Showing posts with label Diagnosis. Show all posts

urinary calculus or kidney stones

Definition of urinary calculusStones in the urinary tract (urinary calculus) is hard as a rock mass formed in the urinary tract and can cause pain, bleeding, blockage of urine flow or infection.





Cause of urinary calculus
Many factors are influential for the incidence of stones in the urinary tract, such as lack of drinking, impaired metabolism.  

The clinical- These stones can form in the kidneys (kidney stones) and in the bladder urinary (bladder stones). The process of stone formation is called urolithiasis (Renal lithiasis, nephrolithiasis).- Stone, especially small ones, may not cause symptoms. Stones in the channel upper urinary lead colic, while under the inhibiting urination.- Stones that obstruct the ureter, renal pelvis and renal tubules can cause back pain or renal colic (colic pain is severe in area between the ribs and hip bones, which spread to the abdomen also pubic area and inner thighs).- Other symptoms are nausea and vomiting, abdominal distension, fever, chills and blood in the urine. Patients may be often waste little water, especially when the stones pass through the ureter.- The urine is often red meat such as water washing and microscopic examination showed many erythrocytes and leukocytes sometimes there.- A stone can cause urinary tract infections. If the stone blocking the flow tract, the bacteria will be trapped in the urine collected over blockage, so there was an infection.
 - If the blockage lasts a long time, the urine will flow back into channels in the kidney, causing the emphasis to be inflate the kidneys (hydronephrosis) and eventually may occur kidney damage.
Diagnosis• Stones that do not cause symptoms, it may not be known deliberate on examination of routine urinalysis (urinalysis).• Stones that cause the pain is usually diagnosed based on symptoms of colic renal, accompanied by the presence of tenderness in his back and groin or pain in the pubic area with no obvious cause.• microscopic urine analysis can indicate the presence of blood, pus or crystals a small stone. Usually do not need another examination, except If pain persists more than a few hours or a diagnosis is uncertain.• Additional tests that may help establish the diagnosis is 24-hour urine collection and blood sampling to assess levels of calcium, cystine, uric acid and other ingredients that can causeof a stone.

Management of urinary calculus
• Colic spasmolitik overcome by injection: atropine 0.5 - 1 mg im for adults.• If there is an infection should be given an antibiotic: 2 x 2 tablets of cotrimoxazole or amoxicillin 500 mg orally 3 times daily for adults. Or other groups which can be used.• Small stones are not causing symptoms of obstruction or infection, usually not need to be treated.• Drink plenty of fluids will increase the formation of urine and helps throw some rocks. If the stone has been lost, it is not necessary anymore immediate treatment.• Stones in the renal pelvis or the ureter at the top of a 1 centimeter or less can often be solved by ultrasonic waves (Extracorporeal Shock Wave Lithotripsy, ESWL). Stone fragments further will be discarded in the urine.• Immediately refer to hospital if there are indications of such operations:o stones> 5 mmo Obstruction of moderate / severeo stones in the urinary tract proximalo recurrent infectionso During the observation of the stone can not fall
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Asthma


Asthma

Definition of Asthma
Asthma is a condition where the airways are narrowed because hyperactivity to certain stimuli, which cause inflammation and temporary narrowing.


Cause of Asthma
According to The Lung Association, there are two factors that trigger asthma:
A. Triggers (trigger) that resulted in disruption of the respiratory tract and
resulting in tightening or narrowing of the airways (Bronchoconstriction) but does not cause inflammation, such as:
- Changes in weather and temperature.
- Stimulate something that is an allergen, such as cigarette smoke, pollen, dust, animal dander, smoke, cold air and exercise, insecticides, dust, air pollution and pets.
- Respiratory tract infections.
- Disorders of emotion.
- Physical work or exercise excessively.

2. Cause (inducer) that mast cells throughout the bronchi release material such as histamine and leukotrienes in response to foreign substances (allergens), such as pollen, fine dust contained in the house or fur, which leads to:
- Smooth muscle contraction
- Increased mucus formation
- Transfer of certain white blood cells into the bronchi that result in inflammation (inflammation) of the respiratory tract where this will reduce the diameter of the airways (called bronchoconstriction) and this causes narrowing of the patient should exert every effort in order to breathe.

Clinical Overview of Asthma
- Shortness of breath on asthma typical wheezing sound with difficulty due to expiration.
- The state is characterized by severe shortness jealous auxiliary muscles breathing and cyanosis known as status asthmaticus can be fatal.
- Dyspnoea in the morning and throughout the night, after physical exercise (especially during cold weather), associated with upper respiratory tract infection, associated with exposure to allergens such as pollen and fur animals.
- A cough that long in the morning and late at night, associated with irritating factors, the cough may be dry, but often there is a clear mucous excreted from the respiratory tract.


Diagnosis of Asthma
Diagnosis of asthma can sometimes be established on the basis of anamnesis and auscultation. In end-expiratory wheezing almost always a sign of illness obstructive pulmonary disease such as asthma. In the mild asthma, almost always normal auscultation when the patient is asymptomatic.


