DIGNOSIS FISIK I

PENYANDANG /PASIEN DAN WUJUDNYA

dr. Pandji Mulyono,SpPD, KEMD,FINASIM

 Evaluation to Establish a Diagnosis
Minimize Morbidity and Mortality
1. History
2. Physical findings
3. Laboratory data
4. Imaging tests

DO IT RIGHT FROM THE START

 I. DATA PRIBADI
II. KELUHAN UTAMA
III. ANAMNESIS (Autoanamnesis – Heteroanamnesis)
III. 1. Anamnesis khusus :
- Riwayat peny. sekarang
- Riwayat peny. diagnosis banding
III. 2. Anamnesis medik dan penyakit dahulu
Anamnesis penyakit keluarga
Anamnesis psikososial (pendidikan & sosio-ekonomi)
Anamnesis makanan (keadaan gizi)
Anamnesis umum (review of sistim).
IV. PEMERIKSAAN FISIK
(Infeksi, Auskultasi , Palpasi, dan Perkusi)
IV. 1. Keadaan umum
IV. 2. Kepala dan leher
IV. 3. Payudara dan aksila
IV. 4. Jantung dan paru
IV. 5. Abdomen
IV. 6. Genetalia-anus-rectum
IV. 7. Ekstremitas
V. LABORATORIUM
(Diagnosis Kimiawi)
VI. PEMERIKSAAN KHUSUS
VII. DIAGNOSIS dan atau DIAGNOSIS BANDING
VIII.PENGOBATAN
IX. KOMPLIKASI
X. PROGNOSIS
PENGELOLAAN PENYAKIT

o KOMUNIKASI/EDUKASI
o Diet/perencanaan makan
o Edukasi
o Bed rest ;absolut/relatip
o atau malah olah raga
o MEDIKAMENTOSA
o Drug of choise
o Drug of supportif/conservatifT
o TINDAKAN/NON MEDIKAMENTOS
Saat Dokter –Pasien Bertemu Pertama Kali yg
diobservasi
• Nampak Sakit atau tidak
• Sakit Berat / Ringan
• Tingkat Pendidikan (Berpendidikan
tinggi/rendah)
• Tingkat ekonomi ( Kaya /menengah/miskin)
Wujud Pasien dapat dilihat pada
• Paras Muka
• Bentuk Badan
• Sikap Badan
• Gaya Jalan
• Suara dan Bahasa
Paras Muka
• dengan melihat paras muka, bisa didapat kesan
kepribadian, antara lain apakah pasien terlihat
✓ Pesimis, berwatak keras, , lemah lembut
✓ apakah hidupnya serba mudah / selalu senang
✓ apakah hidupnya serba sulit / kekurangan
✓ apakah terjalin eye contact ( tatapan mata) atau
menghindar dari dokter

indikasi kurang jujur dalam memberi informasi

lanjt
• Mata cepat sekali berubah arah menuruti gerak
dokter Banyak didapati pada pasien
gangguan jiwa atau pada anak-anak

• Matanya
❑ Exopthalmus Tirotoksikosis

Aslinya
❑ Sipit Bengkak Lipoalbumin

Tebal Mixedema
lanjt
• Warna Kulit
▫ Pucat, muka merah, kuning , hitam, merah
keunguan
▫ bibir dan telinga Sianotik
▫ bercak merah coklat Lepra
▫ rash, kemerahan seperti kupu LE

• Perubahan tulang rahang Acromegali

 Resiko DM, OA,
Gemuk Cholilithiasis,
atherosclerosis,
(picnic type) Happy2, stress :
sindroma depresif

tenang,
Bentuk Badan Atletik mudah bergaul

watak pesimis, mudah

Kurus tersinggung, menyendiri
Resiko : ulcus peptikum

Tinggi Badan Gigantisme /Cretinism ?

Gaya Jalan
• Mencerminkan jiwa dan badan seseorang
▫ Kemauan keras jalannya gagah
▫ kemauan lemah jalannya lesu dan lemah
▫ pria lenggak –lenggok ?

• Jika dihubungkan dengan penyakit :

▫ Parkinson, CVA infark, CVA perdarahan, gangg
cerebelum dan tabesdorsales (spt mabuk)
▫ poliomeilitis, patah tulang, polineuritis , sakit
perut, abses hati, dll
Sikap Badan
• Tidak tenang, mungkin hati gundah, gatal dsb
• Sakit keras tidak dapat duduk tegak dan lemah
• Miring kesatu sisi tanda ada kontraktur otot atau
tulang leher (ankylospondylosis)
Jabatan tangan, Pakaian, Suara, Bahasa
• pada saat jabat tangan rasakan :
▫ Suhu, keringat, kuat/lemahnya genggaman

• Pakaian , aksesori dll cermin kepribadian

dan kemamapuan
• Suara ,
• perempuan yg suaranya berubah spt pria
sindroma androgenitalis ?
• Sengau pilek/flu , pallatum molle lumpuh
• Serak dst
Customarily, the body
temperature is measured in the rectum, the
mouth, the ear, the axilla, or the groin.
Among these sites, the rectal temperature
is approximately 0.3◦C (0.6◦F) higher
than that of the oral or groin reading, the
axillary temperature is approximately
0.5◦C (1.0◦F) less than the oral value.
 Normal body temperature. Internal body temperature is
maintained within a
• narrowrange,±0.6◦C(1.0◦F), in each individual.However, the
population range
• of this set point varies from 36.0 to 37.5◦C (96.5–99.5◦F) making it
impossible to
• know an individual’s normal temperature without a prior established
baseline. A
• clinical shortcut for a patient whose normal baseline temperature is
unknownis to
• regard as probably in the febrile range a maximumoral temperature
above 37.5◦C
• (99.5◦F) and a rectal temperature exceeding 38.0◦C (100.5◦F). The
minimum
• normal temperature is more difficult to define; the oral temperature
often dips
• to 35.0◦C (95.0◦F) during sleep.
Elevated Temperature
Increased body temperature
results from excessive
production of heat or
interference
with heat dissipation.
 Physiologic Elevated
Temperature—Fever
• Release of endogenous pyrogens, particularly
interleukin (IL-1), triggered by
• tissue necrosis, infection, inflammation, and
some tumors, elevates the hypothalamic
• set point leading to an increased body
temperature
Patterns of Fever. The pattern of
temperature fluctuations may be a
useful
diagnostic clue. Many patterns have been
defined
• Continuous Fever. A fever with a normal diurnal variation
of 0.5 to 1.0◦C (1.0
• to 1.5◦F).
• Remittent Fever. A fever with a diurnal variation of more
than 1.1◦C (2.0◦F)
• but with no normal readings.
• IntermittentFever.Episodes of fever separated by days of
normal temperature.
• Examples include tertian fever fromPlasmodium vivax in which
paroxysms of
• malaria are separated by an intervening normal day; quartan fever in
which
• paroxysms from Plasmodium malariae occur with two intervening
normal
• days.
• Relapsing Fever. Bouts of fever occurring every 5 to 7 days
frominfectionwith
• spirochetes of the group Borrelia and Colorado tick fever.
• Episodic Fever. Fever lasts for days or longer followed by
prolonged periods
• (at least 2 weeks) without fever and with remission of clinical illness.
This
• pattern is typical of the familial periodic fevers [Drenth PPH, van der
Meer
• JWM. Hereditary periodic fever. N Engl J Med.
2001;345:1748–1757].
• Pel-Epstein Fever. Occurring inHodgkin disease, bouts of
several days of continuous
• or remittent fever followed by afebrile remissions lasting an irregular
• number of days