Professional Documents
Culture Documents
STEP 1
Pneumonia severity index : is validated risk statification
instrumen which can help indetifying CAP patient who can
safely be trated with patient antibiotic
Determine the or carculate of probability about morbility
and also mortality in patient with pneumonia
Infiltrat : something that from other tissue spread into another
tissue and trap in the tissue
Example : pus , bacteria , eksudat
Dim : the sound that you made almost likely hepar sound or
lien sound
The sound that make by percution in lung because there are
sputum fibrin in pleura that sound became a dim because
the contain
STEP 2
1) Why the man feel dyspneu and cough with green
sputum and fever ?
2) Why in the lung examination the doctor get dim and
wet ronchi in the bronchial basis ?
3) How to score the penumonia severity index ?
4) Why in rontgen photo is found infiltrat in both og the
lung ?
5) Why the doctor ask the patient to do gram staining and
sputum culturing ?
6) What is diagnosis and different diagnosis ?
STEP 3
1) Why the man feel dyspneu and cough with green
sputum and fever ?
Included because of inflamation , inflamation in this boddies
in the sinus tissue or bronchial tissue and etc
Trap the mucus , mucus became the nest of the agent , agen
reproducing multiply white blood cell infiltrate mukus , the
pigmen of the white blood cell is green that why the colour
green
Fever : the body has inflamation , and the bodies
temperature get higher and the brain soldier white blood
cell to attack that place because its full of agent
Fever caused by released inflamatory mediator like IL1 and
TNF
2) Why in the lung examination the doctor get dim and
wet ronchi in the bronchial basis ?
STEP 3
1. Why the man feel dyspneu and cough with green sputum and
fever ?
Most of the time, your nose and airways filter germs out of the air you breathe. This
keeps your lungs from becoming infected. But germs sometimes find a way to enter the lungs
and cause infections. This is more likely to occur when:
When the germs that cause pneumonia reach your lungs, the lungs' air sacs (alveoli) become
inflamed and fill up with fluid. This causes the symptoms of pneumonia, such as a cough,
fever, chills, and trouble breathing.
When you have pneumonia, oxygen may have trouble reaching your blood. If there is too
little oxygen in your blood, your body cells can't work properly. Because of this and the
infection spreading through the body, pneumonia can cause death.
http://www.lung.org/lung-disease/pneumonia/understandingpneumonia.html
Mikroorganisme (MO) yang masuk ke dalam tubuh umumnya memiliki suatu zat
toksin/racun tertentu yang dikenal sebagai pirogen eksogen. Dengan masuknya MO
tersebut, tubuh akan berusaha melawan dan mencegahnya yakni dengan memerintahkan
pertahanan tubuh antara lain berupa leukosit, makrofag, dan limfosit untuk memakannya
(fagositosit). Dengan adanya proses fagositosit ini, tubuh itu akan mengelurkan zat kimia
yang dikenal sebagai pirogen endogen (khususnya interleukin 1/ IL-1) yang berfungsi
sebagai anti infeksi. Pirogen endogen yang keluar, selanjutnya akan merangsang sel-sel
endotel hipotalamus untuk mengeluarkan suatu substansi yakni asam arakhidonat. Asam
arakhidonat bisa keluar dengan adanya bantuan enzim fosfolipase A2.
Proses selanjutnya adalah, asam arakhidonat yang dikeluarkan oleh hipotalamus akan
pemacu pengeluaran prostaglandin (PGE2). Pengeluaran prostaglandin pun berkat
bantuan dan campur tangan dari enzim siklooksigenase (COX). Pengeluaran prostaglandin
ternyata akan mempengaruhi kerja dari termostat hipotalamus. Sebagai kompensasinya,
hipotalamus selanjutnya akan meningkatkan titik patokan suhu tubuh (di atas suhu
normal). Adanya peningkatan titik patakan ini dikarenakan mesin tersebut merasa bahwa
suhu tubuh sekarang dibawah batas normal. Akibatnya terjadilah respon dingin/ menggigil.
Adanya proses mengigil ini ditujukan utuk menghasilkan panas tubuh yang lebih banyak.
Sehingga terjadilah demam(suhu tubuh meningkat pada seseorang).
Guyton Hall Fisiologi Kedokteran
2. Why in the lung examination the doctor get dim and wet ronchi
in the bronchial basis ?
Wet ronchi can be heard in the tissue because exsudat and
fibrin in the alveolus , this sound can be heard to in the
surface of pleura
Patofisiology sylvia
Pneumonia affects your lungs in two ways. It may be in only one part, or lobe, of
your lung, which is called lobar pneumonia. Or, it may be widespread with
patches throughout both lungs, which is called bronchial pneumonia (or
bronchopneumonia).
http://www.lung.org/lungdisease/pneumonia/understanding-pneumonia.html
lobus atas sering ditimbulkan Klebsiella spp, tuberkulosis atau amiloidosis. Pada lobus
bawah dapat terj adi infiltrat at'rbat St ap hy lo c o c cus atau bakteriemia.
5. Why the doctor ask the patient to do gram staining and sputum
culturing ?
Pemeriksaan dahak. l).Pewamaan gram dan pemeriksaan basil tahan asam (BTA)
adalah suatu tindakan rutin;2). Kultur mikobakteri dan jamur. Pemeriksaan ini
dilakukan pada pasien yang didapatkan adanya kelainan foto toraks berupa infilfrat
di apeks atau kavitas atau pada pasien imunokompromis; 3). Pemeriksaan sitologi
dilakukan pada pasien batuk yang dicurigai juga menderita kanker paru; 4).
