary artery disease (CAD) merupakan penyebab terbanyak dari gagal jantung baik pada laki-laki dan perempuan dan bertanggung jawab untuk 60-75% penyebab gagal jantung. Hipertensi juga berkontribusi pada perkembangan gagal jantung pada 75% pasien, termasuk pada pasien CAD. Jadi hipertensi dan CAD berinteraksi dalam perkembangan gagal jantung, begitu pula dengan diabetes mellitus. Cardiomyopathy dan gangguan katub jantung juga dapat menyebabkan terjadinya gagal jantung.</span></span></div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: justify;"><b style="mso-bidi-font-weight: normal;"><span style="font-size: 12pt; mso-bidi-font-family: Calibri;"><span style="font-family: Calibri;">Patogenesis</span></span></b></div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; tab-stops: 1.0cm; text-align: justify; text-indent: 1cm;"><span style="font-size: 12pt; mso-bidi-font-family: Calibri;"><span style="font-family: Calibri;">Gagal jantung merupakan penyakit progresif yang dimulai dengan adanya index event, bisa berupa kerusakan otot jantung atau gangguan kemampuan myocardium, sehingga jantung tidak dapat berkontraksi secara normal. Index event dapat terjadi dengan onset yang tidak jelas seperti AMI, onset yang bertahap seperti pada tekanan hemodinamik atau volume yang overload, serta herediter seperti kardiomiopati genetik. Index event akan menyebabkan penurunan kemampuan pompa jantung. Pada sebagian besar pasien, awal dari penurunan kemampuan pompa jantung tidak memunculkan gejala. Hal ini disebabkan adanya mekanisme kompensasi yang diaktifkan, meliputi: (1) aktivasi sistem RAA dan sistem saraf adrenergik yang bertugas untuk menjaga cardiac output dengan meningkatkan retensi garam dan air, dan (2) peningkatan kontraktilitas myocardium. Selain itu terdapat aktivasi molekul vasodilator meliputi atrial natriuretic peptide (ANP) dan brain natriuretic peptide (BNP), prostaglandin (PGE2 dan PGI2), dan nitrit oxide (NO) yang yang dapat mengimbangi vasokonstriksi vaskular perifer yang berlebihan. </span></span></div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; tab-stops: 1.0cm; text-align: justify; text-indent: 1cm;"><span style="font-size: 12pt; mso-bidi-font-family: Calibri;"><span style="font-family: Calibri;">Penurunan cardiac output pada gagal jantung akan memberikan sinyal kepada CNS sehingga dikeluarkan ADH oleh hipofisis. ADH merupakan vasokonstriktor yang kuat yang akan meningkatkan permeabilitas duktus kolektivus sehingga terjadi reabsorbsi air. CNS juga mengaktivasi sistem saraf simpatis. Stimulasi simpatis pada ginjal menyebabkan pengeluaran renin, sehingga dihasilkan peningkatan kadar angiotensin II dan aldosteron dalam sirkulasi. Aktivasi sistem RAA akan menyebabkan retensi air garam dan air dan menyebabkan vasokonstriksi pembuluh darah perifer, hipertrofi myocyte, kematian sel myocyte dan fibrosis myocyte. Adanya remodelling progresif pada jantung akan menyebabkan terjadinya kegagalan kompensasi yaitu terjadi disfungsi endotel karena stimulasi neurohormonal yang berlebihan, vasokonstriksi karena stimulasi simpatis serta retensi garam dan aiar karena stimulasi sistem RAA.</span></span></div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; tab-stops: 1.0cm; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; tab-stops: 1.0cm; text-align: justify;"><b style="mso-bidi-font-weight: normal;"><span style="font-size: 12pt; mso-bidi-font-family: Calibri;"><span style="font-family: Calibri;">Manifestasi Klinis</span></span></b></div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; tab-stops: 1.0cm; text-align: justify; text-indent: 1cm;"><span style="font-size: 12pt; mso-bidi-font-family: Calibri;"><span style="font-family: Calibri;">Gejala utama dari gagal jantung adalah kelelahan dan sesak nafas. Awalnya kelelahan dijelaskan karena cardiac output yang rendah namun abnormalitas otot skelet dan komorbiditas non-cardiac (anemia) juga berkontribusi pada gejala ini. Pada tahap awal gagal jantung, sesak nafas terjadi saat beraktivitas, namun dengan berkembangnya penyakit sesak nafas dapat terjadi pada aktivitas yang ringan bahkan lama kelamaan pada keadaan istirahat. Mekanisme terjadinya sesak nafas adalah terjadinya kongesti paru.</span></span></div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; tab-stops: 1.0cm; text-align: justify; text-indent: 1cm;"><span style="font-size: 12pt; mso-bidi-font-family: Calibri;"><span style="font-family: Calibri;">Orthopnea merupakan gejala berupa sesak nafas dalam posisi berbaring. Hal ini disebabkan redistribusi cairan dari sirkulasi splancnic dan ekstremitas bawah ke sirkulasi sentral saat berbaring, sehingga terjadi peningkatan tekanan kapiler paru. Orthopnea dapat berkurang dengan duduk atau tidur dengan menggunakan banyak bantal.</span></span></div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; tab-stops: 1.0cm; text-align: justify; text-indent: 1cm;"><span style="font-size: 12pt; mso-bidi-font-family: Calibri;"><span style="font-family: Calibri;">Paroxysmal nocturnal dyspnea<span style="mso-spacerun: yes;"> </span>adalah sesak nafas yang terjadi pada malam hari dan biasanya membangunkan pasien dari tidurnya. PND dapat berupa batuk ataupun bersin. Hal ini disebabkan adanya peningkatan arteri bronchial yang menyebabkan kompresi jalan nafas.</span></span></div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; tab-stops: 1.0cm; text-align: justify; text-indent: 1cm;"><span style="font-size: 12pt; mso-bidi-font-family: Calibri;"><span style="font-family: Calibri;">Manifestasi lain dapat berupa pernafasan Cheyne-stoke, anoreksia, nausea, nyeri abdomen dan rasa penuh di abdomen, nocturia, insomnia.</span></span></div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; tab-stops: 1.0cm; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; tab-stops: 1.0cm; text-align: justify;"><b style="mso-bidi-font-weight: normal;"><span style="font-size: 12pt; mso-bidi-font-family: Calibri;"><span style="font-family: Calibri;">Pemeriksaan Fisik</span></span></b></div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt 1cm; mso-list: l1 level1 lfo1; tab-stops: 1.0cm; text-align: justify; text-indent: -1cm;"><span style="font-family: "Arial", "sans-serif"; font-size: 12pt; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">-<span style="font-family: "Times New Roman";"> </span></span></span><span style="font-size: 12pt; mso-bidi-font-family: Calibri;"><span style="font-family: Calibri;">Keadaan umum dan vital sign</span></span></div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt 1cm; tab-stops: 1.0cm; text-align: justify;"><span style="font-size: 12pt; mso-bidi-font-family: Calibri;"><span style="font-family: Calibri;">Pada pasien dengan gagal jantung ringan sampai sedang, pasien tampak baik saat istirahat kecuali adanya rasa tidak nyaman saat berbaring. Pada pasien yang lebih berat, pasien lebih nyaman saat duduk, sulit bernafas dan bicara tersendat karena sesak nafas. Vasokonstriksi perifer menyebabkan ekstremitas dingin dan sianosis pada bibir.</span></span></div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt 1cm; tab-stops: 1.0cm; text-align: justify;"><span style="font-size: 12pt; mso-bidi-font-family: Calibri;"><span style="font-family: Calibri;">Tekanan darah normal, tinggi atau rendah, takikardi , takipnea.</span></span></div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt 1cm; mso-list: l1 level1 lfo1; tab-stops: 1.0cm; text-align: justify; text-indent: -1cm;"><span style="font-family: "Arial", "sans-serif"; font-size: 12pt; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">-<span style="font-family: "Times New Roman";"> </span></span></span><span style="font-size: 12pt; mso-bidi-font-family: Calibri;"><span style="font-family: Calibri;">Vena jugularis</span></span></div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt 1cm; tab-stops: 1.0cm; text-align: justify;"><span style="font-size: 12pt; mso-bidi-font-family: Calibri;"><span style="font-family: Calibri;">Dapat terjadi peningkatan tekanan jugularis.</span></span></div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt 1cm; mso-list: l1 level1 lfo1; tab-stops: 1.0cm; text-align: justify; text-indent: -1cm;"><span style="font-family: "Arial", "sans-serif"; font-size: 12pt; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">-<span style="font-family: "Times New Roman";"> </span></span></span><span style="font-size: 12pt; mso-bidi-font-family: Calibri;"><span style="font-family: Calibri;">Pemeriksaan paru</span></span></div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt 1cm; tab-stops: 1.0cm; text-align: justify;"><span style="font-size: 12pt; mso-bidi-font-family: Calibri;"><span style="font-family: Calibri;">Terdapat pulmonary cracles (rales atau krepitasi) karena adanya transudasi cairan dari intravaskular kedalam alveoli. Pada pasien dengan edema paru dapat terdengar rales pada kedua lapangan paru dan dapat pula ditambah adanya wheezing. Dapat pula terjadi efusi pleura yang disebabkan peningkatan tekanan kapiler pleura sehingga terjadi perpindahan cairan ke kavitas pleura.</span></span></div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt 1cm; mso-list: l1 level1 lfo1; tab-stops: 1.0cm; text-align: justify; text-indent: -1cm;"><span style="font-family: "Arial", "sans-serif"; font-size: 12pt; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">-<span style="font-family: "Times New Roman";"> </span></span></span><span style="font-size: 12pt; mso-bidi-font-family: Calibri;"><span style="font-family: Calibri;">Pemeriksaan jantung</span></span></div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt 1cm; tab-stops: 1.0cm; text-align: justify;"><span style="font-size: 12pt; mso-bidi-font-family: Calibri;"><span style="font-family: Calibri;">Pada pasien dengan kardiomegali maka ictus cordis akan bergeser ke garis midclavicular dan impulse dapat teraba lebih dari 2 intercosta. Dapat terdengar suara jantung 3 (S3). Pada pasien gagal jantung lanjut kebanyakan didapatkan murmur karena regurgitasi mitral dan tricuspid.</span></span></div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt 1cm; mso-list: l1 level1 lfo1; tab-stops: 1.0cm; text-align: justify; text-indent: -1cm;"><span style="font-family: "Arial", "sans-serif"; font-size: 12pt; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">-<span style="font-family: "Times New Roman";"> </span></span></span><span style="font-size: 12pt; mso-bidi-font-family: Calibri;"><span style="font-family: Calibri;">Pemeriksaan abdomen dan ekstremitas</span></span></div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt 1cm; tab-stops: 1.0cm; text-align: justify;"><span style="font-size: 12pt; mso-bidi-font-family: Calibri;"><span style="font-family: Calibri;">Hepatomegali merupakan tanda yang penting. Ascites merupakan tanda gagal jantung lanjut.</span></span></div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt 1cm; tab-stops: 1.0cm; text-align: justify;"><span style="font-size: 12pt; mso-bidi-font-family: Calibri;"><span style="font-family: Calibri;">Edema perifer merupakan manifestasi utama dari gagal jantung, namun tidak spesifik. Edema perifer biasanya simetris dan terjadi pada pergelangan kaki dan area pretibial pada pasien yang dapat berjalan, sedangkan pada pasien yang berbaring edema akan terjadi pada area sacral dan scrotum.</span></span></div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; tab-stops: 1.0cm; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; tab-stops: 1.0cm; text-align: justify;"><b style="mso-bidi-font-weight: normal;"><span style="font-size: 12pt; mso-bidi-font-family: Calibri;"><span style="font-family: Calibri;">Pemeriksaan Penunjang</span></span></b></div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt 1cm; mso-list: l1 level1 lfo1; tab-stops: 1.0cm; text-align: justify; text-indent: -1cm;"><span style="font-family: "Arial", "sans-serif"; font-size: 12pt; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">-<span style="font-family: "Times New Roman";"> </span></span></span><span style="font-size: 12pt; mso-bidi-font-family: Calibri;"><span style="font-family: Calibri;">Pemeriksaan rutin</span></span></div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt 1cm; tab-stops: 1.0cm; text-align: justify;"><span style="font-size: 12pt; mso-bidi-font-family: Calibri;"><span style="font-family: Calibri;">pemeriksaan darah lengkap, pemeriksaan elektrolit, BUN, serum kreatinin, enzim hepar, dan urinalisis. Pada pasien tertentu harus diperiksa faktor risiko DM (glukosa plasma puasa) dan dislipidemia (profil lipid).