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limafadenopati limfadenitis
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5/19/2018 IT 7 - Pendekatan Diagnostik Limfadenopati Limfadenitis - ND (1)
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Limfadenopati :
pendekatan diagnostik
Dr. Norman Djamaluddin, SpPD K- HOM
Su agian Hematologi Onkologi Medik
!agian Pen"akit Dalam #SMH Palemang
PendekatanDiagnostik
Limfadenopatidan Limfadenitis
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The Lymphatic System
The body has approximately 600 lymph nodes,but only those in the submandibular, axillary oringuinal regions may normally be palpable inhealthy people. Lymphadenopathy refers to
nodes that are abnormal in either si!e,consistency or number. There are "ariousclassi#cations of lymphadenopathy, but a simpleand clinically useful system is to classifylymphadenopathy as $generali!ed$ if lymph
nodes are enlarged in t%o or more noncontiguousareas or $locali!ed$ if only one area is in"ol"ed.
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Distinguishing bet%een locali!ed andgenerali!ed lymphadenopathy isimportant in formulating a
di&erential diagnosis.
'n primary care patients %ithunexplained lymphadenopathy,
approximately ()* of patients %illpresent %ith locali!edlymphadenopathy and )* %ith
generali!ed lymphadenopathy.
5/19/2018 IT 7 - Pendekatan Diagnostik Limfadenopati Limfadenitis - ND (1)
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5/19/2018 IT 7 - Pendekatan Diagnostik Limfadenopati Limfadenitis - ND (1)
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Kelenjar geta$ ening le$er
!a%emore &'. P$"si(ian )**)+:)*-*
5/19/2018 IT 7 - Pendekatan Diagnostik Limfadenopati Limfadenitis - ND (1)
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Kelenjar geta$ ening aksila
!a%emore &'. P$"si(ian )**)+:)*-*
5/19/2018 IT 7 - Pendekatan Diagnostik Limfadenopati Limfadenitis - ND (1)
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Kelenjar geta$ ening inguinal
!a%emore &'. P$"si(ian )**)+:)*-*
5/19/2018 IT 7 - Pendekatan Diagnostik Limfadenopati Limfadenitis - ND (1)
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Le/el kelenjar geta$ ening le$er
#oins K0. &r($ Otolar"ngol Head Ne(k Surg. )**)+)1:23-1
Le/el : sumental dan
sumandiular
Le/el ) : upper jugularLe/el : middle jugular
Le/el 4 : lo5er jugular
Le/el 3 : posterior
triangle group
Le/el : anterior triangle
group
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Pendekatan diagnosis
limfadenopati
6
6
6
6
Definisi
Klasifikasi
7tiologi
Pendekatan diagnosis
5/19/2018 IT 7 - Pendekatan Diagnostik Limfadenopati Limfadenitis - ND (1)
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Definisi
Limfadenopati
Pembesaran kelen+ar getah bening denganukuran lebih besar dari cm.
errer -. m am Physician//123(2ataubnormalitas ukuran atau karakter kelen+argetah bening
4a!emore 5. Physician 0016630(70
Limfadenitis
-adang pada kelen+ar getah bening yang
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Klasifikasi
Limfadenopati
lokalisata
6 Limfadenopati
pada regio
Limfadenopati
generalisata
6 limfadenopati
pada ) atau lei$
regio anatomi
"ang ereda
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M8&M8
!a%emore &'. P$"si(ian )**)+:)*-*8atrogeni(
unusual (ondition
7tiologiMalignan(ies
8nfe(tions
&utoimmune
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7tiologi : Malignan(ies
6
6
6
6
6
Lekemia
Limfoma
Neoplasma kulit
Kaposi sarkoma
Metastase
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7tiologi : 8nfe(tious
6
66
6
6
66
6
6
6
6
6
6
!ru(ellosis
9at-s(rat($ disease
9M
H8, infeksi primer
Limfogranuloma /enerium
Mononukleosis
;aringitis
#uela
0uerkulosis
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7tiologi : &utoimun
6
66
6
Lupus eritematosis sistemik
&rtritis rematoid
Dermatomiositis
Sindroma Sjogren
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7tiologi :Mis(ellaneous
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7tiologi : SH&K
S
Sar(oidosis
Sili(osis
Storage disease
H
Hipertiroidisme
Histiositosis
Hipertrigliseridemia
!a%emore &'. P$"si(ian )**)+:)*-*
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7tiologi : 8atrogeni(
6 Serum si(kness
6 Oat =oatan :
&lopurinol
&tenolol
9aptopril
9arama%epineH"drala%ine
Penisilin
Pirimidone
Pirimetamine
Kuinidin
0rimetoprim sulfametoksa%oleSulinda(
;enitoin
!a%emore &'. P$"si(ian )**)+:)*-*
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Pendekatan diagnosis
limfadenopati
6
6
6
6
Definisi
Klasifikasi
7tiologi
Pendekatan diagnosis
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Pendekatan diagnosis
6 &namnesa
= >mur penderita dan laman"a
limfadenopati
)1 penderita, pen"ea enign dan self
limiting :
= 2?@ penderita erusia kurang dari
* ta$un
= 3?@ penderita antara -3* ta$un
= ?@ penderita di atas 3* ta$un.
