Klu Interna & Farmakologi

7/21/2019 Klu Interna & Farmakologi

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UKDI

2015

PRAJOGO WIBOWO



Anti Hipertensi







JNC VII





AC)*I + ARB



ACE-Inhibitor +

Diuretik

•,arget BP- . /012342 mm5g

. /062372 mm5g i& 89 or

rena di!ea!e :;<

. /0=>3?> i& protein%ria @

0g3=1h

• I& BP @=2302 mm5g above

target BP %!e t$o*dr%g

combination

• 5, ; 89

. BP 062*064372*74-

i&e!tye modi&ication 6mo dr%g

. BP @012342- dr%g

o%rce!- ,he eventh Report o& the Joint Nationa Committee on

Prevention# 8etection# )va%ation# and ,reatment o& 5igh BoodPre!!%re( =226( on!en!%! Pengendaian dan Pencegahan 8iabete! 9eit%!

,ipe = di Indone!ia( =22D(



8i%reti"a antihiperten!i

• Bia!a dipa"ai thiazide . 5C, !inge do!e=>*>2 mg3hari !eama =*1 mingg%

:bia do!i! dinai""an !ebe%m 1 mingg%

to"!i"<

• )&e" 5ipo"aemia :terapi !%pemen ;<#

dehidra!i# hiper%ri!emia :go%t<#

hipergi"emia# 8)



CALCIU CHANNEL BLOC!ERS

• CCB men%r%n"an PR + BP

• 9e"ani!me "erEa pada hiperten!i :dan# pada

!ebagian# angina< - hambat in&%"! caci%m

"e daam !e otot poo! arteria• Pening"atan ri!i"o in&ar" mio"ard# rein&ar"!i

+ "ematian# ter%tama oeh !hort acting CCB

:Ni&edipine<

• Piihan A"lodipine

• Ni&edipine ta"i"ardi



β - BLOKER

• Pen%r%nan Cardiac O%tp%t

• 9etoproo + Atenoo- β1-cardioselective

• Beta'oo + bi#oprolol - F 0 *!eective boc"er! yang

metaboi!me primernya di hepar# tapi $aktu paruhn%a

la"a

• Nebivoo -F 0 *!eective boc"er dan va!odiator

• Labetalol - p%nya ra!io 6-0 !ebagai antagoni! F- per

ora tanpa pengar%h 5R dan CO indi"a!i hiperten!i

"arena pheo&hro"o&%to"a + h%perten#i'ee"er(en&ie#

• Car'edilol# antagoni! F dan :~ abetao< indi"a!i

HT + heart )ailure





Obat 5, dengan Indi"a!i h%!%!

o%rce- ,he eventh Report o& the Joint Nationa Committee on Prevention# 8etection# )va%ation# and,reatment o& 5igh Bood Pre!!%re( =226(



8r%g

combination! in

hyperten!ion-

recommendation!

Preferred

ACEInhibitor/diuretic

ARB/diuretic

ACE-Inhibitor/CCB

ARB/CCB

Acceptable

Beta-blocker/diuretic

CCB (dihydropyridine)/beta-blocker

CCB/diuretic

Renin inhibitor/diuretic

Renin inhibitor/CCB

Dihydopyridine CCB/non-dihydropyridine CCB

Unacceptable

ACE-Inhibitor/ARB

Renin inhibitor/ARB

Renin inhibitor/ACE-Inhibitor

RA inhibitor/beta-blocker

CCB (non-dihydropyridine)/beta-blocker

Centrally actin! a!ent/beta-blocker









Anti Angina



Hn!tabe Angina

o%rce- )%ropean 5eart Jo%rna :)%ropean ociety o& Cardioogy<( =22D(

iy ( Pathophy!ioogy o& 5eart 8i!ea!e( 1th ed( =22?(



Coronary 5eart 8i!ea!e

o%rce- Porth! )!!entia! o& Pathophy!ioogy Concept! o& Atered 5eath tate!



Ac%te Coronary yndrome!

o%rce!- ,*egment )evation 9yocardia In&arction( 5arri!on! Principe! o& Interna 9edicine( 0? th )d( =227( iy ( Ac%te Coronary yndrome!( Pathophy!ioogy o& 5eart 8i!ea!e( 1th ed( =22?(







Loka#i #u"batan Lead Arteri !oroner

In&erior II# III# aVK RCA

Antero!epta V0*V= A8

Anteroapi"a V6*V1 A8 :di!ta<

Anteroatera V>*VD# I# aV CKL

Po!terior V0*V= :ta R $ave# notM $ave<

RCA

o%rce!- iy ( )ectrocardiogram( Pathophy!ioogy o& 5eart 8i!ea!e( 1th ed( =22?(



Nitrate

AN,I ANGINA



AN,I ANGINA

I di" i



Indi"a!i



• ,erapi !pe!i&i" %nt%" mencegah in&ar" myocard dan

"ematian mengand%ng antiplatelet :a!pirin# A8P

receptor boc"er!< and lipid-lo$erin( a(ent##

"h%!%!nya !tatin

• Hnt%" terapi r%matan chronic !tabe angina# lon(-a&tin(

nitrate## &&b# ata% * blo&ker# bi!a dipiih dr%g o&

choice tergant%ng individ%a re!pon!e(

• Pada 5,# monotherapy dengan !o$reea!e ata% ong*

acting ccb or F boc"er! m%ng"in ade%ate(

• Pada normoten!i# ong*acting nitrate! m%ng"in coco"(

• ombina!i * blo&ker + &&b :eg# propranoo ;

ni&edipine< ata% = CCB berbeda :eg# ni&edipine and

verapami< ebih e&e"ti&







Pembl! dara!

) b i P 8V,



)mboi Par% ec 8V,

• ,em%an "a!i" . ,a"i"ardia . ,anda= di!&%ng!i RV

• 8i!ten!i vena E%g%er • Left parasternal lift • = "omponen

p%mona mengera!• 9%rm%r !i!toi" yg

mening"at padain!pira!i



Acute Limb Ischemia

• Pen%r%nan per&%!ie"!tremita! !ecaramendada" yang dapatmengancam viabiita! Earingan

• On!et , "in((u• DP Pain# paor#

p%!ee!!ne!!#pare!the!ia# poi"iothermia#parai!i!

• Goden period- D Eam• 8'- arteriogra&i 8opper

"orce# $nter-"ociet% &onsenss 'or t!e (anagement o' PA) * +A"& $$ ,idelines* .

Ch i Li b



Chronic Limb

Ischemia

• In!%&i!ien!i arteriperi&er , "in((u

• !laudika#io

inter"itten . 8ipic% a"tivita! +

eeva!i t%ng"ai . 9etaboi!me

anaerob a!ama"tat muscle

cramping . Nyeri ata%

b%rning padapantar pedi!

