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PENYAKIT PARU AKIBAT KERJA

PENYAKIT PARU AKIBAT KERJA. ASBESTOSIS. ASBESTOSIS. Penyaji Materi : dr. Sinatra Gunawan, MK3, SpOk. PENYAKIT PARU AKIBAT KERJA. Pajanan: ASBES. Berdasar tipe serat dibagi menjadi 2 grup: Serpentine: Chrysotile (putih)

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PENYAKIT PARU AKIBAT KERJA

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  1. PENYAKIT PARU AKIBAT KERJA ASBESTOSIS

  2. ASBESTOSIS Penyaji Materi : dr. Sinatra Gunawan, MK3, SpOk

  3. PENYAKIT PARU AKIBAT KERJA • Pajanan: ASBES • Berdasar tipe serat dibagi menjadi 2 grup: • Serpentine: Chrysotile(putih) • Amphiboles: Crocidolite(biru) , Tremolite , Amosite(coklat) dan Anthophyllite • Berbeda dalam struktur kristalin, bahan kimia, karakter fisik serat, aspekratio ( ratio panjang dan diameter).

  4. PENYAKIT PARU AKIBAT KERJA • ASBES • Chrysotile: berbentuk ikal • Crocidolite berbentuk spt batang

  5. PENYAKIT PARU AKIBAT KERJA • PENYAKIT ASBESTOSIS : • Pneumokoniosis akibat serat asbes. • Serat dapat yang mencapai bronchus terminalis atau alveoli berukuran sangat kecil (<5 m) , sehingga sering TIDAK DISADARI pekerja. • Klinis berubah kelainan pada fibrotik paru akibat inhalasi serat asbes.

  6. PENYAKIT PARU AKIBAT KERJA • ASBESTOSIS : • Penyakit saluran pernafasan berupa fibrosis paru interstitial difusa bilateral yang terjadi akibat menghirup serat asbes • Pada paru-paru terbentuk jaringan parut (fibrotik) yang luas • Dapat terus berlanjut walaupun sudah bebas dari pajanan asbes

  7. PENYAKIT PARU AKIBAT KERJA • ASBESTOSIS : • Diffuse Interstitial Pulmonary Fibrosis (asbestosis). Pertama kali dilaporkan di Ingris pada awal 1900. • Dapat menyebabkan kanker paru. • Selain dari pajanan di tempat kerja, serat asbes dapat terbawa melalui pakaian pekerja kerumah atau sebaliknya. • Merokok menyebabkan meningkatnya resiko terjadinya penyakit akibat asbes.

  8. PENYAKIT PARU AKIBAT KERJA • PATO FISIOLOGI • Asbes terinhalasi ke saluran nafas. • Kemampuan menembus ke dalam rongga paru sampai ke jaringan paru yang terdalam (alveolus) tergantung ukuran. • Serat yang berukuran ≤ 5m sekitar 80% dapat menembus ke alveolus dan sekitar 20 % nya akan tertahan di hidung

  9. PENYAKIT PARU AKIBAT KERJA • PATO FISIOLOGI • Akibat inhalasi serat, terjadi proses inflamasi karena tertahannya serat asbes di paru. •  Terjadi perubahan berupa fibrotik paru. • Ciri Fibrosis paru pada asbestosis: interstitial, tersebar (diffuse) dan lokasi terutama di lobus bawah paru.

  10. PENYAKIT PARU AKIBAT KERJA • GEJALA KLINIS • Baru timbul 10-15 tahun bahkan > 20 tahun, yaitu bila sudah terbentuk jaringan parut yang luas di paru. • Nafas pendek setelah beraktifitas • Batuk kering • Rhonki kering dibasal paru • Clubbing finger

  11. PENYAKIT PARU AKIBAT KERJA • MIKROSKOPIS • Asbestos bodies, merupakan marker dari pajanan asbes • “Dumbbell-shaped bodies” berukuran 20-50 m • Serat asbes yang diserang oleh makrofag alveolus  • Terjadinya endapan dari material mukopolisakarida dan besi (dari pemecahan Hb oleh makrofag) • Pigmen besi akan memberi warna coklat keemasan

  12. PENYAKIT PARU AKIBAT KERJA • RADIOLOGI : Thorax Photo • Penebalan pleura atau kalsifikasi dari pleura (pleural plaque) • Fibrosis paru biasanya dilapangan paru kiri bawah • Kadang - kadang akan ditemukan pembesaran kelenjar hilus. • Pada kasus lanjut dapat dilihat adanya “honeycombing” • “shaggy heart“ ditemukan di jantung atau batas diafragma.

