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Leukopenia
 Leukopenia results most commonly from a
decrease in granulocytes, which are the most
prevalent circulating white cells. Lymphopenias
are much less common; they are associated with
congenital immunodeficiency diseases or are
acquired in association with specific clinical states,
such as advanced human immunodeficiency virus
(HIV) infection or treatment with corticosteroids
Acute leukemia
Pathophysiology of Acute Leukemias
 Although acute leukemias are rapidly growing tumors,
normal bone marrow progenitors grow at an even more
rapid rate. The principal pathogenetic problem in acute
leukemia is a block in differentiation. This leads to the
accumulation of immature leukemic blasts in the bone
marrow, which suppress the function of normal
hematopoietic stem cells by physical displacement and
other poorly understood mechanisms. Eventually bone
marrow failure results, which accounts for the major
clinical manifestations of acute leukemia. Thus, the
therapeutic goal is to reduce the leukemic clone sufficiently
to allow normal hematopoiesis to resume.
 Polycythemia
 Polycythemia, or erythrocytosis, denotes an abnormally high
concentration of red cells, usually with a corresponding increase
in hemoglobin level. The increase in red cells can be relative, when
there is hemoconcentration due to decreased plasma volume, or
absolute, when there is an increase in total red cell mass. Relative
polycythemia results from any cause of dehydration, such as
deprivation of water, prolonged vomiting, diarrhea, or excessive
use of diuretics. It is also associated with an obscure condition of
unknown etiology called stress polycythemia, or Gaisböck
syndrome. Affected individuals are usually hypertensive, obese,
and anxious ("stressed"). Absolute polycythemia is primary when
it results from an intrinsic abnormality of the myeloid stem cells
and secondary when the red cell progenitors are responding to
increased levels of erythropoietin
 Definition
Anemia means lack of blood, where the condition when
the number of red blood cells or the amount of
hemoglobin (oxygen-carrying protein) in red blood cells
is below normal.
 This causes the flow of oxygen to decrease to the
body's organs.
 Symptoms
 Iron supplements can be used for iron deficiency.
Vitamin B supplements can be used for low vitamin
levels. Blood transfusion can be used for blood loss.
Medications to encourage blood formation can be
used if the body's blood production is reduced
Sickle cell anemia is a serious condition in which red
blood cells become crescent-shaped, like the letter C.
Normal red blood cells are donut-shaped without a hole
(circle, flat in the middle), thus allowing them to pass
through blood vessels easily and supply oxygen to all
parts body.
Diagnose
 symptoms of sickle cell disease
 Hb generally ranges from 6-9 gr / dL
 Sickle cells and target cells are found in the blood
Therapy
 Blood transfusion
This transfusion therapy aims to add the amount of
normal hemoglobin in the blood so that it can prevent
the polymerization process.
 Gene therapy
This gene therapy uses stem cells and viruses as vectors
 Red blood
infections caused
by plasmodium
parasites,
transmitted by the
bite of an infected
female Anopheles
mosquito (usually
from sick to non-
sick)
Pain area: abdominal or muscular area
Whole body
Gastrointestinal
Also common
 People who travel to malaria-prone areas usually take
protective medicine before, during and after the trip.
Treatment includes taking antimalarial drugs
(antibiotics and antiparasites)
Autoimmune diseases are diseases that occur due to
the immune system attacking healthy cells in your
own body. This disease develops when your immune
system is wrong in assessing healthy cells in your
body, and instead considers it a foreign substance.
As a result, your body starts producing antibodies
that will attack and damage healthy cells in your
body.
Autoimmune diseases can affect almost all parts of
the body, including the brain, nerves, muscles, skin,
joints, eyes, heart, lungs, kidneys, digestive tract,
glands, and blood vessels.
What are some common autoimmune diseases?
Rheumatism
Rheumatism or arthritis is an autoimmune disease that
attacks the joints. The immune system produces
antibodies that attach to the joint lining, so immune
cells attack the joints and cause inflammation, swelling,
and pain. People with rheumatism usually feel
symptoms such as joint pain, stiffness, and swelling, so
that it can reduce motion. If left untreated, rheumatism
can cause permanent joint damage gradually.
Psoriasis
Psoriasis is a disease caused by the growth of new skin
cells that are so fast that they accumulate on the surface
of the skin. This disease causes the skin to become
reddish, thicker, scaly, and look like silver-white patches.
In addition, it can also cause itching and pain in the
skin.
Multiple sclerosis
Multiple sclerosis is an autoimmune disease that attacks
the protective layer around the nerve. This can cause
damage that affects the brain and spinal cord. People
with multiple sclerosis can show symptoms, such as
blindness, poor coordination, paralysis, muscle tension,
numbness, and weakness. Symptoms can vary because
the location and level of attack varies between
individuals.
ASTHMA
 Conditions when the airways are inflamed, narrow and
swollen, and produce mucus of making extra so
difficult breathe
 chronic inflammatory airway diseases due to
hyperresponsive reactions of body immune cells such
as mast cells, eosinophils and T lymphocytes to certain
stimuli
There are several factors that cause
asthma
 predisposing factors
-genetic
 precipitation factors
-allergen
-changes in the weather
-stressful
-work environment
Management of Asthma
 Knowledge - kromones
 Monitoring - B2-Inhalation
 Avoid risk factors agonist
 Long-term medical - B2-oral agonist
treatment - Anticholinergics
- inhalation  Slow deep breathing
glucocorticosteroids exercise
- oral
glucocorticosteroids
PNEUMONIA
 Pneumonia, also known as wet lung, is an infection
that causes inflammation of the air sacs in one or both
lungs. In patients with pneumonia, a collection of
small air sacs at the end of the respiratory tract in the
lungs (alveoli) will be inflamed and filled with fluid or
pus. As a result, sufferers experience shortness of
breath, cough with phlegm, fever, or chills
 Pneumonia occurs when germs defeat the immune
system, causing inflammation of the lungs. The most
common infections are caused by bacteria and viruses
in the air we breathe.
 Based on the cause of the bacteria, pneumonia can be
classified into:
-Pneumonia due to bacteria.
-Viral pneumonia.
-Fungal pneumonia.
-Mycoplasmas
Prevention of Pneumonia

