D E M A MD E M A M

Dr. CHAIRUL ZULFI.MSiDr. CHAIRUL ZULFI.MSi

PendahuluanPendahuluan Sejarah Sejarah DefinisiDefinisi EtiologiEtiologi PatofisiologiPatofisiologi KlasifikasiKlasifikasi komplikasikomplikasi

sejarahsejarah

Hipocrates : demam adalah tanda Hipocrates : demam adalah tanda penyakitpenyakit

Galileo : mencipta alat ukur suhu Galileo : mencipta alat ukur suhu dipakai di klinik oleh Santoriodipakai di klinik oleh Santorio

Traube : memperlihatkan kurva suhu Traube : memperlihatkan kurva suhu secara menyeluruh secara menyeluruh digunakan secara digunakan secara luas oleh Wunderlich luas oleh Wunderlich memprediksi memprediksi kondisi pasienkondisi pasien

definisidefinisi Suhu tubuh diatas 37,2Suhu tubuh diatas 37,2o o C C kisaran normal: 36,5 kisaran normal: 36,5o o C – C –

37,237,2o o C C peninggian suhu karena pergeseran “set peninggian suhu karena pergeseran “set point“ point“ pireksia ( pyrexia ) pireksia ( pyrexia )

Hiperpireksia : suhu tubuh Hiperpireksia : suhu tubuh >> 41,2 41,2oo C C Hipotermi : suhu tubuh Hipotermi : suhu tubuh << 35 35oo C C Hipertermi : mekanisme pengendalian suhu tubuh Hipertermi : mekanisme pengendalian suhu tubuh

gagalgagal Suhu rektal / oral – aksila berbeda 0,5Suhu rektal / oral – aksila berbeda 0,5oo C C Fungsi demam ( 39Fungsi demam ( 39oo C ): petunjuk produksi antibodi C ): petunjuk produksi antibodi

dan proliferasi sel limfosit T mening-kat > 20 x suhu dan proliferasi sel limfosit T mening-kat > 20 x suhu normalnormal

Definisi Demam : Suhu tubuh di atas normal akibat proses patologis

Fluktuasi suhu tubuh sesuai irama sirkadian dengan variasi diurnal

Homeostasis suhu Produksi panas Pelepasan panas

Proses Metabolik Radiasi + Evaporasi

Kelainan Suhu Tubuh = Pirexia - Hipertermi - Demam

Endotoxin, Microoganism, Microbial Product and Toxins,

Phagocytosis, Immune Comlexes,Tissue Injury

Failure of Thermoregulatory Homeostasis:

Heat Production, Heat Dissipation,or Hipotalmic Insult

Mononuclear Phagocyte

Interleulin-1 (IL-1)

IL-1 Binds to Receptor in PreopticNucleus of Anterior Hyphothalamus:

Prostaglandin Levels,Hyphotalmic Thermal

Muscle Tone, Sweating,

Cutaneous Vasocontriction

Pyrexia

Fever Hyperthermia

Patofisiologi

Patofisiologi

Keadaan akibat demam : - BMR meningkat - 13% / 1 ºC ;40% pada 40 ºC - Konsumsi Oksigen 7% / 1 ºC - Katabolisme jaringan meningkat - Kehilangan cairan tubuh meningkat - Cadangan lemak dan glikogen menurun - Motilitas saluran cerna meningkat - Mual-mual, anoreksia - Nyeri otot dan sendi - Kelemahan umum dan keletihan

Etiologi

- Infeksi- Penyakit keganasan- Trauma / penyakit degeneratif pada SSP- Penyakit darah- Penyakit cardio vaskuler- Penyakit endokrin- Paparan fisis- Paparan kimiawi- Gangguan keseimbangan cairan tubuh- Demam faktisius- Demam psikogenik- Demam tak terdiagnosis = F.U.O.