</span></span></div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt 1cm; mso-list: l1 level1 lfo1; tab-stops: 1.0cm; text-align: justify; text-indent: -1cm;"><span style="font-family: "Arial", "sans-serif"; font-size: 12pt; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">-<span style="font-family: "Times New Roman";"> </span></span></span><span style="font-size: 12pt; mso-bidi-font-family: Calibri;"><span style="font-family: Calibri;">Elektrokardiogram</span></span></div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt 1cm; tab-stops: 1.0cm; text-align: justify;"><span style="font-size: 12pt; mso-bidi-font-family: Calibri;"><span style="font-family: Calibri;">Periksa ritme jantung, adanya hipretrofi ventrikel kiri, atau adanya infark miokard sebelumnya.</span></span></div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt 1cm; mso-list: l1 level1 lfo1; tab-stops: 1.0cm; text-align: justify; text-indent: -1cm;"><span style="font-family: "Arial", "sans-serif"; font-size: 12pt; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">-<span style="font-family: "Times New Roman";"> </span></span></span><span style="font-size: 12pt; mso-bidi-font-family: Calibri;"><span style="font-family: Calibri;">X-ray thoraks</span></span></div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt 1cm; tab-stops: 1.0cm; text-align: justify;"><span style="font-size: 12pt; mso-bidi-font-family: Calibri;"><span style="font-family: Calibri;">Ditentukan ukuran jantung dan bentuknya dan keadaan vaskularisasi pulmonal. Pada pasien gagal jantung akut akan didapatkan hipertensi pulmonal, edema interstitial atau edema paru, namun pada gagal jantung kronik hal-hal tersebut mungkin tidak ditemukan.</span></span></div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; tab-stops: 1.0cm; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; tab-stops: 1.0cm; text-align: justify;"><b style="mso-bidi-font-weight: normal;"><span style="font-size: 12pt; mso-bidi-font-family: Calibri;"><span style="font-family: Calibri;">Treatmen</span></span></b></div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; tab-stops: 1.0cm; text-align: justify;"><span lang="SV" style="font-size: 12pt; mso-ansi-language: SV; mso-bidi-font-family: Calibri;"></span><b style="mso-bidi-font-weight: normal;"><span style="font-size: 12pt; mso-bidi-font-family: Calibri;"></span></b></div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt 1cm; mso-list: l1 level1 lfo1; tab-stops: 1.0cm; text-align: justify; text-indent: -1cm;"><span style="font-family: "Arial", "sans-serif"; font-size: 12pt; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">-<span style="font-family: "Times New Roman";"> </span></span></span><span style="font-size: 12pt; mso-bidi-font-family: Calibri;"><span style="font-family: Calibri;">Penderita gagal jantung perlu istirahat sesuai dengan berat penyakit. Pada gejala berat berbaring setengah duduk paling baik. Selanjutnya aktivitas fisik disesuaikan dengan kemampuan jantung.</span></span></div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt 1cm; mso-list: l1 level1 lfo1; tab-stops: 1.0cm; text-align: justify; text-indent: -1cm;"><span style="font-family: "Arial", "sans-serif"; font-size: 12pt; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">-<span style="font-family: "Times New Roman";"> </span></span></span><span style="font-size: 12pt; mso-bidi-font-family: Calibri;"><span style="font-family: Calibri;">Penderita harus membatasi asupan garam.</span></span></div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt 1cm; mso-list: l1 level1 lfo1; tab-stops: 1.0cm; text-align: justify; text-indent: -1cm;"><span style="font-family: "Arial", "sans-serif"; font-size: 12pt; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">-<span style="font-family: "Times New Roman";"> </span></span></span><span style="font-size: 12pt; mso-bidi-font-family: Calibri;"><span style="font-family: Calibri;">Diuretik furosemid tablet 40 mg 1-2 kali sehari bermanfaat sebagai obat tunggal untuk gagal jantung yang tanda bendungannya menonjol. Diuretik ini dapat diberikan tanpa digitalis bila tidak ada takikardia.</span></span></div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt 1cm; mso-list: l1 level1 lfo1; tab-stops: 1.0cm; text-align: justify; text-indent: -1cm;"><span style="font-family: "Arial", "sans-serif"; font-size: 12pt; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">-<span style="font-family: "Times New Roman";"> </span></span></span><span style="font-size: 12pt; mso-bidi-font-family: Calibri;"><span style="font-family: Calibri;">Bila diuretik digunakan bersama dengan digitalis maka perlu diberikan KCL 500 mg 1-3 kali sehari secara oral, dengan monitoring kadar Na+ dan K+ plasma.</span></span></div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt 1cm; mso-list: l1 level1 lfo1; tab-stops: 1.0cm; text-align: justify; text-indent: -1cm;"><span style="font-family: "Arial", "sans-serif"; font-size: 12pt; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">-<span style="font-family: "Times New Roman";"> </span></span></span><span style="font-size: 12pt; mso-bidi-font-family: Calibri;"><span style="font-family: Calibri;">Pada gagal jantung yang lebih berat mungkin diperluka digitalis. Digitalis<span style="mso-spacerun: yes;"> </span>sebailnya dilakukan secara lambat dengan digoksin 0,25 mg/hari.</span></span></div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt 1cm; mso-list: l1 level1 lfo1; tab-stops: 1.0cm; text-align: justify; text-indent: -1cm;"><span style="font-family: "Arial", "sans-serif"; font-size: 12pt; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">-<span style="font-family: "Times New Roman";"> </span></span></span><span style="font-size: 12pt; mso-bidi-font-family: Calibri;"><span style="font-family: Calibri;">Bila mungkin berikan oksigen.</span></span></div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt 1cm; mso-list: l1 level1 lfo1; tab-stops: 1.0cm; text-align: justify; text-indent: -1cm;"><span style="font-family: "Arial", "sans-serif"; font-size: 12pt; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">-<span style="font-family: "Times New Roman";"> </span></span></span><span style="font-size: 12pt; mso-bidi-font-family: Calibri;"><span style="font-family: Calibri;">Penderita yang menunjukkan keluhan dalam keadaan istirahat atau yang disertai gejala edema paru perlu dirujuk, sebelumnya diberikan dulu furosemid, KCl dan digoksin.</span></span></div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt 1cm; tab-stops: 1.0cm; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; tab-stops: 1.0cm; text-align: justify; text-indent: 1cm;"><span style="font-size: 12pt; mso-bidi-font-family: Calibri;"><span style="font-family: Calibri;">Dalam memberikan treatmen untuk pasien gagal jantung pendekatan yang digunakan adalah klasifikasi gagal jantung dalam 4 stage.</span></span></div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt 1cm; mso-list: l0 level1 lfo2; tab-stops: 1.0cm; text-align: justify; text-indent: -1cm;"><span style="font-size: 12pt; mso-bidi-font-family: Calibri;"><span style="mso-list: Ignore;"><span style="font-family: Calibri;">1.</span><span style="font-family: "Times New Roman";"> </span></span></span><span style="font-size: 12pt; mso-bidi-font-family: Calibri;"><span style="font-family: Calibri;">Stage A</span></span></div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt 1cm; tab-stops: 1.0cm; text-align: justify;"><span style="font-size: 12pt; mso-bidi-font-family: Calibri;"><span style="font-family: Calibri;">Pasien mempunyai risiko tinggi untuk terjadi gagal jantung namun tanpa penyakit jantung struktural atau tanda gagal jantung.</span></span></div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt 1cm; tab-stops: 1.0cm; text-align: justify;"><span style="font-size: 12pt; mso-bidi-font-family: Calibri;"><span style="font-family: Calibri;">Contohnya pasien dengan hipertensi, atherosklerosis, DM, obesitas, sindroma metabolik.</span></span></div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt 1cm; tab-stops: 1.0cm; text-align: justify;"><span style="font-size: 12pt; mso-bidi-font-family: Calibri;"><span style="font-family: Calibri;">Terapi : terapi hipertensi, hentikan merokok, terapi dislipidemia, aktivitas fisik yang teratur, hindari alkohol, kontrol sindroma metabolik, apabila diperlukan beri ACE inhibitor.</span></span></div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt 1cm; mso-list: l0 level1 lfo2; tab-stops: 1.0cm; text-align: justify; text-indent: -1cm;"><span style="font-size: 12pt; mso-bidi-font-family: Calibri;"><span style="mso-list: Ignore;"><span style="font-family: Calibri;">2.</span><span style="font-family: "Times New Roman";"> </span></span></span><span style="font-size: 12pt; mso-bidi-font-family: Calibri;"><span style="font-family: Calibri;">Stage B</span></span></div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt 1cm; tab-stops: 1.0cm; text-align: justify;"><span style="font-size: 12pt; mso-bidi-font-family: Calibri;"><span style="font-family: Calibri;">Pasien mempunyai penyakit jantung struktural namun tidak ada gejala gagal jantung.</span></span></div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt 1cm; tab-stops: 1.0cm; text-align: justify;"><span style="font-size: 12pt; mso-bidi-font-family: Calibri;"><span style="font-family: Calibri;">Contohnya pasien dengan infark miokard sebelumnya, left ventricular remodeling, hipertrofi ventrikel kiri.</span></span></div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt 1cm; tab-stops: 1.0cm; text-align: justify;"><span style="font-size: 12pt; mso-bidi-font-family: Calibri;"><span style="font-family: Calibri;">Terapi : semua terapi pada stage A, pada pasien yang sesuai berikan ACE inhibitor atau ARBs, β blocker, dapat pula dipasang implantable defibrillator.</span></span></div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt 1cm; mso-list: l0 level1 lfo2; tab-stops: 1.0cm; text-align: justify; text-indent: -1cm;"><span style="font-size: 12pt; mso-bidi-font-family: Calibri;"><span style="mso-list: Ignore;"><span style="font-family: Calibri;">3.</span><span style="font-family: "Times New Roman";"> </span></span></span><span style="font-size: 12pt; mso-bidi-font-family: Calibri;"><span style="font-family: Calibri;">Stage C</span></span></div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt 1cm; tab-stops: 1.0cm; text-align: justify;"><span style="font-size: 12pt; mso-bidi-font-family: Calibri;"><span style="font-family: Calibri;">Pasien mempunyai penyakit jantung struktural, dengan gejala gagal jantung sebelumnya.</span></span></div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt 1cm; tab-stops: 1.0cm; text-align: justify;"><span style="font-size: 12pt; mso-bidi-font-family: Calibri;"><span style="font-family: Calibri;">Contohnya pasien yang sudah diketahui mempunyai penyakit jantung struktural, pasien denga sesak nafas dan kelelahan dan penurunan toleransi terhadap aktivitas fisik.</span></span></div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt 1cm; tab-stops: 1.0cm; text-align: justify;"><span style="font-size: 12pt; mso-bidi-font-family: Calibri;"><span style="font-family: Calibri;">Terapi : semua terapi pada stage A dan B, kurangi konsumsi garam, berikan diuretik, ACE inhibitor, β blocker. Pada pasien yang sesuai berikan ARBs, digitalis, hydralazine, pemasangan<span style="mso-spacerun: yes;"> </span>biventricular pacing, implantable defibrilator.