Ppt Pbl Blok 23 Stefi
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Transcript of Ppt Pbl Blok 23 Stefi
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8/18/2019 Ppt Pbl Blok 23 Stefi
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SKLERITIS OD DANPENANGANANNYA
Stef Taur
1020133
A2
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SKENARIO 11
Seorang perepuan u!"a #$ ta%un &atang 'e po(" uu u'r"&&engan 'e(u%an ata 'anan !a'"t &an !e&"'"t era% !e*a' 1"nggu +ang (a(u,
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R-.-SAN .ASALA/
Seorang perepuan u!"a #$ ta%un &engan 'e(u%an ata 'an!a'"t &an !e&"'"t era%
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.IND .AP
R.
Anane!"!
P PP
D DD
Et"o(og"
ep"&e"o(o
g"patof!"o(og"
.an" e!ta!"'("n"!
Tata(a'!ana
Kop("'a!"
Pen4ega%an
Progno!"!
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ANA.NESIS 5erapa (aa ata tapa' era%6
A&a'a% ra!a t"&a' n+aan atau "r"ta!"6
Apa'a% tera!a n+er"6 Apa'a% (e"% uru' &"gera''an6 A&a'a% n+er" 'epa(a +ang e
A&a'a% gangguan peng("%atan6
Apa'a% ata tera!a (eng'et6 A&a'a% e'!u Apa'a% ata tera!a 'er"ng atau per"%6
A&a'a% tan&a !"!te"' 8"!a(n+a &ea)atra(g"a) atau rua6
A&a'a% ra!a gata( pa&a ata atau a&a'a%
A&a'a% otoo"a6
"&ent"ta!Pa!"en
Ke(u%an-taa
RPS
RPD
RK RS
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PE.ERIKSAAN ISIK o T"&a' a&a penurunan 'eta*
peng("%atan
o Kon*ungt":a u(" &"&apat'put"% &e'at ("u!
o Len!a &an !egen po!ter"ata! nora(
Peer"'!aan :"!u!
Peer"'!aan!egen ant po!t
Peer"'!aan(apang pan&ang
Peer"'!aan gera'o(a ata
Peer"'!aante'anan o(a ata
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PE.ERIKSAAN PEN-N;ANG
Peer"'!aan &ara% (eng'ap &an (a*u en&ap &ara%
a'tor r%euato"& &a(a !eru
Ant"o&" ant"nu'(ear !eru 8ANA
Seru ant"neutrop%"( 4+top(a!"4 ant"o&"e! 8AN te!t Rontgen t%ora>
Seru TA?A5S) @DRL
Seru a!a urat
5?S4an -(tra!onograp%+
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ORKING DIAGNOSIS
S'(er"t"! OD
SkleritisAnterior
SkleritisPosterior
gangguan granu(oato!a 'ron"' +ang&"tan&a" o(e% &e'!tru'!" 'o(agen) !eu'an
!e() &an 'ea"nan :a!'u(er +ang enan&a'ana&an+a :a!'u("t"!
• D"u!e anter
• No&u(ar ante• Ne4rot"B"ng a
C"t% "na• Ne4rot"B"ng a
C"t%out "na
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Difuse anterior scleritispera&angan +ang e(ua! pa&a !e(uru%peru'aan !'(era, .erupa'an !'(er"t"!+ang pa("ng uu ter*a&",
Nodular anterior scleritis
!atu atau (e"% no&u( ra&ang er"te) t"&a'&apat &"gera''an) &an n+er" pa&a !'(eraanter"or, 20 'a!u! er'eang en*a&"!'(er"t"! ne'ro!"!,
Necrotizing anterior scleritis withinammationpen+a'"t !"!te"' !epert" rheumatoid
arthtitis, N+er" !angat erat &an 'eru!a'anpa&a !'(era ter("%at *e(a!,
Necrotizing anterior scleritis withoutinammationpa!"en +ang !u&a% (aa en&er"tar%euato"& art%r"t"!, D"a'"at'an o(e%peentu'an no&u( reato"& &an
a!enn+a ge*a(a,
Skleritis posterior ;arang ter*a&" &an &"tana&an+a n+er" te'an u(propto!"!, Ter&apat perapenea(an (ap"!an po!tee&ea retrou(ar, Dappeng(epa!an ret"na e'!a'u(ar) &an pap"(e&e
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DIERENTIAL DIAGNOSIS
Episkleritis Pterigium Ping
Rea'!" ra&ang *ar"ngan "'at :a!'u(ar+ang ter(eta' antara 'on*ungt":a &an
peru'aan !'(era
Pertuu%anfro:a!'u(ar 'on*ungt":a
+ang er!"at&egenerat":e &an "n:a!"
