Kelompok X Pleno (2)

8/8/2019 Kelompok X Pleno (2)

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PLENARY PRESENTATION

ENDOCRINE AND METABOLICSYSTEM

MODULE OF POLYURIAGROUP X

FACULTY OF MEDICHINE OF MUHAMMADIYAH JAKARTAUNIVERSITY


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MEMBER OFGROUP X

Bambang Hady Pratama 2007730024Bunga Kartika Yunus 2007730134

Cilvina Wulandari 2007730029Faridah Laili 2007730050

Febbyana Anggun Sari 2007730053Litta Septina Mahmelia 2007730075

M. Fourta Lasocto 2007730077Muhammad Barkah 2007730086

Reni Apriyanti 2007730101Septiana Amelia 2007730113

Vidya Rahmatullah 2007730124


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SCENARIO

A man 50 y.o, come to doctor withcomplaint polyuria since 2 months

ago. Patient often get up 4 5 timeat night to mixtion. Patient also

complaint always thirsty and

throat feel dry. Around 3 monthsago, patient experience trafficaccident and ever coma 5 days.


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KEYWORD

A man 50 y.oComplaint polyuria since 2 months ago

Get up 4 5 time at night to mixionComplaint always thirsty and throat feel dryAround 3 months ago, patient experience

traffic accident and ever coma 5 days


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QUESTION

Explain the anatomy and histology of organ that have arelation with the case!Explain the physiology of urine production!Explain the relation polyuria with always thirsty, throatfeel dry and traffic accident!Explain the biochemistry of organ that have a relationwith the case!What is the mechanism of polyuria in our body?What is the diagnose step for this scenario?What is the differential diagnose for this scenario?How is the therapy from the scenario?


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ANATOMY, HISTOLOGY, ANDPHYSIOLOGY of Pituitary


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Pituitary

Pars anterior Pars posterior

Pars intermediaSisa kantong Rathke


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Pituitary Gland


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ANTIDEURETIK HORMONE(ADH) Vasopressin


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Synthesis atnerve cell

body innucleus

supraoptichypothalamu

s

ADH


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Kidney


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Function of Kidney

Excretion of metabolic and chemical resultRegulation of electrolyte and waterconcentrationRegulation of osmolality body fluid andconcentration of electrolyte.Regulation of artery pressure .Regulation of basa-aci

Secretion,metabolism and excretion of hormonGluconeogenesis


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Mec an sm o Ur neproduction

iltration in glomerulus

2. Tubulus Secretion

3. Rearbsorpsition


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Excess Fluid Intake

Fluid in body

ElectrolytesubstanceConstant

in reabsorption

Water excesscant absorption

Urineosmolarity

Secretion ADHby posterior

hypofisis

Permeabilityof tubule distal

& duct coligentesWith water

Urinevolume

& thin


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Trauma

POLYURIA

d


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Kidney Cant ResponseWith ADH

intertisium Medulla formof kidney hyperosmotic

Or failure in tubules distal and duct coligentes

Kidney abnormally

Segment of tubules distal cant respond with AD

Urine volume and T

M


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POLYDIPSI

Mec an sm oPolydipsi


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Anamnesis Question about the especiallysymptoms like:

Polydipsi

Anorexia

Dehydration

Hypernatremia

Lot of urine

excretion


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Physic Examination

Gastrointestinal: polydipsi, weigh lossCardiovascular: sign of dehydration (tachycardia,hypotension, etc).

Respiration: sign of dehydration (tachypneu, pale ).Renal: polyuria 5-30 l/day, nocturia.Integument: mucosa membrane and dry skin.


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Support Examination

Water deprivation test- Dehydration Test until 8 jam.- Dehydration Test (overnight)

Pitresin TestMRI pituitary and hypothalamus.


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DIFFERENTIAL DIAGNOSIS

DDDIABETESINSIPIDUS

DIABETES MELITUS

Diabetes type 2 Diabetes type 1

DEFINI

TION

Caused by disorderof

neurohypophyseal-renal reflexsystem. Then,failure of bodyconverting thewater, it makesthe urine volumeover 3 liters a day,dehidration, andgreat thirsty,sometimes great

thirsty and greathunger

Diabetes mellitusis a long-term

condition wherethe body is unableto regulate theamount of glucosein the bloodproperly. Diabetesdevelops whenthe body nolonger respondsadequately to thenatural hormone

insulin, or whenproduction of

Diabetes mellitusis a autoimune

disease thatditentukan secaragenetic withdestructionimunologic cellthat producionhormone insulin,so that insulin notformed.


