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SILICOSIS

SILICOSIS. Penyaji : Dr. Sinatra Gunawan, MK3, SpOk Referensi : Amer Rassam MD 1 , Gerry San Pedro MD 2 , Daniel Banks MD 1 . Department of Internal Medicine LSUHSC-Shreveport. Silicosis. General. The most prevalent and oldest known OLD in the world

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SILICOSIS

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  1. SILICOSIS Penyaji : Dr. Sinatra Gunawan, MK3, SpOk Referensi : Amer Rassam MD1, Gerry San Pedro MD2, Daniel Banks MD1. Department of Internal Medicine LSUHSC-Shreveport

  2. Silicosis General • The most prevalent and oldest known OLD in the world • Exposure to crystalline silica (quartz) • Mining, glassmaking, ceramics, sandblasting, foundries, and brick yards • Most commonly, latency 20-30 years • In the USA, > 2 million workers are at risk

  3. Silicosis Forms of Silicosis • *Chronic or pure nodular silicosis - 35% quartz • Complicated nodular silicosis (PMF) < 5% • Accelerated silicosis – 50% quartz – after 5 years of exposure – smaller nodules in the middle zones of the lung • Acute silicosis – silico-proteinosis - fatal

  4. Silicosis Pathogenesis • Progresses even in absence of further exposure • Rapid progression: R/O TB • Workers with nodules < 5 mm have long-term survival similar to that of the general population • Inflammatory response mediated by alveolar macrophages • TNF released by macrophages may be an essential component of the inflammatory response

  5. Silicosis Simple Nodular Silicosis • Small fibrocalcific nodules in upper lung • Hilar lymphadenopathy (eggshell calcification) • Increased susceptibility to TB • Yearly PPDs are recommended • D.D.: TB, CWP, Berylliosis

  6. Silicosis Complicated Nodular Silicosis (PMF) • Large nodules > 1 cm tend to coalesce • Increased susceptibility to TB • No specific treatment

  7. Decline in FVC & FEV1 in Silicosis Liters 10/95 11/95 4/96 6/96 10/96 3/97 From: Occupational Lung Disease “An International Perspective” Daniel E. Banks and John E. Parker. 1998

  8. Silicosis Remember ! • Yearly PPDs are recommended in patients with silicosis • A + PPD in these patients should receive prophylaxis no matter what the patient age or duration of + PPD • If symptoms are rapidly worsening, think of TB

  9. Accelerated Silicosis with PMF From: Occupational Lung Disease “An International Perspective” Daniel E. Banks and John E. Parker. 1998

  10. Diffuse Nodular Silicosis & Egg-shell calcification From: Occupational Lung Disease “An International Perspective” Daniel E. Banks and John E. Parker. 1998

  11. Massive Conglomerate Silicosis (Angel’s Wings) From: Occupational Lung Disease “An International Perspective” Daniel E. Banks and John E. Parker. 1998

  12. Egg-shell Calcification – Pathognomonic for Silicosis From: Occupational Lung Disease “An International Perspective” Daniel E. Banks and John E. Parker. 1998

  13. Progressive Massive Fibrosis - Silicotuberculosis From: Occupational Lung Disease “An International Perspective” Daniel E. Banks and John E. Parker. 1998

  14. SILICA • Why Target Crystalline Silica Exposure? • Widespread Occurrence and use - • Maritime • Agriculture • Construction • General Industry • Number of Related Deaths • Number of exposed workers • Health Effects

  15. SILICA • Occurrence of Crystalline Silica • Silicon Dioxide is basic component of sand, quartz, & granite • Quartz is second most common mineral in earth’s crust • Airborne silica is produced by, among other activities: • Sandblasting • Rock Drilling • Roof Bolting • Foundry Work • Stone Cutting • Drilling • Quarrying • Tunneling

  16. SILICA • Industries with Silica Exposure • Electronics • Foundries • Ceramics, clay & pottery, stone, glass • Construction • Agriculture • Maritime • Mining • Railroad ( setting & laying track) • Slate & flint quarrying & flint crushing • Use & manufacture of abrasives • Manufacture of soap & detergents

  17. SILICA • Number of Silica Related Deaths. • Total US deaths 1968-1990 where silica is reported on death certificate : 13,744 people. • Deaths where silicosis is reported as underlying cause of death : 6,322 people. • 68% of silica related deaths reported in 12 states. • 10% of silica-related deaths reported from construction industry.

  18. SILICA • Health Effects • Pulmonary fibrosis (silicosis) • Acute silicosis (1 to 3 years) • Accelerated silicosis (3 to 10 years) • Chronic silicosis (5 to 25 years) • Possible Lung Cancer

  19. SILICA • Inspection Targeting • Wherever possible, inspections will be focused to particular establishments where known exposures to crystalline have occurred or there are known cases of silicosis • Process • Identify establishments • Select sites by use of random number tables • Numbers of Inspections determined by regions • Sites with effective control programs are exited after program review

  20. SILICA • Elements of an effective, On-going Control Program for Crystalline Silica • Personal Monitoring • Medical Surveillance • Training • Availability of monitoring/Surveillance data to workers • Respiratory Protection Program • Hygiene facilities & clothing change areas

  21. SILICA • Elements of Control Program (continued) • Recordkeeping • Exposures below PEL or a current program with interim protection • Housekeeping • In construction : A Safety & Health Program • Regulated areas to limit exposures

  22. BERLANJUT KE PAK bag-3D

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