ILMU PATOLOGI KLINIK -...
-
Upload
truongthuy -
Category
Documents
-
view
228 -
download
5
Transcript of ILMU PATOLOGI KLINIK -...
![Page 1: ILMU PATOLOGI KLINIK - fkg.usu.ac.idfkg.usu.ac.id/images/Bahan_Kuliah/BLOK_9/PK1---ILMU-PATOLOGI... · – Darah rutin – Urine rutin ... Laju endapan darah Nilai MC : - MCV - MCH](https://reader034.fdocument.pub/reader034/viewer/2022052515/5a78d6997f8b9aa17b8d5342/html5/thumbnails/1.jpg)
ILMU PATOLOGI KLINIK
Dr. BURHANUDDIN NST, SpPK-KN,FISH
![Page 2: ILMU PATOLOGI KLINIK - fkg.usu.ac.idfkg.usu.ac.id/images/Bahan_Kuliah/BLOK_9/PK1---ILMU-PATOLOGI... · – Darah rutin – Urine rutin ... Laju endapan darah Nilai MC : - MCV - MCH](https://reader034.fdocument.pub/reader034/viewer/2022052515/5a78d6997f8b9aa17b8d5342/html5/thumbnails/2.jpg)
ILMU PATOLOGI KLINIK
Cabang ilmu kedokteran yang:
1. Memeriksa dan mempelajari contoh bahan yang berasal dari manusia :
* Darah * Urine
* Tinja * Cairan tubuh lainnya
2. Mempelajari pengelolaan (management) laboratorium
![Page 3: ILMU PATOLOGI KLINIK - fkg.usu.ac.idfkg.usu.ac.id/images/Bahan_Kuliah/BLOK_9/PK1---ILMU-PATOLOGI... · – Darah rutin – Urine rutin ... Laju endapan darah Nilai MC : - MCV - MCH](https://reader034.fdocument.pub/reader034/viewer/2022052515/5a78d6997f8b9aa17b8d5342/html5/thumbnails/3.jpg)
SUBDIVISI
• Hematologi Bank darah
• Nefrologi
• Metabolik Endokrin
• Hepatogastroenterologi
• Alergi-Imunologi
• Penyakit infeksi dan tropik
• Cardiovaskuler
• Onkologi
![Page 4: ILMU PATOLOGI KLINIK - fkg.usu.ac.idfkg.usu.ac.id/images/Bahan_Kuliah/BLOK_9/PK1---ILMU-PATOLOGI... · – Darah rutin – Urine rutin ... Laju endapan darah Nilai MC : - MCV - MCH](https://reader034.fdocument.pub/reader034/viewer/2022052515/5a78d6997f8b9aa17b8d5342/html5/thumbnails/4.jpg)
Cara Pemeriksaan Laboratorium dikelompokkan :
• Kimia klinik
• Hematologi
• Imunologi-Serologi
• Mikrobiologi (biakan kuman)
• Mikroskopi
• Menggunakan isotop
![Page 5: ILMU PATOLOGI KLINIK - fkg.usu.ac.idfkg.usu.ac.id/images/Bahan_Kuliah/BLOK_9/PK1---ILMU-PATOLOGI... · – Darah rutin – Urine rutin ... Laju endapan darah Nilai MC : - MCV - MCH](https://reader034.fdocument.pub/reader034/viewer/2022052515/5a78d6997f8b9aa17b8d5342/html5/thumbnails/5.jpg)
Tujuan Pemeriksaan Laboratorium
1. Diagnosis penyakit
2. Petunjuk untuk pengobatan, penatalaksanaan dan monitoring pengobatan
3. Mengetahui prognosa penyakit
![Page 6: ILMU PATOLOGI KLINIK - fkg.usu.ac.idfkg.usu.ac.id/images/Bahan_Kuliah/BLOK_9/PK1---ILMU-PATOLOGI... · – Darah rutin – Urine rutin ... Laju endapan darah Nilai MC : - MCV - MCH](https://reader034.fdocument.pub/reader034/viewer/2022052515/5a78d6997f8b9aa17b8d5342/html5/thumbnails/6.jpg)
PASIEN
DOKTER
TAFSIR HASIL
Permintaan
pemeriksaan
laboratorium
Hasil lab.
