Batukkkkk.docx

Seorang laki-laki 69 tahun pensiunan bekerja di pabrik semen, dibawa ke rumah sakit oleh anaknya yang juga seorang dokter puskesmas karena menderita sesak yang hebat dan sangat lemah. Kondisi kelemahan ini sebernarnya telah dialaminya sejak 4 bulan lalu, diamana pada saat itu ia menderita batuk yang tidak produktif yang disertai demam, yang membaik setelah diberikan antibiotic selama 6 hari ditambah obat-obatan simptomatik. saat ini ia juga menderita batuk yang produktif dengan sputum yang kecoklatan sejak 4 hari lalu, dan sejak 2 hari lalu ia mengeluh demam yang disertai muntah. Ia tidak ada riwayat merokok ataupun minum minuman keras, ia tidak pernah keluar kota atau melakukan perjalanan jarak jauh sejak 1 tahun terakhir dan tidak pernah kontak dengan orang sakit sebelumnya. Selain itu ia sering mengalami gastric reflux yang disertai dengan mual dan muntah. A 69-year-old retired man worked in a cement factory, was taken to a hospital by his son who was also a doctor at the puskesmas because he was suffering from severe and very weak congestion. This weakness has been experienced since 4 months ago, at which time he suffered from an unproductive cough with fever, which improved after being given antibiotics for 6 days plus symptomatic drugs. now he also suffers from a productive cough with brownish sputum since 4 days ago, and since 2 days ago he complained of fever accompanied by vomiting. He has no history of smoking or drinking liquor, he has never been out of town or traveled long distances for the past 1 year and has never had contact with sick people before. In addition he often experiences gastric reflux which is accompanied by nausea and vomiting. Kata kunci

1. 69-year-old male 2. Retired workers at the cement factory 3. Great and very weak tightness 4. Weaknesses that have been experienced since 4 months ago 5. An unproductive cough accompanied by fever 6. Improved after being given antibiotics for 6 days plus symptomatic drugs 7. Currently suffering from a productive cough 8. Brownish sputum since 4 days ago 9. Complaining with fever accompanied by vomiting 2 days ago 10. There is no history of smoking or drinking 11. Have never been out of town or traveled far since the last 1 year 12. Never contacted a sick person before 13. Often experience gastric reflux which is accompanied by nausea and vomiting Kata sulit : Gastric reflux : melemahnya tonus spinchter dengan oesophagus sehingga cairan dari lambung bisa masuk ke oesophagus sehingga menimbulkan mual dan muntah. Gastric reflux: weakening of the sphincter or stomach tone so that fluid from the stomach can enter the esophagus, causing nausea and vomiting.

Pertanyaan 1. What is the anatomy and physiology of the respiratory system? 2. How are the symptoms of pathomechanism experienced by patient?(DISPNEU, coughing, weakness, gastric reflux) 3. What is the mechanism of unproductive coughing productive cough? 4. What are the differential diagnoses of the scenario? 5. What are the steps for establishing a diagnosis? 6. What are the factors that aggravate the patient's condition? 7. What are the benefits of administering antibiotic and symptomatic drugs? 8. Have any previous symptom connection with symptoms now? 9. Is there a history relationship with the history now? 10. What is the management and prevention of DB? 11. What is the prognosis and complications in the DB?

2. PATOMEKANISM DISPNEU Occurs due to an increase in airway resistance which causes gas exchange to be disrupted. Dyspnea can also occur in people who have decreased pulmonary compliance, the lower the ability to pulmonary compliance, the greater the transmural pressure gradient that must be formed during inspiration to produce normal lung development. For example, replacing lung tissue with fibrous connective tissue due to silica or irritant inhalation is the same. Cough Stimulation on the cough receptor is passed to the center of the cough to the medulla, from the medulla sent an answer to the muscles of the chest wall and larynx so that coughing occurs. Cough reflexes are very important to maintain the integrity of the airways by removing foreign objects or bronchopulmonary secretions. There are 4 phases of the coughing mechanism, i.e. irritation phase deep inspiration phase compression phase expulsion / expiration phase WEAKNESS Decreased alveolar function because the inflammatory process causes the formation of connective tissue in the lungs. Gas exchange is interrupted REDUCTION Oxygenation to tissues

