Professional Documents
Culture Documents
INTRODUCTION
1.1 Background
Respration system id the thirteen block in the 4th semester competency-
based curriculum in medical faculty of Muhammadiyah Palembang
University . Learning in this block is very important to learn in medical
faculty of Muhammadiyah Palembang University.
On this occasion, a case study tutorial of scenario A which presents
cases that related to the Respiration disease .
Mr.Adi, a 36 years old, came to the doctor with chief complain of
coughing up blood since 3 days ago. Mr.Adi often cough with greenish white
mucous since one month ago, followed by mild fever, profuse nocturnal
sweating, decreased of appetite, weight loss, and sometimes cough
accompanied by chest pain. Mr.Adi lived at the slum with his wife and 3 years
old son. His co-worker also suffer the same complain. Mr.Adi never
experience this symptom before. Doctor recommend Mr. Adi to get lung x-ray
examination.
Physical examination.
Sense : compos mentis, BW 60 kg, Height 164 cm.
Vital sign : BP 110/70 mmHg, Pulse 98x/minute, RR 20x/minute, T 37.7̊C
Specific examination:
Head : anemic conjungtive (-)
Thoraks : pulmo
Inspection : lung movement static and dynamic symmetric
Palpation : increased of steam fremitus on the right upper
lobe of the lung.
Percution : dullness on the right apex of the lung
Auscultation : increase of vesicular and moderate rales on the
right upper lobe of the lung
Abdomen : flat, supple, normal bowel movement, hepar and lien not palpable
1
Extremity : in normal limit
Additional Examination :
Laboratorium :
Hb : 11 g%, WBC : 6500/mm3, ESR : 140 mm/hr, Diff count 0/2/2/76/14/6.
1.2 Purpose
the purpose of this case study tutorial report are:
1. As a group task report which is a competency-based curriculum learning
system in the medical facultyof Muhammadiyah Palembang.
2. Can solve cases given in a scenario by group analysis and learning
methods
3. The purpose of the tutorial learning method is reached
2
CHAPTER II
DISCUSSION
3
experience this symptom before. Doctor recommend Mr. Adi to get lung x-ray
examination.
Physical examination.
Sense : compos mentis, BW 60 kg, Height 164 cm.
Vital sign : BP 110/70 mmHg, Pulse 98x/minute, RR 20x/minute, T 37.7̊C
Specific examination:
Head : anemic conjungtive (-)
Thoraks : pulmo
Inspection : lung movement static and dynamic symmetric
Palpation : increased of steam fremitus on the right upper lobe
of the lung.
Percution : dullness on the right apex of the lung
Auscultation : increase of vesicular and moderate rales on the
right upper lobe of the lung
Abdomen : flat, supple, normal bowel movement, hepar and lien not palpable
Extremity : in normal limit
Additional Examination :
Laboratorium :
Hb : 11 g%, WBC : 6500/mm3, ESR : 140 mm/hr, Diff count 0/2/2/76/14/6.
4
The chest x-ray, the most commonly
Lung X-Ray performed diagnostic x-ray examination can
4
examination produce image of the lungs airways, bood
vessel and the bones of the spine.
A decresed suggest air or fluid in the pleura
5 Stem fremitus
spaces or decreased in lung issue density.
The occurrence of excessive sweating during
Profuse nocturnal
6 sleep. The person may or may not also
sweating
perspire excessively while awake.
High life populate urban people in area
7 Lived at the slum obesity where living condition are very bad
and where the houses are in bad condition.
The spitting of blood or originated in the
8 Hemoptysis
lung or bronchial tubes.
(Dorland, 2015)
5
Inspection : lung movement static and dynamic symmetric
Palpation : increased of steam fremitus on the right upper lobe
of the lung.
Percution : dullness on the right apex of the lung
Auscultation : increase of vesicular and moderate rales on the
right upper lobe of the lung
Abdomen : flat, supple, normal bowel movement, hepar and lien not
palpable
Extremity : in normal limit
4. Additional Examination :
Laboratorium :
Hb : 11 g%, WBC : 6500/mm3, ESR : 140 mm/hr, Diff count
0/2/2/76/14/6.
