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IPD
3. H. Pylori

Konsensus Nasional. Penatalaksanaan Dispepsia dan Infeksi Helicobacter pylori. 2014.

 H. pylori

Konsensus Nasional. Penatalaksanaan Dispepsia dan Infeksi Helicobacter pylori. 2014.

H. pylori
5. ARTRITIS
 Ciri OA RA Gout Spondilitis
Ankilosa
Prevalens Arthritis
Female>male, >50
tahun, obesitas
Female>male
40-70 tahun
Male>female, >30
thn, hiperurisemia
Male>female,
dekade 2-3
Awitan gradual gradual akut Variabel

Inflamasi - + + +

Patologi Degenerasi Pannus Mikrotophi Enthesitis

Jumlah Sendi Poli Poli Mono-poli Oligo/poli

Tipe Sendi Kecil/besar Kecil Kecil-besar Besar

Predileksi Pinggul, lutut, MCP, PIP, MTP, kaki, Sacroiliac

punggung, 1st CMC, pergelangan pergelangan kaki & Spine
DIP, PIP tangan/kaki, kaki tangan Perifer besar

Temuan Sendi Bouchards nodes Ulnar dev, Swan Kristal urat En bloc spine
Heberdens nodes neck, Boutonniere enthesopathy
Perubahan tulang Osteofit Osteopenia erosi Erosi
erosi ankilosis

Temuan - Nodul subkutan, Tophi, Uveitis, IBD,

Extraartikular pulmonari cardiac olecranon bursitis, konjungtivitis, insuf
splenomegaly batu ginjal aorta, psoriasis
Lab Normal RF +, anti CCP Asam urat
Artritis
 6. IBD
Manifestasi sistemik
IBD:
Eritema nodosum
Artritis perifer,
asimetrik,
poliartikular, sendi
besar, ankylosing
spondylitis
Uveitis/iritis,
episkleritis
Steatosis hepatik
Nefrolitiasis
Low bone mass
Tromboembolik
 IBD
Diagnosis of ulcerative colitis is
based on clinical symptoms
confirmed by objective findings
from endo scopic & histological
examinations.

Mayo endoscopic score for

ulcerative colitis
1=mild; erythema, decreased
vascular pattern, mild friability
2=moderate; marked erythema,
absent vascular pattern, friability,
erosions.
Score 3=severe; spontaneous
bleeding, ulceration.
 IBD
The gold standard for all
patients with Crohns
disease is a full
ileocolonoscopy with
biopsies.

Endoscopic features of
CD:
rectal sparing,
aphthous ulcerations,
fistulas,
skip lesions.
 Diagnosis Characteristic
Crohn disease diarrhea; abdominal pain that is usually insidious in the right lower
quadrant, triggered or aggravated frequently after meals; weight loss;
& an association with a tender, inflammatory mass in the right lower
quadrant. The diarrhea is usually nonbloody.
Colitis ulcerative diarrhea, with or without blood in the stool. If inflammation is
confined to the rectum (proctitis), blood may be seen on the surface
of the stool; other symptoms include tenesmus, urgency, rectal pain,
and passage of mucus, without diarrhea.
Colon carcinoma Lesions of the right colon commonly ulcerate, leading to chronic,
insidious blood loss without a change in the appearance of the stool
anemia of iron deficiency fatigue, palpitations, & even angina
pectoris.

Since stool becomes more formed as it passes into the transverse &
descending colon, tumors of the left colon tend to impede the passage
of stool, resulting in the development of abdominal cramping,
occasional obstruction, & even perforation.
Diverticulosis Uncomplicated Diverticular Disease75% : abdominal pain, fever,
leukocytosis, anorexia, obstipation.
Complicated Diverticular Disease25%: abscess, perforation, stricture,
fistula.
Polyp Mostly asymptomatic, some can cause bleeding.
13. Leukemia
Mekanisme Kerja Obat anti diabetik
oral
GLP-1:
Glukagon like
petide 1, an
incretin derived
from the
proglucagon
gene, inducing
pancreas to
release insulin
and suppresing
glucagon
MATA
http://medical-dictionary.thefreedictionary.com/hemianopia
NEURO
KULIT
Indication Acyclovir Valacyclovir Famciclovir
First episode 400 mg tid OR 1000 mg bid 250 mg tid (for
200 mg 5 (for 7-10 d) 7-10 d)
times/d (for 7-
10 d)
Recurrent 400 mg tid OR 500 mg bid (for 1000 mg bid
800 mg PO bid 3 d) OR (for 1 d)
(for 5 d) OR Valacyclovir 1 g Tzank Smear
800 mg PO tid orally once a
(for 2 d) day (for 5 days)
Daily 400 mg bid 500 mg once 250 mg bid
suppression daily
or
1000 mg once
daily
(if >9
recurrences/y)

http://emedicine.medscape
.com/article/274874-
overview#aw2aab6b7
https://www.cdc.gov/std/tg2015/herpes.htm
ANAK
58. Ventricular Septal Defect
 VSD:
Pathophysiology & Clinical Findings
Pansystolic murmur & thrill
Flow across VSD
over left lower sternum.

If defect is large 3rd heart sound

Over flow across mitral valve
& mid diastolic rumble at the apex.

