Diagnosis Ditegakkan Bila Ditemukan 2 Atau Lebih Gejala Mayor Atau 1 Gejala Mayor Dan 2 Gejala Minor
Gejala Total
-
Upload
indrimangampa -
Category
Documents
-
view
233 -
download
3
description
Transcript of Gejala Total
THT Pseudocroupperadangan subglotis akut
• Demam • Batuk non produktif • Memburuk pada malam
hari • Sianosis • Serak, kadang2
Peradangan subglotis sampai glottis (rima glottis sempit)Hiperemis ringan plika vokalisX foto : Steeple sign
Virus
THT Epiglotitissupraglotik dan epiglotis, akut
Demam ringan, odinofagi ringan, bisa beratDroolingBatuk jarangGejala berkembang sangat cepat, tdk spesifikà sumbatan mendadak (2-24 jam)à emergency
Udem epiglotis, plika ariepiglotika, aritenoid dan supraglotis
Penimbunan saliva di hipofaring
Daerah plika vokalis dan subglotis normal
Tidak disarankan melakukan laringoskopi
Laringoskopi direct à cherry red app
X- foto soft tissue colli lateral à Thumb sign
H. Influenza tipa B
THT Laringitis difteri Serak, batuk, sesak, stridor inspirasi, panas tinggiBullneck
Pseudomembran
Aspirasi Trakea • Batuk • Demam • Sesak nafas • Stridor
Lihat separah apa (x foto, BGA)
THT Trakeitisakibat sekunder infeksi virus
• Batuk yang dalam (mirip croup)
• Panas tinggi • Nyeri dada • Serak (kadang) • Sesak nafas • Kadang nyeri telinga
Udem dan hiperemis pada trakea
1. Kultur dari nasofaring /trakea
S. aureus
THT Benda Asing Trakea-bronkus
Bisa batuk2
Trakea:Batuk paroksimal mendadak Sianosis / asfiksia bising / wheezeAudibel slap ( benda bergerak )Flutter atau palpatory thrillRetraksi dinding dada
Foto rongen paru Bronkoskopi
Sterm fremitus dan auskultasi lemah
Bronkus:Rasa tersumbat / tercekik batuk paroksismal Bising di bronkus Stem fremitus kanan dan kiri beda Auskultasi lemah pada bronkus yang tersumbat
Segmen:Segmen : Perasaan tersumbat dan tercekik Batuk paroksismal Bising pada segmen yang kena Auskultasi melemah pada segmen yang kena
“Symtomless interval”
THT Adenoitis Kronik - Tidur mendengkur - Rinore - Batuk-batuk - Kurang pendengaran - Facies adenoides :- Palatal phenomena :
negatif - Adenoid membesar
Bakteri
THT Tonsilitis Akut - Sakit telan / odinofagi
- Lesu - Suhu naik - Sakit kepala dan
sakit di otot-otot - Kadang-kadang
batuk, serak, nafas bau
- Otalgia
Tonsil : - hiperemi - edema -
permukaan / kripte tertutup detritus.Uvula : hiperemis dan edemaFaring : Hipersekresi
BakteriVirus
THT Tonsilitis Kronik - Sakit telan ringan (pancingen)
- Lesu - Kurang nafsu makan - Sakit kepala
- Tonsil :* Hiperemis, edema?* Kripte melebar,
detritus?* Permukaan benjol2
- Ngantukan Panas nglemeng/meriang/subfebril
* Atropi/hipertrofi
THT Faringitis Akut - Faring terasa kering - Odinofagi - Otalgia-refered pain- Berdahak :Encer → Mukoid → Lengket - Sakit kepala - Febris
Mukosa faring :1. Bengkak (udem)2. Merah (hiperemi)3. Lendir : serus
- Suhu badan naik - Kel. Limfe leher membesar
Bakteri?
THT Faringitis Kronik - Diskomfort di tenggorok
- Rasa kering di tenggorok à tipe atrofi
- Rasa selalu ada lendir di tenggorok à tipe hipertrofi
- Batuk-batuk - Kemerahan mukosa
faringPembesaran kel. Limfe leher
Bentuk atrofi:* Mukosa kering * Mukosa atrofi * Mukosa mengkilat
Bentuk hipertrofi:* Mukosa banyak lendir * MUkosa tidak rata
Faktor disposisi
THT Abses Peritonsil - Panas - Nyeri telan (spontan)- Buka mulut terbatas
(trismus)- Ngiler (droling)
- ”Hot potato’s voice” - Droling - Uvula udem, deviasi
ke sisi sebelah - Tonsil membesar
(sering sebelah)- Trismus
Kel. Limfe di bawah angulus mandibula
Bakteri
THT Parotitis Supuratif pre/post aurikula à sudut rahang bawah, discharge purulendysgeusia dan limfadenopati servikalparah, mungkin ada yang disertai demam , abses pada ruang parafaringeal, termasuk angina Ludwig ’ s
bakteri
THT Abses Submandibula (Ludwig’s Angina)
- Sakit gigi M I – M III bawah
- Bengkak submandibula :* Keras (SPT-papan)* Unilateral
- Sakit spontan
Bakteri
- Trismus Komplikasi :
- Udem laring à Dispnea
- Mediastinitis à Abses mediastinum
- Tromboplebitis à Trombus ke otak
THT Obstructive Sleep Apnea Syndrome (OSAS)
Pernafasan abnormal selama tidur
Kantuk berlebih siang hari
Kelainan nasal, faringeal, laryngeal, neurologis/ congenital, farmakologik
THT Cystic Higroma (cystic lymphangioma)
Bisa juga di tempat lain, tapi sering di leherDlm kehamilan, congenital, atau saat masa perkembangan (makin membesar).