</span></span></div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt 1cm; mso-list: l0 level1 lfo2; tab-stops: 1.0cm; text-align: justify; text-indent: -1cm;"><span style="font-size: 12pt; mso-bidi-font-family: Calibri;"><span style="mso-list: Ignore;"><span style="font-family: Calibri;">4.</span><span style="font-family: "Times New Roman";"> </span></span></span><span style="font-size: 12pt; mso-bidi-font-family: Calibri;"><span style="font-family: Calibri;">Stage D</span></span></div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt 1cm; tab-stops: 1.0cm; text-align: justify;"><span style="font-size: 12pt; mso-bidi-font-family: Calibri;"><span style="font-family: Calibri;">Gagal jantung yang memerlukan intervensi khusus.</span></span></div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt 1cm; tab-stops: 1.0cm; text-align: justify;"><span style="font-size: 12pt; mso-bidi-font-family: Calibri;"><span style="font-family: Calibri;">Contohnya pasien yang mengalami gejala saat istirahat walaupun sudah diterapi maksimal.</span></span></div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt 1cm; tab-stops: 1.0cm; text-align: justify;"><span style="font-size: 12pt; mso-bidi-font-family: Calibri;"><span style="font-family: Calibri;">Terapi : terapi pada stage A,B, dan C, end of life hospice, heart transplantation, inotropik kronis.</span></span></div>Anonymoushttp://www.blogger.com/profile/17040699491469284898noreply@blogger.com0tag:blogger.com,1999:blog-7514639870940573862.post-12978292756148683492011-10-02T07:51:00.000-07:002011-10-03T00:03:34.461-07:00pterygium<div class="MsoNormal" style="margin: 0cm 0cm 10pt; text-align: justify;"><span style="font-family: Times, "Times New Roman", serif; font-size: 12pt; line-height: 115%;">Pterygium atau yang lebih dikenal sebagai mata berselaput banyak dialami dikalangan masyarakat, terutama masyarakat didaerah katulistiwa. Penyakit ini awalnya tidak dirasakan mengganggu oleh penderita. Namun hati-hati karena bila terus diabaikan, penyakit ini dapat mengakibatkan <u>kebutaan</u>.</span><br />
<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgDklTvHgbsR4zpJT_gvY14yf-RIpTKk5kCq0uCjerKC_1sVdVlTW2o6F_Y7RVuStp4rjrUO63OQ-k8fAtG_X1-Zljb2yfAChoKFYX3nxNwzOZl3CopNtK8BOfULCaD6ssFhji_TCse_Bbr/s1600/Pterig1.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="131" kca="true" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgDklTvHgbsR4zpJT_gvY14yf-RIpTKk5kCq0uCjerKC_1sVdVlTW2o6F_Y7RVuStp4rjrUO63OQ-k8fAtG_X1-Zljb2yfAChoKFYX3nxNwzOZl3CopNtK8BOfULCaD6ssFhji_TCse_Bbr/s200/Pterig1.jpg" width="200" /></a></div></div><span style="font-family: Times, "Times New Roman", serif; font-size: 12pt; line-height: 115%; mso-ansi-language: IN; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US;"></span><br />
<span style="font-family: Times, "Times New Roman", serif;"><a name='more'></a></span><br />
<div class="MsoListParagraphCxSpFirst" style="margin: 0cm 0cm 0pt; mso-add-space: auto; text-align: justify;"><b style="mso-bidi-font-weight: normal;"><u><span style="font-family: Times, "Times New Roman", serif; font-size: 12pt; line-height: 115%;">PTERYGIUM</span></u></b></div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt; mso-add-space: auto; text-align: justify;"><span style="font-family: Times, "Times New Roman", serif;"><br />
</span></div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt; mso-add-space: auto; text-align: justify;"><span style="font-family: Times, "Times New Roman", serif; font-size: 12pt; line-height: 115%;">Pterygium adalah suatu penyakit mata yang ditunjukkan dengan adanya pertumbuhan massa okular dibagian eksterna, superfisial yang biasanya terbentuk disekitar limbus dan tumbuh hingga permukaan kornea. Pterygium dapat tumbuh menjadi bervariasi mulai dari lesi yang kecil dan atropik hingga lesi yang besar, agresif dan tumbuh dengan cepat sehingga dapat mengubah topografi kornea dan mengubah <i style="mso-bidi-font-style: normal;">optical center</i> dari kornea.</span></div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt; mso-add-space: auto; text-align: justify;"><u><span style="font-family: Times, "Times New Roman", serif; font-size: 12pt; line-height: 115%;">Patofisiologi</span></u></div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt; mso-add-space: auto; text-align: justify;"><span style="font-family: Times, "Times New Roman", serif; font-size: 12pt; line-height: 115%;">Patofisiologi pterygium mempunyai karakteristik berupa degenerasi dari kolagen dan proliferasi jaringan fibrovaskular yang diselubungi dengan lapisan epitelium. Area kolagen abnormal ini pada pemeriksaan histopatologi dengan pewarnaan HE menunjukkan adanya basofil. Beberapa faktor risiko pterygium meliputi paparan ultraviolet, mikrotrauma kronis pada mata, infeksi mikroba atau virus. Selain itu beberapa kondisi seperti kekurangan funsi lakrimasi, konjungtivitis kronis, dan defisiensi vitamin A juga berpotensi menimbulkan pterygium.</span></div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt; mso-add-space: auto; text-align: justify;"><u><span style="font-family: Times, "Times New Roman", serif; font-size: 12pt; line-height: 115%;">Epidemiologi</span></u></div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt; mso-add-space: auto; text-align: justify;"><span style="font-family: Times, "Times New Roman", serif; font-size: 12pt; line-height: 115%;">Prevalensi dari pterygium bervariasi dan meningkat dengan peningkatan paparan terhadap sinar ultraviolet. Pasien dengan usia lebih dari 40 tahun mempunyai prevalensi pterygium yang paling tinggi, sedangkan pasien dengan usia 20-40 tahun mempunyai insidensi pterygium yang paling tinggi. Pterigium dapat menyebabkan gangguan fungsi visual, sumber peradangan yang menyebabkan mata merah dan iritasi mata.</span></div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt; mso-add-space: auto; text-align: justify;"><u><span style="font-family: Times, "Times New Roman", serif; font-size: 12pt; line-height: 115%;">Penampakan Klinis</span></u></div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt; mso-add-space: auto; text-align: justify;"><span style="font-family: Times, "Times New Roman", serif; font-size: 12pt; line-height: 115%;">Pasien dengan pterygium mempunyai keluhan yang bervariasi mulai dari mata merah, bengkak, gatal, iritasi, dan pandangan kabur.</span></div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt; mso-add-space: auto; text-align: justify;"><span style="font-family: Times, "Times New Roman", serif; font-size: 12pt; line-height: 115%;">Pterygium tumbuh sebagai jaringan fibrovaskular pada permukaan konjungtiva dan kornea. Bentuk yang paling umum adalah tumbuh pada konjungtiva sisi nasal dan memanjang hingga kornea.</span></div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt; mso-add-space: auto; text-align: justify;"><span style="font-family: Times, "Times New Roman", serif; font-size: 12pt; line-height: 115%;">Secara umum pterygium dapat diklasifikasikan menjadi 3 tipe, yaitu:</span></div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 1cm; mso-add-space: auto; mso-list: l0 level1 lfo1; text-align: justify; text-indent: -1cm;"><span style="font-family: Times, "Times New Roman", serif;"><span style="font-size: 12pt; line-height: 115%; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">1. </span></span><span style="font-size: 12pt; line-height: 115%;">tipe 1 : pterygium kecil, lesi hanya terbatas pada limbus atau menginvasi kornea pada tepinya saja.</span></span></div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 1cm; mso-add-space: auto; mso-list: l0 level1 lfo1; text-align: justify; text-indent: -1cm;"><span style="font-family: Times, "Times New Roman", serif;"><span style="font-size: 12pt; line-height: 115%; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">2. </span></span><span style="font-size: 12pt; line-height: 115%;">tipe 2 : disebut juga sebagai pterygium primer advanced atau pterygium rekuren tanpa keterlibatan zona optik. Pada tipe ini pterygium tumbuh hingga kornea, namun tidak sampai pada zona optik.</span></span></div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 1cm; mso-add-space: auto; mso-list: l0 level1 lfo1; text-align: justify; text-indent: -1cm;"><span style="font-family: Times, "Times New Roman", serif;"><span style="font-size: 12pt; line-height: 115%; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">3. </span></span><span style="font-size: 12pt; line-height: 115%;">tipe 3 : pterygium primer atau rekuren dengan keterlibatan zona optik, merupakan bentuk pterygium yang paling berat, dan dapat menyebabkan kebutaan.</span></span></div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt; mso-add-space: auto; text-align: justify;"><u><span style="font-family: Times, "Times New Roman", serif; font-size: 12pt; line-height: 115%;">Penatalaksanaan</span></u></div><div class="MsoListParagraphCxSpLast" style="margin: 0cm 0cm 10pt; mso-add-space: auto; text-align: justify;"><span style="font-family: Times, "Times New Roman", serif; font-size: 12pt; line-height: 115%;">Pada prinsipnya, tatalaksana pterygium adalah dengan tindakan operasi. Terdapat beberapa teknik operasi yang telah dikembangakan, diantaranya adalah teknik <i style="mso-bidi-font-style: normal;">Bare Sclera, McReynold</i>, Transplantasi membran amnion (TMA), <i style="mso-bidi-font-style: normal;">Conjungtival flap</i>, dan <i style="mso-bidi-font-style: normal;">Conjungtival autograft</i>.</span><br />
<span style="font-family: Times, "Times New Roman", serif; font-size: 12pt; line-height: 115%; mso-ansi-language: IN; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US;">Masalah yang sangat penting dalam penanganan pterygium adalah masalah kekambuhan, yaitu angka kekambuhan pterygium yang sangat tinggi. Hal ini dapat dicegah dengan mengurangi kontak langsung mata kita dengan cahaya matahari, megnghindari debu dan angin dengan cara menggunakan kaca mata yang tepat.</span></div><div class="MsoNormal" style="margin: 0cm 0cm 10pt; text-align: justify;"><b style="mso-bidi-font-weight: normal;"><u><span style="font-family: Times, "Times New Roman", serif; font-size: 12pt; line-height: 115%;">Status Pasien</span></u></b></div><div class="MsoNormal" style="margin: 0cm 0cm 10pt; text-align: justify;"><span style="font-family: Times, "Times New Roman", serif; font-size: 12pt; line-height: 115%;">Nama<span style="mso-tab-count: 2;"> </span>:Ny S.</span></div><div class="MsoNormal" style="margin: 0cm 0cm 10pt; text-align: justify;"><span style="font-family: Times, "Times New Roman", serif; font-size: 12pt; line-height: 115%;">Umur<span style="mso-tab-count: 2;"> </span>: 35 tahun</span></div><div class="MsoNormal" style="margin: 0cm 0cm 10pt; text-align: justify;"><span style="font-family: Times, "Times New Roman", serif; font-size: 12pt; line-height: 115%;">Pekerjaan<span style="mso-tab-count: 1;"> </span>: Ibu Rumah Tangga</span></div><div class="MsoNormal" style="margin: 0cm 0cm 10pt; text-align: justify;"><b style="mso-bidi-font-weight: normal;"><u><span style="font-family: Times, "Times New Roman", serif; font-size: 12pt; line-height: 115%;">Anamnesis</span></u></b></div><div class="MsoNormal" style="margin: 0cm 0cm 10pt 42.55pt; text-align: justify; text-indent: -42.55pt;"><span style="font-family: Times, "Times New Roman", serif; font-size: 12pt; line-height: 115%;">KU<span style="mso-tab-count: 1;"> </span>: OD dan OS pandangan kabur</span></div><div class="MsoNormal" style="margin: 0cm 0cm 10pt 42.55pt; text-align: justify; text-indent: -42.55pt;"><span style="font-family: Times, "Times New Roman", serif; font-size: 12pt; line-height: 115%;">RPS<span style="mso-tab-count: 1;"> </span>: Pasien mengeluhkan pandangan kabur pada kedua mata. Keluhan ini muncul sudah sejak 4 tahun yang lalu, namun tidak terlalu mengganggu. Keluhan disertai dengan keluhan berupa mata merah, mata terus menerus berair (nrocos), dan rasa mengganjal. Keluhan dirasakan makin lama makin bertambah parah dan mengganggu.</span></div><div class="MsoNormal" style="margin: 0cm 0cm 10pt 42.55pt; text-align: justify; text-indent: -42.55pt;"><span style="font-family: Times, "Times New Roman", serif; font-size: 12pt; line-height: 115%;">RPD<span style="mso-tab-count: 1;"> </span>: Pasien pernah mengalami keluhan serupa yaitu saat pasien SMA, diobati dengan obat tetes dan membaik. Pasien tidak mempunyai riwayat hipertensi dan diabetes mellitus.</span></div><div class="MsoNormal" style="margin: 0cm 0cm 10pt 42.55pt; text-align: justify; text-indent: -42.55pt;"><b style="mso-bidi-font-weight: normal;"><u><span style="font-family: Times, "Times New Roman", serif; font-size: 12pt; line-height: 115%;">Pemeriksaan</span></u></b></div><span style="font-family: Times, "Times New Roman", serif;"><br />