5en*o(an pau(" +an
pa&a
ata 'er"ng) ra!a n+er" r"ngan)&an ra!a enggan*a(, Ter&apatpu(a 'on*ungt":a +ang 'eot"'
.ata "r"tat") era%)en"u('an a!t"gat
5"(a era&a&"!e'"t
&egenera!peu(u%
e
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ETIOLOGI
pro!e! "uno(og" +a'n" ter*a&" rea'!" t"pe I@ 8%"per!en!"t"fta(aat &an t"pe III 8'op(e'! "un &an &"!erta" pen+a'"t
Pen+a'"t auto"unF artr"t"! r%euato"&) po("artr"t"! no&o!a) eru(ang) granu(oato!"! Cegener) (upu! er"teato!u! !"!tp"o&era gangreno!u) 'o("t"! u(!erat":a) neropat" IgA) arp!or"at"'a
Pen+a'"t granu(oato!a &an "ne'!"o!a F tuer'u(o!"!) !"f("!to'!op(a!o!"!) %erpe! !"p(e'!) %erpe! Bo!ter) "ne'!" !tre"ne'!" !taf(o'o'u!) a!perg"(o!"!) (epra,
La"n?(a"n F f!"' 8ra&"a!") (u'a a'ar tera() '""a 8(u'a a'aa!a) pen+ea e'an"! 8traua teu!) pee&a%an) (
ro!a!ea,
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EPIDE.IOLOGI
S'(er"t"! a&a(a% pen+a'"t +ang *arang &"*upa"
D" Aer"'a Ser"'at "n!"&en!" 'e*a&"an &"per'"ra'an 'a!u! 10,000 popu(a!",
9# a&a(a% !'(er"t"! anter"or
n+a a&a(a% !'(er"t"! po!ter"or an"ta (e"% an+a' ter'ena &ar"pa&a pr"a &engan peran&
1) F 1,
In!"&en !'(er"t"! terutaa ter*a&" antara $0?0 ta%un,
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GE;ALA KLINIS
rasa nyeri berat yang
dapat menyebar ke
dahi, alis, dan dagu
.ata era% era"r
Penurunan'eta*aan
peng("%atan
otoo"a
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PATOISIOLOGI
Ter*a&"n+a &"!regu(a!" pa&a pen+a'"t auto"un !e4ara uu a'tor pre&"!po!"!" &ar" !'(er"t"!, Pro!e! "naa!" "!a &"!ea''op(e'! "un +ang er%uungan &engan 'eru!a'an :a!'u(ar%"per!en!"t":"ta! t"pe III &an re!pon 'ron"' granu(oatou! 8rea'%"per!en!"t":"ta! t"pe I@, Intera'!" ter!eut a&a(a% ag"an &ar" a't" &"ana &apat en+ea'an 'eru!a'an !'(era a'"at &ep
"un pa&a peu(u% &" ep"!'(era &an !'(era +ang en+ea''ap"(er &an :enu(a po!t 'ap"(er 8"'roag"opat" "naa!" &an re!e( perantara, S"at auto"un !'(er"t"! *uga er%uungan &enga!"!te"' +ang en&a!ar"n+a,
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PENATALAKSANAAN
ant" "naa!" non !tero"& !"!te"'F
"n&oeta!"n 7$g per %ar") atau "uproen 00g per %ar"
Terap" pre&n"!one ora( 0)$?1)$ g='g=%ar"
T"n&a'an e&a% *arang &"(a'u'an
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KO.PLIKASI
.a'u(ar e&ea
Perora!" &ar" !'(era
S'(eroa(a!"a
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PROGNOSIS
In&":"&u &engan !'(er"t"! r"ngan "a!an+a t"&a' a'an enga(a'eru!a'an peng("%atan +ang peranen, /a!"( a'%"r 4en&erungtergantung pa&a pen+a'"t pen+erta +ang enga'"at'an !'(eNecrotizing scleritis uun+a enga'"at'an %"(angn+apeng("%atan &an e"("'" 21 'eung'"nan en"ngga( &a(ata%un,
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KESI.P-LAN
Pa!"en Can"ta #$ ta%un "n" &"&"agno!a ter'ena !'(er"t"! pa&a S'(er"t"! a&a(a% gangguan granu(oato!a 'ron"', Ke(a"nan?'e!'(er"t"! urn" &"perantara" o(e% pro!e! "uno(og" +a'n" ter*at"pe I@ 8%"per!en!"t"fta! t"pe (aat &an t"pe III 8'op(e'! "&"!erta" pen+a'"t !"!te"',