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1. Infeksi
Infection through the
mucosa or wounded skin
Proliferate in the
bloodstream or
extracellularly within organ
Disseminate
hematogenously to all
organs
1. Infeksi
Anicteric leptospirosis (90%),
follows a biphasic course:
Initial phase (47 days):
sudden onset of fever,
severe general malaise,
muscular pain (esp calves),
conjunctival congestion,
leptospires can be isolated from
most tissues.
Therapy:
Doxycycline (100 mg PO bid) or
Amoxicillin (500 mg PO tid) or
Ampicillin (500 mg PO tid)
Therapy:
Penicillin (1.5 million units
IV or IM q6h) or
Ceftriaxone (1 g/d IV) or
Cefotaxime (1 g IV q6h)
2 & 3.
Infark Miokard
4. Rheumatoid Arthritis
NSAIDs:
Are important for symptomatic relief but play only a minor role, if any, in
altering the underlying disease process.
Aspirin is the oldest drug of the non-steroidal class, but because of its high
rate of GI toxicity, a narrow window between toxic and anti-inflammatory
serum levels, and the inconvenience of multiple daily doses, aspirins use as
the initial choice of drug therapy has largely been replaced by other NSAIDs
Glucocorticoid:
The paradigm ("bridge therapy") is to shut off inflammation rapidly with
glucocorticoids, and then to taper these as the slower-acting DMARD begin to
work.
4. Rheumatoid Arthritis
5. GERD
Barrett esophagus:
Komplikasi kronik GERD yang ditandai oleh metaplasia
intestinal di mukosa epitel gepeng esofagus.
Metaplasia Barrett dengan banyak
sel goblet
6. Endokrin
Thyroid Ophthalmopathy
1. Vigouroux sign: eyelid fullness
2. Stellwag sign: incomplete and infrequent blinking
3. Grave sign: resistance to pulling down the retracted upper
lid
4. Goffory sign: absent creases in the forehead on superior
gaze
5. Mobius sign: poor convergence
6. Ballet sign: restriction of one or more extraocular muscles
7. Lid signs: Lid lag and lid retraction
7. Endokrin
8. Anticoagulant Therapy
8. Anticoagulant Therapy
9. Unstable
Angina
Recurrent
symptoms/ischemia,
heart failure,
serious arrhythmia.
9. Unstable Angina
2011 ACCF/AHA Focused Update Incorporated Into the ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non
ST-Elevation Myocardial Infarction
Diagnosis
A1 + A2 + A3 establishes PV
A1 + A2 + two of category B establishes PV
Polycythemia vera (PV) develops slowly. The disease may not cause signs or
symptoms for years.
When signs and symptoms are present, they're the result of the thick blood that
occurs with PV. This thickness slows the flow of oxygen-rich blood to all parts of
your body. Without enough oxygen, many parts of your body won't work normally.
The signs and symptoms of PV include:
Headaches, dizziness, and weakness
Shortness of breath & problems breathing while lying down
Feelings of pressure or fullness on the left side of the abdomen due to an enlarged spleen (an
organ in the abdomen)
Double or blurred vision and blind spots
Itching all over (especially after a warm bath), reddened face, and a burning feeling on your
skin (especially your hands and feet)
Bleeding from your gums and heavy bleeding from small cuts
Unexplained weight loss
Fatigue (tiredness)
Excessive sweating
Very painful swelling in a single joint, usually the big toe (called gouty arthritis)
In rare cases, people who have PV may have pain in their bones.
http://www.nhlbi.nih.gov/health/health-topics/topics/poly/signs.html
11. Disentri
Trias disentri: demam, tenesmus, diare berdarah.
Manifestasi klinis disentri
amoeba:
Awitan perlahan atau
fulminan.
Tenesmus terdapat pada
50% pasien & selalu terkait
dengan keterlibatan
rektosigmoid.
Nyeri tekan abdomen
bawah, biasanya di daerah
caecum, kolon transversum
atau sigmoid.
11. Disentri
Diagnosis
Characteristic
Crohn disease
Colitis ulcerative
Disentri
Shigellosis
Variasi dari diare cair yang ringan hingga disentri berat. Pada kasus
berat, awitan cepat, dengan tenesmus, demam, dan feses lendir
darah yang sering. Sering disertai demam, sakit kepala, & malaise.
IBS
Fauci et al. Harrisons principles of internal medicine. 18th ed. McGraw-Hill; 2012.
12. Angina
12. Angina
Physical sign:
Jaundice, cachexia, & scratch marks.
palpable gall bladder (Courvoisier's sign).
distant metastases hepatomegaly, ascites, left supraclavicular
lymphadenopathy (Virchow's node), & periumbilical lymphadenopathy (Sister
Mary Joseph's nodes).
Diagnosis:
contrast-enhanced CT is the imaging modality of choice
EUS-guided fine-needle aspiration is the technique of choice. If theres any
doubt CT scan.
Harrisons principles of internal medicine. 18th ed. McGraw-Hill; 2011.