Amniosintesis atau CVS USG pedigree - Pemeriksaan infeksi
virus lainnya - Pencarian tanda hisrops
amnion
THT Kista Brankialis I : preaurikula II : sudut mandibula, submandibulaIII : sering mengalami abses tiroid à DD Kista BrakialisIV : di laring (jarang)
CT Scan à gold standard Gambaran lesi homogen
Neuro SPONDILOSIS SERVIKALIS
• dull aching pain, unilateral / bilateralintermiten /
konstan, diprovokasi dengan
Penunjang : (bila ada defisit neurologik)
• X foto polos vertebra servical
rotasi leher • kaku , spasme dan
tenderness• Nyeri kepala bangun
tidur ~ TTH
• MRI • EMG
• Berhubungan dg pekerjaan : mengetik, menggambar, sekretaris
• Faktor stress dan ketegangan mental
Nyeri kencang• Mobilitas leher :
terbatas • Palpasi : tenderness
difus / terbatas ~ trigger spot
FROZEN SHOULDER (Nyeri bahu)
Carotico-cavernous fistule
CCF symptoms include bruit (a humming sound within the skull due to high blood flow through the arteriovenous fistula), progressive visual loss, and pulsatile proptosis or progressive bulging of the eye due to dilatation of the veins draining the eye. Pain is the symptom that patients often find the most difficult to tolerate.
Patients usually present with sudden or insidious onset of redness in one eye, associated with progressive proptosis or bulging.
They may have a history of similar episodes in the past.
Retinitis Pigmentosa
Rod cells gradually lose their ability to respond to light
GK : nictalopia, constricted visual field
Fundus : bone sicule-like pigment, arteriolar narrowing, pallor of disc (variable)
T : vit A palmitate, DHA, hindari cahaya, no high-dose vit E
Stargardt Disease
GK : gradual impairment of central vision, presentation on second decades
S : fovea atrophy surrounded by discrete yellowish round or pisciform flecks at the level of RPE, if flecks are widely scattered disebut fundus flavimaculatus
T : low vision aid, light protection
Myopic degeneration
Krn myopia à elongation of eye à thinning RPE and choroid (>-6 D, axial length >26 mm), liable to glaucoma and cataract
T : optical correction, pressure control, sclera buckling
ARMD (Age related macular disease)
GK : early – central vision may be blurred or distorted, objects looking unusual size/shape and straight lines appearing wav or fuzzy (over several months)
S : dry armd (90%) : drusen/yellowish debris in retina, atrophic
Wet armd (more progressive) : choroidal neovascularization
Chorioretinitis toxoplasma
GK : unilateral, mild ocular pain, blurred vision, new onset of floating spots
S : granulomatous iritis, vitritis, optic disc swelling, neuroretiniits, vasculitis, white-yelllow choreoretinal lesions, may be old inactive in the fellow eye
Diabetic retinopathy
S : non-proliferative : mircroaneurism, dot & blot intraretinal hemorrhage, hard exudates, dilatation and beading of retinal vein
Proliferative : neuvascularization on disc or else where
Hypertensive retinopathy
HTN can affect choroid, retina and n.II
- Nerve fiber layer micro-infarcts (Cotton wool spots) due to disruption of axoplasmic transport (lap ganglion keluar)
- Dot/blot and flame shaped hemorrhage
Traction/drawing to retina
GK : flashes
C : exudativa (uveal effucsion infection/inflammation), rhegmatogenous (retinal break), tractional (proliferative DR)
Indirect carotid-cavernous sinus fistulas tend to cause fewer, less serious symptoms. This is because of their relatively low rate of blood flow. Direct fistulas usually require more urgent attention. For both types, symptoms may include:
a bulging eye, which may pulsate a red eye an eye which protrudes forwards double vision loss of vision an audible swish or buzz coming from your eye weak or missing eye movements pains in your face ringing in your ears headaches nosebleeds
GIANT CELL ARTERITIS
Giant cell arteritis is an inflammation of the lining of your arteries — the blood vessels that carry oxygen-rich blood from your heart to the rest of your body. Most often, it affects the arteries in your head, especially those in your temples. For this reason, giant cell arteritis is sometimes called temporal arteritis or cranial arteritis.
Giant cell arteritis frequently causes headaches, jaw pain, and blurred or double vision. Blindness and, less often, stroke are the most serious complications of giant cell arteritis.