6
Anatomy
1. Cavum Nasalis
The nose is a breathing organ where located outside and
composed of cartilage. At the tip and the base of the nose is
supported by the nasal bone. The nasal cavity is divided into two
parts by the nasal septum, ie the left and right. The front of the
septum is supported by cartilage, while the back is supported by
the vomer bone and ethmoid bone bulge. The lower portion of the
nasal cavity is limited by the bone of the palate, and the maxilla.
The upper part is limited by the ethmoid, the side by the maxillary
bone, the inferior nasal cones, and the ethomoid while the middle
is limited by the nasal septum.
On the lateral wall there are three bulges called konka nasalis
superior, konka media and konka inferior. Through the cracks in
7
these three bulges inspiration air will be heated by the blood
inside the capillaries and moisturized by the mucus secreted by
goblet cells. Mucus can also clear the air from the dust.
The upper portion of the nasal cavity contains the olfactory
area, which contains the scavenger cells. These cells are
associated with the first brain nerve (olfactory nerve). The length
is about 10 cm. The air that will enter the lungs will first enter
through the nose first. About 15,000 liters of air every day will
pass through the nose.
2. Pharynx
The pharynx is located behind the nose, mouth and throat in
front of the vertebrae. The pharynx is about 7 cm long. The
conical pharynx consists of the membranous musculo and is
connected with the esophagus and trachea. Composed of layers of
mucosa, fibrous and muscle, where the main muscle is a
constrictor muscle that contracts when the food enters the pharynx
and pushes it into the esophagus.
In the curve of the pharynx there are tonsils (tonsils) lymph
glands that contain lymphocyte glands and are a defense against
infection, here lies in the intersection between the airway and road
food. Upward the front corresponds to the nasal cavity, by the
intermediate hole called koana, the pitch state is related to the oral
cavity by means of a hole called ismus fausium.
At the base of the pharynx, there is a respiratory valve
called the epiglottis. The piglotis serves to close the end of the
respiratory tract (larynx) so that the food does not enter the
respiratory tract.
Faring consists of 3 parts, namely:
a. The nasal pharynx (nasopharynx), located behind the nose
where there is the eustachian tube, the adenoid gland.
8
b. Oral pharynx (oropharynx), located behind the mouth, there is
tonil (tonsil).
c. The laryngeal (larynxngofaring) pharynx, is the lowest part of
the pharynx located in the larynx.
3. Larynx
From the pharynx, breathing air will go to the larynx. The
larynx is composed of cartilage fragments that make up the
Adam's apple. It is composed of tongue, cartilage valves, cartilage
shield, cartilage cartilage, and cartilage bracelet.
The inside of the laryngeal wall is moved by the muscles to
close and open the glottis. Gllotis is a gap-like opening that
connects the pharynx with the trachea.
The larynx can be closed by the epiglottis (valve base of the
throat). When swallowing food, epiglottis cover the larynx. As
you breathe, the epiglottis will open.
On the larynx there are vocal cords that vibrate when there is
air through them. For example, when we speak.
4. Trachea
The throat is a pipe that is ± 10 cm long, located partially on
the neck and part of the chest cavity. Throat walls are thin and
rigid, surrounded by cartilage rings. The sections are coated by
mucous membranes and have a layer consisting of ciliated cells.
This cilia serves to filter out foreign objects entering the
respiratory tract.
9
5. Bronchus
Bronchus is the part that connects the lungs with the
trachea.Bronkus consists of a slab of cartilage and the walls
consist of smooth muscle.
The bronchus is composed of branching, ie the right and left
bronchus. The location of the right and left bronchus is slightly
different. The right ruler is more vertical than the left. Because of
this structure, so the right bronkus will easily enter the foreign
body. That is why the right lung of a person is more susceptible to
bronchitis disease.
Bronchus then branch again as much as 20-25 times
branching forming bronchiolus.Dong bronchiolus walls and not
cartilage.Pada tip of bronchiol is composed alveoli shaped like
grapes.
