masalah organ respirasi
TRANSCRIPT
MASALAH ORGAN RESPIRASISKDI 2006Lampiran 1
A. Daftar Masalah Individu (116)Masalah yang sering dijumpai (4)
B. Daftar masalah komunitas
1. BATUK 2. SESAK NAPAS 3. NYERI DADA 4. PANAS BADAN
= PROBLEMS =
HIPOTESIS : BATUK
GI tract : - GERD
Sistem Pertahanan Paru
REFLEKS BATUK
Komponen utama
Reseptor batuk
Serabut saraf aferen
Pusat batuk
Susunan saraf eferen
Efektor
Histologi bronkus
Surface view of bronchiolar epithelium shows tufts of cilia (Ci) forming on individual ciliated cells and microvilli (MV) on other cells. Note secretion droplet in process of release from goblet cell (arrow).
3 fase mekanisme batuk : (1) fase inspirasi
(2) fase kompresi dan (3) fase ekspirasi
4 fase :(1) fase iritasi(2) inspirasi
(3) kompresi (4) ekspulsi
Bronkitis Akut - Cindy Thung FKUPH
Komponen refleks batukReseptor Aferen Pusat
batukEferen Efektor
LaringTrakeaBronkusTelingaPleuraLambung
HidungSinus paranasalis
Faring
PerikardiumDiafragma
Cabang nervus vagus
Nervus trigeminus
Nervus glosofaringus
Nervus frenikus
Tersebar merata di medula oblongata dekat pusat pernafasan,di bawah kontrol pusat yang lebih tinggi
Nervus vagus
Nervus frenikus intercostal dan lumbaris
Saraf-saraf trigeminus, fasialis, hipoglosus, dan lain-lain
Laring. Trakea dan bronkus
Diafragma, otot-otot intercostal, abdominal, dan otot lumbal
Otot-otot saluran nafas atas, dan otot-otot bantu nafas
Penyebab Batukberdasarkan saraf aferen yang distimulasi
Sputum
Bening • Iritasi traktus respiratorius• Infeksi oleh virus
Kuning dan bau khas (nanah) •Bronkiektasis, abses paru, pneumoni karena stafilokok
Hijau keruh & bau busuk •Infeksi dengan kuman penyebab kuman anaerob
Bintik-bintik hitam dam dahak •Polusi udara berat
Warna seperti karat besi & panas tinggi •Pneumonia karena Pneumococcus
Seperti jelly kismis /kurma disertai panas tinggi •Pneumonia dengan Klebsiella
Klasifikasi Batuk Hati-hati awal batuk kronik!!
TRIA
D DIA
GNOSIS
BATUK KRONIK
Guideline for International Classification of Diseases, Ninth Revision [ICD-9]
URTI ACUTE BRONCHITIS
SINUSITIS VIRAL FOREIGN BODY ASPIRATION
LVHF
EPIDEMI - Symptoms usually last for more than 1 week but less than 4 weeks- Disease that swell the nasal mucous membrane, such as viral or allergic rhinitis, are usually the underlying cause
SYMPTOMS -Pain is usually unilateral over the maxillary sinus or is toothache-like- Change of secretions from mucoid to purulent green or yellow-Postnasal drainage, headache, and cough may also be present
SIGNS - Occasional visible swelling or erythema over a sinus
LAB. FINDING
ETIOLOGY - HIPOTESIS
HEMATOLOGI
HEART LUNG
MUSCULOSCELETAL
METABOLIC
JIWAKIDNEY
DYSPNEA GI
LAIN-LAIN :Anatomi, Fisiologi, Lingkungan
SESAK
Pulmo
Non-Pulmo
Obstruktif Pleura & parenkim Obs.Sal. Imm.DiagVas.
