1. Dr. Sinatra Gunawan, MK3, SpOk
SILICOSIS
Penyaji :
Dr. Sinatra Gunawan, MK3, SpOk
Referensi :
Amer Rassam MD1, Gerry San Pedro MD2, Daniel Banks MD1.
Department of Internal Medicine
LSUHSC-Shreveport

2. Silicosis General The most prevalent and oldest known OLD in the world
Exposure to crystalline silica (quartz)
Mining, glassmaking, ceramics, sandblasting, foundries, and brick yards
Most commonly, latency years
In the USA, > 2 million workers are at risk

3. Silicosis Forms of Silicosis
*Chronic or pure nodular silicosis - 35% quartz
Complicated nodular silicosis (PMF) < 5%
Accelerated silicosis – 50% quartz – after 5 years of exposure – smaller nodules in the middle zones of the lung
Acute silicosis – silico-proteinosis - fatal

4. Silicosis Pathogenesis Progresses even in absence of further exposure
Rapid progression: R/O TB
Workers with nodules < 5 mm have long-term survival similar to that of the general population
Inflammatory response mediated by alveolar macrophages
TNF released by macrophages may be an essential component of the inflammatory response

5. Silicosis Simple Nodular Silicosis
Small fibrocalcific nodules in upper lung
Hilar lymphadenopathy (eggshell calcification)
Increased susceptibility to TB
Yearly PPDs are recommended
D.D.: TB, CWP, Berylliosis

6. Silicosis Complicated Nodular Silicosis (PMF)
Large nodules > 1 cm tend to coalesce
Increased susceptibility to TB
No specific treatment

7. Decline in FVC & FEV1 in Silicosis
Liters
10/95
11/95
4/96
6/96
10/96
3/97
From: Occupational Lung Disease “An International Perspective” Daniel E. Banks and John E. Parker

8. Silicosis
Remember !
Yearly PPDs are recommended in patients with silicosis
A + PPD in these patients should receive prophylaxis no matter what the patient age or duration of + PPD
If symptoms are rapidly worsening, think of TB

9. Accelerated Silicosis with PMF
From: Occupational Lung Disease “An International Perspective” Daniel E. Banks and John E. Parker

10. Diffuse Nodular Silicosis & Egg-shell calcification
From: Occupational Lung Disease “An International Perspective” Daniel E. Banks and John E. Parker

11. Massive Conglomerate Silicosis (Angel’s Wings)
From: Occupational Lung Disease “An International Perspective” Daniel E. Banks and John E. Parker

12. Egg-shell Calcification – Pathognomonic for Silicosis
From: Occupational Lung Disease “An International Perspective” Daniel E. Banks and John E. Parker

13. Progressive Massive Fibrosis - Silicotuberculosis
From: Occupational Lung Disease “An International Perspective” Daniel E. Banks and John E. Parker

14. SILICA Why Target Crystalline Silica Exposure?
Widespread Occurrence and use -
Maritime
Agriculture
Construction
General Industry
Number of Related Deaths
Number of exposed workers
Health Effects

15. SILICA Occurrence of Crystalline Silica
Silicon Dioxide is basic component of sand, quartz, & granite
Quartz is second most common mineral in earth’s crust
Airborne silica is produced by, among other activities:
Sandblasting
Rock Drilling
Roof Bolting
Foundry Work
Stone Cutting
Drilling
Quarrying
Tunneling

16. SILICA Industries with Silica Exposure Electronics Foundries
Ceramics, clay & pottery, stone, glass
Construction
Agriculture
Maritime
Mining
Railroad ( setting & laying track)
Slate & flint quarrying & flint crushing
Use & manufacture of abrasives
Manufacture of soap & detergents

17. SILICA Number of Silica Related Deaths.
Total US deaths where silica is reported on death certificate : 13,744 people.
Deaths where silicosis is reported as underlying cause of death : 6,322 people.
68% of silica related deaths reported in 12 states.
10% of silica-related deaths reported from construction industry.

18. SILICA Health Effects Pulmonary fibrosis (silicosis)
Acute silicosis (1 to 3 years)
Accelerated silicosis (3 to 10 years)
Chronic silicosis (5 to 25 years)
Possible Lung Cancer

19. SILICA Inspection Targeting
Wherever possible, inspections will be focused to particular establishments where known exposures to crystalline have occurred or there are known cases of silicosis
Process
Identify establishments
Select sites by use of random number tables
Numbers of Inspections determined by regions
Sites with effective control programs are exited after program review

20. SILICA
Elements of an effective, On-going Control Program for Crystalline Silica
Personal Monitoring
Medical Surveillance
Training
Availability of monitoring/Surveillance data to workers
Respiratory Protection Program
Hygiene facilities & clothing change areas

21. SILICA Elements of Control Program (continued) Recordkeeping
Exposures below PEL or a current program with interim protection
Housekeeping
In construction : A Safety & Health Program
Regulated areas to limit exposures

22. BERLANJUT KE PAK bag-3D