Gout Arthritis

Uric acid is a normal ingredient in the body and the end result of purine metabolism, the degradation of purine nucleotide which is an important ingredient in the body as a component of nucleic acids and produce energy in the cell nucleus. Under normal circumstances a proper balance between formation and degradation of purine nucleotides as well as the ability of the kidneys to excrete uric acid. If there is excess formation (overproduction) or decreased excretion (underexcretion) or two there will be an increase in the concentration of blood uric acid, called hyperuricemia. Circumstances would risk the onset of hyperuricemia with gout arthritis, gout nephropathy, or kidney stones.

Hyperuricemia is a medical term that means conditions in the blood uric acid levels exceed the "normal" is more than 7.0 mg / dl. Hyperuricemia can occur due to increased production or decreased removal of uric acid, or a combination of both. Persistence conditions predisposing to hyperuricemia (supporting factors) a person has arthritis due to gout (gouty arthritis), kidney stones caused by uric acid or renal impairment.

Gout arthritis is a disease caused by deposition of monosodium urate crystals that occur due to super saturation of the extra cellular fluid and result in one or more clinical manifestations.

Symptom
Symptoms of gout will be marked with the initial attack that attacks the joints will usually last for several days and then disappear until the next attack. Symptoms of gout should really watch out to avoid gout attacks are more severe. Other symptoms of gout are usually characterized by the following symptoms:

• Muscle pain, knee joints, hips, back, hips, shoulders and shoulder joints affected by gout visible swelling, redness, heat and tremendous pain during the night and morning.
•   Body aches and often feel exhausted
• Taste Tingling and pains are very severe
       
•  Frequent urination especially at night or early morning when I wake up
     
•   If symptoms of uric acid was also attacked in the kidney area will lead to bladder stones, so people are difficult to urinate

Symptoms of gout is a pain in the joints due to the crystallization of uric acid formed in the peripheral joints. This is because the joints are colder than in the center of the body. In cold temperatures veins tend to freeze. Other symptoms of uric acid that can result from crystallization in the joints is a very severe tingling.

DIAGNOSIS
Pseudogout, septic arthritis, rheumatoid arthritis

Examination support
• ESR, CRP
• Analysis of joint fluid
• Uric acid blood and urine 24 hours
• U, creatinine, CCT
• Radiology joints

THERAPY
1. Counseling
2. Acute phase of treatment:
    a. Colchicine. Dose of 0.5 mg given every hour until there is improvement there is inflammation or signs of toxic or dose not exceed 8 mg/24jam
    b. Anti-inflammatory non-steroidal
    c. Low-dose glucocorticoids if any contraindications of colchicine and non-steroidal anti-inflammatory drugs.

3. Treatment of hyperuricemia:
    a. Low-purine diet
    b. Xanthine oxidase inhibitors (for the overproduction of type), such as allopurinol

COMPLICATIONS
• Tofus
• joint deformity
• gout nephropathy, renal failure, urinary tract stones

Anxiety

anxiety is a subjective phenomenon which occurs in certain people. In general, patients come to the clinic of internal medicine with somatic complaints. Anxiety disorder is one of the mental disorder that is often found in patients who visited the mental health section. Symptoms are also very similar to a heart attack made ​​in the first patient used to come frequently to the emergency room or a heart specialist / internal medicine. This disorder is diagnosed when in the past month there have been more than 3 (three) times the panic attacks. The attack came suddenly, and in between the attacks the patient was worried if he was experiencing the situation again (anticipatory anxiety). The attacks also have disrupted the function of both personal and social patient. Anxiety can be decreased when has the desire to heal with medication alone or join the community of sharing that had the same anxiety disorder.

DIAGNOSIS
1. Excessive feelings of anxiety, subjective, unrealistic
2. There are complaints and symptoms as follows:
    • Tension motor: muscle twitching, stiffness, aches, chest pain, joint pain
    • Hyperactivity autonomous: shortness of breath, palpitations, wet palms, dry mouth, nausea, mules, diarrhea and other
    • If found organic abnormalities are generally complaint is not comparable with organ abnormalities were found
   • Vigilance excessive catching capacity is reduced: easily startled, irritable difficulty concentrating, difficulty sleeping, etc.
3. Impaired activities of daily living: decreased work ability, impaired social relationships, lack of self care, etc.

