Académique Documents
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Group 28
Our Member
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12.
Niko Citami
Eisa Mayestika
Fatimah Amalia `
Lukman Karim
Eva Silvia R
Virda Permatasari
Tommy Darmawan
Niken Suciningrum
Christina Fanny
Wilda Purnama
Nurul Aini
Dimas Didik S
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11700248
11700250
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Scenario
Mr. Mansyur (25 years old), present to hospital Accident and
Emergency department (A&E) with coughing up blood15cc every
cough (with 3-4 times coughing up blood in one day) since two
days ago, the colour is fresh red, bubbly. Every coughing up
blood is always out, even while in the A&E blood multiply the
blood which comes out.
keywords
1. Tuberculosis
2. coughing up blood
Problem
1. How does patients complaint the symptom?
2. How does the principle of handling emergencies in patients?
3. How to educate patients and their families?
Discussion
Pulmonary Tuberculosis
Mycobacterium tuberculosis
Pulmonary tuberculosis includes 80% of the overall incidence of
tuberculosis disease, while the remaining 20% is extrapulmonary
tuberculosis.
Etiology
Modes of Infection
Coughing or sneezing
Droplet
10
Pathophysiology
Primary infection
Near the apex of the lung or pleura lower lobe.
Have a process of degeneration of necrotic or swiss cheese but
could not
White blood cells die
Necrotic lung tissue
11
Secondary Infection
Re-infection also leads to clinical forms of active tuberculosis
TB bacilli can still latent for many years and then switched back
if the client durability decreases.
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13
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Clinical symptoms
No.
Common Symptoms
Specially Symptomp
1.
Cough> 3 weeks
Wheezing sound"
2.
fever
3.
4.
Sweating at night
5.
malaise
6.
Anorexia
15
Risk Factor
Some risk factors for with TB are:
1.Sex
2.Status nutrition
3.Sosio-economy
4.Education
5.Toxic
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Complication
1.
2.
3.
4.
5.
6.
7.
Blood cough
Pneumothorax
Respiratory failure
Heart failure
Effusion pleura
Asphyxia
Shock Hipovolemik
17
Discussion
Pulmonary Cancer (CA Pulmo)
18
attack branching
segments
Cilia lost
desquamation
resulting in the
deposition of
carcinogens
direct invasion of
the ribs and
vertebral bodies.
metaplasia,
hyperplasia and
dysplasia
obstruction
lesions pheripheal
penetrate the
pleural space
ulceration of
bronchial
suppuration distal
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Histological Type
According to the WHO histological classification in 1999, but for
the clinical needs enough if only it can be seen:
Carsinoma epidermoid
small cell carcinoma
adenocarcinoma
large Cell carcinoma
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Discussion
Bronkiektasis
Dilation of bronchi caused by weakness of the bronchial wall
permanent
Group of respiratory tract infections
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Etiology
1. Infection
2. Heriditer abnormalities or congenital abnormalities
3. Mechanical factors that facilitate the emergence of
infectious
4. Patients often have a history of pneumonia as a complication
of measles, whooping cough, or other infectious diseases in
childhood.
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Clinical Symptom
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
Chronic cough
Sputum which much, especially in the morning, after sleeping and lying down
sputum containing blood spots
coughing up blood
Cough with sputum cough accompanying a cold for 1-2 weeks or none symptoms
at all (mild Bronchiectasis)
sputum which much less than 200-300 cc
fever
anorexia
weight loss
anemia
pleural pain
malaise
Dypsneu
Found clubbed fingers (30-50% case)
24
Pathophysiology
Congenital and acquired
1.Congenital
babies and children
permanent damage of the development of the bronchial tree
25
Pathophysiology
2. Acquired
Adults and children
Bacterial infections, bronchial obstruction and other
complications factor
Scheme next page
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infection
Components damages of
the mucosa and
bronchial wall
inflammation of
cytokines, nitric and
neutrophils
damage to the
alveolar tissue
bronkiektasis
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Clinical Symptoms
Anamnesa
1.Patient identity
a.Name
b.Sex
c.Age
d.Work
e.Wedding Status
f.Lastest Education
2.Main complaint
: Mr. Mansyur
: Male
: 25 years old
: Rice seller
: Not merried
: High School
: coughing up blood
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3.
4.
1)
2)
3)
: had never
: denied
: denied
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EARLY HYPOTHESIS
Based on anamnesis, physical examination, and laboratory
examination of the scenarios above, the case experienced by Mr.
Mansour (25 years) can be taken early on hemoptosis hypothesis
as follows:
1 Tuberculosis
2 Lung Ca
3 Bronchiectasis
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Hypothesis Final
Pulmonary Tuberculosis
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MECHANISM DIAGNOSIS
34
Myobacterium TBC
Live in alveoli
No infection
Cough
Sputum purulent
Hemoptisis
Weight loss
inflamation
Spread by Spleen
Fibrosis
Calsification
Exudation
Necrosis
Cavity
Tightness
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Hematemesis
Prodromal
scratchy throat
Nausea, flatulence
Colour
Fresh red
Dark red
Bubbly
(+)
(-)
contents
Leukocytes, macrofaq
food particles
PH
Alkalis
Acid
Anemia
(+) or (-)
(+)
Benzidine test
(-)
(+)
History disease
Lung/heart
Stomach/liver
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Treatment
Education
1. Dont forget to regularly take medication every day, as
recommended by a doctor
2. Always cover your mouth with a tissue when coughing, sneezing or
laughing. Keep in covered tissue and dispose of waste in place.
3. As usual, such as school, play, and work. During TB patients take
medication properly, the risk of passing will be lost. So the daily
social activities and there is nothing to be limited, so people with
TB do not ostracized or shunned.
4. Circulation in the room should be good, if necessary, add a fan to
get rid of the air in the room. Try to stay in the room or house that
has good light ventilation. TB germs are easily spread in a closed
room and no air circulation.
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Prevention of Disease
1.
2.
3.
4.
Using masks
Spitting should be at a certain place
BCG is given to infants aged 3-14 months
The food should be high in carbohydrates and high in protein
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ANY QUESTION?
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