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TUTORIAL
DEMAM TYPHOID
Kepaniteraan Klinik Ilmu Kesehatan Anak BUD RS SEKARWANGI
FAKULTAS KEDOKTERAN UNIVERSITAS U!AADI"A!
Pembimbing:dr. Deden Tommy,Sp.A
M. Habibu I!"anDi#a Adia $urandi
$ida Amaia Sya!ida!
Tiara %ania&inny 'ideia
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Iden(i(a" Pa"ien
$ama : An. ASUmur : ) (a!un
*eni" +eamin : Perempuan$ama Orang (ua : Tn. IAama( : ibada-
Tangga Ma"u- RS : / *anuari 01234/.11
5ib$o. +amar : 261177
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Aoanamne"i"
+eu!an U(ama:
• Pana" "e8a- 9 !ari "ebeum ma"u- RS
+eu!an Tamba!an:• a(u- ;<=, mua;<=, diare ;<=, pu"ing ;<=, ema"
;<=
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Ri5aya( Penya-i( Se-arang:
• OS da(ang -e RSI*P dengan -eu!an
demam "e8a- 9 !ari "ebeum ma"u- RS,a5anya o" !anya mera"a meriang "aa( "oremen8eang maam !ari, namun "aa( ini ibu o"mera"a demam nya "ema-in (inggi. OS
mengeu! ba(u- "e8a- 2 !ari yang au, muanamun (ida- mun(a!, diare "e8a- 2 !ari yangau, >air, (ida- ada endir dan dara!, A+norma.
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Ri$a%at &en()*atan'
• OS beum perna! beroba( "ebeumnya.• OS (ida- "edang men8aani pengoba(an 8ang-a
pan8ang.
Ri$a%at Kehamilan I*u
• Seama !ami ibu OS ru(in peri-"a -e!amian -eidan "e(iap buan. Seama !ami ibu OS (ida-meng-on"um"i oba(?oba(an dan (ida- ada -eu!an.+ondi"i 8anin bai- "eama -e!amian.
Ri$a%at Kelahiran
• U"ia -e!amian >u-up buan, a!ir "e>ara norma,di(oong oe! idan, L @ 0)11 gram, P @ 2) >m,pa">a a!ir menangi" "pon(an, ibu OS (ida- ada-eu!an pa">a per"ainan, -eadaan bayi bai-
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Ri$a%at Imunisasi
• +e"an imuni"a"i eng-ap
Ri$a%at Tum*uh Kem*an(
• Mo(ori- -a"ar :• Mo(ori- !au" :• +omuni-a"i a(au berbi>ara : -e"an "e"uai u"ia• So"ia dan -emandirian :
Ri$a%at Aler(i
• Di"ang-a
Ri$a%at &sik)s)sial
• Tingga di 5iaya! pemu-iman pada( pendudu-, "u-a
8a8an "embaragan, dan poa ma-an yg (ida- (era(ur
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PEMERI+SAA$ 'ISI+
• Kea+aan umum? +e"adaran : ompo" Men(i"? +e"an "a-i(: Tampa- "a-i( "edang
•
Tan+a Vital? Su!u : 6/,
? $adi : )B73meni(, reguar -ua(
ang-a(? Pernapa"an : 02 73meni(
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S(a(u" Cenerai"+epaa
Ubun?ubun Suda! menu(up
ata
+on8ung(i#a anemi"S-era i-(eri-
?3??3?
ulut
Mu-o"a bibirLida!
Lembab+o(or ;<=
Leher
Pembe"aran +C ?3?
Th)raks
In"pe-"iPer-u"iPapa"iAu"-u(a"i
en(u- dan gera- "ime(ri" Tida- dia-u-an Tida- dia-u-an%S -anan@-iri8 8 0 #e"i-uer
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S(a(u" Cenerai"
Abdomen
In"pe-"i
Au"-u(a"iPapa"iPer-u"i
Da(ar
U ;<= mening-a(Supe, (urgor -embai >epa( Timpani di "euru! -uadran
Ekstremitas
+anan : a(a" dan ba5a!+iri : a(a" dan ba5a!
