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DEMAM

dr. CHAIRUL ZULFI.MSi

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

Failure of Thermoregulatory Homeostasis: Heat Production, Heat Dissipation, or Hipotalmic Insult

Hyperthermia

Muscle Tone, Sweating, Cutaneous Vasocontriction

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

Decrease heat dissipation

Hypothalmic insult

Infection Causing Fever of Undertermined Origin


Systemic Infection Tuberculosis (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.

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

Kalassifikasi : - Demam Trivial

- Demam Tanggung
- Demam Serius

Tipe Demam : - Hektik


- Septik - Remiten - Intermitten - Kontinyu

- 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

Anamnesis : - Cara timbul


- Lama - Tipe - Sifat harian - Keluhan penyerta - Tempat dikunjungi terakhir - Kontak / gigitan hewan - Risiko pekerjaan - Trauma / pembedahan

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 ( ? )

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