HEMOPTISIS

Group 28

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Our Member1. Niko Citami 117002402. Eisa Mayestika 117002463. Fatimah Amalia ` 11700248

4. Lukman Karim 117002505. Eva Silvia R 11700252

6. Virda Permatasari 117002567. Tommy Darmawan 117002588. Niken Suciningrum 11700260

9. Christina Fanny 1120026210. Wilda Purnama 1170026411. Nurul Aini 11700266

12. Dimas Didik S 11700268

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ScenarioMr. Mansyur (25 years old), present to hospital Accident and Emergency department (A&E) with coughing up blood15cc every cough (with 3-4 times coughing up blood in one day) since two days ago, the colour is fresh red, bubbly. Every coughing up blood is always out, even while in the A&E blood multiply the blood which comes out.

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keywords1. Tuberculosis2. coughing up blood

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Problem1. How does patients complaint the symptom?2. How does the principle of handling emergencies in patients?3. How to educate patients and their families?

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The types of diseases associated

1. Tuberculosis pulmonary2. Lung cancer3. Bronkiektasis

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DiscussionPulmonary Tuberculosis

•Mycobacterium tuberculosis•Pulmonary tuberculosis includes 80% of the overall incidence of tuberculosis disease, while the remaining 20% is extrapulmonary tuberculosis.

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Blood cough in pulmonary tuberculosis because:1.Aneurysm rupture in the wall cavity contained (rasmussen’s aneurysm)2.Rupture in thin walls of the cavity which contains many small blood vessels3.Ulceration of the parenchymal tissue of the lungs or bronchi / bronchioles4.The process of exudation in the lung parenchyma damage the pulmonary capillaries5.Pulmonary fibrosis pulmonary tuberculosis in the former the blood vessels6.The presence of calcification which causes damage to blood vessel walls.

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Etiology• Mycobacterium tuberculosis germ• straight rods • Ziehl-Neelsen on will appear in red with a blue background• Die if exposed to direct sunlight• this germs in the body tissues can be dormant (Hibernation)• Bacilli that exist in sputum spark can survive in 8-10 days

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Modes of Infection• Coughing or sneezing• Droplet

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Pathophysiology Primary infection

•Near the apex of the lung or pleura lower lobe.•Have a process of degeneration of necrotic or swiss cheese but could not•White blood cells die•Necrotic lung tissue

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Secondary Infection•Re-infection also leads to clinical forms of active tuberculosis•TB bacilli can still latent for many years and then switched back if the client durability decreases.

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Factors that have a role in the development of TB into active disease:1.old age2.Immunosuppression3.HIV infection4.Malnutrition5.the presence of other disease states (DM,CKD, or malignancy)6.genetic predisposition

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Clinical symptoms

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No. Common Symptoms Specially Symptomp

1. Cough> 3 weeks Wheezing sound"

2. fever Weakened voice accompanied by shortness of breath

3. Weight loss for no reason If there is fluid in the pleural cavity, may be accompanied by chest pains

4. Sweating at night If the bone, there will be symptoms such as bone infection that may one day form the channel and lead to the skin over

5. malaise

6. Anorexia

Risk FactorSome risk factors for with TB are:1.Sex2.Status nutrition 3.Sosio-economy4.Education 5.Toxic

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Complication 1. Blood cough2. Pneumothorax3. Respiratory failure4. Heart failure5. Effusion pleura6. Asphyxia7. Shock Hipovolemik

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Discussion

Pulmonary Cancer (CA Pulmo)

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attack branching segments

Cilia lost

desquamation resulting in the deposition of carcinogens

metaplasia, hyperplasia and

dysplasia

lesions pheripheal

penetrate the pleural space

direct invasion of the ribs and

vertebral bodies.

obstruction

ulceration of bronchial

suppuration distal

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Histological TypeAccording to the WHO histological classification in 1999, but for the clinical needs enough if only it can be seen: •Carsinoma epidermoid•small cell carcinoma•adenocarcinoma•large Cell carcinoma

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Differential lung cancer (Wasripin, 2007):

1.Small Cell Lung Cancer (SCLC)•The incidence of lung cancer SCLC type is only about 20% of the total incidence of lung cancer.•growing very fast and aggressive.•If not treated immediately it can last only 2 to 4 months.

2.Non Small Cell Lung Cancer (NCLC)•adenocarsinoma, this type is the most common (40%). •squamous cell carcinoma, the number of cases around 20-30%. •Large Cell Carcinoma, the number of cases around 10-15%.

3.Most of the patients diagnosed with NSCLC (70-80%) is already in the advanced stage III - IV.

