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Lymph

Type of Immunity

Sistem limfatik terdiri dari :


o Pembuluh limfatik yang membantu
mengembalikan cairan jaringan ke
sistem sirkulasi.
o Nodus dan nodul limfe yang berupa
massa jaringan limfatik yang berbeda
dalam ukuran dan lokasinya.
o Limpa (spleen) yang berperan dalam
proses fagositosis patogen serta
memproduksi leukosit dan antibodi.
o Kelenjar timus yang berfungsi pada
permulaam masa anak dan akan
menurun saat menjelang dewasa.
o Nodus limfatik membentuk kelompok
yang berhubungan dengan pembuluh
limfe untuk menghancurkan material
asing.
o Kelompok nodul limfatik terletak paa
daerah cervikal, axilla dan inguinal.

Pembuluh Limfe (LYMPH VESSELS)


o Sistem pumbuluh limfe mulai dari kapiler limfe yang terdapat di
beberapa jaringan.
o Kapiler limfe sangat permiabel dan berfungsi mengumpulkan
cairan jaringan dan protein.
o Contoh : Lacteals are specialized lymph capillaries in the villi of
the small intestine; they absorb the fat-soluble end products of
digestion, such as fatty acids and vitamins A, D, E, and K.
o Kapiler limfe merupakan bagian dari pembuluh limfe yang besar
ang mempunyai struktur seperti vena. Mempunyai mekanisme
venous return (The smooth muscle layer of the larger lymph
vessels constricts, and the one-way valves prevent backflow of
lymph).
o Pembuluh limfe pada ekstremitas (kaki) : skeletal muscle pump.

Sistem Limfe
lymph system is responsible for the
following:
Cleansing the cellular environment
Returning proteins and tissue fluids
to the blood (drainage)
Providing
a
pathway
for
the
absorption of fats and fat-soluble
vitamins into the bloodstream.
Defending the body against disease.

Lymph
Lymph is a virtually colorless fluid
similar to blood plasma in
composition that carries harmful
substances from tissues to lymph
nodes to befiltered.

Lymph
Lymph nodes come in many variations of the jelly bean size
mentioned above but a standard nod eis about one inch long
and the size of a bean.
When a human is born, they have about 600-700 lymph
nodes. As we age, the number of lymph nodes decreases to
about 100.
They are covered in a capsule and are divided into the cortex
and medulla. The cortex holds the lymphocytes known as Bcells which produce antibodies that circulate.
The rest of thecortex contains T-cells that circulate the
lymphatic system searching and destroying pathogens.
The medulla is where a macrophage, another type of
leukocyte, attach the the fibers of the node. Lymph node are
what filter lymph.

Kanker atau tumor ganas adalah


pertumbuhan sel/jaringan yang tidak
terkendali,
terus
bertumbuh/bertambah,
immortal
(tidak dapat mati). Sel kanker dapat
menyusup ke jaringan sekitar dan
dapat
membentuk
anak
sebar
(Riskesdas, 2013).

Riskesdas, 2013

LYMPHOMA
Hodgkins disease, a neoplastic disorder, is
characterized
by
painless,
progressive
enlargement of the lymph nodes, spleen, and
other lymphoid tissue (Sommer et al, 2007).
The enlargement is caused by a proliferation of
lymphocytes, histiocytes, eosinophils.
Malignant
lymphoma,
or
NHL,
is
a
heterogeneous grouping of several disease
types that range from the aggressive, rapidly
fatal diffuse histiocytic lymphoma to the
indolent nodular varieties

LYMPHOMA
Malignant
lymphoma,
also
called
lymphosarcoma
or
non-Hodgkins
lymphoma (NHL), is a diffuse group of
neoplastic diseases that are characterized
by rampant proliferation of lymphocytes
(Sommer, Johnson, Beery, 2007).
Malignant lymphoma, or NHL, is a
heterogeneous grouping of several disease
types that range from the aggressive,
rapidly fatal diffuse histiocytic lymphoma
to the indolent nodular varieties.