  13. PENYAKIT PARU AKIBAT KERJA • PENGOBATAN Tujuan: agar pasien dapat bernafas dgn lebih mudah, mencegah flu dan infeksi saluran nafas, dan mengontrol komplikasi akibat asbestosis stadium lanjut • Antibiotik • Mengeluarkan dahak dari paru-paru melalui prosedur postural drainase, perkusi dada dan vibrasi. • inhalasi • Oksigen • Steroid dan imunosupresant

  14. PENYAKIT PARU AKIBAT KERJA • PENCEGAHAN • Mengurangi kadar serat dan debu asbes di lingkungan kerja • Berhenti merokok • Penggantian material • Wet procces • Lokal exhaust ventilation • APD

  15. PENYAKIT PARU AKIBAT KERJA • BIOPSI • Incisi dengan bantuan kamera: - Pleura yang sangat tebal, dan terdapat fibrous adhesi dari dasar paru sampai pleura parietalis. • Thoracotomi dan biopsi terbuka:  • Kalsifikasi pleura parietal dan pleura viseralis yg luas • Diafragma yg seluruhnya diliputi bercak kalsifikasi, shg menggangu pergerakan diafragma (pneumonitis interstitial) • Asbestos bodies • > 8 juta serat asbes pada tiap gram paru kering, dimana 68 %nya adalah asbes jenis tremolite. • Sama dengan sample mineral vermiculite dari dari Libby, Montana.

  16. PENYAKIT PARU AKIBAT KERJA • PASCA BIOPSI • Keluhan < • Beberapa minggu kemudian, tiba-tiba sesak nafas hebat & hyperkapnia (penyebab tidak jelas) • Therapy yang diberikan tidak banyak menolong • Memutuskan untuk “comfort care” • Meninggal 2 bulan kemudian dirumah akibat gagal nafas dan hyperkapnia • Tidak dilakukan otopsi pada pasien ini.

  17. PENYAKIT PARU AKIBAT KERJA • KESIMPULAN • Diagnosa asbestosis: dapat ditegakan dari adanya pajanan agen, gejala klinis, retriksi paru, penurunan DLCO gambaran X-Ray dan ditemukannya asbestosis bodies • Asbes mempunyai efek karsinogenik • Efek asbes terhadap kesehatan dapat timbul dalam waktu yang sangat lama sejak pajanan yang pertama kali.

  18. PENYAKIT PARU AKIBAT KERJA • SARAN • Penggunaan APD, wet procces dan exhaust ventilation dapat digunakan unt mengurangi resiko menderita asbestosis. • Berhenti merokok unt mengurangi resiko menderita kanker paru. • Penggunaan bahan pengganti asbes, unt menghindari bahaya asbes terhadap konsumen dan pekerja

  19. Asbestos Exposure – Pleural Effects

  20. Asbestos Exposure – Pleural Effects • It is not Asbestosis • Bilateral mid-thoracic pleural thickening / plaque formation. Apices are spared. • Plaques spare costophrenic angles & do not adversely affect lung function • Occasionally, benign exudative hemorrhagic pleural effusions are identified. This may result in pleural thickening. • Pleural thickening, if extensive, may cause restrictive lung disease

  21. Asbestos Exposure • Malignant mesotheliomas are associated with Asbestos exposure (80%) • Arise from the mesothelial cell of the pleura • Latency period can be > 35 years • It is NOT associated with smoking • It is usually a rapidly fatal disease • Pleural plaques / thickening do NOT become mesothelioma • Exposure may be minimal, latency is important

  22. Asbestosis & Asbestos exposure General • The most pervasive OLD • Greatest impact on morbidity and mortality • In 1990 – 40,000 workers directly exposed • In 1990 – 3-5 million individuals indirectly exposed. • 25 million Americans have had occupational exposure to Asbestos

  23. Asbestosis & Asbestos exposure General • Many millions have environmental exposure • Insulation, building products, brake and clutch linings, and demolition of asbestos containing building in urban areas • It has been federally regulated by OSHA since its inception in 1972 • Forms: Chrysotile or white asbestos, crocidolite, amosite, anthophyllite, tremolite, and actinolite.