Characteristic
Acute cholecystitis
Choledocolithiasis
Acute pancreatitis
Chronic pancreatitis
Severe pyelonephritis:
high fever,
rigors,
nausea, vomiting, &
flank and/or loin pain.
Tidak
Anemia megaloblastik ;
Periksa vitamin B12 dan folat
Anemia
nonmegaloblastik
Retikulosit
Defisiensi
vitamin B12
Tidak
defisiensi
Uji Schilling:
membaik
dgn faktor
intrinsik
Peny. Sintesis
DNA herediter
Ya
Anemia
pernisiosa,
Reseksi
gaster
Obat yang
mengganggu
DNA
Tidak
Peny. Ileal, pembedahan
Pertumbuhan berlebihan
bakteri usus halus
Cacing pita
Malabsorpsi karena obat
Defisiensi
folat
Diet kurang
Malabsorpsi dipicu obat
Reseksi jejunum
Tropical sprue, sensiivitas
thd gluten.
Peningkatan kebutuhan:
kehamilan, hemolisis kronik
N/
Anemia hemolitik
Anemia hemoragik
Toksisitas alkohol
Hipotiroidisme
Penyakit hati
Bila bukan sebab
diatas: periksa
sumsum tulang
MDS
Aplasia eritrosit
Anemia sideroblastik didapat
Anemia diseritropoeitik herediter
tipe I, tipe III
Mechanism of toxicity:
Cyanide binds to cellular cytochrome oxidase blocking the
aerobic utilization of oxygen metabolic acidosis.
Symptoms
headache, nausea, dyspnea, & confusion.
Syncope, seizures, coma, agonal respirations, & cardiovascular
collapse ensue rapidly after heavy exposure.
Poisoning & drug overdose by the faculty, staff and associates of the California Poison Control
System third edition
19. EKG
19. EKG
RVH
R > S di V1
R di V1 7 mm,
Rasio R/S di sepanjang
prekordium
LVH
S di V1 + R di V5 atau V6
35 mm
R di aVL + S di V3 > 28
mm pada laki-laki atau >
20 mm pada perempuan
R di aVL 11 mm
19. EKG
The marrow aspirate and biopsy are essential to the diagnosis of the
myeloproliferative disorders.
The marrow aspirate provides information as to individual cell morphology and the
distribution of cell types. It also provides essential information in diagnosis and
management of patients with CML as they become increasingly dysplastic and
evolve to acute leukemia.
23. Endokrin
Classic clinical manifestations of hypothyroidism include:
Cretinism
Hypothyroidism that develops in infancy or early childhood
Clinical features: impaired development of the skeletal system and
central nervous system, manifested by severe mental retardation,
short stature, coarse facial features, a protruding tongue, and
umbilical hernia
Myxedema
Developing in the older child or adult
Symptoms: generalized fatigue, apathy, cold intolerant,
overweight, constipation, decreased sweating, shortness of
breath, & decreased exercise capacity.
23. Endokrin
Jod-basedow effect
Hipertiroidisme yang diinduksi oleh pemberian
iodin pada pasien dengan struma multinodular,
penyakit Grave laten.
24. Polyuria
If polyuria is shown to be dilute, pathophysiologic
mechanisms include:
1. Hypothalamic or central diabetes insipidus with inability
to synthesize and secrete vasopressin;
2. Nephrogenic diabetes insipidus with an inadequate renal
response to vasopressin;
3. Transient diabetes insipidus of pregnancy produced by
accelerated metabolism of vasopressin;
24. Polyuria
25. Dyspepsia
Epigastric pain described as a burning or gnawing
discomfort can be present in both DU and GU.
Duodenal ulcer:
The typical pain pattern occurs 90 minutes to 3 hours after a
meal and is frequently relieved by antacids or food.
Pain that awakes the patient from sleep (between midnight and
3 A.M.) is the most discriminating symptom, with two-thirds of
DU patients describing this complaint. Unfortunately, this
symptom is also present in one-third of patients with NUD.
Gastric ulcer:
Discomfort may actually be precipitated by food.
Nausea and weight loss occur more commonly in GU patients.
Harrisons principles of internal medicine
26. Hepatitis
Incubation periods for hepatitis A range from 1545 days (mean, 4 weeks), for
hepatitis B and D from 30180 days (mean, 812 weeks), for hepatitis C from 15
160 days (mean, 7 weeks), and for hepatitis E from 1460 days (mean, 56 weeks).
During the recovery phase, constitutional symptoms disappear, but usually some
liver enlargement and abnormalities in liver biochemical tests are still evident.
28. Osteoartritis
28. Osteoartritis
Since OA is a mechanically driven disease, the mainstay of
treatment involves altering loading across the painful joint
and improving the function of joint protectors, so they can
better distribute load across the joint.
Ways of lessening focal load across the joint include
(1) avoiding activities that overload the joint, as evidenced by
their causing pain;
(2) improving the strength and conditioning of muscles that
bridge the joint, so as to optimize their function; and
(3) unloading the joint, either by redistributing load within the
joint with a brace or a splint or by unloading the joint during
weight bearing with a cane or a crutch.
