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00514514005145140051451400514514005145140051451400514514005145140051451400514514
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00514514005145140051451400514514005145140051451400514514005145140051451400514514
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00514514005145140051451400514514005145140051451400514514005145140051451400514514
00514514005145140051451400514514005145140051451400514514005145140051451400514514
00514514005145140051451400514514005145140051451400514514005145140051451400514514
00514514005145140051451400514514005145140051451400514514005145140051451400514514
00514514005145140051451400514514005145140051451400514514005145140051451400514514
00514514005145140051451400514514005145140051451400514514005145140051451400514514
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00514514005145140051451400514514005145140051451400514514005145140051451400514514
00514514005145140051451400514514005145140051451400514514005145140051451400514514
00514514005145140051451401ffd9}}}}}\pard\sb0\sl-240{\bkmkstart Pg1}{\bkmkend Pg1
}\par\pard\ql \li4938\sb0\sl-276\slmult0 \par\pard\ql\li4938\sb0\sl-276\slmult0
\par\pard\ql\li4938\sb0\sl-276\slmult0 \par\pard\ql\li4938\sb0\sl-276\slmult0 \p
ar\pard\ql\li4938\sb0\sl-276\slmult0 \par\pard\ql\li4938\sb0\sl-276\slmult0 \par
\pard\ql\li4938\sb0\sl-276\slmult0 \par\pard\ql\li4938\sb0\sl-276\slmult0 \par\p
ard\ql\li4938\sb0\sl-276\slmult0 \par\pard\ql\li4938\sb0\sl-276\slmult0 \par\par
d\ql\li4938\sb0\sl-276\slmult0 \par\pard\ql\li4938\sb0\sl-276\slmult0 \par\pard\
ql\li4938\sb0\sl-276\slmult0 \par\pard\ql\li4938\sb0\sl-276\slmult0 \par\pard\ql
\li4938\sb0\sl-276\slmult0 \par\pard\ql\li4938\sb132\sl-276\slmult0 \up0 \expndt
w-5\charscalex100 \ul0\nosupersub\cf1\f2\fs24 TUGAS REFERAT \par\pard\ql \li5302
\sb0\sl-322\slmult0 \par\pard\ql\li5302\sb244\sl-322\slmult0 \up0 \expndtw-4\cha
rscalex100 \ul0\nosupersub\cf2\f3\fs28 SIANOSIS \par\pard\ql \li5262\sb0\sl-276\
slmult0 \par\pard\ql\li5262\sb0\sl-276\slmult0 \par\pard\ql\li5262\sb0\sl-276\sl
mult0 \par\pard\ql\li5262\sb0\sl-276\slmult0 \par\pard\ql\li5262\sb72\sl-276\slm
ult0 \up0 \expndtw-3\charscalex100 \ul0\nosupersub\cf1\f2\fs24 Pembimbing: \par\
pard\ql \li4402\sb244\sl-276\slmult0 \up0 \expndtw-3\charscalex100 dr. Moch. Nad
jib Moein, SpA. \par\pard\ql \li5667\sb0\sl-276\slmult0 \par\pard\ql\li5667\sb0\
sl-276\slmult0 \par\pard\ql\li5667\sb0\sl-276\slmult0 \par\pard\ql\li5667\sb0\sl
-276\slmult0 \par\pard\ql\li5667\sb180\sl-276\slmult0 \up0 \expndtw-3\charscalex
100 Oleh: \par\pard\ql \li4828\ri4626\sb43\sl-520\slmult0 \up0 \expndtw-5\charsc
alex100 Aryani Vindhya Putri \line \up0 \expndtw-5\charscalex100 201020401011035
\par\pard\ql \li4298\sb0\sl-276\slmult0 \par\pard\ql\li4298\sb0\sl-276\slmult0
\par\pard\ql\li4298\sb0\sl-276\slmult0 \par\pard\ql\li4298\sb0\sl-276\slmult0 \p
ar\pard\ql\li4298\sb0\sl-276\slmult0 \par\pard\ql\li4298\sb0\sl-276\slmult0 \par
\pard\ql\li4298\sb86\sl-276\slmult0 \up0 \expndtw-5\charscalex100 SMF ILMU PENYA
KIT ANAK \par\pard\ql \li3642\sb244\sl-276\slmult0 \up0 \expndtw-3\charscalex100
RUMAH SAKIT UMUM HAJI SURABAYA \par\pard\ql \li5715\sb244\sl-276\slmult0 \up0 \
expndtw-3\charscalex100 2011 \par\pard\ql \li10328\sb0\sl-253\slmult0 \par\pard\
ql\li10328\sb0\sl-253\slmult0 \par\pard\ql\li10328\sb0\sl-253\slmult0 \par\pard\
ql\li10328\sb0\sl-253\slmult0 \par\pard\ql\li10328\sb0\sl-253\slmult0 \par\pard\
ql\li10328\sb0\sl-253\slmult0 \par\pard\ql\li10328\sb0\sl-253\slmult0 \par\pard\
ql\li10328\sb0\sl-253\slmult0 \par\pard\ql\li10328\sb19\sl-253\slmult0 \up0 \exp
ndtw0\charscalex111 \ul0\nosupersub\cf3\f4\fs22 1 \par\pard\sect\sectd\fs24\pape
rw11900\paperh16840\pard\sb0\sl-240{\bkmkstart Pg2}{\bkmkend Pg2}\par\pard\li180
1\sb0\sl-276\slmult0\par\pard\li1801\sb0\sl-276\slmult0\par\pard\li1801\sb0\sl-2
76\slmult0\par\pard\li1801\sb0\sl-276\slmult0\par\pard\li1801\sb112\sl-276\slmul
t0\fi3592 \up0 \expndtw0\charscalex100 \ul0\nosupersub\cf1\f2\fs24 SIANOSIS\par\
pard\li1801\sb276\sl-276\slmult0\fi0 \up0 \expndtw0\charscalex100 1. Definisi\p
ar\pard\qj \li1801\ri1241\sb42\sl-550\slmult0\fi720 \up0 \expndtw0\charscalex102
\ul0\nosupersub\cf4\f5\fs24 Sianosis adalah diskolorasi kebiruan pada kulit da
n membran mukosa akibat \line \up0 \expndtw-3\charscalex100 konsentrasi hemoglo
bin tereduksi (deoksihemoglobin) dalam darah yang berlebihan yang \line \up0 \ex
pndtw0\charscalex100 lebih dari 5 g% (\ul0\nosupersub\cf5\f6\fs24 kamus kedokter
an Dorland).\ul0\nosupersub\cf4\f5\fs24 Molekul hemoglobin berubah warna dari \
line \up0 \expndtw0\charscalex100 biru menjadi merah bila berikatan dengan oksig
en di paru kanan dan kiri. Jika terdapat \line \up0 \expndtw-2\charscalex100 leb

ih dari 50 mL deoksihemoglobin, maka kulit akan tampak berwarna kebiruan. \par\p

ard\qj \li1801\sb0\sl-550\slmult0 \par\pard\qj\li1801\sb0\sl-550\slmult0 \par\pa
rd\qj\li1801\ri1241\sb31\sl-550\slmult0\fi360 \up0 \expndtw-1\charscalex100 Sian
osis biasanya ditemukan oleh anggota keluarga. Perubahan warna kulit menjadi \up
0 \expndtw-1\charscalex100 kebiru-biruan yang samar mungkin sama sekali ti
dak diperhatikan pasien. Macam \up0 \expndtw-3\charscalex100 sianosis ada 2,
yaitu : Sianosis sentral dan sianosis perifer. \par\pard\qj \li1801\ri1243\sb268
\sl-553\slmult0\fi360 \up0 \expndtw-4\charscalex100 Sianosis sentral terjadi kar
ena tidak memadainya oksigenasi arterian secara bermakna. \line \up0 \expndtw0\c
harscalex100 Ini seringkali disebabkan oleh gangguan atau penyakit paru yang m
enyebabkan darah \line \up0 \expndtw-3\charscalex100 vena campuran memintas p
aru-paru (misalnya pintas intrakardial). Perubahan warna \line \up0 \expndt
w-2\charscalex100 menjadi kebiruan paling baik dilihat pada membrana mukosa mulu
t (misalnya frenulum) \line \up0 \expndtw0\charscalex100 dan bibir. Sianosis per
ifer disebabkan oleh ekstraksi oksigen yang berlebihan di bagian \line \up0 \exp
ndtw0\charscalex100 perifer. Keadaan ini terbatas pada sianosis ekstremitas (mis
alnya jari tangan, jari kaki, \line \up0 \expndtw-3\charscalex100 hidung). \par\
pard\ql \li2161\sb0\sl-276\slmult0 \par\pard\ql\li2161\sb240\sl-276\slmult0 \up0
\expndtw-3\charscalex100 Tanyakanlah penanyaan-pertanyaan berikut: \par\pard\li
1801\sb0\sl-276\slmult0\par\pard\li1801\sb0\sl-276\slmult0\par\pard\li1801\sb4\s
l-276\slmult0\fi0\tx2161 \up0 \expndtw-2\charscalex100 -\tab \up0 \expndtw-2\cha
rscalex100 \u8220?Dimana letak sianosis tersebut?\u8221?\par\pard\li1801\sb276\s
l-276\slmult0\fi0\tx2161 \up0 \expndtw-2\charscalex100 -\tab \up0 \expndtw-2\cha
rscalex100 \u8220?Sudah berapa lama Anda mengalami sianosis?\u8221?\par\pard\li1
801\sb275\sl-276\slmult0\fi0\tx2161 \up0 \expndtw-2\charscalex100 -\tab \up0 \ex
pndtw-1\charscalex100 \u8220?Apakah Anda mengetahui bahwa Anda menderita penyaki
t paru/ penyakit jantung/\par\pard\ql \li2161\sb269\sl-276\slmult0 \up0 \expndtw
-3\charscalex100 penyakit darah?\u8221? \par\pard\ql \li10328\sb123\sl-253\slmul
t0 \up0 \expndtw0\charscalex111 \ul0\nosupersub\cf3\f4\fs22 2
{\shp {\*\shpinst\shpleft3601\shptop5830\shpright3661\shpbottom5830\shpfhdr0\shp
bxpage\shpbypage\shpwr3\shpwrk0\shpfblwtxt1\shpz180\shplid0{\sp{\sn shapeType}{\
sv 20}}{\sp{\sn fBehindDocument}{\sv 1}}{\sp{\sn lineColor}{\sv 16711680}}{\sp{\
sn lineWidth}{\sv 10558}}
}}\par\pard\sect\sectd\fs24\paperw11900\paperh16840\pard\sb0\sl-240{\bkmkstart P
g3}{\bkmkend Pg3}\par\pard\li1801\sb0\sl-276\slmult0\par\pard\li1801\sb0\sl-276\
slmult0\par\pard\li1801\sb0\sl-276\slmult0\par\pard\li1801\sb0\sl-276\slmult0\pa
r\pard\li1801\sb112\sl-276\slmult0\fi0\tx2161 \up0 \expndtw-3\charscalex100 \ul0
\nosupersub\cf4\f5\fs24 -\tab \up0 \expndtw-3\charscalex100 \u8220?Apa yang memb
uat sianosisnya menjadi berat?\u8221?\par\pard\li1801\sb276\sl-276\slmult0\fi0\t
x2161 \up0 \expndtw-3\charscalex100 -\tab \up0 \expndtw-2\charscalex100 \u8220?A
pakah ada kelainan lain yang berkaitan seperti sesak napas/ batuk/ perdarahan?\u
8221?\par\pard\li1801\sb276\sl-276\slmult0\fi0\tx2161 \up0 \expndtw-3\charscalex
100 -\tab \up0 \expndtw-3\charscalex100 \u8220?Jenis pekerjaan apa yang Anda lak
ukan?\u8221?\par\pard\li1801\sb276\sl-276\slmult0\fi0\tx2161 \up0 \expndtw-3\cha
rscalex100 -\tab \up0 \expndtw-3\charscalex100 \u8220?Apakah ada anggota keluarg
a lain yang menderita sianosis?\u8221?\par\pard\ql \li1801\sb0\sl-276\slmult0 \p
ar\pard\ql\li1801\sb0\sl-276\slmult0 \par\pard\ql\li1801\sb0\sl-276\slmult0 \par
\pard\ql\li1801\sb0\sl-276\slmult0 \par\pard\ql\li1801\sb0\sl-276\slmult0 \par\p
ard\ql\li1801\sb4\sl-276\slmult0 \up0 \expndtw-3\charscalex100 \ul0\nosupersub\c
f1\f2\fs24 Sianosis sejak lahir \par\pard\qj \li1801\ri1241\sb316\sl-552\slmult0
\fi360 \up0 \expndtw0\charscalex103 \ul0\nosupersub\cf4\f5\fs24 Sianosis sejak l
ahir berkaitan dengan penyakit jantung kongenital. Sianosis yang \line \up0 \exp
ndtw-3\charscalex100 timbul akut dapat terjadi pada penyakit saluran pernapasan
yang berat, terutama obstruksi \line \up0 \expndtw-2\charscalex100 akut pada sal
uran napas. Sianosis perifer disebabkan oleh meningkatnya ekstraksi oksigen \lin
e \up0 \expndtw0\charscalex100 pada keadaan jantung yang rendah dan dijumpai pad
a bagian-bagian tubuh yang lebih \line \up0 \expndtw0\charscalex100 dingin seper
ti dasar kuku dan permukaan luar bibir. Sianosis periler lenyap bila daerah \lin
e \up0 \expndtw0\charscalex100 tersebut dihangatkan. Sianosis kuku dan tangan ya
ng hangat mengarah kepada sianosis \line \up0 \expndtw-2\charscalex100 sentral.