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<table border="1" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border-bottom: medium none; border-collapse: collapse; border-left: medium none; border-right: medium none; border-top: medium none; margin: auto auto auto 42.55pt; mso-border-alt: solid black .5pt; mso-border-insideh: .5pt solid black; mso-border-insidev: .5pt solid black; mso-padding-alt: 0cm 5.4pt 0cm 5.4pt; mso-yfti-tbllook: 1184;"><tbody>
<tr style="mso-yfti-firstrow: yes; mso-yfti-irow: 0;"><td style="background-color: transparent; border-bottom: black 1pt solid; border-left: black 1pt solid; border-right: black 1pt solid; border-top: black 1pt solid; mso-border-alt: solid black .5pt; padding-bottom: 0cm; padding-left: 5.4pt; padding-right: 5.4pt; padding-top: 0cm; width: 161.3pt;" valign="top" width="215"><div align="right" class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: right;"><span style="font-family: Times, "Times New Roman", serif; font-size: 12pt;">OD</span></div></td><td style="background-color: transparent; border-bottom: black 1pt solid; border-left: #f0f0f0; border-right: black 1pt solid; border-top: black 1pt solid; mso-border-alt: solid black .5pt; mso-border-left-alt: solid black .5pt; padding-bottom: 0cm; padding-left: 5.4pt; padding-right: 5.4pt; padding-top: 0cm; width: 99.25pt;" valign="top" width="132"><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: justify;"><span style="font-family: Times, "Times New Roman", serif;"><br />
</span></div></td><td style="background-color: transparent; border-bottom: black 1pt solid; border-left: #f0f0f0; border-right: black 1pt solid; border-top: black 1pt solid; mso-border-alt: solid black .5pt; mso-border-left-alt: solid black .5pt; padding-bottom: 0cm; padding-left: 5.4pt; padding-right: 5.4pt; padding-top: 0cm; width: 159pt;" valign="top" width="212"><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: justify;"><span style="font-family: Times, "Times New Roman", serif; font-size: 12pt;">OS</span></div></td></tr>
<tr style="mso-yfti-irow: 1;"><td style="background-color: transparent; border-bottom: black 1pt solid; border-left: black 1pt solid; border-right: black 1pt solid; border-top: #f0f0f0; mso-border-alt: solid black .5pt; mso-border-top-alt: solid black .5pt; padding-bottom: 0cm; padding-left: 5.4pt; padding-right: 5.4pt; padding-top: 0cm; width: 161.3pt;" valign="top" width="215"><div align="right" class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: right;"><span style="font-family: Times, "Times New Roman", serif;">6/6</span></div></td><td style="background-color: transparent; border-bottom: black 1pt solid; border-left: #f0f0f0; border-right: black 1pt solid; border-top: #f0f0f0; mso-border-alt: solid black .5pt; mso-border-left-alt: solid black .5pt; mso-border-top-alt: solid black .5pt; padding-bottom: 0cm; padding-left: 5.4pt; padding-right: 5.4pt; padding-top: 0cm; width: 99.25pt;" valign="top" width="132"><div align="center" class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: center;"><span style="font-family: Times, "Times New Roman", serif;">Visus</span></div></td><td style="background-color: transparent; border-bottom: black 1pt solid; border-left: #f0f0f0; border-right: black 1pt solid; border-top: #f0f0f0; mso-border-alt: solid black .5pt; mso-border-left-alt: solid black .5pt; mso-border-top-alt: solid black .5pt; padding-bottom: 0cm; padding-left: 5.4pt; padding-right: 5.4pt; padding-top: 0cm; width: 159pt;" valign="top" width="212"><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt;"><span style="font-family: Times, "Times New Roman", serif;">1/300; 3/60 (temporal)</span></div></td></tr>
<tr style="mso-yfti-irow: 2;"><td style="background-color: transparent; border-bottom: black 1pt solid; border-left: black 1pt solid; border-right: black 1pt solid; border-top: #f0f0f0; mso-border-alt: solid black .5pt; mso-border-top-alt: solid black .5pt; padding-bottom: 0cm; padding-left: 5.4pt; padding-right: 5.4pt; padding-top: 0cm; width: 161.3pt;" valign="top" width="215"><div align="right" class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: right;"><span style="font-family: Times, "Times New Roman", serif;">dbn</span></div></td><td style="background-color: transparent; border-bottom: black 1pt solid; border-left: #f0f0f0; border-right: black 1pt solid; border-top: #f0f0f0; mso-border-alt: solid black .5pt; mso-border-left-alt: solid black .5pt; mso-border-top-alt: solid black .5pt; padding-bottom: 0cm; padding-left: 5.4pt; padding-right: 5.4pt; padding-top: 0cm; width: 99.25pt;" valign="top" width="132"><div align="center" class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: center;"><span style="font-family: Times, "Times New Roman", serif;">Palpebra</span></div></td><td style="background-color: transparent; border-bottom: black 1pt solid; border-left: #f0f0f0; border-right: black 1pt solid; border-top: #f0f0f0; mso-border-alt: solid black .5pt; mso-border-left-alt: solid black .5pt; mso-border-top-alt: solid black .5pt; padding-bottom: 0cm; padding-left: 5.4pt; padding-right: 5.4pt; padding-top: 0cm; width: 159pt;" valign="top" width="212"><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt;"><span style="font-family: Times, "Times New Roman", serif;">dbn</span></div></td></tr>
<tr style="mso-yfti-irow: 3;"><td style="background-color: transparent; border-bottom: black 1pt solid; border-left: black 1pt solid; border-right: black 1pt solid; border-top: #f0f0f0; mso-border-alt: solid black .5pt; mso-border-top-alt: solid black .5pt; padding-bottom: 0cm; padding-left: 5.4pt; padding-right: 5.4pt; padding-top: 0cm; width: 161.3pt;" valign="top" width="215"><div align="right" class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: right;"><span style="font-family: Times, "Times New Roman", serif;">dbn</span></div></td><td style="background-color: transparent; border-bottom: black 1pt solid; border-left: #f0f0f0; border-right: black 1pt solid; border-top: #f0f0f0; mso-border-alt: solid black .5pt; mso-border-left-alt: solid black .5pt; mso-border-top-alt: solid black .5pt; padding-bottom: 0cm; padding-left: 5.4pt; padding-right: 5.4pt; padding-top: 0cm; width: 99.25pt;" valign="top" width="132"><div align="center" class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: center;"><span style="font-family: Times, "Times New Roman", serif;">Konjungtiva</span></div></td><td style="background-color: transparent; border-bottom: black 1pt solid; border-left: #f0f0f0; border-right: black 1pt solid; border-top: #f0f0f0; mso-border-alt: solid black .5pt; mso-border-left-alt: solid black .5pt; mso-border-top-alt: solid black .5pt; padding-bottom: 0cm; padding-left: 5.4pt; padding-right: 5.4pt; padding-top: 0cm; width: 159pt;" valign="top" width="212"><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt;"><span style="font-family: Times, "Times New Roman", serif;">Hiperemis(-), pterigium(+)</span></div></td></tr>
<tr style="mso-yfti-irow: 4;"><td style="background-color: transparent; border-bottom: black 1pt solid; border-left: black 1pt solid; border-right: black 1pt solid; border-top: #f0f0f0; mso-border-alt: solid black .5pt; mso-border-top-alt: solid black .5pt; padding-bottom: 0cm; padding-left: 5.4pt; padding-right: 5.4pt; padding-top: 0cm; width: 161.3pt;" valign="top" width="215"><div align="right" class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: right;"><span style="font-family: Times, "Times New Roman", serif;">Jernih</span></div></td><td style="background-color: transparent; border-bottom: black 1pt solid; border-left: #f0f0f0; border-right: black 1pt solid; border-top: #f0f0f0; mso-border-alt: solid black .5pt; mso-border-left-alt: solid black .5pt; mso-border-top-alt: solid black .5pt; padding-bottom: 0cm; padding-left: 5.4pt; padding-right: 5.4pt; padding-top: 0cm; width: 99.25pt;" valign="top" width="132"><div align="center" class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: center;"><span style="font-family: Times, "Times New Roman", serif;">Kornea</span></div></td><td style="background-color: transparent; border-bottom: black 1pt solid; border-left: #f0f0f0; border-right: black 1pt solid; border-top: #f0f0f0; mso-border-alt: solid black .5pt; mso-border-left-alt: solid black .5pt; mso-border-top-alt: solid black .5pt; padding-bottom: 0cm; padding-left: 5.4pt; padding-right: 5.4pt; padding-top: 0cm; width: 159pt;" valign="top" width="212"><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt;"><span style="font-family: Times, "Times New Roman", serif;">sdn</span></div></td></tr>
<tr style="mso-yfti-irow: 5;"><td style="background-color: transparent; border-bottom: black 1pt solid; border-left: black 1pt solid; border-right: black 1pt solid; border-top: #f0f0f0; mso-border-alt: solid black .5pt; mso-border-top-alt: solid black .5pt; padding-bottom: 0cm; padding-left: 5.4pt; padding-right: 5.4pt; padding-top: 0cm; width: 161.3pt;" valign="top" width="215"><div align="right" class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: right;"><span style="font-family: Times, "Times New Roman", serif;">Kesan dangkal, jernih</span></div></td><td style="background-color: transparent; border-bottom: black 1pt solid; border-left: #f0f0f0; border-right: black 1pt solid; border-top: #f0f0f0; mso-border-alt: solid black .5pt; mso-border-left-alt: solid black .5pt; mso-border-top-alt: solid black .5pt; padding-bottom: 0cm; padding-left: 5.4pt; padding-right: 5.4pt; padding-top: 0cm; width: 99.25pt;" valign="top" width="132"><div align="center" class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: center;"><span style="font-family: Times, "Times New Roman", serif;">COA</span></div></td><td style="background-color: transparent; border-bottom: black 1pt solid; border-left: #f0f0f0; border-right: black 1pt solid; border-top: #f0f0f0; mso-border-alt: solid black .5pt; mso-border-left-alt: solid black .5pt; mso-border-top-alt: solid black .5pt; padding-bottom: 0cm; padding-left: 5.4pt; padding-right: 5.4pt; padding-top: 0cm; width: 159pt;" valign="top" width="212"><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt;"><span style="font-family: Times, "Times New Roman", serif;">sdn</span></div></td></tr>
<tr style="mso-yfti-irow: 6;"><td style="background-color: transparent; border-bottom: black 1pt solid; border-left: black 1pt solid; border-right: black 1pt solid; border-top: #f0f0f0; mso-border-alt: solid black .5pt; mso-border-top-alt: solid black .5pt; padding-bottom: 0cm; padding-left: 5.4pt; padding-right: 5.4pt; padding-top: 0cm; width: 161.3pt;" valign="top" width="215"><div align="right" class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: right;"><span style="font-family: Times, "Times New Roman", serif;">Bulat, sentral, Ø 3 mm, RC (+)</span></div></td><td style="background-color: transparent; border-bottom: black 1pt solid; border-left: #f0f0f0; border-right: black 1pt solid; border-top: #f0f0f0; mso-border-alt: solid black .5pt; mso-border-left-alt: solid black .5pt; mso-border-top-alt: solid black .5pt; padding-bottom: 0cm; padding-left: 5.4pt; padding-right: 5.4pt; padding-top: 0cm; width: 99.25pt;" valign="top" width="132"><div align="center" class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: center;"><span style="font-family: Times, "Times New Roman", serif;">Iris/pupil</span></div></td><td style="background-color: transparent; border-bottom: black 1pt solid; border-left: #f0f0f0; border-right: black 1pt solid; border-top: #f0f0f0; mso-border-alt: solid black .5pt; mso-border-left-alt: solid black .5pt; mso-border-top-alt: solid black .5pt; padding-bottom: 0cm; padding-left: 5.4pt; padding-right: 5.4pt; padding-top: 0cm; width: 159pt;" valign="top" width="212"><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt;"><span style="font-family: Times, "Times New Roman", serif;">sdn</span></div></td></tr>