Pengumpulan
bahan
LABORATORIUM KLINIK
![Page 7: ILMU PATOLOGI KLINIK - fkg.usu.ac.idfkg.usu.ac.id/images/Bahan_Kuliah/BLOK_9/PK1---ILMU-PATOLOGI... · – Darah rutin – Urine rutin ... Laju endapan darah Nilai MC : - MCV - MCH](https://reader034.fdocument.pub/reader034/viewer/2022052515/5a78d6997f8b9aa17b8d5342/html5/thumbnails/7.jpg)
Pengambilan contoh bahan
1. Darah Hemolet, misal : ujung jari dan tumit Semprit, misal : vena dan arteri
2. Antikoagulan EDTA untuk cell counts Heparin untuk analisa darah dan pengobatan Natrium sitrat 3,8 % untuk LED, PT, APTT & TT
![Page 8: ILMU PATOLOGI KLINIK - fkg.usu.ac.idfkg.usu.ac.id/images/Bahan_Kuliah/BLOK_9/PK1---ILMU-PATOLOGI... · – Darah rutin – Urine rutin ... Laju endapan darah Nilai MC : - MCV - MCH](https://reader034.fdocument.pub/reader034/viewer/2022052515/5a78d6997f8b9aa17b8d5342/html5/thumbnails/8.jpg)
Persyaratan pengambilan darah
a. Puasa
• Gula darah puasa
• Lemak darah :
Cholesterol
Trigliserida
HDL
LDL
b. Adrandom (sewaktu), tidak puasa
c. Post-prandial, sesudah makan
![Page 9: ILMU PATOLOGI KLINIK - fkg.usu.ac.idfkg.usu.ac.id/images/Bahan_Kuliah/BLOK_9/PK1---ILMU-PATOLOGI... · – Darah rutin – Urine rutin ... Laju endapan darah Nilai MC : - MCV - MCH](https://reader034.fdocument.pub/reader034/viewer/2022052515/5a78d6997f8b9aa17b8d5342/html5/thumbnails/9.jpg)
3. Urin Adrandom, PP Pagi 12 jam, 24 jam 4 porsi 2 atau 3 gelas Kateterisasi Pungsi supra-pubik Urin porsi aliran tengah
(midstream)
![Page 10: ILMU PATOLOGI KLINIK - fkg.usu.ac.idfkg.usu.ac.id/images/Bahan_Kuliah/BLOK_9/PK1---ILMU-PATOLOGI... · – Darah rutin – Urine rutin ... Laju endapan darah Nilai MC : - MCV - MCH](https://reader034.fdocument.pub/reader034/viewer/2022052515/5a78d6997f8b9aa17b8d5342/html5/thumbnails/10.jpg)
Pemeriksaan (test) Laboratorium • Rutin
– Darah rutin
– Urine rutin
– Feses rutin
![Page 11: ILMU PATOLOGI KLINIK - fkg.usu.ac.idfkg.usu.ac.id/images/Bahan_Kuliah/BLOK_9/PK1---ILMU-PATOLOGI... · – Darah rutin – Urine rutin ... Laju endapan darah Nilai MC : - MCV - MCH](https://reader034.fdocument.pub/reader034/viewer/2022052515/5a78d6997f8b9aa17b8d5342/html5/thumbnails/11.jpg)
Sederhana
– Faal hati
– Faal ginjal
– Lemak
– Gula darah
– Imunologi / serologi
– Mikrobiologi
– Hematologi / hemostasis
– Sperma
– Sputum
![Page 12: ILMU PATOLOGI KLINIK - fkg.usu.ac.idfkg.usu.ac.id/images/Bahan_Kuliah/BLOK_9/PK1---ILMU-PATOLOGI... · – Darah rutin – Urine rutin ... Laju endapan darah Nilai MC : - MCV - MCH](https://reader034.fdocument.pub/reader034/viewer/2022052515/5a78d6997f8b9aa17b8d5342/html5/thumbnails/12.jpg)
Khusus (canggih)
– Virologi
– Faal tiroid
– Kadar obat / toksikologi
– Elektroforesa
– AGDA
– Faktor-faktor bekuan
– Komplemen
– Hormon-hormon lain
![Page 13: ILMU PATOLOGI KLINIK - fkg.usu.ac.idfkg.usu.ac.id/images/Bahan_Kuliah/BLOK_9/PK1---ILMU-PATOLOGI... · – Darah rutin – Urine rutin ... Laju endapan darah Nilai MC : - MCV - MCH](https://reader034.fdocument.pub/reader034/viewer/2022052515/5a78d6997f8b9aa17b8d5342/html5/thumbnails/13.jpg)
PEMERIKSAAN LABORATORIUM RUTIN
DARAH
Hb (Hemoglobin)
Jumlah Lekosit
Hitung Jenis dan Morfologi
Laju Endapan Darah
![Page 14: ILMU PATOLOGI KLINIK - fkg.usu.ac.idfkg.usu.ac.id/images/Bahan_Kuliah/BLOK_9/PK1---ILMU-PATOLOGI... · – Darah rutin – Urine rutin ... Laju endapan darah Nilai MC : - MCV - MCH](https://reader034.fdocument.pub/reader034/viewer/2022052515/5a78d6997f8b9aa17b8d5342/html5/thumbnails/14.jpg)
URIN :
Makroskopi – Warna – Kejernihan
- Protein
- Reduksi
Mikroskopi – Sedimen
TINJA :
Makroskopi – Warna, Konsistensi, Darah, Lendir
Mikroskopi – Amuba, Kista, Telur Cacing
![Page 15: ILMU PATOLOGI KLINIK - fkg.usu.ac.idfkg.usu.ac.id/images/Bahan_Kuliah/BLOK_9/PK1---ILMU-PATOLOGI... · – Darah rutin – Urine rutin ... Laju endapan darah Nilai MC : - MCV - MCH](https://reader034.fdocument.pub/reader034/viewer/2022052515/5a78d6997f8b9aa17b8d5342/html5/thumbnails/15.jpg)
PEMERIKSAAN DARAH
Hb (Sahli, Cyan)
Jumlah leukosit
Hitung Jenis dan morfologi
Laju endapan darah
Nilai MC : - MCV
- MCH
- MCHC
Jumlah eritrosit
Hematokrit
Jumlah Trombosit
A = Darah Rutin
A + B = Darah Lengkap
A
B
![Page 16: ILMU PATOLOGI KLINIK - fkg.usu.ac.idfkg.usu.ac.id/images/Bahan_Kuliah/BLOK_9/PK1---ILMU-PATOLOGI... · – Darah rutin – Urine rutin ... Laju endapan darah Nilai MC : - MCV - MCH](https://reader034.fdocument.pub/reader034/viewer/2022052515/5a78d6997f8b9aa17b8d5342/html5/thumbnails/16.jpg)
ANEMIA
Patokan WHO
Kadar Hb g/dl
DEWASA
PRIA < 13
WANITA TAK HAMIL < 12
WANITA HAMIL < 11
ANAK
• ½ - 6 tahun < 11
• 6 – 14 tahun < 12
![Page 17: ILMU PATOLOGI KLINIK - fkg.usu.ac.idfkg.usu.ac.id/images/Bahan_Kuliah/BLOK_9/PK1---ILMU-PATOLOGI... · – Darah rutin – Urine rutin ... Laju endapan darah Nilai MC : - MCV - MCH](https://reader034.fdocument.pub/reader034/viewer/2022052515/5a78d6997f8b9aa17b8d5342/html5/thumbnails/17.jpg)
Jumlah Leukosit : 5000 – 10.000/mL
Hitung Jenis (%) pengecatan giemsa
- Eosinofil : 0 – 3
- Basofil : 0 – 1
- Batang : 2 - 6
- Segmen : 50 – 70
- Limfosit : 20 – 40
- Monosit : 2 - 8
![Page 18: ILMU PATOLOGI KLINIK - fkg.usu.ac.idfkg.usu.ac.id/images/Bahan_Kuliah/BLOK_9/PK1---ILMU-PATOLOGI... · – Darah rutin – Urine rutin ... Laju endapan darah Nilai MC : - MCV - MCH](https://reader034.fdocument.pub/reader034/viewer/2022052515/5a78d6997f8b9aa17b8d5342/html5/thumbnails/18.jpg)
![Page 19: ILMU PATOLOGI KLINIK - fkg.usu.ac.idfkg.usu.ac.id/images/Bahan_Kuliah/BLOK_9/PK1---ILMU-PATOLOGI... · – Darah rutin – Urine rutin ... Laju endapan darah Nilai MC : - MCV - MCH](https://reader034.fdocument.pub/reader034/viewer/2022052515/5a78d6997f8b9aa17b8d5342/html5/thumbnails/19.jpg)
L E D
WESTERGREN
PRIA : < 10 mm/jam
WANITA : < 15 mm/jam
WINTROBE
PRIA : < 10 mm/jam
WANITA : < 20 mm/jam
![Page 20: ILMU PATOLOGI KLINIK - fkg.usu.ac.idfkg.usu.ac.id/images/Bahan_Kuliah/BLOK_9/PK1---ILMU-PATOLOGI... · – Darah rutin – Urine rutin ... Laju endapan darah Nilai MC : - MCV - MCH](https://reader034.fdocument.pub/reader034/viewer/2022052515/5a78d6997f8b9aa17b8d5342/html5/thumbnails/20.jpg)
![Page 21: ILMU PATOLOGI KLINIK - fkg.usu.ac.idfkg.usu.ac.id/images/Bahan_Kuliah/BLOK_9/PK1---ILMU-PATOLOGI... · – Darah rutin – Urine rutin ... Laju endapan darah Nilai MC : - MCV - MCH](https://reader034.fdocument.pub/reader034/viewer/2022052515/5a78d6997f8b9aa17b8d5342/html5/thumbnails/21.jpg)
NILAI MC
MCV = VER
77 – 93 fl
MCH = HER
27 – 32 pg
MCHC = KHER
31 – 35 g/dl
![Page 22: ILMU PATOLOGI KLINIK - fkg.usu.ac.idfkg.usu.ac.id/images/Bahan_Kuliah/BLOK_9/PK1---ILMU-PATOLOGI... · – Darah rutin – Urine rutin ... Laju endapan darah Nilai MC : - MCV - MCH](https://reader034.fdocument.pub/reader034/viewer/2022052515/5a78d6997f8b9aa17b8d5342/html5/thumbnails/22.jpg)
![Page 23: ILMU PATOLOGI KLINIK - fkg.usu.ac.idfkg.usu.ac.id/images/Bahan_Kuliah/BLOK_9/PK1---ILMU-PATOLOGI... · – Darah rutin – Urine rutin ... Laju endapan darah Nilai MC : - MCV - MCH](https://reader034.fdocument.pub/reader034/viewer/2022052515/5a78d6997f8b9aa17b8d5342/html5/thumbnails/23.jpg)
PEMERIKSAAN URIN
Makroskopik
Warna : kuning muda, jernih
Protein (-) : tes pemanasan
~ < 150 mg/24 jam A
Reduksi (-) : benedict
~ < 100 mg/24 jam
![Page 24: ILMU PATOLOGI KLINIK - fkg.usu.ac.idfkg.usu.ac.id/images/Bahan_Kuliah/BLOK_9/PK1---ILMU-PATOLOGI... · – Darah rutin – Urine rutin ... Laju endapan darah Nilai MC : - MCV - MCH](https://reader034.fdocument.pub/reader034/viewer/2022052515/5a78d6997f8b9aa17b8d5342/html5/thumbnails/24.jpg)
Urobilin (+) : sclesinger
Bilirubin (-) : rosin/fouchet B
pH
BJ
Mikroskopik
Sedimen :
- Leukosit : < 5/LPB C
- Eritrosit : < 3/ LPB
- Silinder : ---
A + C = Rutin
A + B + C = Lengkap
![Page 25: ILMU PATOLOGI KLINIK - fkg.usu.ac.idfkg.usu.ac.id/images/Bahan_Kuliah/BLOK_9/PK1---ILMU-PATOLOGI... · – Darah rutin – Urine rutin ... Laju endapan darah Nilai MC : - MCV - MCH](https://reader034.fdocument.pub/reader034/viewer/2022052515/5a78d6997f8b9aa17b8d5342/html5/thumbnails/25.jpg)
TINJA
• Makroskopis
- Warna/bau
- Konsistensi
- Lendir/darah
• Mikroskopis
- Larutan eosin 1-2% - Amuba/kista
- Larutan NaCL 0.9% - Telur cacing
- Darah
- Lemak
![Page 26: ILMU PATOLOGI KLINIK - fkg.usu.ac.idfkg.usu.ac.id/images/Bahan_Kuliah/BLOK_9/PK1---ILMU-PATOLOGI... · – Darah rutin – Urine rutin ... Laju endapan darah Nilai MC : - MCV - MCH](https://reader034.fdocument.pub/reader034/viewer/2022052515/5a78d6997f8b9aa17b8d5342/html5/thumbnails/26.jpg)
PENCERNAAN
- Serat otot (lar. Eosin 1-2%)
- Karbohidrat (lar. Lugol 1-2%)
- Lemak (lar. Sudan III)
DARAH SAMAR
- Cara Guajac
- Hematest