noninfeksius
Asma BPPOKOSA Antharx
pneumoni
• Efusi pleura
• pneumothoraks
Emboli paru
Hipertensi pulmonal
Kanker laring
Aspirasi paru
Tumor diafragma
Lesi N.phenicu
s
Fraktur iga
KifosisObesiti
scoliosis
HAPEBarotrau
ma
CO
hamil
AnxietasPanic attack
histeria
ALSGBSMGMS
GERDAnemia leukimia
sepsis
Kardiomyopathy
Pulmonary edema
CHFAVM
Anatomis Kardiovaskuler Hematogenik GI Neuromuskular Psikis Fisiologis Linkungan
Acute dyspnea
• Asthma• Pulmonary infection• Pulmonary edema• Pneumothorax• Pulmonary embolism• Metabolic acidosis• ARDS• Panic attacks
Acute dyspnea• Orthopnea (dypnea on recombency) & nocturnal dyspnea :
asthma, GERD, left ventricular dysfunction or OSA• Rapid onset of severe dyspnea when supine :
phrenic nerve impairment leading to diaphragmatic weakness or paralysis
• Platypnea ( dyspnea that worsen in the upright position ):arteriovenous malformations at the lung basis or hepatopulmonary syndrome, resulting in increased shunting and hypoxemia in the upright position ( orthodeoxia )
Lain-lain :- Asma B : ringan-sedang-berat-mengancam jiwa- Pneumotoraks ventil – ikan koi- KAD : Kusmaul
Differential Diagnosis of Acute Dyspnea
• Anxiety / hyperventilation• Asthma• Chest trauma• Pneumothorax dan Spontaneous pneumothorax• Fractured ribs• Pulmonary contusion• Pulmonary edema• Pulmonary embolism
ASTHMA BR PNEUMOTORAKS SPONTAN
PULM EDEMA EMBOLI PARU(Pulm Venous Thromboembolism)
EPIDEMI - Predisposition to venous thrombosis, usually of lower extremities
SYMPTOMS -Episodic or chronic symptoms of airflow obstruction: breathlessness, cough, wheezing, and chest tightness.- Symptoms frequently worse at night or in the early morning
- Acute onset of unilateral chest pain and dyspnea.
-Acute onset or worsening of dyspnea at rest.
- One or more of following: dyspnea, chest pain, hemoptysis, syncope.
SIGNS - Prolonged expiration and diffuse wheezes on physical examination
-Minimal physical finding in mild cases; unilateral chest expansion, decreased tactile fremitus, hyperresonance, diminished breath sounds, mediastinal shift, cyanosis and hypotensionin tension pneumothorax.- Presence of pleural air on chest radiograph
-Tachycardia, diaphoresis, cyanosis.- pulmonary rales, ronchi; expiratory wheezing
Tachypnea and a widened alveolar-arterial PO₂
LAB. FINDING - Limitation of airflow on pulmonary function testing or positive bronchoprovocation challenge.- Complete or partial reversibility of airflow obstruction, either spontaneously or following bronchodilator therapy
- Radiograph shows interstitial and alveolar edema with or without cardiomegaly.- Arterial hypoxemia
- Characteristic defects on V-Q lung scan, helical CT scan on the chest, or pulmonary arteriogram
ANXIETY CHEST TRAUMA PULMONARY CONTUSION
RIBS FRACTURES
-This causes widespread fluffy shadowon the chest X-ray owing to intrapulmonary haemorrhage.- This may give rise to ARDS
- Caused by trauma or coughing (particularly in the elderly), and can occur in patients with osteoporesis.- Pathological fractures are due to metastatic spread from Ca of the the bronchus, breast, kidney, prostate or thyroid.
SYMPTOMS - Overt anxiety or an overt manifestation of a defence mechanism (eg, a phobia), or both.-Not limited to an adjusment disorder.- Somatic symptoms referable to the autonomic nervouss system (eg, dyspnea, palpitations, paresthesia).- Not a result of physical disorders, psychiatric conditions (eg, schizophrenia), or drug abuse.
-Rib can also become involved by a mesothelioma.- Pain prevents adequate chest expansion and coughing and this can lead to pneumonia.- Fractures may not be readily visible on a PA chest X-ray, so lateral X-rays and oblique views may be necessary.
SIGNS - Tx. Is with adequate oral analgesia, by local infiltration or an intercostal nerve block.-Two fractures in one rib can lead to a flail segment with paradoxical movement, ie part of the chest wall moves inwards during inspiration.
LAB. FINDING This can produce inefficient ventilation and may require IPPB, especially if several ribs are similarly affected.
