Professional Documents
Culture Documents
Responsi Limfadenitis
Responsi Limfadenitis
TUBERCULOUS LYMPHADENITIS
LECTURER
:
DR. DR. BAMBANG ARIANTO, SP.B
BY
:
TANIA WANGUNHARDJO
PATRICIA HILDAGARDIS BULAN
CASE REPORT
PATIENT IDENTITY
Name
: Mr. RI
Age
: 22 years old
Sex
: Male
Religion
: Moslem
Ethnic
: Java
Occupation
: Student
Education
: Senior high school
Address
: Medokan Semampir AWS Surabaya
Medical Record : 520267
Control
: November, 25th 2015
HISTORY TAKING
Then, he came to the outpatient surgery clinique in Haji Hospital. There was
GENERAL STATUS
General conditions: moderate illness
Awareness / GCS: Compos mentis / 4-5-6
Vital sign:
Tension: 110/80mmHg
Pulse: 72 bpm
Weight: 60 kg
RR: 20 tpm
Temp.axilla: 36,80C
GENERAL STATUS
Head / face:
Anemia / jaundice / cyanosis / dyspnea: - / - / - / Neck : enlarged lymph nodes (-) / (-) , thyroid gland (-)
Axilla : enlarged lymph nodes (-) / (+)
Thorax:
Pulmo:
I
: normochest, retraction (-)
P
: symmetric breathing movement
P
: sonor/sonor
A
: vesicular/vesicular, rhonchi -/-, wheezing -/-
Cor:
I
P
P
A
Abdomen:
I
A
P
P
: flat, symmetric
: bowel sound (+), normal
: soepel (+), tenderness (-)
: tympani (+)
LOCAL STATUS
Regio: Axilla sinistra
I :
nodul (+)
diameter 4,5 x 3,5 x 0,5 cm
blood (-)
pus (-)
hyperemia (-)
P:
tenderness (+)
consistency soft solid
mobile
flat surface
clear border
fluctuation (-)
warm (+)
NEUROLOGICAL STATUS
GCS : 4-5-6
Meningeal Sign
Stiff neck
: Laseque
: -/ Kernig
: -/ Brudzinski I,II,III,IV
: -/-/-/ N. Cranialis : Pupil round isokhor 3mm/3mm; light reflex
+/+
N VII and XII normal
Motoric : +5 / +5
+5 / +5
Sensory : normal
Physiology reflex
BPR +2/+2
TPR +2/+2
Phatology reflex
Babinski
Chaddok
Hoffmman
Tromner
:
KPR +2/+2
APR +2/+2
:
: -/: -/: -/: -/-
ASSESMENT
Working diagnose: Axillary Nodul
Primary diagnose: Tuberculous lymphadenitis
Secondary diagnose:Complication diagnose:-
PLANNING
Planning diagnose : Planning therapy :
LITERARY
INTRODUCTION
Tuberculosis (TB) :
lymphadenitis
5 principal groups:
1. pectoral
2. subscapular
3. humeral
4. central
5. apical
Subclavian lymphatic
trunk
Right lymphatic duct
Left : thoracic duct
DEFINITION
Lymphadenopathy :
EPIDEMIOLOGY
The incidence of mycobacterial lymphadenitis has increased ~
mycobacterial infection
every year
lymphadenitis.
In HIV (+) extrapulmonary TB 53 62% cases of TB
PATHOGENESIS
Local / systemic manifestation
Primary or Reactivation
Primary infection :
CLINICAL PRESENTATION
Duration of symptoms : few weeks several months
Unilateral single / multiple painless slow growing mass / masses;
Tenderness (+) if :
Stage I
enlarged, mobile, firm and slightly tender
Histologically : nonspecific relative hyperplasia
Stage II
enlarged, firm and fixed to surrounding tissue and to each other.
Histologically : periadenitis.
Stage III
The caseation occurs within the lymph node which burst out and
collects beneath the deep fascia.
Stage IV
The caseous material perforates the deep fascia and escapes into the
superficial fascia resulting in coller stud abscess formation.
Stage V
The cold abscess burst out and gives rise to a persistent discharging
sinus.
DIAGNOSIS
HISTORY
1.
2.
3.
4.
PHYSICAL EXAMINATION
Size
Pain/tenderness
Consistency
Matting
Location
SMEARS
CULTURE
TUBERCULIN TEST
MOLECULAR TESTING
HISTOPATHOLOGY
Chest radiograph
Ultrasound
CT
MRI
MANAGEMENT
DOTS : Category I (2HRZE/4H3R3)
6 months evaluation
AntiTB :
TERIMA KASIH