• 8'- ABI

"orce# 0asclar )isease o' +!e Etremities* Harrison2s Principle o' $nternal (edicine* 13t! ed* .

Tro"boan(iti# R1 in)la"a#i non-atero"ato#a .'a#o#pa#"e0 pada arteri 2



(obliteran# .Buer(er/#di#ea#e0

. p 0 p'ena ke&il ulku# atau (an(ren di(iti

Laki-laki "uda3 perokok

8iabetic arteriopathy 9a"rova!"%er- CA8# PA8# CVA

9i"rova!"%er- retinopati# ne&ropati# ne%ropati# gangren

Giant ce arteriti! Va!"%iti! pada percabangan "rania ar"%! aorta# ter%tama a(,emporai! :tempora arteriti!Q< ; demam# &atig%e# BB t%r%n#anore"!ia

Arteri*arteri $aEah

"a%di"a!io mandib%a

Chronic imb i!chemia ,er%tama arteri e"!tremita! ba$ah !eteah "e%ar daripercabangan aortoiia"a :a( Iia"a# a( Kemorai!# a( ,ibiai!# a(8or!ai! pedi!<8'- ABI /2(4

Arteriti! ,a"aya!% Va!"%iti! gran%omato!a !i!temi" aorta dan

percabangannya a( %b"avia + a( Brachiocephaica

a%di"a!io e"!tremita!# p%!a!i a( Bra"hiai!# perbedaan,8 @02 mm5g antara "ed%a engan# br%it a( !%b"avia ata%aorta



Penya"it Jant%ng Re%mati"

• e"%eae demamre%mati" a"%t yangtida" di*t' ade"%at

• 9ani&e!ta!i 02*62 th

pa!ca 8RA• Penya"it Eant%ng

"at%p . S- &%!i "omi!%ra

fish mouth . AI ; 9 . AS ; AI ; 9

o%rce- Vav%ar 5eart 8i!ea!e( iy ( Pathophy!ioogy o& 5eart 8i!ea!e( 1th ed( =22?(

abatine 9( Poc"et 9edicine( 1th ed( =200(



)ndo"arditi! In&e"ti&

o%rce- e'ton 8J( 8iagno!tic Approach to In&ective )ndocarditi!( Avaiabe at-



Penya"it Eant%ng re%mati" Penya"it Eant%ng "at%p :9# A# AI<# ri$ayatdemam re%mati" a"%t# t' tida" ade"%at

Peri"arditi! Nyeri dada taEam# menEaar "e m( ,rapezi%!# S dgre!pira!i# dg d%d%" "e depan#Pericardia &riction r%b ;3*( )&%!i peri"ardia ;3*

)G- , eeva!i di&%!# o$ MR bia e&%!iperi"ardia

9yo"arditi! T peri"arditi! ; S ,roponin,anda*tanda C5K



Penya"it Jant%ng ongenita



P8A

• P8A "eci- a!imptomati"• P8A be!ar- !imptomati"

IS4B berulan(# takikardia3poor )eedin(3 #lo$ (ro$th . S airan "e par%

. %!ia = . 6 b%an !aat

tahanan va!"%er par%t%r%n

• Pira% dari "iri "e "anan be!ar beban vo%me V + A diata!i A# V e&t heart&ai%re

• Hiperten#i pul"onal tahanan va!"%er par% tinggi

penya"it va!"%er par% reversed shunting #iano#i##iano#i#

.#.#indro"a Ei#en"en(er0

BA5I 4REATUR• otot poo! va!"%er par% be%m

!emp%rna• tahanan va!"%er t%r%n ebih cepat

• gaga Eant%ng ebih a$a

o%rce- Congenita 5eart 8i!ea!e( Pathophy!ioogy o& 5eart 8i!ea!e( =22?(



Patent 8%ct%! Arterio!%!

PDA kecil murmur kontinyu – machinery murmur

pirau kiri - kanan saat fase sistolik dan diastolik

PDA besar – PH

pulsus celler S2 (P2) keras murmur kontinyu

pirau masih kiri - kanan

fase sistolik dan diastolik murmur sistolik

pirau kiri - kanan hanya

fase sistolik tidak terdengar murmur murmur diastolik awal

aliran melewati katup mitral

%b"avia !ini!tra

o%rce- Roebiono P( Penya"it Jant%ng Ba$aan- ect%re( =224(



Ca%dicatio intermitten

• Intermittent ca%dication a"ibat dari ob!tr%"!iairan darah oeh atheroma! pada arteri !edang

dan be!ar

• 4ento1i)%lline # a 'anthine derivative# i! tho%ght

to act by red%cing the vi!co!ity o& bood#ao$ing it to &o$ more ea!iy thro%gh partiay

ob!tr%cted area!(

• Cilo#ta6ol# a pho!phodie!tera!e type 6 :P8)6<

inhibitor# i! poory %nder!tood# b%t may have

!eective antipateet and va!odiating e&&ect!(



HeArt 5ailre



Gaga Jant%ng anan

• Cor p%monae- RV enargement ec

primary lung disease RV hypertrophy RV &ai%re• )tioogy-

. P%monary inter!titia di!ea!e- COP8#a!thma# inter!titia %ng di!ea!e

. P%monary va!c%ar di!ea!e- p%monary5,# P)

. 9echanica ventiation- "ipho!coio!i!#obe!ity# OA# ne%rom%!c%ar

• ign! + !ymptom! . H%po1ia tachycardia# cyano!i!# c%bbing . RH7 R7 li)t

. S loud 4,3 ri(ht #ided S8 . R7 )ailure bac"$ard &ai%re

S JVP# hepatomegay :to cardiaccirrho!i!<# a!cite!# peda edema

tric%!pid reg%rgitation RA diation right !ided 1 gaop

o%rce!- abatine 9( Poc"et 9edicine( 1th ed( =200(



Gaga Jant%ng anan

• )CG- RV5:RA8# R@ V0<#

tachyarrythmia

• Ro- RV5 :boot*

!haped# ape"!

terang"at<

De)ibrila#i



De)ibrila#i



o%rce- Jone! A( )CG Note!- Interpretation and 9anagement G%ide( =22>



8r%g! &or 5eart Kai%re

9olon(an Sub 9olon(an Sediaan

Inotropi" Gi"o!ida Eant%ng Agoni! F*adrenergi"Inhibitor

&o!&odie!tera!e

8igitai!# 8igo"!in# 8igito"!in8ob%tamin Amrinon# 9irinon

8i%reti" oop di%reti",iazid

K%ro!emid5C,B%metanid

9etoazon

Va!odiator AC) inhibitor Rea"!a!i otot poo!ang!%ng

Captopri# )naapri# Ko!inopri# M%inapriNa nitrop%!id# 5idraa!in# I!o!orbid9ino"!idi# Amodipin# Keodipin



Indi"a!i

Gi"o!ida• Conge!tive heart &ai%re

• 8epre!i nod%! AV :pada ta"i"ardi

!%praventri"e paro"!i!ma<



8igo"!inhati*hati pada GAGA GINJA

do!i! dit%r%n"an

8igito"!in

hati*hati pada GANGGHAN KHNGI5)PAR



)RACHNAN 8IGI,AI

G)JAA• )"topi" ventri"e# di!ritmia ventri"e#

ta"i"ardi atria paro"!i!ma dengan

bo"# bo" Eant%ng deraEat = ata% 6:"ompet<

• Anore"!ia# N3V# nyeri abdomen

• Per%bahan per!ep!i "%ning*hiEa%#ha%!ina!i vi!%a# p!i"o!i!





