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HEMOPTISIS

Group 28

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Niko Citami
Eisa Mayestika
Fatimah Amalia `
Lukman Karim
Eva Silvia R
Virda Permatasari
Tommy Darmawan
Niken Suciningrum
Christina Fanny
Wilda Purnama
Nurul Aini
Dimas Didik S

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Scenario
Mr. Mansyur (25 years old), present to hospital Accident and
Emergency department (A&E) with coughing up blood15cc every
cough (with 3-4 times coughing up blood in one day) since two
days ago, the colour is fresh red, bubbly. Every coughing up
blood is always out, even while in the A&E blood multiply the
blood which comes out.

keywords
1. Tuberculosis
2. coughing up blood

Problem
1. How does patients complaint the symptom?
2. How does the principle of handling emergencies in patients?
3. How to educate patients and their families?

The types of diseases associated


1. Tuberculosis pulmonary
2. Lung cancer
3. Bronkiektasis

Discussion
Pulmonary Tuberculosis
Mycobacterium tuberculosis
Pulmonary tuberculosis includes 80% of the overall incidence of
tuberculosis disease, while the remaining 20% is extrapulmonary
tuberculosis.

Blood cough in pulmonary tuberculosis because:


1.Aneurysm rupture in the wall cavity contained (rasmussens
aneurysm)
2.Rupture in thin walls of the cavity which contains many small
blood vessels
3.Ulceration of the parenchymal tissue of the lungs or bronchi /
bronchioles
4.The process of exudation in the lung parenchyma damage the
pulmonary capillaries
5.Pulmonary fibrosis pulmonary tuberculosis in the former the
blood vessels
6.The presence of calcification which causes damage to blood
vessel walls.

Etiology

Mycobacterium tuberculosis germ


straight rods
Ziehl-Neelsen on will appear in red with a blue background
Die if exposed to direct sunlight
this germs in the body tissues can be dormant (Hibernation)
Bacilli that exist in sputum spark can survive in 8-10 days

Modes of Infection
Coughing or sneezing
Droplet

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Pathophysiology
Primary infection
Near the apex of the lung or pleura lower lobe.
Have a process of degeneration of necrotic or swiss cheese but
could not
White blood cells die
Necrotic lung tissue

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Secondary Infection
Re-infection also leads to clinical forms of active tuberculosis
TB bacilli can still latent for many years and then switched back
if the client durability decreases.

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Factors that have a role in the development of TB into active


disease:
1.old age
2.Immunosuppression
3.HIV infection
4.Malnutrition
5.the presence of other disease states (DM,CKD, or malignancy)
6.genetic predisposition

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Clinical symptoms
No.

Common Symptoms

Specially Symptomp

1.

Cough> 3 weeks

Wheezing sound"

2.

fever

Weakened voice accompanied by


shortness of breath

3.

Weight loss for no reason

If there is fluid in the pleural cavity,


may be accompanied by chest pains

4.

Sweating at night

If the bone, there will be symptoms


such as bone infection that may one
day form the channel and lead to the
skin over

5.

malaise

6.

Anorexia

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Risk Factor
Some risk factors for with TB are:
1.Sex
2.Status nutrition
3.Sosio-economy
4.Education
5.Toxic

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Complication
1.
2.
3.
4.
5.
6.
7.

Blood cough
Pneumothorax
Respiratory failure
Heart failure
Effusion pleura
Asphyxia
Shock Hipovolemik

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Discussion
Pulmonary Cancer (CA Pulmo)

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attack branching
segments

Cilia lost
desquamation
resulting in the
deposition of
carcinogens

direct invasion of
the ribs and
vertebral bodies.

metaplasia,
hyperplasia and
dysplasia

obstruction

lesions pheripheal
penetrate the
pleural space

ulceration of
bronchial
suppuration distal

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Histological Type
According to the WHO histological classification in 1999, but for
the clinical needs enough if only it can be seen:
Carsinoma epidermoid
small cell carcinoma
adenocarcinoma
large Cell carcinoma

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Differential lung cancer (Wasripin, 2007):

1.Small Cell Lung Cancer (SCLC)


The incidence of lung cancer SCLC type is only about 20% of the total
incidence of lung cancer.
growing very fast and aggressive.
If not treated immediately it can last only 2 to 4 months.
2.Non Small Cell Lung Cancer (NCLC)
adenocarsinoma, this type is the most common (40%).
squamous cell carcinoma, the number of cases around 20-30%.
Large Cell Carcinoma, the number of cases around 10-15%.
3.Most of the patients diagnosed with NSCLC (70-80%) is already in the
advanced stage III - IV.

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Discussion
Bronkiektasis
Dilation of bronchi caused by weakness of the bronchial wall
permanent
Group of respiratory tract infections

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Etiology
1. Infection
2. Heriditer abnormalities or congenital abnormalities
3. Mechanical factors that facilitate the emergence of
infectious
4. Patients often have a history of pneumonia as a complication
of measles, whooping cough, or other infectious diseases in
childhood.