30. Kardiologi
CML
ALL
AML
The bone marrow makes abnormal leukocyte dont die when they
should crowd out normal leukocytes, erythrocytes, & platelets. This
makes it hard for normal blood cells to do their work.
Prevalence
Over 55 y.o.
Mainly adults
Common in
children
Adults &
children
Mature
lymphocyte,
smudge cells
Mature granulocyte,
dominant myelocyte
& segment
Therapy
Lymphoblas Myeloblast
t >20%
>20%, aeur rod
may (+)
Treated right away
33. Pharmacology
Acetaminophen intoxication
Acute ingestion of more than 150200 mg/kg in children or 67 g in
adults is potentially hepatotoxic.
High-risk patients include alcoholics and patients taking
anticonvulsant medications or isoniazid.
Clinical manifestations:
Early after acute acetaminophen overdose, there are usually no
symptoms other than anorexia, nausea, or vomiting. Rarely, a massive
overdose may cause altered mental status and metabolic acidosis.
After 2448 hours, when transaminase levels (AST and ALT) rise,
hepatic necrosis becomes evident. If acute fulminant hepatic failure
occurs, encephalopathy and death may ensue.
33. Pharmacology
Management
N-acetylcysteine
loading dose 140 mg/kg orally. The effectiveness of NAC depends on
early treatment, before the metabolite accumulates; it is of maximal
benefit if started within 810 hours
If vomiting interferes with oral acetylcysteine administration, give it by
gastric tube and use high-dose metoclopramide (12 mg/kg
intravenously (IV); or ondansetron, or give the NAC intravenously if
necessary.
Decontamination
1. Prehospital. Administer activated charcoal, if available.
2. Hospital. Administer activated charcoal. Gastric emptying is not
necessary if charcoal can be given promptly. Do not administer charcoal if
more than 34 hours have passed since ingestion, unless delayed
absorption is suspected.
34. Farmakologi
Potassium & digitalis inhibit each other's binding to Na+/K+ ATPase.
Hyperkalemia reduces the enzyme-inhibiting actions of cardiac glycosides
abnormal cardiac automaticity is inhibited by hyperkalemia reduces the
(toxic) effects of digitalis.
Hypokalemia facilitates these actions increases the (toxic) effects of
digitalis.
35. Tuberkulosis
Gejala Klinis
PF
Roentgen
37. DM Complications
39. Diabetes
Exercise increases the effectiveness of insulin.
Regular daily moderate exercise improve utilization
of fats & carbohydrates in patients with diabetes.
40. Diabetes
A person presenting with unexplained acute lower respiratory illness with fever
(>38 C ) and cough, shortness of breath or difficulty breathing.
AND 1/more of the following exposures in the 7 days prior to symptom onset:
a. Close contact (within 1 metre) with a person (e.g. caring for, speaking with, or
touching) who is a suspected, probable, or confirmed H5N1 case;
b. Exposure (e.g. handling, slaughtering, defeathering, butchering, preparation for
consumption) to poultry or wild birds or their remains or to environments
contaminated by their faeces in an area where H5N1 infections in animals or
humans have been suspected or confirmed in the last month;
c. Consumption of raw or undercooked poultry products in an area where H5N1
infections in animals or humans have been suspected or confirmed in the last
month;
d. Close contact with a confirmed H5N1 infected animal other than poultry or wild
birds (e.g. cat or pig);
e. Handling samples (animal or human) suspected of containing H5N1 virus in a
laboratory or other setting.
Probable definition 2:
A person dying of an unexplained acute respiratory illness who is
considered to be epidemiologically linked by time, place, and
exposure to a probable or confirmed H5N1 case.
42. Pulmonologi
Obstruktif:
FEV1 is decreased out of proportion to the FVC, an obstructive pattern is
present.
The normal FEV1/FVC ratio is greater than 0.75 for those 60 years of age or
younger and greater than 0.70 for those older than 60 years.
A normal percent predicted FEV1 is between 80% and 120%.
Restriktif:
A reduction in all volumes and capacities.
The classic findings TLC or FRC < 75% of predicted, reduced RV and VC, and a
normal to high FEV1/FVC ratio.
42. Pulmonologi
42. Pulmonologi
45. HIV
45. HIV
Some treatment guidelines, particularly those in the
United States, now recommend ART for all HIV-infected
patients, regardless of CD4 count, whereas some other
(e.g., British) guidelines recommend ART for patients
with CD4 counts less than 350 cells/mm3.
The level of evidence to support therapy initiation
guidelines is strongest for CD4 counts less than 200
cells/mm3 and weakens as the CD4 counts studied
increase to greater than 500 cells/mm3.
46. Arthritis
Rheumatoid arthritis (RA)
Penyakit inflamasi kronik dengan penyebab yang belum
diketahui, ditandai oleh poliartritis perifer yang simetrik.
Skor 6/lebih: definite RA.
Faktor reumatoid merupakan autoantibodi yang
menyerang IgG lebih spesifik menandakan autoimunitas
daripada CRP yang merupakan penanda inflamasi.
