mata dan neuro
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ILMU PENYAKIT MATA
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53. Vitamin A Deficiency
myorganicchemistry.wikispaces.com
Retinolelaboration of
rhodopsin by the rods the sensory receptors of the
retina responsible for visionunder low levels of
illumination Vitamin A deficiency
interfere with rhodopsinproduction
impair rod function
Night blindness
VITAMIN A DEFICIENCY AND ITS CONSEQUENCES A field guide to detectionand control.Alfred Sommer. World Health Organization. Geneva:1995
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Conjunctival Xerosis
The epithelium of the conjunctiva transformed to the stratified squamous typeLoss of gobletcells, formation of a granular cell layer and keratinization of the surfaceNcolumnar cell
appears in the temporal quadrantTherapyo resolve within 25 days, most will disappear within 2 weeks
Night blindness
Responds rapidly, usually within 2448 hours to vitamin A therapy
Corneal Xerosis
responds within 25 days with the cornea regaining its normal appearance in 12 weeks
Xerophthalmia Fundus
disappear within 2
4 months in response to vitamin A therapy
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VITAMIN A DEFICIENCY AND
ITS CONSEQUENCES A field
guide to detection and control.
Alfred Sommer. World Health
Organization. Geneva:1995
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http://www.moondrag
on.org/health/disorders/xerophthalmia.html
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54. REFRACTIVE DISORDER
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Refractive Disorder
Myopia Concave lens. The smallestDioptri to corret the visualaquity to 6/6Minus lenses to be used to
correct myopia should be nostronger than abso-lutely necessary.Accommodative asthenopia(rapid ocular fatigue) resultsfrom the excessive stresscaused by chronic con-traction of the atrophicciliary muscle.
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55. Cataract Any opacity of the lens or loss of transparency of the lens that causes
diminution or impairment of vision Classification : based on etiological, morphological, stage of maturity
Etiological classification :
Senile
Traumatic (penetrating, concussion, infrared irradiation, electrocution)
Metabolic (diabetes, hypoglicemia, galactosemia, galactokinase deficiency,hypocalcemia)
Toxic (corticosteroids, chlorpromazine, miotics, gold, amiodarone)
Complicated (anterior uveitis, hereditary retinal and vitreoretinal disorder, high
myopia, intraocular neoplasia
Maternal infections (rubella, toxoplasmosis, CMV)
Maternal drug ingestion (thalidomide, corticosteroids)
Presenile cataract (myotonic dystrophy, atopic dermatitis)
Syndromes with cataract (downs syndrome, werners syndrome, lowes
syndrome)
Hereditary
Secondary cataracthttp://sdhawan.com/ophthalmology/lens&cataract.pdf E-mail: sdhawan@sdhawan.com
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CataractSign & symptoms:
Near-sightedness (myopia shift)Early in the development of age-relatedcataract, the power of the lens may beincreasedReduce the perception of bluecolorsgradual yellowing andopacification of the lensGradual vision lossAlmost always one eye is affectedearlier than the otherShadow test +
Morphological classification : Capsular Subcapsular Nuclear Cortical Lamellar Sutural
Stage of maturity classification: Immature Mature Intumescent Hypermature
Morgagnian Chronological classification: Congenital (since birth) Infantile ( first year of life) Juvenile (1-13years) Presenile (13-35 years)