<tr style="mso-yfti-irow: 7;"><td style="background-color: transparent; border-bottom: black 1pt solid; border-left: black 1pt solid; border-right: black 1pt solid; border-top: #f0f0f0; mso-border-alt: solid black .5pt; mso-border-top-alt: solid black .5pt; padding-bottom: 0cm; padding-left: 5.4pt; padding-right: 5.4pt; padding-top: 0cm; width: 161.3pt;" valign="top" width="215"><div align="right" class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: right;"><span style="font-family: Times, "Times New Roman", serif;">Jernih</span></div></td><td style="background-color: transparent; border-bottom: black 1pt solid; border-left: #f0f0f0; border-right: black 1pt solid; border-top: #f0f0f0; mso-border-alt: solid black .5pt; mso-border-left-alt: solid black .5pt; mso-border-top-alt: solid black .5pt; padding-bottom: 0cm; padding-left: 5.4pt; padding-right: 5.4pt; padding-top: 0cm; width: 99.25pt;" valign="top" width="132"><div align="center" class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: center;"><span style="font-family: Times, "Times New Roman", serif;">Lensa</span></div></td><td style="background-color: transparent; border-bottom: black 1pt solid; border-left: #f0f0f0; border-right: black 1pt solid; border-top: #f0f0f0; mso-border-alt: solid black .5pt; mso-border-left-alt: solid black .5pt; mso-border-top-alt: solid black .5pt; padding-bottom: 0cm; padding-left: 5.4pt; padding-right: 5.4pt; padding-top: 0cm; width: 159pt;" valign="top" width="212"><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt;"><span style="font-family: Times, "Times New Roman", serif;">sdn</span></div></td></tr>
<tr style="mso-yfti-irow: 8;"><td style="background-color: transparent; border-bottom: black 1pt solid; border-left: black 1pt solid; border-right: black 1pt solid; border-top: #f0f0f0; mso-border-alt: solid black .5pt; mso-border-top-alt: solid black .5pt; padding-bottom: 0cm; padding-left: 5.4pt; padding-right: 5.4pt; padding-top: 0cm; width: 161.3pt;" valign="top" width="215"><div align="right" class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: right;"><span style="font-family: Times, "Times New Roman", serif;">Jernih</span></div></td><td style="background-color: transparent; border-bottom: black 1pt solid; border-left: #f0f0f0; border-right: black 1pt solid; border-top: #f0f0f0; mso-border-alt: solid black .5pt; mso-border-left-alt: solid black .5pt; mso-border-top-alt: solid black .5pt; padding-bottom: 0cm; padding-left: 5.4pt; padding-right: 5.4pt; padding-top: 0cm; width: 99.25pt;" valign="top" width="132"><div align="center" class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: center;"><span style="font-family: Times, "Times New Roman", serif;">Fundus Media</span></div></td><td style="background-color: transparent; border-bottom: black 1pt solid; border-left: #f0f0f0; border-right: black 1pt solid; border-top: #f0f0f0; mso-border-alt: solid black .5pt; mso-border-left-alt: solid black .5pt; mso-border-top-alt: solid black .5pt; padding-bottom: 0cm; padding-left: 5.4pt; padding-right: 5.4pt; padding-top: 0cm; width: 159pt;" valign="top" width="212"><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt;"><span style="font-family: Times, "Times New Roman", serif;">sdn</span></div></td></tr>
<tr style="mso-yfti-irow: 9;"><td style="background-color: transparent; border-bottom: black 1pt solid; border-left: black 1pt solid; border-right: black 1pt solid; border-top: #f0f0f0; mso-border-alt: solid black .5pt; mso-border-top-alt: solid black .5pt; padding-bottom: 0cm; padding-left: 5.4pt; padding-right: 5.4pt; padding-top: 0cm; width: 161.3pt;" valign="top" width="215"><div align="right" class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: right;"><span style="font-family: Times, "Times New Roman", serif;">BT; CD 0,3 ; a/v 2/3</span></div></td><td style="background-color: transparent; border-bottom: black 1pt solid; border-left: #f0f0f0; border-right: black 1pt solid; border-top: #f0f0f0; mso-border-alt: solid black .5pt; mso-border-left-alt: solid black .5pt; mso-border-top-alt: solid black .5pt; padding-bottom: 0cm; padding-left: 5.4pt; padding-right: 5.4pt; padding-top: 0cm; width: 99.25pt;" valign="top" width="132"><div align="center" class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: center;"><span style="font-family: Times, "Times New Roman", serif;">Papil</span></div></td><td style="background-color: transparent; border-bottom: black 1pt solid; border-left: #f0f0f0; border-right: black 1pt solid; border-top: #f0f0f0; mso-border-alt: solid black .5pt; mso-border-left-alt: solid black .5pt; mso-border-top-alt: solid black .5pt; padding-bottom: 0cm; padding-left: 5.4pt; padding-right: 5.4pt; padding-top: 0cm; width: 159pt;" valign="top" width="212"><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt;"><span style="font-family: Times, "Times New Roman", serif;">sdn</span></div></td></tr>
<tr style="mso-yfti-irow: 10;"><td style="background-color: transparent; border-bottom: black 1pt solid; border-left: black 1pt solid; border-right: black 1pt solid; border-top: #f0f0f0; mso-border-alt: solid black .5pt; mso-border-top-alt: solid black .5pt; padding-bottom: 0cm; padding-left: 5.4pt; padding-right: 5.4pt; padding-top: 0cm; width: 161.3pt;" valign="top" width="215"><div align="right" class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: right;"><span style="font-family: Times, "Times New Roman", serif;">Ref (+)</span></div></td><td style="background-color: transparent; border-bottom: black 1pt solid; border-left: #f0f0f0; border-right: black 1pt solid; border-top: #f0f0f0; mso-border-alt: solid black .5pt; mso-border-left-alt: solid black .5pt; mso-border-top-alt: solid black .5pt; padding-bottom: 0cm; padding-left: 5.4pt; padding-right: 5.4pt; padding-top: 0cm; width: 99.25pt;" valign="top" width="132"><div align="center" class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: center;"><span style="font-family: Times, "Times New Roman", serif;">Makula</span></div></td><td style="background-color: transparent; border-bottom: black 1pt solid; border-left: #f0f0f0; border-right: black 1pt solid; border-top: #f0f0f0; mso-border-alt: solid black .5pt; mso-border-left-alt: solid black .5pt; mso-border-top-alt: solid black .5pt; padding-bottom: 0cm; padding-left: 5.4pt; padding-right: 5.4pt; padding-top: 0cm; width: 159pt;" valign="top" width="212"><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt;"><span style="font-family: Times, "Times New Roman", serif;">sdn</span></div></td></tr>
<tr style="mso-yfti-irow: 11;"><td style="background-color: transparent; border-bottom: black 1pt solid; border-left: black 1pt solid; border-right: black 1pt solid; border-top: #f0f0f0; mso-border-alt: solid black .5pt; mso-border-top-alt: solid black .5pt; padding-bottom: 0cm; padding-left: 5.4pt; padding-right: 5.4pt; padding-top: 0cm; width: 161.3pt;" valign="top" width="215"><div align="right" class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: right;"><span style="font-family: Times, "Times New Roman", serif;">dbn</span></div></td><td style="background-color: transparent; border-bottom: black 1pt solid; border-left: #f0f0f0; border-right: black 1pt solid; border-top: #f0f0f0; mso-border-alt: solid black .5pt; mso-border-left-alt: solid black .5pt; mso-border-top-alt: solid black .5pt; padding-bottom: 0cm; padding-left: 5.4pt; padding-right: 5.4pt; padding-top: 0cm; width: 99.25pt;" valign="top" width="132"><div align="center" class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: center;"><span style="font-family: Times, "Times New Roman", serif;">Retina</span></div></td><td style="background-color: transparent; border-bottom: black 1pt solid; border-left: #f0f0f0; border-right: black 1pt solid; border-top: #f0f0f0; mso-border-alt: solid black .5pt; mso-border-left-alt: solid black .5pt; mso-border-top-alt: solid black .5pt; padding-bottom: 0cm; padding-left: 5.4pt; padding-right: 5.4pt; padding-top: 0cm; width: 159pt;" valign="top" width="212"><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt;"><span style="font-family: Times, "Times New Roman", serif;">sdn</span></div></td></tr>
<tr style="mso-yfti-irow: 12;"><td style="background-color: transparent; border-bottom: black 1pt solid; border-left: black 1pt solid; border-right: black 1pt solid; border-top: #f0f0f0; mso-border-alt: solid black .5pt; mso-border-top-alt: solid black .5pt; padding-bottom: 0cm; padding-left: 5.4pt; padding-right: 5.4pt; padding-top: 0cm; width: 161.3pt;" valign="top" width="215"><div align="right" class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: right;"><span style="font-family: Times, "Times New Roman", serif;">N (palpasi)</span></div></td><td style="background-color: transparent; border-bottom: black 1pt solid; border-left: #f0f0f0; border-right: black 1pt solid; border-top: #f0f0f0; mso-border-alt: solid black .5pt; mso-border-left-alt: solid black .5pt; mso-border-top-alt: solid black .5pt; padding-bottom: 0cm; padding-left: 5.4pt; padding-right: 5.4pt; padding-top: 0cm; width: 99.25pt;" valign="top" width="132"><div align="center" class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: center;"><span style="font-family: Times, "Times New Roman", serif;">TIO</span></div></td><td style="background-color: transparent; border-bottom: black 1pt solid; border-left: #f0f0f0; border-right: black 1pt solid; border-top: #f0f0f0; mso-border-alt: solid black .5pt; mso-border-left-alt: solid black .5pt; mso-border-top-alt: solid black .5pt; padding-bottom: 0cm; padding-left: 5.4pt; padding-right: 5.4pt; padding-top: 0cm; width: 159pt;" valign="top" width="212"><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt;"><span style="font-family: Times, "Times New Roman", serif;">N (palpasi)</span></div></td></tr>
<tr style="mso-yfti-irow: 13; mso-yfti-lastrow: yes;"><td style="background-color: transparent; border-bottom: black 1pt solid; border-left: black 1pt solid; border-right: black 1pt solid; border-top: #f0f0f0; mso-border-alt: solid black .5pt; mso-border-top-alt: solid black .5pt; padding-bottom: 0cm; padding-left: 5.4pt; padding-right: 5.4pt; padding-top: 0cm; width: 161.3pt;" valign="top" width="215"><div align="right" class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: right;"><span style="font-family: Times, "Times New Roman", serif;">bebas</span></div></td><td style="background-color: transparent; border-bottom: black 1pt solid; border-left: #f0f0f0; border-right: black 1pt solid; border-top: #f0f0f0; mso-border-alt: solid black .5pt; mso-border-left-alt: solid black .5pt; mso-border-top-alt: solid black .5pt; padding-bottom: 0cm; padding-left: 5.4pt; padding-right: 5.4pt; padding-top: 0cm; width: 99.25pt;" valign="top" width="132"><div align="center" class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: center;"><span style="font-family: Times, "Times New Roman", serif;">GBM</span></div></td><td style="background-color: transparent; border-bottom: black 1pt solid; border-left: #f0f0f0; border-right: black 1pt solid; border-top: #f0f0f0; mso-border-alt: solid black .5pt; mso-border-left-alt: solid black .5pt; mso-border-top-alt: solid black .5pt; padding-bottom: 0cm; padding-left: 5.4pt; padding-right: 5.4pt; padding-top: 0cm; width: 159pt;" valign="top" width="212"><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt;"><span style="font-family: Times, "Times New Roman", serif;">Bebas</span></div></td></tr>
</tbody></table><span style="font-family: Times, "Times New Roman", serif;"><br />
</span><br />
<div class="MsoNormal" style="margin: 0cm 0cm 10pt 42.55pt; text-align: justify; text-indent: -42.55pt;"><span style="font-family: Times, "Times New Roman", serif;"><br />
