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SLE

Definisi - multisystem inflame autoimun disease w clinical manifestasi + ANA production


Criteria diagnosis 4 out of the following symptoms OR biopsy + and ANA positive
MNEMONIC
Oral ulcer
Rash (malar)
Discoid rash
Exagerated photosensitivity
Renal proteinuria (>500 or 3+) OR urinary cellular cast / lupus nephritis/ nephrotic syndrome
Hematologic hemolytic anemia
Immunological anti ds-DNA positive / C3 C4 turun
Serositis pleural effusion, pericarditis
Arthritis - athralgia
Neurological seizure psychosis
ANA positive Treatment
Renal cyclosporine/mycophenolate/cyclophosphamide
Kl kena SLE, boleh lahirin ga? Kl 1 tahun dah remisi, boleh.

Restrictive lung disease


FEV1/FVC ratio bs remains normal or decreased due to FVC decrease more. Why? Because
restrictive lung disease decrease capacity, thus expiration jg masalah. Jd duaduanya decreased.
BUT ada some case where restrictivenya lebih parah, kyk chest wallnya stiff dll. Jd FVC nya
decrease more. FEV1/FVC ratio normal or increased
-

Symptoms susah bgt to breath soalnya hrs extra effort to open lungs. Accessory muscles
(sternocleido) jg work. Auscultasi? CRACKLES sound of stiff alveoli open. Ky opening a Velcro
Asthma
Triad pathoph hypersekresi, inflamasi bronkus, bronkokonstriksi
Triad classic wheezing, cough, dyspnea with episodic exarcebation. Trus biasa ada allergen
Diagnostic test
Peak expiratory flow (PEF) longer when used with bronchodilator
Spirometry obstruktiv, thus, FEV1/FVC ratio = turun soalnya FEV1 turun. Tp kl
bronchodilator, FEV1 naik.
Methacholine test test threshold ke methacholine/histamine. Kl asthma, brarti low dose aja
udah bronchospasm
DD
Upper airway obstruksi
COPD, bronchiectasis
Obat
Reliever SABA (shortacting B2 adrenergic agonist) salbutamol, albuterol
- anticholinergic
Controller

corticosteroid
LABA - salmaterol

Anemia
1. jaundice hemolysis
2. splenomegaly thalassemia, chronic hemolysis
3. petechiae/purpura bleeding disorder
4. glossitis iron ato b12
5. koilonychias iron
6. neurological b12
ferritin naik kl infeksi chronic
ferritin berfungsi sbg CRP atau ESR
Microcytic anemia (pemeriksaan LAB)
IDA
-

Fe
TIBC
Ferritin
Marrow Fe

Thalassemia
- normal iron
- RDW normal trait
- RDW cacat major
Anemia of chronic inflammation
- Fe
- TIBC
- Ferritin
Sideroblastic Anemia
- Fe
- Normal TIBC
- Ferritin
- Ada ring sideroblastic di blood smear
Normocytic anemia

Indikasi tranfusi
Whole blood kl hemorrhagic hebat, hilang 25 % volum darah
6 x delta Hb x BB
1kg x 70 cc darah
PRC kl Hb kurang dr 8
3 x delta Hb (Hb yg mau dicapai Hb sekarang) x BB

Hemoptysis
Definisi spitting of blood from lungs or bronchial
Massive
- blood loss 100-1000 ml in 24 hrs
nonmassive
- <200 ml
hemoptysis
- no nausea and vomiting
- asphyxia
- sputum frothy, bright red or pink
- alkaline
hematemesis
- rarely asphyxia
- sputum coffee ground appearance
- brown to black
- acidic soalnya udah kena asam lambung
DIAGNOSTIC WORKUP
Ada fever? Malaria bisa tp rare bgt. Biasa associated with chills bla2
Hematemesisnya itu diawali dgn blood free vomitus? Mallory Weiss syndrome (tear in
mucosal layer at the junction of gaster n esophagus
HISTORY TAKING CHEST X-RAY CT SCAN BRONCHOSCOPY
management nonmasive hemoptysis
goal stop bleeding, cegah aspiration, treat underlying
- depends on underlying cause fenobarbital 10-25 mg/4 hrs or librium 10-25 mg/hrs
- kl bleeding >20 100 cc, di pasang IV line, CVP, CBC, electrolyte, PT-APTT
management massive hemoptysis
- vital sign
- avoid airway obstruction
- stop bleeding
- specific therapy adrenaline, bronchial washing
THE MOST IMPORTANT IS THE SOURCE OF HEMOPTYSIS

Upper respiratory tract infection


-

sinus
nasal passages
pharynx
larynx
trachea
bronchi
alveoli

-Rhinitis inflame of nasal mucosa


-Rhinosinusitis (sinusitis) paranasal sinus. Ethmoid(antara mata), sphenoid(mata ato
cavalry), frontal (dahi), maxilla(cheek)
-nasopharyngitis(common cold) nostril(nares) pharynx, hypopharynx (laryngoharynx)
uvula, tonsil
Rhinosinusitis
Nasal discharge
Hyposmia/anosmia
Facial pain
Sore throat (result from irritation from nasal secretion dripping into posterior pharynx)
Epiglottis
Sore throat
Odonophygia
Dysphagia
Loss of voice
Laryngotracheitis
Hoarseness/loss of voice
Barking cough (anak kecil batuknya ky anjinglautmengongong (seal-like barking))
Etiology mostly grup A strepotococal
Diagnosis rapid antigen test (sgt specific tp ga sensitive) thus kl dia ve, cek culture, while
tungu hasil rapid antigen test. EFISIEN!!!!! Streptococcal antibody appear 4-5 weeks. Thus,
ga perlu cek
Treatment
Oxygen (air dehumidifier)
Antibiotic
glucocorticoid
Sinusitis
Facial pain
Plain radiography air-fluid level and mucosal thickening (tp ga specific)
Surgical care if
- peritonsillar, oropharyngeal or intracranial abscess
- repeated streptococcal infection (4-5 peryear)
Prevention
hygiene
Imaging studies r not indicated for nasopharyngitis (common cold)

Vomiting in children
Retching dry hives
Vomiting center located di lateral medullary reticular formation of brainstem
Ada muscarinic (M1), histamine (H1), serotonin
Vomiting pathway dibagi 4
CTZ
Vagal afferent system
Vestibular system
Higher cortical centers

Efek dr blood or CSF


Distention from GI tract
Motion sickness or
labrythine
?? stress ato psychiatric

D 2 receptor
Serotonin
M1 receptor
H1 receptor
??

Vomiting phase
1.
preejection gastric relaxation, retroperistalsis
2.
retching dry hive. Contraction of abd wall, diaphragm, tp glottis ketutup
3.
ejection phase intense contraction of abd muscles, tp relaxation of
pharyngoesophageal sphincter
kl projectile, ga ada phase 1 and 2