TUTORIAL BLOK XVI SKENARIO A

KELOMPOK V

Tutor : Dr.Sudarto,SpPD, FINASIM

FAKULTAS KEDOKTERAN UNIVERSITAS SRIWIJAYA

TAHUN 2013

Anggota Kelompok :
Briggita
Carollius
Rahman

A.
Nyimas Nur S.
M. Syahid
Retno Anjar S
Luthfy
Hanifah
Agien
Abdul
Catri
Firman
Vindy
Aini
Sellita

Skenario
Mr. X, a 30 years old truck driver, was admitted to hospital
with massive hemaptoe. He complained that 6 hours ago he
had a severe bout of coughing with fresh blood of about 3
glasses. He also said that in the previous month he had
productive cough with a lot of phlegm, mild fever, loss of
appetite and rapid loss of body weight, and shortness of
breath. Since a week ago, he felt his symptoms were
worsening.

Physical examination
General appearance: he looked severely sick and pale. Body
height: 170 cm, Body weight: 50 kg, BP: 100/70 mmHg, HR
100x/minute, RR: 36x/minute, temp 37.8 C.
There was a tattoo on the left arm and enlargement of the
right neck lymph node, and stomatitis. In chest auscultation
there was an increase of vesiculer sound at the right upper
lung with moderate rales.

Contd
Laboratory:
Hb: 8g%, WBC: 7000/Ul, ESR: 70
mm/hr, DiffCount: -/3/2/75/15/5,
Acid Fat Bacili: (-), HIV test (+),
CD4 140 uL
Radiology:
Chest radiograph showed infiltrate
at right upper lung.

Klarifikasi Istilah
Massive

hematoe
Productive cough
Phlegm
Stomatitis
Vesicular sound
Moderate rales
CD4
Infiltrate at right upper lung

Anamnesis
Batuk kronis teriritasinya arteri bronkiolus
batuk darah 600ml 6 jam yang lalu
Infeksi M. tuberculosis pembentukkan mukus
yang berlebih Productive cough beberapa
bulan yang lalu
Infeksi M. tuberculosis pengeluaran sitokin
(prostaglandin) menaikkan ambang termostat
tubuh di hipotalamus demam ringan
Infeksi M. tuberculosis pengeluaran sitokin (TNF
) menekan pusat lapar di hipotalamus Hilang
nafsu makan
Infeksi kronis, hilang nafsu makan Penurunan
BB
M. tuberculosis tuberkel ulserasi pada bronkus
respon peradangan infiltrasi pada paru

Pemeriksaan Fisik
BMI

: 17,3 kg / m2 rendah
BP: 100/70 mmHg normal
HR 100x/minute normal
Shortness of breath tubuh kurang oksigen RR:
36x/minute (tachipneu )
Infeksi temp 37.8 C (subfebris)
There was a tattoo on the left arm faktor resiko
HIV and enlargement of the right neck lymph node
Infeksi HIV infeksi opotunistik stomatitis
(biasanya Candida albicans)
Akumulasi makrofag (berupa cairan) vesiculer
sound at the right upper lung with moderate rales.

Pemeriksaan Tambahan
Lab:

Infeksi ESR: 70 mm/hr

Acid Fat Bacili: (-) diulang lagi
sampai 3x
HIV test (+) mengidap HIV
CD4 140 uL (500 1600 uL)
rendah akibat infeksi HIV
Radiology:

Ada cairan Chest radiograph

showed infiltrate at right upper lung.

Tatalaksana
Prinsipnya

obati terlebih dahulu TBC, terapi

HIV dimulai setelah 2 bulan pengobatan TBC
Tidak boleh diberikan rimfapisin pada orang
yang diberikan obat protease inhibitor
(kecuali ritonavir) diganti rifabutin
Metode DOTS (directly observed treatment
short course strategy)
2RHZ/4 R3H3 (2 bulan rifabutin (600 mg), INH (400
mg), pirazinamid (2000 mg), sehari sekali dan
dilanjutkan dengan rifabutin (600 mg), INH (600
mg ) 3x seminggu selama 4 bulan)
Vitamin B6

Contd
Pengobatan

HIV bertujuan
menurunkan mortalitas dini.
ARV
Kombinasi obat zidovudin (2 x 200
mg)+ lamifudin (2 x 150 mg) +
evafirenz (1 x 600 mg malam)

Kesimpulan
Tuan

X, 30 tahun menderita TBC paru

yang disertai HIV

Referensi :
Perhimpunan

Dokter Spesialis
Penyakit Dalam. 2009. IPDL Jilid II
Edisi V. Jakarta : InternaPublishing
Price, Sylvia A dan larraine M
Wilson. 2006. Patofisiologi:
Konsep Klinis Proses-Proses
Penyakit Edisi 6 Volume
1&2.Jakarta: EGC
Robbins, Kumar, Ramzi S.Cotran.
2007. Buku Ajar Patologi Edisi 7.

THANK YOU FOR

YOUR KIND
ATTENTION

???

ANY
QUESTION
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