Respi LBM 3 SGD 15 .docx

8/10/2019 Respi LBM 3 SGD 15 .docx

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LBM 3 : BATUK BERDAHAK KENTL DISERTAI PANAS BADAN

STEP 1

Pneumonia severity index : is validated risk statificationinstrumen which can help indetifying CAP patient who cansafely be trated with patient antibiotic

Determine the or carculate of probability about morbilityand also mortality in patient with pneumonia

Infiltrat : something that from other tissue spread into anothertissue and trap in the tissueExample : pus , bacteria , eksudat

Dim : the sound that you made almost likely hepar sound orlien sound

The sound that make by percution in lung because there aresputum fibrin in pleura that sound became a dim becausethe contain

STEP 21) Why the man feel dyspneu and cough with green

sputum and fever ?

2) Why in the lung examination the doctor get dim andwet ronchi in the bronchial basis ?

3) How to score the penumonia severity index ?4) Why in rontgen photo is found infiltrat in both og the

lung ?5) Why the doctor ask the patient to do gram staining and

sputum culturing ?6) What is diagnosis and different diagnosis ?


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7) What are the etiologies from the scenario ?8) Why in routine blood examination get leukositosis ?9) What causes his RR increased until 32/minutes and HR

110/minutes?10) What are risks factor possible causes pneumonia ?11) What are treatments ?12) What are additional examination ?

STEP 3

1) Why the man feel dyspneu and cough with greensputum and fever ?

Included because of inflamation , inflamation in this boddiesin the sinus tissue or bronchial tissue and etc

Trap the mucus , mucus became the nest of the agent , agenreproducing multiply white blood cell infiltrate mukus , thepigmen of the white blood cell is green that why the colourgreen Fever : the body has inflamation , and the bodiestemperature get higher and the brain soldier white bloodcell to attack that place because its full of agent

Fever caused by released inflamatory mediator like IL1 andTNF

2) Why in the lung examination the doctor get dim andwet ronchi in the bronchial basis ?


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Wet ronchi can be heard in the tissue because exsudat andfibrin in the alveolus , this sound can be heard to in thesurface of pleura

3) What causes his RR increased until 32/minutes and HR110/minutes?

- Because of dyspnea , the compentation is increasthe RR to fullfill the need of oxygen

- Dyspneu Hipoksemia increas HR . because theblood bring more O2 to all of our body

4) Why in rontgen photo is found infiltrat in both og thelung ?

Because of there are exudat and fibrin in alveolus

5) Why the doctor ask the patient to do gram staining andsputum culturing ?

The main purpose of gram staining to identify certainpatogen to determine adekuat treatment

6) Why in routine blood examination get leukositosis ?

Because of had a inflamation progresChemokines such as IL8 and granulocyte colonystimulating factor .


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- If the caused by bacterial infection usually theleukocyte is increase if caused by virus infectionusually leukocyte increase or normal

7) How to score the penumonia severity index ?

- Risk class 1 : out patient treatment and give oralantibiotic

- Risk class 2 & 3 : out patient treatment andintravena antibiotic or treated and monitored for 24hours in hospital

- Risk class 4 & 5 : should be hospitalized treatment

8) What is diagnosis and different diagnosis ?

Diagnosis : Pneumonia

DD : bronchitis acute , bronchopneumonia ,9) What are the etiologies from the scenario ?

- Bacteria : streptococcus pneumonia , streptococcuspyogenes , staphylococcus aureus

- Fungi : coccidioidies immitis , aspergilus ,phycomycetes

- Virus : influenza virus , adenovirus

10) What are clasification of pneumonia ?

- Pneumonia bacterial : caused by bacteria- Pneumonia non bacterial- Pneumonia pneumosistis- Pneumonia atipik


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11) What are risks factor possible causes pneumonia ?

- Age > 65thn- Alcoholism- Malnutrisi- Smokker- Abdominal and thoracs surgery- Long time bedrest- Cancer- HIV- Asthma- Immunosipresion- COPD

12) What are additional examination ?

- CBC bloodtest white blood cell- Culture sputum- Pleural fluid culture- Bronchoscopy- Pulse oxymetri

13) What are treatments ?

