LO

1. Crepitation refers to situations where noises are produced by the rubbing of parts one against the
other, as in: Crepitus, a crunching sensation felt in certain medical problems. as that produced
by the fractured ends of a bone moving against each other or as that in tissues affected
with gas gangrene.
Crepitus is grating (jeruji), crackling or popping sounds (kertak) and
sensations experienced under the skin and joints or a crackling
sensation(keretakan) due to the presence of air in the
subcutaneous tissue.
The sound can be created when two rough surfaces in an organism's
body come into contact—for example, in osteoarthritis or rheumatoid
arthritis when the cartilage around joints erodes and the surfaces in
the joint grind against one another, or when the
two fractured surfaces of the broken bones rub together. When a
joint's cartilage degenerates, the joint is no longer adequately protected against
friction and impacts. In addition, the loss of cartilage can alter the joint's
biomechanics and cause bones to grind against one another. These changes can
result in crepitus.
Crepitus is a common sign of bone fracture. Crepitus can easily be
created and observed by exerting a small amount of force on a joint,
thus 'cracking it'. This is caused by bubbles of nitrogen forming in
the synovial fluid bursting. Almost every joint in the body can be
'cracked' in this way, but the joints which require the least amount of
effort include the hallux, knuckles and neck joints. In soft tissues,
crepitus can be produced when gas is introduced into an area where it
is normally not present.
The term can also be used when describing the sounds produced
by lung conditions such as interstitial lung disease—these are also
referred to as "rales". Crepitus is often loud enough to be heard by
the human ear, although a stethoscope may be needed to detect
instances caused by respiratory diseases.
In times of poor surgical practice, post-surgical complications
involved anaerobic infection by Clostridium perfringens strains,
which can cause gas gangrene in tissues, also giving rise to crepitus.
Subcutaneous crepitus (or surgical emphysema) is a crackling sound
resulting from subcutaneous emphysema, or air trapped in
the subcutaneous tissues.
Common causes of creptius include:
Tendons or ligaments snapping (membentur) over the joint's bony structures. This
snapping sometimes causes pain.
Bunyi ini dapat muncul berupa derik akibat gesekan ujung-
ujung tulang patah, juga dari pergerakan sendi.[1][1] Selain
itu bunyi gelembung-gelembung udara pada emfisem subkutis bila
ditekan juga merupakan Krepitasi.[
 2. A pathologic fracture is a broken bone that’s caused by a disease, rather than an
injury. Pathologic fractures don’t always have symptoms. When they do, they share
the same symptoms as an injury-related fracture. These include:
- mild to severe pain near the broken bone
- bruising, tenderness, and swelling near the broken bone
- numbness, tingling, or weakness near the broken bone
The causes
1. Osteoporosis
2. Cancer
3. Osteomalacia
4. Osteomyelitis
Other diseases can also lead to pathologic fractures. Some of these include:
- noncancerous tumors and cysts
- Paget’s disease of bone, a rare condition that causes unusual bone structure
- osteogenesis imperfecta

3. cancers are most likely to spread to the bone are Prostate, breast, and lung, Kidney
Thyroid

4. Mucoid sputum is clear, white or grey and occurs in asthma and

chronic bronchitis and in acute viral respiratory infections before
secondary bacterial infection ensues. Drying of mucoid sputum
during asthma attacks makes the sputum stringy in consistency,
even forming casts.

5. A positron emission tomography (PET) scan is an imaging test that allows your
doctor to check for diseases in your body. The scan uses a special dye containing
radioactive tracers. These tracers are either swallowed, inhaled, or injected into a vein
in your arm depending on what part of the body is being examined. Certain organs
and tissues then absorb the tracer. When detected by a PET scanner, the tracers help
your doctor to see how well your organs and tissues are working. The tracer will
collect in areas of higher chemical activity, which is helpful because certain tissues of
the body, and certain diseases, have a higher level of chemical activity. These areas of
disease will show up as bright spots on the PET scan. The PET scan can measure
blood flow, oxygen use, how your body uses sugar, and much more. A PET scan is
typically an outpatient procedure. This means you can go about your day after the test
is finished. Your doctor may order a PET scan to inspect your blood flow, your
oxygen intake, or the metabolism of your organs and tissues. PET scans show
problems at the cellular level
PET scans are most commonly used to detect:
- cancer
- heart problems
- brain disorders, including problems with the central nervous system (CNS)
Cancer cells have a higher metabolic rate than noncancerous cells. Because of this high
level of chemical activity, cancer cells show up as bright spots on PET scans. For this
reason, PET scans are useful both for detecting cancer and for:
- seeing if the cancer has spread
- seeing if a cancer treatment is working
- checking for a cancer recurrence

