demam
DESCRIPTION
bahan kuliah pakarTRANSCRIPT
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D E M A M
Dr. CHAIRUL ZULFI.MSi
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PendahuluanSejarah DefinisiEtiologiPatofisiologiKlasifikasikomplikasi
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sejarahHipocrates : demam adalah tanda penyakitGalileo : mencipta alat ukur suhu dipakai di klinik oleh SantorioTraube : memperlihatkan kurva suhu secara menyeluruh digunakan secara luas oleh Wunderlich memprediksi kondisi pasien
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definisiSuhu 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 CHipotermi : suhu tubuh < 35o CHipertermi : mekanisme pengendalian suhu tubuh gagalSuhu rektal / oral aksila berbeda 0,5o CFungsi demam ( 39o C ): petunjuk produksi antibodi dan proliferasi sel limfosit T mening-kat > 20 x suhu normal
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Definisi Demam : Suhu tubuh di atas normal akibat proses patologis
Fluktuasi suhu tubuh sesuai irama sirkadian dengan variasi diurnal
Homeostasis suhu Produksi panas Pelepasan panas
Proses Metabolik Radiasi + Evaporasi
Kelainan Suhu Tubuh = Pirexia - Hipertermi - Demam
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Patofisiologi
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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
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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.
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Cause of Hyperthermia
Mechanism of Thermoregulatory Example Disturbance Exercice hiperthermia Increase heat Thyroid stormProduction Pheochromocytoma Drugs (e.g. malignant hyperthermia of anesthesia Heatstroke Dehydration Decrease heat Autonomic disfungtion dissipation Occlusive dressings Drugs (e.g. atropine) Infection (e.g. granulomas, enchephalitis) Hypothalmic Tumor, Trauma, Vascular insult insult Drugs (e.g. neuroleptic malignant syndroma
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Infection Causing Fever of Undertermined Origin
Systemic InfectionTuberculosis (miliary)Infective endocarditis (primarily bacterial endocarditis, but also endocarditis with a fungal, Q fever, or clamydial etiology)Bacteremia from an inapparent primary focus Cronic meningococcemia Brucellosis Listeriosis, vibrosis, leptospirosis, relapsing fever(caused by Borrelia recurrentis), -bite fever (due either to Streptobacillus moniliformis or to Spirillum minus)Miscellaneuous Psittacosis, toxoplasmosis (disseminated acquired form), Q fever, disseminated deep mycotic infection (e.g. histoplasmosis, blatomycosis), cytomengalovirus infection.
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Localized Infection and AbscessesHepatic infection Liver abscess, CholangitisIntraperitoneal infections Upper abdomen : empyema of gallbrader, pericholecystic and sub hepatic abscess, right or left subphrenic abscess, lesser sac abscess Lower abdomen: periappendicial and peridiventicular abscessOther intra-abdominal abscess Turbo-ovarian abscess; pelvic inflamatory disease and pelvic abscess Retroperitoneal abscess; pancreatic abscessUrinary tract infections Perinephric abscess Renal carbuncle Pyelonephritis with ureteral obstruction and pyonephrosis Prostatic abscess
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Kalassifikasi : - Demam Trivial - Demam Tanggung - Demam Serius
Tipe Demam : - Hektik - Septik - Remiten - Intermitten - Kontinyu - Siklik
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HEKTIK
HEKTIK
PTCA.M.P.M.A.M.P.M.A.M.P.M.A.M.P.M.
160
140
120
100
80
60
40
SEPTIK
SEPTIK
PTCA.M.P.M.A.M.P.M.A.M.P.M.A.M.P.M.
160
140
120
100
80
60
40
INTERRMITEN
INTERMITEN
PTCA.M.P.M.A.M.P.M.A.M.P.M.A.M.P.M.
160
140
120
100
80
60
40
CONTINUA
CONTINUA
PTCA.M.P.M.A.M.P.M.A.M.P.M.A.M.P.M.