6. Pulmo
The lungs are located in the chest cavity, the plain facing to
the middle of the chest / mediastinum cavity. In the center there is
10
the lung or hilus. At the front mediastinum lies the heart. The
lungs are wrapped by a membrane called pleura.
The right lung consists of 3 superior, inferior lobes and dexter
media while the left lung consists of 2 superior and inferior lobes.
Innervation of the lungs: The aferrent and eferrent visceralis
fibers are from the truncus sympaticus and the parasympatiscus
fibers are from the vagus nerve.
Physiology
The respiratory system includes the airway to the lungs, the lungs
themselves, and the thoracic (chest) and abdominal respiratory muscles
that play a role in producing airflow through the inlet and outlet
passages.
11
muscles: sternocleidomastoideus lifts the sternum upward and the
hundredth, scalenous and intercostal muscle externally lifts the ribs
12
exercise where total contact time is reduced. Thus, the diffusion block
may support the occurrence of hypoxemia, but it is not recognized as a
major factor.
(Sherwood, 2012)
13
The meaning of coughing up blood is hemoptysis. Hemoptysis is
the expectoration of blood the originates from all part of respiratory
tract, from the alveolus to the glottis
(Lascalzo, J.2016)
14
a. Cough productive
Cough that produces sputum or mucus (sputum), so it is better
known as the cough up phlegm.. cough more productive to have the
hallmark of the chest feels full and ringing. They have had a cough
more productive general are having trouble breathing and
accompanied by the sputum. Cough the job should not be treated
with medication suppressant coughing for mucus will be clustered
in the lungs.
b. Coughing is not productive
Coughing is not productive cough that does not produce
sputum (sputum), which is also called dry cough, cough are not
often make the throat itch, causing the sound of a husky or missing.
Coughing is often triggered by the following food particles, the
irritants, cigarette smoke (It's okay by active smokers and passive),
and changes in temperature. The cough can be a symptom of the
rest of the viral infection or flu.
a. Cough acute
Cough acute is cough that lasted less than three weeks, as well
as happens in one episode. cough of this type are generally caused
by flu and allergies. The cough so that the commonly encountered is
a type of acute cough light with a mild fever and runny nose.
b. Cough chronic
Cough chronic is cough lasting more than three weeks.Or going
on in three episodes for three consecutive months. All right of this
type are usually caused by bronchitis, asthma, and tuberculosis.
(Junaidi, 2010)
15
e. How is the pathophysiology of coughing of blood?
Answer :
Risk factor mycrobaterium TB droplet lower respiratory
system inflammation produced mucous accumulation of
mucous rupture of a small blood vessel coughing up blood.
(Amin and Bahar, 2007)
INFECTION
CANCER
16
however, metastatic lung carcinoma rarely results in
bleeding.6 Obstructive lesions may cause a secondary infection,
resulting in hemoptysis.
IDIOPATHY
HEMOPTYSIS IN CHILDREN
17
years. Another important cause is bronchiectasis, which often is
secondary to cystic fibrosis. Primary pulmonary tuberculosis is a rare
cause estimated to occur in less than 1 percent of cases. Although
uncommon, trauma is another possible cause. Blunt-force trauma may
result in hemoptysis secondary to pulmonary contusion and
hemorrhage. Bleeding caused by suffocation, deliberate or accidental,
also should be considered.
Patient History
18
e. Green sputum is probably a process of pus-piling, green color this is
due to the presence of verdoperoksidase, green sputum is often found
in patients with bronkhiektasis due to hoarding sputum in the
widened and infected bronchus.
f. Sputum pink and frothy may be a sign of acute pulmonary edema
g. Sputum slimy, sticky, gray / white possible signs of bronchitis
chronic.
h. Foul-smelling sputum may be an abscess lung / bronkhiektasis.
i. Blood or haemoptysis is common in Tuberculosis.
j. Usual color caused by bacterial pneumococci (in pneumonia).
k. contains pus, color can give clues for effective treatment in patients
with chronic bronchitis.
l. The yellow-greenish (mukopurulent) color indicates that treatment
with antibiotics can reduce symptoms.
m. The green color is caused by Neutrophil myeloperoxidase.
n. Slimy white milk or opaque often means that antibiotics will not be
effective in treating symptoms. This information can be associated
with the presence of bacterial or viral infections though current
research does not support that generalization.
o. Foamed white-may come from obstruction or even edema.