Deff DIAGNOSIS
Mixed anxiety and depressive disorders, depression, somatization disorder, organ abnormalities were found (coincidence)

Examination support
• Hb, hematocrit, leukocytes, urea, creatinine, blood sugar, liver function tests, complete urine
• Analysis of blood gases, K, Na, Ca, T3, T4, TSH, as indicated
• Chest X-ray, if necessary
• ECG, electromyogram, electroencephalogram, if necessary
• Endoscopy, colonoscopy, ultrasound, if necessary

THERAPY
Nonpharmacologic: education, reassurance, psychotherapy, hypnotherapy,

pharmacologic:
• Benzodiazepines: Diazepam, alprazolam, clobazam
• Non benzodiazepim: Buspiron, beta blockers if symptoms of autonomic hyperactivity prominent
• Symptomatic, as indicated

COMPLICATIONS
Less / not able to perform daily activities (work).

Conclusion
Anxiety disorder is one of the mental disorder that is often found in patients who visited the mental health section or clinic of interna. In these patients obtained a major symptom anxiety syndrome. The main symptoms of excessive anxiety arises especially when alone at home, difficulty concentrating, multiorgan found physical complaints such as palpitations, shortness of breath at times choked up, trembling.

aplastic Anemia

Anemia is a condition where red blood cell count or the number homoglobin (oxygen-carrying protein) in red blood cells is below normal. Red blood cells contain homoglobin, allowing them to transport oxygen from the lungs and deliver it to all parts of the body. Anemia leads to reduced number of red blood cells or amount homoglobin in red blood cells, so that blood can not carry oxygen in the body as needed.

Aplastic anemia is anemia due to bone marrow aplasia in which hemopoiesis tissue is replaced by fat tissue, divided into two, namely:

A. Severe aplastic anemia
1. Bone marrow cells <25% and there are 2 of the 3 following symptoms

•  Granulocytes <500/uI
•   Platelets <20.000/uI
•   Reticulocytes <10% 0

2. plastic anemia

• The bone marrow is hypoplastic
• Pensitopenia with one of three blood tests such as severe aplastic anemia

DIAGNOSIS
• History:

1. History of exposure to toxic substances (drugs, workplace, hobbies), suffering from a viral infection last 6 months (hepatitis, parvovirus), had received a blood transfusion
2.   Symptoms of anemia: weakness / weakness, dizziness, shortness of breath / heart failure, dizzy
3.   Signs of infection: fever often
4.   As a result of thrombocytopenia: bleeding (menstrual length, epistaxis, bleeding gums, bleeding under the skin, hematuria, blood mixed bowel, vomiting of blood)

• Physical examination: conjunctival pallor, tachycardia, signs of bleeding
• Investigation: complete blood count was found pancytopenia, viral serology (hepatitis, parvovirus)
• Definitive diagnosis: bone marrow cytology and histopathology

DIAGNOSIS
Myelofibrosis, hemolytic anemia, deficiency anemia, anemia due to chronic disease, anemia due to disease of bone marrow malignancy, hypersplenism, acute leukemia
Examination support
• Laboratory: complete blood count, viral serology
• Aspiration and biopsy of bone marrow

TREATMENT
Adjunctive therapy:
• Transfusion of blood components (PRC and / or TC) as indicated (on the topic of blood transfusion)
• Avoid and cope with infection
• Corticosteroids: prednisone 1-2 mg / kg / day
• Androgens: Metenolol acetate 2-3 mg / kg / day. maximum is given for 3 months
• Splenectomy done when no response to steroids. If the patient refused splenectomy immunosuppressive therapy can be given:

• Cyclosporine 5 mg / kg / day
• ATG (anti-thymocyte globulin) 15mg/kgBB/hari intravenously for 5 days
• Bone marrow transplant, if found suitable HLA

