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Irza Wahid
Div of Hematology Medical Oncology Dept of Internal Medicine, School of Medicine, Univ of Andalas Dr. M Djamil Hospital
: Dr Irza Wahid SpPD KHOM : Padang / 23 November 1967 : Jalan Kolam Indah Raya No A6 Cendana Mata Air Padang : 075161952 08126605439 : Staf Subagian Hematologi Onkologi Medik Bagian Ilmu Penyakit dalam FK Unand / RS Dr M Djamil
Nama Sekolah SD Yos Sudarso Padang SMP Negeri 1 Padang SMA Negeri 1 Padang FK Unand Padang FK Unand / BLU RS Dr M Djamil Padang FK Unand / BLU RS Dr M Djamil Padang FKUI / RSCM / RSKD Jakarta 1973 -1980 1980 -1983 1983 -1986 1986 1993 01/07/1998 10/07/ 2003 Waktu
Nama Pendidikan No 1 2 3 4 5 6 SD SMP SMA Kedokteran Umum Program Pendidikan Dokter Spesialis I Ilmu Penyakit Dalam Program Pendidikan Dokter Spesialis II Konsultan Hematologi Onkologi Medik
01/01/2004 31/12/2006
FK Unand
01/07/2008 sekarang
Kanker
Multidisiplin Diagnosis
s/d Tatalaksana
Terminology
Supportive Care
Services that are provided in addition to curative treatments for cancer patients (Dept of Health 2000) Care given to improve the quality of life of patients who have a serious or life-threatening disease. The goal of supportive care is to prevent or treat as early as possible the symptoms of a disease, side effects caused by treatment of a disease, and psychological, social, and spiritual problems related to a disease or its treatment. Also called palliative care, comfort care, and symptom management. (National Cancer Institute, USA)
Supportive Care
Patient focused Support of patients from screening through treatment and into palliative phase Management of cancer symptoms and side effects of treatment
Holistic intent
Acute Chronic
Diagnosis
Death
Palliative Phase
Diagnosis
Palliative Phase
Death
Supportive Care Phase Anticancer Treatment Phase curative intent Diagnosis Palliative Treatment non-curative intent
Palliative Phase
Death
Palliative Phase
Death
Bereavement preparation
Supportive Care
Totality of medical, nursing , psychological, rehabilitative support. From onset of the disease ,through various herapeutic phases for longterm cure /until death Scope of supportive care:
Heterogenous Management of cancer manifestation : Malnutrition, pain, Infection. Prevention of therapeutic side effects Management of therapeutic side effects cardiac, renal , liver, fluid, electrolyte, hypercoagulation, thrombosis, nausea/vomitus, dyspepsia, diarrhea, fracture etc Psychological and spiritual support. :depression , anxiety 14 AHR etc
Metabolic Hematologic
Neurologic
Gastrointestinal
Cardiovascular
Cardiac event
Alopecia Rash
16 AHR
Nutritional support?
Cancer cachexia seems resistant to intervention with enteral or parenteral nutrition Likely due to metabolic changes increased tumour or host production of proinflammatory cytokines Need to overcome metabolic changes What about specific dietary nutrients?
17 AHR
18 AHR
Treatment for cancer can induce or exacerbate anaemia: the extent of this varies according to the type of tumour and treatment
19 AHR
ANEMIA
Parameter : Kadar hemoglobin Metode Sahli Pria dewasa : Wanita dewasa : Hamil : Hb < 13 : < 12 : < 11 gr % Gejala dan tanda Hb hipoksia kompensasi kardiovaskular * Pucat * angina pektoris * kardiomegali Mukosa * claudicatio intermiten * palpitasi Kulit * tinitus * dispneu * berkunang * bising sistolik * cepat lelah * gagal jantung Gradasi anemia ringan : sedang : berat : > 8 : 6 8 : < 6 gr % Morfologi mikro / normo / makrositer -- hipo/normo/hiperkrom Patofisiologi defisiensi aplastik hemolitik perdarahan Etiologi Cacing, low intake, kelainan imun, trauma, CANCER
23 AHR
Common Organisms : Gram-negative Escheria coli Pseudomonas aeruginosa Gram-positive staphylococcus epidermidis staphylococcus aureus -hemolytic Streptococcus spp. Yeast Candida spp Fungi Aspergillus flavus and Aspergillus fumigatus Virus Herpes simplex
The sites and organism listed account for about 80% of infections during granulocytopenia
24 AHR
Finding
Possibly more common in winter and less common in summer 25% to 50% idiopathic 15%-25% associated with cancer 20% following surgery (3 months) 6-month incidence, 7%; Higher rate in patients with cancer Recurrent PE more likely after PE than after DVT 30-day incidence 6% after incident DVT 30-day incidence 12% after PE Death strongly associated with cancer, age, and cardiovascular disease
Risk Factors
Recurrent VTE
VTE Recurrence
Predictors of First Overall VTE Recurrence
Baseline Characteristic
Age Body Mass Index Neurologic disease with extremity paresis Malignant neoplasm With chemotherapy Without chemotherapy
Hazard Ratio
(95% CI)
4.
5.
Lipodermatosclerosis
Venous stasis ulcer
Vomiting is a physiologic process, not a pathologic process. It is the bodys natural defense against ingestion of toxic substances.
Dopamine
Histamine
Serotonin
Endorphins
Emetic center
Substance P Cannabinoid
GABA
Levels of Emetogenicity
Cisplatin Mechlorethamine
Age
Younger patients vomit more than older patients Women vomit more than men
Gender
Alcohol history
Patients with a history of heavy alcohol use vomit less than those without such a history
Patients with a history of morning sickness or motion sickness are more likely to vomit
Nausea/vomiting history
Metoclopramide
(n=11)
Placebo
(n=10)
P 0.001 0.028
Metoclopramide
(n=11)
Prochlorperazine
(n=10)
P 0.005 NS
0.042
NS
Ondansteron
Vomiting
Nausea Nausea/Vomiting Preference
p
0.0005
0.0025 0.0008 0.003
64%
66% 56% 14%