Sianosis sentral hanya terjadi bila saturasi oksigen turun di bawah 80%. Sianosi
s \line \up0 \expndtw0\charscalex100 sentral secara difus mengenai kulit dan
membran mukosa dan tidak lenyap dengan \line \up0 \expndtw-2\charscalex100 me
nghangatkan daerah itu. Untuk timbulnya sianosis sentral paling sedikit harus ad
a 2-3 \line \up0 \expndtw-3\charscalex100 gram hemoglobin tak jenuh per 100 cc d
arah. Latihan fisik memperberat sianosis sentral, \line \up0 \expndtw-4\charscal
ex100 karena otot-otot yang beketja memerlukan peningkatan ekstraksi oksigen dar
i darah. Pada \line \up0 \expndtw-2\charscalex100 pasien dengan anemia berat, di
mana kadar hemoglobin turun secara bermakna, sianosis \line \up0 \expndtw-2\cha
rscalex100 mungkin tidak dijumpai. Clubbing dijumpai pada sianosis sentra
l dan menunjukkan \line \up0 \expndtw-3\charscalex100 kelainan kardiopulmoiler
yang berat. \par\pard\qj \li1801\ri1244\sb290\sl-550\slmult0\fi360 \up0 \expndtw
-3\charscalex100 Beberapa pekerja, seperti tukang las listrik, menghirup kadar t
oksik gas nitrogen yang \up0 \expndtw-3\charscalex100 dapat menimbulkan sianosis
dengan methemoglobinemia. Methenioglobinemia herediter \up0 \expndtw-3\charscal
ex100 adalah suatu kelainan hemoglobin primer yang menyebabkan sianosis kongenit
al. \par\pard\ql \li10328\sb0\sl-253\slmult0 \par\pard\ql\li10328\sb103\sl-253\s
lmult0 \up0 \expndtw0\charscalex111 \ul0\nosupersub\cf3\f4\fs22 3 \par\pard\sect
\sectd\fs24\paperw11900\paperh16840\pard\sb0\sl-240{\bkmkstart Pg4}{\bkmkend Pg4
}\par\pard\ql \li2161\sb0\sl-276\slmult0 \par\pard\ql\li2161\sb0\sl-276\slmult0
\par\pard\ql\li2161\sb0\sl-276\slmult0 \par\pard\ql\li2161\sb0\sl-276\slmult0 \p
ar\pard\ql\li2161\sb108\sl-276\slmult0 \up0 \expndtw-3\charscalex100 \ul0\nosupe
rsub\cf1\f2\fs24 Sianosis sentral \par\pard\ql \li2161\sb0\sl-276\slmult0 \par\p
ard\ql\li2161\sb268\sl-276\slmult0 \up0 \expndtw-3\charscalex100 \ul0\nosupersub
\cf4\f5\fs24 1. Saturasi oksigen dalam arteri yang menurun \par\pard\qj \li2161\
ri1243\sb338\sl-550\slmult0 \up0 \expndtw0\charscalex107 - Kadar oksigen insp
irasi berkurang: berada di tempat yang sangat tinggi. \line \up0 \expndtw
-1\charscalex100 - Penyakit paru: hambatan aliran udara yang kronis dengan korpu
lmonal, emboli paru \line \up0 \expndtw-3\charscalex100 masif. \par\pard\li2161\
sb241\sl-276\slmult0\fi0\tx3078\tx6433 \up0 \expndtw0\charscalex101 - Pirau\tab
\up0 \expndtw0\charscalex101 (shunt) jantung kanan ke kiri\tab \up0 \expndt
w0\charscalex101 (penyakit jantung kongenital sianosis).\par\pard\li2161\sb27
6\sl-276\slmult0\fi0 \up0 \expndtw0\charscalex101 2. Polisitemia.\par\pard\ql \l
i2161\sb0\sl-276\slmult0 \par\pard\ql\li2161\sb272\sl-276\slmult0 \up0 \expndtw3\charscalex100 3. Kelainan hemoglobin dan methemoglobinemia. \par\pard\ql \li21
61\sb0\sl-276\slmult0 \par\pard\ql\li2161\sb0\sl-276\slmult0 \par\pard\ql\li2161
\sb12\sl-276\slmult0 \up0 \expndtw-2\charscalex100 4. Biru metilen (diberikan un
tuk pemeriksaan jantung-kurva zat pewarna.) \par\pard\ql \li10328\sb0\sl-253\slm
ult0 \par\pard\ql\li10328\sb0\sl-253\slmult0 \par\pard\ql\li10328\sb0\sl-253\slm
ult0 \par\pard\ql\li10328\sb0\sl-253\slmult0 \par\pard\ql\li10328\sb0\sl-253\slm
ult0 \par\pard\ql\li10328\sb0\sl-253\slmult0 \par\pard\ql\li10328\sb0\sl-253\slm
ult0 \par\pard\ql\li10328\sb0\sl-253\slmult0 \par\pard\ql\li10328\sb0\sl-253\slm
ult0 \par\pard\ql\li10328\sb0\sl-253\slmult0 \par\pard\ql\li10328\sb0\sl-253\slm
ult0 \par\pard\ql\li10328\sb0\sl-253\slmult0 \par\pard\ql\li10328\sb0\sl-253\slm
ult0 \par\pard\ql\li10328\sb0\sl-253\slmult0 \par\pard\ql\li10328\sb0\sl-253\slm
ult0 \par\pard\ql\li10328\sb0\sl-253\slmult0 \par\pard\ql\li10328\sb0\sl-253\slm
ult0 \par\pard\ql\li10328\sb0\sl-253\slmult0 \par\pard\ql\li10328\sb0\sl-253\slm
ult0 \par\pard\ql\li10328\sb0\sl-253\slmult0 \par\pard\ql\li10328\sb0\sl-253\slm
ult0 \par\pard\ql\li10328\sb0\sl-253\slmult0 \par\pard\ql\li10328\sb0\sl-253\slm
ult0 \par\pard\ql\li10328\sb0\sl-253\slmult0 \par\pard\ql\li10328\sb0\sl-253\slm
ult0 \par\pard\ql\li10328\sb0\sl-253\slmult0 \par\pard\ql\li10328\sb0\sl-253\slm
ult0 \par\pard\ql\li10328\sb0\sl-253\slmult0 \par\pard\ql\li10328\sb0\sl-253\slm
ult0 \par\pard\ql\li10328\sb0\sl-253\slmult0 \par\pard\ql\li10328\sb0\sl-253\slm
ult0 \par\pard\ql\li10328\sb0\sl-253\slmult0 \par\pard\ql\li10328\sb27\sl-253\sl
mult0 \up0 \expndtw0\charscalex111 \ul0\nosupersub\cf3\f4\fs22 4 \par\pard\sect\
sectd\fs24\paperw11900\paperh16840\pard\sb0\sl-240{\bkmkstart Pg5}{\bkmkend Pg5}
\par\pard\ql \li2161\sb0\sl-276\slmult0 \par\pard\ql\li2161\sb0\sl-276\slmult0 \
par\pard\ql\li2161\sb0\sl-276\slmult0 \par\pard\ql\li2161\sb0\sl-276\slmult0 \pa
r\pard\ql\li2161\sb0\sl-276\slmult0 \par\pard\ql\li2161\sb112\sl-276\slmult0 \up
0 \expndtw-3\charscalex100 \ul0\nosupersub\cf1\f2\fs24 Sianosis perifer \par\par