160
140
120
100
80
60
40
REMITEN
REMITEN
PTCA.M.P.M.A.M.P.M.A.M.P.M.A.M.P.M.
160
140
120
100
80
60
40
-
HEKTIK
HEKTIK
PTCA.M.P.M.A.M.P.M.A.M.P.M.A.M.P.M.
160
140
120
100
80
60
40
SEPTIK
SEPTIK
PTCA.M.P.M.A.M.P.M.A.M.P.M.A.M.P.M.
160
140
120
100
80
60
40
INTERRMITEN
INTERMITEN
PTCA.M.P.M.A.M.P.M.A.M.P.M.A.M.P.M.
160
140
120
100
80
60
40
CONTINUA
CONTINUA
PTCA.M.P.M.A.M.P.M.A.M.P.M.A.M.P.M.
160
140
120
100
80
60
40
REMITEN
REMITEN
PTCA.M.P.M.A.M.P.M.A.M.P.M.A.M.P.M.
160
140
120
100
80
60
40
-
HEKTIK
HEKTIK
PTCA.M.P.M.A.M.P.M.A.M.P.M.A.M.P.M.
160
140
120
100
80
60
40
SEPTIK
SEPTIK
PTCA.M.P.M.A.M.P.M.A.M.P.M.A.M.P.M.
160
140
120
100
80
60
40
INTERRMITEN
INTERMITEN
PTCA.M.P.M.A.M.P.M.A.M.P.M.A.M.P.M.
160
140
120
100
80
60
40
CONTINUA
CONTINUA
PTCA.M.P.M.A.M.P.M.A.M.P.M.A.M.P.M.
160
140
120
100
80
60
40
REMITEN
REMITEN
PTCA.M.P.M.A.M.P.M.A.M.P.M.A.M.P.M.
160
140
120
100
80
60
40
-
HEKTIK
HEKTIK
PTCA.M.P.M.A.M.P.M.A.M.P.M.A.M.P.M.
160
140
120
100
80
60
40
SEPTIK
SEPTIK
PTCA.M.P.M.A.M.P.M.A.M.P.M.A.M.P.M.
160
140
120
100
80
60
40
INTERRMITEN
INTERMITEN
PTCA.M.P.M.A.M.P.M.A.M.P.M.A.M.P.M.
160
140
120
100
80
60
40
CONTINUA
CONTINUA
PTCA.M.P.M.A.M.P.M.A.M.P.M.A.M.P.M.
160
140
120
100
80
60
40
REMITEN
REMITEN
PTCA.M.P.M.A.M.P.M.A.M.P.M.A.M.P.M.
160
140
120
100
80
60
40
-
HEKTIK
HEKTIK
PTCA.M.P.M.A.M.P.M.A.M.P.M.A.M.P.M.
160
140
120
100
80
60
40
SEPTIK
SEPTIK
PTCA.M.P.M.A.M.P.M.A.M.P.M.A.M.P.M.
160
140
120
100
80
60
40
INTERRMITEN
INTERMITEN
PTCA.M.P.M.A.M.P.M.A.M.P.M.A.M.P.M.
160
140
120
100
80
60
40
CONTINUA
CONTINUA
PTCA.M.P.M.A.M.P.M.A.M.P.M.A.M.P.M.
160
140
120
100
80
60
40
REMITEN
REMITEN
PTCA.M.P.M.A.M.P.M.A.M.P.M.A.M.P.M.
160
140
120
100
80
60
40
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PenatalaksanaanPendekatan Diagnosis + penatalaksanaan kelainan dasar Perbaiki metabolik - kardiovaskuler - sistem respirasi Dinginkan / turunkan suhu
Anamnesis : - Cara timbul - Lama - Tipe - Sifat harian - Keluhan penyerta - Tempat dikunjungi terakhir - Kontak / gigitan hewan - Risiko pekerjaan - Trauma / pembedahan
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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
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pengobatanMedika mentosa : simtomatik suportip analgetik antipiretikNon medikamentosa : kompres dingin / panas ( ? )
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