Can varyGenerally, signs and symptoms of giant cell arteritis include:
Persistent, severe head pain and tenderness, usually in your temple area
Vision loss or double vision
Scalp tenderness — it may hurt to comb your hair or even to lay your head on a pillow, especially where the arteries are inflamed
Jaw pain (jaw claudication) when you chew or open your mouth wide
Sudden, permanent loss of vision in one eye
Fever
Unexplained weight loss
Diagnosis
o help diagnose giant cell arteritis, you may have some or all of the following tests:
Physical exam. In addition to asking about your symptoms and medical history, your doctor is likely to perform a thorough physical exam, paying particular attention to your temporal arteries. Often, one or both of these arteries are tender with a reduced pulse and a hard, cord-like feel and appearance.
Blood tests. If your doctor suspects giant cell arteritis, you're likely to have a blood test that checks your erythrocyte sedimentation rate — commonly referred to as the sed rate. This test measures how quickly red blood cells fall to the bottom of a tube of blood. Red cells that drop rapidly may indicate inflammation in your body.
You may also have a test that measures C-reactive protein (CRP), a substance your liver produces when inflammation is present. The same tests may be used to follow your progress during treatment.
Biopsy. The best way to confirm a diagnosis of giant cell arteritis is by taking a small sample (biopsy) of the temporal artery. Because the inflammation may not occur in all
parts of the artery, more than one sample may be needed. The procedure is performed on an outpatient basis during local anesthesia, usually with little discomfort or scarring. The sample is examined under a microscope in a laboratory.
If you have giant cell arteritis, the artery will often show inflammation that includes abnormally large cells, called giant cells, which give the disease its name. Unfortunately, a biopsy isn't foolproof. It's possible to have giant cell arteritis and still have a negative biopsy result. If the results aren't clear, your doctor may advise another temporal artery biopsy on the other side of your head.
Although a temporal artery biopsy is the standard test for diagnosing giant cell arteritis, imaging tests may also be used for diagnosing giant cell arteritis and for monitoring treatment. Possible tests include:
Magnetic resonance angiography (MRA). This test combines the use of magnetic resonance imaging (MRI) with the use of a contrast material that produces detailed images of your blood vessels. Let your doctor know ahead of time if you're uncomfortable being confined in a small space because the test is conducted in a tube-shaped machine.
Doppler ultrasound. This test uses sound waves to produce images of blood flowing through your blood vessels.
Positron emission tomography (PET). Using an intravenous tracer solution that contains a tiny amount of radioactive material, a PET scan can produce detailed images of your blood vessels and highlight areas of inflammation.
K : loss of vision, aortic aneurysm, stroke
GLAUKOMA
sindrom:
- optic neuropati (cupping/excavation)
- visual field defect (arcuate)
- TIO tinggi (30%)
RF : DM, HTN
myopia, hipermetropia
2 mekanisme : TIO naik atau krn perfusi yg kurang
Open Angle (POAG)
chronic progressive, incidious, sometimes asymptomatic until relatively late (thief of sight)
familial tendency
Angle Closure (PACG)
Prodromal/SubAcute
elevated IOP are of short duration, key: history (short episode of unilateral pain, redness, blurring vision+halos around the light)
Acute
emergency
IOP raise rapidly (severe pain, redness, blurring vision)
Chronic Angle Closure
GK mirip open angle
ada faktor predisposisi
dever develop acute rise in IOP but form peripheral anterior synechia (PAS)
Absolute glaucoma
end result of any uncontrolled glaucoma, IOP still high, redness, visus 0, often painfull, optic nerve atrophy
Degenerative glaucoma
visus 0, bullous keratopathy (often painfull) atrofi iris, atrofi ciliary body, cataract
DEFEK JALUR PENGLIHATAN
(liat gambar slide)
Papiledema
GK : nyeri kepala, muntah, bisa defisit neurologis dan penurunan kesadaran,
visus umumnya N, kecuali sudah kronis (atrofi papil), pelebaran bintik buta (di lap pandang)
T : disc swelling, batas kabur, hiperemis, vasculature melear dan berkelok, perdarahan dan eksudat peripapil, Paton's line
Optic Neuritis
- Papilitis
GK : penurunan visus subakut (2-7 hari), gangguan penglihatan warna dan kontras, nyeri gerak bola mata
T : visus turun, lap pandang tu/ sentral skotoma, refleks pupil menurun, papil udem, hiperemis pelebaran vena
- Neuritis retrobulber
patient sees nothing, docotor seen nothing
ISCHEMIC OPTIC NEUROPATHY
Stroke mata (nonarteritic anterior ischemic optic neuropathy)
stroke mata, a. siliaris posterior brevis
FR : hipertensi, DM, hiperkolestrol
GK : peurunan visus mendadak, tanpa rasa sakit
T : refleks pupil menurun, papil udem sektoral atau menyeluruh, kepucatan
Compresi
Toxic and Nutritional
Traumatic
Hereditary
Pupil
RAPD/Marcus Gunn Pupill
defek sistem afferent, yg ipsi direct refleknya melambat
Tonic pupil
reaksi pupil thd sinar berkurang
krusakan pd ggl siliaris atau n. siliaris brevis
Horner's syndrome
miosis, ptosis, anhidrosis
krn simpatisnya terganggu