6. What causes shortness of breath with lung cancer?

lung cancer tumors grow in a way that blocks airways,
put pressure on lungs or cause inflammation in the
respiratory system. All of these situations can prevent
your respiratory system from working properly, leading to
problems getting in enough air.
 explains that the most common causes of shortness of
breath, as Blocked airways: Lung tumors can grow into or press
against the airway, narrowing the passage and making it
difficult to get enough air in and out of the body.
 Fluid buildup: In some patients with lung cancer, lung cancer
cells invade the space between the lungs and the chest wall,
called the pleural space. This condition, called pleural
effusion, causes fluid to build up around the lungs, making it
harder for the lung to fully expand and take in enough air.
 Low levels of oxygen in the blood: Lung cancer can decrease red blood
cells, which are responsible for transporting oxygen from the
lungs up to the heart and the rest of the body.
 collapse of parts of the lung, pneumonia (due to trapping of bacteria in obstructed
airways) or abscess formation. Inflammatory processes in the lung such as fibrosis
and lymphangitis (thickening of the lymphatics in the lung which may be caused by
cancer cells) can also contribute to shortness of breath. 

7. When a person has a respiratory illness or strong

cough, this can irritate the airways and potentially
cause them to cough up blood.
Coughing up blood (haemoptysis) has many possible
causes. Below is a brief overview of the more common
and important causes:
- Infection
- Tuberculosis (TB) infection of the lung used to be a very
common cause of haemoptysis.
Numerous possibilities are present when considering the aetiology of haemoptysis in the
post-primary TB patient. Although the pathogenesis of haemoptysis, as a sequelae of
PTB, occurs most commonly due to destruction and structural remodelling of the lung
parenchyma and its vasculature, other concomitant disease processes may occur in these
patients resulting in haemoptysis. Up to 40–60% of patients with prior pulmonary TB
suffer from airway and parenchymal destruction with fibrosis and cavitation, the hallmark
being apical and posterior traction bronchiectasis with upper lobe fibro-cavitation and
mediastinal shift toward the diseased lung [8]. Post tuberculous fibro-cavitatory disease
 and bronchiectasis leads to irreversible damage and dilation of the airways and its
associated vasculature. The bronchial vasculature becomes hypertrophied, ectatic and
exposed. The hyper vascularity, disrupted architectural support and open exposure of
these vessels make them easily prone to bleeding and these abnormalities account for the
majority of clinically evident haemoptysis in the post-PTB patient.
8.

Kandungan Rokok yang Bersifat Merusak

Karbon monoksida
Salah satu kandungan rokok yang merupakan gas beracun adalah
karbon monoksida. Jika terhirup terlalu banyak, sel-sel darah merah
akan lebih banyak berikatan dengan karbon monoksida dibanding
dengan oksigen.
Tar
Kandungan rokok lainnya yang bersifat karsinogenik adalah tar. Tar
yang terhirup oleh perokok akan mengendap di paru-paru. Timbunan
tar ini berisiko tinggi menyebabkan penyakit pada paru-paru,
seperti kanker paru-paru dan emfisema.
Arsenik
Arsenik merupakan golongan pertama karsinogen. Paparan
terhadap arsenik tingkat tinggi dapat meningkatkan risiko
terjadinya kanker paru-paru.
Benzo [a] pyrene
Bahan kimia yang satu ini biasanya ditemukan dalam residu hasil distilasi
tar sebagai produk sampingan dari pembuatan batu bara. Senyawa yang
satu ini termasuk karsinogen penyebab kanker paru-paru 
Kromium
Kromium bisa menyebabkan kanker paru-paru jika terpapar terlalu lama.
9. What Are the Risk Factors for Lung Cancer?
Secondhand smoke
1. Exposure to radon
Radon is a naturally occurring radioactive gas that results from the breakdown of uranium in
soil and rocks.
2. Exposure to asbestos
People who work with asbestos (such as in mines (tambang), mills (pabrik), textile
plants(pabrik tekstil), places where insulation is used, and shipyards) are several times more
likely to die of lung cancer. 
3. Other carcinogens (cancer-causing agents) found in some workplaces that can
increase lung cancer risk include:
- Radioactive ores such as uranium
- Inhaled chemicals such as arsenic, beryllium, cadmium, silica, vinyl chloride, nickel
compounds, chromium compounds, coal products, mustard gas, and chloromethyl
ethers
- Diesel exhaust(knalpot)
- smokers who took beta carotene supplements actually had an increased risk of lung
cancer.
- People who have had radiation therapy to the chest for other cancers are at higher risk
for lung cancer, particularly if they smoke.
- In cities, air pollution (especially near heavily trafficked roads) appears to raise the
risk of lung cancer slightly.
- Personal or family history of lung cancer
- Tuberculosis can cause scarring of lung tissue, which can be a risk
factor for developing lung cancer.
- Military service may have presented both veterans and active-duty
personnel with exposures to industrial substances, asbestos bearing
materials, and air pollution, as well as exposure to tactical chemicals
(Agent Orange, for example). 
- Breathing in other people’s smoke (passive smoking).