LYMPHOMA
NHLs adalah keganasan (kanker) yang
berasal dari sistem kelenjar getah bening
dan biasanya menyebar ke seluruh tubuh.
Beberapa jenis limfoma NHL berkembang
sangat lambat (medicastore.com).
more than 60,000 new cases of lymphoma
that are diagnosed each year in the United
States, approximately 55,000 of them will
be NHL. In the past 30 years, the incidence
of NHL has increased by more than 80%,
making it one of the largest increases of
any cancer.
This increase is unexpected and is only

Penyebab
Penyebab NHL belum diketahui, tetapi
beberapa bukti menunjukkan adanya
hubungan dengan virus. Perkembangan
penyakit berkaitan dengan infeksi karena
HTLV-1 (human T-cell Lymphotropic Virus
tipe I), yang fungsinya menyerupai HIV.
exposures
to
viruses
and
immunosuppression,
organ transplantation,
a history of cancer treated with radiation,
acquired immune deficiencies,

Gejala
Pembesaran kelenjar getah bening, pembesaran pada
tonsil dapat mengganggu proses menelan, pembesaran
kelenjar getah bening pada dada atau perut dapat
menekan berbagai organ dan menyebabkan :

gangguan pernafasan,

sembelit,

nyeri perut,
pembengkaan tungkai,
penyebaran pada darah menyebabkan leukemia,
penyebaran ke sumsum tulang , saluran cerna, kulit,
sehingga menyebabkan anemia, ruam kulit,
gejalan neurologis (kelemahan dan sensasi abnorma)l

Gejala
Biasanya yang membesar kelenjar
getah bening bagian dalam yang
menyebabkan :
Pengumpulan cairan di sekitar
paru sehingga timbul sesak
Penyumbatan
kelenjar
getah
bening
sehingga
terjadi
penumpukan cairan
Penekanan
usus
sehinggan
menyebabkan
anoreksia
dan

Gejala
Gangguan
pernafasan
Pembengkakan
wajah
Anoreksia
Sembelit
Nyeri perut
kembung
Pembengkakan
tungkai
Penurunan BB
Diare
Malabsorpsi

Penyebab

Kemungkina
n Timbul
Gejala
Pembesaran kelenjar 20-30%
getah bening di dada
Pembesaran kelenjar 30-405
getah bening di perut
Penyumbatan
10%
pembuluh
getah
bening
di
lipatan
paha
Penyebaran limfoma 10%
ke usus halus

Pengumpulan cairan
di sekitar paru (efusi
pleura)
Kehitaman
dan
menebal di kulit yang
terasa gatal
Demam
Keringat malam hari
Anemia

Penyumbatan
pembuluh 20-30%
getah bening di dada
Penyebaran limfoma ke kulit

10-20%

Penyebaran
limfoma
ke 50-60%
seluruh tubuh
Perdarahan ke dalam saluran 30%
bisa
pencernaan
sampai 100%
Penghancuran
SDM
oleh
limpa yang membesar dan
terlalu aktif
Penghancuran
SDM
oleh
antibodi abnormal (anemia
hemolitik)
Penghancuran
sumsum
tulang karena penyebaran
limfoma
ketidakmampuan
sumsum

KOMPLIKASI

hypercalcemia,
increased uric acid levels,
meningitis,
anemia,
as tumors grow, they may compress the
vital
organs
and
cause
organ
dysfunction;
problems
from
organ
compression include complications such
as increased intracranial pressure.

Tekanan Intra Kranial (ICP)


The skull is a fixed compartment
containing approximately :
80% brain tissue,
10% cerebrospinal fluid (CSF),
10% blood volume.
an increase in brain size, blood volume,
or CSF must be accompanied by an equal
decrease in 1 of these components or an
elevation in ICP will occur.

TIK
The Monro-Kellie doctrine states that
the skull is a rigid compartment
containing three components: brain,
blood, and cerebrospinal fluid. If an
increase in one component is not
accompanied by a decrease in one or
both of the other components, the
result
is
increased
intracranial
pressure

ICP
Elevated ICP leads to a decrease in
cerebral perfusion pressure (CPP)
and decreased flow, resulting in
cerebral ischemia.
Intracranial
pressure
values
consistently greater than 40 mm Hg
represent lifethreatening intracranial
hypertension because of the risk for
brain herniation.