P)NGOBA,AN )RACHNAN 8IGI,AI• top gi"o!ida + di%reti"a yang "e%ar ;

• Ra$at ICH

•)G "ontiny%

• Beri &enitoin# ido"ain# pro"ainamid %nt%"

ta"iaritmia

• Beri ai%m bia AV bo"# "ontraindi"a!i

• Beri Ig antidigo"!in

• 5indari "ardiover!i ee"tri"



Anti Aritmia

Ob t A ti it i



Obat Antiarit"ia

9olon(an obat ekani#"e !er:a 2 &ontoh obat

ea! I Obat*obat yang men%r%n"an re!pon membran mea%i bo"ade"ana Na# di"eompo""an !e!%ai e&e"nya pada repoari!a!i- A(%inidin# pro"ainamid# di!opiramidB(ido"ain# &enitoin# to"ainidC()"ainid# &e"ainid

ea! II Obat*obat yang menghambat a"tivita! !impati" mea%i inhibitor Fadrenergi"- A(PropanooB(Obat F bo"er !eEeni!

ea! III Obat*obat yang memperpanEang poten!ia a"!i- A(AmiodaronB(Bretii%m

ea! IV Obat*obat yang menghambat airan ma!%" Ca yang ambat- A(Verapami

B(Obat bo"er "ana Ca













A ti it i i di k i



Antiarit"ia %an( #erin( dipakai

9olon(an 4reparat

Inhibitor "ana Na %inidin# Pro"ainamid# 8i!opiramid# Aprindinido"ain# 9e"!iatin# Kenitoin# ,o"ainid

Inhibitor "ana Ca AmiodaronVerapami# 8itiazem

impatopegia Propanoo# Bretii%m

Indi"a!i



Indi"a!i

%inidin• Aritmia ventri"e + e"topi" ventri"e

• K%tter :Atria Kibria!i< !ebe%mnya

diberi digitai! ata% β blo6er nt6!indari vagoliti6 pada nods A0

7 Kontra6si prematr atrial

Pro"ainamid :T "%inidin<



8i!opiramid• ,a"i"ardi ventri"e

7 Kontra6si e6topi6 ventri6el



ido"ain• 8i!ritmia ventri"e

Kenitoin

• 8i!ritmia ventri"e pada "erac%nan

digitai!



Bretei%m• Aritmia ventri"e di ICH

Amiodaron

• 8i!ritmia atria + ventri"%ar yang

re!i!ten terhadap obat



)iabetes



In!%in



In!%in

%mber- on!en!%! Pengendaian dan Pencegahan 8iabete! 9eit%! ,ipe = di Indone!ia( P)R)NI =22D(



A8 +



A8 +

55o%rce- Wo!dor& J(# et a(

IPA8 Cinica Practice

Con!en!%! G%ideine! =22D*=22?- 8iabetic "etoacido!i!(

9anaEemen 55



9anaEemen 55

•Rehidra!i agre!i& • 0*6 N 2(4X = Eam

. Ji"a Na;@0>2- ar%tan hipotoni" NaC2(1>X

•Pa!ca hemodinami" !tabi- menggantide&i!it cairan 7*02 daam 0*= hari . NaC 2(1>X a% 8>W

. In&%!ion rate! o& =22.622 m3h o&hypotonic !o%tion

• In!%in :!hort acting< . Bo%! 02 IH ata% 2(0> IH3"gBB

. 8rip 2(0 IH3"gBB3Eam

o%rce!- 8iabete! 9eit%!( 5arri!on! Principe! o& Interna 9edicine( 0? th )d( =227(

Pet%nE%" Pra"ti! ,erapi In!%in pada Pa!ien 8iabete! 9eit%!( P)R)NI =22?(



)islipidemia

5ipertrigi!eridemia



5ipertrigi!eridemia

9anaEemen 8i!ipidemia-0( ,ent%"an !a!aran 8

=( 9odi&i"a!i gaya hid%p D mingg%

6( ,erapi &arma"oogi!0( 8

=( ,G

Ei"a @ =22 pa!ca !a!aran 8 tercapai# 8 dosisstatin ata tamba!6an asam ni6otinat:;brat Hiper+, s*d* <=>. mg:dL# statin dptdigna6an

Hiper+, <?.. mg:dL

trn6an +,@

;brat6( 58

I& i!oated o$ 58 in C58 e%ivaent- nicotinicacid# &ibrate

o%rce!- Pet%nE%" Pra"ti! Penataa"!anaan 8i!ipidemia( P)R)NI =221(

Nationa Choe!tero )d%cation Program( Cinician! Poc"et Re&erence( =22?(



o%rce!- Pet%nE%" Pra"ti! Penataa"!anaan 8i!ipidemia( P)R)NI =221( Nationa Choe!tero )d%cation Program( Cinician! Poc"et Re&erence( =22?(



5iper*8 ata% 5iper o*, aspan lema6 total lema6



9anagement o& 8y!ipidemia in Ad%t!( Am Fam Physician( 0447

Cen!

5iper*,G a!%pan "arbohidrat# a"oho# ema"

)&e" obat terhadap "adar ipid !er%m



)&e" obat terhadap "adar ipid !er%m

:per"eni<

Obat !ol-LDL !ol-HDL T9

tatin ?@- ↑ >*0>X ↓ ?*62X

Re!in ?->< ↑ 6*>X * 3 ↑

Kibrat ↓ >*=>X ↑ 02*=2X ,<-<

A!am ni"otinat ↓>*=>X ↑ 0>*6>X ,<-<

Penghambatab!orb!i "oe!tero

?-?@ ↑ 6*1X *

Statin# .H9-CoA Redu&ta#e Inhibitor#0



Co""on eature#

• 8ecrea!e 8 + V8• It i! !tandard therapy to initiate

red%cta!e inhibitor therapy immediatey

a&ter myocardia in&arction# irre!pectiveo& ipid eve!