The metabolic process in the tissue does not produce maximum energy Weakness BROWNISH SPUTUM Toxic particles (quartz crystals and silica dioxide) enter the respiratory tract Stimulating macrophages secrete inflammatory mediators. Inflammation, fibrogenesis and can damage and oxidize lysosomial membrane lipids and eventually kill macrophages. Brownish sputum GASTRIC REFLUX

Long contact between the reflux material and the esophageal cough mucosa (increased intraabdominal pressure) decreases the resistance of gastric reflux esophageal mucosal tissue to the esophagus nausea and vomiting. Video Air enters into body through nostrils of nose the nostrils consists of fine hairs, that lines the passage (the way through which air passes) and also lined with mucus. what is the use of fine hair and mucus lining in the nostril passage? the fine hair iof nostrils filter the air from dust, dirt and microorganism. and mucus also trap and facilitates smooth flow of air with its moist characteristic.. then the air passes through throat the throat also called as wind pipe or trachea which is sorrounded by rings of cartilago.. what is the necessary of rings of cartilago ROC helps in free, unrestricted flow of air through wind pipe and helps in preventing air passage from collapse if cartilago rings are absent, then it increases pressure during exhalation on compression of ribcage and wind pipe, will be closed restrictsair flow and interfere normal breathing. through threat, air passes into lungs

within lungs, the passage divides into smaller and smaller tubes and finally ends with balloon like structures which are called as ALVEOLI THE ALVEOLI IS THE SURFACE WHERE EXCHANGE of gases take place. the walls of alveoli consist of network of blood vessels. when we breath in. we lift our ribs, diaphragm flattens, followed by chest becomes larger. and that case air is sucked into lungs and alveoli is filled with air. and then blood carrie co2 from all parts of the body and releases co2 into alveoli. and that proceeds to the oxygen that is present in the alveoli ia taken by blood by alveolar blood vessels. oxygen is transported to all cells of the body through blood vessels

Udara masuk ke tubuh melalui lubang hidung lubang hidung terdiri dari rambut-rambut halus, yang melapisi bagian (cara udara melaluinya) dan juga dilapisi dengan lendir. apa gunanya rambut halus dan lapisan lendir di lubang hidung? bulu-bulu halus dari lubang hidung menyaring udara dari debu, kotoran dan mikroorganisme. dan lendir juga menjebak dan memfasilitasi aliran udara yang lancar dengan karakteristik lembabnya .. lalu udara melewati tenggorokan tenggorokan juga disebut sebagai pipa angin atau trakea yang dikelilingi oleh cincin tulang rawan .. apa perlunya cincin cartilago ROC membantu dalam aliran udara bebas dan tidak terbatas melalui pipa angin dan membantu mencegah jalan udara runtuh jika cincin tulang rawan tidak ada, maka itu meningkatkan tekanan selama pernafasan pada kompresi tulang rusuk dan pipa angin, akan ditutup membatasi aliran udara dan mengganggu pernapasan normal. melalui ancaman, udara masuk ke paru-paru di dalam paru-paru, bagian itu terbagi menjadi tabung yang lebih kecil dan lebih kecil dan akhirnya berakhir dengan struktur seperti balon yang disebut sebagai ALVEOLI ALVEOLI ADALAH PERMUKAAN DI MANA PERTUKARAN gas terjadi. dinding alveoli terdiri dari jaringan pembuluh darah. ketika kita menarik napas. kita mengangkat tulang rusuk kita, diafragma rata, diikuti oleh dada menjadi lebih besar. dan selubung udara tersedot ke paru-paru dan alveoli terisi udara. dan kemudian co2 pembawa darah dari semua bagian tubuh dan melepaskan co2 ke dalam alveoli. dan yang menghasilkan oksigen yang ada dalam alveoli ia diambil oleh darah oleh pembuluh darah alveolar. oksigen diangkut ke semua sel tubuh melalui pembuluh darah