Hemoptisis Translete With Penjelasan

8/10/2019 Hemoptisis Translete With Penjelasan

1/40

HEMOPTISIS

Group 28

1


2/40

Our Member

1. Niko Citami 11700240

2. Eisa Mayestika 11700246

3. Fatimah Amalia 11700248

4. Lukman Karim 11700250

5. Eva Silvia R 117002526. Virda Permatasari 11700256

7. Tommy Darmawan 11700258

8. Niken Suciningrum 11700260

9. Christina Fanny 11200262

10. Wilda Purnama 1170026411. Nurul Aini 11700266

12. Dimas Didik S 11700268

2


3/40

Scenario

Mr. Mansyur (25 years old), present to hospital

Accident and Emergency department (A&E) with

hemoptisis 15cc every cough (with 3-4 times

homoptisis 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.

3


4/40

keywords

1. Tuberculosis

Pulmonary tuberculosis is a infectious disease that caused bybasil Myobacterium tuberculosis which one of lowerrespiratory tract disease that most basil input to

pulmonary tissue through airbone infection or droplet andthen experienced a process known as focus primary fromghon

2. Blood Cough

Blood cough (Hemoptisis) is blood or blood sputum which

coughed from lower respiratory tract that start fromglotis to distal, blood cough will stopped itself if rips of theblood vessels are not widely, and than closure of thewound will quickly occur

4


5/40

Problem

1. How does patients complaint the symptom?

2. How does the principle of handling

emergencies in patients?

3. How to educate patients and their families?

5


6/40

The types of diseases associated

1. Tuberculosis pulmonary

2. Lung cancer

3. Bronkiektasis


7/40


8/40

Blood cough in pulmonary tuberculosis because:

1.Aneurysm rupture in the wall cavity contained(rasmussensaneurysm)

2.Rupture in thin walls of the cavity which containsmany small blood vessels

3.Ulceration of the parenchymal tissue of the lungs

or bronchi / bronchioles4.The process of exudation in the lung parenchymadamage the pulmonary capillaries

5.Pulmonary fibrosis pulmonary tuberculosis in the

former the blood vessels6.The presence of calcification which causesdamage to blood vessel walls.


9/40

Etiologi

Mycobacterium tuberculosis germ be straight orslightly curved, measuring the length and width 3 5 . Ziehl-Neelsen on will appear in red with a bluebackground. Mycobacterium tuberculosis can die if

exposed to direct sunlight for 2 hours.Mycobacterium tuberculosis is contagious, has ahigh durability and can survive several hours of darkand damp place. Therefore, this germs in the body

tissues can be dormant (hibernation) long asleepfor several years. Bacilli that exist in sputum sparkcan survive in 8-10 days


10/40

Modes of Infection

When coughing or sneezing, patient spread

germs into the air in the form of droplet

(sputum spark). Dropletscontaining the bacteria

can survive in air at room temperature for

several hours. After TB germs enter the body

through breathing, the TB germs can spread

from the lungs to other body parts


11/40

Pathophysiology

Primary infection

Primary infection. The first time a client is infectedby tuberculosis referred to as "primary infection"

and is usuallyfound on or near the apex of thelung lower lobe pleura.

Primary site of infection may have a process ofdegeneration of necrotic or swiss cheese but could

not, which cause to the formation of cavities filledby masses of tubercle bacilli such as cheese, whiteblood cells are dead,and necrotic lung tissue.


12/40

Secondary infection

Secondary infection. In addition to the primary

disease is progressive, 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.It is important to periodically review the client

who has had TB infection to determine the

presence of active disease.


13/40

Factors that have a role in the development of

TB into active disease:

1.old age

2.Immunosuppression

3.HIV infection

4.Malnutrition

5.the presence of other disease states (DM,CKD,

or malignancy)

6.genetic predisposition


14/40

Clinical symptoms

14

No. Common Symptoms Specially Symptomp

1. Cough> 3 weeks In the event of partial bronchial

obstruction due to compression of

enlarged lymph glands make noise

"wheezing"

2. fever Weakened voice accompanied byshortness 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


15/40

Risk factor

Some risk factors for with TB are:

1.Sex

2.Status nutrition3.Sosio-economy

4.Education

5.Toxic


16/40

komplikation

In patients with tuberculosis may occur several complications,either before treatment or during treatment and aftertreatment completion. Some the complications that arisemungikin are:

1.Blood cough

2.Pneumothorax

3.Respiratory failure

4.Heart failure

5.Effusion pleura

6.Asphyxia or blockage of airway due to a blood clot

7.Shock Hipovolemik (Circulatory failure cause due to loss ofblood)


17/40

Discussion

Pulmonary Cancer (CA Pulmo)


18/40

Originally attack branching segments / subbronchus causing lost cilia and desquamation

resulting in the deposition of carcinogens. With thedeposition of carcinogens then cause metaplasia,hyperplasia and dysplasia. When peripheral lesionscaused by metaplasia, hyperplasia and dysplasia

penetrate the pleural space,pleural effusion usuallyarises, and can be followed by direct invasion to theribs and vertebral bodies. The central location oflesions derived from one of the largest branches of

the bronchi. These lesions are caused by bronchialobstructionand ulceration followed by suppurationin the distal part.