Senile
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Katarak Traumatik
Paling sering disebabkan oleh cedera benda asing di lensa atautrauma tumpul bola mata
Sering mengenai pekerja industri
Gejala dan Tanda:
Penglihatan kabur mendadak
Mata merah
Lensa opak
Perdarahan intraokular
gambaran bintangpada lensa posterior yang dapat dilihat
melalui pupil yang dilatasi maksimal
Komplikasi : infeksi, uveitis, ablasio retina, glaukoma
Tatalaksana : antibiotik sistemik dan topikal, kortikosteroid topikal,
katarak dikelurakan pada saat pengeluaran benda asing atau
setelah peradangan mereda
f
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Inflammatory diseases
Ocular toxocariasis
Congenital toxoplasmosis
Congenital cytomegalovirus retinitis
Herpes simplex retinitis
Other types of fetal iridochoroiditis
Pseudo-uveitis Endophthalmitis
Tumors
Retinoblastoma
Medulloepithelioma
Naevoxanthome juvenile
Glioneuroma
Leukemia
Choroidal hemangiomaCombined retinal hamartoma
Congenital malformations
Persistent Hyperplastic Fetal Vasculature (PHFV)
Posterior coloboma
Retinal fold
Myelinated nerve fibres
Morning Glory Syndrome
X-linked retinoschisis
Retinal dysplasia
Norries disease
Incontinentia pigmenti
Phakomatoses
Astrocytic hamartoma (Bournevilles tuberous
sclerosis)
Retinal capillary hemangioma (von Hippel-
Lindau)
Encephalotrigeminal syndrome (Sturge-
Weber)
Neurofibromatosis (von Recklinhausen) (NF1
Divers
Vitreous hemorrhageRetinal detachment
Strabismus (Brckners phenomenon)
Stickler syndrome
Trauma
Contusion of the globeIntraocular foreign body
Shaken baby syndrome
Vascular diseases
Retinopathy of prematurity
Coats
disease
Familial exudative vitreoretinopathy
56. Differential Diagnosis
in Pediatric Leukocoriahttp://www.ncbi.nlm.n
ih.gov/pmc
/articles/PMC2704541/
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Retinoblastoma Retinoblastoma(Rb) is a rapidly
developing cancer that develops inthe cells of retina, the light-detectingtissue of the eye.
Caused by a mutation in a genecontrolling cell division, causing cellsto grow out of control and becomecancerous.
Signs and Symptoms : The pupil of the eye appears white instead
of red when light shines into it (known as"cat's eye reflex" or "white eye"). This maybe seen in flash photographs of the patient.
The eyes appear to be looking in differentdirections (crossed eyes).
Pain or redness in the eye.
An enlarged or dilated pupil
Blurred vision or poor vision
Different colored irises
Treatment : The priority is to
preserve the life of the child, then topreserve vision, and then tominimize complications or sideeffects of treatment.
Treatment options :chemotherapy,cryotherapy, radioactive plaques,laser therapy, external beamradiotherapy and surgical removal ofthe eyeball (enucleation)
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Retinoblastoma
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Katarak sejenis kerusakan mata yang menyebabkan lensa mata berselaput
dan rabun. Lensa mata menjadi keruh dan cahaya tidak dapat
menembus
Ablasio retina Lepasnya retina sensorik dari RPE akibat adanya robekan, tarikan
atau terkumpulnya cairan pada retina. Gejala:vitreous floaters,
fotopsia, terhalang pandangan tepi seperti ada tirai
Displasia retina an eye disease affecting the retina of animals and, less commonly,humans. It is usually a nonprogressive disease and can be caused
by viral infections, drugs, vitamin A deficiency, or genetic defects.
Retinal dysplasia is characterized by folds or rosettes (round
clumps) of the retinal tissue.