d\ql \li2161\sb0\sl-276\slmult0 \par\pard\ql\li2161\sb268\sl-276\slmult0 \up0 \e

xpndtw-3\charscalex100 \ul0\nosupersub\cf4\f5\fs24 1. Semua penyebab dari sianos
is sentral menyebabkan sianosis perifer. \par\pard\ql \li2161\sb0\sl-276\slmult0
\par\pard\ql\li2161\sb0\sl-276\slmult0 \par\pard\ql\li2161\sb12\sl-276\slmult0
\up0 \expndtw-3\charscalex100 2. Terkena hawa dingin. \par\pard\ql \li2161\sb0\s
l-276\slmult0 \par\pard\ql\li2161\sb0\sl-276\slmult0 \par\pard\ql\li2161\sb12\sl
-276\slmult0 \up0 \expndtw-5\charscalex100 3. Curah jantung yang berkurang; gaga
l ventrikel kiri atau syok. \par\pard\ql \li2161\sb0\sl-276\slmult0 \par\pard\ql
\li2161\sb268\sl-276\slmult0 \up0 \expndtw-3\charscalex100 4. Obstruksi arteri a
tau vena. \par\pard\ql \li1801\sb0\sl-276\slmult0 \par\pard\ql\li1801\sb0\sl-276
\slmult0 \par\pard\ql\li1801\sb0\sl-276\slmult0 \par\pard\ql\li1801\sb276\sl-276
\slmult0 \up0 \expndtw-3\charscalex100 \ul0\nosupersub\cf1\f2\fs24 2. Sistem Pe
redaran Darah \par\pard\qj \li1441\ri1241\sb56\sl-552\slmult0\fi720 \up0 \expndt
w0\charscalex100 \ul0\nosupersub\cf4\f5\fs24 Pada fetus, semua bahan makanan dan
kebutuhan untuk hidup semuanya diperoleh \line \up0 \expndtw0\charscalex102 dar
i ibu melalui plasenta, demikian juga dengan semua bahan yang tidak dibutuhkan l
agi \line \up0 \expndtw-1\charscalex100 dikembalikan ke plasenta ibu. Darah yang
berasal dari plasenta mengandung O2 sekitar 60-\line \up0 \expndtw-3\charscalex
100 70%, darah masuk melalui V. Umbilikalis dan diteruskan ke duktus venosus mas
uk ke dalam \line \up0 \expndtw-2\charscalex100 hepar kemudian darah dari hepar
ini masuk kedalam vena cava inferior lalu ke dalam atrium \line \up0 \expndtw0\c
harscalex104 kanan. Saat di atrium kanan, darah kaya O2 ini diteruskan ke dalam
atrium kiri melalui \line \up0 \expndtw0\charscalex100 foramen ovale. Selanjutny
a ke dalam ventrikel kiri, dan diteruskan ke aorta. Namun, pada \line \up0 \expn
dtw0\charscalex100 aorta sebagian besar darah ini digunakan untuk mensuplai pemb
uluh koroner, ekstremitas \line \up0 \expndtw0\charscalex100 atas dan kepala. Se
bagian kecilnya lagi diteruskan ke aorta desendens. Darah dari otak dan \line \u
p0 \expndtw0\charscalex100 ekstermitas atas ini dikembalikan ke vena cava superi
or, kemudian ke dalam atrium kanan \line \up0 \expndtw0\charscalex100 dan diteru
skan lagi ke ventrikel kanan. Karena tahanan paru masih besar dan kapiler serta
\line \up0 \expndtw0\charscalex103 alveoli masih menutup maka darah dari truncus
pulmonalis tertahan dan sebagian besar \line \up0 \expndtw0\charscalex100 diter
uskan melalui duktus arteriosus ke aorta desenden untuk bergabung dengan sisa da
rah \line \up0 \expndtw0\charscalex100 dari ventrikel kiri. Kemudian darah campu
ran ini diteruskan ke sistemik serta organ dalam \par\pard\ql \li10328\sb0\sl-25
3\slmult0 \par\pard\ql\li10328\sb0\sl-253\slmult0 \par\pard\ql\li10328\sb0\sl-25
3\slmult0 \par\pard\ql\li10328\sb136\sl-253\slmult0 \up0 \expndtw0\charscalex111
\ul0\nosupersub\cf3\f4\fs22 5
{\shp {\*\shpinst\shpleft1800\shptop6432\shpright10466\shpbottom6708\shpfhdr0\sh
pbxpage\shpbypage\shpwr3\shpwrk0\shpfblwtxt1\shpz8\shplid0
{\sp{\sn shapeType}{\sv 0}}{\sp{\sn fFlipH}{\sv 0}}{\sp{\sn fFlipV}{\sv 0}}{\sp{
\sn geoRight}{\sv 8666}}{\sp{\sn geoBottom}{\sv 276}}
{\sp{\sn pVerticies}{\sv 8;4;(0,276);(8666,276);(8666,0);(0,0)}}
{\sp{\sn pSegmentInfo}{\sv 2;10;16384;45824;1;45824;1;45824;1;45824;24577;32768}
}
{\sp{\sn fFillOK}{\sv 1}}{\sp{\sn fFilled}{\sv 1}}{\sp{\sn fillColor}{\sv 167772
15}}{\sp{\sn fLine}{\sv 0}}{\sp{\sn lineType}{\sv 0}}{\sp{\sn fArrowheadsOK}{\sv
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}}
{\shp {\*\shpinst\shpleft1440\shptop6708\shpright10466\shpbottom14436\shpfhdr0\s
hpbxpage\shpbypage\shpwr3\shpwrk0\shpfblwtxt1\shpz10\shplid1
{\sp{\sn shapeType}{\sv 0}}{\sp{\sn fFlipH}{\sv 0}}{\sp{\sn fFlipV}{\sv 0}}{\sp{
\sn geoRight}{\sv 9026}}{\sp{\sn geoBottom}{\sv 7728}}
{\sp{\sn pVerticies}{\sv 8;4;(0,7728);(9026,7728);(9026,0);(0,0)}}
{\sp{\sn pSegmentInfo}{\sv 2;10;16384;45824;1;45824;1;45824;1;45824;24577;32768}
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{\sp{\sn fFillOK}{\sv 1}}{\sp{\sn fFilled}{\sv 1}}{\sp{\sn fillColor}{\sv 167772
15}}{\sp{\sn fLine}{\sv 0}}{\sp{\sn lineType}{\sv 0}}{\sp{\sn fArrowheadsOK}{\sv

1}}{\sp{\sn fBehindDocument}{\sv 1}}{\sp{\sn lineColor}{\sv 0}}

}}\par\pard\sect\sectd\fs24\paperw11900\paperh16840\pard\sb0\sl-240{\bkmkstart P
g6}{\bkmkend Pg6}\par\pard\qj \li1441\sb0\sl-540\slmult0 \par\pard\qj\li1441\ri1
245\sb454\sl-540\slmult0 \up0 \expndtw-1\charscalex100 \ul0\nosupersub\cf4\f5\fs
24 bawah, kemudian ke vena cava inferior dan sebagian besarnya lagi di teruskan
kedalam arteri \up0 \expndtw-1\charscalex100 umbilikalis dan ke plasenta. Begitu
lah siklus darah sistem sirkulasi fetus yang normal. \par\pard\ql \li1441\sb0\sl
-276\slmult0 \par\pard\ql\li1441\sb0\sl-276\slmult0 \par\pard\ql\li1441\sb0\sl-2
76\slmult0 \par\pard\ql\li1441\sb0\sl-276\slmult0 \par\pard\ql\li1441\sb235\sl-2
76\slmult0 \up0 \expndtw-3\charscalex100 \ul0\nosupersub\cf1\f2\fs24 3.1 Sesaat
setelah lahir \par\pard\qj \li1441\ri1241\sb57\sl-551\slmult0\fi720 \up0 \expndt
w0\charscalex102 \ul0\nosupersub\cf4\f5\fs24 Saat inspirasi pertama dimulai,
maka alveoli kapiler paru mulai\ul0\nosupersub\cf1\f2\fs24 \ul0\nosupersub
\cf4\f5\fs24 terbuka serta \up0 \expndtw0\charscalex106 konstriksi dari trun
cus pulmonalis menghilang. Maka paru mulai berfungsi untuk \up0 \expndtw0
\charscalex104 menukarkan gas dan tekanan dari atrium kanan mengecil, disertai d
engan ikatan plasenta \up0 \expndtw0\charscalex100 sehingga aliran darah plasent
a tidak ada lagi, dan darah dari paru langsung masuk kedalam \up0 \expndtw0\char
scalex100 atrium kiri, karena tekanan di atrium kiri kini lebih besar daripada t
ekanan di atrium kanan, \up0 \expndtw0\charscalex100 maka terdapat desakan pa
da sekat, sehingga foramen ovale menutup. Kemudian darah \up0 \expndtw0\c
harscalex100 dilanjutkan lagi ke ventrikel kanan, menuju sistemik, kembali ke da
lam atrium kiri. Karena \up0 \expndtw0\charscalex102 plasenta telah diikat, maka
kadar prostaglandin dari plasenta sudah tidak ada, maka duktus \up0 \expndtw0\c
harscalex103 venosus dan duktus arteriosus secara anatomi dan fisiologi menutup
dan berubah menjadi \up0 \expndtw-3\charscalex100 ligamentum. dan terjadilah ali
ran darah normal orang dewasa. \par\pard\ql \li1441\sb0\sl-276\slmult0 \par\pard
\ql\li1441\sb0\sl-276\slmult0 \par\pard\ql\li1441\sb0\sl-276\slmult0 \par\pard\q
l\li1441\sb149\sl-276\slmult0 \up0 \expndtw-3\charscalex100 \ul0\nosupersub\cf7\
f8\fs24 3.2 Penyebab Sianosis pada Penyakit Jantung Kongenital \par\pard\ql \li1
441\sb0\sl-276\slmult0 \par\pard\ql\li1441\sb208\sl-276\slmult0 \up0 \expndtw-3\
charscalex100 TETRALOGI FALLOT \par\pard\qj \li1441\ri1242\sb256\sl-552\slmult0\
fi720 \up0 \expndtw0\charscalex102 \ul0\nosupersub\cf8\f9\fs24 Tetralogi Fallot
adalah kelainan dalam bentuk penyakit jantung bawaaan sianotik \line \up0 \expnd
tw0\charscalex103 yang memungkinkan kehidupan sampai dewasa. Secara anatom
ik, Tetralogi Fallot \line \up0 \expndtw-2\charscalex100 merupakan malformasi
yang berupa gabungan dari Defek Septum Ventrikel (VSD), stenosis \line \up0 \exp
ndtw-2\charscalex100 katup pulmonal (umumnya stenosis subinfundibular), deviasi
katup aorta ke kanan sehingga \line \up0 \expndtw-1\charscalex100 kedua ventrike
l bermuara ke aorta (overriding aorta), dan hipertrofi ventrikel kanan. Defek \l
ine \up0 \expndtw-1\charscalex100 septum ventrikel biasanya tunggal, besar
dan bersifat non restriktif, \up0 \expndtw-2\charscalex100 80% bersifat \par
\pard\ql \li10328\sb0\sl-253\slmult0 \par\pard\ql\li10328\sb62\sl-253\slmult0 \u
p0 \expndtw0\charscalex111 \ul0\nosupersub\cf3\f4\fs22 6
{\shp {\*\shpinst\shpleft1440\shptop1440\shpright10466\shpbottom2268\shpfhdr0\sh
pbxpage\shpbypage\shpwr3\shpwrk0\shpfblwtxt1\shpz8\shplid0
{\sp{\sn shapeType}{\sv 0}}{\sp{\sn fFlipH}{\sv 0}}{\sp{\sn fFlipV}{\sv 0}}{\sp{
\sn geoRight}{\sv 9026}}{\sp{\sn geoBottom}{\sv 828}}
{\sp{\sn pVerticies}{\sv 8;4;(0,828);(9026,828);(9026,0);(0,0)}}
{\sp{\sn pSegmentInfo}{\sv 2;10;16384;45824;1;45824;1;45824;1;45824;24577;32768}
}
{\sp{\sn fFillOK}{\sv 1}}{\sp{\sn fFilled}{\sv 1}}{\sp{\sn fillColor}{\sv 167772
15}}{\sp{\sn fLine}{\sv 0}}{\sp{\sn lineType}{\sv 0}}{\sp{\sn fArrowheadsOK}{\sv
1}}{\sp{\sn fBehindDocument}{\sv 1}}{\sp{\sn lineColor}{\sv 0}}
}}
{\shp {\*\shpinst\shpleft1440\shptop2268\shpright10466\shpbottom2820\shpfhdr0\sh
pbxpage\shpbypage\shpwr3\shpwrk0\shpfblwtxt1\shpz10\shplid1
{\sp{\sn shapeType}{\sv 0}}{\sp{\sn fFlipH}{\sv 0}}{\sp{\sn fFlipV}{\sv 0}}{\sp{

