TUTORIAL REPORT MODULE II

RESPIRATION BLOCK
“SCENARIO 3”

Tutor : dr. Edward Pandu Wiriansyah, Sp.P

Arranged By : Group 14
- A. Nadia Slistia N (11020160012)
- Nur Aisyah (11020160028)
- A. Mufida Gunawan (11020160031)
- Rani Meiriska (11020160047)
- Ridha Mardhatillah (11020160048)
- Aulia Wahyu Ramdani (11020160064)
- Muh. Syawal Rahis (11020160079)
- Andry Pratama (11020160107)
- Ayu Azizah Syen (11020160122)
- Fauziah Suparjo (11020160138)
- Hartina Burhan (11020160155)

FAKULTAS KEDOKTERAN
UNIVERSITAS MUSLIM INDONESIA
MAKASSAR
2017
FOREWORD

Praise our thanks to Allah SWT for His grace and guidance so that this tutorial
report can be completed on time. Aamiin.
We realize there are still many shortcomings in this tutorial report, because it is
criticism and suggestions that are constructive in nature we hope to spur us to create
better works.
Finally, we would like to thank all those who have provided assistance in the
preparation of this paper, especially to:
1. Dr. Zulfiyah Surdam as the Secretary of the Immunology Block
2. Dr. Edward Pandu Wiriansyah, Sp.p as our group tutorial tutor
3. Friends who have supported and helped provide motivation in completing this
tutorial report.

May Allah SWT be able to reward in kindness and sacrifice with the abundance of
mercy from Him. Aamiin yaa Robbal A'lamiin.

Makassar, 20 June 2017

Group 14
SCENARIO 3
A child, 16-year-old came to the puskesmas with a hoarse and sometimes shortness
of breath complaint two days ago. found complaints of cough cold with fever. on
physical examination found to exist :inflammation in the nasal cavity and pharynx.
laryngoscopy indirecta examination was obtained by vocal cord of udem and
hyperemia

DIFFICULT WORD :
1. Indirect laryngoscopy : How to view the larynx indirectly with the
help of glass larynx

KEYWORD :
1. A child , 16 years old
2. Voice hoarse
3. Cough and cold
4. Fever
5. Physical examination : - Inflamation in the nose and pharynx
6. Indirect laryngoscopy

QUESTION
1. What is the anatomical case?
2. Explain about virus and bacterial of tractus respiratory !
3. How can cough and fever happen?
4. Explain the mechanism of udem!
5. Explain the mechanism of dispneu!
6. Explain about the influence between smoke and disease!
7. What is the differential diagnose ? explain!
8. What does laryngoscopy looks like?
9. What is the perspective islam based on thr scenario?
QUESTION AND ANSWER
1. What is the anatomical case?
Answer:
The upper respiratory tract consists of:
a. nostril (cavum nasalis)
The nose is formed by bone (os) and cartilage (cartilage). The nose is formed by a
small part of the bone, the rest consists of connective tissue and cartilage
(connective tissue). The inside of the nose is a hole which is separated into left and
right holes by the septum (septum). The nasal cavity contains the hair (fimbriae),
which functions as a filter (filter) harshly against foreign objects that enter. On the
surface (mucosa) of the nose there are ciliated epithelium are goblet cells
containing. These cells secrete mucus so that it can capture a foreign object gets
into the respiratory tract. We can smell because in the hole of the nose there are
receptors. Odor receptors located in the cribriform plate, inside are the tip of the
cranial nerve I (Nervous Olfactorius).
The nose serves as the airway, air regulator, humidity regulator (humidifikasi),
temperature regulator, protector and filter the air, indra Kisser, and resonator sound.

Picture: Anatomy of the upper respiratory

b. the Sinus paranasalis
Paranasalis sinus is an open area on a bone head. Named after the bones of the place
he was namely sinus frontal, sinus, sinus sphenoidalis ethmoidalis, and sinus
maxillaris. The sine function to:
1. helps to warm and humidifikasi
2. Lighten the weight of the bones of the skull
3. Set the sound of the human voice with resonance
c. the pharynx
The pharynx is a muscular chimney-shaped pipe located starting from the base of
the skull to the esophagus with the connection at a height of cartilage (kabrtilago)
the cricoid cartilage. The pharynx is used at the time of ' digestion ' (swallows) like
at the moment breathe. Based on its location of the pharynx is divided into three at
the back
1. nose (naso-pharynx)
The back of the mouth (oro-pharynx), and behind the larynx (laringofaring). Naso-
pharyngeal found on superior in the area there are ciliated epithelium (pseudo
stratified) and tonsillar (adenoidal problems), as well as the estuaries of the
eustachian tube is. The throat is surrounded by tonsillar and adenoidal problems,
lymphoid tissue, etc. The important structure as a chain of lymph limfatikus to keep
the body from invasion of the organism gets into the nose and throat.
2. Oro-pharyngeal
serves to accommodate the air of the naso-pharynx and food from the mouth. In this
section there is a Platinum tonsili (posterior) and tonsili lingual nerve (the base of
the tongue).

3. Laringofaring
Laringofaring is the very end of the pharynx. This section can also be bypassed by
air and food. Laringofaring are lined by stratified squamous epithelium.
Laringofaring is often also called the hypopharynx. Laringofaring is the meeting
place between the respiratory tract with the digestive tract. While the ingestion of
food eating food that has a "right of way" so tertutupnya respiratory tract, therefore
we cannot swallow while breathing.
d. Larynx
The larynx is often referred to as the ' voice box ' formed by the epiteliumlined
structure associated with the pharynx (above) and trakhea (below). The larynx is
located in anterior to the spine (vertebrae) of the 4th and 6th. The upper part of the
esophagus is posterior in the larynx.
The main function of the larynx is for the establishment of sound, as the lower
airway protection from foreign objects and to facilitate the process of occurrence of
cough.
Laryngeal consists of:
1. The Epiglottis; cartilage that closes valves and opening during swallowing.
2. Glotis; the hole between the vocal cords and larynx.
3. Thyroid cartilage; the largest cartilage on trakhea, there are parts that form a
jakun.
4. Of the cricoid cartilage; the ring intact cartilage in the larynx (located below the
thyroid cartilage).
5. aritenoid Cartilage; used in the movement of the vocal cords together with the
thyroid cartilage.
6. The vocal cords; a ligament that was controlled by the movement of the muscles
that produce sound and stick to the lumen of the larynx.