Fibroplasia retrolental a disease of the eye affecting prematurely-born babies generally
having received intensive neonatal care. It is thought to be caused
by disorganized growth of retinal blood vessels which may result
in scarring and retinal detachment. Risk factor: prematurity,
oxygen toxicity
Inflammatory diseases Tumors
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Inflammatory diseases
Ocular toxocariasis
Congenital toxoplasmosis
Congenital cytomegalovirus retinitis
Congenital cataract
Herpes simplex retinitis
Other types of fetal iridochoroiditis
Pseudo-uveitis
Endophthalmitis
Tumors
Retinoblastoma
Medulloepithelioma
Naevoxanthome juvenile
Glioneuroma
Leukemia
Choroidal hemangioma
Combined retinal hamartoma
Congenital malformations
Persistent Hyperplastic Fetal Vasculature (PHFV)
Posterior coloboma
Retinal fold
Myelinated nerve fibresMorning Glory Syndrome
X-linked retinoschisis
Retinal dysplasia
Norries disease
Incontinentia pigmenti
Phakomatoses
Astrocytic hamartoma (Bournevilles
tuberous sclerosis)
Retinal capillary hemangioma (von Hippel-
Lindau)Encephalotrigeminal syndrome (Sturge-
Weber)
Neurofibromatosis (von Recklinhausen) (NF
1
DiversVitreous hemorrhage
Retinal detachment
Strabismus (Brckners phenomenon)
Stickler syndrome
TraumaContusion of the globe
Intraocular foreign body
Shaken baby syndrome
Vascular diseases
Retinopathy of prematurity
Coatsdisease
Familial exudative vitreoretino ath
57. Differential Diagnosis
in Pediatric Leukocoriahttp://www.ncbi.nlm.n
ih.gov/pmc/articles/PMC2704541/
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Katarak Kongenital Perubahan pada kebeningan struktur lensa mata yang muncul pada
saat kelahiran bayi atau segera setelah bayi lahir dengan usia < 1 tahun
Unilateral/Bilateral
Keruh/buram di lensa terlihat sebagai bintik/bercak putih dan dapatdilihat dengan mata telanjang
Faktor resiko :kelainan kromosom, atau gangguan penyakit maternalselama masa kehamilan seperti penyakit metabolis (galaktosemia),infeksi intraurin (rubella pada trimester pertama), pemakaian obatselama kehamilan, toksoplasmosis, DM, hipoparatiroidism
Penyulit : makula lutea tidak cukup mendapat rangsangan
tidakberkembang sempurnaambliopia sensoris; nistagmus; strabismus
Pengobatan : operasi.
Ilmu Penyakit Mata, Sidarta Ilyas, 2005
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Retinoblastoma Keganasan pada sel retina. Tampak seperti mata kucing/mata
memantulkan cahaya putih, pupil tampak membesar
Ablasio retina Lepasnya retina sensorik dari RPE akibat adanya robekan, tarikan
atau terkumpulnya cairan pada retina. Gejala:vitreous floaters,
fotopsia, terhalang pandangan tepi seperti ada tirai
Displasia retina an eye disease affecting the retina of animals and, less commonly,humans. It is usually a nonprogressive disease and can be caused
by viral infections, drugs, vitamin A deficiency, or genetic defects.
Retinal dysplasia is characterized by folds or rosettes (round
clumps) of the retinal tissue.
Fibroplasia retrolental a disease of the eye affecting prematurely-born babies generally
having received intensive neonatal care. It is thought to be caused
by disorganized growth of retinal blood vessels which may result
in scarring and retinal detachment. Risk factor: prematurity,
oxygen toxicity
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58. KORNEA
uveitis posterior
perdarahan vitreous Ablasio retina oklusi arteri atau
vena retinal neuritis optik
neuropati optik akutkarena obat(misalnyaetambutol), migrain,tumor otak