• Hepatotok#ik3 rhabdo"%ol%#i#



Kib t



Kibrate

• H%pertri(l%&eride"ia dimana V8predominan dan

dy!betaipoproteinemia(





+!%roid Endocrinelain

Grave! 8i!ea!e



Grave ! 8i!ea!e

• A%toimm%ne thyroid*!tim%ating Ig :TSI<#antithyrogob%in# ANA

• Ca%!e! D2*72X o&thyroto'ico!i!

• Kemae-mae T >*02-0#12*D2 y

• Cin( 9ani&e!ta!ion- . Di))u#e3 nontender

(oiter Th%roid bruit .+0 . Papitation# !$eating#

an'io%!ne!!# &atig%e#$ea"ne!!# $eight o!!#

diarrhea#oigomenorrhea

. Ophtamoogy . Pretibia my'edema . P%mmer! nai

Ophtamoogy-

preorbita

edema#

conE%nctiva

inEection#

propto!i!

eparated

&ingernai! &rom

naibed




o%rce- ,hyroid Gand 8i!order!( 5arri!on! Principe! o& Interna 9edicine( 0?th )d( =227(

retini!me



retini!me

• 5ipotiroidi!me "ongenita#bayi# ana"• )tioogi- de&i!ien!i iodine#• 9ani&e!ta!i "ini!-

. Gangg%an pert%mb%hant%ang !hort !tat%re#coar!e &acia &eat%re!#short stature

. Gangg%an per"embanganP retarda!i menta t(%( In %tero

. Coar!e &acia &eat%re! . Protr%ding tong%e

o%rce!- Robbin! + Cotran! Pathoogic Ba!i! o& 8i!ea!e( ?th ed( =22>(

Bate! G%ide to Cinica )'amination(



8$ar&i!me 8$ar&i!me pit%itari- !hort !tat%re ec de&i!ien!i gro$th hormone8$ar&i!me ec a"ondropa!ia- !hort !tat%re ec gangg%anpemanEangan t%ang pada ca"ram epi&i!i!

Giganti!me 5iper!e"re!i gro$th hormone pada ana" :!ebe%m pen%t%panca"ram epi&i!i!<

A"romegai 5iper!e"re!i gro$th hormone !eteah pen%t%pan ca"ram epi&i!i!9i"ro!e&ai H"%ran "epaa / *= 8

9i'edema 5ipotiroidi!me pada remaEa ata% de$a!a8itandai dengan meambatnya a"tivita! &i!i" dan menta# &atig%e#apati!# intoeran !%h% dingin# over$eight# !e!a" napa!# edema#broadening and coar!ening o& &acia &eat%re!# idah membe!ar#!%ara !era" dan daam :h%!"y voice<

Creatinine ina!e



Creatinine ina!e

• I!oenzim C- . C!-B .:antun(# N /DX< 8 pada AMI9 miokarditis9

peri6arditis dgn mio6arditis9 r!abdomiolisis9 crushinjury

D CK-MM (otot rangka9 F /?-1..G S pada crushinjury # "eEang# hipertermia maigna# inEe"!i I9

. C!-BB .otak# N T 2X< S pada &edera otak :CVA#tra%ma<# hipertermia maigna# in&ar" "oon

o%rce- Gomea G# 5ai!t A( Cinician! Poc"et Re&erence( 00th ed( =22?(



Kass Par

a!%! Gaga Pengobatan



a!%! Gaga e goba a

Feni# !a#u# De)ini#i

!a#u# baru Pa!ien yang tida" pernah mendapat terapi ,B ata%pernah mendapat terapi /0 b%an

!a#u# ka"buh Pa!ien yang pernah dinyata"an !emb%h# timb% agi,B a"ti&

!a#u# (a(al .smear positive failure0

• Pa!ien yang !p%t%m B,A tetap po!iti& !eteahmendapat OA,@ > b%an# ata%• Pa!ien yang menghenti"an pengobatannya !eteahmendapat OA, 0*> b%an dan !p%t%m B,A ma!ihpo!iti&

!a#u# kronik Pa!ien yang !p%t%m B,A*nya tetap po!iti& !eteahmendapat pengobatan %ang :retreatment < eng"apyang di!%pervi!i bai"

DR-TB Re!i!ten!i terhadap ri&ampi!in dan IN5 ;3* OA, ain

%mber- ,%ber"%o!i! Pedoman 8iagno!i! + Penataa"!anaan di Indone!ia( P8PI =22D(

ategori OA,



g


5epatiti! Imba! Obat pada ,erapi ,B




pirometri



• PPO- K)V03KVC /?2X

• 8eraEat- K)V0

"orce# ,lobal "trateg% 'or t!e )iagnosis9 (anagement9 and Prevention o' &!ronic Obstrctive Plmonar)isease* ,OL) ..3*

Bron"ie"ta!i!



• 8iata!i bron"hi abnorma +permanen pooling materiap%r%en

• In&ama!i + de!tr%"!i !a%rannapa! %"( menengah &ibro!i!#em&i!ema# bron"opne%monia#

ateeta"!i!• )tioogi-

. In&e"!i- P. aeruginosa, H.influenza

. Non*in&e"!i- ga! ammonia# a!pira!ia!am amb%ng

• 9ani&e!ta!i "ini!- bat%" p%r%enber%ang*per!i!ten# hemopti!i!

• PK- rhon"hi# $heezing• 8'- ro# CT .(old #tandard0

"orce# Bronc!iectasis* Harrison2s Principles o' $nternal (edicine* 13! ed* ..4*



,B $ith m%tipe nod%e!

•9igratory bronchopne%monia•9%tipe nod%e! hea $ith @@@ caci&ied gran%oma! :TB

granulomas are usually 1 or 2 in number•5i!topa!momaTtarget calcification!bull"s#eye calcification in center

o& nod%e :Pathognomonic<

III*learningradiolog%*com

A!ido!i! Re!piratori"



p

Di#order 4roble" Etiolo(% 4h%#i&al )indin(#

9etaboicacido!i!

Gain o& 5; oro!! o& 5CO6*

8iarrhea# R,A# A8#actic acido!i!

%!!ma% re!piratory#dry m%co%! membrane#!peci&ic phy!ica &indingto it! ca%!e

9etaboica"ao!i!

Gain o& 5CO6* or o!! o& 5;

o!! o& ga!tric !ecretion:vomiting<# thiazide3oopdi%retic!

,etany# Chvo!te" !ign#!peci&ic phy!ica &indingto it! ca%!e

Re!piratoryacido!i!

5ypoventiation :CO=

retention<

COP8# a!thma# CNdi!ea!e# OA

8y!pnea# an'iety#cyano!i!# !peci&ic

phy!ica &inding to it!ca%!e

Re!piratorya"ao!i!

5iperventiation :CO= o!!<#

high atit%de

5ypo'ia tachypnea

pne%monia# p%m(

)dema# P)# re!trictive%ng di!ea!e

5yperventiation#cardiac rhythmdi!t%rbance



Pen%a6it Hepar

I"ter%! Ob!tr%"ti&



oe!i!titi! A"%t et ca%!a oeithia!i!



• )c ob!tr%"!i d%"t%! !i!ti"%!:bia!anya pada 5artmann! po%ch<

• 9ani&e!ta!i "ini!- . Nyeri per%t "%adran "anan ata!#

inten!ita! + d%ra!i @ epi!ode "oi"biier !ebe%mnya

. 8emam# m%a# m%ntah . 9a!!a ; nyeri te"an "%adran "anan

ata! abdomen# ba$ah iga "anan . 8e&an! m%!"%er . $urphy"s sign :) T D>X# P T 7?X<

• 8'- US9 hepatobilier . oeithia!i!- !en!iti& + !pe!i&i"

. oe!i!titi!- penebaan dinding @> mm#cairan peri"oe!i!ti"# 9%rphy!onogra&i"

HG- po!terior aco%!tic !hado$

+ 9%rphy HG

"orce# Biiary !y!tem( abi!ton! te'tboo" o& !%rgery- the bioogica ba!i! o& modern !%rgica practice( 07th ed( =22?(

NEJM ..4J=>4#4.?

)n!e&aopati 5epati"



p p

• egagaan hatimemetaboi!me N56 ;!%b!tan!i ain edema!erebri ; &a!ene%rotran!mitter

• Pemic%- S ammonia :inta"e#!ir"%a!i enterohepati"<

• Clinical dx ∆MS +asterixis

7 +# protein9 la6tlosa9ri'aimin7 Pro;la6sis o# la6tlosa

ri'aimin

"orce# "abatine ("* Poc6et (edicine* ?t! ed* .11*

Pan"reatiti! A"%t ec oeithia!i!



• )tioogi- bat% emped%:12X<#a"ohoi!me :62X<

• 9ani&e!ta!i- nyeriepiga!tri%m menEaar "ep%ngg%ng# ter%!*

mener%!# dg bng667 Lab#

D 8 amilase9 lipase . G S94T >1 "en%okon(

pankreatiti# e& (all#tone

. AP# biir%bin tida"!pe!i&i"

"orce# "abatine ("* Poc6et (edicine* ?t! ed* .11*

Abses %epar



p

• 9ani&e!ta!i "ini!

. Amoebia!i! inte!tina ulku#ber(aun( .flask-shaped ulcer) diare berdarah

. Amoebia!i! e"!trainte!tina menemb%! dinding coon !i!temi"

• A"oebi& li'er di#ea#e .ab#e# hepar0

demam menetap# nyeri epiga!tri%m#diare

• 8'- . 8i!enteri amoeba- &e!e! tro)o6oit

%an( "en(andun( RBC di &e!e!#PCR# %Ei antigen &e!e!

. Amoebic iver di!ea!e US9##erolo(i3 "ikro#kopi #ediaana#pira#i

• ,'- . etronida6ole > 1 < "( -?< hari

o%rce!- Robbin! + Cotran! Pathoogic Ba!i! o& 8i!ea!e( ?th ed( =22>(

%!anto# ( Para!itoogy ect%re ga!trointe!tina mod%e( Kac%ty o& 9edicine Hniver!ity o& Indone!ia(

5epatiti! A"%t

5 titi A



5epatiti! A

• Keca*ora• No

chronicity . Ig9-

ac%tein&ection

. IgG- pa!t

in&ection

5epatiti! B



5epatiti! B• Bood# !e'%a#

perinata

• Inc%bation 0*D :=*6< mo

• Ac%te in&ection- . < #ub&lini&al . 62X Ea%ndice . 0X &%minant

hepatiti!

• Chronicity . >X :ad%t*

ac%ired< . 42X :perinatay

ac%ired< . Cirrho!i!- =2*62X

o& chronic hep B

"orce# "abatine ("* Poc6et (edicine* ?t! ed* .1

Acte 0iral Hepatitis* Harrison2s Principle o' $nternal (edicine* 13t! ed* .

eroogi + Viroogi 5BV



4etanda Interpreta#i

5B!Ag In&e"!i a"ti&3!edang berang!%ng( 9%nc% !ebe%m geEaa= m%nc%

5BeAg B%"ti repi"a!i vir%! dan in&e"tivita!

Ig9 anti*5Bc In&e"!i a"%tWindo$ period :5B!Ag :*<# anti*5B! not yet :;<

Anti*5B! Re!o%!i penya"it a"ti& Petanda im%nita! :petanda t%ngga pa!ca im%ni!a!i<

IgG anti*5Bc In&e"!i 5BV ampa% :5B!Ag :*<< ata% "roni! :5B!Ag :;<<

IgG anti*5Be Repi"a!i vir%! //# in&e"tivita! //

5BV 8NA Repi"a!i a"ti& vir%! di hepar

"orce# "abatine ("* Poc6et (edicine* ?t! ed* .1

5epatiti! C



5epatiti! C /.G

trans'sion9>.G $)

Little evidenceo' seal orperinataltransmission

$ncbation 1->M mo

Acte in'ection# 75%

subcinica >G Candice

&!ronicit% >.G &irr!osis# .G

o' c!ronic"orce# "abatine ("* Poc6et (edicine* ?t! ed* .1

Acte 0iral Hepatitis* Harrison2s Principle o' $nternal (edicine* 13t! ed* .

Bari%m )nema . Ca oore"ta



• IB8- S ri!i"o• GeEaa-

. oon di!ta- per%bahan poade&e"a!i# ob!tr%"!i# "oi" abdomen#hematochezia

. oon pro"!ima- anemia de&( Be!i#

nyeri dull # &e!e! cair • ,%mor mar"er- CA 04*4• creening-

. Bari%m enema Se <-< . oono!"opi god !tandard %t"

!creening e 42X

. C, "oonogra&i

• 8'- Biop!i "oono!"opi

Bari%m enema double

contrast& "ar!inoma an%ar

"on!tri"ti&- apple core'

lesion

o%rce!- ieberman 8A( creening &or coorecta cancer( N)J9 =2246D0-00?4(

$$$(earningradioogy(com



Rea"!i 5iper!en!itivita!