2. Explain about virus and bacterial of tractus respiratory !

Answer:
BAKTERI
Streptococcus pyogenes
- Morphology
Streptococcus consists of a coccus that is 0.5-1 μm in diameter. In the typical chain
form, kokus rather lengthwise in the direction of the chain axis. Streptococcal
pathogens if grown in suitable fluid or solid seed often form long chains consisting
of eight pieces of coccus or more.
The streptococci that infect humans is positive Gram

- Disease occurring due to local infection Streptococts beta hemolytic group

A
Sore throat
A disease that almost everyone has ever felt. Caused by In infants and young
children arising as subacute nasofaringitis with serous secretions and a slight fever;
and the infection tends to extend into the middle ear, the mastoid process and the
cerebral membrane. The ceroical gum sap gland is usually enlarged. The illness can
last for weeks. In older children and adults, the disease progresses more acutely
with severe nasopharyngitis and tonsillitis, hyperemic mucous membranes and
swollen with purulent exudates. Cervical lymph node enlarged and pain, usually
accompanied by high fever. Streptococcal bacterial infection in the upper
respiratory tract is usually not about the lungs. Pneumonia due to Streptococcus
beta hemolytic usually occurs after viral infections, such as influenza or morbili.

Corynebacterium diphtheria
- Morphology
Diphtheria germ-shaped slim stems measuring 1.5-5 pm x 0.5-L pm and usually
one end is bulging so shaped mace, not berspora, not moving, positive Gram and
not acid resistant. In the preparation it often appears to form the composition of the
letters V, L, Y, Chinese writing or woven fencing (pallade). Pleomorphic forms are
often covered, especially when germs are bred in suboptimal seed. Babes-Ernst
metacromatyl granules can be seen by Neisser or methylene Loeffler methylation.
The examination of these metachromatic granules is not specific.
- Disease occurring:
Diphtheria is a particularly acute infection. in the upper respiratory tract is caused
by C. toxigenic diphtheria. Sometimes skin, conjunctiva and vulva can become
infected. Skin dermisia is more common in tropical regions.
Diphtheria disease primarily affects children less than 15 years of age who are not
immunized, especially between the ages of 1-9 years, but may also be present in
unvaccinated adults or in newborns. In the respiratory tract, a common primary
lesion is found in the throat / nasopharynx in which a gray pseudomembrane
appears.

Haemophilus influenzae
- Morphology
Members of the genus haemophilus are true parasites. Some species are parogenic.
The germs of this genus are Gram-negative rods, unable to move and
for its growth requires growth factors contained in the blood (haemo = blood, philos
= love or liking). Regarding the mechanism by which certain strains of H.
influenzae suddenly become virulent and cause severe infections of the epiglottis,
larynx or branched bronchi, is not known with certainty.
- Disease occurring:
H. influenzae causes a number of infections of the upper respiratory tract such
as pharyngitis, otitis media and sinusitis which are particularly important in
chronic lung diseases
Bordetella pertussis
- Morphology
In primary isolation, the germ form is usually uniform, but after subculture may be
pleomorphic. Formsfilaments and thick rods are common. These germs live
aerobically, not forming H2S, indol and acetylmethylcarbinol. Now disa
so that the three Bordetella species are better classified as one germ.
In B. pertussis two kinds of toxins are found:
l. Endotoxins that are thermostable and contained within the cell wall of germs. The
nature of the autotoxin is similar to that of endotoxins produced by other Gram
negative germs.
2. Proteins that are thermolable and der- monecrotic. This toxin is formed in the
protoplasm and can be released from the cell by breaking the cell, or by extraction
using NaCl.
- Disease occurring :
Pertussis disease is spread all over the world and is easily contagious. Humans are
the only source of B. pertussis, and the spread of these organisms is almost always
caused by people with active infection

VIRUS
RHINOVIRUS:
The incubation period of rhinovirus is 2-4 days. Human infections are limited to the
respiratory tract. The predominant symptom is nasal such as obstruction, sneezing,
raspy voice, malaise, headache and also frequent cough. There is no fever, and
usually the patient gets tracheobronkitis. The sickness of the disease depends on the
number of viruses that enter. The virus infects, replicates inside the ciliated
epithelial cells in the nose and during the first 2 to 5 days of the illness, the virus
can be isolated from pharyngeal secretions but not from other secretions or body
fluids. A small number of infected epithelial cells are excreted into nasal secretions.
The mechanism of resonance increase in mucus production is most likely due to the
response of the immune system to viral infections with swelling and inflammation
(inflammation) of the nasal membrane, as well as increased mucus production. This
mucus captures the materials we breathe like dust, powders, bacteria and viruses.
When the mucus contains the virus and into the body cells, then someone will
experience complaints of colds.
Common cold or abbreviated CC is an upper respiratory tract infection (ISPA). As
already mentioned the cause is mainly the Rhinovirus group. In addition to causing
CC, Rhinovirus may lead to bronhitis, ear inflammation, sinusitis and lower
respiratory infections such as pneumonia. Even this virus can trigger asthma
attacks.
Adenovirus
Adenoviruses will attack cells especially in mucopiletal cells konjingtiva,
respiratory tract, gastrointestinal tract, and urinary tract. Process this infection
begins with its attachment to cell receptors through proteins fiber virus which then
continues to replicate and eventually experienced viremia.
Moreover this virus can multiply and become latent infection on lymphoid glands
such as adenoids, tonsils, and Peyer's patches and can become reactive back to
immunosupressed state or infected by another agent.
Epstein Barr Virus
EB virus is usually transmitted through infected saliva and initiates infection in the
oropharynx. Viral replication occurs in pharyngeal epithelial cells and salivary
glands. EB virus is the cause of infectious mononucleosis. The disease is more
common in children and young adults. Virus-infected B cells synthesize
immunoglobulin. Mononucleosis is a polyclonal transformation of B cells. During
the course of infection most patients develop heterophile antibodies.
After an incubation period of 30-50 days, there are symptoms of headache, malaise,
fatigue, and sore throat. Fever lasts up to 10 days, enlarged lymph nodes and spleen.
Infectious mononucleosis disease has its own cured characteristics and lasts 2-4
weeks. As the disease progresses, there is an increase in the number of white blood
cells in the circulation with dominant lymphocytes.