- Antibiotik penisilin , selafosforin , amoxylin ,amoxycilin

- Cough drugs : antitusif , mukolitik , espektoran


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STEP 3

1. Why the man feel dyspneu and cough with green sputum and

fever ?

Most of the time, your nose and airways filter germs out of the air you breathe. Thiskeeps your lungs from becoming infected. But germs sometimes find a way to enter the lungsand cause infections. This is more likely to occur when:

Your immune system is weak. A germ is very strong or present in large amounts. Your body fails to filter germs out of the air you breathe.

When the germs that cause pneumonia reach your lungs, the lungs' air sacs (alveoli) becomeinflamed and fill up with fluid. This causes the symptoms of pneumonia, such as a cough,fever, chills, and trouble breathing.

When you have pneumonia, oxygen may have trouble reaching your blood. If there is toolittle oxygen in your blood, your body cells can't work properly. Because of this and theinfection spreading through the body, pneumonia can cause death.

http://www.lung.org/lung-disease/pneumonia/understanding-pneumonia.html

Mikroorganisme (MO) yang masuk ke dalam tubuh umumnya memiliki suatu zattoksin/racun tertentu yang dikenal sebagai pirogen eksogen. Dengan masuknya MOtersebut, tubuh akan berusaha melawan dan mencegahnya yakni dengan memerintahkanpertahanan tubuh antara lain berupa leukosit, makrofag, dan limfosit untuk memakannya(fagositosit). Dengan adanya proses fagositosit ini, tubuh itu akan mengelurkan zat kimiayang dikenal sebagai pirogen endogen (khususnya interleukin 1/ IL-1) yang berfungsisebagai anti infeksi. Pirogen endogen yang keluar, selanjutnya akan merangsang sel-selendotel hipotalamus untuk mengeluarkan suatu substansi yakni asam arakhidonat. Asamarakhidonat bisa keluar dengan adanya bantuan enzim fosfolipase A2.

Proses selanjutnya adalah, asam arakhidonat yang dikeluarkan oleh hipotalamus akanpemacu pengeluaran prostaglandin (PGE2). Pengeluaran prostaglandin pun berkatbantuan dan campur tangan dari enzim siklooksigenase (COX). Pengeluaran prostaglandinternyata akan mempengaruhi kerja dari termostat hipotalamus. Sebagai kompensasinya,hipotalamus selanjutnya akan meningkatkan titik patokan suhu tubuh (di atas suhunormal). Adanya peningkatan titik patakan ini dikarenakan mesin tersebut merasa bahwasuhu tubuh sekarang dibawah batas normal. Akibatnya terjadilah respon dingin/ menggigil.Adanya proses mengigil ini ditujukan utuk menghasilkan panas tubuh yang lebih banyak.

Sehingga terjadilah demam(suhu tubuh meningkat pada seseorang). Guyton Hall Fisiologi Kedokteran
http://www.lung.org/lung-disease/pneumonia/understanding-pneumonia.htmlhttp://www.lung.org/lung-disease/pneumonia/understanding-pneumonia.htmlhttp://www.lung.org/lung-disease/pneumonia/understanding-pneumonia.htmlhttp://www.lung.org/lung-disease/pneumonia/understanding-pneumonia.htmlhttp://www.lung.org/lung-disease/pneumonia/understanding-pneumonia.html


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2. Why in the lung examination the doctor get dim and wet ronchiin the bronchial basis ?

Wet ronchi can be heard in the tissue because exsudat andfibrin in the alveolus , this sound can be heard to in thesurface of pleuraPatofisiology sylvia

Pneumonia affects your lungs in two ways. It may be in only one part, or lobe, ofyour lung, which is called lobar pneumonia. Or, it may be widespread with

patches throughout both lungs, which is called bronchial pneumonia (or bronchopneumonia).


3. What causes his RR increased until 32/minutes and HR110/minutes?

- Because of dyspnea , the compentation is increasthe RR to fullfill the need of oxygen

- Dyspneu Hipoksemia increas HR . because the

blood bring more O2 to all of our body

4. Why in rontgen photo is found infiltrat in both og the lung ?

Pemeriksaan radiologis. Pola radiologis dapat berupa pneumonia alveolar dengangambaran airbronkhogram ( airspace disease) misalnya oleh Streptococcus pneumoniae,bronkopneumonia (segmental disease) oleh antara lair. staphylococcus, virus ataumikoplasma; dan pneumonia interstisial (interstitial disease) oleh virus dan ikoplasma.

