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LAPORAN KASUS

TUBERKULOSIS PARU

RSUD KEBUMEN

Oleh :

Retmiza

08711202

Pembimbing :

dr. Iwan Danardono, Sp.Rad

FAKULTAS KEDOKTERAN

UNIERSITAS ISLAM INDONESIA

!O"!AKARTA

201#

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BAB I

PENDAHULUAN

T$be%&$l'(i( )*%$ +TB, *-*l*h ($*.$ )en/*&i. ine&(i &%'ni( /*ng ($-*h (*ng*. l*m*

-i&en*l )*-* m*n$(i* mi(*ln/* -ih$b$ng&*n -eng*n .em)*. .ingg*l -i-*e%*h $%b*ni(*(i

ling&$ng*n /*ng )*-*. -*n -ib$&.i&*n -eng*n *-*n/* )enem$*n &e%$(*&*n .$l*ng e.eb%*

.h'%*& /*ng &h*( TB -*%i &e%*ng&*3 P*-* )e%m$l**n *b*- 14 in(i-en(i )en/*&i. .$be%&$l'(i(

-i E%')* -*n *me%i&* Se%i&*. (*ng*. be(*%3 Ang&* &em*.i*n 5$&$) .inggi /*&ni 600 )e% 

1003000 )en-$-$& -*n *ng&* &em*.i*n be%&i(*% 1#09 -*%i (em$* &em*.i*n3 U(*h*$(*h*

$n.$& meng$%*ngi *ng&* &em*.i*n -il*&$&*n (e)e%.i menghi%$) $-*%* (eg*% -i *l*m .e%b$&*

m*&*n min$m m*&*n*n be%gi;i membe%i&*n 'b*.'b*.*nb (e)e%./i .$be%&$lin -igi.*l

min/*& i&*n -*n l*inl*in3

In-'ne(i* *-*l*h nege%i )%e*len(i &e # .e%.inggi -i -$ni* (e.*l*h >3000 .*h$n 14483

Be%-*(*%&*n ($%e/ %$m*h* .*ngg* 148 -*n ($%e/ Ke(eh*.*n N*(i'n*l 2001 Tb

menem)*.i %*n&ing n'm'% # (ebg*i )en/eb*b &em*.i*n .e%.inggi -i In-ine(i*3 S$*.$ ($%e/

mengen*i )%e*len(i TB /*ng -il*&(*n*&*n -i 1 )%')in(i In-'ne(i* .*h$n 14741482 /*i$

%*.*%*.* )%e*len(i TB )*-* 1 )%')in(i In-'ne(i* /*i.$ 0249 -eng*n )e%*len(i .e%.inggi

*-* -i NTT /*i.$ 0769 -*n /*ng .e%en-*h -i B*li /*i.$ 00893

Peme%i&*(**n )en$n=*ng /*ng (e%ing -il*&$&*n )*-* &*($( ini *-*l*h %'n.gen .h'%*&3

R'n.gen *-*l*h (eb$*h (*.$*n )eng$&$%*n %*-i*(i i'n -i $-*%* be%$)* (in*% ? *.*$ (in*% 

"*mm*3 R'n.gen /*i.$ =$ml*h %*-i*(i /*ng -ib$.$h&*n $n.$& mengh*n.*%&*n m$*.*n )'(i.i 

-*n neg*.i -*%i (*.$*n ele&.%'-* (.*.i& m$*.*n li(.%i&3 R'n.gen me%$)*&*n gel'mb*ng 5*h*/*

/*ng -i)*n5*%&*n 'leh -in-ing &*5* )*-* .*b$ng (**. ele&.%'n men*b%*& -in-ing .e%(eb$.

*&ib*. .e%=*-in/* )el$5$.*n li(.%i& mel*l$i g*( /*ng m*(ih .e%(i(* -i -*l*m .*b$ng3 P*-* (**.

 be%(*m**n ele&.%'n i.$ me%*ng(*ng *.'m )*-* &*5* $n.$& mengel$*%&*n gel'mb*ng

ele&.%'m*gne.i& /*ng )*n=*ng gel'mb*ngn/* (*ng*. )en-e& -*l*m ben.$& (in*% ?3

Sin*% ? -*)*. mem$-*%&*n be%b*g*i =eni( b*h*n &imi*3 Sin*% ? =$g* -*)*. menemb$(

 be%b*g*i m*.e%i /*ng .i-*& -*)*. -i.emb$( 'leh (in*% .*m)*& bi*(* /*ng ($-*h -i&en*l (**.