3. How can cough and fever happen?

Answer :
- Cough
Cough is an important form of body defense reflexes to increase the secretion of
mucus secretions and other particles from the airway and protects aspiration against
foreign influx. Each cough takes place through the stimulation of a complex arcus
reflex. This is initiated by cough receptors located in the trachea, carina, large
airway branching points, and smaller airways in the distal, as well as in the pharynx.
The larynx and tracheobronchial receptors have good response to mechanical and
chemical stimuli.
Chemically sensitive receptors, acids and capsaicin compounds will trigger a
cough reflex through the activation of a vanilloid type 1 receptor (capsaicin). The
impulse of the stimulated cough receptor will cross the afferent path through the
vagus nerve to the "cough center" of the medulla. The cough center will produce an
efferent signal that travels down the vagus, the phrenic nerve and spinal motor
nerves to activate the expiratory muscles that are helpful in coughing.
The cough mechanism can be divided into three stages:
1. The inspiration phase: the inhalation phase that produces a volume needed for
effective cough
2. Compression phase: closure of the larynx combined with contractions the
muscles of the chest wall, diagframa resulting in the abdominal wall tense due to
intrathoracic pressure.
3. Expiratory phase: the glottis will open, resulting in airflow high expiration and
coughing sound
- Fever
Fever occurs due to the release of pyrogen substances in the body. Substance
pyrogen itself can be divided into two namely exogenous and endogenous.
Pirogenexogenous pyrogens are derived from outside the body such as
microorganisms and toxin. While the endogenous pyrogens are pyrogens derived
from within the body includes interleukin-1 (IL-1), interleukin-6 (IL-6), and tumor
necrosing factor-alpha (TNF-A). The main sources of endogenous pyrogens are
monocytes, lymphocytes and neutrophils. All of the above substances cause cell-
mononuclear phagocyte cells (monocytes, tissue macrophages or kupfeer cells)
make cytokines that act as endogenous pyrogens, a small, similar protein
interleukin, which is an important mediator of immune cells between cells. These
cytokines are produced systemically or locally and successfully enter the
circulation. Interleukin-1, interleukin-6, tumor necrosis factor α and interferon α,
interferon β and interferon γ are cytokines that play a role against the occurrence of
fever. These cytokines are also produced bycells in the Central Nervous System
(CNS) and then work in the preoptic region anterior hypothalamus. Cytokines will
trigger the release of arachidonic acid from membrane phospholipid with the aid of
phospholipase A2 enzyme. Arachidonic acid subsequently converted into
prostaglandins due to the role of the enzyme cyclooxygenase (COX, also called
PGH synthase) and cause fever at the central thermoregulation level in the
hypothalamus.
The cycloosigenase enzyme is present in two forms (isoform), ie cyclooxygenase-
1 (COX-1) and cyclooxygenase-2 (COX-2). Both isoforms different distribution on
the network and also has a regulatory function different. COX-1 is a constitutive
enzyme that catalyzes formation prostanoid regulators on various tissues, especially
on the lactic tract lining gastrointestinal, kidney, platelet and vascular epithelium.
While the COX-2 unconstitutive but inducible, inter alia when there is an
inflammatory stimuli, mitogenesis or oncogenesis. After the stimuli are then formed
prostanoid which is a mediator of pain and inflammation. This discovery leads to,
that COX-1 catalyzes the formation of responsible prostaglandins perform
physiological regulatory functions, while COX-2 catalyzes formation of
prostaglandins that cause inflammation.
Prostaglandin E2 (PGE2) is one type of prostaglandin causing a fever. The anterior
hypothalamus contains many neurons thermosensitive. This area is also rich in
serotonin and norepineprin acts as an intermediary for the occurrence of fever,
endogenous pyrogens increase concentration of the mediator. Furthermore these
two monoamines will increase cyclic adenosine monophosphate (cAMP) and
prostaglandin in the arrangement the central nervous system so the thermostat
temperature increases and the body becomes hot to adjust to thermostat
temperature.

4. Explain the mechanism of udem!

Answer :
Etiology of swelling:
Edema (Swelling)
There are 5 common direct-induced swelling mechanisms:
a. Decrease in colloid osmotic pressure
This pressure drop causes excess fluid to escape while the reabsorbed liquid is less
than normal; therefore the excess fluid remains in the intertisium space.
b. Increased capillary hydrostatic pressure
Increased venous pressure, such as when blood is blocked in the vein, causes an
increase in capillary blood pressure as the capillaries drain their contents into the
vein.
c. Increased capillary permeability
The increased permeability of capillary walls allows more plasma proteins to emit
from the plasma into the interstitial fluid. The decrease in plasma osmotic osmotic
pressure that occurs decreases the effective inlet pressure, while the increased
osmotic colloid pressure of the interstitial fluid occurring as a result of increased
protein in the interstitial fluid improves the effective outlet.
d. Lymphatic obstruction
Blockage of the lymph vessels causes edema because the excess fluid of the
filtration is retained in the interstitial fluid and can not be returned to the blood
through the lymph vessels.
e. Excess sodium and body water
In congestive heart failure, cardiac output decreases as contraction strength
decreases. To compensate, an increase in the amount of aldosterone leads to sodium
and water retention. The plasma volume increases, as well as intravascular venous
capillary pressure. This failing heart is unable to pump this increased venous return,
and fluid is forced into the interstitial space.

Usually the vocal cords will open and close smoothly, forming sound
through movement. When laryngitis occurs, eating the vocal cords will undergo a
process of inflammation, the vocal cords will swell, causing a change in sound. As
a result the voice will sound more hoarse
If the tissue is injured by infection with germs, then in this network will
occur a series of reactions that cause the destruction of agents that endanger the
network or which prevents the agent is widespread. These reactions then also cause
the injured tissue to be repaired. This series of reactions is called inflammation. The
vocal cords will then become visible edema, and the vibration process is also
generally impaired. It can also trigger a raucous sound caused by a phonation
disorder. The membrane covering the vocal cords also appears reddish and swollen.

5. Explain the mechanism of dispneu!

Answer :
Dyspnea is associated with ventilation. Ventilation is affected by the metabolic
needs of oxygen consumption and carbon dioxide elimination. The frequency of
ventilation depends on the stimulation of the diacepteptor present in the carotid and
aortic bodies. In addition, this frequency is also influenced by signals from neural
receptors present in the pulmonary parenchyma, large and small airways,
respiratory muscles, and thoracic wall. In dyspnea, there is an increase in muscle
effort in the inspiration and expiration process. Since dypsnea is subjective, dypsnea
is not always correlated with the degree of physiologic change. Some patients may
complain of severe respiratory failure with minor physiologic changes, while others
may deny the occurrence of a respiratory insufficiency despite the presence of
cardiopulmonary deterioration. explains the mechanism of dypsnea in all clinical
situations.have formulated a theory of length-tensioninappropriateness which states
the basic defect of dypsnea is a mismatch between the tapal muscle produced
volume with the tidal volume (length change). Whenever the difference arises, the
muscle spindle of the intercostal muscle transmits the signal that brings the
breathing condition into something that is realized. The jukstakapillary receptor
located in the alveolar interstitium and supplied by unmelelised vagal nerve fibers
will be stimulated by inhibition of the new activity. All these conditions will
activate the Hering-Breuer reflex where the inspiration effort will be stopped before
maximum inspiration is achieved and cause rapid breathing to deny. The
jukstakapillary receptor is also responsible for the emergence of dyspnea in
situations where there is resistance to pulmonary activity, such as in pulmonary
edema. In patients with pulmonary edema, accumulated fluid activates alveolar
diersteinitic nerve fibers and directly leads to dyspnea. Inhaled substances that can
irritate activate receptors in the respiratory epithelium and produce quick, shallow
breath, cough, and bronchospasm. In response to anxiety, the central nervous
system may also increase the frequency of breathing. In patients with
hyperventilation, correction decreases PCO2 alone does not reduce the sensation of
the breath is not complete. It reflects interactions between chemicals and nerves in
breathing. Other theories associate dyspnea with acid-base imbalances, central
nervous system mechanisms, decreased breathing capacity, increased breathing
effort, increased tran- quant transpulmonary, respiratory muscle weakness,
increased oxygen demand for breathing, intercostal muscle inertia and diaphragm,
as well as abnormal flow of respiration.