Differential diagnosis of chronic dyspnea :
1. Respiratory– Airway disease
• Upper airway obstruction– Asthma– COPD– Cystic fibrosis
– Parenchymal lung disease• Interstitial lung disease• Malignancy – primary or metastatic• pneumonia
– Pulmonary vascular disease• Arteriovenous malformations• Intravascular obstruction• Vasculitis• Venous occlusive disease
– Pleural disease• Effusion• Fibrosis• Malignancy
– Chest wall disease• Deformities (e.g. kyphoscoliosis)• Abdominal “loading” (e.g. ascites, pregnancy, obesity)
– Respiratory muscle disease• Neuromuscular disorders (e.g. myasthenia gravis, polio)• Phrenic nerve dysfunction• Weakness
2. Cardiovascular– Decreased cardiac output• Cardiomyopathy– Dilated– Hypertrophic– Infiltrative– Ischemic– Valvular disease– Pericardial disease– Congenital disease
– Increased pulmonary venous pressure• Diastolic dysfunction– Hypertrophic disease– Ischemia
• Mitral stenosis• Pulmonary venous occlusive disease• Right-to-left shunt
3. Hematology : Anemia 4. Anatomy : Kyphoscoliosis berat5. Psychological : anxiety 6. Neurology : GBS, myasthenia gravis , polio 7. Deconditioning 8. GIT : gastric asthma9. High altitude : Acute Mountains Sickness, HAPE; Barotrauma, 10. Renal : Chronic renal failure11. Endocrinology : KAD
CHEST PAIN
CARDIOVASCULAR
PULMONARY
GASTROINTESTINALMUSCULOSKLETAL
PSYCHOGENIC
Pleural Mediastinal Gastrointestinal Muskuloskeletal
Sifat Tajam, menusuk-nusuk, seperti di iris
Tumpul, rasa terbakar Tumpul , rasa terbakar Tajam
Lokasi Terlokalisir Sentral/retrosternal/substernal
Retrosternal Setempat (sesuai kelainan otot dada )
Penjalaran - Menjalar ke leher, bahu, lengan kiri
Menjalar ke punggung, bahu dan lengan
Sepanjang perjalanan otot
Faktor memperberat
Semakin berat saat batuk/inspirasi
Aktifitas fisik Makan dan menelan Bertambah berat saat inspirasi Dan gerakan otot/skletal. Akktivitas fisik.
Faktor memperingan
Menahan nafas atau sisi dada yang sakit digerakan
nitrogliserin Antasid Istirahat
NYERI DADA
Table : DD of Chest Pain1. Angina pectoric / myocardial infarction2. Other cardiavascular caues
a. Likely ischemic in origin(1) Aortic stenosis (2) Hypertrophic cardiomyopathy(3) Severe Systemic hypertension (4) Severe anemia/hypoxia(5) Severe right ventricular hypertension (6) Aortic regurgitation
b. Nonischemic in origin(1) Aortic dissection (2) Pericarditis (3) Mitral valve prolapse
3. Gastrointestinala. Esophageal b. Esophageal refluxb. Esophageal rupture d. Peptic ulcer disease
4. Psychogenica. Anxiety b. Depression c. Cardiac psychosis d. Self gain
5. Neuromusculoskeletala. Thoracic outlet syndrome b. Costochondritis (Tietze’s syndrome)c. Herpes zoster d. Chest wall pain and tendernesse. Degenerative joint diseaseof cervical/thoracic spine
6. Pulmonary a. Pneumothorax b. Pneumonia with pleural involvementc. Pulmonary embolus with or without plmonary infarction
7. Pleurisy
CARDIOVASCULAR
ANGINA PECTORIS
MYOCARDIAL INFARCTION
PERICARDITIS
AORTA DISEKANS
Ardiac failure
Angina pectoris Myocardial infarction Pericardits Aortic dissection
EPIDEMIOLO
A history of hypertension or Marrfan’s syndrome is often present
SYMPTOMS
Precordial chest pain, usually precipitated by stress or exertion, relieved rapidly by rest or nitrates
Sudden but not instantaneous development of prolonged (30 minutes) anterior chest discomfort (sometimes felt as “gas” or pressure) that may produce arrhythmias, hypotension, shock, or cardiac failure.Sometimes painless, masqueriding as acute CHF, syncope, stroke, or shock.
Substernal chest pain, which is relieved by sitting forward. Pain is less common in purulent pericarditis & has a gradual onset in TB dis.
- Sudden severe chest pain with radiation to the back, occasionally migrating to the abdomen and hips.