(Price and Wilson, 2006)
19
in chronic bronchitis, acute bacterial bronchitis, bacterial pneumonia,
atelectasis, cystic fibrosis.
Clear or Thin White Mucus
Clear or cloudy (white), thin and translucent mucus means there is no
(or not much) pus or blood in it. Causes of clear white phlegm include:
Acute viral bronchitis (chest cold) is inflammation of bronchi
(airways between windpipe and lungs), sometimes affecting persons
with common cold, influenza or other viral respiratory
infection. Low-grade fever, runny nose, itchy throat, hoarseness,
wheezing and initially dry and then productive cough with clear
mucus may last from several days to several weeks. Mucus can, in
some days, turn to yellow or green.
Acute bronchitis caused by irritant gases (environmental or
occupational) resembles viral bronchitis but usually there is no fever.
Former smokers with chronic bronchitis may cough up white
phlegm. White mucus in chronic bronchitis does not require
antibiotic treatment.
Asthma
Thick White Mucus
Main causes of thick, non-translucent, white mucus:
Drinking milk or other thick drinks can make originally clear mucus
thick. Milk may cover the back of the throat, but milk itself does not
cause mucus.
In gastroesophageal reflux disease (GERD), gastric acid may back up
from esophagus into the windpipe and throat. Burning stomach, chest
(behind the breastbone), and throat, and coughing up white, thick,
often frothy mucus are main symptoms. Often, white mucus is the
only symptom in GERD
Brown or Rusty Mucus
Brown mucus can be due to:
Chocolate, cocoa or other foods that stain mucus brown
20
Smoking – from resins and tars in smoke
Inhaling dust or smog
Infection, especially in chronic bronchitis
Blood, arising from the lungs, bronchi, windpipe or voice box
Grey Mucus
Grey mucus can be caused by air pollution , cigarette or
marijuana smoking.
Black Mucus
Black mucus can be due to:
Smoking marijuana, cigarettes, cocaine or other substances. It is not
possible to reliably say, if someone is smoking marijuana or
cigarettes on the basis of the smoker mucus color. A smoker who has
quit smoking may cough up mucus (black or other colors) for several
days or weeks after quitting.
Air pollution
Coal workers pneumoconiosis or anthrosilicosis (black lung disease)
Fungal (mold) lung infection, like allergic broncopulmonary
aspergillosis (ABPA), causing bronciectasis
Old blood from COPD (bronchitis or emphysema), tuberculosis,
cancer or other bronchial or pulmonary disorder
Blood in Mucus
Blood in mucus appears as red strikes, brown mesh or obviously
red blood.
Pink Mucus
Pink mucus in asthma contains eosinophils (a type of white blood
cells appearing in bronchial wall in certain allergies).
Frothy Mucus
Frothy mucus originates from lungs. In pneumonia or lung edema,
fluid washes some surfactant (a substance that keeps lung vesicles
dilated) from vesicular walls into inflammatory fluid and makes it
21
frothy. Frothy mucus may be also caused by gastroesophageal reflux
disease (GERD).
(Jan Modric, 2010)
a. Infection
- Virus
- Bacteria
- Mushrooms
b. Non infection
- Temperature
- Teething
22
lymphoma. As an additional symptom, people who have cancer also
experience fever and unexplained weight loss.
d. Drugs. Using certain medications can cause night dries. The most
common drug that causes it is antidepressants. From 8% to 22% of
people taking antidepressants will experience excessive night
sweats. Other psychiatric medications are also associated with night
sweats. In addition, fever-lowering drugs, such as aspirin and
acetaminophen (paracetamol), can sometimes cause sweating.