6. Explain about the influence between smoke and disease!

Answer :
Cigarette smoke is a complex mixture of 4700 chemicals, including free
radicals and oxidants (O2-) in high concentrations. Reactive Oxygen Consumption
(ROS) from macrophages and neutrophils. Claired neutrophil sequestration
sequestration in the lung micro circulation due to exposure to cigarette smoke can
increase oxidants. On the other hand cigarette smoke also reduces plasma
antioxidant capacity associated with decreased sulfhydryl protein in plasma or
glutathione (GSH). This decrease in GSH 124.25 leads to increased lipid peroxidase
and transcription of proinflammatory cytokine genes that play a role in
bronchogenic carcinoma.
Many studies on the effects of passive smokers are done on animals. Research on
experienced man, there is a significant increase in wall thickness in the respiratory
tract in children suddenly (sudden infant death syndrome) due to exposure to
secondhand smoke passive. No changes are found in the muscular layer, bronchial
mucosa or respiratory tract epithelium. Rather repeated this change due to increased
form of collagen.
1. The relationship between heavy smokers with cough and the journey they
experience:
Cigarettes have several kinds of content in it, one of the ingredients that is, is TAR.
TAR can paralyze the cilia of the hairs that exist on the surface of the respiratory
that serves as objects that enter the air respiration, this TAR can settle along the
respiratory tract and the cause of cough and breath breath.TAR stuck on the airway
can cause cancer of the airway

2. Pulse and respiration increased in heavy smokers

The association between smoking and increased cardiovascular disease has been
widely demonstrated. Apart from smoking duration, the risk of smoking is greatly
dependent on the number of cigarettes smoked per day. A person more than a pack
of cigarettes a day becomes 2 times more vulnerable than those who do not smoke.
Toxic chemicals, such as nicotine and carbon monoxide smoked through cigarettes,
enter the bloodstream and damage the endothelial vessel lining, the process and
atherosclerosis and hypertension.
Nicotine in the tembakaulah cause of blood pressure immediately after the first
suction. Like substances in cigarette smoke, nicotine is absorbed by the blood-tiny
blood vessels inside the lungs and passed into the bloodstream. In just a few seconds
the nicotine has reached the brain. The brain is pregnant with nicotine by signaling
the adrenal glands to release epinephrine (adrenaline). This powerful hormone will
constrict blood and energy to heavier because of higher pressure. After smoking
two cigarettes only then both systolic and diastolic pressure will increase 10 mmHg.
Blood pressure will remain at this altitude up to 30 minutes after stopping smoking.
While the effects of nicotine slowly disappear, blood pressure will also decrease
slowly. But in heavy smokers blood pressure will be at high levels throughout the
day.
Directly after contact with nicotine will arise stimulant to the adrenal glands that
cause the release of epinephrine (adrenaline). The release of body adrenaline that
glucose can heal, other than that respiration and heartbeat will be the same, meaning
smokers often experience hyperglycemia (excess sugar in the blood). Nicotine
indirectly causes the release of dopamine in the brain that controls pleasure and
motivation. In addition to the above organ damage also nerve damage and
behavioral changes.
The pulse increased in the first minute of smoking and increased 30% after 10
minutes. Systolic pressure increased by 10%. This increase occurs as a result:
1. Activation of the parasympathetic nervous system due to stimulation of the
sympathetic ganglion by Nicotine leading to norepinephrine release. Stimulation of
the adrenal medulla receptor releases epinephrine.
2. Epinephrine stimulates the "adrenergic B heart receptor"
3. Nicotine stimulates insulin from the pancreas, meaning smokers often have
hyperglycemia (excess sugar in the blood).
4. Directly after contact with nicotine will arise stimulant to the adrenal glands that
cause the release of epinephrine (adrenaline). The release of body adrenaline rises
glucose suddenly so that blood sugar levels rise and blood pressure also increases,
in addition to breathing and heart rate will increase.
3. Heavy smokers can not stop smoking, because: the effects of nicotine contained
in cigarettes. Nicotine works on the nervous system by stimulating the release of
adrenaline. The brain will instruct the body to make more endorphin
substances.Endorphin adalh protein compound that diesbut "body's natural pain
killer". Chemical structor endorphin is not much different from morphin.
Endorphins can make a person feel relaxed and euphoria. Smoking also stimulates

the nervous system so that the smoker feels comfortable, relaxed then the smoker
will repeat it again and again.

7. What is the differential diagnose ? explain!

Answer:
- PHARYNGITIS

1. Definition
Pharyngitis is an inflammation or infection of the mucous membrane pharyngeal
or tonsillopalatine. Acute pharyngitis usually is part of an acute oropharynx
infection that is tonsilopharyngitis acute or part of influenza (rinofaringitis) .Acute
pharyngitis is an infection of the pharynx caused by viruses or bacteria,
characterized by the presence of pain throat, exudate and hyperemic pharynx, fever,
enlargement lymph nodes and malaise (Vincent, 2004).
2. Etiology
Pharyngitis is an inflammation of the pharyngeal wall caused by virus (40-60%),
bacteria (5-40%), allergies, trauma, irritants, and others. Pharyngitis can be caused
by virus esorbacteria.

-Viruses namely Rhinovirus,Adenovirus,Parainfluenza,Coxsackievirus, Epstein

Barr virus,Herpesvirus.
-Bacteria is,Streptococcus ß hemolyticus group A, Chlamydia Corynebacterium
diphtheriae, Hemophilus influenzae,Neisseria gonorrhoeae.

-Candidiasis a rare occurrence exceptin patients

immunocompromise is those with HIV and AIDS, Irritation stimulating foods are
often a precipitating factor or which aggravates (Ministry of Health, 2007).

