Hemoptisis Translete With Penjelasan

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  • 8/10/2019 Hemoptisis Translete With Penjelasan



    Group 28


  • 8/10/2019 Hemoptisis Translete With Penjelasan


    Our Member

    1. Niko Citami 11700240

    2. Eisa Mayestika 11700246

    3. Fatimah Amalia 11700248

    4. Lukman Karim 11700250

    5. Eva Silvia R 117002526. Virda Permatasari 11700256

    7. Tommy Darmawan 11700258

    8. Niken Suciningrum 11700260

    9. Christina Fanny 11200262

    10. Wilda Purnama 1170026411. Nurul Aini 11700266

    12. Dimas Didik S 11700268


  • 8/10/2019 Hemoptisis Translete With Penjelasan



    Mr. Mansyur (25 years old), present to hospital

    Accident and Emergency department (A&E) with

    hemoptisis 15cc every cough (with 3-4 times

    homoptisis 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.


  • 8/10/2019 Hemoptisis Translete With Penjelasan



    1. Tuberculosis

    Pulmonary tuberculosis is a infectious disease that caused bybasil Myobacterium tuberculosis which one of lowerrespiratory tract disease that most basil input to

    pulmonary tissue through airbone infection or droplet andthen experienced a process known as focus primary fromghon

    2. Blood Cough

    Blood cough (Hemoptisis) is blood or blood sputum which

    coughed from lower respiratory tract that start fromglotis to distal, blood cough will stopped itself if rips of theblood vessels are not widely, and than closure of thewound will quickly occur


  • 8/10/2019 Hemoptisis Translete With Penjelasan



    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?


  • 8/10/2019 Hemoptisis Translete With Penjelasan


    The types of diseases associated

    1. Tuberculosis pulmonary

    2. Lung cancer

    3. Bronkiektasis

  • 8/10/2019 Hemoptisis Translete With Penjelasan


  • 8/10/2019 Hemoptisis Translete With Penjelasan


    Blood cough in pulmonary tuberculosis because:

    1.Aneurysm rupture in the wall cavity contained(rasmussensaneurysm)

    2.Rupture in thin walls of the cavity which containsmany small blood vessels

    3.Ulceration of the parenchymal tissue of the lungs

    or bronchi / bronchioles4.The process of exudation in the lung parenchymadamage the pulmonary capillaries

    5.Pulmonary fibrosis pulmonary tuberculosis in the

    former the blood vessels6.The presence of calcification which causesdamage to blood vessel walls.

  • 8/10/2019 Hemoptisis Translete With Penjelasan



    Mycobacterium tuberculosis germ be straight orslightly curved, measuring the length and width 3 5 . Ziehl-Neelsen on will appear in red with a bluebackground. Mycobacterium tuberculosis can die if

    exposed to direct sunlight for 2 hours.Mycobacterium tuberculosis is contagious, has ahigh durability and can survive several hours of darkand damp place. Therefore, this germs in the body

    tissues can be dormant (hibernation) long asleepfor several years. Bacilli that exist in sputum sparkcan survive in 8-10 days

  • 8/10/2019 Hemoptisis Translete With Penjelasan


    Modes of Infection

    When coughing or sneezing, patient spread

    germs into the air in the form of droplet

    (sputum spark). Dropletscontaining the bacteria

    can survive in air at room temperature for

    several hours. After TB germs enter the body

    through breathing, the TB germs can spread

    from the lungs to other body parts

  • 8/10/2019 Hemoptisis Translete With Penjelasan



    Primary infection

    Primary infection. The first time a client is infectedby tuberculosis referred to as "primary infection"

    and is usuallyfound on or near the apex of thelung lower lobe pleura.

    Primary site of infection may have a process ofdegeneration of necrotic or swiss cheese but could

    not, which cause to the formation of cavities filledby masses of tubercle bacilli such as cheese, whiteblood cells are dead,and necrotic lung tissue.

  • 8/10/2019 Hemoptisis Translete With Penjelasan


    Secondary infection

    Secondary infection. In addition to the primary

    disease is progressive, 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.It is important to periodically review the client

    who has had TB infection to determine the

    presence of active disease.