MATA TENANGVISUS TURUN
PERLAHAN
MATA TENANGVISUS TURUNMENDADAK
MATA MERAH
VISUS NORMALMATA MERAHVISUS TURUN
Keratitis Keratokonjungt
ivitis Ulkus Kornea Uveitis glaukoma akut Endoftalmitis
panoftalmitis
Katarak
Glaukoma retinopati
penyakitsistemik
retinitispigmentosa
kelainanrefraksi
konjungtivitismurni
Trakoma mata kering,
xeroftalmia Pterigium Pinguekula
Episkleritis skleritis
ANAMNESIS
mengenai mediarefraksi (kornea,uvea, atauseluruh mata)
struktur yangbervaskulersklerakonjungtiva
tidakmenghalangimedia refraksi
http://emedicine medscape com/article/798100
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Corneal Ulcer An inflammatory or more seriously, infective condition of the cornea
involving disruption of its epithelial layer with involvement of thecorneal stroma (Fluoresens test (+))
Causative Agent Feature Treatment
Fungal Fusarium & candida species, conjungtivalinjection, satellite lesion, stromal infiltration,hypopion, anterior chamber reaction
Natamycin,amphotericin B,Azole derivatives,
Flucytosine 1%Protozoa infection(Acanthamoeba)
associated with contact lens users swimming inpools
Viral HSV is the most common cause, Dendriticlesion,decrease visual accuity
Acyclovir
Staphylococcus(marginal ulcer)
Rapid corneal destruction; 24-48 hour, stromalabscess formation, corneal edema, anteriorsegment inflammation. Centered corneal ulcers.Traumatic events, contact lens, structuralmalposition
Tobramycin/cefazolin eye drops,quinolones(moxifloxacin)Pseudomonas
Streptococcus
connective tissuedisease
RA, Sjgren syndrome, Mooren ulcer, or asystemic vasculitic disorder (SLE)
http://emedicine.medscape.com/article/798100
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59. RETINOPATI
uveitis posterior
perdarahan vitreous Ablasio retina oklusi arteri atau
vena retinal neuritis optik
neuropati optik akutkarena obat(misalnyaetambutol), migrain,tumor otak
MATA TENANGVISUS TURUN
PERLAHAN
MATA TENANGVISUS TURUNMENDADAK
MATA MERAH
VISUS NORMALMATA MERAHVISUS TURUN
Keratitis Keratokonjungt
ivitis Ulkus Kornea Uveitis glaukoma akut Endoftalmitis
panoftalmitis
Katarak Glaukoma retinopati
penyakitsistemik
retinitis
pigmentosa kelainan
refraksi
konjungtivitismurni
Trakoma mata kering,
xeroftalmia Pterigium Pinguekula
Episkleritis skleritis
ANAMNESIS
mengenai mediarefraksi (kornea,uvea, atauseluruh mata)
struktur yangbervaskulersklerakonjungtiva
tidakmenghalangimedia refraksi
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RETINOPATI HIPERTENSI Kelainan retina dan pembuluh darah retina akibat tekanan
darah tinggiarteri besarnya tidak teratur, eksudat padaretina, edema retina, perdarahan retina
Kelainan pembuluh darah dapat berupa : penyempitan
umum/setempat, percabangan yang tajam, fenomena crossing,sklerose
Pada retina tampak : akibat sklerose (refleks copper wire/silverwire, lumen pembuluh irreguler, fenomena crossing);perdarahan atau eksudat retina (gambaran seperti bintang,cotton wool patches); perdarahan vena (flame shaped)
Ilmu Penyakit Mata, Sidarta Ilyas, 2005
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CLASSIFICATION SYMPTOMS FEATURE
Mild non-proliferative (mild
pre-proliferative)
None Microaneurysms only, reflects structural
changes in the retina
Proliferative retinopathy Floaters, sudden
visual loss
New vessel formation either at the disc
(NVD) or elsewhere (NVE), vitreous or
preretinal haemorrhage
Central and branch retinal
artery occlusion
Penurunanpenglihatanhebat yang tidak
nyeri yang terjadidalam periodebeberapa detik.