3. Risk Factor
Other risk factors for acute pharyngitis include cold air, decreased immune system
caused by influenza virus infection, consumption of malnourished foods, alcohol
consumption
excessive, smoking and someone who lives in our neighborhood who suffer from a
sore throat or a fever (Gore, 2013)
4. Epidemiology
Each year ± 40 million people visit the service center health due to pharyngitis.
Children and adults generally experience 3-5 times viral infection of the channel
upper respiration including pharyngitis (Ministry of Health Republic of Indonesia,
2013). Frequency of appearance of more pharyngitis often in the population of
children. Approximately 15-30% of cases of pharyngitis in school-aged children
and 10% of cases of pharyngitis in people adult. Usually occurs in the winter is a
result of infection of Streptococcus ß hemolyticus group A. Faringitis is rare occurs
in children younger than three years (Acerra, 2010).
5. Pharyngitis Classification
A. Acute Pharyngitis
 Pharyngitis Classification
a. Viral pharyngitis

Can be caused by Rinovirus, Adenovirus, Epstein Barr Virus (EBV), Influenza

Virus, Coxsachievirus, Cytomegalovirus and others. Symptoms and signs usually
there is a fever accompanied by rhinorrhea, nausea, pain throat, difficulty
swallowing. On examination looks pharynx and hyperemic tonsils. Influenza virus,
Coxsachievirus and Cytomegalovirus do not produce exudate. Coxsachievirus can
cause lesions vesicular in the oropharynx and skin lesions of the form
maculopapular rash. In adenovirus also cause symptoms of conjunctivitis especially
in children. Epstein bar virus causes pharyngitis accompanied by production
exudates on a large pharynx. There is an enlargemen lymph glands throughout the
body especially retroservikal and hepatosplenomegaly. Pharyngitis caused HIV-1
causes complaints of sore throat, pain swallowing, nausea and fever. On
examination looks pharyngeal hyperemic, exudate exists, acute lymphadenopathy
in neck and patient look weak.
b. Bacterial pharyngitis

Streptococcus infection ß hemolyticus group A is causes of acute pharyngitis in

adults (15%) and in children (30%). Symptoms and signs are usually sufferers
complaining of severe headache, vomiting, sometimes sometimes accompanied by
fever with high temperatures, rare accompanied by cough. On examination looks
tonsils enlarged, pharynx and hyperemic tonsils and present exudate on its surface.
A few days later arise petechiae spots on the palate and pharynx. The anterior neck
lymph glands are enlarged, supple and painful when there is emphasis. Pharyngitis
due to bacterial infection Streptococcus ß hemolyticus group A can be estimated
using Centorcriteria,namely:

-Anterior cervically lymphadenopaty

-Tonsillary exudate
-Absence of cough
- Fever
Each of these criteria when found in a score of one. When the score 0-1 then the
patient does not experience pharyngitis due infection of Streptococcus ß
hemolyticus group A, if score 1-3 then the patient has a 40% chance of being
infected Streptococcus ß hemolyticus group A and when the score is four patients
have a 50% chance of being infected Streptococcus ß hemolyticus group A
(Ministry
Health of the Republic of Indonesia, 2014).
c. .Fungalitisfungal
Candida can grow in the oral mucosa and cavity pharynx. Symptoms and signs are
usually pain complaints throat and swallowing pain. On examination looks white
plaque in the oropharynx and other pharyngeal mucosa hyperemic. Breeding of this
mushroom is done in agar sabouroud dextrosa
d. Pharyngitisgonorrhea
Only in patients who make contact orogenital.

1.1.2 Chronic Pharyngitis

 Chronic Pharyngitis
a. Chronic hyperplastic pharyngitis

In chronic hyperplastic pharyngitis changes occur pharyngeal posterior wall

mucosa. Looks lymph glands under the pharyngeal and lateral mucosa of
hyperplasia. On examination looks mucous posterior wall uneven, granular.
Symptoms and signs are usually the patient complaining at first the throat is dry
and itchy and finally cough that bereak
b. Chronic physiitis atrophy

Chronic physiitis atrophy often coincides with atrophic rhinitis. In atrophic rhinitis,
air respiration is not regulated temperature and humidity so it raises
stimulation and infection of the pharynx. Symptoms and signs usually the patient
complained of dry throat and thick and smelly mouth. On examination looks the
pharyngeal mucosa is covered by thick and thick mucus lifted looked dry mucosa.

1.1.3 Specific Pharyngitis

a. Pharyngitistuberculosis
Is a secondary process of pulmonary tuberculosis. On bovinum acid-resistant germ
infection may arise primary pharyngeal tuberculosis. How exogenous infections are
contact with sputum containing germs or inhalation of germs through the air. How
to Endogen Infection namely the spread through the blood in tuberculosis miliaris.
When the infection arises hematogenously then tonsils can be affected on both sides
and frequent lesions found on the posterior wall of the pharynx, the pharyngeal
arcus anterior, lateral wall of the hypopharynx, mole and palate durum palate.
Regional neck glands swell, current lymphogenic dissemination. Symptoms and
signs usually the patient is in a poor general state of being anorexies and
odophyhdes. Patients complain of that pain great in the throat, pain in the ear or
otalgia as well cervical lymph node enlargement

b. Pharyngitis is lethal

Treponema pallidum (Syphilis) can cause infection in the pharyngeal areas, as well
as lung diseases other organs. The clinical picture depends on the stage
his illness. Primary stage abnormalities are present at tongue, palate mole, tonsil
and posterior pharyngeal wall in the form of whitish spots. If the infection continues
there will be ulcers in the pharyngeal regions like ulcers in the genitalia are painless
and acquired also a painless mandibular gland enlargement press. Secondary stage
abnormalities are rare, but erythema can occur in the pharyngeal wall propagates
toward the larynx. Tertiary-stage abnormalities are present on the tonsils and palate,
rarely found on the walls posterior pharynx. In tertiary stages are usually present
guma, guma on the posterior wall of the pharynx may be widespread to the cervical
vertebra and if it breaks causing death. The gums are in the palate mole, when
healed will form scar tissue which may cause impaired palatal function
permanently. Diagnosis is done with serologic examination, penicillin therapy with
dose High is the ultimate choice for healing
(Rusmarjonno and hermani, 2007).
6. Pathophysiology
In pharyngitis caused by infection, bacteria or virus can directly invade the
pharyngeal mucosa and will cause local inflammatory response. Germs will
infiltrate the epithelial lining, then will erode the epithelium so that the superficial
lymphoid tissue react and there will be inflammatory inflammation with infiltration
polymorphonuclear leukocytes. In the early stages there are hyperemic, then
increased edema and secretion. At first the exudate is serous but becomes thickened
and then tends to become dry and can be attached to the wall of the pharynx. With
a hyperemic state, the blood vessels of the pharyngeal wall will be widened. The
yellow, white or gray will be obtained within the follicle or lymphoid tissue. It
appears that the lymphoid follicles and spots on the walls the posterior pharynx or
which lies more laterally will become inflamed and swollen. Viruses such as
Rhinovirus and Coronaviruses may cause secondary irritation of the mucosa
pharynx due to nasal secretions (Bailey, 2006; Adam, 2009).
Streptococcal infection has a special characteristic of invasion local and
extracelullar release of toxins and proteases that can be causing severe tissue
damage due to fragment M protein from Streptococcus ß hemolyticus group A has
a structure which is similar to sarcolema in the myocardium and connected with
rheumatic fever and heart valve damage. other than that can also cause acute
glomerulonephritis due to function glomerulus disrupted due to the formation of
antigen complexes antibodies
(Bailey, 2006; Adam, 2009).
7. Signs and symptoms