 Undergo vaccination.
 Maintaining the immune system.
 Maintain cleanliness.
 Quit smoking.
 Avoid consumption of alcoholic drinks.
Emphysema
 Emphysema is one of two common diseases that occur
in people with Chronic Obstructive Pulmonary
Disease (COPD). This disease damages the air sacs in
the lungs (also called alveoli) by making them lose
elasticity permanently.

 Alveoli is a place of exchange of oxygen and carbon

dioxide in the lungs. Damaged alveoli causes the
ability of the lungs to supply oxygen to the blood
decreases
Causes of emphysema :
 One reason a person can get the disease is excessive exposure to
chemical irritants, such as cigarette smoke. In addition, long-
term exposure to air pollution and hazards in the work
environment can also trigger this condition.

 Initially, your lungs may become inflamed due to excessive

exposure. As a result of that exposure, your lungs then lose their
elasticity thereby narrowing the airways and inhibiting the flow
of incoming air. This respiratory disorder occurs.

 Smoking is the main reason for all lung diseases, including

emphysema. Another factor that may also be the cause of this
disease is the genetic element, although it is actually quite rare.
Prevention :
 Emphysema is a chronic disease. That is, this disease
cannot be cured. Although not able to be cured, this
disease can still be controlled with drugs. In addition,
therapy and surgery can also help control this disease
and improve quality of life.
 Some ways to prevent this disease from getting worse
include:
 Quitting smoking is the most effective control of emphysema
and lung disease. Avoiding other pollutants will also help to
prevent this condition from worsening.
 The pulmonary rehabilitation program will teach you how to
practice breathing, how to reduce stress, and how to exercise
with emphysema
 Oxygen therapy.
 Medications to reduce inflammation (anti-inflammatory).
 Medications to open the airways and thin the phlegm
(bronchodilators).
 Antibiotics and vaccinations to prevent infection.
Lung Cancer
 Lung cancer is a condition when malignant cells
(cancer) form in the lungs. This cancer is more
commonly experienced by people who have the habit
of smoking and is one of the three most common types
of cancer in Indonesia.
Cause of Lung Cancer :
Smoking is a major cause of lung cancer, so most
sufferers are active smokers. However, people who don't
smoke can also get lung cancer.
Other factors that can increase the risk of lung cancer
are:
 Have a family member who also has lung cancer
 Frequent exposure to air pollution
Lung Cancer Treatment :
 The main treatment for early stage lung cancer is
surgery. If the cancer has reached an advanced stage,
then treatment can be done with radiotherapy and
chemotherapy.

