Week 1 (1) ICM-1 (Vincent 01071170136) “Fatigue”

Definition Etiology
 Inability to initiate activity, maintain activity. Psychologic: depression, anxiety, somatization disorder,
 Difficulty with concentration, memory, emotional stability. malnutrition/drug addict.
 Different from somnolence, dyspnea and muscle Pharmacologic: hypnotic, antiHT (β-blocker), antidepressant,
weakness.  antihistamine, opioid, muscle relaxant, drug abuse and
Bisa fisiologis, tapi chronic fatigue (>6mo) ga normal. withdrawal.
(Recent <1mo; Prolonged 1-6mo; Chronic >6mo). Endocrine: hypothyroid, DM, CKD, hepatic failure, apathetic
hyperthyroid, pituitary insufficiency, hypercalcemia, adrenal
Patofisiologi, dapat disebabkan oleh stress: insufficiency.
 Psikiatrik (gangguan tidur, masalah kejiwaan) Neoplastic-hematologic: occult malignancy, severe anemia.
 Fisikal (oksigenasi jaringan berkurang, hypocortisolism, Infection: TB, hepatitis, HIV, endocarditis, mononucleosis,
dll.) parasitic dz, CMV.
 Keduanya Cardiopulmo: CHF, COPD.
Connective tissue: rheumatoid.
Sleep disturbance: sleep apnea, esophageal reflux, allergic
rhinitis, psychologic.
Idiopathic: idiopathic chronic fatigue, chronic fatigue
syndrome, fibromyalgia.

Clinical Manifestation: SOB, muscle weakness, ↓BW, cold,

dry, short, difficulty concentrate, 3P DM, chest pain, vomit
diarrhea, fever chill, anxiety.

PF: keadaan umum, TTV, Tiroid, KGB, Neurological exam,

muscle tone, cardiopulmonary exam.

Pemeriksaan penunjang: CBC, Fe studies (serum iron, TIBC,

ferritin), ESR, elektrolit, glucose, BUN/creatinine, SGPT SGOT,
protein (albumin, globulin), TSH T3, HIV test atau infeksi lain,
blood smear, CPK, imaging (x-ray, CT), ECG, stool exam,
urinalysis, vit B12 B9 D.
Chronic Fatigue Syndrome
Persistent (6mo) or intermittent, unexplained, relapsing,
definitive start, not recent exertion result, no improve with
rest. Exclusion of other disease. 4 minor criteria for 6mo after
onset:
Recent impaired memory/concentration; odynophagia; painful
axillar/cervical adenophatia; myalgia; polyartralgia without
phlogosis; headache w/ new pattern/seriousness; sleep which
doesn’t improve by rest; discomfort post effort >24h.
Algoritma Diagnosis

Terapi
 treat underlying cause.
 Doctor-patient relationship
 Antidepressant
 Cognitive Behavioral Therapy (lebih baik)
 Graded Exercise Therapy

Anemia: gejala dan dapat menyebabkan fatigue juga. Hb

kurang sehingga kemampuan darah untuk mengikat oksigen
menurun.
Klasifikasi Anemia
defisiensi besi
dan penyakit
kronik kan
bisa sama-
sama micro-
hypo atau
normo-
normo.

Kalau berdasarkan klasifikasi di atas maka yang jadi

pertanyaan adalah, “Apakah ada supresi dari bone marrow?”. 
 Hyporegenerative: Supresi bone marrow, ditandai dengan
penurunan Reticulocyte disertain pancytopenia
 Regenerative: Tak ada supresi bone marrow, ditandai
dengan Reticulocyte yang meningkat atau normal. Misalnya
hemolysis disertai ikterik, organomegaly, Hburia, decreased
haptoglobin, increased uric acid, increased LDH.

Pemeriksaan fisik anemia 

Prinsip terapi Anemia 

 Kalau ada penyebabnya terapi kausanya.
 Pemberian ferrous sulfate untuk memperbaiki cadangan
besi, biasanya selama 3 bulan.
 Transfusi apabila Hb <7 g/dL, atau <8 g/dL apabila ada
masalah jantung.
Diagnosis
 Anemia (chronic
disease: Fe deficiency
anemia)
 Liver cirrhosis: portal
hypertension 
 HF (cirrhotic
cardiomyopathy):
pulmonary oedema

Terapi
-Ferrous sulfate 3.3mg/Hb/hari
untuk anemia iron deficiency.

-Diuretics dan digoxin untuk

heart failure.

-High protein low Na diet,

albumin transfusion untuk
cirrhosis.
-Somatostatin untuk
menurunkan hipertensi
portal.
-Laxative untuk menurunkan
kadar ammonia sehingga
mencegah timbulnya hepatic
encephalopathy.
-Vitamin K dan ligase apabila
terjadi perdarahan seperti
esophageal varices.