Tgl.

Jaga 13 Juni 2023 Tim Jaga: 4 CR Chief Jaga: dr Amrin

Diagnosis Introduction Etiology Epidemiology Pathophysiology Evaluation Treatment / Management

Lung Empyema Empyema is defin Around 20% of pat Like with all infections, prompt initiation of antibioti
ed as a collection ients with pneumo Due to the association bet The development of empyema Due to the lack of specificity in a c cs and source control is fundamental. Treatment of e
of pus in the pleur nia will develop a ween pneumonia and empy can be described in a sequence linical presentation, more tests are mpyema usually involves medical and surgical treat
al cavity, gram-po parapneumonic eff ema, patients at increased r of events. During an inflammat needed to establish a diagnosis.[8] ment. In community-acquired empyema, the use of a
sitive, or culture fr usion that may lead isk for pneumonia will also ory process such as pneumoni third or fourth-generation cephalosporin plus metroni
om the pleural flui to empyema. Seve be at higher risk for empye a, there is an increase in fluid p To evaluate for the presence of any dazole or ampicillin with a beta-lactamase inhibitor
d. Empyema is us nty percent of patie ma. Some risk factors have roduction in the pleural cavity pleural effusion, the first test that s will provided good coverage. In hospital-acquired or
ually associated w nts with empyema been identified as unique f known as the exudate stage. As hould be ordered is a chest x-ray. I trauma-related, and surgery-related empyema, covera
ith pneumonia but have parapneumon or developing empyema. A the disease progresses microor t is a widely available and simple t ge of Pseudomonas and MRSA by adding vancomyci
may also develop ic effusion, the oth mong these factors are dia ganisms, usually bacteria, can est, but it is not 100% sensitive n, cefepime, and metronidazole or piperacillin-tazoba
after thoracic surg er 30% of cases are betes mellitus, intravenous colonize the fluid and generate ctam is essential
ery or thoracic tra related to trauma, p drug abuse, immunosuppre d an empyema. This fluid is ch
uma. In the United ost-thoracic surger ssion, gastric acid reflux, a aracterized by elevated lactate
States, there are ap y, esophageal ruptu nd alcohol abuse. dehydrogenase, proteins, neutr
proximately 32,00 res, or cervical infe ophils, and dead cells
0 cases per year. E ctions, and a small
mpyema is associa number are not rela
ted with elevated ted to previous pne
morbidity and mor umonia or interven
tality, around 20% tion, this is known
to 30% of patients as primary empye
affected will either ma
die or required fur
ther surgery in the
first year after dev
eloping empyema.
Early intervention
is crucial in the m
anagement of emp
yema
Rectal Prolapse Pediatric populatio Pediatric populations are m Diagnosis of rectal prolapse is mos
Rectal prolaps ns are more likely t ore likely to develop rectal t commonly made based on history Conservative management of rectal prolapse includ
e refers specifi o develop rectal pr prolapse due to several ana As noted above, rectal prolaps and physical alone. As mentioned es stool softeners and/or laxatives, avoidance of prol
cally to prolap olapse due to sever tomic differences in early c e refers specifically to prolapse above, prolapse often resolves by t onged straining, and treatment of any predisposing u
se of some or al anatomic differe hildhood. In children, the r of some or all of the rectal muc he time the patient reaches medical nderlying conditions. Compliance with bowel regime
all of the recta nces in early childh ectum follows a vertical co osa through the external anal s attention, and thus the clinician mu n is important because patients who have repeat inst
l mucosa throu ood. In children, th urse along the sacrum and phincter. There are 2 types of r st rely on history for diagnosis. Pat ances of rectal prolapse may be less responsive to re
gh the external e rectum follows a coccyx and is also in a rela ectal prolapse: type 1 and type ients with constipation as the likel ctal prolapse in the future. Generally, these conserva
anal sphincter. vertical course alo tively lower position than t 2, also called false procidentia y cause of their prolapse should re tive tools work for about 90% of patients who develo
In pediatric po ng the sacrum and he other pelvic organs. The and true procidentia, respective ceive contrast radiography of the c p rectal prolapse before age 3. For children with cys
coccyx and is also rectum also has a rather re ly. Type 1, which is partial or olon and anorectal manometry tic fibrosis, who as mentioned above are predisposed
pulations aged
in a relatively lowe dundant rectal mucosa whi mucosal prolapse, produces ra to rectal prolapse, adjustment of pancreatic enzymes
between infan
r position than the ch is attached to the underl dial folds at the junction with t is important
cy and age 4, r
ectal prolapse other pelvic organ ying muscularis only loose he anal skin. This type is usual
is usually a sel s. The rectum also ly ly involves less than 2 cm of pr
f-limiting con has a rather redund olapse and only the mucosa is
dition, respond ant rectal mucosa prolapsed. Type 2, or complete
ing to conserv which is attached t prolapse, is characterized by fu