Cause of Hyperthermia

Mechanism of Thermoregulatory Example Disturbance Exercice hiperthermia Increase heat Thyroid stormProduction Pheochromocytoma Drugs (e.g. malignant hyperthermia of anesthesia Heatstroke Dehydration Decrease heat Autonomic disfungtion dissipation Occlusive dressings Drugs (e.g. atropine) Infection (e.g. granulomas, enchephalitis) Hypothalmic Tumor, Trauma, Vascular insult insult Drugs (e.g. neuroleptic malignant syndroma

Infection Causing Fever of Undertermined Origin

Systemic InfectionTuberculosis (miliary)Infective endocarditis (primarily bacterial endocarditis, but also endocarditis with a fungal, Q fever, or clamydial etiology)Bacteremia from an inapparent primary focus Cronic meningococcemia Brucellosis Listeriosis, vibrosis, leptospirosis, relapsing fever(caused by Borrelia recurrentis), -bite fever (due either to Streptobacillus moniliformis or to Spirillum minus)Miscellaneuous Psittacosis, toxoplasmosis (disseminated acquired form), Q fever, disseminated deep mycotic infection (e.g. histoplasmosis, blatomycosis), cytomengalovirus infection.

Localized Infection and AbscessesHepatic infection Liver abscess, CholangitisIntraperitoneal infections Upper abdomen : empyema of gallbrader, pericholecystic and sub hepatic abscess, right or left subphrenic abscess, lesser sac abscess Lower abdomen: periappendicial and peridiventicular abscessOther intra-abdominal abscess Turbo-ovarian abscess; pelvic inflamatory disease and pelvic abscess Retroperitoneal abscess; pancreatic abscessUrinary tract infections Perinephric abscess Renal carbuncle Pyelonephritis with ureteral obstruction and pyonephrosis Prostatic abscess

Kalassifikasi : - Demam Trivial

- Demam Tanggung

- Demam Serius

Tipe Demam : - Hektik

- Septik

- Remiten

- Intermitten

- Kontinyu

- Siklik

P TC

41O160

40O140

39O120

38O

37O

36O

35O

100

80

60

40

HEKTIK

A.M. P.M. A.M. P.M.A.M. P.M. A.M. P.M.

P TC

SEPTIK

A.M. P.M. A.M. P.M. A.M. P.M. A.M. P.M.

160 41O

140 40O

120 39O

100 38O

40 35O

80 37O

60 36O

P TC

INTERMITEN

A.M. P.M. A.M. P.M. A.M. P.M. A.M. P.M.

160 41O

140 40O

120 39O

100 38O

40 35O

80 37O

60 36O

P TC

CONTINUA

A.M. P.M. A.M. P.M. A.M. P.M. A.M. P.M.

160 41O

140 40O

120 39O

100 38O

40 35O

80 37O

60 36O

P TC

REMITEN

A.M. P.M. A.M. P.M. A.M. P.M. A.M. P.M.

160 41O

140 40O

120 39O

100 38O

40 35O

80 37O

60 36O

PenatalaksanaanPendekatan• Diagnosis + penatalaksanaan kelainan dasar• Perbaiki metabolik - kardiovaskuler - sistem respirasi• Dinginkan / turunkan suhu

Anamnesis : - Cara timbul - Lama - Tipe - Sifat harian - Keluhan penyerta - Tempat dikunjungi terakhir - Kontak / gigitan hewan - Risiko pekerjaan - Trauma / pembedahan

Pemeriksaan Fisik : - Paru - Hati - Limpa - Kelenjar getah bening - Kulit - kuku - membrana mukosa - Rektum

Pemeriksaan Penunjang : - Rutin : * Darah - urine - tinja * Mikrobiologi * Kimia klinik * Sumsum tulang * Imunologik - Khusus: PBI -T3 -T4 - LE - AFP - LCS - Patologi anatomik - Radiologis - Pencitraan - Endoskopik

pengobatanpengobatan Medika mentosa : simtomatik – Medika mentosa : simtomatik –

suportip suportip analgetik antipiretik analgetik antipiretik Non medikamentosa : kompres Non medikamentosa : kompres

dingin / panas ( ? )dingin / panas ( ? )

terima kasih