Diagnosis
Biopsi
CT scan

BIOPSY
Fine needle aspiration (FNA) or core needle
biopsy: In an FNA biopsy, the doctor uses a very
thin, hollow needle attached to a syringe to
withdraw (aspirate) a small amount of tissue from
an enlarged lymph node or a tumor mass. For a
core needle biopsy, the doctor uses a larger
needle to remove a slightly larger piece of tissue (
http://www.cancer.org/cancer/non-hodgkinlympho
ma/detailedguide/non-hodgkin-lymphoma-diagnosi
s
.
Bone marrow aspiration and biopsy: These
procedures are often done after lymphoma has
been diagnosed to help determine if it has
reached the bone marrow. The 2 tests are often

Computed Tomography (CT)


Scan
The CT scan is an x-ray test that produces detailed,
cross-sectional images of your body. Instead of
taking one picture, like a regular x-ray, a CT
scanner takes many pictures as it rotates around
you. A computer then combines these pictures into
an image of a slice of your body.
Unlike a regular x-ray, CT scans can show the detail
in soft tissues (such as internal organs). This scan
can help tell if any lymph nodes or organs in your
body are enlarged. CT scans are useful for looking
for lymphoma in the abdomen, pelvis, chest, head,
and neck.

Spectrum of histopathologic diagnosis of lymph node biopsies: A


descriptive study from a tertiary care center in South India over 5
years
Arun Roy, Rakhee Kar, Debdatta Basu, Bhawana Ashok Badhe
Year : 2013 | Volume : 56 | Issue : 2 | Page : 103-108
http://www.ijpmonline.org

Abstract
Aims: Lymphadenopathy is a common clinical problem and biopsies
undertaken to determine the cause of nodal enlargement may be
neoplastic or non-neoplastic. The former are mainly lymphohematogenous
malignancies and metastases while the causes of non-neoplastic
lymphadenopathy are varied. This study was undertaken to determine the
histopathological spectrum of lymphadenectomies.
Materials and Methods: This was a descriptive cross-sectional study
wherein 1010 cases of histologically diagnosed peripheral lymph node
biopsies in the Department of Pathology, Jawaharlal Institute of
Postgraduate Medical Education and Research, Puducherry from January
2007 to June 2012 were reviewed. Surgical resection specimens with lymph
node dissection were excluded from the study.
Results: Neoplastic lesions were more common comprising 53% (535
cases) and included 32.1% (324 cases) of non-Hodgkin lymphoma, 12.4%
(125 cases) of Hodgkin lymphoma and 8.5% (86 cases) of metastatic
lesions. The non-neoplastic lesions were 47% (475 cases), which included
21.6% (218 cases) of non-specific reactive lymphoid hyperplasia, 6.8% (69
cases) of other reactive or specific lymphoid hyperplasia, 18% (182 cases)
of tuberculous lymphadenitis, 0.6% (6 cases) of other granulomatous
lesions.

Pengobatan

Radiasi
Surgery
Kemoterapi
Stem Cells Transplant

Radiotherapy

Kemoterapi

Vincristine
Cyclophosphamide
Doxorubicin
Metrotreksat
Prednison

Vincristine
Vincristine merupakan salah satu kemoterapi yang
digunakan pada keganasan hematologi dan tumor
solid
karena
mekanisme
kerjanya,
aktivitas
antikankernya, dan dapat dikombinasikan dengan
kemoterapi lain.
Vincristine
menyebabkan
depolimerisasi
mikrotubulus, metaphase arrest, dan apoptosis sel
yang sedang menjalani mitosis.
Mekanisme kerja: mencegah polimerisasi tubulin
menjadi mikrotubulus.
Cepat terdistribusi ke jaringan, dimetabolisme luas di
hati, ekskresi terutama melalui saluran empedu.

Vincristine
Indikasi:
Leukemia akut, limfoma Hodgkin dan nonHodgkin, neuroblastoma, rabdomiosarkoma,
osteosarkoma, sarkoma Ewing, fungoides
mikosis, tumor Wilms, kanker payudara,
kanker serviks, kanker paru.
Efek Samping:
Neurotoksik, konstipasi, ileus paralitik,
alopesia, mielosupresi, mual-muntah, diare,
stomatitis.