Signs and symptoms of pharyngitis depend on infecting microorganisms. Broadly

speaking pharyngitis howing common signs and symptoms such as weakness,
anorexia, fever, hoarseness, stiffness and pain in the neck muscles.
Typical symptoms by type, namely:Viral faringitis (usually by rhinovirus): begins
with symptoms of rhinitis and a few days later, pharyngitis develops. Another
symptom of fever is accompanied by rhinorrhea and nausea.

a. Bacterial pharyngitis: severe headache, vomiting, sometimes accompanied

by fever with high temperature, rarely accompanied cough.
b. Fungalitis fungal: especially sore throat and pain swallow.
c. Chronic hyperplastic pharyngitis: first dry throat, itching and finally
coughing up phlegm.
d. Pharyngitis atrophy: commonly dry and thick throat and mouth smelling.
e. Pharyngitis tuberculosis: severe pain in the pharynx and not respond with
non-specific bacterial treatment.
f. If garyngitis or gland pharyngitis is suspected, asked history of sexual
relations
8. Enforcement Diagnosis

ClinicalDiagnosis
Diagnosis based on anamnesis, physical examination and investigation if necessary

 Anamnesis
Anamnesis must be in accordance with the microorganisms infect. Broadly
speaking pharyngitis patients complaining of weakness, anorexia, fever,
hoarseness, stiffness and pain in the neck muscles. Typical symptoms by type
microorganisms,namely:

a. Viral faringitis, usually by Rhinovirus, begins with symptoms of rhinitis and a

few days later arise pharyngitis. Another symptom of fever is accompanied by
rhinorrhea and nausea.

b. Bacterial pharyngitis, usually patients complain of pain great head, vomiting,

sometimes accompanied by fever with high temperature and rarely accompanied by
cough.

c. Fungalitis fungal, especially sore throat and pain swallow.

d. Chronic hyperplastic pharyngitis, first throat dry, itchy and eventually cough with
phlegm.

e. Chronic physiitis atrophy, generally dry throat and thick and smelly mouth.
f. Pharyngitis tuberculosis, usually severe pain in the pharynx and does not respond
to bacterial treatment non-specific.

g. If suspected pharyngitis gonorrhea or pharyngitis luetika, asked about the

patient's sexual relationship.

 Physical examination

a. Viral pharyngitis, on examination appears pharynx and hyperemic tonsils,

exudate (influenza virus, coxsachievirus, cytomegalovirus does not produce
exudate). In coxsachievirus can cause lesions vesicular in the oropharynx and skin
lesions of the form maculopapular rash.

b. Bacterial pharyngitis, on examination looks tonsils enlarged, pharynx and

hyperemic tonsils and present exudate on its surface. A few days later arise
petechiae spots on the palate and pharynx. Sometimes the lymph nodes are found
anterior enlarged, supple and pain in emphasis.
c. Fungalitis fungal, on examination looks white plaque in the oropharynx and base
of the tongue, while the mucosa other pharynx is hyperemic.

d.Hyperplastic chronicitis, on examination

visible lymph glands under the pharyngeal mucosa and lateral hyperplasia. On
examination looks mucous posterior wall uneven and granular (cobble stone).
e. Chronic physiitis atrophy, on examination appears the pharyngeal mucosa is
covered by thick and thick mucus lifted looked dry mucosa.
f. Pharyngitis tuberculosis, on examination appears granuloma of the pelvas in the
pharyngeal and laryngeal mucosa.

g. Lung pharyngitis depends on the stage of the disease.

- Primary stage

On tongue palate mole, tonsils and walls posterior pharynx in the form of
whitish spots. When continued infection of ulcers in the pharyngeal region such as
ulcers in the genitalia that is not pain. Too obtained enlargement of the mandibular
gland.

-Secondary stadium
This stage is rarely found. On the wall of the pharynx there is erythema that radiates
toward the larynx.
-tertiary stages
There's a gum. Predilection of the tonsils and palate

 Supporting investigation
Pharyngitis is diagnosed by examination throat (throat culture). Cultural
examination have a sensitivity of 90-95% of diagnosis, so more relied upon as a
determinan to the pharyngitis's cause reliable

Throat culture is a method that done to confirm a diagnosis of pharyngitis which is

caused by bacteria Group A Beta-Hemolytic Streptococcus (GABHS). Group A
Beta-Hemolytic Streptococcus (GABHS) rapid antigen detection test is a method
for diagnosing pharyngitis due to GABHS infection. This test will be an indication
if patients have a moderate risk or if a doctor provide antibiotic therapy with high
risk for patient. If the results obtained are positive then treatment given antibiotics
appropriately but if the result negative then antibiotic treatment is stopped later
follow-up. Rapid antigen detection test is not sensitive to Streptococcus Group C
and G or type other pathogenic bacteria (Kazzi et al., 2006).
 To achieve accurate results, take the smear throat is done on the tonsil and
pharyngeal areas posterior. Specimens were inoculated on blood agar and planted
antibiotic disks. The standard criteria for enforcement diagnosis of GABHS
infection is the percentage of sensitivity reaching 90-99%. Throat culture is very
important for patients who are more than ten days old (Vincent,2004).
9. Management
Management of pharyngitis should be appropriate cause.
a. Management Objectives

Overcome symptoms as soon as possible, limit the spread infection and limit
complications.

b. Main Therapy Comprehensive management of acute pharyngitis, that is:

1.Get enough rest

2.Drinking enough water

3.Gargle with warm water

4. Giving pharmacotherapy:

c. Topical
Antiseptic mouthwash

- Maintain oral hygiene

- In fungalitis fungal given nystatin 100.000-400.000 2 times / day.

- Pharyngitis chronic hyperplastic local therapy with doing caustic pharynx by using
chemicals 25% argentin nitras solution.

d. Oral systemic

- Anti virus metisoprinol (isoprenosine) administered on viral infection with a dose

of 60-100 mg / kgBW divided in 4-6 times / day given in adults and children less
than five years given 50 mg / kgBW divided in 4-6 times / day giving.
- Pharyngitis due to bacteria especially when suspected cause Streptococcus group
A is given antibiotics penicillin G benzathine 50.000 U / kgBB / IM single or dose
amoxicillin 50 mg / kgBB dose is divided 3 times / day during ten days and in adults
3x500 mg for 6-10 days or erythromycin 4x500 mg / day. In addition to antibiotics
as well iven corticosteroids because steroids have been demonstrated clinical
improvement because it can suppress inflammatory reactions. Steroids that can be
administered are dexamethasone 3x0.5 mg in adults for three days and in children
0.01 mg / kgBW / day divided three times of administration for three days.
- Faringitis gonorrhea, third generation cephalosporins, Ceftriaxone 2 gr IV / IM
single dose.