SIGNS 3 component friction rub early; rub later disapears with increased pericardial fluid.Pulsus paradoxicus (exceeding 10 mmHg is abnormal
-Patient appears to be in shock, but blood pressure isnormal or elevated; pulse discrepancy in many patients- acute aortic regurgitation may develop
LABORATORY FINDING
ECG or scintigraphic evidence of ischemia during pain or stress testing.Angiographic demonstration of significant obstruction of major coronary vessels.
ECG:ST-segment elevation or depression, evolving Q waves, symmetric inversion of Twaves.Elevatin of cardiac markers(CK-MB, troponin T, or troponin I ).Appearance of segmental wall motion abnormality by imaging techniques.
PULMONARY
Emboli paru
Pneumothorax
Pneumonia
Pleuritis/efusi pleura
Tracheobronchitis
PNEUMOTHORAX PNEUMONIA PLEURAL EFFUSION
PULM VENOUS THROMBOEMBOLISM
TRACHEOBRONCHITIS
EPIDEMIO Occurs out side of the hospital or less than 48 hours after admission in a patient who is not hospitalized or residing in a long-term care facility for more than 14 days before the onset of symptoms
Predisposition to venous thrombosis, usually of the lower extremities
SYMPTOMS Acute onset of unilateral chest pain & dyspnea
Fever or hypothermia, cough with or without sputum, dysnea, chest discomfort, sweat, or rigors.
May be asymptomatic; chest pain frequently seen in the setting of pleuritis, trauma, or infection; dyspnea is common with large effusions
One or more of the following: dyspnea, chest pain, hemoptysis, syncope
SIGNS Minimal physical findings in mild cases; unilateral chest expansion, decreased tactile fremitus, hyperresonance, diminihed breath sounds, medistinal shift, cyanosis & hypotension in tension
Bronchial breath sounds or rales are frequent auscultatory findings
Dullness to percussion & decreased breath sounds over the effusion
Tachypnea & a widened alveolar-arterial PO₂ difference
LABORATORY FINDING
Presence of pleural air on chest radiograph
Parenchymal infiltrates on chest radiograph
Radiographic evidence of pleural effusionDiagnostic finding on thoracentesis
Characteristic defects on V-Q lung scan, helical CTscan of the chest, or pulmonary arteriogram
PENYAKIT PARU KOMPETENSI DOKTER UMUM
PNEUMOTHORAK PNEUMONIA EFUSI PLEURA
EPIDEMIOLOGI
LAKI-LAKI KURUS USIA 10-30 TAHUN
RESIKO KEMATIAN MENINGKAT DI AMERIKA SERIKAT PADA USIA LANJUT DAN PECANDU ALKOHOL
PADA PRIA DAN WANITA DISEMUA USIA DI NEGARA BERKEMBANG
SIGN •PENURUNAN SUARA NAFAS•PENURUNAN VOCAL FREMITUS•PENURUNAN PERGERAKAN DINDING DADA•PADA PERKUSI DIDAPATKAN HIPERSONOR•ADA EFEK DESAKAN PADA DAERAH MEDIASTINUM DAN TRAKEA
•DEMAM ATAU HIPOTERMI•TAKIPOE, TAKIKARDY,•RONKHI
•PENURUNAN SUARA NAPAS VOCAL FREMITUS PADA PALPASI•DIDAPATKAN SUARA REDUP PADA PERKUSI
SYMPTOMS •NYERI DADA MINIMAL –BERAT PADA SELURUH LAPANG PARU •SESAK NAFAS
•DEMAM AKUT ATAU SUBAKUT•BATUK DENGAN ATAU TANPA SPUTUM•SESAK NAPAS •GEJALA LAIN: RIGORS,BERKERINGAT, RASA TIDAK NYAMAN PADA DADA, BATUK DARAH, LEMAH LESU, ANOREXIA, SAKIT KEPALA, NYERI PERUT, DAN PLEURISY
•KADANG KADANG ASIMPTOMATIK, TETAPI BIASANYA ADA NYERI DADA YANG DISERTAI PLEURITIS, TRAUMA DAN INFEKSI•TERDAPAT SESAK NAPAS PADA EFUSI YANG MASIF
PENUNJANG •RONTGEN THORAK RONTGEN THORAK •RONTGEN THORAX
GASTROINTESTINAL
GASTRITIS
GERD
INFECTIOUS ESOPHAGITIS
PEPTIC ULCER DISEASE