T%pe4rotot%pe

I""une e&hani#"# 4atholo(i& Le#ion#



T%pe%p

Di#order I""une e&hani#"# 4atholo(i& Le#ion#

,ipe I Immediate

Anaphya'i!aergie! bronchiaa!thma :atopic&orm!<

Prod%ction o& Ig) antibody immediateNreea!e o& va!oactive amine! and othermediator! &rom ma!t ce! recr%itment o&in&ammatory ce! :ate*pha!e reaction<

Va!c%ar diation#edema# !mooth m%!cecontraction# m%c%!prod%ction# in&ammation

,ipeII

Antibody*mediated

A%toimm%nehemoytic anemiaGoodpa!t%re!yndrome

Prod%ction o& IgG# Ig9 bind! to antigenNon target ce or ti!!%e phagocyto!i! orNy!i! o& target ce by activatedcompement or Kc receptor! recr%itment

o& e%"ocyte!

Ce y!i! in&ammation

,ipeIII

Imm%necompe'mediated

y!temic %p%!erythemato!%!!ome &orm! o&gomer%onephriti!!er%m !ic"ne!! Arth%! reaction

8epo!ition o& antigen*antibody compe'e!compement activation recr%itment o&N N

e%"ocyte! by compement prod%ct! andKc receptor! reea!e o& enzyme! andNother to'ic moec%e!

Necrotizing va!c%iti!:&ibrinoid necro!i!<in&ammation

,ipeIV

Ce*mediated:deayed<

Contact dermatiti!m%tipe !cero!i!type I# diabete!tran!pantreEection

t%berc%o!i!

Activated , ymphocyte! i< reea!e o&Ncyto"ine! and macrophage activation ii<, ce*mediated cytoto'icity

Periva!c%ar ce%arin&itrate! edema cede!tr%ction gran%oma&ormation



8iagno!i! Banding Arthriti!



OA RA 9out

Patoogi degenerati& Pann%! 8epo!i!i "ri!ta %rat:mi"rotophi<

On!et grad%a Grad%a A"%t

In&ama!i :*< :;< :;<

o"a!i Pangg%# %t%t#vertebra

9CP# PIP# $ri!t#an"e# "a"i

9,P# "a"i# an"e#

eteribatan !endi Poi Poi# !imetri! 9ono

,em%an "ha! Nod%! Bo%chard#5eberden

8evia!i %nar# !$annec"# bo%tonniere

ri!ta %rat

)"!traarti"%er * Nod% !%b"%tan#p%moner# "ardia"#!penomegai

,ophiBat% ginEaB%r!iti! oe"ranon

ab dbn RK :;<# anti*CCP :;< S a! ( Hrat


Go%t



Chronic Go%t



7 (ani'estation# top!i9 nep!rolit!iasis9 brsitis9 c!ronictop!aceos got

&!ronic treatment#7 rate prodction MloI prine diet

7 M- de!%dration drgs Mt!ia"id9 oo# diuretic9#$ra"inamide7 &ro#!$axis 'reent attac6 I!en starting

anti!%perricemic t!erap% M"A$)9 colc!icine

7 Anti!$#eruricemic goal A Q mg:dL

D $'# top!i M9 nep!rolit!iasis M9 or 'reent attac6 Mmin* attac6s9 ric acid </ mg:dL

D ant!ine oidase in!ibitor Mao#urinoD ricosric M#robenecidDo not start w/o prophylaxis & until 2-4 wk after acute attack


Go%t and Other Cry!ta Arthropathie!( 5arri!on! Principe! o& Interna 9edicine( 0?th ed( =227(

Rhe%matoid Arthriti!



• ign!- &hroni&##%""etri& pol%arthriti#

• Pathoogy- In&ammatory#proi&erative !ynoviati!!%e :pann%!<

&ormation<# idiopathic#genetic

• 4ain3 #$ellin(3 "ornin(#ti))ne## ? h

• PIP# 9CP# $ri!t!# "nee!#an"e!# 9,P!# cervica!pine

• Joint de&ormitie!




o%rce- Aetaha et a( =202 Rhe%matoid arthriti! ca!!i&ication criteria( Arth (heum( =202

eptember?D-=>D4.70(







Hematologi

Anemia



Anemia Apa!ti"



• Hipo#elularita# !%m!%m t%ang

• 4an#itopenia . Anemia . e%"openia in&e"!i ber%ang . ,rombo!itopenia petechiae# p%rp%ra

• Bimoda pea" remaEa + an!ia• )tioogi-

. Idiopati" . 8e!tr%"!i !e p%nca- radia#i# ke"o# "imia

:benzen< . R' obat idio!in"rati"- klora")enikol#

NSAID# #ul)a# prep( )ma!# "arbamazepin . 7iru#- 55V*D# 5IV# )BV# parvo*B04#

po#thepatiti# .non A3 B3 C0

• 8'- . Pan!itopenia dg RI /=X . Biop!i !%m!%m t%ang

%m!%m hipoproi&erati&# diganti"an

oeh Earingan ema"


Anemia 9egaoba!ti"



ANEIA A!ROSITI!

• nemia megalo!lastik gangg%an !inte!i! 8NA . De)i#ien#i a#a" )olat

• 9an%tri!i :a"ohoi"# vegan<• Ggn metaboi!me &oat :pirimetamin#

trimetoprim<

7 8 demand M!amil9 dialisis . De)i#ien#i B?, neuropati

:peri&er# "o%mna aterai! +po!terior tra"t%! !pinothaami"%!#"orte"! !erebri< baa# pare!te!i#!en!a!i po!i!i + vibra!i# demen!ia#ata"!ia

• 9an%tri!i :a"ohoi"# vegan<• Anemia perni!io!a• Ga!tre"tomi #Crohn!# !pr%e

• nemia non-megalo!lastik - iverdi!ea!e# a"ohoi!me

H"%ran eritro!it @ im&o!it# ova :ma"ro*

ovao!it<


9%tipe myeoma



p y

• 9aignan!i !e B Ab mono"ona Ig9• GeEaa-

. Proi&era!i !e pa!ma di !%m!%m t%ang ane"ia . Le#i litik tulan( n%eri tulan(# )raktur ko"pre#i3

hiperCa,+

. In)ek#i berulan( ec hipogammagob%inemia . 9in:al protein light chain to"!i" thd ginEa gaga

ginEa# !indroma ne&roti"

• )e"tro&ore!i! 5b- Ben&e-Fone# protein :ight chain<

• 5ap%! darah tepi- ro%ea%'• Biop!i !%m!%m t%ang- pa!ma!ito!i! @02X




9%tipe p%nch*o%t e!ion! O!teopenia

Kra"t%r "ompre!i

o%rce- $$$(earningradioogy(com



ani)e#ta#i

Kra"t%r"ompre!i

O!teodi!tro&iginEa

Reten!i &o!&at

hiper&o!&atemia

hipo"a!emia hiperP,5

!e"%nder

O!teopenia * o!teoporo!i!