ative manage o the underlying m ll-thickness extrusion of the re
ment. The hig uscularis only loos ctal wall.
hest incidence ely
of rectal prola
pse has been n
oted in the firs
t year of life.
[1] However,
children prese
nting after age
4 usually have
a chronic cond
ition predispos
ing them to ha
ve developed r
ectal prolapse.
[2] In some ca
ses, prolapse
may persist in
definitely, req
uiring surgical
intervention.
Kanker payudara Ca mammae erkiraan jumlah kasus Kanker payudara biasanya Penanganan ca mammae Kanker payudara (ca mammae) adalah keganasan
(ca mammae) terjadi ketika kanker payudara mencapai terjadi karena adanya interaksi bergantung pada faktor-faktor pada payudara (mammae) yang berasal dari sel
adalah keganasan beberapa sel 1,7 juta kasus dan jumlah antara faktor lingkungan dan seperti stadium ca mammae dan kelenjar, saluran kelenjar, dan jaringan penunjang
pada payudara payudara mulai kematian hingga 521.900 genetik. Jalur PI3K/AKT dan usia pasien. Penanganan ca payudara
(mammae) yang tumbuh secara jiwa di tahun 2012. jalur RAS/MEK/ERK mammae biasanya berupa operasi,
berasal dari sel tidak normal. Sel- Separuh kasus kanker merupakan jalur yang dan dilanjutkan dengan kemoterapi
kelenjar, saluran sel tidak normal ini payudara dan hampir 38% memproteksi sel normal dari atau terapi radiasi, atau keduanya
kelenjar, dan membelah lebih jumlah kematian akibat bunuh diri sel (Kabel & Baali, (Jezdic, 2018). Ca mammae ER+
jaringan cepat daripada sel- kanker payudara 2015). Ketika gen yang seringkali ditangani dengan
penunjang sel sehat dan terus ditemukan di negara maju mengkode jalur perlindungan pemberian terapi hormoneblocking
payudara menumpuk, seperti Amerika Serikat, ini bermutasi, selsel menjadi selama beberapa tahun. Antibodi
membentuk Inggris, Australia, Selandia tidak mampu melakukan monoklonal atau imunomodulator
benjolan atau Baru, dan beberapa negara bunuh diri ketika mereka tidak lainnya dapat diberikan pada
massa. Sel-sel di Eropa Utara dan Barat lagi diperlukan, yang stadium lanjut dengan metastasis
dapat menyebar kemudian dapat mengarah jauh.
(bermetastasis) pada perkembangan kanker
melalui payudara
ke kelenjar getah
bening atau ke
bagian lain dari
tubuh. Keganasan
paling sering
dimulai dari sel-sel
di saluran
penghasil air susu
(invasive ductal
carcinoma). Ca
mammae juga
dapat bermula
pada jaringan
kelenjar yang
disebut lobulus
(invasive lobular
carcinoma)
(Jezdic, 2018).
Para peneliti
mengidentifikasi
faktor-faktor
hormonal, gaya
hidup, dan
lingkungan dapat
meningkatkan
risiko ca mammae
(Falco, 2019).
Kemungkinan
besar ca mammae
disebabkan oleh
interaksi kompleks
susunan genetik
 dan gaya hidup.
Appendicitis is inf The cause of appen The emergency department physici In the emergency department, the patient must be kep
lammation of the dicitis is usually an Appendicitis occurs most o The pathophysiology of appen an must refrain from giving the pat t nil per os (NPO) and hydrated intravenously with cr
Appendicitis vermiform append obstruction of the a ften between the ages of 5 dicitis likely stems from obstru ient any pain medication until the s ystalloid, and antibiotics should be administered intra
ix. Appendix a hol ppendiceal lumen. and 45, with a mean age of ction of the appendiceal orific urgeon has seen the patient. The an venously as per the surgeon. The responsibility for th
low organ located  This can be from a 28. The incidence is appro e. The background etiology of algesics can mask the peritoneal si e consent falls on the surgeon. The gold-standard trea
at the tip of the ce n appendicolith (st ximately 233/per 100,000 the obstruction might differ in gns and lead to a delay in diagnosi tment for acute appendicitis is to perform an appende
cum, usually in th one of the appendi people. Males have a slight the different age groups. While s or even a ruptured appendix ctomy. Laparoscopic appendectomy is preferred over
e right lower quad x) or some other m ly higher predisposition to lymphoid hyperplasia is essent the open approach. Most uncomplicated appendecto
rant of the abdome echanical etiologie developing acute appendici ial, this results in inflammatio mies are performed laparoscopically. Several studies
n. However, it ca s. Appendiceal tum tis than females, with a life n, localized ischemia, perforati have compared the outcomes with the laparoscopic a
n be located in al ors such as carcino time incidence of 8.6% and on, and the development of a c ppendectomy group and patients who underwent ope
most any area of t id tumors, appendi 6.7% for men, and women, ontained abscess or frank perfo n appendectomy.
he abdomen, depe ceal adenocarcino respectively. Approximatel ration with resultant peritoniti
nding on if there ma, intestinal paras y 300,000 hospital visits ye s. This obstruction may be cau
were any abnorma ites, and hypertrop arly in the United States fo sed by lymphoid hyperplasia, i
l developmental is hied lymphatic tiss r appendicitis-related issue nfections (parasitic), fecaliths,
sues, including mi ue are all known ca s. or benign or malignant tumors
dgut malrotation, uses of appendicea
or if there are any l obstruction and a
other special condi ppendicitis
tions such as preg
nancy or prior abd
ominal surgeries