ECG: Left ventricular hypertrophy or

biventricular hypertrophy,
LA, LV, RV volume overload peaked/notched P wave
Ro: gross cardiomegaly

Dyspnea, feeding difficulties, poor

High systolic pressure & high growth, profuse perspiration,
pneumonia, heart failure.
flow to the lungs
pulmonary hypertension Duskiness during crying or infection
Ph/: increased of 2nd heart sound

1. Nelsons textbook of pediatrics. 18th ed.

 VSD:
Pathophysiology & Clinical Findings
cardiomegaly with
prominence of
both ventricles,
the left atrium, &
the pulmonary artery.
pulmonary vascular
marking

1. Nelsons textbook of pediatrics. 18th ed.

Atrial Septal Defect
 ASD:
Pathophysiology & Clinical Findings
The degree of L-to-R shunting is dependent on:
- the size of the defect,
- the relative compliance of the R and L ventricles, &
- the relative vascular resistance in the pulmonary & systemic circulations

Infant has thick & less compliant RV minimal symptoms

As children grow older: subtle failure to thrive, fatigue, dyspneu on effort,
recurrent respiratory tract infection

Enlargement of the RA & RV

Overflow in the right side of Dilatation of the pulmonary artery
heart The LA may be enlarged

Pulmonary vascular resistance may begin to increase in adulthood

reversal of the shunt & cyanosis
1. Nelsons textbook of pediatrics. 18th ed.
 ASD:
Pathophysiology & Clinical Findings
Ro:
Increased flow into right side of - enlargement of RV, RA, &
the heart & lungs pulmonary artery
- increased vasvular marking

Constant increased of Wide, fixed 2nd heart sound

ventricular diastolic volume splitting

Increased flow across tricuspid Mid-diastolic murmur at the lower

valve left sternal border

Increased flow across Thrill & systolic ejection murmur, best

heard at left middle & upper sternal
pulmonary valve border

Flow across the septal defect doesnt produce murmur because the pressure gap
between LA & RA is not significant
1. Nelsons textbook of pediatrics. 18th ed.
 ASD:
Pathophysiology & Clinical Findings

size of the main

pulmonary artery
size of the right atrium
size of the right ventricle
(seen best on the lateral
view as soft tissue filling in
the lower & middle
retrosternal space).
1. Nelsons textbook of pediatrics. 18th ed.
2. Essentials of Radiology. 2nd ed.
Patent Ductus Arteriosus
Coarctasio of Aorta
Tetralogi Fallot
 59. Indeks Eritrosit
Indeks eritrosit/ indeks
kospouskuleradalah batasan untuk
ukuran dan isi hemoglobin eritrosit.
terdiri atas :
(MCV : mean corpuscular volume)
(MCH : mean corpuscular hemoglobin)
(MCHC : mean corpuscular hemoglobin)
(RDW : RBC distribution width atau luas
distribusi eritrosit) perbedaan
ukuran
Indeks eritrosit dipergunakan secara
luas dalam mengklasifikasi anemia atau
sebagai penunjang dalam membedakan
berbagai macam anemia.
mean corpuscular volume (MCV)
Volume/ ukuran eritrosit :
mikrositik (ukuran kecil),
normositik (ukuran normal),
dan makrositik (ukuran besar).
mean corpuscular hemoglobin
(MCH)
bobot hemoglobin di dalam
eritrosit tanpa memperhatikan
ukurannya.
mean corpuscular hemoglobin
concentration (MCHC)
konsentrasi hemoglobin per
unit volume eritrosit.
 Retikulosit
Retikulosit : eritrosit muda yang sitoplasmanya masih
mengandung sejumlah besar sisa-sisa ribosome dan RNA
yang berasal dari sisa inti dari prekursornya (sel darah
muda).
Jumlah retikulosit yg meningkat menunjukkan kemampuan
respon sumsum tulang ketika anemia (misal perdarahan)
Indikator aktivitas sumsum tulang, banyaknya retikulosit
dalam darah tepi menggambarkan eritropoesis yang
hampir akurat.
Peningkatan jumlah retikulosit di darah tepi menggambarkan
akselerasi produksi eritrosit dalam sumsum tulang.
hitung retikulosit yang rendah dapat mengindikasikan keadan
hipofungsi sumsum tulang atau anemia aplastik.
Hipokrom: MCH normal Hiperkrom: MCH normal
Mikrositik: MCV normal Makrositik: MCV normal
52. Anemia Penyakit Kronik
 68. HEPATITIS B VIRUS
HBsAg (the virus coat, s= surface)
the earliest serological marker in the serum.
HBeAg
Degradation product of HBcAg.
It is a marker for replicating HBV.
HBcAg (c = core)
found in the nuclei of the hepatocytes.
not present in the serum in its free form.
Anti-HBs
Sufficiently high titres of antibodies ensure
imunity.
Anti-Hbe
suggests cessation of infectivity.
Anti-HBc
the earliest immunological response to HBV
detectable even during serological gap.

Principle & practice of hepatology.

COURSE OF HBV INFECTION
HEPATITIS VIRUS
HEPATITIS C VIRUS
 70. Diare
Diare akut: berlangsung < 1
minggu, umumnya karena infeksi
Diare akut cair
Diare akut berdarah
Diare berlanjut: diare infeksi yang
berlanjut > 1 minggu
Diare Persisten: Bila diare
melanjut tidak sembuh dan
melewati 14 hari atau lebih
Diare kronik: diare karena sebab
apapun yang berlangsung 14 hari
atau lebih
Disentri: diare
mengandung lendir dan
darah
Diare primer: infeksi
memang terjadi pada
saluran cerna (misal:
infeksi Salmonella)
Diare sekunder: diare
sebagai gejala ikutan dari
berbagai penyakit
sistemik seperti pada
bronkopnemonia,
ensefalitis dan lain-lain
OBSGYN