GERD GASTRITIS(GASTROPATHY)
INFECTIOUS ESOPHAGITIS
PEPTIC ULCER DISEASE
EPIDEMIOLOGY Most commonly seen in alcoholics, critically ill patients, or patients taking NSAIDS
Immunosuppressed patient
HISTORY OF NONSPECIFIC EPIGASTRIC PAIN PRESENT IN 80-90% OF PATIENTS WITH VARIABLE RELATIONSHIP TO MEALS
SYMPTOMS Heartburn; may be exacerbatad by meals, bending, or recumbency
Often asymptomatic; may cause epigastric pain, nausea, and vomiting.May cause hematemesis; usually not significant bleeding
Odynophagia, dysphagia, and chest pain
ULCER SYMPTOMS CHARACTERIZED BY RHYTHMICITY & PERIODICITYOF NSAIDS-INDUCED ULCERS, 30-50% ARE ASYMPTOMATIC10-20% OF PATIENTS PRESENT WITH ULCER COMPLICATIONS WITHOUT ANTECEDENT SYMPTOMS
SIGNS
LABORATORY FINDING Endoscopy demonstrates abnormalities in 50% of patients.Barium esophagoscophy seldom helpfull
Endoscopy with biopsy establishes diagnosis
UPPER ENDOSCOPY WITH ANTRAL BIOPSY FOR h PYLORI IS THE DIAGNOSTIC PROCEDURE OF COISE IN MOST PATIENTS
MUSKULOSKLETAL
Chest wall pain and tenderness
Kostokondritis (tietze’s syndrome)
Herpes zoster
Thoracic outlet syndrome
Degenerative joint disease of cervical/thoracic spine
Chest wall pain and tenderness
Herpes zoster Kostokondritis (tietze’s syndrome)
Thoracic outlet syndrome
Degenerative joint disease of cervical/thoracic spine
EPIDEMI
SYMPTOMS
SIGNS
LAB. FINDING
PSIKOGENIK
Anxietas
Depression
Cardiac neurosis
ANXIETAS DEPRESSION CARDIAC NEUROSIS
EPIDEMIOLOGY
SYMPTOMS Overt anxiety or an overt manifestation of a defense mechanism (such as a phobia), or both.Not limited to an adjustment disorder.Somatic symptoms referable to the autonomic nervous systemor to a specific organ system (eg., dyspnea, palpitations, paresthesias).Not a result of physical disorders, psychiatric conditions (eg, schizophrenia), or drug abuse (eg, cocaine)
Lowered mood, varying from mild sadness to intense feeling of guilt, worthlessness, & hopelessness.Difficulty in thinking, including inability to concentrate, ruminations, & lack of decisiveness.Loss of interest, with diminished involvement in work recreation.Somatic complaints such as headache, disrupted, lessened, excessive sleep; lost of energy; change in appetite; decseaed sexual driveanxiety
SIGNS
LABORATORY FINDING
FEVER
• A regulated rise to a new "set point" of body temperature.
• Elevation of body temperature that exceeds the normal daily variation and occurs in conjunction with an increase in the hypothalamic set point [e.g., from 37°C to 39°C
PATHOGENESIS OF FEVER
Patofisiologi Demam
HYPERTHERMIA• Characterized by an uncontrolled increase in body
metabolic heat production that exceeds the body's ability to lose heat
• Hypothalamic thermoregulatory center is unchanged
• Hyperthermia does not involve pyrogenic molecules
• Heat stroke, drug-induced hyperthermia, malignant hyperthermia
• Does not respond to antipyretics
FEVER OF UNKNOWN ORIGIN( FUO)
“Demam selama lebih dari 3 minggu dengan suhu badan di atas 38,3°C dan tetap belum ditemukan penyebabnya walaupun telah di teliti selama satu
minggu secara intensif dengan menggunakan sarana laboratorium dan penunjang medis
lainnya”
(Buku Ajar Ilmu Penyakit Dalam)
FEVER OF UNKNOWN ORIGIN
• Illness of at least 3 weeks duration.
• Fever over 38.3 °C on several occasions.
