7. Tabel differential Diagnosis dari CHFCHFCRFCOPD

DefinisiSuatu sindrom klinis yang terjadi padapasien yang mengalami abnormalitas (baik akiba tketurunan atau didapat) pada struktur atau fungsi jantungGagal ginjal ditandai oleh ketidakmampuan ginjal mempertahankan fungsi normalnya untuk mempertahankan volum dan komposisi cairan tubuh dalam keadaan asupan makanan normal.Penyakit yang dapat dicegah dan diobati dengan beberapa efek ekstrapulmoner yang signifikan yang dapat berkontribusi terhadap tingkat keparahan pada pasien individu. Komponen paru yang ditandai dengan keterbatasan aliran udara yang tidak sepenuhnya reversibel. Keterbatasan aliran udara biasanya progresif dan berhubungan dengan respon inflamasi abnormal dari paru terhadap partikel atau gas berbahaya.

Penyebaba. Underlying causes: Underlying causes of heart failure include structural abnormalities (congenital or acquired) that affect the peripheral and coronary arterial circulation, pericardium, myocardium, or cardiac valves, thus leading to increased hemodynamic burden or myocardial or coronary insufficiencyb. Fundamental causes: Fundamental causes include the biochemical and physiologic mechanisms, through which either an increased hemodynamic burden or a reduction in oxygen delivery to the myocardium results in impairment of myocardial contractionc. Precipitating causes: Overt heart failure may be precipitated by progression of the underlying heart disease (eg, further narrowing of a stenotic aortic valve or mitral valve) or various conditions (fever, anemia, infection) or medications (chemotherapy, NSAIDs) that alter the homeostasis of heart failure patientsd. Genetics of cardiomyopathy: Dilated, arrhythmic right ventricular and restrictive cardiomyopathies are known genetic causes of heart failureInfrequently, CKD is caused by primary kidney disease (e.g., glomerular diseases, tubulointerstitial diseases, obstruction, and polycystic kidney disease).But in the vast majority of cases, it is associated with other medical conditions, such as diabetes and hypertension.

a. Asap tembakau : termasuk rokok , pipa , cerutu , dan jenis lain dari rokok tembakau ygpopuler di banyak negara , serta asap tembakau lingkungan ( ETS ) Debu Kerja dan bahan kimia ( uap , iritasi , dan asap ) ketika eksposur yang cukup intens atau lamab. Polusi udara dalam ruangan dari bahan bakar biomassa yang digunakan untuk memasak dan pemanasan di tempat tinggal kurang berventilasi , faktor risiko yang terutama mempengaruhi angkakejadian PPOK padaperempuan di negara berkembangc. polusi udara terbuka juga berkontribusi terhadap total beban paru-paru ' partikel inhalasi , meskipun tampaknya memiliki efek yang relatif kecil dalam menyebabkan PPOK .

Tanda dan Gejalaa. Exertional dyspnea and/or dyspnea at restb. Orthopneac. Acute pulmonary edemad. Chest pain/pressure and palpitationse. Tachycardiaf. Fatigue and weaknessg. Nocturia and oliguriah. Anorexia,i. weight loss,j. nauseak. Exophthalmos and/or visible pulsation of eyesl. Distention of neck veinsm. Weak, rapid, and threadypulsen. Rales, wheezingS3gallop and/or pulsusalternanso. Increased intensity of P2heart soundp. Hepatojugular refluxq. Ascitesr. hepatomegaly, and/or anasarcas. Central or peripheral cyanosis, pallorPatients with CKD stages 1-3 (GFR >30 mL/min/1.73 m) are generally asymptomatic.a. Manifestasikardiovaskulermencakuphipertensi, penyakitjantungkoroner, edema pulmonal, perikarditis.b. GejaladermatologiPruritusc. Gejala gastrointestinalAnoreksia, mualmuntahd. neuromuskulerkesadaranberubahtidakmampuberkonsentrasi, kedutanotot, kejanga. Dyspneub. Chronic coughc. Chronis sputum productiond. Tachypnea and respiratory distress with simple activitiese. Use of accessory respiratory muscles and paradoxical indrawing of lower intercostal spaces (Hoover sign)f. Cyanosisg. Elevated jugular venous pulse (JVP)h. Peripheral edemai. Hyperinflation (barrel chest)j. Wheezing Frequently heard on forced and unforced expirationk. Diffusely decreased breath soundsl. Hyperresonance on percussionm. Prolonged expirationn. Coarse crackles beginning with inspiration in some cases

Pemeriksaanpenunjanga. A blood count may reveal anemia and a high red-cell distri- bution width (RDW)b. Hypokalemia/hyperkalemiac. Hyponatremiad. Chest radiography : cardiomegalya. Anemiab. Hyperphosphatemiac. Hypocalcemia: d. Hyperparathyroidisme. Volume overloadf. Metabolic acidosisg. Uremic Arterial blood gas (ABG) findings are as follows: Patients with mild COPD have mild to moderate hypoxemia without hypercapnia. pH usually is near normal; a pH below 7.3 generally indicates acute respiratory compromise. Chronic respiratory acidosis leads to compensatory metabolic alkalosis

Referensi :1. Current Medical Diagnosis & Treatment fifty secondedition 20132. Global inititiative for chronic Obstructive Lung Disease 20133. United States Renal Data System. United States Renal Data System 2010 Annual Data Report: Atlas of Chronic Kidney Disease and End-Stage Renal Disease in the United States. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases; 2010.www.usrds.org/adr.htm4. ESSENTIALS OF CLINICAL NEPHROLOGY. Mohamed A. Sobh. Professor and Head of Nephrology Department Urology and Nephrology Center, University of Mansoura, Mansoura, Egypt. 1