Chronic Rhino Sinusitis With Suspect Ion Nasal Polyps New
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Transcript of Chronic Rhino Sinusitis With Suspect Ion Nasal Polyps New
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CASE REPORT
BY :
ENDRO TANOYO YANUAR ADI KURNIAFUAD ANSHORI INDERA NOOR A.
YOHANES AGUNG P. ABDUL SYUKUR
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PATIENT IDENTITY
Name : Mr. H
Age : 60 years old
Sex : Male
Adress : Bayan, Purworejo
Occupation : Farmer Last studied : SD
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ANAMNESIS
Chief complaint : obstructed right and leftnostril
Present Ilnessess: Since 1 year before, thispatient complains obstructed right and leftnose.
Obstructed nose is felt continually. Patientcomplained of frequent runny nose(+),
yellow-green nasal mucus, the nose smells(+),especially on waking up. Patient frequentexperienced colds when exposed to dust(+),sneezing(+), itching of the nose(+). Pain is felt
on the nose, on the right cheek and left(+).
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Patient also complained of frequent cough (+), feels a
lot of mucus in the throat (+), and often swallow
mucus. Patient has no complaints on the ear (-) &
sore throat (-), fever (-) and a history of tooth
extraction (-).
History of treatment: patients always to seek health
care if the patient has complaints like this, and
experienced temporary improvement.
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Past Illnesses :
Denied history of trauma
History of dust allergy (+) History of asthma denied
History of itching in the skin denied
Denied a history of hypertension and diabetes
mellitus
History denied bleeding nose
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Family History :
No family history of similar illness
Dust allergy history denied History of asthma denied
History of itching in the skin denied
Denied a history of hypertension and diabetes
mellitus
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RESUME ANAMNESIS
Nasal obstruction (+) on the right & left nose
Rhinorrhea (+)
Pain on nose and around cheek (+) Sneezing (+)
Itching on the nose (+)
Smell from the nose (+) Dust allergic (+)
Cough (+)
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PEMERIKSAAN FISIK
Status Generalis :
KU : Good, CM, adequate nutrition
VS : BP : 130/90 mmHgP : 88/mnt
RR : 24/mnt
T : 36,7 C
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Ear
Ear Examination: Auricle Normal
CAE laceration(-), Cerumen(+)N,Oedema(-)
Tymphanic Membrane redness(-),
Normal
Kanan Kiri
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Nose
Mass (+)
mucopurulen
Discharge (+)
Posterior Rhinoscopy : no Examination
Kanan Kiri
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Throat
Throat Examination:
Mucosal layer normal, redness(-), Ulcer(-), Tonsils normal
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DIAGNOSIS
Chronic Rhinosinusitis with Bilateral nasal
polyp
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Treatment
Ceftriaxone
Metronidazole
Dolak 3 x 30mg
Metilprednisolone
Aldisa 2 x 1
Natrium diklofenac
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PLAN
Ro SPN
Allergic test
Pro op Sinus : Polipectomy Anthrotomy
Medial, Ethmoidectomy
PROGNOSIS
Dubia ad bonam
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Anatomy
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Paranasal Sinus Drainage
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Vascularization and Innervation
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Nasal Polyp
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DEFINITION
Nasal polyps is the mass of benign / sessile stemmedfrom the nose-clear pale yellow, single or multiple,and stemmed from the mucoperiosteal tissue or
mucoperichondrial and filled with edematous stromaand inflammatory cells (Bailey, 2004)
Histologically, polyps are edematous nasal mucosatissue (Brown, 1997)
Nasal polyps that prolapse is part stemmed from themucosa of the nose / paranasal sinuses, and is not aneoplasm (Bhargava, 2002)
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Mass intracelluler fluid accumuluation
swell :
Vascular tissue
Polysacharide deposite
Sodium Absorption
ion Cl -
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Nasal Polyp characterized by chronic
eosinophils inflammation:eosinophil + mast cell+neutrophil
cytokine & other mediators
sodium Uptake
polyp water retention
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Etiologi (Scott Brown,1997)
Bernoulli phenomen
Polysacharide change
Vasomotor imbalance Infection
Allergy
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Nasal obstructionpmain complaint
Rhinorea, Sneezing
Hyposmia/anosmia
Post nasal drip Headache
Epistaxis
Clinical Symptoms
(Scott Brown,1997)
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Clinical Signs
Outer Nose : broad face, froglike
Anterior Rhinoscopy : polypsappear smooth, pale colors likepearl, shiny, not painful to thetouch(Bhargava, 2002)
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DiagnosisDiagnosis
Major factor Facial pain / pressure
Nasal obstruction /blockage
Nasal discharge /purulence / discoloredpostnasal drainage
Hyposmia / anosmia
Purulence in nasal cavityon examination
Fever ( acute rhinosinusitisonly)
Minor factor Headache
Fever (all nonacute )
Halitosis Fatigue
Dental pain
Cough
Ear pain / pressure /
fullness
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DIAGNOSIS
GEJALA KLINIS :
1) Nasal congestion
2) Sneezing
3) Discharge4) Expansion of the nose
5) anosmia
6) Snoring / breathing through the mouth
7) Dizziness, epiphora, PND rarely8) Talk impaired
(Bhargava, 2002)
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PATHOGENESIS
Ostium
Occlusion
Inflammation of
thelamina propria
Changes ofthe mucosal
gas
metabolism
Inhibition of
ventilation &
drainage
Stagnation of
secretion
Change in the
composition & pH
ofsecretion
Ciliary &
epithelial
damage
Change ofthe
host milieu.