(Sherwood, 2012)
23
amenorrhea, which reflects decreased hormonal .The disorder can
be corrected by administration food back.
2. Social factors
Patients find support for their actions in society which
emphasizes the shortness and practice. No get together with family
is specific to anorexia nervosa. Patients with possible anorexia have
a family history of depression, alcohol dependence, or a disorder
eat.
3. Psychological and psychodynamic factors
Anorexia nervosa appears to be a reaction to need in
adolescents to become more independent and improve social and
sexual functioning. Usually they have no sense of autonomy and
independence, usually grown under parental control. Self-starved
hunger (self starvation) may be an attempt to gain recognition as a
unique person and special. Only through unusual self-discipline of
anorexia patients can developing a sense of autonomy and
independence.
4. Infection
5. There is chronisc disease, TB
6. Diabetes Melitus (DM)
(Wilfley et all, 2007)
Chest Pain
a. Tuberkulosis
b. asma
c. bronkitis
d. lung abscess
(Djojodibroto, 2014)
i. What is the meaning of cough with greenish white mucous since one
month ago, followed by mild fever, profuse nocturnal sweating,
24
decreased of appetite, weight loss, and sometimes cough accompanied
by chest pain?
Answer :
Mild fever
25
Profuse nocturnal sweating
Chest pain
people infected actively tbc droplet bacilli tb entering the
respiratory tract penetrate the respiratory system respiratory
mechanism colonize in the lower airway activate the immune
response inflammation T cells and fibrous tissue envelopes the
macrophages and bacilli (ingesti ) fibrosis stimulates pain
receptors spinal cord pain perception chest pain
(Amin and Bahar, 2007)
Relation of gender men are more at risk for such complaints than
women. Age don’t have any relation because tuberculosis can be
experienced by all ages.
(Sudoyo, 2014)
26
l. What is the relation of the complaint with chief complain?
Answer :
2. Mr.Adi lived at the slum with his wife and 3 years old son. His co-
worker also suffer the same complain. Mr.Adi never experience this
symptom before. Doctor recommend Mr. Adi to get lung x-ray
examination.
a. What is the meaning of he lived at the slum with his wife and 3 years
old son?
Answer :
The meaning of living in a slum environment is that the hygiene in
the neighborhood is less awake and densely populated, also closely
related to the dark place and the existing air can not exchange with the
outside air, causing bacteria to survive there. so that if any of the
infected population will quickly spread. and this is one of the risk
factors of TB transmission, with droplets.
27
Its meaning is friends who composed transmit the disease through
droplet nuclei (airborne disease).
(Anjali, 2015)
d. What is the meaning of the doctor recommend mr. Ardi to get lung x-
ray?
Answer :
x-ray lung can play a very important role, because based on the
location, shape, extent and consistency of the abnormalities can be
suspected the existence of tb lesions. likewise, only lung photographs
can objectively describe abnormal anatomic abnormalities and extent of
abnormalities. This inspection also leaves behind the authentic
documents, which will be crucial for the evaluation of healing.
(Danusantoso, 2017)
28
The course of tuberculosis is divided into four stages:
The second stage, When this happens then the monocytes in the
blood as well as other inflammatory cells will be attracted to the lungs.
The monocyte will differentiate into a macrophage which then returns
ready for mengingesti but does not kill mycobacteria.
29
Phagocytosis and the introduction of germs M.TB. various
receptors have been identified in terms of M. tuberculosis phagocytosis
by macrophages and dendritic cells: complement receptors are primarily
responsible for the uptake of an ozsonified TB germ; MRs and binding
receptors for non-ionoped TB drug uptake. TLR plays an important role
in MTB immune recognition. In regard to CD14, TLR2 binds to
lipoarabinomannan (LAM), a heterodimer of TLR2 and TLR6 that
binds to a 19 kDa MTB lipoprotein, TLR4 binds to a non-heat-bound
cell factor, and the likelihood of TLR9 binding to the MTB DNA. After
binding to the TLR, the main signal path will cause cell activation and
cytokine production. TLR-TLR is produced not only on the cell surface
but also in the phagosome; thus, immune activation may occur with or
without phagocytosis. On the other hand, phagocytosis alone may not
cause immune activation without involving TLR-TLR.