\sn geoRight}{\sv 9026}}{\sp{\sn geoBottom}{\sv 552}}

{\sp{\sn pVerticies}{\sv 8;4;(0,552);(9026,552);(9026,0);(0,0)}}
{\sp{\sn pSegmentInfo}{\sv 2;10;16384;45824;1;45824;1;45824;1;45824;24577;32768}
}
{\sp{\sn fFillOK}{\sv 1}}{\sp{\sn fFilled}{\sv 1}}{\sp{\sn fillColor}{\sv 167772
15}}{\sp{\sn fLine}{\sv 0}}{\sp{\sn lineType}{\sv 0}}{\sp{\sn fArrowheadsOK}{\sv
1}}{\sp{\sn fBehindDocument}{\sv 1}}{\sp{\sn lineColor}{\sv 0}}
}}
{\shp {\*\shpinst\shpleft1440\shptop2820\shpright10466\shpbottom3372\shpfhdr0\sh
pbxpage\shpbypage\shpwr3\shpwrk0\shpfblwtxt1\shpz12\shplid2
{\sp{\sn shapeType}{\sv 0}}{\sp{\sn fFlipH}{\sv 0}}{\sp{\sn fFlipV}{\sv 0}}{\sp{
\sn geoRight}{\sv 9026}}{\sp{\sn geoBottom}{\sv 552}}
{\sp{\sn pVerticies}{\sv 8;4;(0,552);(9026,552);(9026,0);(0,0)}}
{\sp{\sn pSegmentInfo}{\sv 2;10;16384;45824;1;45824;1;45824;1;45824;24577;32768}
}
{\sp{\sn fFillOK}{\sv 1}}{\sp{\sn fFilled}{\sv 1}}{\sp{\sn fillColor}{\sv 167772
15}}{\sp{\sn fLine}{\sv 0}}{\sp{\sn lineType}{\sv 0}}{\sp{\sn fArrowheadsOK}{\sv
1}}{\sp{\sn fBehindDocument}{\sv 1}}{\sp{\sn lineColor}{\sv 0}}
}}
{\shp {\*\shpinst\shpleft1440\shptop3372\shpright10466\shpbottom3924\shpfhdr0\sh
pbxpage\shpbypage\shpwr3\shpwrk0\shpfblwtxt1\shpz14\shplid3
{\sp{\sn shapeType}{\sv 0}}{\sp{\sn fFlipH}{\sv 0}}{\sp{\sn fFlipV}{\sv 0}}{\sp{
\sn geoRight}{\sv 9026}}{\sp{\sn geoBottom}{\sv 552}}
{\sp{\sn pVerticies}{\sv 8;4;(0,552);(9026,552);(9026,0);(0,0)}}
{\sp{\sn pSegmentInfo}{\sv 2;10;16384;45824;1;45824;1;45824;1;45824;24577;32768}
}
{\sp{\sn fFillOK}{\sv 1}}{\sp{\sn fFilled}{\sv 1}}{\sp{\sn fillColor}{\sv 167772
15}}{\sp{\sn fLine}{\sv 0}}{\sp{\sn lineType}{\sv 0}}{\sp{\sn fArrowheadsOK}{\sv
1}}{\sp{\sn fBehindDocument}{\sv 1}}{\sp{\sn lineColor}{\sv 0}}
}}
{\shp {\*\shpinst\shpleft1440\shptop3924\shpright10466\shpbottom9444\shpfhdr0\sh
pbxpage\shpbypage\shpwr3\shpwrk0\shpfblwtxt1\shpz16\shplid4
{\sp{\sn shapeType}{\sv 0}}{\sp{\sn fFlipH}{\sv 0}}{\sp{\sn fFlipV}{\sv 0}}{\sp{
\sn geoRight}{\sv 9026}}{\sp{\sn geoBottom}{\sv 5520}}
{\sp{\sn pVerticies}{\sv 8;4;(0,5520);(9026,5520);(9026,0);(0,0)}}
{\sp{\sn pSegmentInfo}{\sv 2;10;16384;45824;1;45824;1;45824;1;45824;24577;32768}
}
{\sp{\sn fFillOK}{\sv 1}}{\sp{\sn fFilled}{\sv 1}}{\sp{\sn fillColor}{\sv 167772
15}}{\sp{\sn fLine}{\sv 0}}{\sp{\sn lineType}{\sv 0}}{\sp{\sn fArrowheadsOK}{\sv
1}}{\sp{\sn fBehindDocument}{\sv 1}}{\sp{\sn lineColor}{\sv 0}}
}}
{\shp {\*\shpinst\shpleft1440\shptop9444\shpright10466\shpbottom9996\shpfhdr0\sh
pbxpage\shpbypage\shpwr3\shpwrk0\shpfblwtxt1\shpz18\shplid5
{\sp{\sn shapeType}{\sv 0}}{\sp{\sn fFlipH}{\sv 0}}{\sp{\sn fFlipV}{\sv 0}}{\sp{
\sn geoRight}{\sv 9026}}{\sp{\sn geoBottom}{\sv 552}}
{\sp{\sn pVerticies}{\sv 8;4;(0,552);(9026,552);(9026,0);(0,0)}}
{\sp{\sn pSegmentInfo}{\sv 2;10;16384;45824;1;45824;1;45824;1;45824;24577;32768}
}
{\sp{\sn fFillOK}{\sv 1}}{\sp{\sn fFilled}{\sv 1}}{\sp{\sn fillColor}{\sv 167772
15}}{\sp{\sn fLine}{\sv 0}}{\sp{\sn lineType}{\sv 0}}{\sp{\sn fArrowheadsOK}{\sv
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}}
{\shp {\*\shpinst\shpleft1440\shptop9996\shpright10466\shpbottom10748\shpfhdr0\s
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{\sp{\sn shapeType}{\sv 0}}{\sp{\sn fFlipH}{\sv 0}}{\sp{\sn fFlipV}{\sv 0}}{\sp{

\sn geoRight}{\sv 9026}}{\sp{\sn geoBottom}{\sv 752}}

{\sp{\sn pVerticies}{\sv 8;4;(0,752);(9026,752);(9026,0);(0,0)}}
{\sp{\sn pSegmentInfo}{\sv 2;10;16384;45824;1;45824;1;45824;1;45824;24577;32768}
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{\sp{\sn fFillOK}{\sv 1}}{\sp{\sn fFilled}{\sv 1}}{\sp{\sn fillColor}{\sv 167772
15}}{\sp{\sn fLine}{\sv 0}}{\sp{\sn lineType}{\sv 0}}{\sp{\sn fArrowheadsOK}{\sv
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}}
{\shp {\*\shpinst\shpleft1440\shptop10748\shpright10466\shpbottom11500\shpfhdr0\
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{\sp{\sn shapeType}{\sv 0}}{\sp{\sn fFlipH}{\sv 0}}{\sp{\sn fFlipV}{\sv 0}}{\sp{
\sn geoRight}{\sv 9026}}{\sp{\sn geoBottom}{\sv 752}}
{\sp{\sn pVerticies}{\sv 8;4;(0,752);(9026,752);(9026,0);(0,0)}}
{\sp{\sn pSegmentInfo}{\sv 2;10;16384;45824;1;45824;1;45824;1;45824;24577;32768}
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{\sp{\sn fFillOK}{\sv 1}}{\sp{\sn fFilled}{\sv 1}}{\sp{\sn fillColor}{\sv 167772
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}}
{\shp {\*\shpinst\shpleft1440\shptop11500\shpright10466\shpbottom15012\shpfhdr0\
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{\sp{\sn shapeType}{\sv 0}}{\sp{\sn fFlipH}{\sv 0}}{\sp{\sn fFlipV}{\sv 0}}{\sp{
\sn geoRight}{\sv 9026}}{\sp{\sn geoBottom}{\sv 3512}}
{\sp{\sn pVerticies}{\sv 8;4;(0,3512);(9026,3512);(9026,0);(0,0)}}
{\sp{\sn pSegmentInfo}{\sv 2;10;16384;45824;1;45824;1;45824;1;45824;24577;32768}
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{\sp{\sn fFillOK}{\sv 1}}{\sp{\sn fFilled}{\sv 1}}{\sp{\sn fillColor}{\sv 167772
15}}{\sp{\sn fLine}{\sv 0}}{\sp{\sn lineType}{\sv 0}}{\sp{\sn fArrowheadsOK}{\sv
1}}{\sp{\sn fBehindDocument}{\sv 1}}{\sp{\sn lineColor}{\sv 0}}
}}\par\pard\sect\sectd\fs24\paperw11900\paperh16840\pard\sb0\sl-240{\bkmkstart P
g7}{\bkmkend Pg7}\par\pard\qj \li1441\sb0\sl-552\slmult0 \par\pard\qj\li1441\ri1
241\sb432\sl-552\slmult0 \up0 \expndtw-3\charscalex100 \ul0\nosupersub\cf8\f9\fs
24 perimembran. Stenosis pulmonal, pada sebagian besar kasus berupa stenosis sub
infundibular, \line \up0 \expndtw-2\charscalex100 katup biasanya abnormal, wa
laupun biasanya bukan sebagai penyebab utama obstruksi. \line \up0 \expndtw
-3\charscalex100 Dapat juga terjadi atresia dari infundibulum atau katup, serta
hipoplasia dari arteri pulmonal. \line \up0 \expndtw0\charscalex100 Overriding a
orta, derajat overriding aorta terhadap ventrikel bervariasi 5% - 95%. Oleh \
line \up0 \expndtw0\charscalex100 karena itu, Tetralogi Fallot bisa sebagai doub
le outlet ventrikel kanan bila lebih dari 50% \line \up0 \expndtw-2\charscalex10
0 muara aorta berada di ventrikel kanan. Hal ini penting saat tindakan
koreksi di mana \line \up0 \expndtw0\charscalex100 diperlukan penutup yang
lebih besar. Lesi yang menyertai, penting diketahui karena \line \up0 \e
xpndtw-2\charscalex100 mempunyai nilai pada saat tindakan koreksi bedah. Dapat b
erupa ASD, VSD tipe muskuler, \line \up0 \expndtw-3\charscalex100 defek septum
atrioventrikuler anomali arteri koroner. \up0 \expndtw-3\charscalex100 (Perh
impunan Dokter Spesialis \par\pard\qj \li1441\ri1245\sb0\sl-560\slmult0 \up0 \
expndtw-1\charscalex100 Penyakit Dalam Indonesia. 2006.\ul0\nosupersub\cf9\f10\f
s24 Buku Ajar Ilmu Penyakit Dalam Jilid II Edisi IV\ul0\nosupersub\cf8\f9\fs24
. Jakarta: \up0 \expndtw-5\charscalex100 Departemen IlmuPenyakit Dalam FKUI.) \p
ar\pard\ql \li1441\sb0\sl-276\slmult0 \par\pard\ql\li1441\sb0\sl-276\slmult0 \pa
r\pard\ql\li1441\sb0\sl-276\slmult0 \par\pard\ql\li1441\sb129\sl-276\slmult0 \up
0 \expndtw-3\charscalex100 \ul0\nosupersub\cf7\f8\fs24 Gejala \par\pard\qj \li14
41\ri1503\sb66\sl-540\slmult0\fi720 \up0 \expndtw-4\charscalex100 \ul0\nosupersu
b\cf8\f9\fs24 Gejala yang timbul tergantung dari derajat stenosis pulmonal, vent
rikel septal defek \up0 \expndtw-5\charscalex100 (VSD), dan resistensi vaskular
sistemik. Gejalanya bisa berupa : \par\pard\qj \li1441\ri2080\sb21\sl-540\slmult
0 \up0 \expndtw-4\charscalex100 a. Terjadi gangguan pertumbuhan, kadang terjadi