COMPLICATIONS
Infection can be fatal, bleeding, heart failure in severe anemia

AFERESIS

DEFINITIONS
Aferesis is the separation of blood components directly to the person using the blood component separator

PURPOSE
Removing some blood components, can be either cell (cytopheresis) or plasma (plasmapheresis / plasma exchange)

INDICATIONS

therapeutic:
• Sitoferesis
• Eritrositoperesis: Sickle cell anemia, malaria parasitaemia
• Tromboferesis: Trombositemia symptomatic
• Leukoferesis: Leukemia with hiperleukositosis, rheumatoid arthritis (in certain circumstances)
• Plasmapheresis: Abnormalities of paraprotein (hyperviscosity syndrome, cryoglobulinemia, Fabry disease, familial hypercholesterolemia), immunological abnormalities (Goodpasture's syndrome, myasthenia gravis, eaton-lambert syndrome, guailain-barre syndrome, pemphigus, ITP, an inhibitor of coagulation factor), vasculitis (SLE, glomerulonefriitis mesangiokapiler, Wagener's granulomatosis), deficiency of plasma factor (TTP), toxicity of drugs or other toxic materials.

donor:
To meet the needs of the patient's blood components:
• Tromboferesis
• Plasmapheresis
• Leukoferesis, to support the program PBSCT

CONTRAINDICATIONS
• Aferesis therapeutic
• Patients with poor conditions and hemodynamic disturbances
• Aferesis donor
• Levels of platelet / leukocyte / albumin / hemoglobin / hematocrit below the normal
• ABO-Rh type is not suitable, cross matching the (+)
• Contain HBsAg / anti-HCV / HIV / VDRL and malaria
• less weight, old age, children
• Suffering from heart disease, lung, kidney failure, chronic or acute diseases other

PREPARATION

Materials and tools:
• Machine aferesis
• Set aferesis disposable, set trombaferesis, plasmapheresis sets, set leukaferesis, set eritositaferesis
• anticoagulant ACD-A
• Intravenous Access
• AV fisual
• Heparin injection of 0.9% saline infusion
• Albumin (to plasmapheresis)
• Emergency Drugs: Ca gluconate injection, inj adrenaline, corticosteroid inj, inj antihistamines, saline infusion, plasma expander, oxygen, resuscitation equipment and emergency drugs for resuscitation

patients:
• Explanation of procedures that will be undertaken
• Physical examination: hemodynamics, weight, height
• Laboratory: ABO-Rh blood goals, cross-matching, DPL, HBsAg, anti HCV
• Informed consent
• Swallowing calcium tablets a day earlier

COMPLICATIONS
Hypocalcaemia (tingling lips and fingers, chest distress, dark view) hemodynamic disturbances and impairment of consciousness

Liver ABSCESS

Liver ABSCESS

Liver abscess is still a health and social problems in some countries in Asia, Africa and South America. High prevalence is closely related to poor sanitation, low economic status and poor nutrition. Increasing urbanization led to increased cases of liver abscess in urban areas.

DEFINITIONS
Liver abscess is a pathological cavity containing necrotic tissue arising in the liver tissue due to amoebic infection or bacterial

DIAGNOSIS
• History: fever, abdominal pain upper right feeling
• Physical examination: jaundice, hepatomegaly tenderness, right upper abdominal tenderness
• Lab: leukocytosis, impaired liver function
• Ultrasound: a cavity in the liver
• Aspiration: pussy (+)

DIAGNOSIS
Hepatoma, cholecystitis, liver tuberculosis,

Examination support
DPL, SGPT, bilirubin, amoebic serology; ultrasound, fluid pus culture

THERAPY
• Bed rest, high-calorie high-protein diet
• In amoebic abscess: Metronidazole 4 x 500-750 mg / day for 5-10 days. in pyogenic abscesses: a broad-spectrum antibiotics according to culture results or germs. In the mixed abscess: a combination of metronidazole and antibiotics
• drainage of the abscess fluid, especially in cases with conservative treatment fails or if the abscess is large (> 5 cm)

COMPLICATIONS
Rupture of the abscess (the pleura, lung, pericardium, intestines, skin or intraperitoneal) bleeding in the abscess, sepsis