- In hyperplastic chronicitis pharyngitis, if necessary can given antitussive cough

medicine or expectorant. Disease nose and paranasal sinus should be treated.
- Chronic pharyngitis treatment atrophy is aimed at rhinitis atrophy.
- For cases of chronic hyperplastic pharyngitis is performed caustic once daily for
3-5days.

 Counseling and Education:

1. Tell the family to keep the immune system by eating nutritious meals and
regular exercise.
2. Tell the family to stop smoking.

3.Tell the family to avoid eating-food which can irritate the throat.
4.Tell the family and patient to always keep oral hygiene.

5.Tell the family to wash hands regularly

10. Complications
Common complications of pharyngitis are sinusitis, otitis media, epiglottitis,
mastoiditis, and pneumonia. Pharyngitis caused by streptococcus infection if not
treated promptly causing peritonsillar abscess, acute rheumatic fever, toxic shock
syndrome, peritonsillar sellulitis, retrofaringeal abscess and obstruction of the
respiratory tract resulting from swelling of the larynx. Acute rheumatic fever is
reported to occur in one of 400 infections Untreated GABHS (Ministry of Health
Republic of Indonesia, 2013).

- EPIGLOTTITIS

Definition :
Epiglottitis is an inflammatory condition occurring in the supraglotic area of the
larynx, including epiglottis, valecules, aritenoid, and ariepiglotica folds, so it is
often also called supraglotitis or supraglotic laryngitis.
Etiology:
The following are bacterial causes of epiglottitis:
 Haemophilus influenzae type b (Hib)
 Streptococcus pneumoniae
 Staphylococcus aureus
 Streptococcus beta-haemolyticus tipe a
 Haemophilus parainfluenzae
Noninfectious etiologies include thermal injuries, and trauma-causing blind finger
sweeps to remove a foreign body from the pharynx.
Epidemiology :
Epiglottitis is most common in children aged 2-8 year and also in adult (>85 years
old), although it can occur at any age. Men are more frequent than women with a
ratio of 3 : 1. Since the widespread use of the Hib vaccine, the incidence and
causative agents of epiglottitis have changed. However, vaccinated children can
even develop epiglottitis due to non – type b H influenzae.
Signs and Symtomps:
• Fever
• Severe sore throat
• Dyspnea –Shortness of breath or difficulty in breathing
• Drooling of saliva
• Dysphagia –Difficulty swallowing
• Dysphonia –Hoarseness of voice
• Stridor heard during inspiration

Patomechanism :
Haemophilus influenzae type b (Hib) or Streptococcus pneumonia may colonize
the pharynx of otherwise healthy children through the transmission of breathing
from intimate contact. These bacteria can penetrate the mucosal barrier, invade the
bloodstream and cause bacteremia and epiglottic hatching and surrounding tissue.
Bacteraemia can also cause infections of the meninges, skin, lungs, ears, joints, and
other structures.
Infection usually begins in the upper respiratory tract as inflammation of the nose
and throat. Then the infection moves downwards, into the epiglottis. Infection is
often accompanied by bacteremia (blood infection). Epiglottitis can be fatal soon
because inflammation of the infected tissue can clog the airways and stop breathing.
Infections usually start suddenly and develop rapidly.
Epiglottitis can invade the posterior tongue and larynx. This condition causes the
occurrence of stridor (airway obstruction) and septicemia. In the pharynx there is
inflammation and epiglottis becomes hyperemic (like red cherries). Noninfective
inflammation of the structures around the epiglottis may also be caused by heat or
chemical injury or from local trauma, including blunt trauma to the neck.
 Supporting Examination:
1. Blood test : an increase in the number of white blood cells signifies the
occurrence of inflammatory processes.
2. Throat swab : to know whether or not there is a bacterial infection or virus.
3. Radiology : “thumb sign” is indicative of severe inflammation of the
epiglottis with potential for irrevocable loss of the airway. Difficulty in breathing
and stridor are common signs of epiglottitis in children, but are less frequent in
adults. Stridor, tachycardia, tachypnea, rapid onset of symptoms and a “thumb-
sign” on lateral X-rays of the neck.

4. Laryngoscopy : an epiglottis red inflamed with edema resembling a 'cherry

red' image. Also an inflammation of the plaque ariepiglottica.
(a). Normal epiglottis. (b). Epiglottis with inflammation

TREATMENT :
If someone has epiglottitis, the most important treatment is to ensure that they are
getting enough oxygen into their lungs. Hospitalization is highly recommended
because of the danger of airway obstruction.

For example, oxygen can be given using a mask over their mouth and nose.
Sometimes someone may need help with their breathing, using a ventilator. A
ventilator is a machine that is mechanically operated to maintain the flow of oxygen
and air into and out of the lungs.

In severe cases, if the epiglottis is swollen and blocking the airway, even if oxygen
is given, it would not be able to reach the lungs. So, a procedure called a
tracheostomy is done. This is where a small cut is made in the windpipe (trachea).
This allows a tube to pass below the swollen epiglottis so that oxygen can be
delivered to the lungs. Someone with a tracheostomy may also need help with their
breathing using a ventilator.

Antibiotics are another important part of the treatment. They help to fight the
infection. A steroid medicine may also be given to help reduce the inflammation
around the epiglottis. Hydrocortisone or dexamethasone is given to relieve edema.
Administration of antibiotics such as ampicillin (100 mg/kg weight/days) or
cephalosporins (50 mg/kg weight/days) is effective against infections and can be
administered parenterally.

Complication :
In classic cases involving bacteremia with Haemophilus influenzae, other structures
may have concomitant infectious processes. These may include the following:
 Meningitis
 Pneumonia
 Septic arthritis
 Otitis media

Prognosis :
The prognosis is good for patients with epiglottitis whose airways have been
secured. The mortality rate is less than 1% in these patients. However, mortality
rates as high as 10% can occur in children whose airways are not protected by
endotracheal intubation.

- Laryngitis
Laryngitis is an inflammation of the larynx that can be caused by bacteria, viruses,
or fungi. Laryngitis is also a result of excessive use of sound, exposure to exogenous
pollutants, or infection of the vocal cords. Gastrofageal reflux, bronchitis, and
pneumonia may also cause laryngitis.

Laryngitis in children is often suffered by children ages 3 months to 3 years, and is

usually accompanied by inflammation of the trachea and bronchi and is referred to
as croup disease. The disease is often caused by viruses, namely parainfluenza
virus, adenovirus, influenza A and B viruses, RSV, and measles virus. In addition,
M. pneumonia can also cause croup.