Managementof Asthma
- The originator of the attack whenever possible factor is eliminated.
- In mild attacks can be given an injection of adrenalin 1: 1000 0.2 to 0.3 ml subcutaneously may be repeated several times with intervals of 10-15 minutes. Child dose 0.01 mg / kg body weight which can be repeated with attention to blood pressure, pulse and respiratory function.
- Bronchodilators are elected theophylline 100-150 mg 3 times daily in people adults and 10-15 mg / kg daily for children.
- Other options: Salbutamol 2-4 mg 3 times daily for adults
- Ephedrine 10-15 mg three times daily can be used to increase the efficacy theofilin.
- Prednisone is only required if the above medications do not help and given several days to prevent status asthmaticus. However administration should not be too late.
- Patients with status asthmaticus requiring oxygen therapy, parenteral and intensive care so that early action should be referred to as the following:
• Patients infused glucose 5%
Aminophylline 5-6 mg / kg was injected iv slowly if the person is not received oral theophylline.
• Prednisone 10-20 mg 2 times daily for several days, then lowered the dose that can be stopped as soon as possible.
• If you have not been addressed by adrenaline, it can be used first adrenalin.
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Arthritis


Arthritis
Definition of Arthritis
Arthritis is a general term for inflammation (inflammation) and swelling in the joints.


Cause of Arthritis
Arthritis can be osteoarthritis (OA) or rheumatoid arthritis (AR), but the most of the encounter is osteoarthritis. In the main causative factor of OA the trauma or the wear of joints, whereas the AR immunological factors play a role.


Clinical Overview of Arthritis
- Symptoms of arthritis vary depending on which joint is involved. OA is more frequent
attacking backer joints weight. Therefore, obesity should be avoided. Meanwhile, AR initially more frequently attack the joints small joints such as wrist or foot, but in advanced can also attack large joints such as shoulder and hip joints.
- Another complaint is similar to the actual arthritis is reumatism derived from soft tissues outside the joint. Which in layman known as gout most are reumatism.
- The joints affected are usually swollen, red and painful.
- AR attack usually begins with prodromal symptoms of weakness, loss of appetite, pain and stiffness throughout the body. Symptoms in the joints is usually occur gradually after few weeks or months.


- Joint pain in the AR is intermittent, there is a period of remission, are symmetrical bilateral, and associated with cold air.
- Attacks are usually sesisi OA. The main symptoms are joint pain associated with the motion. Patients also feel stiff in the joints
attacked.
- On radiological examination usually shows widening of the joint OA at an early stage, osteophytes, bone sclerosis and narrowing of the cavity between joints at an advanced stage.
- Deformities can occur in OA and AR after the destruction of the health center joints

 Diagnosis of Arthritis
Pain and swelling in the joints.

Management of Arthritis
- Complaints to the joints or soft tissues around it could be solved with regular analgesics or anti-inflammatory drugs given after eat.
• asetosal 1 gram 3 times daily
• Fenilbutason 200 mg 3 times daily
• ibuprofen 400 mg three times daily
- Resting the joint is required in the acute situation. Later in the OA, patients may need to improve posture, reduce weight, or physiotherapy.
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Anemia


Anemia

Definition of Anemia
Anemia can be classified according to several criteria, but the most is a practical grouping based on the occurrence of anemia post hemorrhage, hemolytic anemia, deficiency anemia, aplastic anemia and anemia due to malignancy.



Cause of Anemia
Insufficient blood production (due to a deficiency or failure of the bone marrow), excessive blood loss, excessive destruction of blood or a combination of these factors. Blood loss and chronic cryptic, for example in ankilostomiasis, cause iron deficiency anemia, hemolysis, among others, while it occurs G6PD deficiency and thalassemia.

Clinical Overview of Anemia
- Anemia caused by sudden blood loss, and many will spur
body's homeostatic compensation. Acute blood loss as much as 12-15%
will give the symptoms of pallor, tachycardia with normal blood pressure or
low. Loss of 15-20% causes the blood pressure begins to drop until
shock, and loss of 20% can result in death.
- Deficiency anemia is characterized by fatigue, frequent palpitations, fatigue and irritability
headache. Optic disc atrophy of the tongue looks. Sometimes enlarged heart and sound
systolic murmur. In the peripheral blood picture of anemia appear hipokrom and
mikrositer, while low serum iron content.
- Deficiency of vitamin B12 and folic acid causes megaloblastic anemia
which may be accompanied by neurological symptoms.
- Hemolytic anemia may be accompanied by an increase in blood bilirubin (jaundice).
The spleen is generally enlarged.
- Aplastic anemia is apparent from the low levels of hemoglobin and other systemic symptoms,
without enlargement of the organ.