sirkulasi kolateral ke paru sehingga \up0 \expndtw-5\charscalex100 dapat mempert

ahankan pertumbuhan. \par\pard\ql \li1441\sb239\sl-276\slmult0 \up0 \expndtw-3\c
harscalex100 b. Bayi mengalami kesulitan untuk menyusu \par\pard\qj \li1441\ri18
62\sb66\sl-540\slmult0 \up0 \expndtw-2\charscalex100 c. Sianosis. Sianosis yang
terjadi simetris, akibat pirau dari ventrikel kanan ke ventrikel \up0 \expndtw-3
\charscalex100 kiri. Melalui defek besar yang non restriktif. \par\pard\qj \li14
41\ri1254\sb21\sl-540\slmult0 \up0 \expndtw-2\charscalex100 d. Jari tangan clubb
ing (seperti tabuh genderang karena kulit atau tulang di sekitar kuku jari \up0
\expndtw-3\charscalex100 tangan membesar) \par\pard\ql \li1441\sb239\sl-276\slmu
lt0 \up0 \expndtw-3\charscalex100 e. Sesak napas jika melakukan aktivitas. \par\
pard\ql \li1441\sb0\sl-276\slmult0 \par\pard\ql\li1441\sb8\sl-276\slmult0 \up0 \
expndtw-3\charscalex100 f. Setelah melakukan aktivitas, anak selalu jongkok (sku
ating) \par\pard\ql \li10328\sb0\sl-253\slmult0 \par\pard\ql\li10328\sb0\sl-253\
slmult0 \par\pard\ql\li10328\sb0\sl-253\slmult0 \par\pard\ql\li10328\sb4\sl-253\
slmult0 \up0 \expndtw0\charscalex111 \ul0\nosupersub\cf3\f4\fs22 7
{\shp {\*\shpinst\shpleft1440\shptop1440\shpright10466\shpbottom7236\shpfhdr0\sh
pbxpage\shpbypage\shpwr3\shpwrk0\shpfblwtxt1\shpz8\shplid0
{\sp{\sn shapeType}{\sv 0}}{\sp{\sn fFlipH}{\sv 0}}{\sp{\sn fFlipV}{\sv 0}}{\sp{
\sn geoRight}{\sv 9026}}{\sp{\sn geoBottom}{\sv 5796}}
{\sp{\sn pVerticies}{\sv 8;4;(0,5796);(9026,5796);(9026,0);(0,0)}}
{\sp{\sn pSegmentInfo}{\sv 2;10;16384;45824;1;45824;1;45824;1;45824;24577;32768}
}
{\sp{\sn fFillOK}{\sv 1}}{\sp{\sn fFilled}{\sv 1}}{\sp{\sn fillColor}{\sv 167772
15}}{\sp{\sn fLine}{\sv 0}}{\sp{\sn lineType}{\sv 0}}{\sp{\sn fArrowheadsOK}{\sv
1}}{\sp{\sn fBehindDocument}{\sv 1}}{\sp{\sn lineColor}{\sv 0}}
}}\par\pard\sect\sectd\fs24\paperw11900\paperh16840\pard\sb0\sl-240{\bkmkstart P
g8}{\bkmkend Pg8}\par\pard\qj \li1441\sb0\sl-550\slmult0 \par\pard\qj\li1441\ri1
241\sb436\sl-550\slmult0\fi720 \up0 \expndtw-1\charscalex100 \ul0\nosupersub\cf8
\f9\fs24 Anak dengan keluhan ini akan biru sejak lahir, karena hipoksia. Pertumb
uhan badan \up0 \expndtw-1\charscalex100 kurang dibanding anak sebayanya. Gejala
yang khas adalah spel sianotik dimana anak tiba\up0 \expndtw0\charscalex100 tib
a tampak lebih biru, pernapasan cepat, kesadaran menurun, dan kadang- kadang dis
ertai \up0 \expndtw0\charscalex100 kejang. Episode ini umumnya dialami pada usia
3 bulan sampai kurang lebih 3 tahun dan \up0 \expndtw-1\charscalex100 sering ti
mbul pada pagi hari waktu anak bangun tidur atau setelah buang air besar. Demam
\up0 \expndtw-3\charscalex100 juga bisa merupakan pencetus. Kelainan ini m
empunyai insidens tertinggi dari seluruh \up0 \expndtw-5\charscalex100 kelai
nan jantung bawaan biru, yaitu kurang lebih 50%. \par\pard\ql \li1441\sb0\sl-276
\slmult0 \par\pard\ql\li1441\sb0\sl-276\slmult0 \par\pard\ql\li1441\sb0\sl-276\s
lmult0 \par\pard\ql\li1441\sb169\sl-276\slmult0 \up0 \expndtw-5\charscalex100 \u
l0\nosupersub\cf1\f2\fs24 Transposition Of Great Arteri ( TGA) \par\pard\qj \li1
441\ri1241\sb36\sl-553\slmult0\fi720 \up0 \expndtw-4\charscalex100 \ul0\nosupers
ub\cf4\f5\fs24 Transposisi Arteri Besar adalah kelainan letak dari aorta dan art
eri pulmonalis. Dalam \up0 \expndtw0\charscalex104 keadaan normal, aorta berhubu
ngan dengan ventrikel kiri jantung dan arteri pulmonalis \up0 \expndtw-2\charsca
lex100 berhubungan dengan ventrikel kanan jantung. Pada transposisi arteri besar
yang terjadi adalah \up0 \expndtw0\charscalex104 kebalikannya. Aorta terletak d
i ventikel kanan jantung dan arteri pulmonalis terletak di \up0 \expndtw-1\chars
calex100 ventrikel kiri jantung. Darah dari seluruh tubuh yang kekurangan oksige
n akan mengalir ke \up0 \expndtw-3\charscalex100 dalam aorta dan kembali dialirk
an ke seluruh tubuh. Sedangkan darah yang berasal dari paru \up0 \expndtw-5\char
scalex100 dan kaya akan oksigen akan kembali dialirkan ke paru. \par\pard\qj \li
1441\ri1243\sb0\sl-554\slmult0\fi720 \up0 \expndtw-1\charscalex100 Transposisi a
rteri besar dikelompokkan ke dalam kelainan jantung sianotik, dimana \line \up0
\expndtw0\charscalex100 terjadi pemompaan darah yang kekurangan oksigen ke selur
uh tubuh, yang menyebabkan \line \up0 \expndtw0\charscalex102 sianosis (kulit me
njadi ungu kebiruan) dan sesak nafas. Bayi dengan kelainan ini, setelah \line \u
p0 \expndtw0\charscalex100 lahir bisa bertahan sebentar saja karena adanya luban
g diantara atrium kiri dan kanan yang \line \up0 \expndtw-3\charscalex100 disebu

t foramen ovale. Foramen ovale ini dalam keadaan normal ditemukan pada bayi keti
ka \line \up0 \expndtw0\charscalex100 lahir. Dengan adanya lubang ini, maka seju
mlah kecil darah yang kaya akan oksigen akan \line \up0 \expndtw0\charscalex103
mengalir dari atrium kiri ke atrium kanan, lalu ke ventrikel kanan dan ke aorta
sehingga \line \up0 \expndtw0\charscalex103 mampu memenuhi kebutuhan tubuh akan
oksigen dan bayi tetap hidup. Transposition of \par\pard\ql \li10328\sb0\sl-253\
slmult0 \par\pard\ql\li10328\sb0\sl-253\slmult0 \par\pard\ql\li10328\sb196\sl-25
3\slmult0 \up0 \expndtw0\charscalex111 \ul0\nosupersub\cf3\f4\fs22 8
{\shp {\*\shpinst\shpleft1440\shptop1440\shpright10466\shpbottom5028\shpfhdr0\sh
pbxpage\shpbypage\shpwr3\shpwrk0\shpfblwtxt1\shpz8\shplid0
{\sp{\sn shapeType}{\sv 0}}{\sp{\sn fFlipH}{\sv 0}}{\sp{\sn fFlipV}{\sv 0}}{\sp{
\sn geoRight}{\sv 9026}}{\sp{\sn geoBottom}{\sv 3588}}
{\sp{\sn pVerticies}{\sv 8;4;(0,3588);(9026,3588);(9026,0);(0,0)}}
{\sp{\sn pSegmentInfo}{\sv 2;10;16384;45824;1;45824;1;45824;1;45824;24577;32768}
}
{\sp{\sn fFillOK}{\sv 1}}{\sp{\sn fFilled}{\sv 1}}{\sp{\sn fillColor}{\sv 167772
15}}{\sp{\sn fLine}{\sv 0}}{\sp{\sn lineType}{\sv 0}}{\sp{\sn fArrowheadsOK}{\sv
1}}{\sp{\sn fBehindDocument}{\sv 1}}{\sp{\sn lineColor}{\sv 0}}
}}
{\shp {\*\shpinst\shpleft1440\shptop6608\shpright10466\shpbottom10196\shpfhdr0\s
hpbxpage\shpbypage\shpwr3\shpwrk0\shpfblwtxt1\shpz10\shplid1
{\sp{\sn shapeType}{\sv 0}}{\sp{\sn fFlipH}{\sv 0}}{\sp{\sn fFlipV}{\sv 0}}{\sp{
\sn geoRight}{\sv 9026}}{\sp{\sn geoBottom}{\sv 3588}}
{\sp{\sn pVerticies}{\sv 8;4;(0,3588);(9026,3588);(9026,0);(0,0)}}
{\sp{\sn pSegmentInfo}{\sv 2;10;16384;45824;1;45824;1;45824;1;45824;24577;32768}
}
{\sp{\sn fFillOK}{\sv 1}}{\sp{\sn fFilled}{\sv 1}}{\sp{\sn fillColor}{\sv 167772
15}}{\sp{\sn fLine}{\sv 0}}{\sp{\sn lineType}{\sv 0}}{\sp{\sn fArrowheadsOK}{\sv
1}}{\sp{\sn fBehindDocument}{\sv 1}}{\sp{\sn lineColor}{\sv 0}}
}}
{\shp {\*\shpinst\shpleft1440\shptop10196\shpright10466\shpbottom14612\shpfhdr0\
shpbxpage\shpbypage\shpwr3\shpwrk0\shpfblwtxt1\shpz12\shplid2
{\sp{\sn shapeType}{\sv 0}}{\sp{\sn fFlipH}{\sv 0}}{\sp{\sn fFlipV}{\sv 0}}{\sp{
\sn geoRight}{\sv 9026}}{\sp{\sn geoBottom}{\sv 4416}}
{\sp{\sn pVerticies}{\sv 8;4;(0,4416);(9026,4416);(9026,0);(0,0)}}
{\sp{\sn pSegmentInfo}{\sv 2;10;16384;45824;1;45824;1;45824;1;45824;24577;32768}
}
{\sp{\sn fFillOK}{\sv 1}}{\sp{\sn fFilled}{\sv 1}}{\sp{\sn fillColor}{\sv 167772
15}}{\sp{\sn fLine}{\sv 0}}{\sp{\sn lineType}{\sv 0}}{\sp{\sn fArrowheadsOK}{\sv
1}}{\sp{\sn fBehindDocument}{\sv 1}}{\sp{\sn lineColor}{\sv 0}}
}}\par\pard\sect\sectd\fs24\paperw11900\paperh16840\pard\sb0\sl-240{\bkmkstart P
g9}{\bkmkend Pg9}\par\pard\qj \li1441\sb0\sl-540\slmult0 \par\pard\qj\li1441\ri1
244\sb454\sl-540\slmult0 \up0 \expndtw-1\charscalex100 \ul0\nosupersub\cf4\f5\fs
24 Great Arteries (TGA) adalah kelainan jantung bawaan (kongenital) dimana Aorta
keluar dari \up0 \expndtw-3\charscalex100 ventrikel kanan dan Arteri Pulmonalis
keluar dari ventrikel kiri. \par\pard\ql \li1441\sb0\sl-276\slmult0 \par\pard\q
l\li1441\sb0\sl-276\slmult0 \par\pard\ql\li1441\sb247\sl-276\slmult0 \up0 \expnd
tw-3\charscalex100 \ul0\nosupersub\cf1\f2\fs24 Manifestasi Klinis \par\pard\ql \
li1441\sb264\sl-276\slmult0 \up0 \expndtw-3\charscalex100 \ul0\nosupersub\cf4\f5
\fs24 \u8226? Riwayat biru (sianosis) sejak lahir. \par\pard\qj \li1441\ri1692\s
b66\sl-540\slmult0 \up0 \expndtw-2\charscalex100 \u8226? Tanda-tanda gagal jantu
ng kongestif yang sudah muncul sejak minggu-minggu pertama \up0 \expndtw-3\chars
calex100 kelahiran. \par\pard\ql \li1441\sb239\sl-276\slmult0 \up0 \expndtw-3\ch
arscalex100 \u8226? Pasien terlihat takipneu dan seringkali disertai retraksi. \
par\pard\qj \li1441\ri1250\sb66\sl-540\slmult0 \up0 \expndtw0\charscalex105 \u82
26? Bunyi jantung S2 keras dan tunggal. Murmur tidak terdengar pada TGA tanpa VS
D. \up0 \expndtw-5\charscalex100 Adanya \par\pard\li1441\sb243\sl-276\slmult0\fi