Rheumatoid Arthritis
Rheumatoid nodules &
olecranon bursitis.
48. TB-HIV
49. Farmakologi
50. Asma
Pemeriksaan spirometri dalam diagnosis asma :
Obstruksi jalan napas diketahui dari nilai rasio VEP1/ KVP < 75% atau
VEP1 < 80% nilai prediksi.
Reversibilitas: perbaikan VEP1 15% secara spontan, atau setelah
inhalasi bronkodilator (uji bronkodilator), atau setelah pemberian
bronkodilator oral 10-14 hari, atau setelah pemberian kortikosteroid
(inhalasi/ oral) 2 minggu.
Menilai derajat berat asma
Tujuan : merendahkan tekanan bola mata secepatnya kemudian bila tekanan normal dan
mata tenang operasi
Supresi produksi aqueous humor
Beta bloker topikal: Timolol maleate 0.25% dan 0.5%, betaxolol 0.25% dan 0.5%,
levobunolol 0.25% dan 0.5%, metipranolol 0.3%, dan carteolol 1% dua kali sehari dan
timolol maleate 0.1%, 0.25%, dan 0.5% gel satu kali sehari (bekerja dalam 20 menit,
reduksi maksimum TIO 1-2 jam stlh diteteskan)
Pemberian timolol topikal tidak cukup efektif dalam menurunkan TIO glaukoma akut
sudut tertutup.
Apraclonidine: 0.5% tiga kali sehari
Brimonidine: 0.2% dua kali sehari
Inhibitor karbonat anhidrase:
Topikal: Dorzolamide hydrochloride 2% dan brinzolamide 1% (2-3 x/hari)
Sistemik: Acetazolamide 500 mg iv dan 4x125-250 mg oral (pada glaukoma akut
sudut tertutup harus segera diberikan, efek mulai bekerja 1 jam, puncak pada 4
jam)
Ilmu Penyakit Mata Ed 3. Jakarta: Balai Penerbit FKUI; 2006
Klasifikasi lainnya:
Glaukoma kongenital primer
anomali perkembangan yang
mempengaruhi trabecular
meshwork.
Glaukoma kongenital
sekunder: kelainan kongenital
mata dan sistemik lainnya,
kelainan sekunder akibat
trauma, inflamasi, dan tumor.
Patogenesis
Abnormalitas anatomi trabeluar meshwork penumpukan
cairan aqueous humor peninggian tekanan intraokuler
bisa terkompensasi krn jaringan mata anak masih lembek
sehingga seluruh mata membesar (panjang bisa 32 mm,
kornea bisa 16 mm buftalmos & megalokornea) kornea
menipis sehingga kurvatura kornea berkurang
Ketika mata tidak dapat lagi meregang bisa terjadi
penggaungan dan atrofi papil saraf optik
Buku ilmu penyakit mata Nana Wijaya & Oftalmologi umum Vaugahn & Asbury
Diagnosis glaukoma
kongenital tahap lanjut
dengan mendapati:
Megalokornea
Robekan membran
descement
Pengeruhan difus kornea
Buku ilmu penyakit mata Nana Wijaya & Oftalmologi umum Vaugahn & Asbury
Tatalaksana
Medikamentosa hingga
TIO normal
Acetazolamide
pilokarpin
Operasi:
Goniotomi (memotong
jaringan yg menutup
trabekula atau memotong
iris yg berinsersi pada
trabekula
Goniopuncture: membuat
fistula antara bilik depan
dan jaringan
subkonjungtiva (dilakukan
bila goniotomi tidak
berhasil)
Buku ilmu penyakit mata Nana Wijaya & Oftalmologi umum Vaugahn & Asbury
Tujuan : merendahkan tekanan bola mata secepatnya kemudian bila tekanan normal dan
mata tenang operasi
Supresi produksi aqueous humor
Beta bloker topikal: Timolol maleate 0.25% dan 0.5%, betaxolol 0.25% dan 0.5%,
levobunolol 0.25% dan 0.5%, metipranolol 0.3%, dan carteolol 1% dua kali sehari dan
timolol maleate 0.1%, 0.25%, dan 0.5% gel satu kali sehari (bekerja dalam 20 menit,
reduksi maksimum TIO 1-2 jam stlh diteteskan)
Pemberian timolol topikal tidak cukup efektif dalam menurunkan TIO glaukoma akut
sudut tertutup.
Apraclonidine: 0.5% tiga kali sehari
Brimonidine: 0.2% dua kali sehari
Inhibitor karbonat anhidrase:
Topikal: Dorzolamide hydrochloride 2% dan brinzolamide 1% (2-3 x/hari)
Sistemik: Acetazolamide 500 mg iv dan 4x125-250 mg oral (pada glaukoma akut
sudut tertutup harus segera diberikan, efek mulai bekerja 1 jam, puncak pada 4
jam)
Ilmu Penyakit Mata Ed 3. Jakarta: Balai Penerbit FKUI; 2006
54. KONJUNGTIVITIS
VERNAL
Nama lain:
spring catarrh
seasonal conjunctivitis
warm weather conjunctivitis
Tatalaksana
Self-limiting
Akut:
Steroid topikal (+sistemik
bila perlu), jangka
pendek mengurangi
gatal (waspada efek
samping: glaukoma,
katarak, dll.)
