Seorang laki-laki 69 tahun pensiunan bekerja di pabrik semen, dibawa ke rumah sakit oleh anaknya yang

juga seorang dokter puskesmas karena menderita sesak yang hebat dan sangat lemah. Kondisi
kelemahan ini sebernarnya telah dialaminya sejak 4 bulan lalu, diamana pada saat itu ia menderita
batuk yang tidak produktif yang disertai demam, yang membaik setelah diberikan antibiotic selama 6
hari ditambah obat-obatan simptomatik.
saat ini ia juga menderita batuk yang produktif dengan sputum yang kecoklatan sejak 4 hari lalu, dan
sejak 2 hari lalu ia mengeluh demam yang disertai muntah. Ia tidak ada riwayat merokok ataupun
minum minuman keras, ia tidak pernah keluar kota atau melakukan perjalanan jarak jauh sejak 1 tahun
terakhir dan tidak pernah kontak dengan orang sakit sebelumnya. Selain itu ia sering mengalami gastric
reflux yang disertai dengan mual dan muntah.

A 69-year-old retired man worked in a cement factory, was taken to a hospital by his son who was also a
doctor at the puskesmas because he was suffering from severe and very weak congestion. This
weakness has been experienced since 4 months ago, at which time he suffered from an unproductive
cough with fever, which improved after being given antibiotics for 6 days plus symptomatic drugs.
now he also suffers from a productive cough with brownish sputum since 4 days ago, and since 2 days
ago he complained of fever accompanied by vomiting. He has no history of smoking or drinking liquor,
he has never been out of town or traveled long distances for the past 1 year and has never had contact
with sick people before. In addition he often experiences gastric reflux which is accompanied by nausea
and vomiting.

Kata kunci

1. 69-year-old male
2. Retired workers at the cement factory
3. Great and very weak tightness
4. Weaknesses that have been experienced since 4 months ago
5. An unproductive cough accompanied by fever
6. Improved after being given antibiotics for 6 days plus symptomatic drugs
7. Currently suffering from a productive cough
8. Brownish sputum since 4 days ago
9. Complaining with fever accompanied by vomiting 2 days ago
10. There is no history of smoking or drinking
11. Have never been out of town or traveled far since the last 1 year
12. Never contacted a sick person before
13. Often experience gastric reflux which is accompanied by nausea and vomiting

Kata sulit :

Gastric reflux : melemahnya tonus spinchter dengan oesophagus sehingga cairan dari lambung
bisa masuk ke oesophagus sehingga menimbulkan mual dan muntah.
Gastric reflux: weakening of the sphincter or stomach tone so that fluid from the stomach can enter the
esophagus, causing nausea and vomiting.
Pertanyaan

1. What is the anatomy and physiology of the respiratory system?

2. How are the symptoms of pathomechanism experienced
by patient?(DISPNEU, coughing, weakness, gastric reflux)
3. What is the mechanism of unproductive coughing
productive cough?
4. What are the differential diagnoses of the scenario?
5. What are the steps for establishing a diagnosis?
6. What are the factors that aggravate the patient's condition?
7. What are the benefits of administering antibiotic and symptomatic drugs?
8. Have any previous symptom connection with
symptoms now?
9. Is there a history relationship with the history now?
10. What is the management and prevention of DB?
11. What is the prognosis and complications in the DB?

2. PATOMEKANISM

DISPNEU
Occurs due to an increase in airway resistance which causes gas exchange to be disrupted. Dyspnea can
also occur in people who have decreased pulmonary compliance, the lower the ability to pulmonary
compliance, the greater the transmural pressure gradient that must be formed during inspiration to
produce normal lung development. For example, replacing lung tissue with fibrous connective tissue due
to silica or irritant inhalation is the same.

Cough
Stimulation on the cough receptor is passed to the center of the cough to the medulla, from the medulla
sent an answer to the muscles of the chest wall and larynx so that coughing occurs. Cough reflexes are
very important to maintain the integrity of the airways by removing foreign objects or
bronchopulmonary secretions. There are 4 phases of the coughing mechanism, i.e.
irritation phase
deep inspiration phase
compression phase
expulsion / expiration phase

WEAKNESS

Decreased alveolar function because the inflammatory process causes the formation of connective
tissue in the lungs.

