Professional Documents
Culture Documents
Pendahuluan
Sejarah Definisi Etiologi Patofisiologi Klasifikasi komplikasi
sejarah
Hipocrates : demam adalah tanda penyakit Galileo : mencipta alat ukur suhu dipakai di klinik oleh Santorio Traube : memperlihatkan kurva suhu secara menyeluruh digunakan secara luas oleh Wunderlich memprediksi kondisi pasien
definisi
Suhu tubuh diatas 37,2o C kisaran normal: 36,5o C 37,2o C peninggian suhu karena pergeseran set point pireksia ( pyrexia ) Hiperpireksia : suhu tubuh > 41,2o C Hipotermi : suhu tubuh < 35o C Hipertermi : mekanisme pengendalian suhu tubuh gagal Suhu rektal / oral aksila berbeda 0,5o C Fungsi demam ( 39o C ): petunjuk produksi antibodi dan proliferasi sel limfosit T mening-kat > 20 x suhu normal
Definisi Demam : Suhu tubuh di atas normal akibat proses patologis Fluktuasi suhu tubuh sesuai irama sirkadian dengan variasi diurnal Homeostasis suhu Produksi panas Proses Metabolik Kelainan Suhu Tubuh = Pirexia - Hipertermi - Demam Pelepasan panas Radiasi + Evaporasi
Patofisiologi
Endotoxin, Microoganism, Microbial Product and Toxins, Phagocytosis, Immune Comlexes, Tissue Injury Mononuclear Phagocyte Interleulin-1 (IL-1) IL-1 Binds to Receptor in Preoptic Nucleus of Anterior Hyphothalamus: Prostaglandin Levels, Hyphotalmic Thermal
Fever
Hyperthermia
Pyrexia
Patofisiologi
Keadaan akibat demam : - BMR meningkat - 13% / 1 C ;40% pada 40 C - Konsumsi Oksigen 7% / 1 C - Katabolisme jaringan meningkat - Kehilangan cairan tubuh meningkat - Cadangan lemak dan glikogen menurun - Motilitas saluran cerna meningkat - Mual-mual, anoreksia - Nyeri otot dan sendi - Kelemahan umum dan keletihan
Etiologi
- Infeksi - Penyakit keganasan - Trauma / penyakit degeneratif pada SSP - Penyakit darah - Penyakit cardio vaskuler - Penyakit endokrin - Paparan fisis - Paparan kimiawi - Gangguan keseimbangan cairan tubuh - Demam faktisius - Demam psikogenik - Demam tak terdiagnosis = F.U.O.
Cause of Hyperthermia
Mechanism of Thermoregulatory Disturbance Increase heat Production
Example
Exercice hiperthermia Thyroid storm Pheochromocytoma Drugs (e.g. malignant hyperthermia of anesthesia Heatstroke Dehydration Autonomic disfungtion Occlusive dressings Drugs (e.g. atropine) Infection (e.g. granulomas, enchephalitis) Tumor, Trauma, Vascular insult Drugs (e.g. neuroleptic malignant syndroma
Hypothalmic insult
Localized Infection and Abscesses Hepatic infection Liver abscess, Cholangitis Intraperitoneal infections Upper abdomen : empyema of gallbrader, pericholecystic and sub hepatic abscess, right or left subphrenic abscess, lesser sac abscess Lower abdomen: periappendicial and peridiventicular abscess Other intra-abdominal abscess Turbo-ovarian abscess; pelvic inflamatory disease and pelvic abscess Retroperitoneal abscess; pancreatic abscess Urinary tract infections Perinephric abscess Renal carbuncle Pyelonephritis with ureteral obstruction and pyonephrosis Prostatic abscess
- Demam Tanggung
- Demam Serius
- Siklik
HEKTIK
P 160 TC 41
O
A.M.
P.M.
A.M.
P.M.
A.M.
P.M.
A.M.
P.M.
140
40
120
39
100
38
80
37O
60
36O
40
35
SEPTIK
P 160 TC 41
O
A.M.
P.M.
A.M.
P.M.
A.M.
P.M.
A.M.
P.M.
140
40
120
39O
100
38
80
37
60
36
40
35O
INTERMITEN
P 160 TC 41
O
A.M.
P.M.
A.M.
P.M.
A.M.
P.M.
A.M.
P.M.
140
40
120
39
100
38
80
37 O
60
36 O
40
35
CONTINUA
P 160 TC 41
O
A.M.
P.M.
A.M.
P.M.
A.M.
P.M.
A.M.
P.M.
140
40
120
39
100
38
80
37 O
60
36 O
40
35
REMITEN
P 160 TC 41
O
A.M.
P.M.
A.M.
P.M.
A.M.
P.M.
A.M.
P.M.
140
40
120
39
100
38 O
80
37
60
36
40
35 O
Penatalaksanaan
Pendekatan Diagnosis + penatalaksanaan kelainan dasar Perbaiki metabolik - kardiovaskuler - sistem respirasi Dinginkan / turunkan suhu
Pemeriksaan Fisik : - Paru - Hati - Limpa - Kelenjar getah bening - Kulit - kuku - membrana mukosa - Rektum
Pemeriksaan Penunjang : - Rutin : * Darah - urine - tinja * Mikrobiologi * Kimia klinik * Sumsum tulang * Imunologik - Khusus: PBI -T3 -T4 - LE - AFP - LCS - Patologi anatomik - Radiologis - Pencitraan - Endoskopik
pengobatan
Medika mentosa : simtomatik suportip analgetik antipiretik Non medikamentosa : kompres dingin / panas ( ? )
Terima kasih