Funduskopi : retina superfisialis mengalamipengeruhan kecuali di foveolacherry redspot
Central and branch retinal vein
occlusion
penurunan
penglihatan
mendadak yangtidak nyeri
perdarahan retina kecil-kecil tersebar dan
bercak cotton-wool, dapat juga gambaran
perdarahan hebat dengan perdarahan retinasuperfisialis dan dalam, vena melebar dan
berkelok-kelok, edema makula dan retina
http://bestpractice.bmj.com/best-practice/monograph/532/basics/classification.html http://medweb.bham.ac.uk/easdec/gradingretinopathy.htm
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60-61. KONJUNGTIVITIS
Pathology Etiology Feature Treatment
Bacterial staphylococcistreptococci,
gonocciCorynebacteriumstrains
Acute onset of redness, grittiness,burning sensation, usually bilateral
eyelids difficult to open on waking,diffuse conjungtival injection,mucopurulent discharge, Papillae +
topical antibioticsArtificial tears
Viral Adenovirusherpes
simplex virusor varicella-zoster virus
Unilateral watery eye, redness,discomfort, photophobia, eyelid
edema & pre-auricularlymphadenopathy, follicularconjungtivitis, pseudomembrane(+/-)
Days 3-5 ofworst, clear upin 714 days without
treatmentArtificial tearsrelievedryness and inflammation(swelling)Antiviralherpes simplexvirus or varicella-zoster virus
http://www.cdc.gov/conjunctivitis/about/treatment.html
Conjunctivitis is swelling (inflammation) or infection
of the membrane lining the eyelids (conjunctiva)
Pathology Etiology Feature Treatment
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Pathology Etiology Feature Treatment
Fungal Candida spp. cancauseconjunctivitisBlastomyces
dermatitidisSporothrixschenckii
Not common, mostly occur inimmunocompromised patient,after topical corticosteroid andantibacterial therapy to an
inflamed eye
Topical antifungal
Vernal Allergy Chronic conjungtival bilateralinflammation, associated atopicfamily history, itching,photophobia, foreign bodysensation, blepharospasm,cobblestone pappilae, Horner-trantas dots
Removal allergenTopical antihistamineVasoconstrictors
Inclusion Chlamydia
trachomatis
several weeks/months of red,
irritable eye with mucopurulentsticky discharge, acute orsubacute onset, ocular irritation,foreign body sensation,watering, unilateral ,swollenlids,chemosis ,Follicles
Doxycycline 100 mg
PO bid for 21 days ORErythromycin 250 mgPO qid for 21 daysTopical antibiotics
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62. Cataract
Any opacity of the lens or loss of transparency of the lens that causes
diminution or impairment of vision Classification : based on etiological, morphological, stage of maturity Etiological classification : Senile Traumatic (penetrating, concussion, infrared irradiation, electrocution)
Metabolic (diabetes, hypoglicemia, galactosemia, galactokinasedeficiency, hypocalcemia) Toxic (corticosteroids, chlorpromazine, miotics, gold, amiodarone) Complicated (anterior uveitis, hereditary retinal and vitreoretinal
disorder, high myopia, intraocular neoplasia Maternal infections (rubella, toxoplasmosis, CMV)
Maternal drug ingestion (thalidomide, corticosteroids) Presenile cataract (myotonic dystrophy, atopic dermatitis) Syndromes with cataract (downs syndrome, werners syndrome,
lowes syndrome) Hereditary Secondary cataract
http://sdhawan.com/ophthalmology/lens&cataract.pdf E-mail: sdhawan@sdhawan.com
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Sign & symptoms: Near-sightedness (myopia
shift)Early in the developmentof age-related cataract, thepower of the lens may beincreased
Reduce the perception of blue
colors
gradual yellowing andopacification of the lens
Gradual vision loss
Almost always one eye isaffected earlier than the other
Shadow test +
Morphological classification : Capsular
Subcapsular Nuclear Cortical Lamellar Sutural
Stage of maturity classification:
Immature Mature Intumescent Hypermature Morgagnian
Chronological classification: Congenital (since birth) Infantile ( first year of life) Juvenile (1-13years) Presenile (13-35 years) Senile
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Cataract Treatment : Surgery
Cataract surgery is the removal of the natural lens of the eye that hasdeveloped an opacification then an artificial intraocular lens implant isinserted
Pirenoxine(Catalin) is a medication used in the possible treatment andprevention of cataracts.
A report in the journal of Inorganic Chemistryshowed that in liquid solutionsPirenoxine could cause decreased cloudiness of a crystallin solution producedto mimic the environment of the eye.