Bacterial become
path
oge
nic
Increased
mucosalthickness
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Radiology Examination(Scott Brown 1997)
Ro SPN
Head CT scan
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Therapy
conservative
- corticosteroid
- Antihistamin
- Antibiotic polipoid with suspected sinusitis
- Decongestan
Operation- Polypectomy
- Sinuscopy- Caldwell-Luc
- Ethmoidectomy
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Thank You
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POLIP NASI
Suatu pertumbuhan edematus dari mukosa saluran napas bagian
atas dapat tumbuh dari semua bagian mukosa kavum nasi dari sinus
ethmoidalis, cenderung multipel (Ballantyne, 1979)
Etiologi
ada 2 tipe1. Simpel : gambaran oedem dan hipertropi sub mukosa stroma
jaringan fibrosa dengan cairan serosa pada interseluler.
Permukaan ditutupi epitel kolumner bersiliap epitel
transisional dan skuamosaa. allergik : Sensitivitas inkomplet terhadap alergen mutipel,
eosinofilia + plasma sel ada jumlah besar
b. vasomotor: serupa dengan alergi, tidak ditemukan gejala
alergi
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c. Infeksi : bakteri atau virus
- akut : influensa, single, lembek, sedikit hemoragi
- kronik non spesifik : multipel
- kronik spesifik : mudah pecah, strawbery
d. Mixed infeksi alergi : infeksi sekunder pada alergi
vasomotor
2. Neoplastik
a. Benigna : neurofibroma, fibroma, glioma dsb
b. Maligna : carsinomatous, sarkomatous, sakit, timbulpendarahan, fragil
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Teori Pembentukan Polip
1. Teori Alergi
Alergi & polip hidungppersamaan histologis
terutama edema & eosinofilia dalam darah & sekret
hidung2. Teori Infeksi
Inflamasi kronisp infeksi kuman
3. Teori Obstruksi Mekanik
Obstruksi mekanikp deviasi septum, hiperplasi &
hipertrofi konka inferior atau mediap teori fenomena
Bernoullipperan penting pembentukan polip.
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4. Teori Gangguan Saraf
struktur polip tidak ada serabut-serabut sarafsensoris, vasomotor dan sekreto-motoris
5. Teori Supurasi Sinus
polip hidung timbul akibat supurasi sinus
6. Teori Pembuluh Darah & Limfepolip timbul karena perubahan pembyuluh darah
dalam mukosa hidung, serta infeksi yang berulang
akan menyebabkan periflebitis & perilimfangitis
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Proses pembentukan polip diduga melalui 2 tahap yaitu :
1. Tahap awal terjadi pertumbuhan mukosa berupa edem
dan infiltrasi sel-sel radang seperti eosinofil dan
neutrofil, yang disebabkan oleh alergi, infeksi,gangguan vasomotor & kombinasinnya
2. Tahap kedua mukosa yang udem tersebut akan
menonjol ke kavum nasi karena pengaruh mekanisdari lingkungannya yaitu tekanan negatif.
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Faktor penyebab Faktor pendukung
(aspirin intolerance, infeksi, cystic fibrosis) (Ig E dependent reaction)
Nerve damage Degranulasi mast sel
Denervasi vasomotor Pelepasan histamin
Kenaikan permeabilitas vaskuler
Oedema
Polip
Gambar 1. Etiopatogenesis Polip nasi (Mygind N, 1981)
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Pembentukan Menurut Histologi
1.P
olip EdematusMasa putih mengkilap, jernih, seperti buah anggur
paling sering ditemukan. Mikroskopis tampak sedikit jaringan
fibrous longgar terdapat pada ruangan yang penuh cairan edern
2. Polip Fibrous
Masa putih keruh kurang mengkilap
Mikroskopis jar. Fibrous lebih banyak daripada cairan edemnya.
3. Polip Vaskuler
Masa kemerahan
Mikroskopis jaringan dominan adanya jar. vaskuler disertai
gambaran edema perivaskuler.
Becker. Wet at. 1994pMassa bertangkai atau tak bertungkai
pada mukosa nasal atau sinus disebabkan oleh inflamasi.
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Nasal Polyposis
Pathophysiology: The pathogenesis of nasal
polyposis is unknown. Polyp development has
been linked to chronic inflammation,
autonomic nervous system dysfunction, and
genetic predisposition. Most theories consider
polyps to be the ultimate manifestation of
chronic inflammation; therefore, conditionsleading to chronic inflammation in the nasal
cavity can lead to nasal polyps.
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Most studies suggest that polyps are
associated more strongly with nonallergic
disease than with allergic disease.
Statistically, nasal polyps are more common
in patients with nonallergic asthma (13%)
than with allergic asthma (5%), and only
0.5% of 3000 atopic individuals have nasalpolyps.