i.$3 Pen/*&i. )en/*&i. /*ng -*)*. -il*&$&*n )eme%i&(**n %'n.gen .h'%*& (e)e%.i (e(*& n*)*(

 b*.$& -*%*h &eg*n*(*n %*&.$% ine&(i )*%$ &el*in*n =*n.$ng3 Pengg$n**n .ehn'l'gi ini

($-*h me%*.* )en/eb*%*nn/*3 R$m*h (*&i. -i -*e%*h .e%)en5il )$n &ini ($-*h b*n/*& 

memili&i *l*. ini3

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BAB II

LANDASAN TEORI

Pen/eb*b .$be%&$l'(i( *-*l*h  Mycobacterium Tuberculosis /*i.$ &$m*n be%ben.$& 

 b*.*ng -eng*n $&$%*n )*n=*ng 16$m -*n .eb*l 0#0>$m3 P%'(e( .e%=*-in/* ine&(i 'leh

 M. Tuberkulosis  bi*(*n/* (e5*%* inh*l*(i3 Pen$l*%*n )en/*&i. ini (eb*gi*n be(*% mel*l$i

inh*l*(i h*(il /*ng meng*n-$ng -%')le. n$5lei /*ng -i-*)*. -*%i )*(ien Tb )*%$ -eng*n

 b*.$& be%-*%*h *.*$ ne%-*h*& /*ng meng*n-$ng BTA3 P*-* TB &$li. *.*$ =*%ing*n l$n*& 

 )en$l*%*n/* bi*(*n/* -i(eb*b&*n 'leh  M. Bovis  /*ng -*)*. -i(eb*b&*n 'leh ($($ /*ng

&$%*ng -i(.e%il&*n -eng*n b*i& *.*$ .e%&'n.*min*(i3

PATOGENESIS

T!er"#o$i$ Primer

Pen$l*%*n .$be%&$l'(i( )*%$ .e%=*-i &*%en* &$m*n -ib*.$&&*n *.*$ -ibe%(in&*n &el$*% 

men=*-i -%')le. n$5lei -*l*m $-*%* (e&i.*% &i.*3 P*%.i&el ine&(i ini -*)*. mene.*) -i $-*%*

(el*m* 12 =*m .e%g*n.$ng *-* .i-*&n/* (in*% $l.%*i'le. en.il*(i /*ng b$%$& -*n

&elemb*b*n3 Bil* &$m*n mene.*) -i =*%ing*n )*%$ be%&emb*ng bi*& -eng*n (i.')l*(m*

m*&%'*g3 Di (*n* i* *&*n -*)*. m*($& '%g*n .$b$h l*inn/*3 K$m*n /*ng be%(*%*ng -i

 =*%ing*n )*%$ *&*n be%ben.$& (*%*ng .$be%&$l'(i( )ne$m'ni* &e5il /*ng -i(eb$. (*%*ng

 )%ime% *.*$ ee& )%ime% *.*$  fokus Ghon3 Bil* men=*l*% &e )le$%* *&*n .e%=*-i e$(i )le$%*3

K$m*n ini =$g* -*)*. m*($& mel*l$i (*l$%*n g*(.%'in.e(.in*l =*%ing*n lime '%'*%ing -*n

&$li. /*ng &em$-i*n *&*n .e%=*-i lim*-en')*.i %egi'n*l &em$-i*n b*&.e%i m*($& &e -*l*m

en* -*n men=*l*% &e(el$%$h '%g*n (e)e%.i )*%$ '.*& in=*l .$l*ng3 Bil* m*($& &e *%.e%i

 )$lm'n*li( m*&* *&*n .e%=*-i )e%=*l*%*n &e(el$%$h b*gi*n )*%$ men=*-i Tb milie%3

D*%i (*%*ng )%ime% *&*n .imb$l )e%*-*ng*n (*l$%*n ge.*h bening men$=$ hil$(

+lim*ngi.i( l'&*l, -*n =$g* -ii&$.i )embe(*n &elen=e% ge.*h bening hil$( + lim*-eni.i(

%egi'n*l,3 Lim*ngi.i( l'&*i @ lim*-eni.i( %egi'n*l K'm)le&( P%ime% +R*n&e,3

T!er"#o$i$ Se"nder

T$be%&$l'(i( (e&$n-e% .e%=*- &*%en* im$ni.*( /*ng men$%$n (e)e%.i m*ln$.%i(i

*l&'h'l )en/*&i. m*lign* -i*be.e( AIDS g*g*l gin=*l3 T$be%&$l'(i( (e&$n-e% -im$l*i

-eng*n (*%*ng -ini /*ng be%l'&*(i -i %egi' *.*( )*%$ +b*gi*n *)i&*l )'(.e%i'% l'b$( ($)e%i'% 

*.*$ ine%i'%,

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TB (e&$n-e% =$g* -*)*. be%*(*l -*%i ine&(i e&('gen -*%i $(i* m$-* men=*-i TB $(i*

.$* +el-e%l/ .$be%&$l'(i(,3 Te%g*n.$ng -*%i =$ml*h &$m*n i%$len(in/* -*n im$ni.*( )*(ien

(*%*ng ini -*)*. -ib*gi men=*-i :

Di%e*b('%(i &emb*li -*n (emb$h .*n)* meningg*l&*n 5*5*.