 In addition, there are several other types of treatment

for treating lung cancer, namely targeted therapy,
ablation therapy, photodynamic therapy, and
cryotherapy.
Influenza
 Flu or influenza is a viral infection that attacks the
nose, throat, and lungs. People with flu will experience
fever, headache, runny nose, nasal congestion, and
cough.
 Causes of Flu :
 A person can catch the flu if accidentally inhaling a
splash of saliva in the air, which is released by the
patient when sneezing or coughing. In addition,
touching the mouth or nose after holding an object that
is affected by a splash of saliva, can also be a means of
transmission of the flu virus.
Flu Treatment and Prevention :
 Mild flu can be treated with lots of rest and drink lots
of fluids. However, if symptoms are severe, you should
immediately consult a doctor so that drugs can be
given to accelerate healing and prevent complications.

 The most effective way to prevent the flu is to undergo

influenza vaccination. In addition, you are also advised
to be diligent in washing your hands and avoid being
close to people with the flu.
 Sprue (Stomatitis)
 small, shallow, painful wounds that usually appear on
the soft tissues in the mouth.
 there are two types : - Aphthous stomatitis
-Herpes stomatitis
 causes of disease : a. irritation or trauma
b. vitamin deficiency
c. hormonal changes
d. certain foods
 Prevention : - Watch what you eat
- Choose healthy foods
- Maintain oral hygiene habits
 appendicitis
 inflammation that occurs in the appendix
 Appendicitis occurs because the appendix cavity has
an infection
 Symptoms : - pain in the stomach
- loss of appetite
- constipation or diarrhea
- fever
 Treatment : The surgical removal procedure for the
appendix is known as appendectomy
Glomerulonephritis
Glomerulonephritis is inflammation of the glomerulus,
which is a structure in the kidney consisting of small
blood vessels. These knots help filter blood and remove
excess fluid from the body. If the glomerulus is
damaged, the kidneys will stop working properly, and
can cause kidney failure
Chronic Kidney Disease
Chronic kidney disease is a decrease in kidney function
below normal limits. If you suffer from chronic kidney
disease, that means your kidneys cannot filter out
impurities, are unable to control the amount of water in
the body, also the levels of salt and calcium in the blood.
The metabolic waste that is not useful will remain and
settle in the body so that it can eventually endanger the
patient's condition.
Chronic kidney disease is a common disease associated
with the aging process. The older a person is, the higher
the risk
Urinary Tract Infection
UTI is an infection that affects the part of the urinary
tract. Infection occurs when bacteria enter the urinary
tract through the urethra. When it affects the lower
urinary tract it is known as a bladder infection (cystitis)
and when it affects the upper urinary tract it is known as
kidney infection (pyelonephritis)
UTI above is more dangerous and can trigger urosepsis, a
condition when bacteria in the infected kidney spread to
the blood. Urosepsis can cause blood pressure to fall to
shock, even death.
Kidney Stone
Kidney stone also known as calculus results from a
buildup of mineral salts or other such material in the
kidney. Kidney stone vary in size, larger stones can
block the flow of urine, resulting in severe pain and
blood in the urine
Endometriosis
 Endometriosis is
when the
endometrium that
normally lines the
uterus grows
somewhere else
 Usually occurs in
late 20s, early 30s
Endometriosis
 The exact cause of endometriosis is not known. The
most widely accepted theory however, is that
endometrium flows into the fallopian tubes instead of
passing through the vagina and out of the body.
 Risk factors : History with endometriosis, period
started before age 11, month cycles are short,
menstrual cycles are heavy and last more than 7 days
Endometriosis
 Endometriosis is most commonly diagnosed around
the age of 25 to 40. The most common feature of the
condition is heavy and painful periods.
 There is no known cure for endometriosis. Symptoms
are alleviated using pain relievers and hormone
treatments which help to ease the symptoms,
especially during periods.
 Cervical Cancer
Cervical cancer is cancer of
the cervix or the entrance
to the womb from the
vagina.
The cervix is sometimes
called the uterine cervix.
Cervical Cancer
 Most types of cervical cancers are caused by the
human papillomavirus (HPV).
 Cervical cancer often has no symptoms in its early
stages.
 When diagnosed at an early stage, surgery is a possible
method of treating cervical cancer successfully.
Uterine Fibroids
 Uterine fibroids are non-cancerous
tumors that grow from the muscle
layers of the womb. These benign
growths of smooth muscle can
vary from the size of a bean to
being as large as a melon.
Also called leiomyomas or myomas
Uterine Fibroids
 It remains unclear exactly what causes fibroids. They
may be related to estrogen levels
 The most common signs and symptoms :
 Heavy menstrual bleeding
 Menstrual periods lasting more than a week
 Pelvic pressure or pain
 Frequent urination
 Difficulty emptying the bladder
 Constipation
 Backache or leg pains
 HYPOSPADIAS
 Hypospadias is an abnormality in which the urinary hole in a
baby boy is abnormal. This condition is a congenital abnormality
from birth.
 Hypospadias is common and doesn't cause difficulty in caring for
your infant. Surgery usually restores the normal appearance of
your child's penis. With successful treatment of hypospadias,
most males can have normal urination and reproduction.
 In Indonesia, hypospadias are included in 16 types of congenital
disorders which are the priority of surveillance. The incidence of
hypospadias will increase 13-fold more often in men whose
parents and siblings suffer from hypospadias. About 8% of
incidents come from parents and 14% from brothers with
hypospadias. Distal hypospadias are the most cases in 50-80% of
cases.
ETIOLOGY
 Genetic
 Hormonal
 Other
 How to diagnose? History taking and physical
examination
 Management? Surgery
 Complications
If hypospadias is not treated, it can result in:
 Abnormal appearance of the penis
 Problems learning to use a toilet
 Abnormal curvature of the penis with erection
 Problems with impaired ejaculation
 SYPHILIS
 Syphilis is a bacterial infection usually spread by
sexual contact. Syphilis spreads from person to person
via skin or mucous membrane contact with these
sores.
 Early syphilis can be cured, sometimes with a single
injection of penicillin. Without treatment, syphilis can
severely damage your heart, brain or other organs, and
can be life-threatening, or be passed from mother to
an unborn child.
CAUSES
 The cause of syphilis is a bacterium called Treponema pallidum. The
most common route of transmission is through contact with an
infected person's sore during sexual activity. The bacteria enter your
body through minor cuts or abrasions in your skin or mucous
membranes. Syphilis is contagious during its primary and secondary
stages, and sometimes in the early latent period.
 Less commonly, syphilis may spread through direct unprotected close
contact with an active lesion (such as during kissing) or through an
infected mother to her baby during pregnancy or childbirth (congenital
syphilis).
 Syphilis can't be spread by using the same toilet, bathtub, clothing or
eating utensils, or from doorknobs, swimming pools or hot tubs.
 Once cured, syphilis doesn't recur on its own. However, you can
become reinfected if you have contact with someone's syphilis sore
RISK FACTORS
 Engage in unprotected sex
 Have sex with multiple partners
 Are a man who has sex with men
 Are infected with HIV, the virus that causes AIDS
PREVENTION
 There is no vaccine for syphilis. To help prevent the spread
of syphilis, follow these suggestions:
 Abstain or be monogamous. The only certain way to
avoid syphilis is to forgo having sex. The next-best option is
to have mutually monogamous sex with one partner who is
uninfected.
 Use a latex condom. Condoms can reduce your risk of
contracting syphilis, but only if the condom covers the
syphilis sores.
 Avoid recreational drugs. Excessive use of alcohol or
other drugs can cloud your judgment and lead to unsafe
sexual practices.
DIAGNOSIS
 Syphilis can be diagnosed by testing samples of:
 Blood. Blood tests can confirm the presence of
antibodies that the body produces to fight infection.
The antibodies to the bacteria that cause syphilis
remain in your body for years, so the test can be used
to determine a current or past infection.
 Cerebral spinal fluid. If it's suspected that you have
nervous system complications of syphilis, your doctor
may also suggest collecting a sample of cerebrospinal
fluid through a procedure called a lumbar puncture
(spinal tap).
TREATMENT
 When diagnosed and treated in its early stages,
syphilis is easy to cure. The preferred treatment at all
stages is penicillin, an antibiotic medication that can
kill the organism that causes syphilis. If you're allergic
to penicillin, your doctor will suggest another
antibiotic.
 A single injection of penicillin can stop the disease
from progressing if you've been infected for less than a
year. If you've had syphilis for longer than a year, you
may need additional doses.
 Then follow-up
 BENIGN PROSTATE HYPERPLASIA
 Benign prostatic hyperplasia (BPH) — also called
prostate gland enlargement — is a common condition
as men get older. An enlarged prostate gland can cause
uncomfortable urinary symptoms, such as blocking
the flow of urine out of the bladder. It can also cause
bladder, urinary tract or kidney problems.
 The epidemiology of benign prostatic hyperplasia
increases with age. In Indonesia, research shows
benign prostatic hyperplasia about 50% of men over 50
years.
SYMPTOMS
Common signs and symptoms of BPH include:
 Frequent or urgent need to urinate
 Increased frequency of urination at night (nocturia)
 Difficulty starting urination
 Weak urine stream or a stream that stops and starts
 Dribbling at the end of urination
 Inability to completely empty the bladder

Less common signs and symptoms include:

 Urinary tract infection
 Inability to urinate
 Blood in the urine
CAUSES
 The prostate gland is located beneath your bladder. The
tube that transports urine from the bladder out of your
penis (urethra) passes through the center of the prostate.
When the prostate enlarges, it begins to block urine flow.
 Most men have continued prostate growth throughout life.
In many men, this continued growth enlarges the prostate
enough to cause urinary symptoms or to significantly block
urine flow.
 It isn't entirely clear what causes the prostate to enlarge.
However, it might be due to changes in the balance of sex
hormones as men grow older.
RISK FACTORS
 Aging. Prostate gland enlargement rarely causes signs and
symptoms in men younger than age 40. About one-third of
men experience moderate to severe symptoms by age 60,
and about half do so by age 80.
 Family history. Having a blood relative, such as a father or
a brother, with prostate problems means you're more likely
to have problems.
 Diabetes and heart disease. Studies show that diabetes,
as well as heart disease and use of beta blockers, might
increase the risk of BPH.
 Lifestyle. Obesity increases the risk of BPH, while exercise
can lower your risk.
COMPLICATION(S)
 Sudden inability to urinate (urinary retention). You might need to
have a tube (catheter) inserted into your bladder to drain the urine. Some
men with an enlarged prostate need surgery to relieve urinary retention.
 Urinary tract infections (UTIs). Inability to fully empty the bladder can
increase the risk of infection in your urinary tract. If UTIs occur frequently,
you might need surgery to remove part of the prostate.
 Bladder stones. These are generally caused by an inability to completely
empty the bladder. Bladder stones can cause infection, bladder irritation,
blood in the urine and obstruction of urine flow.
 Bladder damage. A bladder that hasn't emptied completely can stretch
and weaken over time. As a result, the muscular wall of the bladder no
longer contracts properly, making it harder to fully empty your bladder.
 Kidney damage. Pressure in the bladder from urinary retention can
directly damage the kidneys or allow bladder infections to reach the
kidneys.
TREATMENT
A wide variety of treatments are available for enlarged
prostate, including medication, minimally invasive therapies
and surgery. The best treatment choice for you depends on
several factors, including:
 The size of your prostate
 Your age
 Your overall health
 The amount of discomfort or bother you are experiencing
 If your symptoms are tolerable, you might decide to
postpone treatment and simply monitor your symptoms.
For some men, symptoms can ease without treatment.
 Pharmacological therapy
 Surgical therapy
 Laser therapy
 Prostatectomy