Diagnosis
Examination of hemoglobin concentration and peripheral blood.
common Hb <12 g / dl.Pedoman Treatment in Primary Health Centers 2007


Management of Anemia
- Successful treatment depends on the ability to enforce
diagnosis at an early stage.
- Anemia pascaperdarahan treated with blood transfusions as much as 10-20
ml / kg body weight, or plasma expander. If there is no second, intravenous fluids
also can be used.
- The impact can be overcome by slow transfusion of packed red cells.
- Iron deficiency anemia treated with adequate food, sulfas ferosus
10 mg / kg 3 times daily or Iron elementary 1mg/kgBB/hari
- Anemia Megaloblastic specific treatment, therefore, should be distinguished
cause, deficiency of vitamin B12 or folic acid deficiency.
• The dose of vitamin B12 100 mcg / day im, for 5 - 10 days as initial therapy
rumat therapy followed by 100-200 mcg / months to achieve remission.
• The dose of folic acid 0.5 - 1mg/hari orally for 10 days, followed
with 0.1 - 0.5 mg / day.
The use of oral vitamin B12 is useless in pernicious anemia.
Besides the oral dosage is more expensive.
- Autoimmune Hemolysis resolved with prednisone 2-5 mg / kg / day orally and
testosterone 1-2 mg / kg / day iv, for the long term.
- Blood transfusion given only when necessary.
- Refer to hospital
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AIDS


AIDS

Definition
AIDS (Acquired Immuno Deficiency Syndrome) is a collection of symptoms diseases caused by Human Immunodeficiency Virus (HIV). HIV is found in body fluids, especially blood, semen, cairam vagina and breast milk. The virus damages the immune system people and resulted in the decline or loss of endurance, so infection and illness.



Cause of aids
HIV is a virus, a type of retrovirus that includes the virus type using RNA as a molecular carrier of genetic information.


Clinical Overview of aids

  A clinical categories include HIV infection without symptoms (asymptomatic), lymph
denopati generalized persistent and acute primary infection with the disease broadcaster.
  Category B consists of a clinical condition with symptoms in adolescents / adults
infected with HIV are not included in categories C and meet the most
less one of the following criteria:

A) The state associated with the presence of HIV infection or the presence of
immunodeficiency diperantarakan cell (Cell-mediated immunity)
or

B) The conditions that have been deemed by doctors require clinical treatment
or require the management of complications of HIV infection
with an example:
Angiomatosis basilari; oropharyngeal candidiasis; vulvovaginal candidiasis;
Cervical dysplasia; 38.5 OC fever or diarrhea for more than 1 month;
Oral hairy leukoplakia: Herpes zoster; idiopathic thrombocytopenic purpura;
Listeriosis: Pelvic inflammatory disease: Peripheral Neuropathy

  Category C includes the clinical symptoms found in AIDS patients
for example:
Kandisiasis bronchi, trachea and lungs; esophageal candidiasis; Cervical Cancer
invasive; Coccidiodomycosi spread or in the lung; cryptococcosis in
outside the lung; Retinistis cytomegalovirus; Encephalopathy associated
with HIV, Herpes simplex or chronic ulcers over a month
duration; bronchitis, esophagitis or pneumonia; Histoplasmosis spreads
or outside the lung; Isosporiasis instestinal chronicles more than a month;
Kaposi's sarcoma; Lymphoma burkit (or other terms indicate that the lesion
similar); lymphoma immuno blastik, L.primer in the brain; Micobacterium avium
Complex or M.lansii spread outside the lung; M.tuberculosis anywhere
(Pulmonary or extrapulmonary); Pneumocystis carinii pneumonia; Leukoensefalopati
progressive multifocal; recurrent salmonella septicemia;
Taksoplasmosis in the brain.

Diagnosis of aids
Diagnosis based on clinical symptoms and blood examination. On examination the blood can be tested directly against the HIV virus or indirectly by determining the anti-bodies, which have been and more easy to implement. Today many types of tests that have a sensitivity and
high specificity is available.

Treatment / Management of aids
Currently there are three classes of antiretroviral drugs available in Indonesia:

•  Nucleoside Reverse Transcriptase Inhibitors (NsRTI): This drug is known as a nucleoside analog that inhibits the process of change in viral RNA into DNA. This process is necessary so that the virus can replicate. Drug in this group include zidovudine (ZDV or AZT), lamivudine
(3TC), ddI (didanosine) zalcitabine (ddC), stavudine (d4T) and abacavir (ABC).

•  Non-Nucleside Reserve Trancriptase Inhibitor (NNsRTI): this drug although in contrast to NRTIs also inhibit the process of change in RNA into DNA. in drugs include nevirapine (NVP),
efavirenz (EFV) and delavirdine (DLV).
•  Protease Inhibitor (PI): These drugs inhibit the enzyme protease that cuts the long chain acids into proteins of interest more minor. Drugs in golonganini including indinavir (IDV), nelfinavir (NFV), saquinavir (SQV), ritonavir (RTV), amprenavir (APV), and
lopinavir / ritonavir (LPV / r).
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