  • 8/10/2019 Hemoptisis Translete With Penjelasan


    Factors that have a role in the development of

    TB into active disease:

    1.old age


    3.HIV infection


    5.the presence of other disease states (DM,CKD,

    or malignancy)

    6.genetic predisposition

  • 8/10/2019 Hemoptisis Translete With Penjelasan


    Clinical symptoms


    No. Common Symptoms Specially Symptomp

    1. Cough> 3 weeks In the event of partial bronchial

    obstruction due to compression of

    enlarged lymph glands make noise


    2. fever Weakened voice accompanied byshortness 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

  • 8/10/2019 Hemoptisis Translete With Penjelasan


    Risk factor

    Some risk factors for with TB are:


    2.Status nutrition3.Sosio-economy



  • 8/10/2019 Hemoptisis Translete With Penjelasan



    In patients with tuberculosis may occur several complications,either before treatment or during treatment and aftertreatment completion. Some the complications that arisemungikin are:

    1.Blood cough


    3.Respiratory failure

    4.Heart failure

    5.Effusion pleura

    6.Asphyxia or blockage of airway due to a blood clot

    7.Shock Hipovolemik (Circulatory failure cause due to loss ofblood)

  • 8/10/2019 Hemoptisis Translete With Penjelasan



    Pulmonary Cancer (CA Pulmo)

  • 8/10/2019 Hemoptisis Translete With Penjelasan


    Originally attack branching segments / subbronchus causing lost cilia and desquamation

    resulting in the deposition of carcinogens. With thedeposition of carcinogens then cause metaplasia,hyperplasia and dysplasia. When peripheral lesionscaused by metaplasia, hyperplasia and dysplasia

    penetrate the pleural space,pleural effusion usuallyarises, and can be followed by direct invasion to theribs and vertebral bodies. The central location oflesions derived from one of the largest branches of

    the bronchi. These lesions are caused by bronchialobstructionand ulceration followed by suppurationin the distal part.

  • 8/10/2019 Hemoptisis Translete With Penjelasan


    Histological type

    To determine the histologic type, in greater detailused histological classification according to theWHO in 1999, but it's enough if the clinical needcan only be known according to the WHO

    histological classification in 1999, but for the clinicalneeds enough if only it can be seen:

    Carsinoma epidermoid

    small cell carcinoma


    large Cell carcinoma

  • 8/10/2019 Hemoptisis Translete With Penjelasan


    In outline lung cancer is divided into 2 parts: Cel Small Lung Cancer(SCLC) Small Dannon Cel Lung Cancer (NCLC) (Wasripin, 2007):

    1.Small Cell Lung Cancer (SCLC)

    The incidence of lung cancer SCLC type is only about 20% of the totalincidence of lung cancer. However, this type is growing very fast andaggressive. If not treated immediately it can last only 2 to 4 months.

    2.Non Small Cell Lung Cancer (NCLC)

    80% of the total incidence of lung cancer is a type of NSCLC. Can bedivided into three, namely:

    1 adenocarsinoma, this type is the most common (40%).

    2 squamous cell carcinoma, the number of cases around 20-30%.

    3 Large Cell Carcinoma, the number of cases around 10-15%.

  • 8/10/2019 Hemoptisis Translete With Penjelasan




    Bronchiectasis is bronchial dilation of caused by

    the weakness of the bronchial wall permanent.

    The diagnosis confirmed with the help of

    bronchiectasis by HRCT (High Resolution

    Computed Tomography Computer).

    Bronchiectasis is often also included in thegroup of respiratory tract infections


  • 8/10/2019 Hemoptisis Translete With Penjelasan



    1. infection

    2. Heriditer abnormalities or congenitalabnormalities

    3. Mechanical factors that facilitate theemergence of infectious

    4. Patients often have a history of pneumonia

    as a complication of measles, whoopingcough, or other infectious diseases inchildhood.


  • 8/10/2019 Hemoptisis Translete With Penjelasan


    Clinical Symptomp

    1. Chronic cough

    2. Sputum which much, especially in the morning, after sleeping and lying down

    3. sputum containing blood spots

    4. coughing up blood

    5. Cough with sputum cough accompanying a cold for 1-2 weeks or none symptomsat all (mild Bronchiectasis)

    6. sputum which much less than 200-300 cc

    7. fever

    8. anorexia

    9. weight loss

    10. anemia

    11. pleural pain

    12. malaise

    13. Dypsneu

    14. Found clubbed fingers (30-50% case)

  • 8/10/2019 Hemoptisis Translete With Penjelasan



    Bronchiectasis can be congenital but is most

    often acquired

  • 8/10/2019 Hemoptisis Translete With Penjelasan


    2. Acquired

    Adults and children

    Bronchiectasis there are 3 kinds of factors:

