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7/29/2019 pleno minggu 3

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Plenary Discussion

Group

15 C



Akhmad Syukri Harahap

Doan

Fajar Tri Decroli

Fathiyyatul Khaira

Hedo Hidayat

Maretha Anthiya Tamimi

Melati Setia Ningsih

Nisha Anggia

Osharinanda Monita

Vini Jamarin



Miss Sinef’s Feet and Stomach Ms. Sinef, 16 years, came to the health center with complaints

of leg swollen and distended abdomen since 2 weeks ago. From the

physical examination found ascites and edema of both legs. From thelaboratory results obtained albuminurine++++. The doctor

explained to Ms. Sinef and his family, may have been a "leak" in the

kidneys and advocate for referral to hospital, for further

examination and treatment. At the same time also encountered

patients present with complaints of pain during urination, and withpolyuria. Laboratory results visible sediment+++ leukocytes. The

patient is anxious that jengkol which he ate yesterday cause

infection.

In the hospital, laboratory examination of the Ms.Sinef, withresults Esbach 4gr/24 hours, total cholesterol 950 mg/dl. The doctor

explained to Ms. Sinef about her illness and asked Ms. Sinef

Approval renal biopsy to more accurate diagnosis and management.

How do you explain what happened in the two patients above?



Terminology

• Ascites : accumulation of serous liquid in

peritoneum cavity

• Edema : accumulation of liquid in interstisium• Poliuria : excretion of urine more than 2L a day

• Albuminuria : presence of albumin in the urine

• Esbach : examination to assess the levels of normal protein



Identification and Analysis

Problems

1. Why are Mrs. Sinef’s feet swollen and distended

abdomen since 2 weeks ago?

Cause of Edema:

Increased hydrostatic pressure. Hydrostatic pressure is the

pressure that drives fluid from the plasma into the interstitial

space (ex: heart failure, cirrhosis hepatis).

Decreased plasma oncotic pressure. Plasma osmotic pressure is the pressure that maintains the fluid in blood

vessels by drawing fluid from the space intersrtitial.



Causes of fall of plasma oncotic pressure:

- Hepatic Cirrhosis impaired protein synthesis

- Nephrotic syndrome albumin out with urine.

- Less intake of protein

Obstruction of lymph channels.

Increased capillary permeability. (Ex: inflammation, allergy)

Cause Ascites:

portal hypertension. The high resistance to blood flow through the

heart vessels switched to mesentrika. High resistance to flow causesincreased vascular mesentrika and increased capillary pressure - fluid

will then leak.

Decrease colloid osmotic pressure



2. How is laboratory interpretation?

Albuminuria ++++: indicates that the protein comes out with urine over 1 gr/100

ml urine. The presence of proteinuria

showed that there was a disease that

affects the kidneys, especially glomerolus.



3. Why does doctor say there may have

been a leak in the kidney Nn. Sinef?

Because of the results of the spending has

occurred with proteinuria, which in a good

state of renal function there is no

expenditure of protein in the urine.

??



4. Why does the second patient complain

with disuria and polyuria

• pain during urination caused by urinary

tract disorders such as trauma, urinary

tract infections, or urinary tract stones.

• Polyuria may occur in patients with DM

and use diuretic.



5. How is interpretation of laboratory of

the second patient?

Leukocytes+++: indicates the presence of

more than 50 leucocytes/LPK. generallyindicate a urinary tract infection.



6. How is jengkol relationship with theillness now?

• not related

• jengkol acid will form crystals that canirritate the kidneys. This crystal will

cause colicky pain in patients



7. How are the interpretation of esbach and

cholesterol examination of Ms. Sinef?

• Esbach 4gr/ 24 hour massive

albuminuria

• Total cholesterol 950 mg/dl means that

hyperlipidemia. Increased lipidemia

associated with hipoalbuminenia

condition.



8. Why need biopsy assessment to Ms.

Sinef

Kidney biopsy is one of the diagnostic

techniques in determining histophatology

of kidney damage.



9. how is the management of these patients in both?

Patient I:

• protein diet, low fat and low salt• Diuretic

• Inhibition of angiotensin-converting (ACE Inhbitor)

Patient II:• Maintain cleanliness around the sex organs and the urinary

tract

• Each urinate, wipe from front to back. This reduces the

possibility of entry of bacteria from the anus to the urethra.

• Do not hold back urine. Discard the urine as needed

• Many consume fluids

• Provide appropriate antibiotic culture results



Scheme



LEARNING OBJECTIVES

Student can explain about:

1. Immunology disorder of urinaria

system2. Urine duct Infections



Any Questions??

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