0\tx6106 \up0 \expndtw0\charscalex101 VSD akan menyebabkan murmur sistolik\t

ab \up0 \expndtw0\charscalex101 (regurgitan), sedangkan adanya PS akan\par\p
ard\li1441\sb276\sl-276\slmult0\fi0 \up0 \expndtw0\charscalex101 menyebabkan bun
yi murmur sistolik ejeksi\par\pard\ql \li1441\sb268\sl-276\slmult0 \up0 \expndtw
-5\charscalex100 \u8226? Hepatomegali dapat ditemukan pada TGA dengan CHF. \par\
pard\qj \li1441\ri1249\sb66\sl-540\slmult0 \up0 \expndtw0\charscalex100 \u8226?
Hipoksemia pada pasien tidak akan responsif terhadap pemberian oksigen. Hipoglik
emia \line \up0 \expndtw-3\charscalex100 dan \par\pard\ql \li1441\sb239\sl-276\s
lmult0 \up0 \expndtw-3\charscalex100 hipokalsemia sering pula ditemukan pada pem
eriksaan laboratorium \par\pard\ql \li1441\sb0\sl-276\slmult0 \par\pard\ql\li144
1\sb0\sl-276\slmult0 \par\pard\ql\li1441\sb272\sl-276\slmult0 \up0 \expndtw-5\ch
arscalex100 \ul0\nosupersub\cf1\f2\fs24 Patens Ductus Arteriosus ( PDA ) \par\pa
rd\qj \li1441\ri1246\sb58\sl-550\slmult0\fi541 \up0 \expndtw0\charscalex100 \ul0
\nosupersub\cf4\f5\fs24 Duktus arteriosus adalah saluran yang berasal dari arkus
aorta ke IV pada janin yang \line \up0 \expndtw-2\charscalex100 menhubungkan ar
teri pulmonalis dengan aorta desendens. Pada bayi normal ductus tersebut \line \
up0 \expndtw-3\charscalex100 menutup secara fongsional \up0 \expndtw-3\charsca
lex100 10-15 jam setelah lahir dan secara anatomis menjadi \par\pard\qj \
li1441\ri1243\sb0\sl-560\slmult0 \up0 \expndtw-2\charscalex100 ligamentumarterio
sum pada usia 2-3 minggu. Bila tidak menutup maka disebut ductus \up0
\expndtw-3\charscalex100 arteriosus persisten (Persistent Ductus Arteriosus = PD
A). \par\pard\li1441\sb217\sl-276\slmult0\fi0\tx6062 \up0 \expndtw-2\charscalex1
00 (\ul0\nosupersub\cf8\f9\fs24 Fakultas Kedokteran Universitas Indonesia.\ta
b \up0 \expndtw-2\charscalex100 1998.\ul0\nosupersub\cf9\f10\fs24 Buku Ajar K
ardiologi\ul0\nosupersub\cf8\f9\fs24 . Jakarta: Gaya\par\pard\li1441\sb276\sl276\slmult0\fi0 \up0 \expndtw-2\charscalex100 Baru.\par\pard\ql \li10328\sb0\sl253\slmult0 \par\pard\ql\li10328\sb158\sl-253\slmult0 \up0 \expndtw0\charscalex1
11 \ul0\nosupersub\cf3\f4\fs22 9
{\shp {\*\shpinst\shpleft1440\shptop1440\shpright10466\shpbottom2268\shpfhdr0\sh
pbxpage\shpbypage\shpwr3\shpwrk0\shpfblwtxt1\shpz8\shplid0
{\sp{\sn shapeType}{\sv 0}}{\sp{\sn fFlipH}{\sv 0}}{\sp{\sn fFlipV}{\sv 0}}{\sp{
\sn geoRight}{\sv 9026}}{\sp{\sn geoBottom}{\sv 828}}
{\sp{\sn pVerticies}{\sv 8;4;(0,828);(9026,828);(9026,0);(0,0)}}
{\sp{\sn pSegmentInfo}{\sv 2;10;16384;45824;1;45824;1;45824;1;45824;24577;32768}
}
{\sp{\sn fFillOK}{\sv 1}}{\sp{\sn fFilled}{\sv 1}}{\sp{\sn fillColor}{\sv 167772
15}}{\sp{\sn fLine}{\sv 0}}{\sp{\sn lineType}{\sv 0}}{\sp{\sn fArrowheadsOK}{\sv
1}}{\sp{\sn fBehindDocument}{\sv 1}}{\sp{\sn lineColor}{\sv 0}}
}}
{\shp {\*\shpinst\shpleft1440\shptop10272\shpright10466\shpbottom10548\shpfhdr0\
shpbxpage\shpbypage\shpwr3\shpwrk0\shpfblwtxt1\shpz10\shplid1
{\sp{\sn shapeType}{\sv 0}}{\sp{\sn fFlipH}{\sv 0}}{\sp{\sn fFlipV}{\sv 0}}{\sp{
\sn geoRight}{\sv 9026}}{\sp{\sn geoBottom}{\sv 276}}
{\sp{\sn pVerticies}{\sv 8;4;(0,276);(9026,276);(9026,0);(0,0)}}
{\sp{\sn pSegmentInfo}{\sv 2;10;16384;45824;1;45824;1;45824;1;45824;24577;32768}
}
{\sp{\sn fFillOK}{\sv 1}}{\sp{\sn fFilled}{\sv 1}}{\sp{\sn fillColor}{\sv 167772
15}}{\sp{\sn fLine}{\sv 0}}{\sp{\sn lineType}{\sv 0}}{\sp{\sn fArrowheadsOK}{\sv
1}}{\sp{\sn fBehindDocument}{\sv 1}}{\sp{\sn lineColor}{\sv 0}}
}}\par\pard\sect\sectd\fs24\paperw11900\paperh16840\pard\sb0\sl-240{\bkmkstart P
g10}{\bkmkend Pg10}\par\pard\ql \li1441\sb0\sl-276\slmult0 \par\pard\ql\li1441\s
b0\sl-276\slmult0 \par\pard\ql\li1441\sb0\sl-276\slmult0 \par\pard\ql\li1441\sb0
\sl-276\slmult0 \par\pard\ql\li1441\sb0\sl-276\slmult0 \par\pard\ql\li1441\sb0\s
l-276\slmult0 \par\pard\ql\li1441\sb96\sl-276\slmult0 \up0 \expndtw-8\charscalex
100 \ul0\nosupersub\cf1\f2\fs24 Patofisiologi \par\pard\qj \li1441\ri1241\sb56\s
l-552\slmult0\fi720 \up0 \expndtw0\charscalex102 \ul0\nosupersub\cf4\f5\fs24 Duk
tus arteriosus adalah pembuluh darah yang menghubungkan aliran darah \li
ne \up0 \expndtw0\charscalex100 pulmonal ke aliran darah sistemik dalam masa keh