30
Inflammatory response of phagocytic cells on activation by TB germs.
Immune recognition by macrophages and dendritic cells is followed by
an inflammatory response that plays an important role in the formation
of cytokines.
(Irina, 2012)
31
adulthood, and old age. Bacteria go toIntekst Bacteria may spread:
lymph ears, or lan in the human body through the respiratory tract and
other body parts through the bloodstream.
(Widoyono, 2011)
The Prevention
32
Two views of the chest are taken, one from the back and the
other from the side of the body as the patient stand against the image
recording plate. The technologist, an individual speciall trained to
perform radiolog examination, will position the patient with hands on
hips and chest pressed against the image plate. For the second view, the
patient’s side is against the image plate with arms elevated.
3. Physical examination.
33
Auscultation : increase of vesicular and moderate rales on the
right upper lobe of the lung
Abdomen : flat, supple, normal bowel movement, hepar and lien not
palpable
Extremity : in normal limit.
a. How is the interpretation of Physical and Specific examination?
Answer :
No Case Interpretation
Sense :
Composmentis
1 Normal
Body Weight : 60 kg
IMT = 22,3 (Normal)
Height : 164 cm
Vital Sign
BP : 110/70 mmHg
2 Pulse : 98 x/minute Normal
RR : 20 x/minute
T : 37,7 C Subfebris
3 Head : anemic conjungtive (-) Normal
Thorax : Pulmo
- Inspection : lung movement static and
Normal
dynamic symmetris
- Palpation : Increased of stem fremitus
Abnormal : there’s a
4 on the right upper lobe of the lung.
fluid in bronchus
- Percution : Dullness on the right apex
(Infiltrates right apex
of the lung
of the lung)
- Auscultation : Increase of vesicular and
moderate rales
34
Vesicular increased and Dullness on the rigt apex
people infected actively tbc droplet bacilli tb entering the
respiratory tract penetrate the respiratory system respiratory
mechanism colonize in the lower airway activate the immune
response inflammation T cells and fibrous tissue envelopes the
macrophages and bacilli (ingesti ) fibrosis Vesicular increased
and Dullness on the rigt apex
4. Additional Examination :
Laboratorium :
Hb : 11 g%, WBC : 6500/mm3, ESR : 140 mm/hr, Diff count
0/2/2/76/14/6.
a. How is the interpretation of Additional examination?
Answer :
35
Thorax X-Ray : There is necrosis of There’s no infiltrate
Infiltrate alveolar tissue in the lung appearance
appearance on
right apex of the
lung
Decreased of Lymphocytes
36
also the nearest cell (Lymphocytes) is lysis decreased of
lymphocytes.
5. How to diagnose ?
Answer :
Anamnesis
- Coughing up blood
- cough with greenish white mucous since one month ago
- mild fever
- profuse nocturnal sweating
- decreased of apetitie
- Weight loss
- cough accompanied by chest pain
Physical examination
- T : 37,7 C
Spesific Examination
Thorax :
37
- Inspection : static and dynamic symmetric
- Palpation : increase of steam fremitus on the raight upper lobe of
the lung
- Percution : dullness on the right apex of the lung
- Auscultation : increase of vesicular and moderate rales
9. How to governance?
Answer :
38
(Alimudin et al, 2013)
39
(WHO, 2014)
Approach Considerations
Isolate patients with possible tuberculosis (TB) infection in a
private room with negative pressure (air exhausted to outside or through a
high-efficiency particulate air filter). Medical staff must wear high-
efficiency disposable masks sufficient to filter the tubercle bacillus.
Continue isolation until sputum smears are negative for 3 consecutive
determinations (usually after approximately 2-4 wk of treatment).
Unfortunately, these measures are neither possible nor practical in
countries where TB is a public health problem.