  24. Asbestosis Pathogenesis • Pathogenesis of pulmonary fibrosis is unknown • Inflammation & fibrosis are distributed heterogeneously throughout the lungs • Asbestosis occurs with > 10 years exposure • Cigarette smoking enhances the risk of developing Asbestosis.

  25. Asbestosis Clinical presentation • Progressive dyspnea • Dyspnea is a more prominent complaint than tests of lung function would suggest • Dry cough & pleuritic chest pain • Rales over lateral lower thoracic wall • Advanced cases – clubbing and cyanosis

  26. Asbestosis Radiographic findings • Parenchymal fibrosis mostly in the bases • Small linear opacities in the lower lung zones • Diffuse linear opacities in middle and lower lung zones • HRCT scan can detect interstitial abnormalities that may be missed by regular CXR

  27. Asbestosis – Diffuse Pleural Thickening & Pleural Plaque From: Occupational Lung Disease “An International Perspective” Daniel E. Banks and John E. Parker. 1998

  28. Asbestosis – Diffuse Pleural Thickening & Pleural Plaque From: Occupational Lung Disease “An International Perspective” Daniel E. Banks and John E. Parker. 1998

  29. Asbestosis – Circumscribed Pleural Thickening & Pleural Plaque From: Occupational Lung Disease “An International Perspective” Daniel E. Banks and John E. Parker. 1998

  30. Asbestos Exposure – Pleural Plaque & emphysema From: Occupational Lung Disease “An International Perspective” Daniel E. Banks and John E. Parker. 1998

  31. Asbestosis: Interstitial lung disease Diagnosis • Objective evidence of exposure • History - latency • Fibers in bronchoalveolar lavage fluid • Fibers in lung parenchyma • Bilateral pleural fibrosis +/- present

  32. Asbestosis Diagnosis • Objective evidence of disease • Characteristic radiological findings • Restrictive lung function • Reduced diffusing capacity • Absence of other medical illnesses which can mimic Asbestosis

  33. Asbestosis Miscellaneous • No specific treatment - supportive • Smoking has a synergistic effect in the development of lung cancer • Lung cancers are squamous and adeno • Encourage smoking cessation

  34. ASBES • ASBESTOS IS A FIBROUS MATERIAL IT OCCURS NATURALLY IN MANY PARTS OF THE WORLD. • 3 MAIN TYPES : * CHRYSOTILE - WHITE ASBESTOS * AMOSITE - BROWN ASBESTOS * CROCIDOLITE - BLUE ASBESTOS

  35. ASBES • ASBESTOS PRODUCTS Corrugated Roofing Fire Door

  36. ASBES • ASBESTOS PRODUCTS ASBESTOS INSULATING BOARD USED AS: CEILING PANELS / TILES WALL PANELS/PARTITIONING SOFFITS - INTERNAL/EXTERNAL DOOR LININGS, ESPECIALLY TO FIRE DOORS, HEATING UNIT CUPBOARDS CLADDING TO DUCTS

  37. ASBES • ASBESTOS PRODUCTS Acoustic Panel - School Hall Damage caused by cable ASBESTOS BOARD

  38. ASBES • ASBESTOS PRODUCTS LAGGING - TO BOILERS PIPES CALORIFIERS SPRAYED COATINGS TO - CEILINGS RSJ’S INSULATION GASKETS ROPE

  39. ASBES • ASBESTOS PRODUCTS Pipe Lagging, Gaskets and Woven Asbestos

  40. ASBES • WHEN IS ASBESTOS A RISK TO HEALTH ? • CONSIDER THE TYPE OF PRODUCT. • HOW WELL IS THE ASBESTOS BONDED INTO IT? • IS IT LIKELY TO CONTAIN A SMALL OR LARGE AMOUNT OF ASBESTOS ? And, consider the condition; • GOOD ? E.G. SEALED, PAINTED. • DAMAGED ? EXTENT OF DAMAGE

  41. ASBES • ASBESTOS AWARENESS NOT THE END OF BEING AWARE ASBESTOS CAN KILL !

  42. BERLANJUT KE PAK bag-3C

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