amilan (fetus). Hubungan ini (\ul0\nosupersub\cf5\f6\fs24 shunt\ul0\nosupersub\c

f4\f5\fs24 ) ini \line \up0 \expndtw-1\charscalex100 diperlukan oleh karena sist
em respirasi fetus yang belum bekerja di dalam masa kehamilan \line \up0 \expndt
w-4\charscalex100 tersebut. Aliran darah balik fetus akan bercampur dengan alira
n darah bersih dari ibu (melalui \line \up0 \expndtw0\charscalex103 vena umbilik
alis) kemudian masuk ke dalam atrium kanan dan kemudian dipompa oleh \line \up0
\expndtw0\charscalex103 ventrikel kanan kembali ke aliran sistemik melalui duktu
s arteriosus. Normalnya duktus \line \up0 \expndtw-3\charscalex100 arteriosus be
rasal dari arteri pulmonalis utama (atau arteri pulmonalis kiri) dan berakhir pa
da \line \up0 \expndtw-2\charscalex100 bagian superior dari aorta desendens, 2-1
0 mm distal dari percabangan arteri subklavia kiri. \line \up0 \expndtw-2\charsc
alex100 Dinding duktus arteriosus terutama terdiri dari lapisan otot pol
os \up0 \expndtw-3\charscalex100 (tunika media) yang \par\pard\qj \li1441\ri12
43\sb0\sl-553\slmult0 \up0 \expndtw-3\charscalex100 tersusun spiral. Diantara
sel-sel otot polos terdapat serat-serat elastin yang membentuk \up0 \exp
ndtw-3\charscalex100 lapisan yang berfragmen, berbeda dengan aorta yang memiliki
lapisan elastin yang tebal dan \up0 \expndtw0\charscalex100 tersusun rapat (\u
l0\nosupersub\cf5\f6\fs24 unfragmented\ul0\nosupersub\cf4\f5\fs24 ). Sel-sel oto
t polos pada duktus arteriosus sensitif terhadap \up0 \expndtw-3\charscalex100 m
ediator vasodilator prostaglandin dan vasokonstriktor (pO2). \par\pard\qj \li144
1\ri1242\sb198\sl-550\slmult0\fi720 \up0 \expndtw0\charscalex103 Setelah persali
nan terjadi perubahan sirkulasi dan fisiologis yang dimulai segera \up0 \expndt
w0\charscalex103 setelah eliminasi plasenta dari neonatus. Adanya perubaha
n tekanan, sirkulasi dan \up0 \expndtw-1\charscalex100 meningkatnya pO2 akan
menyebabkan penutupan spontan duktus arteriosus dalam waktu 2 \up0 \expndtw-3\ch
arscalex100 minggu. Duktus arteriosus yang persisten (PDA) akan mengakibatkan pi
rai (shunt) L-R yang \up0 \expndtw-4\charscalex100 kemudian dapat menyebabkan hi
pertensi pulmonal dan sianosis. \par\pard\qj \li1441\ri1246\sb19\sl-540\slmult0\
fi720 \up0 \expndtw-3\charscalex100 Besarnya pirai (shunt) ditentukan oleh diame
ter, panjang PDA serta tahanan vaskuler \up0 \expndtw-5\charscalex100 paru (PVR)
\par\pard\ql \li1441\sb0\sl-276\slmult0 \par\pard\ql\li1441\sb0\sl-276\slmult0
\par\pard\ql\li1441\sb247\sl-276\slmult0 \up0 \expndtw-3\charscalex100 \ul0\nosu
persub\cf1\f2\fs24 Gejala Klinis \par\pard\ql \li1441\sb264\sl-276\slmult0 \up0
\expndtw-3\charscalex100 \ul0\nosupersub\cf4\f5\fs24 \u8226? Batuk \par\pard\ql
\li10187\sb223\sl-253\slmult0 \up0 \expndtw0\charscalex111 \ul0\nosupersub\cf3\f
4\fs22 10
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{\sp{\sn shapeType}{\sv 0}}{\sp{\sn fFlipH}{\sv 0}}{\sp{\sn fFlipV}{\sv 0}}{\sp{
\sn geoRight}{\sv 9026}}{\sp{\sn geoBottom}{\sv 276}}
{\sp{\sn pVerticies}{\sv 8;4;(0,276);(9026,276);(9026,0);(0,0)}}
{\sp{\sn pSegmentInfo}{\sv 2;10;16384;45824;1;45824;1;45824;1;45824;24577;32768}
}
{\sp{\sn fFillOK}{\sv 1}}{\sp{\sn fFilled}{\sv 1}}{\sp{\sn fillColor}{\sv 167772
15}}{\sp{\sn fLine}{\sv 0}}{\sp{\sn lineType}{\sv 0}}{\sp{\sn fArrowheadsOK}{\sv
1}}{\sp{\sn fBehindDocument}{\sv 1}}{\sp{\sn lineColor}{\sv 0}}
}}
{\shp {\*\shpinst\shpleft1440\shptop2268\shpright10466\shpbottom6684\shpfhdr0\sh
pbxpage\shpbypage\shpwr3\shpwrk0\shpfblwtxt1\shpz10\shplid1
{\sp{\sn shapeType}{\sv 0}}{\sp{\sn fFlipH}{\sv 0}}{\sp{\sn fFlipV}{\sv 0}}{\sp{
\sn geoRight}{\sv 9026}}{\sp{\sn geoBottom}{\sv 4416}}
{\sp{\sn pVerticies}{\sv 8;4;(0,4416);(9026,4416);(9026,0);(0,0)}}
{\sp{\sn pSegmentInfo}{\sv 2;10;16384;45824;1;45824;1;45824;1;45824;24577;32768}
}
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15}}{\sp{\sn fLine}{\sv 0}}{\sp{\sn lineType}{\sv 0}}{\sp{\sn fArrowheadsOK}{\sv
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}}\par\pard\sect\sectd\fs24\paperw11900\paperh16840\pard\sb0\sl-240{\bkmkstart P
g11}{\bkmkend Pg11}\par\pard\ql \li1441\sb0\sl-276\slmult0 \par\pard\ql\li1441\s
b0\sl-276\slmult0 \par\pard\ql\li1441\sb0\sl-276\slmult0 \par\pard\ql\li1441\sb0
\sl-276\slmult0 \par\pard\ql\li1441\sb108\sl-276\slmult0 \up0 \expndtw-5\charsca
lex100 \ul0\nosupersub\cf4\f5\fs24 \u8226? Tampak lelah waktu minum susu \par\pa
rd\ql \li1441\sb264\sl-276\slmult0 \up0 \expndtw-3\charscalex100 \u8226? Sesak n
afas \par\pard\ql \li1441\sb0\sl-276\slmult0 \par\pard\ql\li1441\sb8\sl-276\slmu
lt0 \up0 \expndtw-3\charscalex100 \u8226? Pertumbuhan fisik yang lambat \par\par
d\ql \li1441\sb0\sl-276\slmult0 \par\pard\ql\li1441\sb8\sl-276\slmult0 \up0 \exp
ndtw-5\charscalex100 \u8226? Takipneu \par\pard\ql \li1441\sb264\sl-276\slmult0
\up0 \expndtw-3\charscalex100 \u8226? Sianosis setelah sindro eisenmenger \par\p
ard\ql \li1441\sb0\sl-276\slmult0 \par\pard\ql\li1441\sb8\sl-276\slmult0 \up0 \e
xpndtw-3\charscalex100 \u8226? Bising kontinyu \par\pard\ql \li1441\sb264\sl-276
\slmult0 \up0 \expndtw-3\charscalex100 \u8226? Thrill ICS II kiri \par\pard\ql \
li1441\sb0\sl-276\slmult0 \par\pard\ql\li1441\sb8\sl-276\slmult0 \up0 \expndtw-3
\charscalex100 \u8226? Hipertensi Pulmonal \par\pard\ql \li1441\sb0\sl-276\slmul
t0 \par\pard\ql\li1441\sb8\sl-276\slmult0 \up0 \expndtw-3\charscalex100 \u8226?
S2 mengeres \par\pard\ql \li1441\sb264\sl-276\slmult0 \up0 \expndtw-3\charscalex
100 \u8226? Bising diastolik lemah atau hilang \par\pard\li1441\sb0\sl-276\slmul
t0\par\pard\li1441\sb12\sl-276\slmult0\fi0\tx6062 \up0 \expndtw-2\charscalex100
(\ul0\nosupersub\cf8\f9\fs24 Fakultas Kedokteran Universitas Indonesia.\tab \
up0 \expndtw-2\charscalex100 1998.\ul0\nosupersub\cf9\f10\fs24 Buku Ajar Kard
iologi\ul0\nosupersub\cf8\f9\fs24 . Jakarta: Gaya\par\pard\li1441\sb276\sl-276
\slmult0\fi0 \up0 \expndtw-2\charscalex100 Baru. )\par\pard\ql \li1441\sb0\sl-27
6\slmult0 \par\pard\ql\li1441\sb0\sl-276\slmult0 \par\pard\ql\li1441\sb0\sl-276\
slmult0 \par\pard\ql\li1441\sb200\sl-276\slmult0 \up0 \expndtw-5\charscalex100 \
ul0\nosupersub\cf1\f2\fs24 Respirasi \par\pard\qj \li1441\ri1239\sb237\sl-551\sl
mult0\fi720 \up0 \expndtw0\charscalex103 \ul0\nosupersub\cf4\f5\fs24 Respirasi
adalah pertukaran gas-gas antara organisme hidup dan lingkungan \up0 \exp
ndtw0\charscalex100 sekitarnya. Pada manusia dikenal 2 macam respirasi yaitu eks
ternal dan internal. Respirasi \up0 \expndtw0\charscalex102 eksterna adalah pe
ngangkutan oksigen dari atmosfer sampai ke jaringan tubuh dan \up0 \expn
dtw-3\charscalex100 pengangkutan karbon dioksida dari jaringan sampai ke
atmosfer. Sementara bagaimana \up0 \expndtw0\charscalex100 oksigen digunakan o
leh jaringan dan bagaimana karbon dioksida dibebaskan oleh jaringan \up0 \expndt
w-1\charscalex100 disebut respirasi internal. Secara fisiologis sistem respirasi
dibagi menjadi bagian konduksi \up0 \expndtw-3\charscalex100 dari ruang hidung
sampai bronkioli terminalis dan bagian respirasi yang terdiri dari bronkioli \up
0 \expndtw-4\charscalex100 respiratorius sampai alveoli. \par\pard\ql \li1441\sb
0\sl-276\slmult0 \par\pard\ql\li1441\sb161\sl-276\slmult0 \up0 \expndtw-4\charsc
alex100 Proses respirasi merupakan proses yang dapat dibagi menjadi 5 tahap yait
u : \par\pard\ql \li1441\sb0\sl-276\slmult0 \par\pard\ql\li1441\sb208\sl-276\slm
ult0 \up0 \expndtw-2\charscalex100 \ul0\nosupersub\cf3\f4\fs22 1)\ul0\nosupersub
\cf4\f5\fs24 Ventilasi. Adalah proses masuk udara sekitar dan pembagian udara k
e alveoli. \par\pard\ql \li10187\sb163\sl-253\slmult0 \up0 \expndtw0\charscalex1
11 \ul0\nosupersub\cf3\f4\fs22 11 \par\pard\sect\sectd\fs24\paperw11900\paperh16
840\pard\sb0\sl-240{\bkmkstart Pg12}{\bkmkend Pg12}\par\pard\qj \li1441\sb0\sl-5
40\slmult0 \par\pard\qj\li1441\ri1249\sb454\sl-540\slmult0\tx1726 \up0 \expndtw0
\charscalex105 \ul0\nosupersub\cf3\f4\fs22 2)\ul0\nosupersub\cf4\f5\fs24 Difusi