A-ra !anga(, RT 0 de(i-A-ra !anga(, RT 0 de(i-
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Pemeri-"aan Penun8ang
!emat)l)(i Rutin Urinai"a
Leng-ap
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Re"umeOS da(ang -e ICD RS Se-ar5angidengan -eu!an demam "e8a- 6 !ari
"ebeum ma"u- RS, pana" badandira"a-an men8eang "ore !inggamaam dan pana" (urun -e(i-a pagi
dan "iang. OS mengeu! mua danmun(a! 73!ari "e8a- 6 !ari yang au,beum A "e8a- 6 !ari yang au, A+norma. Pem": ida! -o(or ;<=, nyeri(e-an epiga"(rium ;<=. Su!u: 6/, ,$adi: )B73meni(, reguar -ua(ang-a(. Pernapa"an: 02 73meni(. Ha"i
Labora(orium Hb : ,2 gr , H( : 69 F,
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• Demam T%ph)i+
&or-in
gDiagno
"i"
•
Ob".'ebri" e.>.ine-"i #iru" dengandiare a-u(
Diagno
"i"andin
g
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Pena(aa-"anaan
• I%'D R B (pm ma-ro
• Rani(idin 0 7 00 mg I%
•
An(rain 67 001 mg I%• Ondan"en(ron 6 7 0,0 mg I%
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'oo5 Up01 *uni 012
• S : ba(u- ;<=, pie- ;<=, mun(a! ;<=, beum A, "a-i((enggoro-an
• O : Su!u : 6J,). $adi : ))73m
SS0 murni, murmur ;?=,
%b" <3<, &! ?3?, R! ?3?
abdomen da(ar, embu(, U ;<=
a-ra !anga(
• A : Ob" 'ebri" H I% dd Demam Tioid
• P : I%'D R 02 (pm ma-ro
Rani(idin 0 7 09 mg I%
An(rain 6 7 001 mg I%
Ondan"en(ron 6 7 0,9 mg I%
ur#i( 0 7 >(!
ambro7o 6 7 >(!
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'oo5 Up
0 *uni 012
• S : "emaam demam ;<=, ba(u- ;<=, pie- ;<=, mua ;<=, mun(a! ;?=,beum A, nyeri peru(, na"u ma-an ber-urang, ri5aya( mimi"an gu"i berdara! ;?=
• O : Su!u : 6J,). $adi : ))73m
SS0 murni, murmur ;?=,
%b" <3<, &! ?3?, R! ?3? abdomen da(ar, embu(, U ;<=
a-ra !anga(
• A : Ob" 'ebri" H % dd Demam Tioid
• P : I%'D R 00 (pm ma-ro
Rani(idin 0 7 09 mg I% An(rain 6 7 001 mg I%
Ondan"en(ron 6 7 0,9 mg I%
ur#i( 0 7 >(!
ambro7o 6 7 >(!
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Ha"i Labora(o(ium
Tan((al &emerik saan !asil Nilai N)rmal
0 *uni012
Hb 0,0 gr F 0 G 2 gr F
H( 69 F 21 G 29 F
Leu-o"i( 9.)11 mm6 2.111 G .111mm6
Trombo"i( 0J.111mm6
91.111 G 211.111mm6
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'oo5 Up
06 *uni 012
• S : "emaam demam ;<=, ba(u- ;<=, pie- ;<=, mua ;<=, mun(a! ;?=,beum A, nyeri peru(, na"u ma-an ber-urang,
• O : Su!u : 6). $adi : ))73m
SS0 murni, murmur ;?=,
%b" <3<, &! ?3?, R! ?3?
abdomen da(ar, embu(, U ;<=
a-ra !anga(
• A : Ob" 'ebri" H % dd Demam Tioid
• P : I%'D R 00 (pm mi-ro
Rani(idin 0 7 00 mg I%
An(rain 6 7 001 mg I%
Ondan"en(ron 6 7 0,9 mg I%
ur#i( 0 7 >(!
Ambro7o 6 7 >(!
e(ria7on 0 7 )91 mg
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'oo5 Up
02 *uni 012
• S : demam ;?=, ba(u- ;?=, pie- ;?=, mua ;?=, mun(a! ;?=
• O : Su!u : 6J,9 . $adi : ))73m
SS0 murni, murmur ;?=,
%b" <3<, &! ?3?, R! ?3? abdomen da(ar, embu(, U ;<=
a-ra !anga(
• A : Ob" 'ebri" H %II dd Demam Tioid
• P : LPL
e7ime 0 7 K (ab Rani(idin 0 7 (ab a>
para>e(amo 6 7 (ab p>
ur#i( 0 7 >(!
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Tin8auan
Pu"(a-a
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DEFINISI
Demam (ioid adaa! "ua(u
penya-i( ine-"i "i"(emi-ber"ia( a-u( yang
di"ebab-an oe! -umanba(ang gram
nega(i Samonea (yp!i
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DEA TIFOID
ASIA : 900/100.000angka kejadian
3-19 tahun
E&IDEIOL
OGI
Penuaran NN ma-anan(er>emar
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ETIOLOGI
BAKTERI GRANEGATIF
-./FLAGEL
-0/ BERKA&SUL-0/ EBENTUK S&ORAFAKULTATIF ANAEROB-./ ANTIGEN SOATIK
O DAN FLAGELARANTIGEN A
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&ATOGENESIS
PE$EMPELA$ DA$ I$%ASI SEL?SEL PEYERS PATH
A+TERI ERTAHA$ HIDUPDIALIRA$ DARAH
A+TERI ERTAHA$ HIDUP DA$ERMULTI'I+ASI
PRODU+SI E$DOTO+SI$ >AMPME$I$C+AT ELE+TROLIT DA$
AIR +ELUAR
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ANIFESTASI KLINIS
N"ERIKE&ALA ALAISESTE& LADDERTE&ERATURE
1!ARTDIARE2 OBSTI&ASI
DEA TIFOID
BRADIKARDI RELATIF
ORGANOEGALI-./NAUS
EAIALGIA
N"ERI&D
&ERUTRADANGTENGGOROKAN
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LANGKA! DIAGNOSISA
N ANE
SI
S
-Demam
- +urang ena- diperu(-$yeri (uang,
per"endian dan o(o(-+on"(ipa"i3Diare-Mua, Mun(a!