train %mba Nyeri ec regangan padaotot

Nyeri ber%bah dengan pergera"an

O!teomieiti! In&e"!i t%ang ,anda*tanda in&ama!i# demam# e!i iti"t%ang o!teopenia# hiper"a!emia

o%rce!- ,he Pediatric Orthopaedic ociety o& North America(

=20=(

Idiopathic Thrombocytopenic Purpura *ITP



• Tro"bo#itopenia /022#2223mm6• 02X I,P ; anemia hemoiti" a%toim%n +van"s syndrome• )tioogi

. Primer - d' e"!"%!i

. e"%nder- vir%! :5IV# 5CV# 5BV# )BV<# %) Pylori # ANA . Ana"- a"%t pa!ca in&e"!i . 8e$a!a- "roni"

• 9ani&e!ta!i "ini!- perdarahan m%"o"%tan# petechiae#p%rp%ra( Perdarahan !pontan bia ,r /=2#2223mm6

• Pemeri"!aan ab . B,# C, . 5ap%! darah tepi- "e(akario#it . Biop!i !%m!%m t%ang- 8 mega6ariosit

8iate!i! Perdarahan ain



He"ol%ti& Ure"i&S%ndro"e

Thro"boti&Thro"bo&%topeni&

4urpura

8e&ini!i eainan o"%!i& va!"%erec agrega!i pateet

intrarena

eainan o"%!i& va!"%er ecagrega!i pateet !i!temi"

)tioogi higa to'in a"tivita! protea!e **@ vWKdi endote agrega!i

pateet

)pidemioog

i

Ana"# didah%%i diare

berdarah ec )5)C

8e$a!a

9ani&e!ta!iini!

,ria! 5H:trombo!itopenia ;anemia hemoiti"mi"roangiopati" ; gaga

ginEa

Pentad ,,P:trombo!itopenia ; anemiahemoiti" mi"roangiopati" ;Y 9 ; gaga ginEa ;

demam<



4atolo(i ani)e#ta#i

Anemiahemoiti"a%toim%n

A%toim%n:Idiopati"# )# obat :!%&a#ri&ampi!in# %inidin# NAI8#d<<

Anemia

Anemiaapa!ti" 5ipoproi&era!i !%m!%m t%ang Pan!itopenia

im&oma 9aignan!i!e*!e im&oid di Earingan im&oid

im&adenopati#demam# "eringatmaam

e%"emia 9yeoproi&era!i e%"o!ito!i! ;bi!itopenia



(alaria

9aariaBerat



Berat

o%rce- G%ideine! &or the treatment o& maaria( =nd ed( W5O =20

,ataa"!ana 9aaria Berat



Arte"i#inin I7=I• Arte!%nat IV ata% I9 =(1 mg3"gBB :dibagi = do!i!<

pada 2# 0=# =1 Eam# !eanE%tnya 0(= mg3"gBB d !(d(pa!ien dapat min%m obat :hari 1*><

atau• Artemeter I9 6(= mg3"gBB :dibagi = do!i!<#

!eanE%tnya 0(D mg3"gBB d !(d( Pa!ien dapatmin%m obat ora

ACT lan:utan .4O0

• Artemi!inin ; amodia"%in 6 hari atau• %inin ; tetra!i"in3do"!i!i"in3"indami!in ? hari

o%rce!- G%ideine! &or the treatment o& maaria( =nd ed( W5O =20

9aaria Berat( %doyo AW# d""( B%"% AEar Im% Penya"it 8aam( )di!i IV( =22

Peny%it 9aaria



Bla&k $ater)e'er Ac%te intrava!c%ar hemoy!i! ca!!icay occ%ring a&terthe re*introd%ction o& %inine in ong*term re!ident! inPa!modi%m &acipar%m endemic area! and repeatedy%!ing the prod%ct( 0

CINICA PROKI)- ,he !ymptomatoogy appear!br%tay $ith emi!!ion o& porto*coored %rine# icter%!#

paor# na%!ea# &ever and ac%te rena &ai%re(0

Al(id alaria A rare compication o& tropica maaria and it occ%r! in2(6?X o& ca!e!( Agid maaria i! characterized byhemodynamic di!order! a! !hoc" $ith prono%ncedmetaboic change! and hypothermia(=

A !yndromic diagno!i! o& varying etioogy :dehydration#bacteria in&ection# beeding and3or adrena in!%&&iciency<(6

o%rce- 0< Br%nee K# et a( Bac" $ater &ever( Presse $ed) =22= ep ?60:=7<-06=4*61(

=< Popov AK( Agid maaria( $ed Parasito *$os,( =22> Jan*9ar:0<-02*=(

6< acerda 9V( Agid maaria- a !yndromic diagno!i!( (ev -oc Bras $ed Trop( =224 Jan*

Keb1=:0<-?4*70(

9aaria tertiana :viva'<









PerEaanan Penya"it 9aaria

I#tilah De)ini#i



I#tilah De)ini#i

erangan primer Periode m%ai dari a"hir ma!a in"%ba!i hingga m%ai

terEadi !erangan paro"!i!ma :tria! dingin# menggigi#demam + ber"eringat<

Periode aten Periode a!imptomati" tanpa para!itemia# antara d%a"eadaan paro"!i!ma

Re"%ren!i Ber%angnya para!itemia a!e"!%a !eteah pengobatan(8apat di!ebab"an oeh re"r%den!i# reap! :P( viva' dan P(ovae<# ata% in&e"!i bar%

Re"r%den!i Ber%angnya para!itemia a!e"!%a :dengan in&e"!i yang!ama< pa!ca pengobatan( A"ibat "iren! para!itemia

in"ompit "arena pengobatan yang tida" ade"%at(

Reap!e3rech%te Ber%angnya para!itemia a!e"!%a pada maaria P( viva'dan P( ovae yang dorman :hipnozoit< di hati(8apat terEadi daam interva mingg%*b%an(

o%rce!- G%ideine! &or the treatment o& maaria( =nd ed( W5O =202(



+i'oid

8emam ,i&oid



6?2C122C

Co"pli&ation#

Da% -? Da% < Da% Da% ,?