Distribusi infiltratpada segmen apikal lobus bawah atau inferior lobus atas sugestif untukkuman aspirasi. Tetapi pada pasien yang tidak sadar, lokasi ini bisa di mana saja. Infiltrat di


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lobus atas sering ditimbulkan Klebsiella spp, tuberkulosis atau amiloidosis. Pada lobusbawah dapat terj adi infiltrat at'rbat St ap hy lo c o c cus atau bakteriemia.Buku ajar ilmu penyakit dalam

5. Why the doctor ask the patient to do gram staining and sputumculturing ?

Pemeriksaan dahak. l).Pewamaan gram dan pemeriksaan basil tahan asam (BTA)adalah suatu tindakan rutin;2). Kultur mikobakteri dan jamur. Pemeriksaan inidilakukan pada pasien yang didapatkan adanya kelainan foto toraks berupa infilfratdi apeks atau kavitas atau pada pasien imunokompromis; 3). Pemeriksaan sitologidilakukan pada pasien batuk yang dicurigai juga menderita kanker paru; 4).Pewarnaan silver pada dahak untuk mencari Pneumocystis carinii pada pasienimunokompromis.Buku ajar ilmu penyakit dalam

6. Why in routine blood examination get leukositosis ?Leukositosis urnumnya menandai adanya infeksi bakteri; leukosit norma/ rendahdapat disebabkan oleh infeksi virus/mikoplasma atau pada infeksi yang beratsehingga tidak terjadi respons leukosit , orang tua atau lemah. Leukopeniamenunjukkan depresi imunitas, misalnya neutropenia pada infeksi kuman Gramnegatif atau S. aureus pada pasien dengan keganasan dan gangguan kekebalan.Faal hati mungkin terganggu.

Buku ajar ilmu penyakit dalam

7. How to score the penumonia severity index ?


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Demographic factorsAge (in years)MenWomen -10

Nursing home resident +10Coexisting illnesses

Neoplastic disease +30Liver disease +20Congestive heart failure +10Cerebrovascular disease +10Renal disease +10

Findings on physical examinationAltered mental status +20


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Respiratory rate >= 30/min +20Systolic blood pressure = 125 beats/min +10

Laboratory and radiographic findings

Arterial pH = 30/mg/dl (11mmol/liter)

+20

Sodium < 130 mmol/liter +20Glucose >= 250 mg/dl (14 mmol/liter) +10Hematocrit


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Bacterial Pneumonia

Bacterial pneumonia can attack anyone, at any age.

Bacterial pneumonia can occur on its own or develop after you've had a cold or the flu.

People at greatest risk for bacterial pneumonia include people recovering from surgery, people with respiratory diseases or viral infections and people who have weakened immunesystems.

If your body's defenses are weakened by illness, old age, malnutrition, or impairedimmunity the pneumonia bacteria, which can live in healthy throats, can multiply and worktheir way into the lungs. The infection can quickly spread through the bloodstream and

invade the entire body.

Dozens of different types of bacteria can cause pneumonia.

The most common cause of bacterial pneumonia in adults is Streptococcus pneumoniae (pneumococcus), but there is a vaccine available for this form of pneumonia.

Atypical pneumonia is caused by bacteria such as Legionella pneumophila,Mycoplasma pneumoniae, and Chlamydophila pneumoniae.

Pneumocystis jiroveci pneumonia is sometimes seen in people whose immune systemis impaired (due to AIDS or certain medications that suppress the immune system).

Other bacteria that can cause pneumonia include Staphylococcus aureus, Moraxellacatarrhalis, Streptococcus pyogenes, Neisseria meningitidis, Klebsiella pneumoniae,and Haemophilus influenzae.

Viral Pneumonia

Most respiratory viruses attack the upper respiratory tract, but some cause pneumonia,especially in children. Most of these pneumonias are not serious and last a short time butothers can be severe.

