TB + DM + HEMOPTOE

DM
Imunity menurun
Spesific Process
Multiplication bacteri
Perenchym damage
Enlarge Vessels
Cough
Ruptur
Hemoptoe
 TB/pneumonia + DM + SOB

DM( Insulin Deficiency )

Impainment of leucosit & Limfosit Infection by Spesific

Process
Multiplication Bacteri Infection by
nonspesific
Process
Inflamatory

SOB
 Sequence of Event
Imunity
Lung Tumor
Directly effect
Non Spesific of Tumor Mass
Infection Spesific To trachea/bronchus
infection
Release of various
cytokines Airway Obstruction
HCAP
Inf.of MTB & Sputum
Accumulation
TNF α, IL1, IL3 IL 7,
Release of IL-1,
LMF
SOB IL-6 and TNFα

Loss of appetite

Mechanoreceptor
↓ intake stimulation

Loss of body SOB Cough

weight
 AEBC
Chronic inflammation of
central air way Acute exacerbation risk
(Bronchus – Bronchioles) factor (infection, etc)

Inflammatory cells
Infiltrate to respiratory Mucus
epithelium SOB
hypersecretion

AM IL-8

Neutrophils Cytokine TNF-α

release Mucous
production
T lymphocytes
Leukotriene B4
 TB + KU Lemah + SOB
MTB

Inflamation Process

TNF α Bronchogenic Destructive lung

Spread Parenchym
Loss of Appetite
Granuloma SOB
Intake ↓
Cavity
Body Weakness
 TB + EFUSI PLEURA
Spesific Process ( lung TB )

Destructive lung parenchym

Rupture of caseosa focus

Pe ↑ tuberculoprotein in the pleural space

Hipersensitivity reaction ( Delayed Typed Hypersensitivity )

Pe ↑ Permeability Capiler

Pleural Effusion

SOB
 TB + ORGANISASI EFUSI PLEURA
Spesific Process

TNF α Limfogen Multiplication Bacteri

Inside to pleural cavity
Loss of Appetite by caseosa on subpleura Caseosa

Inflamation reaction Fibroinfiltrat

Anemia Intake↓
Fluid accumulation Restrictive Disorders
in Pleural cavity
Body Weakness
Organization of Pleural SOB
Fluid by Fibrotic Process
( Schwarte )

Restrictive disorders
TB + HEPATITIS DRUG INDUCED OAT

Lung TB

OAT

Metabolism in Liver

Liver Damage

SGOT / SGPT & Bilirubin ↑

Nausea
 PERITONITIS TB
Inhalasi MTB Tertelan MTB
Lesi Primer Mukosa Usus
TB Primer ( Dorman) Kel. Limfe Mesenterik
Fokus Dorman di Usus

Imunokompromise

Reaktivitas TB Primer (Fokus Dorman)

Penyebaran Hematogen

Peritonium

Peritonitis TB
 DM + PNEUMONIA
DM

Infection

Spesific Process Pneumonia

Inflamation Process

IL 1

Fever
 DM
ISPA
Imunitas ↓

Inflamasi IL 1 Febris
Pleura
Konsolidasi
Pleuritis
Pneumonia
Chest Pain
 PPOK + PNEUMOTHORAX
>> SMOKING
Inflamation of the Lung Parenchym

Oksidatif Stress Enzym Protease ↑

Destructrion of the lung Parenchym

COPD
Cough
Pe ↑ Intrathoracal Pressure
Locus minoris in Peribronchial
Alveoli Rupture
Pneumothoraks
SOB
PLEURAL EFFUSION E.C NONSPESIFIK PROSES
Infection non spesific

Destructive lung parenchym

Consolidation

Inflamation of lung parenchym

Permeability Capiler ↑

Pleural Effusion

SOB
 PPOK EKSASERBASI AKUT

SMOKING

Inflamation Parenchym of the lung

Oksidatif Stress Enzym Protease ↑

Destructrion Parenchym of the Lung

COPD

Acute Exacerbation
 PPOK + CPCD
Inhaled Particles & Active or Passive tobacco smoke
Inflamation Parenchym of the Lung