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LANGKA! DIAGNOSIS&
EE
R
IK SA
ANFI
SIK
-
Demam (inggi- Peru( di"(en"i dannyeri (e-an peru(
-radi-ardi rea(i#e
-Hepa(o"penomegai
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LANGKA! DIAGNOSIS&
EE
R
I KSA
ANL
AB
.Un(u- menyo-ongdiagno"i"a. dara! (epi :eu-openia,imo"i(o"i" rea(i,ane"inoiab. "um"um (uang :
!iperea-(i RES
0. Un(u-
diagno"i"pa"(ia. bia-anempedub. bia-andara!
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LANGKA! DIAGNOSIS
U#
I
S
E ROL
OGI
. Pemeri-"aan &ida
0. Tube7 T'6. Me(ode enymeimmunoa""ay
2. ELISA9. Pemeri-"aan
dip"(i-
D
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DE
A
T
IF OID
&ENATALAKSA
NAAN
0 Tirah Barin(-
&emenuhanKe*utuhan 1airan
0 Nutrisi
$on?
Medi-amen (o"a
E
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EN
ATA
LA K
S
A NA
A
SA+orameni-o 11mg3+g3Hrdibagi daam 2 do"i" "eama 1?
2 !ari *i-a re"i"(en
Se(ria-"on 11 mg3+g3Hr
dibadi daam ?0 do"i" "eama 9?J!ari+o(rimo-"ao :
Suame(o7aoe 61?21mg3+g3Hr dan Trime(oprim B?)mg3+g3Hr diberi-an daam 07
do"i" "eama 1 !ari
*i-a e-o"i( 01113u: >e7ime D
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DE
A
T
IFOID
KO&LIKASI
+ompi-a"i in(e"(ina :- Perdara!an u"u", perora"i u"u",ieu" parai(i-
+ompi-a"i e-"(rain(e"(ina :-+ardio#a"-uar : mio-ardi(i"-DARAH : Anemia !emoi(i-,
Trombo"i(openia, Trombo"i(-PARU : P, ron-i(i"-HEPATOILIER : Hepa(i(i", +oe"i"(i(i"-$EUROPSI+IATRI : En"eopa(i
Meningi(i" +roni- +arier
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DA'TAR PUSTA+A – Soedarmo, Sumarmo S., d--. Demam (ioid. Daam : u-u a8ar ine-"i
pedia(ri (ropi". Ed. 0. *a-ar(a : adan Penerbi( IDAI Q 011). !. 66)?29. – Ree-i, Sri. Demam (ioid. 011). Diundu! dari
!((p:33medi>a"(ore.>om3ar(i-e306)3DemamTioidpadaAna-ApayangPeruDi-e(a!ui.!(m. 00 *anuari 010.
– Pa5i(ro UE, $oor#i(ry M, Darmo5ando5o &. Demam Tioid. Daam : Soegi8an(oS, Ed. Imu Penya-i( Ana- : Diagno"a dan Pena(aa-"anaan, edi"i . *a-ar(a :
Saemba Medi-a, 0110:?26. – Ri>!ard E. e!rman, Rober( M. +iegman, Ann M. Ar#inQ edi"i ba!a"a
Indone"ia: A Sami- &a!abQ Imu +e"e!a(an Ana- $e"on, ed.9. *a-ar(a: EC Q0111.
– Aan R. Tumbea-a. Diagno"i" dan Ta(a a-"ana Demam Tioid. DaamPedia(ri>" Upda(e. e(a-an per(amaQ I-a(an Do-(er Ana- Indone"ia. *a-ar(a :0116. !. 0?01.
– Pra"e(yo, Ri"-y %. dan I"moedi8an(o. Me(ode diagno"(i- demam (ioid padaana-. Surabaya : '+ U$AIR Q 011. !. ?1.
– Mo!amad, 'a(ma5a(i. Ee-(i(a" -ompre" !anga( daam menurun-an demampada pa"ien Thypoid Abdominalis di ruang C L(.0 RSUD Pro. Dr. H. AoeiSaboe +o(a Coron(ao. 010. Diundu! dari!((p:338ourna.ung.a>.id3e8urna3*HS%o19$o11)0103J'a(5a(y*HS%o19$
o11)010.pd. 00 *anuari 010.
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