Abstract of a research on how pirenoxine (PRX) interacts with selenite orcalcium ions that have been proven as factors leading to the formation of
lens cataract is available athttp://pubs.acs.org/stoken/presspac/presspac/full/10.1021/ic102151p
Researchers found that pirenoxine reduced the cloudiness of the lenssolution containing calcium by 38 percent and reduced the cloudiness of theselenite solution by 11 per cent.
http://en.wikipedia.org/wiki/Pirenoxin
http://pubs.acs.org/stoken/presspac/presspac/full/10.1021/ic102151phttp://pubs.acs.org/stoken/presspac/presspac/full/10.1021/ic102151p -
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Quinolone A family of synthetic broad-spectrum antibacterial drugs
Pilokarpine A parasympathomimetic alkaloid, used to treat chronic open-angle glaucoma, acute angle-closure glaucoma
Betamethasone Corticosteroid for eye inflammation. Contraindicated in fungal
infections and hypersensitivity
Hidroksietilselulosa Eye lubricants, for dry and irritated eye
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63. TRAUMA
Trauma tumpul menyebabkan peningkatan tekanan dalam
orbita dan intraokular disertai deformitas bola mata.
Tanda: nyeri ringan, kekaburan penglihatan, kemosis
hemoragik, laserasi konjungtiva, kamera anterior dangkaldengan atau tanpa dilatasi pupil yang eksentrik, ablasi retina,
hifema, atau perdarahan korpus vitreosus
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Ablasio Retina Ablasio retina adalah suatu keadaan terpisahnya sel kerucut dan batang
retina (retina sensorik) dari sel epitel pigmen retina
Mengakibatkan gangguan nutrisi retina pembuluh darah yang bila
berlangsung lama akan mengakibatkan gangguan fungsi penglihatan Terdapat tiga jenis utama/penyebab ablasio retina yaitu : ablasi retina
regmategenosa, ablasi retina traksi (tarikan) dan ablasi retina eksudatif
Gejala : vitreous floaters, fotopsia, terhalangnya pandangan tepi seperti ada
tirai, metamor-fopsia, dan penurunan visus, Ada semacam tirai tipisberbentuk parabola yang naik perlahan-lahan dari mulai bagian bawah bolamata dan akhirnya menutup pandangan
Funduskopi : adanya robekan retina, retina yang terangkat berwarna keabu-
abuan, biasanya ada fibrosis vitreous atau fibrosis preretinal bila ada traksi.Bila tidak ditemukan robekan kemungkinan suatu ablasio nonregmatogen
Pengobatan: konservatif(untuk nonregmatogen), pneumatic retinopexy,bakel sklera, vitrektomi tertutup
Vaughn DG, Oftalmologi Umum, ed.14
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Hifema Blood in the front (anterior) chamber of the eyea reddish tinge,or a small pool of blood at the bottom of the iris or in the cornea
Luksasio lensa Dislokasi lensa dapat pada anterior atau posterior. Anterior :penglihatan turun mendadak, sakit yang sangat, muntah, matamerah dengan blefarospasme, injeksi siliar, edema kornea.Posterior : skotoma pada lapang pandang dan gejala afakia
Iridosiklitis Radang uvea anterior. Gejala : mata merah, pupil kecil, nyeri,
fotofobia, penglihatan turun ringan dan berair
Perdarahan vitreum Sering timbul pada penderita DM, hipertensi, dan anemia sabit.Gejala :penglihatan buram tiba-tiba, peningkatan floater/kilatancahaya
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64. Eyelids DisordersPathology Feature
Chalazion(meibomian glandlipogranuloma)
Chronic inflamation of Zeis/Meibom gland; when acutely inflammedPainful,warm, swollen, and firm eyelids, granulomatous reaction, lipogranuloma, usuallyon the upper eyelid and inside the lid, painless nodules, Increased tearing,Sensitivity to light
Hordeolum Localized infection or inflammation of the eyelid margin involving hair follicles ofthe eyelashes (external hordeolum) or meibomian glands (internal
hordeolum),Staphylococcal infection; painful, warm, swollen, and tender eyelids,focal collection of PMN cells and necrotic tissue. erythematous, andlocalized,Purulent material exudates
http://en.w
ikipedia.org/wiki/
http://www.ncbi.nlm.n
ih.gov/pub
medhealth/
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http://www.healblog.net/wp-content/uploads/Hordeolum-and-Chalazion.jpg
Chalazion The result of obstruction of the duct of a meibomian gland, which is usually
idiopathic, with secondary lipogranulomatous inflammation
Epidemiology : higher incidence in seborrheoc dermatitis, rosacea, and DM Clinical features : a pale, round, firm lesion of the lid.