• Diagnosis has not been made after three outpatient visits or 3 days of hospitalization
BIG 3
1. Infection, 2. Neoplasm, and 3. Autoimmune Disease
LITTLE 6
1. Drug fever, 2. Granulomatous disease, 3. Regional enteritis, 4. Familial mediterranean fever, 5. Pulmonary emboli, and 6. Factitious fever
DIFFERENTIAL DIAGNOSIS FUO
BIG 3 – 1 . INFECTION
• PYOGENIC ABSCESS• TBC • INFECTIVE ENDOCARDITIS• EBV• CMV• BRUCELLOSIS• FUNGAL INFECTION• PARASITIC INFECTION
TBC 1 PYOGENIC ABSCESS
INFECTIVE ENDOCARDITIS
PARASITIC INFECTION
FUNGAL INFECTION
EBV BRUCELLOSIS
CMV
EPIDEMI -Human are the only reservoir of the disease.-Person-to-personspread occurs via aerosolized infectious droplets from sneezes or coughs.a. Laryngeal TB is highly
infectious.b. Patients w/ HIV
release large numbers of organism
c. Large cavitary lesions are also highly infectious.
3. People w/ these characteristic are at increased risk:
a. immigrants from developing countries b. alcoholics c. urban poor d. single men e. IV drug abusers f. migrant farm
workers g. Prison inmates h. people infected
w/ HIV i.
SYMPTOMS
SIGNS
LAB. FINDING
TBC2 PYOGENICHepatic ABSCESS
INFECTIVE ENDOCARDITIS
PARASITIC INFECTION
FUNGAL INFECTION
EBV BRUCELLOSIS CMV
EPIDEMI - Often in the setting of biliary disease but up to 40% are “cryptogenic” in origin
- Preexisting organic heart lesion
- Spread by oral secretions, with 95% of adults carrying the virus
-Transmitted to human by infected domestic & wild animals:a).cattle,buffalo,camels,yaks &sheepb).swine,fox,caribou,antelope&elk
SYMPTOMS - cough, (sesak, nyeri dada)- fever, fatique, weight loss, night sweat
- Fever -Fever-Evidence of systemic emboli
- Fever, sore throat, and lymphadenopathy are the classic triad of mononucleosis
-Incubation period is 2-4 weeks; symptoms include fever, chills, malaise, anorexia, headache, & back pain
SIGNS - -Jaundice-Right upper quadrant pain
- New or changing heart murmur
Important cause of FUO; lymphadenopathy & splenomegaly are the only positive physical finding
LAB. FINDING
-Positive tuberculin skin test reaction-Pulmonary infiltrates on chest radiograph, most often apical--AFB on smear of sputum or sputum culture positive for MTB
- Detected by imaging studies
-Positive blood culture- Evidence of vegetation on echocardiography
-blood cultures are positive in 70% of cases; hold for 21 days-bone marrow cultures are often positive- Serologic diagnosis is frequently helpful
BIG 3 – 2 . NEOPLASM• LYMPHOMA• LEUKEMIA• RENAL CELL CA• HEPATOCELLULAR CA
BIG 3 - 3. AUTO-IMMUNE DISEASE
SLE
NONLEUKEMIA LYMPHOMA
HODGKINLYMPHOMA NON-HODGKIN
HEPATOCELLULAR CA
RENAL CELL CA
EPIDEMI
SYMPTOMS
SIGNS
LAB. FINDING
SLE STILL’S DISEASE CRYOGLOBULINEMIA POLYARTERITIS NODOSA
EPIDEMI
SYMPTOMS
SIGNS
LAB. FINDING
LITTLE 6 – 1.DRUG FEVER• ANTIMICROBIAL AGENTS : carbapenems,
cephalosporins, minocycline, nitrofurantoin, penicillins, rifampin, sulfonamides
• CARDIOVASCULAR drugs : hydralazine HCl, procainamide HCl, Quinidine)
• H2 BLOCKERS : cimetidine, ranitidine• NSAIDs : Ibuprofen• ANTI CONVULSANTS : barbiturates,
carbamazepine, phenytoine)• IODIDES, PHENOTHIAZIDES,
ANTIHISTAMINES, SALICYLATES
LITTLE 6 – 2.REGIONAL ENTERITIS / CROHN DISEASE
o Insidious onseto Intermittent bouts of low grade fever, diarrhea,
and right lower quadrant paino Right lower quadrant mass and tendernesso Perianal disease with abscess, fistulaso Radiographic evidence of ulceration, stricturing,
or fistulas of the small intestine or colon
LITTLE 6 – 3.FAMILIAL MEDITERRANEAN FEVER