</span></div><div class="MsoNormal" style="margin: 0cm 0cm 10pt 42.55pt; text-align: justify; text-indent: -42.55pt;"><b style="mso-bidi-font-weight: normal;"><u><span style="font-family: Times, "Times New Roman", serif; font-size: 12pt; line-height: 115%;">Diagnosis</span></u></b></div><div class="MsoNormal" style="margin: 0cm 0cm 10pt 42.55pt; text-align: justify; text-indent: -42.55pt;"><span style="font-family: Times, "Times New Roman", serif; font-size: 12pt; line-height: 115%;">OS pterigium derajad III</span></div><div class="MsoNormal" style="margin: 0cm 0cm 10pt 42.55pt; text-align: justify; text-indent: -42.55pt;"><b style="mso-bidi-font-weight: normal;"><u><span style="font-family: Times, "Times New Roman", serif; font-size: 12pt; line-height: 115%;">Terapi</span></u></b></div><div class="MsoNormal" style="margin: 0cm 0cm 10pt 42.55pt; text-align: justify; text-indent: -42.55pt;"><span style="font-family: Times, "Times New Roman", serif; font-size: 12pt; line-height: 115%;">ekstirpasi pterigium</span></div><div class="MsoNormal" style="margin: 0cm 0cm 10pt 42.55pt; text-align: justify; text-indent: -42.55pt;"><span style="font-family: Times, "Times New Roman", serif; font-size: 12pt; line-height: 115%;">c. lyteers ED 4xODS</span></div>Anonymoushttp://www.blogger.com/profile/17040699491469284898noreply@blogger.com0tag:blogger.com,1999:blog-7514639870940573862.post-26346091876397463752011-10-02T07:10:00.001-07:002011-10-02T23:38:57.241-07:00trikiasis<div class="MsoNormal" style="margin: 0cm 0cm 10pt 42.55pt; text-align: justify; text-indent: -42.55pt;"><span style="font-family: "Arial", "sans-serif"; font-size: 12pt; line-height: 115%;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 10pt 42.55pt; text-align: justify; text-indent: -42.55pt;"><b style="mso-bidi-font-weight: normal;"><u><span style="font-family: Times, "Times New Roman", serif; font-size: 12pt; line-height: 115%;">TRIKIASIS</span></u></b></div><div class="MsoNormal" style="margin: 0cm 0cm 10pt; text-align: justify; text-indent: 36pt;"><span style="font-family: Times, "Times New Roman", serif; font-size: 12pt; line-height: 115%;">Trikiasis merupakan kondisi dimana silia bulu mata melengkung ke arah bola mata. Trikiasis biasanya merupakan akibat adanya inflamasi atau sikatrik pada palpebra setelah operasi palpebra, trauma, kalazion atau blefaritis berat. Trikiasis dapat terjadi pada semua usia, namun lebih sering terjadi pada orang dewasa.</span></div><span style="font-family: Times, "Times New Roman", serif;"></span><br />
<div class="MsoNormal" style="margin: 0cm 0cm 10pt; text-align: justify; text-indent: 36pt;"></div><div class="MsoNormal" style="margin: 0cm 0cm 10pt; text-align: justify; text-indent: 36pt;"><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjt1nmvYvJdQi7kBEVpqIdNU3q2Swy7N97Vp-i8Bx19J6eek1PKhIrkkn0M2SufJclpvZi0VcGzjQVZt6Vo81tXraJcb4znUSRvs_0e5xa-Y6zas0jWFACmejkOC6S-cGEyidV0eIVMFFNW/s1600/images.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" kca="true" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjt1nmvYvJdQi7kBEVpqIdNU3q2Swy7N97Vp-i8Bx19J6eek1PKhIrkkn0M2SufJclpvZi0VcGzjQVZt6Vo81tXraJcb4znUSRvs_0e5xa-Y6zas0jWFACmejkOC6S-cGEyidV0eIVMFFNW/s1600/images.jpg" /></a></div><a name='more'></a><div class="separator" style="clear: both; text-align: center;"></div><br />
<span style="font-family: Times, "Times New Roman", serif; font-size: 12pt; line-height: 115%;">Gambaran klinik pada trikiasis adalah:</span></div><div class="MsoListParagraphCxSpFirst" style="margin: 0cm 0cm 0pt 14.2pt; mso-add-space: auto; mso-list: l0 level1 lfo1; text-align: justify; text-indent: -14.2pt;"><span style="font-family: Times, "Times New Roman", serif;"><span style="font-size: 12pt; line-height: 115%; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">- </span></span><span style="font-size: 12pt; line-height: 115%;">posisi palpebra dapat normal namun dapat pula berkaitan dengan adanya entropion (melipatnya margo palpebra kearah dalam sehingga bulu mata menggesek bola mata).</span></span></div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 14.2pt; mso-add-space: auto; mso-list: l0 level1 lfo1; text-align: justify; text-indent: -14.2pt;"><span style="font-family: Times, "Times New Roman", serif;"><span style="font-size: 12pt; line-height: 115%; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">- </span></span><span style="font-size: 12pt; line-height: 115%;">bulu mata tumbuh melengkung kedalam.</span></span></div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 14.2pt; mso-add-space: auto; mso-list: l0 level1 lfo1; text-align: justify; text-indent: -14.2pt;"><span style="font-family: Times, "Times New Roman", serif;"><span style="font-size: 12pt; line-height: 115%; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">- </span></span><span style="font-size: 12pt; line-height: 115%;">pasien akan mengeluhkan adanya sensasi benda asing (rasa mengganjal).</span></span></div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 14.2pt; mso-add-space: auto; mso-list: l0 level1 lfo1; text-align: justify; text-indent: -14.2pt;"><span style="font-family: Times, "Times New Roman", serif;"><span style="font-size: 12pt; line-height: 115%; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">- </span></span><span style="font-size: 12pt; line-height: 115%;">terjadi iritasi konjungtiva yang terjadi secara kronis karena gesekan bulu mata dengan permukaan konjungtiva.</span></span></div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 14.2pt; mso-add-space: auto; mso-list: l0 level1 lfo1; text-align: justify; text-indent: -14.2pt;"><span style="font-family: Times, "Times New Roman", serif;"><span style="font-size: 12pt; line-height: 115%; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">- </span></span><span style="font-size: 12pt; line-height: 115%;">gambaran yang sering ditemukan adalah injeksi konjungtiva, refleks epifora (nrocos), keluarnya cairan mukus, bila parah dapat terjadi abrasi kornea.</span></span></div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt; mso-add-space: auto; text-align: justify;"><span style="font-family: Times, "Times New Roman", serif;"><br />
</span></div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 36pt; text-align: justify;"><span style="font-family: Times, "Times New Roman", serif; font-size: 12pt; line-height: 115%;">Penatalaksanaan trikiasis adalah:</span></div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 14.2pt; mso-add-space: auto; mso-list: l0 level1 lfo1; text-align: justify; text-indent: -14.2pt;"><span style="font-family: Times, "Times New Roman", serif;"><span style="font-size: 12pt; line-height: 115%; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">- </span></span><span style="font-size: 12pt; line-height: 115%;">jika hanya sedikit bulu mata yang tumbuh melengkung kedalam bola mata maka dapat ditangani dengan epilasi mekanik (pencabutan bulu mata). Bulu mata akan tumbuh kembali sekitar 3-4 minggu sehingga harus dicabut kembali.</span></span></div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 14.2pt; mso-add-space: auto; mso-list: l0 level1 lfo1; text-align: justify; text-indent: -14.2pt;"><span style="font-family: Times, "Times New Roman", serif;"><span style="font-size: 12pt; line-height: 115%; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">- </span></span><span style="font-size: 12pt; line-height: 115%;">penanganan permanen dapat dilakukan dengan merusak folikel bulu mata yaitu dengan eksisi langsung, elektrolisis atau radiosurgery.</span></span></div><div class="MsoListParagraphCxSpLast" style="margin: 0cm 0cm 10pt 14.2pt; mso-add-space: auto; mso-list: l0 level1 lfo1; text-align: justify; text-indent: -14.2pt;"><span style="font-family: Times, "Times New Roman", serif;"><span style="font-size: 12pt; line-height: 115%; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">- </span></span><span style="font-size: 12pt; line-height: 115%;">jika ada keterkaitan trikiasis dengan entropion maka sebaiknya dilakukan koreksi terhadap palpebra.</span></span></div><div class="MsoNormal" style="margin: 0cm 0cm 10pt; text-align: justify;"><b style="mso-bidi-font-weight: normal;"><u><span style="font-family: Times, "Times New Roman", serif; font-size: 12pt; line-height: 115%;">Status Pasien</span></u></b></div><div class="MsoNormal" style="margin: 0cm 0cm 10pt; text-align: justify;"><span style="font-family: Times, "Times New Roman", serif; font-size: 12pt; line-height: 115%;">Nama<span style="mso-tab-count: 2;"> </span>:Ny W.</span></div><div class="MsoNormal" style="margin: 0cm 0cm 10pt; text-align: justify;"><span style="font-family: Times, "Times New Roman", serif; font-size: 12pt; line-height: 115%;">Umur<span style="mso-tab-count: 2;"> </span>: 68 tahun</span></div><div class="MsoNormal" style="margin: 0cm 0cm 10pt; text-align: justify;"><span style="font-family: Times, "Times New Roman", serif; font-size: 12pt; line-height: 115%;">Pekerjaan<span style="mso-tab-count: 1;"> </span>: Pensiunan</span></div><div class="MsoNormal" style="margin: 0cm 0cm 10pt; text-align: justify;"><b style="mso-bidi-font-weight: normal;"><u><span style="font-family: Times, "Times New Roman", serif; font-size: 12pt; line-height: 115%;">Anamnesis</span></u></b></div><div class="MsoNormal" style="margin: 0cm 0cm 10pt 42.55pt; text-align: justify; text-indent: -42.55pt;"><span style="font-family: Times, "Times New Roman", serif; font-size: 12pt; line-height: 115%;">KU<span style="mso-tab-count: 1;"> </span>: mata terus menerus berair dan keluar kotoran</span></div><div class="MsoNormal" style="margin: 0cm 0cm 10pt 42.55pt; text-align: justify; text-indent: -42.55pt;"><span style="font-family: Times, "Times New Roman", serif; font-size: 12pt; line-height: 115%;">RPS<span style="mso-tab-count: 1;"> </span>: ± 1 bulan yang lalu keluhan mulai muncul yaitu mata terus menerus berair dan keluar kotoran yang berwarna putih dan kental. Selain itu mata terasa mengganjal dan pedih, namun tidak berwarna merah. Pasien sudah memberikan obat tetes (pasien lupa nama obat) namun belum membaik.</span></div><div class="MsoNormal" style="margin: 0cm 0cm 10pt 42.55pt; text-align: justify; text-indent: -42.55pt;"><span style="font-family: Times, "Times New Roman", serif; font-size: 12pt; line-height: 115%;">RPD<span style="mso-tab-count: 1;"> </span>: Pasien pernah mengalami keluhan serupa, diobati dengan obat tetes dan membaik. Pasien tidak mempunyai riwayat hipertensi dan diabetes mellitus.</span></div><div class="MsoNormal" style="margin: 0cm 0cm 10pt 42.55pt; text-align: justify; text-indent: -42.55pt;"><b style="mso-bidi-font-weight: normal;"><u><span style="font-family: Times, "Times New Roman", serif; font-size: 12pt; line-height: 115%;">Pemeriksaan</span></u></b></div><span style="font-family: Times, "Times New Roman", serif;"><br />
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<table border="1" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border-bottom: medium none; border-collapse: collapse; border-left: medium none; border-right: medium none; border-top: medium none; margin: auto auto auto 42.55pt; mso-border-alt: solid black .5pt; mso-border-insideh: .5pt solid black; mso-border-insidev: .5pt solid black; mso-padding-alt: 0cm 5.4pt 0cm 5.4pt; mso-yfti-tbllook: 1184;"><tbody>
<tr style="mso-yfti-firstrow: yes; mso-yfti-irow: 0;"><td style="background-color: transparent; border-bottom: black 1pt solid; border-left: black 1pt solid; border-right: black 1pt solid; border-top: black 1pt solid; mso-border-alt: solid black .5pt; padding-bottom: 0cm; padding-left: 5.4pt; padding-right: 5.4pt; padding-top: 0cm; width: 161.3pt;" valign="top" width="215"><div align="right" class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: right;"><span style="font-family: Times, "Times New Roman", serif; font-size: 12pt;">OD</span></div></td><td style="background-color: transparent; border-bottom: black 1pt solid; border-left: #f0f0f0; border-right: black 1pt solid; border-top: black 1pt solid; mso-border-alt: solid black .5pt; mso-border-left-alt: solid black .5pt; padding-bottom: 0cm; padding-left: 5.4pt; padding-right: 5.4pt; padding-top: 0cm; width: 99.25pt;" valign="top" width="132"><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: justify;"><span style="font-family: Times, "Times New Roman", serif;"><br />
</span></div></td><td style="background-color: transparent; border-bottom: black 1pt solid; border-left: #f0f0f0; border-right: black 1pt solid; border-top: black 1pt solid; mso-border-alt: solid black .5pt; mso-border-left-alt: solid black .5pt; padding-bottom: 0cm; padding-left: 5.4pt; padding-right: 5.4pt; padding-top: 0cm; width: 159pt;" valign="top" width="212"><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: justify;"><span style="font-family: Times, "Times New Roman", serif; font-size: 12pt;">OS</span></div></td></tr>
<tr style="mso-yfti-irow: 1;"><td style="background-color: transparent; border-bottom: black 1pt solid; border-left: black 1pt solid; border-right: black 1pt solid; border-top: #f0f0f0; mso-border-alt: solid black .5pt; mso-border-top-alt: solid black .5pt; padding-bottom: 0cm; padding-left: 5.4pt; padding-right: 5.4pt; padding-top: 0cm; width: 161.3pt;" valign="top" width="215"><div align="right" class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: right;"><span style="font-family: Times, "Times New Roman", serif;">6/16 F1 PH 6/12 F2</span></div></td><td style="background-color: transparent; border-bottom: black 1pt solid; border-left: #f0f0f0; border-right: black 1pt solid; border-top: #f0f0f0; mso-border-alt: solid black .5pt; mso-border-left-alt: solid black .5pt; mso-border-top-alt: solid black .5pt; padding-bottom: 0cm; padding-left: 5.4pt; padding-right: 5.4pt; padding-top: 0cm; width: 99.25pt;" valign="top" width="132"><div align="center" class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: center;"><span style="font-family: Times, "Times New Roman", serif;">Visus</span></div></td><td style="background-color: transparent; border-bottom: black 1pt solid; border-left: #f0f0f0; border-right: black 1pt solid; border-top: #f0f0f0; mso-border-alt: solid black .5pt; mso-border-left-alt: solid black .5pt; mso-border-top-alt: solid black .5pt; padding-bottom: 0cm; padding-left: 5.4pt; padding-right: 5.4pt; padding-top: 0cm; width: 159pt;" valign="top" width="212"><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt;"><span style="font-family: Times, "Times New Roman", serif;">6/40 PH 6/12</span></div></td></tr>
<tr style="mso-yfti-irow: 2;"><td style="background-color: transparent; border-bottom: black 1pt solid; border-left: black 1pt solid; border-right: black 1pt solid; border-top: #f0f0f0; mso-border-alt: solid black .5pt; mso-border-top-alt: solid black .5pt; padding-bottom: 0cm; padding-left: 5.4pt; padding-right: 5.4pt; padding-top: 0cm; width: 161.3pt;" valign="top" width="215"><div align="right" class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: right;"><span style="font-family: Times, "Times New Roman", serif;">Trikiasis (+); entropion (-)</span></div></td><td style="background-color: transparent; border-bottom: black 1pt solid; border-left: #f0f0f0; border-right: black 1pt solid; border-top: #f0f0f0; mso-border-alt: solid black .5pt; mso-border-left-alt: solid black .5pt; mso-border-top-alt: solid black .5pt; padding-bottom: 0cm; padding-left: 5.4pt; padding-right: 5.4pt; padding-top: 0cm; width: 99.25pt;" valign="top" width="132"><div align="center" class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: center;"><span style="font-family: Times, "Times New Roman", serif;">Palpebra</span></div></td><td style="background-color: transparent; border-bottom: black 1pt solid; border-left: #f0f0f0; border-right: black 1pt solid; border-top: #f0f0f0; mso-border-alt: solid black .5pt; mso-border-left-alt: solid black .5pt; mso-border-top-alt: solid black .5pt; padding-bottom: 0cm; padding-left: 5.4pt; padding-right: 5.4pt; padding-top: 0cm; width: 159pt;" valign="top" width="212"><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt;"><span style="font-family: Times, "Times New Roman", serif;">Trikiasis (+); entropion (-) </span></div></td></tr>
<tr style="mso-yfti-irow: 3;"><td style="background-color: transparent; border-bottom: black 1pt solid; border-left: black 1pt solid; border-right: black 1pt solid; border-top: #f0f0f0; mso-border-alt: solid black .5pt; mso-border-top-alt: solid black .5pt; padding-bottom: 0cm; padding-left: 5.4pt; padding-right: 5.4pt; padding-top: 0cm; width: 161.3pt;" valign="top" width="215"><div align="right" class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: right;"><span style="font-family: Times, "Times New Roman", serif;">Hiperemis, injeksi konjungtiva</span></div></td><td style="background-color: transparent; border-bottom: black 1pt solid; border-left: #f0f0f0; border-right: black 1pt solid; border-top: #f0f0f0; mso-border-alt: solid black .5pt; mso-border-left-alt: solid black .5pt; mso-border-top-alt: solid black .5pt; padding-bottom: 0cm; padding-left: 5.4pt; padding-right: 5.4pt; padding-top: 0cm; width: 99.25pt;" valign="top" width="132"><div align="center" class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: center;"><span style="font-family: Times, "Times New Roman", serif;">Konjungtiva</span></div></td><td style="background-color: transparent; border-bottom: black 1pt solid; border-left: #f0f0f0; border-right: black 1pt solid; border-top: #f0f0f0; mso-border-alt: solid black .5pt; mso-border-left-alt: solid black .5pt; mso-border-top-alt: solid black .5pt; padding-bottom: 0cm; padding-left: 5.4pt; padding-right: 5.4pt; padding-top: 0cm; width: 159pt;" valign="top" width="212"><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt;"><span style="font-family: Times, "Times New Roman", serif;">Hiperemis, injeksi konjungtiva</span></div></td></tr>
<tr style="mso-yfti-irow: 4;"><td style="background-color: transparent; border-bottom: black 1pt solid; border-left: black 1pt solid; border-right: black 1pt solid; border-top: #f0f0f0; mso-border-alt: solid black .5pt; mso-border-top-alt: solid black .5pt; padding-bottom: 0cm; padding-left: 5.4pt; padding-right: 5.4pt; padding-top: 0cm; width: 161.3pt;" valign="top" width="215"><div align="right" class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: right;"><span style="font-family: Times, "Times New Roman", serif;">Jernih</span></div></td><td style="background-color: transparent; border-bottom: black 1pt solid; border-left: #f0f0f0; border-right: black 1pt solid; border-top: #f0f0f0; mso-border-alt: solid black .5pt; mso-border-left-alt: solid black .5pt; mso-border-top-alt: solid black .5pt; padding-bottom: 0cm; padding-left: 5.4pt; padding-right: 5.4pt; padding-top: 0cm; width: 99.25pt;" valign="top" width="132"><div align="center" class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: center;"><span style="font-family: Times, "Times New Roman", serif;">Kornea</span></div></td><td style="background-color: transparent; border-bottom: black 1pt solid; border-left: #f0f0f0; border-right: black 1pt solid; border-top: #f0f0f0; mso-border-alt: solid black .5pt; mso-border-left-alt: solid black .5pt; mso-border-top-alt: solid black .5pt; padding-bottom: 0cm; padding-left: 5.4pt; padding-right: 5.4pt; padding-top: 0cm; width: 159pt;" valign="top" width="212"><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt;"><span style="font-family: Times, "Times New Roman", serif;">Jernih</span></div></td></tr>
<tr style="mso-yfti-irow: 5;"><td style="background-color: transparent; border-bottom: black 1pt solid; border-left: black 1pt solid; border-right: black 1pt solid; border-top: #f0f0f0; mso-border-alt: solid black .5pt; mso-border-top-alt: solid black .5pt; padding-bottom: 0cm; padding-left: 5.4pt; padding-right: 5.4pt; padding-top: 0cm; width: 161.3pt;" valign="top" width="215"><div align="right" class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: right;"><span style="font-family: Times, "Times New Roman", serif;">Kesan dangkal, jernih</span></div></td><td style="background-color: transparent; border-bottom: black 1pt solid; border-left: #f0f0f0; border-right: black 1pt solid; border-top: #f0f0f0; mso-border-alt: solid black .5pt; mso-border-left-alt: solid black .5pt; mso-border-top-alt: solid black .5pt; padding-bottom: 0cm; padding-left: 5.4pt; padding-right: 5.4pt; padding-top: 0cm; width: 99.25pt;" valign="top" width="132"><div align="center" class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: center;"><span style="font-family: Times, "Times New Roman", serif;">COA</span></div></td><td style="background-color: transparent; border-bottom: black 1pt solid; border-left: #f0f0f0; border-right: black 1pt solid; border-top: #f0f0f0; mso-border-alt: solid black .5pt; mso-border-left-alt: solid black .5pt; mso-border-top-alt: solid black .5pt; padding-bottom: 0cm; padding-left: 5.4pt; padding-right: 5.4pt; padding-top: 0cm; width: 159pt;" valign="top" width="212"><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt;"><span style="font-family: Times, "Times New Roman", serif;">Kesan dangkal, jernih</span></div></td></tr>
<tr style="mso-yfti-irow: 6;"><td style="background-color: transparent; border-bottom: black 1pt solid; border-left: black 1pt solid; border-right: black 1pt solid; border-top: #f0f0f0; mso-border-alt: solid black .5pt; mso-border-top-alt: solid black .5pt; padding-bottom: 0cm; padding-left: 5.4pt; padding-right: 5.4pt; padding-top: 0cm; width: 161.3pt;" valign="top" width="215"><div align="right" class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: right;"><span style="font-family: Times, "Times New Roman", serif;">Bulat, sentral, Ø 3 mm, RC (+)</span></div></td><td style="background-color: transparent; border-bottom: black 1pt solid; border-left: #f0f0f0; border-right: black 1pt solid; border-top: #f0f0f0; mso-border-alt: solid black .5pt; mso-border-left-alt: solid black .5pt; mso-border-top-alt: solid black .5pt; padding-bottom: 0cm; padding-left: 5.4pt; padding-right: 5.4pt; padding-top: 0cm; width: 99.25pt;" valign="top" width="132"><div align="center" class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: center;"><span style="font-family: Times, "Times New Roman", serif;">Iris/pupil</span></div></td><td style="background-color: transparent; border-bottom: black 1pt solid; border-left: #f0f0f0; border-right: black 1pt solid; border-top: #f0f0f0; mso-border-alt: solid black .5pt; mso-border-left-alt: solid black .5pt; mso-border-top-alt: solid black .5pt; padding-bottom: 0cm; padding-left: 5.4pt; padding-right: 5.4pt; padding-top: 0cm; width: 159pt;" valign="top" width="212"><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt;"><span style="font-family: Times, "Times New Roman", serif;">Bulat, sentral, Ø 3 mm, RC +</span></div></td></tr>
<tr style="mso-yfti-irow: 7;"><td style="background-color: transparent; border-bottom: black 1pt solid; border-left: black 1pt solid; border-right: black 1pt solid; border-top: #f0f0f0; mso-border-alt: solid black .5pt; mso-border-top-alt: solid black .5pt; padding-bottom: 0cm; padding-left: 5.4pt; padding-right: 5.4pt; padding-top: 0cm; width: 161.3pt;" valign="top" width="215"><div align="right" class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: right;"><span style="font-family: Times, "Times New Roman", serif;">Jernih</span></div></td><td style="background-color: transparent; border-bottom: black 1pt solid; border-left: #f0f0f0; border-right: black 1pt solid; border-top: #f0f0f0; mso-border-alt: solid black .5pt; mso-border-left-alt: solid black .5pt; mso-border-top-alt: solid black .5pt; padding-bottom: 0cm; padding-left: 5.4pt; padding-right: 5.4pt; padding-top: 0cm; width: 99.25pt;" valign="top" width="132"><div align="center" class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: center;"><span style="font-family: Times, "Times New Roman", serif;">Lensa</span></div></td><td style="background-color: transparent; border-bottom: black 1pt solid; border-left: #f0f0f0; border-right: black 1pt solid; border-top: #f0f0f0; mso-border-alt: solid black .5pt; mso-border-left-alt: solid black .5pt; mso-border-top-alt: solid black .5pt; padding-bottom: 0cm; padding-left: 5.4pt; padding-right: 5.4pt; padding-top: 0cm; width: 159pt;" valign="top" width="212"><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt;"><span style="font-family: Times, "Times New Roman", serif;">Keruh tipis</span></div></td></tr>
<tr style="mso-yfti-irow: 8;"><td style="background-color: transparent; border-bottom: black 1pt solid; border-left: black 1pt solid; border-right: black 1pt solid; border-top: #f0f0f0; mso-border-alt: solid black .5pt; mso-border-top-alt: solid black .5pt; padding-bottom: 0cm; padding-left: 5.4pt; padding-right: 5.4pt; padding-top: 0cm; width: 161.3pt;" valign="top" width="215"><div align="right" class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: right;"><span style="font-family: Times, "Times New Roman", serif;">Jernih</span></div></td><td style="background-color: transparent; border-bottom: black 1pt solid; border-left: #f0f0f0; border-right: black 1pt solid; border-top: #f0f0f0; mso-border-alt: solid black .5pt; mso-border-left-alt: solid black .5pt; mso-border-top-alt: solid black .5pt; padding-bottom: 0cm; padding-left: 5.4pt; padding-right: 5.4pt; padding-top: 0cm; width: 99.25pt;" valign="top" width="132"><div align="center" class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: center;"><span style="font-family: Times, "Times New Roman", serif;">Fundus Media</span></div></td><td style="background-color: transparent; border-bottom: black 1pt solid; border-left: #f0f0f0; border-right: black 1pt solid; border-top: #f0f0f0; mso-border-alt: solid black .5pt; mso-border-left-alt: solid black .5pt; mso-border-top-alt: solid black .5pt; padding-bottom: 0cm; padding-left: 5.4pt; padding-right: 5.4pt; padding-top: 0cm; width: 159pt;" valign="top" width="212"><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt;"><span style="font-family: Times, "Times New Roman", serif;">Jernih</span></div></td></tr>
<tr style="mso-yfti-irow: 9;"><td style="background-color: transparent; border-bottom: black 1pt solid; border-left: black 1pt solid; border-right: black 1pt solid; border-top: #f0f0f0; mso-border-alt: solid black .5pt; mso-border-top-alt: solid black .5pt; padding-bottom: 0cm; padding-left: 5.4pt; padding-right: 5.4pt; padding-top: 0cm; width: 161.3pt;" valign="top" width="215"><div align="right" class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: right;"><span style="font-family: Times, "Times New Roman", serif;">BT; CD 0,3 ; a/v 2/3</span></div></td><td style="background-color: transparent; border-bottom: black 1pt solid; border-left: #f0f0f0; border-right: black 1pt solid; border-top: #f0f0f0; mso-border-alt: solid black .5pt; mso-border-left-alt: solid black .5pt; mso-border-top-alt: solid black .5pt; padding-bottom: 0cm; padding-left: 5.4pt; padding-right: 5.4pt; padding-top: 0cm; width: 99.25pt;" valign="top" width="132"><div align="center" class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: center;"><span style="font-family: Times, "Times New Roman", serif;">Papil</span></div></td><td style="background-color: transparent; border-bottom: black 1pt solid; border-left: #f0f0f0; border-right: black 1pt solid; border-top: #f0f0f0; mso-border-alt: solid black .5pt; mso-border-left-alt: solid black .5pt; mso-border-top-alt: solid black .5pt; padding-bottom: 0cm; padding-left: 5.4pt; padding-right: 5.4pt; padding-top: 0cm; width: 159pt;" valign="top" width="212"><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt;"><span style="font-family: Times, "Times New Roman", serif;">BT; CD 0,3 ; a/v 2/3</span></div></td></tr>
<tr style="mso-yfti-irow: 10;"><td style="background-color: transparent; border-bottom: black 1pt solid; border-left: black 1pt solid; border-right: black 1pt solid; border-top: #f0f0f0; mso-border-alt: solid black .5pt; mso-border-top-alt: solid black .5pt; padding-bottom: 0cm; padding-left: 5.4pt; padding-right: 5.4pt; padding-top: 0cm; width: 161.3pt;" valign="top" width="215"><div align="right" class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: right;"><span style="font-family: Times, "Times New Roman", serif;">Ref (+)</span></div></td><td style="background-color: transparent; border-bottom: black 1pt solid; border-left: #f0f0f0; border-right: black 1pt solid; border-top: #f0f0f0; mso-border-alt: solid black .5pt; mso-border-left-alt: solid black .5pt; mso-border-top-alt: solid black .5pt; padding-bottom: 0cm; padding-left: 5.4pt; padding-right: 5.4pt; padding-top: 0cm; width: 99.25pt;" valign="top" width="132"><div align="center" class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: center;"><span style="font-family: Times, "Times New Roman", serif;">Makula</span></div></td><td style="background-color: transparent; border-bottom: black 1pt solid; border-left: #f0f0f0; border-right: black 1pt solid; border-top: #f0f0f0; mso-border-alt: solid black .5pt; mso-border-left-alt: solid black .5pt; mso-border-top-alt: solid black .5pt; padding-bottom: 0cm; padding-left: 5.4pt; padding-right: 5.4pt; padding-top: 0cm; width: 159pt;" valign="top" width="212"><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt;"><span style="font-family: Times, "Times New Roman", serif;">Ref (+)</span></div></td></tr>
<tr style="mso-yfti-irow: 11;"><td style="background-color: transparent; border-bottom: black 1pt solid; border-left: black 1pt solid; border-right: black 1pt solid; border-top: #f0f0f0; mso-border-alt: solid black .5pt; mso-border-top-alt: solid black .5pt; padding-bottom: 0cm; padding-left: 5.4pt; padding-right: 5.4pt; padding-top: 0cm; width: 161.3pt;" valign="top" width="215"><div align="right" class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: right;"><span style="font-family: Times, "Times New Roman", serif;">dbn</span></div></td><td style="background-color: transparent; border-bottom: black 1pt solid; border-left: #f0f0f0; border-right: black 1pt solid; border-top: #f0f0f0; mso-border-alt: solid black .5pt; mso-border-left-alt: solid black .5pt; mso-border-top-alt: solid black .5pt; padding-bottom: 0cm; padding-left: 5.4pt; padding-right: 5.4pt; padding-top: 0cm; width: 99.25pt;" valign="top" width="132"><div align="center" class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: center;"><span style="font-family: Times, "Times New Roman", serif;">Retina</span></div></td><td style="background-color: transparent; border-bottom: black 1pt solid; border-left: #f0f0f0; border-right: black 1pt solid; border-top: #f0f0f0; mso-border-alt: solid black .5pt; mso-border-left-alt: solid black .5pt; mso-border-top-alt: solid black .5pt; padding-bottom: 0cm; padding-left: 5.4pt; padding-right: 5.4pt; padding-top: 0cm; width: 159pt;" valign="top" width="212"><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt;"><span style="font-family: Times, "Times New Roman", serif;">Dbn</span></div></td></tr>
<tr style="mso-yfti-irow: 12;"><td style="background-color: transparent; border-bottom: black 1pt solid; border-left: black 1pt solid; border-right: black 1pt solid; border-top: #f0f0f0; mso-border-alt: solid black .5pt; mso-border-top-alt: solid black .5pt; padding-bottom: 0cm; padding-left: 5.4pt; padding-right: 5.4pt; padding-top: 0cm; width: 161.3pt;" valign="top" width="215"><div align="right" class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: right;"><span style="font-family: Times, "Times New Roman", serif;">N (palpasi)</span></div></td><td style="background-color: transparent; border-bottom: black 1pt solid; border-left: #f0f0f0; border-right: black 1pt solid; border-top: #f0f0f0; mso-border-alt: solid black .5pt; mso-border-left-alt: solid black .5pt; mso-border-top-alt: solid black .5pt; padding-bottom: 0cm; padding-left: 5.4pt; padding-right: 5.4pt; padding-top: 0cm; width: 99.25pt;" valign="top" width="132"><div align="center" class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: center;"><span style="font-family: Times, "Times New Roman", serif;">TIO</span></div></td><td style="background-color: transparent; border-bottom: black 1pt solid; border-left: #f0f0f0; border-right: black 1pt solid; border-top: #f0f0f0; mso-border-alt: solid black .5pt; mso-border-left-alt: solid black .5pt; mso-border-top-alt: solid black .5pt; padding-bottom: 0cm; padding-left: 5.4pt; padding-right: 5.4pt; padding-top: 0cm; width: 159pt;" valign="top" width="212"><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt;"><span style="font-family: Times, "Times New Roman", serif;">N (palpasi)</span></div></td></tr>
<tr style="mso-yfti-irow: 13; mso-yfti-lastrow: yes;"><td style="background-color: transparent; border-bottom: black 1pt solid; border-left: black 1pt solid; border-right: black 1pt solid; border-top: #f0f0f0; mso-border-alt: solid black .5pt; mso-border-top-alt: solid black .5pt; padding-bottom: 0cm; padding-left: 5.4pt; padding-right: 5.4pt; padding-top: 0cm; width: 161.3pt;" valign="top" width="215"><div align="right" class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: right;"><span style="font-family: Times, "Times New Roman", serif;">bebas</span></div></td><td style="background-color: transparent; border-bottom: black 1pt solid; border-left: #f0f0f0; border-right: black 1pt solid; border-top: #f0f0f0; mso-border-alt: solid black .5pt; mso-border-left-alt: solid black .5pt; mso-border-top-alt: solid black .5pt; padding-bottom: 0cm; padding-left: 5.4pt; padding-right: 5.4pt; padding-top: 0cm; width: 99.25pt;" valign="top" width="132"><div align="center" class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: center;"><span style="font-family: Times, "Times New Roman", serif;">GBM</span></div></td><td style="background-color: transparent; border-bottom: black 1pt solid; border-left: #f0f0f0; border-right: black 1pt solid; border-top: #f0f0f0; mso-border-alt: solid black .5pt; mso-border-left-alt: solid black .5pt; mso-border-top-alt: solid black .5pt; padding-bottom: 0cm; padding-left: 5.4pt; padding-right: 5.4pt; padding-top: 0cm; width: 159pt;" valign="top" width="212"><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt;"><span style="font-family: Times, "Times New Roman", serif;">Bebas</span></div></td></tr>
</tbody></table><span style="font-family: Times, "Times New Roman", serif;"><br />
</span><br />
<div class="MsoNormal" style="margin: 0cm 0cm 10pt 42.55pt; text-align: justify; text-indent: -42.55pt;"><span style="font-family: Times, "Times New Roman", serif;"><br />
</span></div><div class="MsoNormal" style="margin: 0cm 0cm 10pt 42.55pt; text-align: justify; text-indent: -42.55pt;"><b style="mso-bidi-font-weight: normal;"><u><span style="font-family: Times, "Times New Roman", serif; font-size: 12pt; line-height: 115%;">Diagnosis</span></u></b></div><div class="MsoNormal" style="margin: 0cm 0cm 10pt 42.55pt; text-align: justify; text-indent: -42.55pt;"><span style="font-family: Times, "Times New Roman", serif; font-size: 12pt; line-height: 115%;">ODS trikiasis</span></div><div class="MsoNormal" style="margin: 0cm 0cm 10pt 42.55pt; text-align: justify; text-indent: -42.55pt;"><b style="mso-bidi-font-weight: normal;"><u><span style="font-family: Times, "Times New Roman", serif; font-size: 12pt; line-height: 115%;">Terapi</span></u></b></div><div class="MsoNormal" style="margin: 0cm 0cm 10pt 42.55pt; text-align: justify; text-indent: -42.55pt;"><span style="font-family: Times, "Times New Roman", serif; font-size: 12pt; line-height: 115%;">epilasi</span></div><div class="MsoNormal" style="margin: 0cm 0cm 10pt 42.55pt; text-align: justify; text-indent: -42.55pt;"><span style="font-family: Times, "Times New Roman", serif; font-size: 12pt; line-height: 115%;">chloramphenicol ED 2xODS</span></div><div class="MsoNormal" style="margin: 0cm 0cm 10pt 42.55pt; text-align: justify; text-indent: -42.55pt;"><span style="font-family: Times, "Times New Roman", serif; font-size: 12pt; line-height: 115%;">c. lyteers ED 4xODS</span></div>Anonymoushttp://www.blogger.com/profile/17040699491469284898noreply@blogger.com3