Vasokonstriktor topikal
Kompres dingin & ice
pack
VKC
AKC
Age at onset
over 30 years
Sex
No sex predilection
Seasonal variation
Discharge
Conjunctival
scarring
Higher incidence of
conjunctival scarring
Horner-Trantas
dots
Conjunctiva
Cobblestone appearance
papillae
Corneal
neovascularization
Not present
Deep corneal
neovascularization tends to
develop
Presence of
eosinophils in
conjunctival
scraping
Presence of eosinophils is
less likely
Corneal abnormalities
Glaucoma
Iris neovascularization
Cataracts
Neuropathies
Diabetic retinopathy
most common and
potentially most blinding
RETINOPATI DIABETIK
NONPROLIFERATIF
ditandai dengan kebocoran
darah dan serum pada
pembuluh darah kapiler
menyebabkan edema jaringan
retina dan terbentuknya
deposit lipoprotein (hard
exudates)
Tidak menyebabkan gangguan
penglihatan mengenai
makula
Edema makula penebalan
daerah makula sebagai akibat
kebocoran kapiler perifoveal
RETINOPATI DIABETIK
PROLIFERATIF
RETINOPATI DIABETIK
Signs and Symptoms
Seeing spots or floaters in the
field of vision
Blurred vision
Having a dark or empty spot in
the center of the vision
Difficulty seeing well at night
On funduscopic exam : cotton
wool spot, flame
hemorrhages, dot-blot
hemorrhages, hard exudates
Pemeriksaan :
Tajam penglihatan
Funduskopi dalam keadaan
pupil dilatasi : direk/indirek
Foto Fundus
USG bila ada perdarahan
vitreus
Tatalaksana :
Fotokoagulasi laser
Bedah vitrektomi
56. Sildenafil
Used in the treatment of erectile dysfunction.
Ocular side-effects include a bluish tinge to the
visual field, hypersensitivity to light, and hazy
vision.
These effects are reversible and may last only a
few minutes or hours.
It has been reported that only 3% of patients
have visual side-effects with the standard 50
milligram dose.
With increased dosage, the ocular side-effect
incidence rate significantly increases.
http://www.mastereyeassociates.com/Portals/60407/images//astig
matism-Cross_Section_of_Astigmatic_Eye.jpg
Tipe-tipe astigmatisma
Astigmatisma hipermetropikus
simpleks, satu meridian utamanya
emetropik, meridian yang lainnya
hipermetropik.
Astigmatisma miopikus simpleks,
satu meridian utamanya emetropik,
meridian lainnya miopi
Astigmatisma hipermetropikus
kompositus, kedua meridian utama
hipermetropik dengan derajat
berbeda.
Astigmatisma miopikus kompositus,
kedua meridian utamanya miopik
dengan derajat berbeda
Astigmatisma mikstus, satu
meridian utamanya hipermetropik,
meridian yang lain miopik.
2.
3.
4.
5.
58. KATARAK-SENILIS
60. Uveitis
Anterior
Intermediate
Posterior
Panuveitis
Fuchs
heterochromic
uveitis
Sarcoidosis
Toxoplasmosis
Tuberculosis
Posner
Schlossman
syndrome
Tuberculosis
Acute retinal
necrosis
Sarcoidosis
Infective uveitis
Lymes disease
Arthritis
associated
uveitis
Behcets disease
Vogt-KoyanagiHarada
Deepankur Mahajan, Pradeep Venkatesh, S.P. Garg ; Uveitis and glaucoma: a critical review : Journal of Current
Glaucoma Practise, September December 2011; 5(3): 14-30
Behcets Disease
Neuro BD
Ocular BD
Intestinal BD
Vascular BD
Behet disease
Oral or genital sores
Uveitis
Skin lesions
Vogt-Koyanagi-Harada Syndrome
CLINICAL FEATURES:
mild ciliary flush
a dilated or sluggishly reactive
pupil
corneal epithelial edema
open angles (No shallow AC)
The IOP is in the range of 40 70
mmHg during an acute attack
Minimal flare
Few cells
Few Keratic precipitate
No pheripheral anterior
synechiae and posterior
synechiae
Keratoconjunctivitis+urethritis +arthritis
Previously: urethritis ( can be seen as genital
ulcer too) /gastroenteritis
http://www.mastereyeassociates.com/Portals/60407/images//astig
matism-Cross_Section_of_Astigmatic_Eye.jpg
Tipe-tipe astigmatisma
Astigmatisma hipermetropikus
simpleks, satu meridian
utamanya emetropik, meridian
yang lainnya hipermetropik.
Astigmatisma miopikus simpleks,
satu meridian utamanya
emetropik, meridian lainnya
miopi
Astigmatisma hipermetropikus
kompositus, kedua meridian
utama hipermetropik dengan
derajat berbeda.
Astigmatisma miopikus
kompositus, kedua meridian
utamanya miopik dengan derajat
berbeda
Astigmatisma mikstus, satu
meridian utamanya
hipermetropik, meridian yang lain
miopik.
2.
3.
4.
5.
Nama
Stadium I
Stadium II
Trakoma (established
trachoma)
Gejala
Folikel imatur, hipertrofi papilar
minimal
Folikel matur pada dataran tarsal
atas
Stadium IIA
Stadium IIB
Stadium III
Stadium IV
Trakoma sembuh
65. UVEITIS
Radang uvea:
mengenai bagian
depan atau
selaput pelangi
(iris) iritis
mengenai bagian
tengah (badan
silier) siklitis
mengenai
selaput hitam
bagian belakang
mata koroiditis
Biasanya iritis
disertai dengan
siklitis = uveitis
anterior/iridosikl
itis
UVEITIS
Dibedakan dalam bentuk
granulomatosa akut-kronis dan
non-granulomatosa akut- kronis
Bersifat idiopatik, ataupun terkait
penyakit autoimun, atau terkait
penyakit sistemik
Biasanya berjalan 6-8 minggu
Dapat kambuh dan atau menjadi
menahun
Gejala akut:
mata sakit
Merah
Fotofobia
penglihatan turun ringan
mata berair
Tanda :
pupil kecil akibat rangsangan
proses radang pada otot
sfingter pupil
edema iris
Terdapat flare atau efek tindal
di dalam bilik mata depan
Bila sangat akut dapat terlihat
hifema atau hipopion
Presipitat halus pada kornea
Radang iris dan badan siliar menyebabkan rusaknya Blood Aqueous Barrier sehingga terjadi
peningkatan protein, fibrin, dan sel-sel radang dalam humor akuos. Pada pemeriksaan biomikroskop
(slit lamp) hal ini tampak sebagai flare, yaitu partikel-partikel kecil dengan gerak Brown (efek tyndall).
Ilmu Penyakit Mata Ed 3. Jakarta: Balai Penerbit FKUI; 2006
UVEITIS
Tatalaksana :
Steroid topikal dan sistemik
Siklopegik
Pengobatan spesifik bila
diketahui kuman penyebab
Penyulit: Glaukoma
sekunder karena adanya
sinekia posterior yang
menyebabkan iris
bombans peningkatan
TIO
Penatalaksanaan :
Bila diagnosis telah ditegakkan penderita harus
memakai obat seumur hidup untuk mencegah
kebutaan
Tujuan pengobatan memperlancar pengeluaran
dan mengurangi produksi aqueous humor
Bila TIO di atas 21 mmHg dan terdapat kelainan
lapang pandang dan papil, maka diberikan
Pilokarpin 1-4% 3x/hari
Bila tidak ada perbaikan tambah timolol 0,25-0,5%,
asetazolamide 3 x 250 mg atau epinefrin 1-2%
Bila pengobatan tidak berhasil trabekulotomi laser
Sidarta Ilyas. Ilmu Penyakit Mata. FKUI
Endoftalmitis
Uveitis
Perdarahan vitreous
Hifema
Retinal detachment
Glaukoma
Oftalmia simpatetik
Pemeriksaan Rutin :
Visus : dgn kartu Snellen/chart
projector + pinhole
TIO : dgn tonometer
aplanasi/schiotz/palpasi
Slit lamp : utk melihat segmen
anterior
USG : utk melihat segmen
posterior (jika memungkinkan)
Ro orbita : jika curiga fraktur
dinding orbita/benda asing
Tatalaksana :
Bergantung pada berat trauma,
mulai dari hanya pemberian
antibiotik sistemik dan atau
topikal, perban tekan, hingga
operasi repair
HIFEMA
Definisi:
Perdarahan pada bilik mata
depan
Tampak seperti warna
merah atau genangan
darah pada dasar iris atau
pada kornea
Tujuan terapi:
Mencegah rebleeding
(biasanya dalam 5 hari
pertama)
Mencegah noda darah
pada kornea
Mencegah atrofi saraf
optik
Komplikasi:
Perdarahan ulang
Sinekiae anterior perifer
Atrofi saraf optik
Glaukoma
Terjadi akibat:
1. Cahaya masuk ke mata dari benda
yang dilihat tidak cukup.
2. Pemusatan cahaya pada retina mata
tidak sempurna.
3. Mekanisme penggabungan bayangan
(fusi) oleh sistem penglihatan yang
lebih sentral (otak) dan upaya untuk
mempertahankannya tidak memadai.
Gejala:
Pandangan kabur
Distorsi bentuk dan ukuran objek
Inflamasi mata
lakrimasi
Mata lelah, terasa panas
Rasa tidak nyaman di mata
Nyeri kepala
Klasifikasi
Refraktif Astenopia
Astenopia yang terjadi akibat kelainan refraksi dan
berkurang dengan penggunaan kacamata
Muscular Astenopia
Terkait dengan kelainan akomodasi dan
ketidakcukupan konvergensi, gejala akan
berkurang dengan latihan konvergensi dan
akomodasi
70. Presbiopia
Koreksilensa positif
untuk menambah
kekuatan lensa yang
berkurang sesuai usia
http://www.ivo.gr/files/items/1/145/51044.jpg
http://emedicine.medscape.com/article/1206147
Causes
Etiology
Clinical
Acute Glaucoma
Pupilllary block
Open-angle
(chronic)
glaucoma
Unknown
Congenital
glaucoma
abnormal eye
development,
congenital infection
Secondary
glaucoma
Drugs
(corticosteroids)
Eye diseases (uveitis,
cataract)
Systemic diseases
Trauma
Absolute
glaucoma
73. DAKRIOSISTITIS
Partial or complete obstruction of the nasolacrimal duct
with inflammation due to infection (Staphylococcus aureus
or Streptococcus B-hemolyticus), tumor, foreign bodies,
after trauma or due to granulomatous diseases.
Clinical features : epiphora, acute, unilateral, painful
inflammation of lacrimal sac, pus from lacrimal punctum,
fever, general malaise, pain radiates to forehead and teeth
Diagnosis : Anel test(+) :not dacryocystitis, probably skin
abcess; (-) or regurgitation (+) : dacryocystitis. Swab and
culture
Treatment : Systemic and topical antibiotic, irrigation of
lacrimal sac, Dacryocystorhinotomy
Uji anel (+): terasa asin di tenggorok atau ada cairan yang masuk
hidung. Uji anel (-) jika tidak terasa asinberarti ada kelainan di
dalam saluran eksresi.
Jika cairan keluar dari pungtum lakrimal superior, berarti ada
obstruksi di duktus nasolakrimalis. Jika cairan keluar lagi melalui
pungtum lakrimal inferior berarti obstruksi terdapat di ujung nasal
kanalikuli lakrimal inferior, maka coba lakukan uji anel pungtum
lakrimal superior.
Keratic Presipitates
78. Entropion
Merupakan pelipatan palpebra ke arah dalam
Penyebab: infeksi (ditandai dengan adanya jaringan
parut), faktor usia, kongenital
Enteropion involusional
yang paling sering dan terjadi akibat proses penuaan
Mengenai palpebra inferior, karena kelemahan otot
palpebra
Enteropion sikatrikal
Mengenai palpebral inferior/ superior
Akibat jaringan parut tarsal
Biasanya akibat peradangan kronik seperti trakoma
80.
Derajat
Serangan
Asma
Alur
Penatalaksanaan
Serangan Asma
Inflammatory Diarrheas
Enteroinvasive E. coli (EIEC)
Shigatoxin-producing E. coli
(STEC)/EHEC
Jenis GGA
GGA prarenal: dehidrasi, syok, perdarahan, gagal jantung, sepsis
GGA renal: pielonefritis, glomerulonefritis, nefrotoksisitas karena obat
atau kemoterapi, lupus nefritis, nekrosis tubular akut, SHU, HSP
GGA pascarenal: keracunan jengkol, batu saluran kemih, obstruksi
saluran kemih, sindrom tumor lisis, buli-buli neurogenik
84. Urinalisis
Makroskopik
Kimia urin
Mikroskopik
Eritrosit
Leukosit
Epitel
Bakteri
Silinder
Kristal
Tatalaksana
Pelepasan
katekolamine
takikardia
increased
myocardial
contractility +
infundibular
stenosis.
VICIOUS
CYCLE
KEMATIAN
Right-to-left shunt meningkat
aliran darah ke
paru berkurang
secara tiba-tiba
TET SPELL
HYPERCYANOTIC SPELL
sianosis progresif
penurunan PO2 dan
peningkatan PCO2 arteri
penurunan pH darah
hiperpnoea
Anamnesis Hepatitis A :
Manifestasi hepatitis A: Anak
dicurigai menderita hepatitis A jika
ada gejala sistemik yang
berhubungan dengan saluran cerna
(malaise, nausea, emesis, anorexia,
rasa tidak nyaman pada perut) dan
ditemukan faktor risiko misalnya
pada keadaan adanya outbreak atau
diketahui sumber penularan.
Hepatitis A
Virus RNA (Picornavirus)
ukuran 27 nm
Kebanyakan kasus pada usia
<5 tahun asimtomatik atau
gejala nonspesifik
Rute penyebaran: fekal oral;
transmisi dari orang-orang
dengan memakan makanan
atau minumanterkontaminasi,
kontak langsung.
Inkubasi: 2-6 minggu (rata-rata
28 hari)
Pedoman Pelayanan Medis IDAI
Behrman RE. Nelsons textbook of pediatrics, 19th ed. McGraw-Hill; 2011.
Serologi
Hepatitis
Mechanism of toxicity:
Cyanide binds to cellular cytochrome
oxidase blocking the aerobic
utilization of oxygen.