S*%*ng /*ng m$l*m$l* mel$*( .e.*)i (ege%* men/emb$h -eng*n (e%b$&*n =*%ing*n

ib%'(i(

GE%ALA&GE%ALA KLINIS

  Dem*m bi*(*n/* ($beb%i( bi(* men5*)*i 6061 De%*=*.

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A-* bebe%*)* 5*%* )emb*gi*n &el*in*n /*ng -*)*. -ilih*. )*-* '.' %'en.gen3 S*l*h (*.$

 )emb*gi*n /*ng -i)e%g$n*&*n -i In-'ne(i* -*n mem*ng lebih )%*&.i( i*l*h :

S*%*ng(*%*ng be%ben.$& **n *.*$ be%5*& be%5*& -eng*n -en.i.*( %en-*h

*.*$ (e-*ng -eng*n b*.*( .i-*& .eg*(3 S*%*ng (*%*ng (e)e%.i ini bi*(*n/*men$n=$&&*n b*h* )%'(e( *&.i 

L$b*ng +&*i.*(,3 Ini (el*l$ be*%.i )%'(e( *&.i &e5$*li bil* l$b*ng ($-*h

(*ng*. &e5il /*ng -in*m*&*n l$b*ng sisa- +%e(i-$*l 5*i./,

S*%*ng (e)e%.i g*%i(g*%i( +ib%'.i&, *.*$ bin.i&bin.i& &*)$% +&*l(ii&*(i, /*ng

 bi*(*n/* men$n=$&&*n b*h* )%'(e( .el*h .en*ng

DIAGNOSIS

Di*gn'(i( )*(.i TB )*%$ /*i.$ -i.em$&*n &$m*n  Mycobacterium Tuberculae  -*l*m

()$.$m *.*$ =*%ing*n )*%$ (e5*%* bi*&*n3

PENGOBATAN

Peng'b*.*n me-i&*men.'(* TB mile% *-*l*h 6 m*5*m 'b*. *n.iTB (el*m* 2 b$l*n

 )e%.*m* -il*n=$.&*n -eng*n I('ni*;i- -*n Ri*m)i5in (el*m* 6> b$l*n (e($*i -eng*n

 )e%&emb*ng*n &lini(3 K'%.i&'(.e%'i- +P%eni('ne, -ibe%i&*n )*-* TB milie%3 P%e-i('ne

 bi*(*n/* -ibe%i&*n -eng*n -'(i( 12 mg&gBBh*%i (el*m* 68 mingg$ &em$-i*n -i.$%$n&*n )e%l*h*nl*h*n hingg* 2> mingg$ &em$-i*n3

Deng*n )eng'b*.*n /*ng .e)*. *&*n .e%=*-i )e%b*i&*n TB milie% be%=*l*n -eng*n

5e)*.3 Re()'n &ebe%h*(il*n .e%*)i *n.*%* l*in *-*l*h hil*ngn/* -em*m (e.l*h 2# mingg$

 )eng'b*.*n )ening&*.*n n*($ m*&*n )e%b*i&*n &$*li.*( hi-$) (eh*%ih*%i -*n )ening&*.*n

