LBM 4 SARAF

STEP 1

1. Paresthesi : perasaan sakit atau persaan yang menyimpang; sensari abnormal spt kesemutan,
rasa terbakar, ditusuk2 dll
2. Hypotensi osthostatic : perubahan tekanan darah saat di ukur dengan posisi telentang dan
duduk. Saat duduk lebih rendah TDnya

STEP 2

1. why she had difficulty in walking, numbness in her two legs ?

2. why she complains of burning in her leg and stiffnes in lower extremity ?
3. why she has fine motor disturbances like unscrewing jar lids and paresthesi in fingers ?
4. how the mechanism of orthostatic hypotention ?
5. what are the additional examination ? and interpretation ?
6. what are the diagnose and DD of scenario ?
7. what are the characterictic to diagnose ?
8. what are the risk factor in the scenario ?
9. what are the therapy of scenario ?
10. what are the complication of scenario ?
11. PENYEBAB POLYNEUROPATI SELAIN DM ?

STEP 3

1. why she had difficulty in walking and numbness in her two legs ?
mati rasa : krn ada peningkatan kadar glukosa menimbulkan komplikasi sst ssp endotel
rusak, thrombus dari anoksia disfungsi komponen sensorik jadi kebas terutama di kedua
tungkai saja
the damage of neuron hard walking because of high concentration of glucose

2. why she complains of burning in her leg and stiffnes in lower extremity ?
saraf sensorik ada serabut2nya
serabut C terkena akan menyebabkan nyeri yg panas
gejala neuropati
- rasa terbakar, kesemutan dll
- negative : baal, kelemahan dll
3. why she has fine motor disturbances like unscrewing jar lids and paresthesi in fingers ?
paresthesi : glukosa tinggi endotel jd sorbitol menghambat myoinositol msk sel saraf
stress osmotic merusak mitkondria dan mengeluarkan protein kinase C menekan Na K
ATPase gangguan sinyal saraf

4. how the mechanism of orthostatic hypotention ?

 orthostatic hypotention : when you sleep and sit you feel
when sleep blod pressure is normal and when sit the baroreceptor and medulla oblongata cant
give signal to heart
cause : dehydration dll

5. what are the additional examination ? and interpretation ?

o filament tes : to know the sensitibilitas
o EMG
o USG pembuluh darah
o Parasthesi tes :
o Sensitibilitas :
o GDS HbA1c can check the glucose stabil or unstabil in 3 month
o Motoric tes : gait walking

6. what are the diagnose and DD of scenario ?

DD : -polyneuropati DM microangiopaty juga gangguan
- SGB
-

Diagnosis :
7. what are the characterictic to diagnose ?
2 from 4 criteria :
- gejala klinik
- tanda kelainan sensors
- tanda kelainan morotic
- pemeriksaan EMG
8. what are the risk factor in the scenario ?
- riwayat DM
- control gula darah yg buruk
- usia tua
- dislipidemia
- merokok
- alcohol
- genetik
9. what are the therapy of scenario ?
non farma : control the glucose, cure the skin of the legs, education the patient
farma : NSAID, gabapentine, antidepressant T cyclic, educatase inhibitor,
10. what are the complication of scenario ?
o complication of DM
- defense decrease high glucose when she had scar hard to cure ulcus
- coma diabeticum fluctuation from hypoglicemi or hyperglicemi
- edem cerebri
 o complication of polyneuropati ???????

STEP 4
RISK FACTOR
ETIOLOGI

DIFFICULT IN
NEUROPATI WALKING
DIABETIC
BURNING

STIFNESS

DISTAL PX. EXAMINATION NUMBENSS

WEAKNESS

LAB TEST BLOOD GLUCOSE

DD

DIAGNOSE

COMPLICATION
TREATMENT