Pewarnaan silver pada dahak untuk mencari Pneumocystis carinii pada pasien
imunokompromis.
Buku ajar ilmu penyakit dalam
Demographic factors
Age (in years)
Men
Women
Nursing home resident
Coexisting illnesses
Neoplastic disease
Liver disease
Congestive heart failure
Cerebrovascular disease
Renal disease
Findings on physical examination
Altered mental status
-10
+10
+30
+20
+10
+10
+10
+20
http://internalmedicine.osu.edu/pulmonary/cap/10675.cfm
8. What is diagnosis and different diagnosis ?
Diagnosis : Pneumonia
DD : bronchitis acute , bronchopneumonia ,
9. What are the etiologies from the scenario ?
Many different germs can cause pneumonia. There are five main causes of pneumonia:
Bacteria
Viruses
Mycoplasmas
Other infectious agents, such as fungiincluding pneumocystis
Various chemicals
If you have viral pneumonia, you also are at risk of getting bacterial pneumonia.
http://www.lung.org/lung-disease/pneumonia/understandingpneumonia.html
10.
Bacterial Pneumonia
Bacterial pneumonia can attack anyone, at any age.
Bacterial pneumonia can occur on its own or develop after you've had a cold or the flu.
People at greatest risk for bacterial pneumonia include people recovering from surgery,
people with respiratory diseases or viral infections and people who have weakened immune
systems.
If your body's defenses are weakenedby illness, old age, malnutrition, or impaired
immunitythe pneumonia bacteria, which can live in healthy throats, can multiply and work
their way into the lungs. The infection can quickly spread through the bloodstream and
invade the entire body.
Dozens of different types of bacteria can cause pneumonia.
Viral Pneumonia
Most respiratory viruses attack the upper respiratory tract, but some cause pneumonia,
especially in children. Most of these pneumonias are not serious and last a short time but
others can be severe.
Viral pneumonia caused by the influenza virus may be severe and sometimes fatal. The virus
invades the lungs and multiplies; however, there are almost no physical signs of lung tissue
becoming filled with fluid. This pneumonia is most serious in people who have pre-existing
heart or lung disease and pregnant women.
In extreme cases, the patient has a desperate need for air and extreme breathlessness. Viral
pneumonias may be complicated by an invasion of bacteria, with all the typical symptoms of
bacterial pneumonia.
Mycoplasma Pneumonia
Mycoplasms are the smallest free-living agents of disease in humankind. They are not
classified as to whether they are bacteria or viruses, but they have traits of both.
Mycoplasms usually cause a mild form of pneumonia, but may be severe. They affect all age
groups, but occur most often in older children and young adults.
Other Types of Pneumonia
Tuberculosis can cause pneumonia (tuberculosis pneumonia). It is a very serious lung
infection and extremely dangerous unless treated early.
Pneumocystis carinii pneumonia (PCP) is caused by an organism believed to be a fungus.
PCP may be the first sign of illness in many persons with AIDS.
PCP can be successfully treated in many cases. It may recur a few months later, but treatment
can help to prevent or delay recurrence.
Other less common pneumonias may be quite serious and occur more often. Various special
pneumonias are caused by the inhalation of food, liquid, gases or dust, and by fungi.
Rickettsia (also considered an organism somewhere between viruses and bacteria) cause
Rocky Mountain spotted fever, Q fever, typhus and psittacosis, diseases that may have mild
or severe effects on the lungs.
http://www.lung.org/lung-disease/pneumonia/understandingpneumonia.html
11.
Cigarette smoking
Recent viral respiratory infectiona cold, laryngitis, influenza,etc.
Difficulty swallowing (due to stroke, dementia, Parkinson's disease, or other
neurological conditions)
Chronic lung disease such as COPD, bronchiectasis, or cystic fibrosis
Cerebral palsy
Other serious illnesses, such as heart disease, liver cirrhosis, or diabetes
Living in a nursing facility
Impaired consciousness (loss of brain function due to dementia, stroke, or other
neurologic conditions)
Recent surgery or trauma
Having a weakened immune system due to illness, certain medications, and
autoimmune disorders
http://www.lung.org/lung-disease/pneumonia/understanding-pneumonia.html
12.
Physical exam: Your doctor will listen to your lungs with a stethoscope. If you have
pneumonia, your lungs may make crackling, bubbling, and rumbling sounds when
you inhale. You also may be wheezing, and it may be hard to hear sounds of breathing
in some areas of your chest.
Chest x-ray (if your doctor suspects pneumonia)
Some patients may need other tests, including:
o CBC blood test to check white blood cell count
o Arterial blood gases to see if enough oxygen is getting into your blood from
the lungs
o CT (or CAT) scan of the chest to see how the lungs are functioning
o Sputum tests to look for the organism (that can detected by studying your spit)
causing your symptoms
o Pleural fluid culture if there is fluid in the space surrounding the lungs
o Pulse oximetry to measure how much oxygen is moving through your
bloodstream, done by simply attaching a small clip to your finger for a brief
time
o Bronchoscopy, a procedure used to look into the lungs' airways, which would
be performed if you are hospitalized and antibiotics are not working well
http://www.lung.org/lung-disease/pneumonia/symptoms-diagnosisand.html
13.