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DiscussionBronkiektasis•Dilation of bronchi caused by weakness of the bronchial wall permanent•Group of respiratory tract infections

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Etiology1. Infection 2. Heriditer abnormalities or congenital abnormalities3. Mechanical factors that facilitate the emergence of

infectious4. Patients often have a history of pneumonia as a

complication of measles, whooping cough, or other infectious diseases in childhood.

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Clinical Symptom1. Chronic cough2. Sputum which much, especially in the morning, after sleeping and lying down3. sputum containing blood spots 4. coughing up blood5. Cough with sputum cough accompanying a cold for 1-2 weeks or none

symptoms at all (mild Bronchiectasis)6. sputum which much less than 200-300 cc 7. fever 8. anorexia 9. weight loss 10. anemia 11. pleural pain 12. malaise 13. Dypsneu 14. Found clubbed fingers (30-50% case)

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Pathophysiology Congenital and acquired1.Congenital•babies and children•permanent damage of the development of the bronchial tree

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Pathophysiology 2. Acquired• Adults and children• Bacterial infections, bronchial obstruction and other

complications factor• Scheme next page

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infection

Components damages of the mucosa and bronchial wall

inflammation of cytokines, nitric and

neutrophils

damage to the alveolar tissue

bronkiektasis

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Clinical SymptomsAnamnesa1.Patient identitya.Name : Mr. Mansyurb.Sex : Malec.Age : 25 years oldd.Work : Rice sellere.Wedding Status : Not merriedf.Lastest Education : High School

2.Main complaint : coughing up blood

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3. Disease History Now:1) 2 days ago coughing up blood (3-4 times a day)2) While in the A&C much bleed as much as 50 cc 3) Fresh red blood color, bubbly, so the issue of blood volume reaches

230cc4) Shape suffered since 1 month ago, accompanied the body feels fell

dizzy5) The decrease appetite6) Body weight was decreased

4. Past History of Disease:1) Past medical treatment : had never

been treated2) History of diabetes therapy, hypertension, TB : denied 3) Other chronic diseases : denied

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5. Family History of Disease :1) Mother suffered Tuberculosis2) His father sufferers (currently in treatment)

6. Socio-Economic History :Had a habit of smoking half a pack (6 cigarettes per day), but

never drink alcohol. Late eating habits and lack of rest.

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EARLY HYPOTHESISBased on anamnesis, physical examination, and laboratory examination of the scenarios above, the case experienced by Mr. Mansour (25 years) can be taken early on hemoptosis hypothesis as follows: 1 Tuberculosis 2 Lung Ca 3 Bronchiectasis

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ANALYSIS OF DIFFERENTIAL DIAGNOSIS

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Hypothesis Final

Pulmonary Tuberculosis

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MECHANISM DIAGNOSIS

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Myobacterium TBC

Entering the airway

Live in alveoli

inflamationNo infection Spread by Spleen

Fibrosis Arise and thick elastic connective tissue

Calsification

Exudation

Necrosis

Cavity

Alveolar excretion can not be returned

Gas can’t back normal diffusion

Tightness

• Cough• Sputum purulent• Hemoptisis• Weight loss

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Differential Hemoptisis and Hematemesis

Hemoptisis Hematemesis

Prodromal scratchy throat Nausea, flatulence

Colour Fresh red Dark red

Bubbly (+) (-)

contents Leukocytes, macrofaq food particles

PH Alkalis Acid

Anemia (+) or (-) (+)

Benzidine test (-) (+)

History disease Lung/heart Stomach/liver

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The mechanism of coughing up blood. (Wolf, 1977)

1) Inflammation of the mucous 2) Pulmonary infarction 3) Rupture of veins or capillaries 4) Membrane abnormalities alveolocapiler 5) Cavity tuberculosis Bleeding 6) Malignant tumor invasion 7) chest injury

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Treatment• Education1. Don’t forget to regularly take medication every day, as

recommended by a doctor2. Always cover your mouth with a tissue when coughing, sneezing or

laughing. Keep in covered tissue and dispose of waste in place.3. As usual, such as school, play, and work. During TB patients take

medication properly, the risk of passing will be lost. So the daily social activities and there is nothing to be limited, so people with TB do not ostracized or shunned.

4. Circulation in the room should be good, if necessary, add a fan to get rid of the air in the room. Try to stay in the room or house that has good light ventilation. TB germs are easily spread in a closed room and no air circulation.

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• Principles of Medical act1 Isoniazid (INH)2. Rifampicin (IRF)3. Pyrazinamide (PZA)4. Etambutol (EMB)5. Streptomycin (SM)

To avoid the emergence of resistant TB bacteria and accelerate disinfection, usually given combination drug consisting of 3-4 kinds of drug

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Prevention of Disease1. Using masks 2. Spitting should be at a certain place 3. BCG is given to infants aged 3-14 months 4. The food should be high in carbohydrates and high in

protein

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ANY QUESTION?41