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Clinical Symptom
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.

Chronic cough
Sputum which much, especially in the morning, after sleeping and lying down
sputum containing blood spots
coughing up blood
Cough with sputum cough accompanying a cold for 1-2 weeks or none symptoms
at all (mild Bronchiectasis)
sputum which much less than 200-300 cc
fever
anorexia
weight loss
anemia
pleural pain
malaise
Dypsneu
Found clubbed fingers (30-50% case)

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Pathophysiology
Congenital and acquired
1.Congenital
babies and children
permanent damage of the development of the bronchial tree

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Pathophysiology
2. Acquired
Adults and children
Bacterial infections, bronchial obstruction and other
complications factor
Scheme next page

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infection

Components damages of
the mucosa and
bronchial wall

inflammation of
cytokines, nitric and
neutrophils

damage to the
alveolar tissue

bronkiektasis

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Clinical Symptoms
Anamnesa
1.Patient identity
a.Name
b.Sex
c.Age
d.Work
e.Wedding Status
f.Lastest Education
2.Main complaint

: Mr. Mansyur
: Male
: 25 years old
: Rice seller
: Not merried
: High School
: coughing up blood
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3.

Disease History Now:


1) 2 days ago coughing up blood (3-4 times a day)
2) While in the A&C much bleed as much as 50 cc
3) Fresh red blood color, bubbly, so the issue of blood volume reaches
230cc
4) Shape suffered since 1 month ago, accompanied the body feels fell
dizzy
5) The decrease appetite
6) Body weight was decreased

4.
1)
2)
3)

Past History of Disease:


Past medical treatment
been treated
History of diabetes therapy, hypertension, TB
Other chronic diseases

: had never
: denied
: denied

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5. Family History of Disease :


1) Mother suffered Tuberculosis
2) His father sufferers (currently in treatment)
6. Socio-Economic History :
Had a habit of smoking half a pack (6 cigarettes per day), but
never drink alcohol. Late eating habits and lack of rest.

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EARLY HYPOTHESIS
Based on anamnesis, physical examination, and laboratory
examination of the scenarios above, the case experienced by Mr.
Mansour (25 years) can be taken early on hemoptosis hypothesis
as follows:
1 Tuberculosis
2 Lung Ca
3 Bronchiectasis

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ANALYSIS OF DIFFERENTIAL DIAGNOSIS

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Hypothesis Final

Pulmonary Tuberculosis

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MECHANISM DIAGNOSIS

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Myobacterium TBC

Entering the airway

Live in alveoli
No infection

Cough
Sputum purulent
Hemoptisis
Weight loss

inflamation

Spread by Spleen

Fibrosis

Arise and thick elastic


connective tissue

Calsification

Exudation

Necrosis

Alveolar excretion can


not be returned

Gas cant back normal


diffusion

Cavity
Tightness

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Differential Hemoptisis and


Hematemesis
Hemoptisis

Hematemesis

Prodromal

scratchy throat

Nausea, flatulence

Colour

Fresh red

Dark red

Bubbly

(+)

(-)

contents

Leukocytes, macrofaq

food particles

PH

Alkalis

Acid

Anemia

(+) or (-)

(+)

Benzidine test

(-)

(+)

History disease

Lung/heart

Stomach/liver

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The mechanism of coughing up blood.


(Wolf, 1977)
1)
2)
3)
4)
5)
6)
7)

Inflammation of the mucous


Pulmonary infarction
Rupture of veins or capillaries
Membrane abnormalities alveolocapiler
Cavity tuberculosis Bleeding
Malignant tumor invasion
chest injury

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Treatment
Education
1. Dont forget to regularly take medication every day, as
recommended by a doctor
2. Always cover your mouth with a tissue when coughing, sneezing or
laughing. Keep in covered tissue and dispose of waste in place.
3. As usual, such as school, play, and work. During TB patients take
medication properly, the risk of passing will be lost. So the daily
social activities and there is nothing to be limited, so people with
TB do not ostracized or shunned.
4. Circulation in the room should be good, if necessary, add a fan to
get rid of the air in the room. Try to stay in the room or house that
has good light ventilation. TB germs are easily spread in a closed
room and no air circulation.

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Principles of Medical act


1 Isoniazid (INH)
2. Rifampicin (IRF)
3. Pyrazinamide (PZA)
4. Etambutol (EMB)
5. Streptomycin (SM)
To avoid the emergence of resistant TB bacteria and accelerate
disinfection, usually given combination drug consisting of 3-4
kinds of drug

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Prevention of Disease
1.
2.
3.
4.

Using masks
Spitting should be at a certain place
BCG is given to infants aged 3-14 months
The food should be high in carbohydrates and high in protein

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ANY QUESTION?
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