In&ubationperiod

A!ymtomatic

In'a#i'e pha#eIntermitent &ever

5eadache

Kati%e

Abdomina di!com&ort

Con!tipation

8iarrhoea

To1i& pha#eContin%o%! &ever

Bradycardia

5epatomegay

penomegay

Con!tipation

8iarrhoea

Ro!e !pot

Con'ale#&en&eperiod

o%rce!- 5adinegoro R( Kever in Chidren- ect%re( K9HI(=202

Bood c%t%re

Keca c%t%re



• 8' method!- c%t%re o& bood# !too# %rine# d%odena :bie< a!pirate# B9a!pirate !pecimen

• Bood c%t%re- main!tay &or d' e 8 a'ter da%-3• God !tandard- B9 a!pirate• Wida-

. Pening"atan @1' ipat !eteah 0 mingg% menega""an d' . HEi t%ngga dengan titer O 036=2 ata% 5 03D12 ; "ini! menyo"ong d'

o%rce!- Bac"gro%nd doc%ment-,he diagno!i!# treatment and prevention o& typhoid &ever( W5O =226(

Pand%an Peayanan 9edi"( PAP8I =224(



)enge



Amoebic Liver .isease



• 9ani&e!ta!i "ini!

. Amoebia!i! inte!tina

ulku#ber(aun( .flask-shaped ulcer) diare berdarah

. Amoebia!i! e"!trainte!tina menemb%! dinding coon !i!temi"

• A"oebi& li'er di#ea#e .ab#e# hepar0 demam menetap# nyeri epiga!tri%m#diare

• 8'- . 8i!enteri amoeba- &e!e! tro)o6oit

%an( "en(andun( RBC di &e!e!#PCR# %Ei antigen &e!e!

. Amoebic iver di!ea!e HG##erolo(i3 "ikro#kopi #ediaana#pira#i

• ,'- . etronida6ole >1< "( -?< hari





Helmint!ologi







-chistosoma 0aponicum



• ,e%r- lateral kno!:tonEoan di !at% !i!i<

• 8e$a!a- betina!ea% menempe

pada Eantan pada

"anai! gine"opori!

• 5abitat- vena

me!enteri"a ie%!

%!anto# ( Para!itoogy ect%re ga!trointe!tina mod%e( Kac%ty o& 9edicine Hniver!ity o& Indone!ia( =22?

C8C( aboratory identi&ication o& para!ite! o& p%bic heath concern( Avaiabe

-chistosomiasis



• ,ran!mi!i- ho!t !ip%t

!er"aria penetra!i "%itman%!ia

• 9ani&e!ta!i "ini! . A"%t- demam# &%*i"e

!yndrome

. roni"- di!&%ng!i !a%rancerna + hepati"# nyeriabdomen# diare berdarah

• 8'- . 9i"ro!"opi- te%r

. eroogi

• ,'- pra6ikuantel 12*D2mg3"g !at% ata% d%a do!i!

%!anto# ( Para!itoogy ect%re ga!trointe!tina mod%e( Kac%ty o& 9edicine Hniver!ity o& Indone!ia( =22?

C8C( aboratory identi&ication o& para!ite! o& p%bic heath concern( Avaiabe

5IV3AI8



• In&e"!i primer .

Repi"a!i vir%! @@@ ; rapid activation ofC81 e'ha%!tion C81 depetion . A!imptomati"3!imptomati" . A&ute retro'iral #%ndro"e 6*D mg

pa!ca in&e"!i 0*= mg monon%ceo!i!*i"e ine!!

• on!tit%!iona- demam# &%*i"e !y#li")adenopati (enerali#ata• Ne%roogi! :en!e&aiti!# meningiti!#

ne%ropati peri&er<• 8ermatoogi!- rua" "akulolapular

erite"ato#a# ulku# "ukokutan

. Windo$ period - D*0= mingg% !ebe%m Ab :;<• Ka!e aten

. A!imptomati"# &)?• AIDSJ HI7 + CD8 ,<< atau IO

Chronic idney .isease



17( Ac%te idney InE%ry



• G Cr Z>2X &romba!eine# or Sab!o%te by 2(>*0(2mg3d

• Oli(uria . :HO /122 m3=1 h . /2(> m3"g D h<

Anuria :HO /022 m3=1h<





Nephrotic yndrome



• Protein%ria @6(> g3=1 h• 5ypoab%minemia /6(2 g3

• )dema

• 5yperipidemia

• ipid%ria

• Compication- hypercoag%abe !tate#

in&ection# dr%g to'icitie! ec decrea!edprotein binding





A!ido!i! a"tat



Di#order 4roble" Etiolo(% 4h%#i&al )indin(#

9etaboicacido!i!

Gain o& 5; oro!! o& 5CO6*

8iarrhea# R,A# A8#actic acido!i!

%!!ma% re!piratory#dry m%co%! membrane#!peci&ic phy!ica &indingto it! ca%!e

9etaboica"ao!i!

Gain o& 5CO6* or o!! o& 5;

o!! o& ga!tric !ecretion:vomiting<# thiazide3oopdi%retic!

,etany# Chvo!te" !ign#!peci&ic phy!ica &indingto it! ca%!e

Re!piratoryacido!i!

5ypoventiation:CO= retention<

COP8# a!thma# CNdi!ea!e# OA

8y!pnea# an'iety#cyano!i!# !peci&icphy!ica &inding to it!

ca%!e

Re!piratorya"ao!i!

5iperventiation:CO= o!!<# high

atit%de

5ypo'ia tachypnea

pne%monia# p%m(

)dema# P)# re!trictive%ng di!ea!e

5yperventiation#cardiac rhythmdi!t%rbance

ri!i! ,iroid



o%rce!- ,hyroid Gand 8i!order!( 5arri!on! Principe! o& Interna 9edicine( 0?th )d( =227(

5ipo"aemia



• )tioogy- . ,ran!ce%ar !hi&ting- a"aemia#

in!%in . GI o!!- diarrhea# a'ative

ab%!e

. Rena o!!- 8A# R,A# oopdi%retic!# hyperado!teroni!m

• Cin( 9ani&e!tation- na%!ea#vomiting# ileu## $eakne###"u#&le &ra"p# arr%th"ia#

•)CG- &attening o& , $ave . ,inver!ion# H $ave


H%perkale"ia Keakne##3 )la&&id paral%#i#3 nau#ea3 pare#the#ia3palpitation



p pEC9J tall T

5yponatremia H!%a%y $ith Na /0=> m)3- na%!ea# vomiting#con&%!ion# ethargy# di!orientationevere :/0=2 m)3< or abr%pt- !eiz%re# coma# death

5ypernatremia Con&%!ion# irritabiity# ethargy# !t%por# coma# m%!cet$itching# !eiz%re

5ypocacemia 5yperactive deep tendon re&e'# carpopeda !pa!m#Chvo!te" !ign# !eiz%re# tetany# aryngo!pa!m)CG- proonged M, interva

5ypercacemia 5,# hypore&e'ia# S ("E&,# s!ortening o' T+ interval

5ypomagne!emia ,achycardia# tremor# m%!ce t$itching# hyperactive re&e'#tetany# !eiz%re

Documents

Klu Interna & Farmakologi