Gas exchange is interrupted

REDUCTION Oxygenation to tissues

The metabolic process in the tissue does not produce maximum energy

Weakness

BROWNISH SPUTUM

Toxic particles (quartz crystals and silica dioxide) enter the respiratory tract

Stimulating macrophages secrete inflammatory mediators.

Inflammation, fibrogenesis and can damage and oxidize lysosomial membrane lipids and eventually kill
macrophages.

Brownish sputum

GASTRIC REFLUX
Long contact between the reflux material and the esophageal cough mucosa (increased
intraabdominal pressure) decreases the resistance of gastric reflux esophageal mucosal tissue to
the esophagus nausea and vomiting.

Video

Air enters into body through nostrils of nose

the nostrils consists of fine hairs, that lines the passage (the way through which air passes) and also
lined with mucus.

what is the use of fine hair and mucus lining in the nostril passage?

the fine hair iof nostrils filter the air from dust, dirt and microorganism. and mucus also trap and
facilitates smooth flow of air with its moist characteristic..

then the air passes through throat

the throat also called as wind pipe or trachea which is sorrounded by rings of cartilago..

what is the necessary of rings of cartilago

ROC helps in free, unrestricted flow of air through wind pipe and helps in preventing air passage from
collapse

if cartilago rings are absent, then it increases pressure during exhalation on compression of ribcage and
wind pipe, will be closed restrictsair flow and interfere normal breathing.

through threat, air passes into lungs

within lungs, the passage divides into smaller and smaller tubes and finally ends with balloon like
structures which are called as ALVEOLI

THE ALVEOLI IS THE SURFACE WHERE EXCHANGE of gases take place. the walls of alveoli consist of
network of blood vessels.

when we breath in. we lift our ribs, diaphragm flattens, followed by chest becomes larger.

and that case air is sucked into lungs and alveoli is filled with air.

and then blood carrie co2 from all parts of the body and releases co2 into alveoli.

and that proceeds to the oxygen that is present in the alveoli ia taken by blood by alveolar blood vessels.

oxygen is transported to all cells of the body through blood vessels

Udara masuk ke tubuh melalui lubang hidung

lubang hidung terdiri dari rambut-rambut halus, yang melapisi bagian (cara udara melaluinya)
dan juga dilapisi dengan lendir.
apa gunanya rambut halus dan lapisan lendir di lubang hidung?
bulu-bulu halus dari lubang hidung menyaring udara dari debu, kotoran dan mikroorganisme.
dan lendir juga menjebak dan memfasilitasi aliran udara yang lancar dengan karakteristik
lembabnya ..
lalu udara melewati tenggorokan
tenggorokan juga disebut sebagai pipa angin atau trakea yang dikelilingi oleh cincin tulang
rawan ..
apa perlunya cincin cartilago
ROC membantu dalam aliran udara bebas dan tidak terbatas melalui pipa angin dan membantu
mencegah jalan udara runtuh
jika cincin tulang rawan tidak ada, maka itu meningkatkan tekanan selama pernafasan pada
kompresi tulang rusuk dan pipa angin, akan ditutup membatasi aliran udara dan mengganggu
pernapasan normal.
melalui ancaman, udara masuk ke paru-paru
di dalam paru-paru, bagian itu terbagi menjadi tabung yang lebih kecil dan lebih kecil dan akhirnya
berakhir dengan struktur seperti balon yang disebut sebagai ALVEOLI
ALVEOLI ADALAH PERMUKAAN DI MANA PERTUKARAN gas terjadi. dinding alveoli terdiri dari jaringan
pembuluh darah.
ketika kita menarik napas. kita mengangkat tulang rusuk kita, diafragma rata, diikuti oleh dada menjadi
lebih besar.
dan selubung udara tersedot ke paru-paru dan alveoli terisi udara.
dan kemudian co2 pembawa darah dari semua bagian tubuh dan melepaskan co2 ke dalam alveoli.
dan yang menghasilkan oksigen yang ada dalam alveoli ia diambil oleh darah oleh pembuluh darah
alveolar.
oksigen diangkut ke semua sel tubuh melalui pembuluh darah