PROBLEM HYPOTHESIS MECHANISM MORE INFO IDK LI

38 Yo Boy Cardiac Cardiac Anamnesis 1. Bagaimana 1. Anatomi vascular

1. Infeksi katup 1. MO  invasi  1. Demam? No mekanisme infeksi (5,7) 3
CC: pain in both of his tiptoes jantung (no infeksi  inflamasi  2. Riwayat trauma? No katup jantung 2. Histologi vascular(6) 3
history of fever) menyerang katup 3. Riwayat penyakit menyebabkan pain di 3. Fisiologi vascular
1. His complaint started since 2. Gangguan jantung  ?  Pain (Diabetes, hipertensi , ujung jari kaki (1,2,3,4,9) 4
1 month ago pembuluh darah (SS) dislipidemia, 2. Bagaimana dari IDK N0 8
Coroner 2. Kolesterol  autoimmune) No jantung bisa
2. complaining started with atherogenesis  4. Riwayat keluarga menimbulkan nyeri di
tingling sensation penyumbatan  (autoimmune, kaki
Non cardiac supply darah diabetes) 3. Gejala apa yang 1. Resti, denden, augy
3. started feel pain in his legs 1. Gangguan berkurang ke arah 5. Life style: active menyebabkan Ketika 2. Yesi, denisa
while walking several syaraf (no bawah  Pain (SS) smoker berjalan sakit tetapi 3. Alya, dimas, yodi,
hundred meters history Non Cardiac 6. Riwayat pengobatan istirahat dia tidak dafa
autoimmune) 1. Autoimmune  7. Pekerjaan sakit
4. pain got worse 2. Gangguan menyerang PNS  4. Kaki nya merasakan
metabolic infeksi  inflamasi  PE dingin dan sakit saat
5. There was changes in skin a. Diabetes pain (SS) 1. GA terkena air pada pagi
colour to black starting (no history 2. Resistensi insulin  2. TTV Normal + hari cuaca dingin ?
from the tips of the toes diabetes) hyperglicemi  saturation O2 5. Struktur apa saja
3. Gangguan lower diabetes  komplikasi 3. HTT dikaki (vaskularisasi)
6. Since 1 week ago, he could
limb neuropati  pain (SS) 6. Perbedaan arteri dan
not walk anymore
a. Trauma 3. Accident trauma Penunjang arteriol hubungkan
lower limb lower limb  inflamasi 1. Lab Exam dengan tunica (H)
7. his feet felt cold and pain
(no history  pain (SS) a. CBC 7. Distribusi aorta ,
when exposed to water in
trauma) 4. ?  Penyumbatan b. Blood glucose posisi, menyilang (A)
the morning.
4. Gangguan perifer  supply darah c. Lipid profile 8. Pemeriksaan arteri
pembuluh darah berkurang kea rah tibialis anterior &
8. He admitted he is an
perifer bawah  pain (SS) posterior
active smoker.
9. Bagaimana
pertukaran di kapiler
9. He smoked 1-3 packs
dengan jaringan
cigarettes per day.
terjadi (lewat apa ?)
10. He started smoking since 10.
15 years old.
11. Extremities:

a. Anterior tibialis artery

pulse: reduce

b. Posterior tibialis artery

pulse: reduce

c. a/r pedis dextra: a

red to blackish
colored necrotic tissue
appears in digiti I, IV,
and V as high as the
distal phalanx to the
proximal phalanx,
pain (+), palpation of
dorsalis pedis artery is
not strong enough to
lift.

d. a/r pedis sinistra: a

blackish colored
necrotic tissue
appears in digiti I, II,
and IV as high as the
distal phalanx to the
proximal phalanx,
pain (+), palpation of
dorsalis pedis artery is
not strong enough to
lift

e.
 RF
1. active smoker.
2. He smoked 1-3 packs
cigarettes per day.
3. He started smoking since
Cardiac Non cardiac 15 years old.
BSCM
38 yo Man

Resistensi ?
Mikroorganisme Kolesterol Autoimmun Trauma
insulin
e
Infeksi katup Gangguan Gangguan Gangguan Gangguan Gangguan
jantung pembuluh syaraf metabolic lower limb pembuluh
darah coroner darah perifer
No history of No history No history
No history of 1,2,3
autoimmune of diabetes of trauma
fever

pain in both of tingling feel pain in his legs his feet felt cold and Since 1 week ago, he changes in skin colour
his tiptoes sensation while walking pain when exposed to could not walk to black starting from
several hundred water in the morning. anymore the tips of the toes
meters
Pain got worse

Physical Examination 4

1. Anatomi Anterior tibialis artery Posterior tibialis artery a/r pedis dextra: a red to a/r pedis sinistra: a blackish
pulse: reduce pulse: reduce blackish colored necrotic tissue colored necrotic tissue appears
vascular
appears in digiti I, IV, and V as in digiti I, II, and IV as high as
2. Histologi
high as the distal phalanx to the the distal phalanx to the
vascular