 be%*. b*-*n3

 N*m* 'b*. D'(i( h*%i*n

+mg&gBBh*%i,

D'(i( m*&(im*l

+mgh*%i,

Ee& (*m)ing

i('ni*;i- 1 #00 Ce)*.i.i( ne$%i.i(

e%ie% 

Ri*m)i5in 1020 >00 he)*.i.i(

Pi%*;in*mi- 1#0 2000 Ce)*.'.'&(i& *%.%*lgi*

E.*mb$.'l 120 120 Ne$%'%i.i( ').i&  

S.%e)'mi5in 160 1000 O.'.'&(i& ne%'.'l(i&  

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KO'PLIKASI

K'm)li&*(i -ini : Ple$%i.i( e$(i )le$%* em)i(em* l*%ingi.i( )'n5e.(

*%.h%')*.h/

K'm)li&*(i l*n=$. : 'b(.%$&(i =*l*n n*)*( &e%$(*&*n )*%$ be%*. hingg* ib%'(i(

 )*%$ 5'% )$lm'n*l *mil'i-'(i( &*%(in'm* )*%$ (in-%'m* g*g*l n*)*(

-e*(* TB milie% -*n &*i.*( TB

BAB III

ANA'NESIS

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 N*m* : N/3 M

Um$% : 68 .*h$n

Al*m*. : &em*ngg$ng*n Ali*n Keb$men

Pe&e%=**n : i%*(*(.*

Ke#)an tama * (e(*& n*)*(

Riwa+at Pen+a"it Se"aran *

Se(*& n*)*( -i%*(*&*n (e=*& 1 mingg$ ini -i%*(*&*n .e%$(mene%$( -*n mengg*ngg$

*&.ii.*(3 Sel*in i.$ )*(ien =$g* mengel$h b*.$& (e=*& 1 .*h$n ini /*ng .*& &$n=$ng (emb$h

-*n 1 mingg$ ini )*(ien mengel$h b*.$&n/* be%-*h*& -*n -eng*n -*h*& /*ng be%*%n*

5'&l*.3 P*(ien =$g* mengel$h (e%ing &el$*% &e%ing*. -im*l*m h*%i3 P*(ien =$g* meng*&$ .i-*& 

n*($ m*&*n *&hi%*&hi% ini -*n meng*l*mi )en$%$n*n be%*. b*-*n3

Riwa+at Pen+a"it Da)# *

B*.$& l*m* +1 .*h$n,

Ci)e%.en(i -i(*ng&*l

Me%'&'& -i(*ng&*l

Riwa+at Pen+a"it Ke#ara *

  Ti-*& *-* &el$*%g* -eng*n &el$h*n (e%$)*

Ke!ia$aan*

Kebe%(ih*n ling&$ng*n %$m*h )*(ien men5$&$)i en.il*(i %$m*h &$%*ng )*(ien

(eh*%ih*%i m*&*n -eng*n m*&*n*n (e*-*n/*3 P*(ien .i-*& menge.*h$i ling&$ng*n .e.*ngg*

-eng*n %i*/*. TB

PE'ERIKSAAN (ISIK 

Ke*-**n $m$m : .*m)*& (e(*& 5'm)'( men.i(

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i.*l (ign :

Te&*n*n -*%*h : 12080

Tem)e%*.$% : #8 -e%*=*. 5el5i$(

 N*-i : 100 meni.

Re()i%*(i : 28 meni.

Peme%i&(**n )e% Regi'

Ke)*l* : &'n=$ng.i* *nemi( +@@, (&le%* i&.e%i& +,

Lehe% : .i-*& *-* )embe(*%*n lim'n'-i P .i-*& mening&*.

*n.$ng : ($*%* =*n.$ng 1 -*n 2 %eg$le% .i-*& *-* bi(ing

P*%$ : ($*%* )*%$ n'%m*l e(&$le% %'n&hi +, hee;ing +,

Ab-'men : ($)el n/e%i .e&*n +, )e%i(.*l.i& n'%m*l .e%*b* m*((*+, he)*% -*n

lien .i-*& .e%*b*

E&.%emi.*( : 'e-em*+,

DIAGNOSIS

TB )*%$

DIAGNOSIS BANDING

K*n&e% )*%$

B%'n&i.i( &%'ni& 

RONTGEN THORAK 

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De$"rip$i

T*m)*& )e%(el$b$ng*n (emi')*& inh'm'gen -i l'b$( ine%i'% )$lm' -e.%*

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T*m)*& inil.%*. -i)*%*&*%-i*l -e.%* -*n -i )$lm' +@,

Sin$( 5'(.'%eni5$( -e.%* -*n (ini(.%* l*n5i)

Di*%*gm* -e.%* -*n (ini(.%* li5in

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.e%(eb*% me%*.* )*-* (el$%$h l*)*ng*n )*%$3 "*mb*%*n l*in *-*l*h )eneb*l*n )*-* )le$%*

+)le$%i.i(, e$(i )le$%* em)i(em* b*/*ng*n hi.*m %*-i'l$(en -i )inggi% )*%$ )le$%*

+)ne$m'.h'%*&(,3

Peme%i&(**n &h$($( *-*l*h b%'n&'g%*i /*i.$ $n.$& melih*. &e%$(*&*n b%'n&$( /*ng

-i(eb*b&*n 'leh .$be%&$l'(i(3 Peme%i&(**n ini -il*&$&*n )*-* )*(ien /*ng *&*n -il*&$&*n

')e%*(i )*%$3 Peme%i&(**n /*ng lebih 5*nggih *-*l*h