• Rare autosomal recessive disorder, unknown pathogenesis• Affect people of mediterranean ancestry• Lack of protease in serosal fluid – inactivate IL-8 and
chemotactic complement factor• Episodic acute peritonitis : fever, severe abdominal pain,
abdominal pain and abdominal tenderness with guarding• Resolve 24-48 hours• Tx Colchicine 0,6 mg PO 3 x 1 (decrease frequency and
severity)
LITTLE 6 – 4.PULMONARY EMBOLI
• Emboli predisposition : venous thrombosis of the lower extrimity
• One or more of the symptoms below : dyspnea, chest pain, hemoptysis, syncope
• Tachyneaa and widened alveolar-arterial P02 difference
• Characteristic defects on ventilation-perfusion lung scan, helical CT scan of the chest, or pulmonary angiogram
LITTLE 6 – 5. FACTITIOUS FEVER
• Psychiatric condition in which a patient deliberately produces or falsifies symptoms of illness for the sole purpose of assuming the sick role, in this case fever
• Personal characteristics– Typically female– Health-related professions– Articulate and well educated– Surprisingly stoic about procedures used to diagnose and
treat them
LITTLE 6 – 6.NEUROLEPTIC MALIGNANT SYNDROME
• Occurs in the setting of the use of neuroleptic agents (antipsychotic pheneothiazides, haloperidol, prochlorperazine, metcoclopramide) or the withdrawl of dopaminergic drugs.
• Characterized by "lead-pipe" muscle rigidity, extrapyramidal side effects, autonomic dysregulation, and hyperthermia
• Inhibition of central dopamine receptors in the hypothalamus, which is result in increased heat generation and decreased heat dissipation
1.DRUG FEVER 2.REGIONAL ENTERITIS / CROHN DISEASE
3.FAMILIAL MEDITERRANEAN FEVER
4.PULMONARY EMBOLI
5.FACTITIOUS FEVER
6.NEUROLEPTIC MALIGNANT SYNDROME
EPIDEMI
SYMPTOMS
SIGNS
LAB. FINDING
THANK YOU FOR YOUR ATTENTION
ABOUT “PROBLEM OF RESPIRATIONS ”
HYPERTHERMIAKEY FEATURES
- A rapidly life-threatening complication- May be due to poisoning by amphetamines (espicially ectasy),
atropine and other anticholinergic drugs, cocaine, dinitrophenol and pentachlorophenol, phencyclidine, salicylates, strychnine, tricyclic antidepressants, other agents
- Overdose of serotonin reuptake inibitors (eg, fluoxetine, paroxetine, sertraline) or use in patient taking MAO (monoamine oxidase) inhibitor may cause agitation, hyperactivity, hyperthermia (serotonin syndrome) vs Cyproheptedine
- Haloperidol and other antipsychotic agents can cause rigidity and hyperthermia (neuroleptic malignant syndrome) vs Bromocriptin
- Malignant hyperthermia is associated with general anesthetic agents (rare) vs Dantrolen
CLINICAL FINDINGSevere hyperthermia ( temperature 40-41°C ) may rapidly cause brain damage
and multiorgan failure
TREATMENT- Remove clothing: spray with tepid (hangat-hangat kuku) water; fan patient- If rectal temp. not normal in 30-60 min or there significant muscle rigidity or
hyperreactivity, include neuromuscular paralysis with nondepolarizing neuromuscular blocker (pancuronium, vecuronium)
- Once paralyzed, patient must be intubated and mechanically ventilated- With seizures, absence of visible muscular convulsive movements may give
false impression that brain seizure activity has ceased; this must be confirmed by EEG.
- Dantrolene, 2-5 mg/kg IV, may be effective for muscle rigidity unresponsive to neuromuscular blockade (ie, malignant hyperthermia) x
- Bromocriptine, 2.5-7.5 mg mg PO daily, for neuroleptic malignant syndrome.
- Cyproheptadine , 4 mg PO Q h for 3-4 doses, for serotonin syndrome
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