    Bacterial infections, bronchial obstruction and

    other complications factor

    Components demages of the mucosa and

    bronchial wall elastin tissue caused by infectioncausing inflammation of cytokines, nitric and

    neutrophils cause damage to the alveolar tissue

  • 8/10/2019 Hemoptisis Translete With Penjelasan



    Components damages

    of the mucosa andbronchial wall

    inflammation of

    cytokines, nitricand neutrophils

    damage to thealveolar tissue


  • 8/10/2019 Hemoptisis Translete With Penjelasan


    Clinical Symptoms


    1.Patient identity

    a.Name : Mr. Mansyur

    b.Sex : Male

    c.Age : 25 years old

    d.Work : Rice seller

    e.Wedding Status : Not merried

    f.Lastest Education : High School

    2.Main complaint : coughing up blood


  • 8/10/2019 Hemoptisis Translete With Penjelasan


    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 bloodvolume reaches 230cc

    4) Shape suffered since 1 month ago, accompanied thebody feels fell dizzy

    5) The decrease appetite6) Body weight was decreased

    4. Past History of Disease:1) Past medical treatment : had never

    been treated

    2) History of diabetes therapy, hypertension, TB : denied

    3) Other chronic diseases : denied


  • 8/10/2019 Hemoptisis Translete With Penjelasan


  • 8/10/2019 Hemoptisis Translete With Penjelasan



    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 asfollows:

    1 Tuberculosis

    2 Lung Ca

    3 Bronchiectasis


  • 8/10/2019 Hemoptisis Translete With Penjelasan


  • 8/10/2019 Hemoptisis Translete With Penjelasan



    Based on the analysis that has been conducted

    on the clinical symptoms, physical examination

    and laboratory examination of patients to the

    three early hypotheses (Differential Diagnosis),we can conclude that the the right diagnosis of

    the patients was pulmonary tuberculosis.

    Myobacterium TBC

  • 8/10/2019 Hemoptisis Translete With Penjelasan


    Myobacterium TBC

    Entering the airway

    Live in alveoli

    inflamationNo infection Spread by Spleen

    Fibrosis Arise and thick elastic

    connective tissue





    Alveolar excretion can

    not be returned

    Gas cant back normal




    Sputum purulent


    Weight loss

  • 8/10/2019 Hemoptisis Translete With Penjelasan


    Differential Hemoptisis and

    HematemesisHemoptisis 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


  • 8/10/2019 Hemoptisis Translete With Penjelasan


    The mechanism of coughing up blood.

    (Wolf, 1977)1) Inflammation of the mucousIn acute or chronic trakeobronkitis, rich mucosal blood vessels become brittle,

    so that even minor trauma is enough to cause coughing up blood.

    2) Pulmonary infarction

    Usually caused by a pulmonary embolism or infection of microorganisms inblood vessels such as cocci infection, viral and fungal infections.

    3) Rupture of veins or capillaries

    Distention of blood vessels due to the increase in intraluminal blood pressureas in acute cardiac decompensation left and mitral stenosis. In mitral

    stenosis, bleeding can occur as a result of bronchial venous dilation.


  • 8/10/2019 Hemoptisis Translete With Penjelasan


    4) Membrane abnormalities alveolocapiler

    Due to the reaction of antibodies to the membrane, as inGoodpasture's syndrome

    5) Cavity tuberculosis Bleeding

    Rupture of a blood vessel wall cavity tuberculosis known as Rasmussenaneurysm; This expansion of blood vessels derived from branchesof the bronchial blood vessels. Bleeding in bronchiectasis due toexpansion of blood vessels of the bronchial branches. Suspectedthis is the case due to bronchial vascular anastomosis andpulmonary

    6) Malignant tumor invasion

    7) chest injury

    Chest wall in a collision, then the network will experience translationlung into the alveoli and this situation will stimulate theoccurrence of coughing up blood.

  • 8/10/2019 Hemoptisis Translete With Penjelasan



    Education1. Dont forget to regularly take medication every day, as

    recommended by a doctor

    2. Always cover your mouth with a tissue when coughing, sneezing orlaughing. Keep in covered tissue and dispose of waste in place.

    3. As usual, such as school, play, and work. During TB patients takemedication properly, the risk of passing will be lost. So the dailysocial activities and there is nothing to be limited, so people withTB do not ostracized or shunned.

    4. Circulation in the room should be good, if necessary, add a fan toget rid of the air in the room. Try to stay in the room or house thathas good light ventilation. TB germs are easily spread in a closedroom and no air circulation.

  • 8/10/2019 Hemoptisis Translete With Penjelasan


  • 8/10/2019 Hemoptisis Translete With Penjelasan


  • 8/10/2019 Hemoptisis Translete With Penjelasan