KP 18.11 Tuberkulosis Tulang Dan Sendi - 2008
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Transcript of KP 18.11 Tuberkulosis Tulang Dan Sendi - 2008
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Tuberkulosis Tulang & Sendi
Menkher Manjas MD, FICS
Bahagian Bedah Tulang RS Dr M Djamil Padang
/ Fakultas kedokteran Unand
Kuliah PBL June 14. Time :09.00-10.50.
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Infeksi Tbc 90 % di Negara berkembang
1990 9 juta penderita aktif
1. Tbc pulmoner
2. Tbc Extra Pulmoner (Tbc Tulang & Sendi) (5%)
Tbc Vertebra (Spondilitis) (Pott Disease)
Tbc tulang (tbc osteomyelitis)
Tbc Sendi (Tuberculous arthritis)
Tbc tendon (Tuberculosis tensynovitis)
Tbc Otot (Tuberculous myositis)
• Red = >300 • Orange = 200-300 • Yellow = 100-200 • Green 50-100 and • Grey <50
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Tbc Tulang & sendi
Endemic tbc paru banyak pada anak & dws
muda
Non Endemic tbc paru banyak pada:
Alkoholism & Drug abuse
Pemakaian kortikosteroid yang lama
Imune deficiencies (AIDS) HIV
Kuman Penyebab
90-95% mikobakterium tbc tipik
■ 2/3 dari tipe human
■ 1/3 dari tipe bovin
5-10% oleh mikobakterium tbc atipik
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Tuberkulosis Sendi
Karakteristik infeksi
Khronis
Granulomatous
Destruktif
Banyak mengenai sendi penopang tubuh
(weight-bearing joint)
Panggul (Coxitis tbc)
Lutut (Gonitis tbc)
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Patogenesa / Stadium1. Std Implantasi / Inflantasi
Inflamsi kapsul sendi
3. Std Destruksi sendi /abses
4. Std Deformitas Ankylosis
Inflamasi rawan sendi
Inflamasi synovium
Inflamsi tulang sendi
2. Std Inflamasi / peradangan sendi
Fase Awal
Fase Lanjut
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Anamnesa
Nyeri dan bengkak berangsur-angsur
Gangguan fungsi sendi
Kontraktur sendi
Riwayat kontak TB & Imunisasi BCG
BB , Keringat malam, & Nafsu makan
Sendi biasanya mengeluarkan cairan /
fistula
Biasanya sudah di th/ Diurut dll
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Pemeriksaan
Umum
Umumnya kurus
Tanda-tanda Tbc Paru +/-
Lokal Sendi
Deformitas Bengkak, bengkok
Udema , kemerahan dll
ROM
Sering ada fistula cairan/nanah
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Darah
Leukositosis, anemia , LED , shift to the left
CRP
Mt test
Kultur & pembiakan kuman sputum /cairan
sendi
Biopsi :
Granulasi khronis dengan perkejuan
Langhan’s giant cell dan acid-fast bacilli
Laboratorium
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Pemeriksaan Radiologis
1. Rontgen Foto
Soft tissue swelling (Udema
jaringan lunak sendi)
Rongga sendi menyempit
Destruksi permukaan sendi
Periarticular osteoporosis
2. CT Scan
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Pengobatan
Sistemik & Lokal
Tujuan
1. Eradikasi / membunuh kuman tbc
2. Mempertahankan ROM sendi
3. Mencegah deformitas sendi
4. Koreksi deformitas yang terjadi.
Tipe pengobatan Konservatif & Operatif
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Pengobatan Sistemik
Perbaikan KU & Gizi
Pemberian OAT 6-12 bulan
Rifampicin 1 X 450 mg
Ethambutol 1 X 750 mg
Isoniazid 1 X 400 mg
B 6
Obat lain Roborantia
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Pengobatan Lokal
Istirahatkan sendi (jangan beri beban)
Bahu / Siku pakai sling
Panggul, lutut, ankle
Crutch (Tongkat)
Skin traksi
Tindakan Operasi
Debridemant / Drainage
Curetage Arthrodese
Prostese
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Kemajuan Pengobatan
Umum
Keluhan / Nyeri
Nafsu makan
Berat badan
Lab. Hb, Lekosit, BBS dan Diff count
Kemajuan ROM sendi
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Coxitis Tbc Infeksi myc tbc pada sendi
panggul
Klinis
Nyeri panggul & Jalan Pincang
Gejala infeksi tbc umum
PE
Deformitas
Ggn ROM Tidak bisa duduk,
jongkok dll
Fistula (+)(-)
Ro Foto
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Pengobatan Umum
Perbaikan gizi Diet TKTP
Pemberian OAT 6-12 bl
Lokal Istirahatkan sendi
Skin traksi sampai nyeri
Jalan bertongkat
Debridemant
Arthrodese
Total Hip Replacement (THR)
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Gonitis Tbc
Infeksi myc tbc pada sendi lutut
Klinis
Lutut bengkak, nyeri dan kaku
PE Lutut bengkak
Kontraktur +
Ggn ROM tidak bisa jongkok
Fistula (+)
Rontgen foto
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Pengobatan
1. Umum Perbaikan gizi Diet TKTP
Pemberian OAT 6-12 bl
2. Lokal Istirahat / Skin traksi sampai nyeri
Exersise lutut sampai ROM normal
Operatif
Debdridemant
Arthrodese (Pengakuan sendi)
Total Knee Replacement (TKR)
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Differential Diagnosa
1. Transient synovitis of the hip joint
penyebab virus
2. Monoarticular rhematoid penyakit
imunologis
3. Haemorhagic arthritis penderita leukemia
4. Pyogenic arthritis karena kuman banal