CO

1. The most common symptoms of lung cancer are:

- A cough that does not go away or gets worse
- Coughing up blood or rust-colored (berwarna karat) sputum (spit or phlegm)
- Chest pain that is often worse with deep breathing, coughing, or laughing
- Hoarseness (suara serak)
- Loss of appetite
- Unexplained weight loss
- Shortness of breath
- Feeling tired or weak
- Infections such as bronchitis and pneumonia that don’t go away or keep coming back
- New onset of wheezing

If lung cancer spreads to other parts of the body, it may cause:

- Bone pain (like pain in the back or hips)
- Nervous system changes (such as headache, weakness or numbness of an arm or leg,
dizziness, balance problems, or seizures), from cancer spread to the brain
- Yellowing of the skin and eyes (jaundice), from cancer spread to the liver
 - Swelling of lymph nodes (collection of immune system cells) such as those in the
neck or above the collarbone (tulang selangka)

2. Pathogenesis
The pathogenesis of lung cancer is like other cancers, beginning with
carcinogen-induced initiation events, followed by a long period of
promotion and progression in a multistep process. Cigarette smoke
both initiates and promotes carcinogenesis. The initiation event happens early
on, as evidenced by similar genetic mutations between current (perokok) and
former smokers (mantan perokok)(e.g. 3p deletion, p53 mutations). Smoking
thus causes a “field effect” on the lung epithelium, providing a large
population of initiated cells and increasing the chance of transformation. The
interaction between inhaled carcinogens and the epithelium of upper and lower airways
leads to the formation of DNA adducts: pieces of DNA covalently bound to a cancer-
causing chemical.
Repair processes may remove the DNA adducts and restore normal DNA, or
alternatively cells with damaged DNA may undergo apoptosis.
If DNA adducts persist or are misrepaired, they result in a mutation and can cause
genomic alterations. These are key events in lung cancer pathogenesis, especially if they
occur in critical oncogenes and tumour suppressor genes. Continued smoke
exposure allows additional mutations to accumulate due to promotion by
chronic irritation and promoters in cigarette smoke (e.g. nicotine, phenol,
formaldehyde). The time delay between smoking onset and cancer onset is
typically long, requiring 20-25 years for cancer formation. Cancer risk
decreases after smoking cessation, but existing initiated cells may progress if
another carcinogen carries on the process.

The pathogenesis of lung cancer is initiated the either the

activation of oncogenes or the inactivation of tumor
suppressor genes, which leads to uncontrolled replication and
growth of the cells in the lungs. There are several factors that
may lead to these genetic mutations: they may be inherited
from parents or acquired by exposure to carcinogens.
There are two broad types of lung cancer: small cell lung cancer
and non-small cell lung cancer. The most common type, non-small
cell lung cancer, is further divided into three subtypes:
adenocarcinoma, squamous cell carcinoma, and large cell lung
carcinoma. Small cell lung cancer is almost exclusively caused by
exposure to cigarette smoke and it is rare for a non-smoker to be
affected by this type. Non-small cell lung cancer has a variety of
causes including cigarette smoke and various other environmental
factors.
Specific Gene Mutations
Epidermal growth factor receptor (EGFR) plays a role in the
regulation of cell multiplication, apoptosis, angiogenesis and tumor
invasion. Genetic mutations that lead to the upregulation of EGFR
are commonly observed in non-small-cell lung carcinoma, which
explains the use of EGFR-inhibitors in the treatment of the disease.

Exposure to carcinogens
Tobacco smoke contains more than 300 harmful substances with at least 40 known potent
carcinogens. Polyaromatic hydrocarbons and nicotine-derived nitrosamine ketone (NNK) are
known to cause DNA damage by forming DNA adducts in animal models. Benzo-A-pyrine
also appears to induce molecular signaling such as AKT, as well as inducing mutations
in p53 and other tumor suppressor genes.
The most common occupational risk factor for lung cancer is exposure to asbestos.
In addition, preexisting nonmalignant lung diseases, such as chronic obstructive pulmonary
disease, idiopathic pulmonary fibrosis, and tuberculosis have all been shown to be associated
with increased lung cancer rates.
The current multiple hit theory suggests that a series of toxic cellular insults disrupts orderly
genetic reproduction. Symptoms ultimately develop from the uncontrolled disorganized
growth that interferes with local or distant anatomy or physiologic processes. [8]

Genetic susceptibility
Advanced molecular techniques have identified amplification of
oncogenes and inactivation of tumor suppressor genes in NSCLC.
The most important abnormalities detected are mutations involving
the ras family of oncogenes. The ras oncogene family has 3
members: