LO TAMBAHAN

1. The different between acute and chronic in fever :

Fever occurs when the body's thermostat (located in the hypothalamus) resets at a higher
temperature, primarily in response to an infection. Elevated body temperature that is not
caused by a resetting of the temperature set point is called hyperthermia. “raises the
hypothalamic set point”
The cause of an acute (ie, duration ≤ 3 days) fever in adults is highly likely to be infectious.
When patients present with fever due to a noninfectious cause, the fever is almost always
chronic or recurrent. Also, an isolated, acute febrile event in patients with a known inflammatory
or neoplastic disorder is still most likely to be infectious. In healthy people, an acute febrile
event is unlikely to be the initial manifestation of a chronic illness.
“kebanyakan penyebab demam akut karena infection contohnya penyakit upper lower
respiratory tracts infection atau GI tract infection Most acute respiratory tract and GI infections
are viral, sedangkan apabila pasien demam bukan karena infeksi biasanya berujung demam
kronik atau berulang”
Klo demam kronik berlangsung lebih dari 3 hari terjadi berulang-ulang sampai berbulan-bulan
Kalo bedanya akut dan kronik pada kasus pain :
Acute pain usually comes on suddenly and is caused by something specific. It is sharp in quality.
Acute pain usually does not last longer than six months. It goes away when there is no longer an
underlying cause for the pain. After acute pain goes away, a person can go on with life as usual.

Chronic pain is pain that is ongoing and usually lasts longer than six months. This type of pain can
continue even after the injury or illness that caused it has healed or gone away. Pain signals
remain active in the nervous system for weeks, months, or years.

2. How to differentiate sources of pain based on clinical features

 Acute pain : Acute pain is short-term pain that comes on suddenly and has a specific
cause, usually tissue injury. Generally, it lasts for fewer than six months biasanya sakit
terasa tajam saat awal tetapi gradually sembuh penyebabnya biasanya
fracture,surgery,cuts,burn
 Chronic pain : Pain that lasts for more than six months, even after the original injury has
healed, is considered chronic. Symptoms yang mengiringi terjadinya chronic pain yaitu
otot tegang,lack of energy,limited mobility contohya frequent headache,lowback
pain,nerve damage pain,arthritis pain
 Nociceptive pain : is the most common type of pain. It’s caused by stimulation of
nociceptors, which are pain receptors for tissue injury. Biasanya terasa kalo terjadi injury
atau inflamasi bisa terjadi secara akut dan kronik bisa terjadi sebagai visceral pain dan
dan somatic pain
 Visceral pain : results from injuries or damage to your internal organs. You can feel it in
the trunk area of your body, which includes your chest, abdomen, and pelvis lebih susah
ditentukan titik sakitnya rasa sakitnya dideskriprisikan sebagai
pressure,aching,squeezing,cramping. Penyebabnya gallstones and appendicitis
 Somatic pain : results from stimulation of the pain receptors in your tissues, rather than
your internal organs. This includes your skin, muscles, joints, connective tissues, and
bones. It’s often easier to pinpoint the location of somatic pain rather than visceral pain.
Somatic pain usually feels like a constant aching or gnawing (perih sekali) sensation.
3. How do the spasm develop in leg
spasms occur when a muscle involuntary and forcibly contracts and cannot relax. These are very
common and can affect any muscle. Typically, they involve part or all of a muscle, or several
muscles in a group. The most common sites for muscle spasms are the thighs, calves, foot arches,
hands, arms, abdomen and sometimes along the ribcage. The spastic muscle may feel harder
than normal to the touch, and/or appear visibly distorted. It may show visible signs of twitching.
Spasms may typically last from seconds to 15 minutes or longer
causes spasm : kurang stretching sebelum aktivitas fisik,muscle fatigue,exercise in heated
temperature,electrolyte imbalance in potassium,magnesium and calcium
For instance, a severe muscle spasm can result from irritation or damage to nerves supplying the
muscle, such as in spinal stenosis or major disc herniations, which disrupt nerve root signals from
the spinal cord. In higher level brain or spinal cord injuries, there is a disruption of normal
inhibiting influences from nerve connections from the brain. There are several brain regions
responsible for the movement of skeletal muscles, so problems in one or several brain regions or
nerve connections can result in abnormal muscle contractions. For example, abnormal, repetitive
spasms are seen in conditions such as dystonias (prolonged, repetitive contractions that cause
twisting/jerking movements), torticollis syndrome (“wry neck”), blepharism (involuntary blinking),
or myoclonus (sudden, irregular, involuntary contractions).
4. How does stiffness happen?
As your joints get older, the spongy cushion of cartilage begins to dry out and stiffen. The joint
lining also produces less synovial fluid, which lubricates the joint. Weak muscles and stiff tendons
also tend to tighten during sleep. if stiffness lasts for less than 15 minutes, the joint is
probably not inflamed.
5. Histology of cartilage

There are three types of cartilage:

 Hyaline - most common, found in the ribs, nose, larynx, trachea. Is a precursor of bone.
 Fibro- is found in invertebral discs, joint capsules, ligaments.
 Elastic - is found in the external ear, epiglottis and larynx.

Hyaline cartilage has widely dispersed fine collagen fibres (type II), which strengthen it.
The collagen fibres are hard to see in sections. It has a perichondrium, and it is the weakest of the
three types of cartilage.
Fibrocartilage - This is the strongest kind of cartilage, because it has alternating layers of hyaline cartilage
matrix and thick layers of dense collagen fibres oriented in the direction of functional stresses.

This type of cartilage does not have a perichondrium as it is usually a transitional layer between hyaline
cartilage and tendon or ligament.

In elastic cartilage - the chondrocytes are found in a threadlike network of elastic fibres within the matrix.
Elastic cartilage provides strength, and elasticity, and maintains the shape of certain structure such as the
external ear. It has a perichondrium

Anatomy of knee
Muscle of lower limb
Vascularization of lower limb