Oksidatif Stress Enzym Protease ↑

Destructrion parenchym of the Lung

COPD
Inadekuat tx. Reinfection
Hipoxia
↓ Vascular Bed
Acidosis & Hypercapnea

HT Pulmonale

Hypertrofi & Dilatation Right Ventricle

Cor Pulmonale
 TUMOR PARU
Chronic Cigarette Smoke

Chronic airway irritation + Inflamation

Displasia Epitel

Ca Bronkogenic

TNF α↑

Nafsu makan menurun

Berat badan menurun

Badan Lemah
LUNG CA + EFUSI PLEURA

Lung Ca

Pleural Infiltration

Permeability Capiler ↑

Pleural Effusion

SOB
 Sequent of Event

Lung Ca Metastatic costae

↓
Pleural infiltration
Destruction
↓ costae
↑Permeability capiler
↓
Pleural effusion
↓
SOB
SOE Diabetes
Mellitus

Immunocompromise
MTb disease

Non spesific Infection of MTb

infection
Increase of
TNFα Increase of
Produce IL-1, Inflamation
mucous
IL-6 process
production
Appetite Increased of
supression intathoracal
Fibrosis Cough pressure
Fever

Loss of
Alveoli rupture
body Hyponatremia
SOB weight
Pneumothora
x
Hipoalbumin
SOB
 TUMOR PARU + VCSS + EFUSI PLEURA
Smoking
Damage to DNA of Bronchial Epithelium
Metaplasia of epithelium
Growth of tumor SOB
Metastase

Enlarge of limfonode Obst. Of N.Laryngeal

Obstruction of limf.
Obstruction of Vein drainage Disfonia

VCSS Extravasasi

Accumulation in pleural space

Pleural effusion
SOB
 PLEURAL EFFUSION e/c Ca MAMMAE
Ca Mammae

Metastasis to the Lung Resp. Of Immunity ↓

Pleural Spaces infection of spesific
or nonspesific
Process

Exretion of Vasoaktif amin Inflamation Process

Permeability of Pleura ↑ Pneumonia

Fluid Accumulation
Pleural Effusion

SOB
 MASSA MEDIASTINUM + BATUK

Massa Mediastinum

Reseptor Mekanis / Kimia

Lengkung Afferen refleks batuk di N. Vagus

M.O & PONS

Batuk
 ABSES LIVER + EMPIEMA
Liver abscess
Subdiafragma
Microorganism in Subpleural

Migration & adherence of PMN cells to adjacent endothelium

Release of mediators & O2 metabolism

Endothelial injury & Capilary leak
Increased interstitial fluid & Pressure

EMPIEMA

SOB
 tumor

Tumor cells Reactive host cells

Cytokines release

IL-1 IL-6 TNF-α IFN- γ

Anorexia Lean tissue wasting

Loss of appetite

Low Intake Body weakness

 Homogen opacD ass: 1. Malignant EPMassif D 2. Ca Paru

Right
Lung
Tumor
Malignancy
↓ Immunity Pleural
Cilia movement infiltration
Release various disorder
Cytokine Inflamation process
malignancy ↑ permeability
capiler
Cough
TNF α Release various
cytokine Pleural Efusion

Loss Of TNF α, IL 1,
Appetite IL 3, IL 6,
IL 8
SOB
Loss of Body
weight Leucocytosis
 Alcalosis
Respiratoric
CAP TB DM TIPE II HIPOALBUMIN
History of Lung TB 2004

Spesific process M.TB

(relaps)

Multiplication of bacteria DM
Chest pain
Leukositosis
Inflamation process Febris
Cilia
Movement
disorder ↑ TNF α

Immunocompromis
CAP
Anorexia e
Cough
Lost of
Appetite

Intake ↓ Non specific

Bacteria
Hypoalbuminemi
Loss of BW
a
SEQUENCE OF EVENT

MTB infection

Destruction of parenchym Inflamation process

↑ TNF α

Enlarged vessels/
hypervascularitation
Lost of Appetite

Cough
Intake ↓

Rupture of vessels

Hemoptoe
 SEQUENCE OF EVENT Unadequate
ATD therapy
Infection of M tb
Efusi pleura
MDR-TB
Inflamation process
Extravasasi
cairan DM
Leukositosis
↑ TNF α
Febris
Permeabilit CXR: infiltrat
y disorder
Anorexia