19/40

Histological type

To determine the histologic type, in greater detailused histological classification according to theWHO in 1999, but it's enough if the clinical needcan only be known according to the WHO

histological classification in 1999, but for the clinicalneeds enough if only it can be seen:

Carsinoma epidermoid

small cell carcinoma

adenocarcinoma

large Cell carcinoma


20/40

In outline lung cancer is divided into 2 parts: Cel Small Lung Cancer(SCLC) Small Dannon Cel Lung Cancer (NCLC) (Wasripin, 2007):

1.Small Cell Lung Cancer (SCLC)

The incidence of lung cancer SCLC type is only about 20% of the totalincidence of lung cancer. However, this type is growing very fast andaggressive. If not treated immediately it can last only 2 to 4 months.

2.Non Small Cell Lung Cancer (NCLC)

80% of the total incidence of lung cancer is a type of NSCLC. Can bedivided into three, namely:

1 adenocarsinoma, this type is the most common (40%).

2 squamous cell carcinoma, the number of cases around 20-30%.

3 Large Cell Carcinoma, the number of cases around 10-15%.


21/40

Discussion

Bronkiektasis

Bronchiectasis is bronchial dilation of caused by

the weakness of the bronchial wall permanent.

The diagnosis confirmed with the help of

bronchiectasis by HRCT (High Resolution

Computed Tomography Computer).

Bronchiectasis is often also included in thegroup of respiratory tract infections

21


22/40

Etiology

1. infection

2. Heriditer abnormalities or congenitalabnormalities

3. Mechanical factors that facilitate theemergence of infectious

4. Patients often have a history of pneumonia

as a complication of measles, whoopingcough, or other infectious diseases inchildhood.

22


23/40

Clinical Symptomp

1. Chronic cough

2. Sputum which much, especially in the morning, after sleeping and lying down

3. sputum containing blood spots

4. coughing up blood

5. Cough with sputum cough accompanying a cold for 1-2 weeks or none symptomsat 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)


24/40

pathophysiologi

Bronchiectasis can be congenital but is most

often acquired


25/40

2. Acquired

Adults and children

Bronchiectasis there are 3 kinds of factors:

Bacterial infections, bronchial obstruction and

other complications factor

Components demages of the mucosa and

bronchial wall elastin tissue caused by infectioncausing inflammation of cytokines, nitric and

neutrophils cause damage to the alveolar tissue


26/40

infection

Components damages

of the mucosa andbronchial wall

inflammation of

cytokines, nitricand neutrophils

damage to thealveolar tissue

bronkiektasis


27/40

Clinical Symptoms

Anamnesa

1.Patient identity

a.Name : Mr. Mansyur

b.Sex : Male

c.Age : 25 years old

d.Work : Rice seller

e.Wedding Status : Not merried

f.Lastest Education : High School

2.Main complaint : coughing up blood

27


28/40

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 bloodvolume reaches 230cc

4) Shape suffered since 1 month ago, accompanied thebody feels fell dizzy

5) The decrease appetite6) Body weight was decreased

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

been treated

2) History of diabetes therapy, hypertension, TB : denied

3) Other chronic diseases : denied

28


29/40


30/40

EARLY HYPOTHESIS

Based 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 asfollows:

1 Tuberculosis

2 Lung Ca

3 Bronchiectasis

30


31/40


32/40

HYPOTHESIS FINAL

Based on the analysis that has been conducted

on the clinical symptoms, physical examination

and laboratory examination of patients to the

three early hypotheses (Differential Diagnosis),we can conclude that the the right diagnosis of

the patients was pulmonary tuberculosis.

Myobacterium TBC


33/40

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 cant back normal

diffusion

Tightness

Cough

Sputum purulent

Hemoptisis

Weight loss


34/40

Differential Hemoptisis and

HematemesisHemoptisis 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

34


35/40

The mechanism of coughing up blood.

(Wolf, 1977)1) Inflammation of the mucousIn acute or chronic trakeobronkitis, rich mucosal blood vessels become brittle,

so that even minor trauma is enough to cause coughing up blood.

2) Pulmonary infarction

Usually caused by a pulmonary embolism or infection of microorganisms inblood vessels such as cocci infection, viral and fungal infections.

3) Rupture of veins or capillaries

Distention of blood vessels due to the increase in intraluminal blood pressureas in acute cardiac decompensation left and mitral stenosis. In mitral

stenosis, bleeding can occur as a result of bronchial venous dilation.

35


36/40

4) Membrane abnormalities alveolocapiler

Due to the reaction of antibodies to the membrane, as inGoodpasture's syndrome

5) Cavity tuberculosis Bleeding

Rupture of a blood vessel wall cavity tuberculosis known as Rasmussenaneurysm; This expansion of blood vessels derived from branchesof the bronchial blood vessels. Bleeding in bronchiectasis due toexpansion of blood vessels of the bronchial branches. Suspectedthis is the case due to bronchial vascular anastomosis andpulmonary

6) Malignant tumor invasion

7) chest injury

Chest wall in a collision, then the network will experience translationlung into the alveoli and this situation will stimulate theoccurrence of coughing up blood.


37/40

Treatment

Education1. Dont forget to regularly take medication every day, as

recommended by a doctor

2. Always cover your mouth with a tissue when coughing, sneezing orlaughing. Keep in covered tissue and dispose of waste in place.

3. As usual, such as school, play, and work. During TB patients takemedication properly, the risk of passing will be lost. So the dailysocial activities and there is nothing to be limited, so people withTB do not ostracized or shunned.

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


38/40


39/40


40/40

Hemoptisis Translete With Penjelasan

Documents

Transcript of Hemoptisis Translete With Penjelasan