;errer #. &m ;am P$"si(ian ??1+31:3
!a%emore &'. P$"si(ian )**)+:)*-*
.
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Pendekatan diagnosis
6 &namnesa
=>mur penderita dan laman"a
limfadenopati :
6 #isiko keganasan seagaipen"ea limfadenopati :
usia 4* ta$un atau lei$ : 4@
usia di a5a$ 4* ta$un : *,4@.
;errer #. &m ;am P$"si(ian ??1+31:3
!a%emore &'. P$"si(ian )**)+:)*-*
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Pendekatan diagnosis
6 &namnesa
=>mur penderita dan laman"a
limfadenopati
limfadenopati "ang erlangsungkurang dari ) minggu atau lei$ dari
ta$un tanpa progresi/itas ukuran
mempun"ai kemungkinan sangat ke(il
diseakan keganasan
;errer #. &m ;am P$"si(ian ??1+31:3
!a%emore &'. P$"si(ian )**)+:)*-*
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Pendekatan diagnosis
6 &namnesa :
6 Paparan
6 Simptom "ang men"ertai
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:istory
First,are there locali!ing symptoms or signs tosuggest infection or neoplasm in a speci#c site;
Second, are there constitutional symptoms suchas fe"er, %eight loss, fatigue or night s%eats tosuggest disorders such as tuberculosis,lymphoma, collagen "ascular diseases,unrecogni!ed infection or malignancy;
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:istory
Third,are there epidemiologic clues such asoccupational exposures, recent tra"el or high7riskbeha"iors that suggest speci#c disorders;
Fourth,is the patient taking a medication thatmay cause lymphadenopathy; Some medicationsare kno%n to speci#cally cause lymphadenopathy
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Pendekatan diagnosis
6 Pemeriksaan fisik
= Karakter dan ukuran kelenjar geta$ ening
6 ) penderita de5asa , dengan ukuran
kelenjar :
=di a5a$ (m : tidak ada keganasan
=-),)3 (m : keganasan : 1@
=di atas ),)3 (m : keganasan : 1 @
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Pendekatan diagnosis
6 Pemeriksaan fisik
=Karakter dan ukuran kelenjar geta$
ening :
ukuran kelenjar maksimum ) (m dan ,3
(m merupakan atas ukuran "angmemerlukan e/aluasi lei$ lanjut untuk
menentukan adan"a keganasan dan
pen"akit granulomatous
;errer #. &m ;am P$"si(ian ??1+31:3
!a%emore &'. P$"si(ian )**)+:)*-*
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Physical 9xamination
Size.
Pain/Tenderness:The presence or absence of tendernessdoes not reliably di&erentiate benign from malignant nodes.
Consistency:Stony7hard nodes are typically a sign ofcancer, usually metastatic. >ery #rm, rubbery nodes
suggest lymphoma. Softer nodes are the result of infectionsor in8ammatory conditions. Suppurant nodes may be8uctuant. The term $shotty$ refers to small nodes that feellike buckshot under the skin, as found in the cer"ical nodesof children %ith "iral illnesses.
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Physical 9xamination
Matting :can be either benign
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Pemeriksaan fisik
6 Pemeriksaan fisik=Lokasi limfadenopati :
6 Limfadenopati daera$ kepala dan
le$er
6 Limfadenopati epitro$lear
6 limfadenopati aksila
6 Limfadenopati suprakla/ikula
6 Limfadenopati inguinal
6 Limfadenopati generalisata
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Physical 9xamination
Supracla"icular lymphadenopathy has the highest risk ofmalignancy, estimated as /0 percent in patients older than*0 years and 2 percent in those younger than age.
Lymphadenopathy of the right supracla"icular node isassociated %ith cancer in the mediastinum, lungs or
esophagus. The left supracla"icular ircho%?s= node recei"es lymphatic
8o% from the thorax and abdomen, and may signalpathology in the testis, o"aries, kidneys, pancreas,prostate, stomach or gallbladder. lthough rarely present
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&lgoritme e/aluasi limfadenopati
&namnesa, pemeriksaan fisikAinak, self
limited
&utoimun
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