Lost of Appetite Immunocompromis

CAP
e

Intake ↓

Hypoalbuminemi Non specific

a Bacteria
 SOE Neurofibromatosi
s

inflammation Mediastinum Directly effect

Right Lung Tumor By Tumor Mass
process / Tumor
malignancy To trakea/bronkus
Obst Of limfe Invasion to
Release various drainage chest wall Airway
Cytokine Obstruction
& Sputum
Extravasation Accumulation
Chest Pain
TNF α, β, TNF α,IL1,
IL1,IL6,IL 7, IL 3, IL6,IL Accumulation Mechanoreceptor
LMF 8 of plural fluid stimulation

Leucocytosi
Loss Of s Pleural Cough
Appetite effusion
Restrictive
Intake ↓ disorders
Loss of
Body SO
weight Anemia B
 Sequent of Event
Left Lung
Tumor

Malignancy
Obst Of limfe ↗ Serum
drainage transaminase
Release various
Cytokine Assesment:
Extravasation
1.Hepatitis
2.Metastasis
TNF α, β, Accumulation to liver
Cilia
IL1,IL6,IL 7, of plural fluid
movement
LMF disorder Nausea &
Pleural effusion Vomiting
Loss Of
Appetite Cough
Restrictive
Loss of disorders
Body
weight SOB
 History Of Sequent of Event
Lung TB
2007 Left Lung
Tumor

Malignancy
Spesific Obst Of limfe
process ↗ Serum
drainage transaminase
Release various M.TB
Cytokine (relaps)
Extravasation Assesment:
Multiplication 1.Hepatitis
of Bacteria 2.Metastasis
TNF α, β, Accumulation to liver
Cilia
IL1,IL6,IL 7, Inflammatio of plural fluid
movement
LMF n Process disorder Nausea &
Pleural effusion Vomiting
Loss Of IL - 1
Appetite Cough
Restrictive
Mild Fever disorders
Loss of
Body
weight
Night SOB
sweats
 Lung Tumor
SOE
Pleural
↓ Immunity infiltration Parenchyme
necrosis
Inflamation process malignancy
↑ permeability
capiler Release
Release various Leucotrien
cytokine Pneumonia
Pleural
TNF α, IL1, IL3 Efusion ↑ Prostaglandin E,
IL 7, LMF ↑ Nociceptor
TNF α, IL 1, sensitivity
IL 3, IL 6,
Loss of IL 8 SOB
appetite ↑ sensitivity to
Bradikinin
Lecositosis
↓ intake

Loss of Chest pain

Anemia
BW
Sequence of event

Non spesifik Spesific Process

proses
destructive Parenkim damage

Membrane permeability

Acumulation pleural fluid

Fibropurulent ( empiema )

SOB
SEQUENCE OF EVENT

Non specific inf MTB infection

Inflamation process
Multiplication bacteria

↑ TNF α
Destruction of parenchym

Lost of Appetite

SOB
Intake ↓ Prod Hcl

Mucosal break
anemia
Bloodish
stool
 Sequent of Event
Left Lung
Tumor

Malignancy

Release various Progressive

Cytokine process
Metastase to
liver
TNF α, β, Parenchym
IL1,IL6,IL 7, damage
LMF Congestive
liver
Loss Of intake
Appetite Back pain

hipoalbuminemi
Loss of a
Body
weight ascites
SOE Non Spesific
Infection Secondary DM
Infention

Inflamation process Imunocompromize

d

Increase Release various

mucous of cytokines Microangiopaty
production vascular damage

IL-1, IL-6, IFN-

γ

PJK OMI
Cough SOB Fever
 PPOK EKSASERBASI AKUT
Non Spesific
DM
Infection
SMOKING

Inflamation Parenchym of the lung

Oksidatif Stress Enzym Protease ↑

Destructrion Parenchym of the Lung

COPD
Acute Exacerbation

SOB
 IFN δ

Sub febrile

anemia

Hypoalbuminemia
 COPD Exacerbation

SMOKING

Inflamation Parenchym of the lung

Oksidatif Stress Enzym Protease ↑

Destructrion Parenchym of the Lung

COPD
URTI
Acute Exacerbation

increase IL6, IL1, TNF a

Cough , SOB, respiratory failure type 2 Fever