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DD DIABETESINSIPIDUS

DIABETES MELITUS


EPI

DEMIOLOG

Y

No significantdifferentiationgender incentral diabetesinsipidus and

nefrogenicdiabetesinsipidus

Sameprevalence in

male and female Mortality is rarehappened inadult

Prevalence :1,4 1,6 %- Often on white

leather among 3 6 %

-


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DIABETES MELITUS


E

TIOLOG

Y

Hypothalamusdysfunction andproduce fewantidiuretichormone

Hypofisis glandrelease antidiuretichormone into bloodstream

Hyphothalamusdestruction orhypofisis gland

caused by operative Brain trauma(especially fractureon basis cranial)

Tumor Sarcoidosis or

tuberculosis

Aneurism or arteryocclusion that going

Type 2 diabetesdevelops whenthe bodybecomes

resistant toinsulin

Autoimune thatto smashpancreas betacell / idiopatic


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DIABETES MELITUS


S

Y MPTOMS

Polyuria (2-40L/day)

Polidypsia Nocturia

Weight loss Dehydration Orthostatic

hypotension Lethargy

Increasedproduction of urineUnusual thirst

TirednessLoss of weightBlurred visionInfections suchas thrush orirritation of thegenitals

PoliuryPolidypsiNocturiaFatigue


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DIABETES MELITUS


PROGNOS

IS

Commonlygood

Depend onkind of diseaseand the basicdisease

NIDDM ( non-insulin dependentdiabetes melitus )have long livesame with nondiabetic, may be

just several yearshorter that canrelation withcardiovasculardisease and cerebrovasculer

IDDM ( insulindependentdiabetesmelitus ) have tolive expectantsekitar 75% fromnon-diabetic


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Non PharmacologyPharmacologyrestDiet

To prevent dehydration,must take enough fluid whenthirsty

Pharmacology :Pharmacology :- In the complete DIS- In the complete DIS need hormonal

replacement..

- DDAVP(1-DESAMINO-8-D-ARGININE- DDAVP(1-DESAMINO-8-D-ARGININEvassopresin) is main drug of choice for DIS.vassopresin) is main drug of choice for DIS.

Dose: 5 10 megDose: 5 10 meg

Side effect Side effect Little side effect and pressor effect, and allergy isLittle side effect and pressor effect, and allergy israrely.rarely.


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Adjuvant Therapy Adjuvant Therapy Thyazide diuretic Thyazide diuretic

Mechanism of drug :Mechanism of drug :be a natriuresys temporary, mild ECFbe a natriuresys temporary, mild ECF

deflation and decreasing GFR.deflation and decreasing GFR.this problem cause increasing of this problem cause increasing of

reabsorption Na+ and water at nephronreabsorption Na+ and water at nephronwhich more procsimal, so causeswhich more procsimal, so causesdecreasing of water enter to tubule distaldecreasing of water enter to tubule distaland collecting duct.and collecting duct.

Dose: 50 100 mg/day.Dose: 50 100 mg/day.

Side effectsSide effectsorthostatic hypotension, but can be used atorthostatic hypotension, but can be used at

DIS and DINDIS and DIN


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ClorpropamideClorpropamideMechanism of DrugMechanism of Drug

Increases effect ADH to kidney tubule,Increases effect ADH to kidney tubule,Can increase to releasing ADH from this pituitaryCan increase to releasing ADH from this pituitaryso this drug no usable at complete DIS or DINso this drug no usable at complete DIS or DIN

Dose:250 750 mg/dayDose:250 750 mg/day

Side effects :Side effects :Hypoglycemia, combine with thyazide to getHypoglycemia, combine with thyazide to get

maximal effectmaximal effect There isnt not sulfonylurea which more effective There isnt not sulfonylurea which more effectiveand less toxically is compared to clorpropamidand less toxically is compared to clorpropamidfor drug DIS.for drug DIS.


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ClofibratClofibratMechanism of drugMechanism of drug

like clorpropamid, clofibrat to increase releasinglike clorpropamid, clofibrat to increase releasingADH endogen.ADH endogen.

Dose: 250 500 mg/ (every 6 8 hour)Dose: 250 500 mg/ (every 6 8 hour)

IndicationIndicationlacking of klofibrat compared to klorpropamidlacking of klofibrat compared to klorpropamid

it is must be given 4x 0ne day, but dont ariseit is must be given 4x 0ne day, but dont arisehypoglycemia.hypoglycemia.

Side effects :Side effects : Trouble Trouble gastrointestinalgastrointestinal , miositis, liver function., miositis, liver function.


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Kelompok X Pleno (2)

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