Results of History (Subjective)

Complaints:
Patients present with a rasp or rasp sound (afonia)
Other symptoms (croup), among others:
• Local symptoms such as hoarse sounds, such as harsh sounds or loud sounds
coming out or sounds with lower tones than normal sounds or even voiceless
alphonies. This happens because of the disturbance of vibration as well as the
tension in the approach of both the left and right vocal cords.
• Shortness of breath and stridor.
• Common inflammatory symptoms such as fever, malaise.
• A long dry cough accompanied by thick sputum.
• Common cold symptoms, sneezing, difficulty swallowing
• Airway obstruction in the presence of laryngeal udem followed by subglottic
udem that occurs within a few hours and is usually common in children
• Chronic laryngitis is characterized by persistent aphonia

Risk factor:
• Excessive voice usage
• Exposure to irritants such as cigarette smoke and alcohol drinks
• The presence of gastrophageal reflux, bronchitis, and pneumonia
• Allergic rhinitis
• Sudden temperature changes
• Malnutrition
• Decreased immune system or tubu resistance

Result of physical examination and simple support:

Physical examination
Special indirect laryngoscopy for adult patients to see the larynx and surrounding
areas
On examination will appear
• Hyperemic laryngeal mucosa, swollen primarily at the top and bottom of the vocal
cords
• Usually there are signs of acute inflammation in the nose or paranasal sinuses
• Airway obstruction in the presence of laryngeal udem followed by sublgotic udem
• In chronic laryngitis, nodules, ulcers and thickening of the mucosa of the vocal
cords may be present

Supporting investigation
• X-lateral AP tissue lateral flaking X-ray: visible bias of subglotted tissue swelling
(steeple sign). This mark is found in 50% of cases
• Photo thorax AP
• Complete blood laboratory examination

Diagnostic Enforcement (Assessment)

Classification :
1. Acute laryngitis
Acute laryngitis is an acute laryngeal inflammation, which can be caused by viruses
and bacteria. Complaints last <3 weeks and are generally caused by influenza virus
infections (type A and B), parainfluenza (type 1,2,3), rhinovirus and adenovirus.
Other causes are haemofilus influenza, branhamellacatarrhalis, streptococcus
pyogenes, staphylococcus aureus and streptococcus pneumoniae.

2. Chronic laryngitis
Chronic laryngitis may occur after recurrent acute laryngitis, and may also be
caused by chronic sinusitis, severe septal deviation, nasal polyps, chronic
bronchitis, smoking, constant exposure to irritants, and excessive alcohol
consumption. Signs of this chronic laryngitis are insignificant throat pain,
hoarseness, and there is edema in the larynx. It may also be due to abuse of voice
(vocal abuse) such as shouting or talking loudly

3. Laryngitis clarification

A. Tuberculosis laryngitis
Caused by pulmonary tuberculosis. After treatment, pulmonary tuberculosis usually
resolves but the laryngitis of tuberculosis persists (requiring longer treatment),
because the laryngeal mucosal structure is very attached to the cartilage as well as
the vascularization is not as good as the lung.
There are 4 stages:
1) Stadium infiltration
2) Ulceration stadium
3) Pericondritic stage
4) Stadium fibrotuberkulosis

B. Laryngitis excessively
Chronic inflammation is rare. In laryngitis is classified lues tertiary stage is the
stage of formation of gums that can occur in the larynx
Differential diagnosis
• Foreign matter on the larynx
•Pharyngitis
• Bronchiolitis
Reference Criteria
Indication of hospital admission if:
• Age of patient under 3 years
• There is a sign of airway obstruction
• Looks toxic, cyanotic, dehydrated or exhausted
• Suspect laryngeal tumors
• Inadequate home care

Infrastructure
• Head light
• Glass of the larynx
• Drugs: analgesic, antipyretic, nasal decongestants, antibiotics

Prognosis
• Prognosis in general dubia ad bonam

8. What does laryngoscopy looks like?

Answer :
Laryngoscopy is a medical action performed to see the laryngeal area (vocal cords).
Indications of laryngoscopy are basically any suspicion of laryngeal abnormalities.
The purpose and advantages of this examination is to look directly at the larynx to
detect the presence of tumors, foreign bodies, nerve damage or other structures, or
other abnormalities. There are two checks to check the larynx directly. First, by
using a flexible tube (flexible) with a fiber optic device inserted through to enter
the larynx. Another method is to use a stiff tube inserted directly from the mouth
into the larynx. Both of these methods, on the endoscope there is a lamp and lens.
The endoscope hose is also equipped with a slime or dirt. Besides, it can also serve
as a biopsy to take tissue samples.
Contraindications Laryngoscopy
Indirect laryngoscopy contraindications do not actually exist. In certain
circumstances it is said to be contraindicated, because examination can not be
performed, for example in patients with great trismus, pharyngeal stenosis and
trauma.
How to Check Laryngoscopy
1. Direct Laryngoscopy
Direct laryngoscopy is a direct visual examination of the larynx by using
laryngoscopy or other device as a laryngoscope. Visual impression obtained in
direct laryngoscopy is more natural when compared with indirect laryngoscopy.
The tool used is a rigid laryngoscope of a metal tube with an illumination lamp
located at the front or rear end.
2. Indirect Laryngoscopy
How to view the larynx indirectly with the help of glass larynx. Indirect
laryngoscopic way: Patients are told to sit upright, head or chin slightly put forward
a little. Patients are told to open the mouth to see the pharynx and determine the
size of the laryngeal mirror used. The size of the larynx used is important because
the glass that is too large will touch the tonsils and laryngeal walls that will cause
vomiting. Patients are asked to stick out the tongue, which is then held with a middle
finger covered with gauze. The index finger is used to hold the upper lip. Very
carefully, the glass is inserted to the position near the back wall of the oropharynx.
Remember, do not touch the back of the tongue, or tonsils or laryngeal walls,
because it will cause vomiting.
Indirect laryngoscopy is performed without anesthesia. However, in sensitive
patients can be given local anesthesia with a suction tablet or spray.

Complications
Complications are rare but may include coughing, choking, temporary sneezing, or
bleeding. Some individuals may react negatively to anesthesia used in the
procedure. Injuries can occur in the nose, throat, mouth, or as a result of the
procedure.
Check up result
Examination by direct or indirect laryngoscopy can help establish the diagnosis of
acute laryngitis.

9. What is the perspective islam based on thr scenario?

Answer:
1. Al-Maidah verses 87-88
“ O ye who believe! Do not forbid the good things that God has made lawful for
you, and do not transgress. Allah does not love those who transgress. And eat the
lawful food again from what Allah has given you, and fear Allah that you believe
in Him.”

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