![Page 27: ILMU PATOLOGI KLINIK - fkg.usu.ac.idfkg.usu.ac.id/images/Bahan_Kuliah/BLOK_9/PK1---ILMU-PATOLOGI... · – Darah rutin – Urine rutin ... Laju endapan darah Nilai MC : - MCV - MCH](https://reader034.fdocument.pub/reader034/viewer/2022052515/5a78d6997f8b9aa17b8d5342/html5/thumbnails/27.jpg)
SPERMA
Semen adalah satu larutan yg dibentuk oleh testis dan organ reproduksi laki-laki yang lain yaitu :
- Seminal vesicle
- Prostate
- Epididymis
- Urethral glands
Pengambilan sampel
- Sesudah 3 hari puasa
- Langsung bawa ke laboratorium (tdk lebih dr 2 jam)
- Temperatur sesuai temperatur badan
![Page 28: ILMU PATOLOGI KLINIK - fkg.usu.ac.idfkg.usu.ac.id/images/Bahan_Kuliah/BLOK_9/PK1---ILMU-PATOLOGI... · – Darah rutin – Urine rutin ... Laju endapan darah Nilai MC : - MCV - MCH](https://reader034.fdocument.pub/reader034/viewer/2022052515/5a78d6997f8b9aa17b8d5342/html5/thumbnails/28.jpg)
Pemeriksaan
Makroskopis : - warna
- pH
- kekentalan
- volume
Mikroskopis : - jumlah
- gerakan
- bentuk
![Page 29: ILMU PATOLOGI KLINIK - fkg.usu.ac.idfkg.usu.ac.id/images/Bahan_Kuliah/BLOK_9/PK1---ILMU-PATOLOGI... · – Darah rutin – Urine rutin ... Laju endapan darah Nilai MC : - MCV - MCH](https://reader034.fdocument.pub/reader034/viewer/2022052515/5a78d6997f8b9aa17b8d5342/html5/thumbnails/29.jpg)
SPUTUM
• Merupakan tracheobronchial secretion
• Campuran antara :
- plasma
- air
- elektrolit
- mucin
- sekresi kelenjar hidung dan ludah
- normal flora dari rongga mulut
![Page 30: ILMU PATOLOGI KLINIK - fkg.usu.ac.idfkg.usu.ac.id/images/Bahan_Kuliah/BLOK_9/PK1---ILMU-PATOLOGI... · – Darah rutin – Urine rutin ... Laju endapan darah Nilai MC : - MCV - MCH](https://reader034.fdocument.pub/reader034/viewer/2022052515/5a78d6997f8b9aa17b8d5342/html5/thumbnails/30.jpg)
KOMPOSISI KIMIA SPUTUM TDD :
95% Air
5 % Solids : - Karbohidrat
- Protein
- Lemak
lekosit
- DNA macrophage
sel-sel bronchus
Solid bertambah bila ada peradangan
DNA pada sistik fibrosis
![Page 31: ILMU PATOLOGI KLINIK - fkg.usu.ac.idfkg.usu.ac.id/images/Bahan_Kuliah/BLOK_9/PK1---ILMU-PATOLOGI... · – Darah rutin – Urine rutin ... Laju endapan darah Nilai MC : - MCV - MCH](https://reader034.fdocument.pub/reader034/viewer/2022052515/5a78d6997f8b9aa17b8d5342/html5/thumbnails/31.jpg)
PEMERIKSAAN
1. Makroskopis :
- Volume
- Eksistensi
- Warna
- Bau
- Lain-lain : - Cheesy masses
- Bronchial casts
- Broncholiths
- Dittrich’s plugs
- Foreign body
- Parasit
![Page 32: ILMU PATOLOGI KLINIK - fkg.usu.ac.idfkg.usu.ac.id/images/Bahan_Kuliah/BLOK_9/PK1---ILMU-PATOLOGI... · – Darah rutin – Urine rutin ... Laju endapan darah Nilai MC : - MCV - MCH](https://reader034.fdocument.pub/reader034/viewer/2022052515/5a78d6997f8b9aa17b8d5342/html5/thumbnails/32.jpg)
2. Mikroskopis
Pewarnaan : - Wright : - sel darah
- kristal
- sel bronchus
- Z.N : mycobact TBC
- Pap : sel maligna
- Gram
3. Kultur