Cyclophosphamide

Farmakologi:

Mekanisme kerja: berikatan silang terhadap DNA


sehingga menghambat proliferasi.

Mengalami biotransformasi di hati menjadi bentuk


aktif, ekskresi terutama melalui ginjal.

Bioavailabilitas sediaan tablet 75%.


Indikasi:
Kanker
payudara,
kanker
paru,
kanker
ovarium,
limfogranulomatosis, limfosarkoma, sarkoma sel retikulum,
leukemia, multipel mieloma.
Peringatan dan Perhatian:
Hati-hati pada pasien mielosupresi, infiltrasi sel kanker ke
sumsum tulang, radioterapi, pernah mendapat obat
sitotoksik, gangguan fungsi hati, ginjal.
Efek Samping:
Sistitis
hemoragik
steril,
alopesia,
mual
muntah,
mielosupresi,
amenorrhea,
gangguan
fungsi
hati,

Doxorubicin

Farmakologi:
Mekanisme kerja: menghambat enzim topoisomerase II
sehingga menghambat proses pembelahan sel dan
pembentukan DNA.
Bersihan plasma cepat, ekskresi terutama melalui
empedu.
Indikasi:
Leukemia akut, tumor Wilm, neuroblastoma, sarkoma
jaringan lunak dan tulang, kanker payudara, kanker
ovarium, kanker kandung kemih (sel transisional), kanker
tiroid, kanker paru, kanker lambung, limfoma Hodgkin &
non-Hodgkin.
Peringatan dan Perhatian :
Perlu pemantauan hematologi, fungsi hati, dan jantung.
Dapat menyebabkan perubahan warna urin.

Asuhan Keperawatan
Pengkajian
A family history of NHL as well as
other cancers increases ones risk of
developing disease, but the amount of
increased risk and the mechanism by
which it occurs remain unclear. There
also appear to be sporadic forms of
the disease, but little information is
available on phenotypic differences.

The peak incidence of NHL occurs later than with


Hodgkins disease, which is more common in men than
in women and is a disease of the middle years. About
25% of cases develop in patients between ages 50 and
59. Maximal risk is between the ages 60 and 69. Small
lymphocytic lymphomas occur in the elderly.
Lymphoblastic lymphoma has a predilection for males
younger than age 20. Follicular lymphomas are
uncommon in the young and occur mainly in midadult
life. Burkitts lymphoma occurs in children and young
adults. Whites have a higher risk than African
Americans and Asian Americans

History
Note any history of infection with HIV, acquired
immunodeficiency syndrome (AIDS), organ transplant,
congenital immunodeficiency, autioimmune diseases, or
other treatment with immunosuppressive drugs.
Patients often have complaints of painless enlarged lymph
nodes (commonly in the neck, mediastinum, or chest wall),
fevers, night sweats, weight loss, weakness, and malaise.
Because nodes and extranodal sites are more likely to be
involved in NHL, the patient may also report vague
abdominal distress (bleeding, bowel obstruction, cramping,
ascites), symptoms of spinal cord compression, or back
pain.
Cough, dyspnea, and chest pain occur about 20% of the
time and are indicative of lung involvement.

Physical Examination
Carefully inspect all the locations for lymph nodes and the
abdomen for signs of hepatosplenomegaly and ascites.
Skin lesions that look like nodules or papules with a
tendency to ulcerate appear in about 20% of cases.
When palpating lymph node chains, examine the
submental, infraclavicular, epitrochlear, iliac, femoral, and
popliteal nodes.
Involved nodes are characteristically painless, firm, and
rubbery in consistency; they are in contrast to the rockhard nodes of carcinoma because they are freely movable
and of varying size.
Palpate the liver or spleen, which may be enlarged. The
patient may also have weight loss and fever.

Psychological
The
diagnosis
of
cancer
is
devastating at any time of life.
Because the disease is most common
in the older adult, the patient may be
planning retirement. The diagnosis of
NHL throws all retirement plans into
disarray and may lead to feelings of
loss, grief, and anger.

Primary Nursing Diagnosis


Risk for infection related to impaired
primary and secondary defenses

Refference
http://www.ijpmonline.org/article.asp
?issn=03774929;year=2013;volume=56;issue=
2;spage=103;epage=108;aulast=Ro
y