Drug therapy
New cases are initially treated with four drugs: isoniazid, rifampin,
pyrazinamide, and either ethambutol or streptomycin. After 2 months, they
are then treated with a continuation phase of 4 months with isoniazid and
rifampin. Patients requiring retreatment should initially receive at least 5
drugs, including isoniazid, rifampin, pyrazinamide, and at least 2
(preferably 3) new drugs to which the patient has not been exposed.
In three phase III trials, shorter TB treatment regimens were not as
effective as standard 6-month regimens. In all of the trials, one of the
standard treatment drugs was replaced with a fluoroquinolone. In the first
study, ethambutol was replaced with gatifloxacin for 2 months of intensive
treatment followed by a 2-month continuation phase. In the shorter
40
regimen group, 21.0% of patients had unfavorable outcomes, compared
with 17.2% of patients in the standard regimen group. Rates of recurrence
were 14.6% and 7.1% in the two groups, respectively.
The second study involved a 4-month treatment regimen in which
moxifloxacin was substituted for isoniazid for 2 months, followed by
moxifloxacin and rifapentine twice weekly for 2 months. This shorter
regimen was inferior to both a 6-month regimen with moxifloxacin and to
a standard 6-month treatment regimen.
In the third study, ethambutol or isoniazid was replaced with
moxifloxacin. Favorable outcomes were seen in 85% and 80% of the two
moxifloxacin groups, compared with 92% of the standard treatment group.
Monitoring
1. Pneumonia
2. Pneumoconiosis
3. Bronchhiectasis
4. Lung abscess
5. Pulmonary tumor
6. Mushrooms
7. Sarcoidosis
41
1. Parenchymal lesions
Thin walled cavity (Open negative syndrome), Aspergilloma, End
stage lung destruction, Scar carcinoma.
2. Airway Lesions
Tuberculous Laryngitis, Bronchiectasis, Tracheobronchial stenosis,
Anthracofibrosis, Broncholithiasis.
3. Vascular Lesions
Rasmussen aneurysm
4. Pleural Lesions
Dry pleurisy, Pleural effusion, Empyema & Bronchopleural fistula,
Pneumothorax
5. General Complications
Cor-pulmonale, Secondary amyloidosis, Chronic respiratory failure.
(Devi, 2014)
42
The meaning :
O mankind, there has to come to you instruction from your Lord and
healing for what is in the breasts and guidance and mercy for the believers.
Q.S. Yunus (10 : 57)
2.7 Conclusion
Mr.Adi, a 36 years old, came with complain hemoptysis, cough with
greenish white mucous, mild fever, profuse nocturnal sweating, anorexia,
weight loss, and chest pain because of tuberculosis pulmonal primary.
43
2.8 Conceptual Framework
Risk factor
(transmission and
environtmet)
droplet infection
Enter to lung
parenchyme
Dormant
microbacterium TB
inside the lung
parenchyeme
microbacterium TB replicate
inside incompromised
Tuberculosis
pulmonal
primary
44
BIBLIOGRAPHY
Amin, Z., Bahar, A. 2007. Tuberkulosis Paru dalam Sudoyo, A., W., dkk. Buku
Ajar Ilmu penyakit Dalam Jilid III Edition 5. Jakarta : EGC.
Danusantoso, H. 2017. Ilmu penyakit dalam Jilid III Edition 5. Jakarta : EGC.
Jane Modric. 2010. Mucus: Causes of White, Yellow, Brown, Grey, Black
Phlegm. Accessed on 21st of june 2018. https://www.healthhype.com/mucus-
causes-of-white-yellow-brown-grey-black-phlegm.html
45
Junaidi, I. 2010. Penyakit Paru & Saluran Napas , Cara Mudah
Mengetahui, Mencegah dan Mengobatinya. Jakarta : Bhuana Ilmu Populer.
Sudoyo A, dkk.2014. Buku Ajar Ilmu Penyakit Dalam Jilid 1 Edisi VI.Jakarta:
Interna Publishing.
46