C. Prehospital
Immediately administer activated charcoal if available. Do not induce vomiting unless
victim is more than 20 minutes from a medical facility and charcoal is not available.
Typical deficits
Water: 6 L, or 100 mL per kg
body weight
Sodium: 7 to 10 mEq per kg body
weight
Potassium: 3 to 5 mEq per kg
body weight
Phosphate: ~1.0 mmol per kg
body weight
until SQ insulin
initiated
Insulin Administration
Adapted from:
Kitabchi AE, Umpierrez GE, Murphy MB, et al; American Diabetes Association. Hyperglycemic crises in
diabetes.treatment
Diabetes Care. 2004;27(Suppl.
1):S94-S102
Insulin
is begun
after the initial fluid resuscitation
INSULIN
IV insulin infusion
regular insulin
0.1 units/kg/hr
Insulin therapy
Turns off the production of ketones
Decreases blood glucose
Decrease to
Thestatus
insulin infusion should be continued until
and neurological
0.05 units/kg/hr
the ph >7.30 and/or the HCO3 >15 mEq/L and the
until SQ insulin
serum ketones have cleared
initiated
Adapted from:
Kitabchi AE, Umpierrez GE, Murphy MB, et al; American Diabetes Association. Hyperglycemic crises in
diabetes. Diabetes Care. 2004;27(Suppl. 1):S94-S102
Potassium Administration
initial serum potassium is <2.5 mmol/L (hypokalemia)
Administer 0.5-1 mEq/kg of potassium chloride in IV
Start potassium replacement early, even before starting insulin therapy
Dextrose Administration
Dextrose
Adapted from:
Kitabchi AE, Umpierrez GE, Murphy MB, et al; American
Diabetes Association. Hyperglycemic crises in diabetes.
Diabetes Care. 2004;27(Suppl. 1):S94-S102
61
Bicarbonate
Bicarbonate therapy is generally
contraindicated in Pediatric DKA due to
increased risk of cerebral edema.
Bicarbonate therapy should only be
considered in cases of:
Severe acidemia
Life-threatening hyperkalemia
Pneumonia
lobularis/
bronkopneumonia
Asthma
bronkiolitis
Acute bronchitis
97-99. Difteri
Penyebab : toksin Corynebacterium diphteriae
Organisme:
Basil batang gram positif
Pembesaran ireguler pada salah satu ujung (club shaped)
Setelah pembelahan sel, membentuk formasi seperti huruf cina
atau palisade
Gejala:
Gejala awal nyeri tenggorok
Bull-neck (bengkak pada leher)
Pseudomembran purulen berwarna putih keabuan di faring,
tonsil, uvula, palatum. Pseudomembran sulit dilepaskan. Jaringan
sekitarnya edema.
Edema dapat menyebabkan stridor dan penyumbatan sal.napas
Todar K. Diphtheria. http://textbookofbacteriology.net/diphtheria.html
Demirci CS. Pediatric diphtheria. http://emedicine.medscape.com/article/963334-overview
http://4.bp.blogspot.com/
100. Poliomyelitis
Poliomyelitis is an enteroviral
infection
Poliovirus is an RNA virus that is
transmitted through the oralfecal route or by ingestion of
contaminated water
The viral replicate in the
nasopharynx and GI tract
invade lymphoid tissues
hematologic spread viremia
neurotropic and produces
destruction of the motor neurons
in the anterior horn
Poliomyelitis:
90-95% of all infection remain
asymptomatic
5-10% abortive type:
Fever
Headache, sore throat
Limb pain, lethargy
GI disturbance
1-2% major poliomyelitis:
Meningitis syndrome
Flaccid paresis with asymmetrical
proximal weakness & areflexia,
mainly in lower limbs
Paresthesia without sensory loss or
autonomic dysfunction
Muscle atrophy
Pemeriksaan penunjang
Darah:
LCS:
20-300 sel, predominan limfosit (lymphocytic pleocytosis), glukosa normal,
protein normal/sedikit meningkat
PCR
Kultur:
Dilakukan pemeriksaan kultur virus dari fese dan apus tenggorok, pada pasien
tersangka infeksi poliomyelitis (pasien AFP)
Histologi:
Ag spesifik enterovirus dilakukan imumofluresens dan pemeriksaan RNA
melalui PCR
Tata Laksana
Tidak ada antivirus untuk terapi infeksi oleh virus polio
Suportif
Pemberian antipiretik/analgetik bila terdapat keluhan demam, nyeri kepala,
atau nyeri otot
Ventilasi mekanik seringkali diperlukan pada pasien paralisis bulbar
Trakeostomi dilakukan pada pasien yang membutuhkan dukungan ventilasi
mekanik jangka panjang
Rehabilitasi medis diperlukan pada kondisi paralisis untuk mencegah
terjadinya dekubitus, pneumonia akibat berbaring lama, serta latihan aktif
serta pasif untuk mencegah kontraktur
Konstipasi diatasi dengan pemberian laksatif dan pemasangan kateter urin
Terapi hipertensi bila terjadi ensefalopati hipertensif