Tahap kedua dari proses pernapasan mencakup proses difusi gas-gas melintasi \li
ne\tab \up0 \expndtw-3\charscalex100 membran alveolus-kapiler yang tipis (tebaln
ya kurang dari 0,5 m). \par\pard\ql \li1441\ri1242\sb210\sl-553\slmult0\tx1726\t
x1726\tx1726 \up0 \expndtw0\charscalex105 \ul0\nosupersub\cf3\f4\fs22 3)\ul0\nos
upersub\cf4\f5\fs24 Hubungan antara ventilasi-perfusi Pemindahan gas secara efe
ktif antara alveolus dan \line\tab \up0 \expndtw0\charscalex100 kapiler paru-par
u membutuhkan distribusi merata dari udara dalam paru-paru dan perfusi \line \ta
b \up0 \expndtw0\charscalex100 (aliran darah) dalam kapiler. Dengan perkata
an lain, ventilasi dan perfusi dari unit \line \tab \up0 \expndtw-3\charsc
alex100 pulmonar harus sesuai. \par\pard\ql \li1441\sb0\sl-276\slmult0 \par\pard
\ql\li1441\sb140\sl-276\slmult0 \up0 \expndtw-2\charscalex100 \ul0\nosupersub\cf
3\f4\fs22 4)\ul0\nosupersub\cf4\f5\fs24 Respirasi internal, meliputi : \par\par
d\ql \li1726\sb0\sl-276\slmult0 \par\pard\ql\li1726\sb208\sl-276\slmult0 \up0 \e
xpndtw-2\charscalex100 \ul0\nosupersub\cf3\f4\fs22 a.\ul0\nosupersub\cf4\f5\fs24
Efisiensi kardiosirkulasi dalam menjalankan darah kaya oksigen \par\pard\ql \
li1726\sb0\sl-276\slmult0 \par\pard\ql\li1726\sb208\sl-276\slmult0 \up0 \expndtw
0\charscalex100 \ul0\nosupersub\cf3\f4\fs22 b.\ul0\nosupersub\cf4\f5\fs24 Dist
ribusi kapiler \par\pard\ql \li1726\sb0\sl-276\slmult0 \par\pard\ql\li1726\sb188
\sl-276\slmult0 \up0 \expndtw-1\charscalex100 \ul0\nosupersub\cf3\f4\fs22 c.\ul0
\nosupersub\cf4\f5\fs24 Difusi, perjalanan gas ke ruang interstitial dan menem
bus dindnig sel \par\pard\ql \li1726\sb0\sl-276\slmult0 \par\pard\ql\li1726\sb20
8\sl-276\slmult0 \up0 \expndtw-2\charscalex100 \ul0\nosupersub\cf3\f4\fs22 d.\ul
0\nosupersub\cf4\f5\fs24 Metabolisme sel yang melibatkan enzim. \par\pard\ql \
li1441\sb0\sl-276\slmult0 \par\pard\ql\li1441\sb188\sl-276\slmult0 \up0 \expndtw
-2\charscalex100 \ul0\nosupersub\cf3\f4\fs22 5)\ul0\nosupersub\cf4\f5\fs24 Peng
endalian Pernapasan \par\pard\qj \li1726\ri1240\sb250\sl-560\slmult0 \up0 \expnd
tw0\charscalex100 Yang disebut pusat pernapasan adalah suatu kelompok neuron yan
g terletak bilateral di \up0 \expndtw-3\charscalex100 dalam substansia retikular
is medula oblongata dan pons. \par\pard\ql \li1441\sb0\sl-276\slmult0 \par\pard\
ql\li1441\sb0\sl-276\slmult0 \par\pard\ql\li1441\sb0\sl-276\slmult0 \par\pard\ql
\li1441\sb0\sl-276\slmult0 \par\pard\ql\li1441\sb151\sl-276\slmult0 \up0 \expndt
w-3\charscalex100 \ul0\nosupersub\cf1\f2\fs24 Penyakit Respirasi \par\pard\qj \l
i1441\ri1244\sb314\sl-555\slmult0\fi720 \up0 \expndtw0\charscalex103 \ul0\nosupe
rsub\cf4\f5\fs24 Gagal pernapasan dapat akut dapat didefinisikan sebagai kurangn
ya PO2 dari 50 \line \up0 \expndtw-2\charscalex100 mmHg dengan atau tanpa PCO2
lebih dari 50 mmHg. Hipoksia dapat disebabkan oleh gagal \line \up0 \expndtw0\ch
arscalex100 kardiovaskuler misalnya syok, hemoglobin abnormal, penyakit ja
ntung, hipoventilasi \line \up0 \expndtw0\charscalex102 alveolar, lesi pirau, m
asalah difusi, abnormalitas ventilasi-perfusi, pengaruh kimia misal \line \up0 \
expndtw0\charscalex100 karbonmonoksida, ketinggian, faktor jaringan loka
l misal peningkatan kebutuhan \par\pard\ql \li10187\sb215\sl-253\slmult0 \
up0 \expndtw0\charscalex109 \ul0\nosupersub\cf3\f4\fs22 12 \par\pard\sect\sectd\
fs24\paperw11900\paperh16840\pard\sb0\sl-240{\bkmkstart Pg13}{\bkmkend Pg13}\par
\pard\qj \li1441\sb0\sl-552\slmult0 \par\pard\qj\li1441\ri1240\sb432\sl-552\slmu
lt0 \up0 \expndtw-4\charscalex100 \ul0\nosupersub\cf4\f5\fs24 metabolisme, diman
a hipoksia dapat menimbulkan efek-efek pada metabolisme jaringan yang \line \up0
\expndtw0\charscalex100 selanjutnya menyebabkan asidosis jaringan dan mengakiba
tkan efek-efek pada tanda vital \line \up0 \expndtw0\charscalex104 dan efek pada
tingkat kesadaran.6 Gagal napas selalu disertai hipoksia. Beberapa kasus \line
\up0 \expndtw-1\charscalex100 umum gagal pernapasan adalah: (1) syaraf pusat, se
gala sesuatu yang menimbulkan depresi \line \up0 \expndtw-1\charscalex100 pada
pusat napas akan menimbulkan gangguan napas misalnya obat-obatan(anestesi
a, \line \up0 \expndtw-2\charscalex100 narkotik, tranquiliser),trauma kepala, ra
dang otak, strok, neoplasma. (2) syaraf tepi: \par\pard\qj \li1441\ri1241\sb262\
sl-560\slmult0 \up0 \expndtw-3\charscalex100 a. Jalan napas, sumbatan jalan napa
s akan menganggu ventilasi dan oksigenasi, tetapi setelah \up0 \expndtw-2\charsc
alex100 sumbatan jalan napas bebas masih tetap ada gangguan ventilasi maka harus
di cari penyebab \up0 \expndtw-3\charscalex100 yang lain. \par\pard\qj \li1441\
ri1246\sb261\sl-560\slmult0 \up0 \expndtw0\charscalex100 b. Paru, kelainan di
paru seperti radang, aspirasi, atelektasis, edem, contusio, dapat \up0

\expndtw-5\charscalex100 menyebabkan gangguan napas. \par\pard\qj \li1441\ri1248

\sb261\sl-560\slmult0 \up0 \expndtw0\charscalex104 c. Rongga pleura, normalnya r
ongga pleura kosong dan bertekanan negatif, tetapi biula \line \up0 \expndtw0\ch
arscalex100 sesuatu yang menyebabkan tekanan menjadi positif seperti udara (pne
umothorak), cairan \line \up0 \expndtw-4\charscalex100 (fluidothorak), darah (he
mothorak) maka paru dapat terdesak dan timbul gangguan napas. \par\pard\qj \li14
41\ri1248\sb269\sl-550\slmult0 \up0 \expndtw-2\charscalex100 d. Dinding dada, pa
tah tulang iga yang multipel apalagi segmental akan menyebabkan nyeri \up0 \expn
dtw0\charscalex100 waktu inspirasi dan terjadinya flail chest sehingga terjadi h
ipoventilasi sampai atelektasis \up0 \expndtw-5\charscalex100 paru, scleroderma,
kyphoscoliosis. \par\pard\qj \li1441\ri1240\sb288\sl-553\slmult0 \up0 \expndtw0
\charscalex104 e. Otot napas, otot inspirasi utama adalah diafragma dan interkos
tal eksternus. Bila ada \line \up0 \expndtw-2\charscalex100 kelumpuhan otot-otot
tersebut misal karena sisa obat pelumpuh otot, myastenia gravis, akan \line \up
0 \expndtw-4\charscalex100 menyebabkan gangguan napas. Tekanan intra abdominal y
ang tinggi akan menghambat gerak \line \up0 \expndtw-5\charscalex100 diafragma.
\par\pard\ql \li10187\sb0\sl-253\slmult0 \par\pard\ql\li10187\sb0\sl-253\slmult0
\par\pard\ql\li10187\sb0\sl-253\slmult0 \par\pard\ql\li10187\sb0\sl-253\slmult0
\par\pard\ql\li10187\sb163\sl-253\slmult0 \up0 \expndtw0\charscalex109 \ul0\nos
upersub\cf3\f4\fs22 13 \par\pard\sect\sectd\fs24\paperw11900\paperh16840\pard\sb
0\sl-240{\bkmkstart Pg14}{\bkmkend Pg14}\par\pard\qj \li1441\sb0\sl-551\slmult0
\par\pard\qj\li1441\ri1241\sb434\sl-551\slmult0 \up0 \expndtw-1\charscalex100 \u
l0\nosupersub\cf4\f5\fs24 f. Syaraf, kelumpuhan atau menurunnya fungsi syaraf ya
ng mengnervasi otot interkostal dan \line \up0 \expndtw0\charscalex100 diafragma
akan menurunkan kemampuan inspirasi sehingga terjadi hipoventilasi. Misalnya: \
line \up0 \expndtw0\charscalex100 Blok subarachnoid yang terlalu tinggi, ce
dera tulang leher, Guillain Barre Syndrome, \line \up0 \expndtw0\charscalex
104 Poliomyelitis. Percabangan neuromuscular misalnaya otot yang relaksasi
, keracunan \line \up0 \expndtw0\charscalex100 organophospat. (4) Post operasi
misal bedah thorak, bedah abdomen. Dalam anestesi, gagal \line \up0 \expndtw-2\c
harscalex100 pernapasan/sumbatan jalan napas dapat disebabkan oleh tindakan oper
asi itu sendiri misalnya \line \up0 \expndtw0\charscalex102 karena obat pelumpuh
otot, karena muntahan,/lendir, suatu penyakit,(koma, stroke, radang \line \up0
\expndtw-2\charscalex100 otak), trauma/kecelakaan (trauma maksilofasial, trauma
kepala, keracunan). \par\pard\ql \li10187\sb0\sl-253\slmult0 \par\pard\ql\li1018
7\sb0\sl-253\slmult0 \par\pard\ql\li10187\sb0\sl-253\slmult0 \par\pard\ql\li1018
7\sb0\sl-253\slmult0 \par\pard\ql\li10187\sb0\sl-253\slmult0 \par\pard\ql\li1018
7\sb0\sl-253\slmult0 \par\pard\ql\li10187\sb0\sl-253\slmult0 \par\pard\ql\li1018
7\sb0\sl-253\slmult0 \par\pard\ql\li10187\sb0\sl-253\slmult0 \par\pard\ql\li1018
7\sb0\sl-253\slmult0 \par\pard\ql\li10187\sb0\sl-253\slmult0 \par\pard\ql\li1018
7\sb0\sl-253\slmult0 \par\pard\ql\li10187\sb0\sl-253\slmult0 \par\pard\ql\li1018
7\sb0\sl-253\slmult0 \par\pard\ql\li10187\sb0\sl-253\slmult0 \par\pard\ql\li1018
7\sb0\sl-253\slmult0 \par\pard\ql\li10187\sb0\sl-253\slmult0 \par\pard\ql\li1018
7\sb0\sl-253\slmult0 \par\pard\ql\li10187\sb0\sl-253\slmult0 \par\pard\ql\li1018
7\sb0\sl-253\slmult0 \par\pard\ql\li10187\sb0\sl-253\slmult0 \par\pard\ql\li1018
7\sb0\sl-253\slmult0 \par\pard\ql\li10187\sb0\sl-253\slmult0 \par\pard\ql\li1018
7\sb0\sl-253\slmult0 \par\pard\ql\li10187\sb0\sl-253\slmult0 \par\pard\ql\li1018
7\sb0\sl-253\slmult0 \par\pard\ql\li10187\sb0\sl-253\slmult0 \par\pard\ql\li1018
7\sb0\sl-253\slmult0 \par\pard\ql\li10187\sb0\sl-253\slmult0 \par\pard\ql\li1018
7\sb0\sl-253\slmult0 \par\pard\ql\li10187\sb0\sl-253\slmult0 \par\pard\ql\li1018
7\sb0\sl-253\slmult0 \par\pard\ql\li10187\sb0\sl-253\slmult0 \par\pard\ql\li1018
7\sb0\sl-253\slmult0 \par\pard\ql\li10187\sb0\sl-253\slmult0 \par\pard\ql\li1018
7\sb0\sl-253\slmult0 \par\pard\ql\li10187\sb0\sl-253\slmult0 \par\pard\ql\li1018
7\sb0\sl-253\slmult0 \par\pard\ql\li10187\sb142\sl-253\slmult0 \up0 \expndtw0\ch
arscalex111 \ul0\nosupersub\cf3\f4\fs22 14 \par\pard\sect\sectd\fs24}