Viral pneumonia caused by the influenza virus may be severe and sometimes fatal. The virusinvades the lungs and multiplies; however, there are almost no physical signs of lung tissue

becoming filled with fluid. This pneumonia is most serious in people who have pre-existingheart or lung disease and pregnant women.

In extreme cases, the patient has a desperate need for air and extreme breathlessness. Viral pneumonias may be complicated by an invasion of bacteria, with all the typical symptoms of bacterial pneumonia.

Mycoplasma Pneumonia

Mycoplasms are the smallest free-living agents of disease in humankind. They are notclassified as to whether they are bacteria or viruses, but they have traits of both.


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Mycoplasms usually cause a mild form of pneumonia, but may be severe. They affect all agegroups, but occur most often in older children and young adults.

Other Types of Pneumonia

Tuberculosis can cause pneumonia (tuberculosis pneumonia). It is a very serious lunginfection and extremely dangerous unless treated early.

Pneumocystis carinii pneumonia (PCP) is caused by an organism believed to be a fungus.PCP may be the first sign of illness in many persons with AIDS.

PCP can be successfully treated in many cases. It may recur a few months later, but treatmentcan help to prevent or delay recurrence.

Other less common pneumonias may be quite serious and occur more often. Various special pneumonias are caused by the inhalation of food, liquid, gases or dust, and by fungi.

Rickettsia (also considered an organism somewhere between viruses and bacteria) causeRocky Mountain spotted fever, Q fever, typhus and psittacosis, diseases that may have mildor severe effects on the lungs.


11. What are risks factor possible causes pneumonia ?

Risk factors (that increase your chances of getting pneumonia) include:

Cigarette smoking Recent viral respiratory infection a cold, laryngitis, influenza, etc. Difficulty swallowing (due to stroke, dementia, Parkinson's disease, or other

neurological conditions) Chronic lung disease such as COPD , bronchiectasis , or cystic fibrosis Cerebral palsy Other serious illnesses, such as heart disease, liver cirrhosis, or diabetes Living in a nursing facility Impaired consciousness (loss of brain function due to dementia, stroke, or other

neurologic conditions) Recent surgery or trauma Having a weakened immune system due to illness, certain medications, and

autoimmune disorders


12. What are additional examination ?
http://www.lung.org/lung-disease/influenza/http://www.lung.org/lung-disease/influenza/http://www.lung.org/lung-disease/influenza/http://www.lung.org/lung-disease/copd/http://www.lung.org/lung-disease/copd/http://www.lung.org/lung-disease/copd/http://www.lung.org/lung-disease/bronchiectasis/http://www.lung.org/lung-disease/bronchiectasis/http://www.lung.org/lung-disease/bronchiectasis/http://www.lung.org/lung-disease/cystic-fibrosis/http://www.lung.org/lung-disease/cystic-fibrosis/http://www.lung.org/lung-disease/cystic-fibrosis/http://www.lung.org/lung-disease/cystic-fibrosis/http://www.lung.org/lung-disease/bronchiectasis/http://www.lung.org/lung-disease/copd/http://www.lung.org/lung-disease/influenza/


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Physical exam: Your doctor will listen to your lungs with a stethoscope. If you have pneumonia, your lungs may make crackling, bubbling, and rumbling sounds whenyou inhale. You also may be wheezing, and it may be hard to hear sounds of breathingin some areas of your chest.

Chest x-ray (if your doctor suspects pneumonia)

Some patients may need other tests, including:o CBC blood test to check white blood cell counto Arterial blood gases to see if enough oxygen is getting into your blood from

the lungso CT (or CAT) scan of the chest to see how the lungs are functioningo Sputum tests to look for the organism (that can detected by studying your spit)

causing your symptomso Pleural fluid culture if there is fluid in the space surrounding the lungso Pulse oximetry to measure how much oxygen is moving through your

bloodstream, done by simply attaching a small clip to your finger for a brieftime

o Bronchoscopy, a procedure used to look into the lungs' airways, which would be performed if you are hospitalized and antibiotics are not working well

http://www.lung.org/lung-disease/pneumonia/symptoms-diagnosis-and.html

13. What are treatments ?

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Respi LBM 3 SGD 15 .docx