Diagnosis : made clinically Treatment : incision of the cyst and removed by curetting. Steroid injection
can initiate remission Prognosis : ocaasionally recurrent
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NEUROLOGI
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65. CAUDA EQUINA SYNDROME Cauda equina syndrome (CES) is a rare syndrome that has been described as a complex of
symptoms and signs
low back pain, unilateral or bilateral sciatica, motor weakness oflower extremities, sensory disturbance in saddle area, and loss of visceral functionresulting from compression of the cauda equina.
CES occurs in approximately 2% of cases of herniated lumbar discs and is one of the fewspinal surgical emergencies.
Etiology : tumors, trauma, spinal stenosis, inflammatory conditions
Signs : include weakness of the muscles of the lower extremeties innervated by thecompressed lumbar roots (often paraplegia), detrusor weaknesses causing urinaryretention and post-void residual incontinence, decreased anal tone and consequent fecalincontinence; sexual dysfunction; saddle anesthesia; bilateral (or unilateral) sciatic leg painand weakness; and absence of ankle reflex. Pain may, however, be wholly absent; thepatient may complain only of lack of bladder control and of saddle-anaesthesia, and maywalk into the consulting-room.
Red Flag Symptoms:(requiring urgent hospitalisation) include sciatic leg pain and/or severeback pain, with altered sensation over saddle area (genitals, uretha, anus, inner thighs),urine retention or incontinence
Diagnosis : CT or MRI
Treatment : Surgical decompression
http://en.wikipedia.org/wiki/Cauda_equina_syndrome
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66-67. HEAD INJURY
Brain hematoma : a collection of blood within brain tissue.
Hematoma inside the cranium is named according to itslocation:
Subdural hematoma: blood collection between brain and dura
Epidural hematoma: blood collection between dura and theskull
Subarachnoid Hemorrhage: beneath the arachnoid membrane
Intracerebral hematoma: blood collection within the brain
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Subdural Hematoma A collection of blood below the inner layer of the dura but external to the brain
and arachnoid membrane.
Subdural hematoma is the most common type of traumatic intracranial mass
lesion. Usually resulting from tears in bridging veins which cross the subdural space
May cause an increase in intracranial pressure (ICP) compression of anddamage to delicate brain tissue
Characterized on the basis of their size and location and the amount of timeelapsed since the inciting event age (ie, whether they are acute, subacute, or
chronic) : Acute subdural hematomas: less than 72 hours old and are hyperdense compared with
the brain on computed tomography scans.
Subacute phase: begins 3-7 days after acute injury; the surgical literature favors 3 days,whereas the radiological literature favors 7. Subacute subdural hematomas are isodenseor hypodense compared with the brain.
Chronic subdural hematomas are 21 days (3 wk) or older and are hypodense comparedwith the brain. However, may be mixed in nature, such as when acute bleeding hasoccurred into a chronic subdural hematoma.
Symptoms: gradually increasing headache and confusion.
CT Appearance : crescent shape
Treatment: depends on the size and rate of growth. Careful monitoring, insertionof small cathehersuck the blood, craniotomy removal of hematoma
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Epidural Hematomas
70%-80% located intemporoparietal region whereskull fractures cross the path of
middle meningeal artery or itsdural branches
May present with lucid periodimmediately after trauma and adelay before symptoms evident
on CT : Lens shaped (biconvexlens) hematomas that do notcross suture lines
Subdural hematomas : crescent shaped density
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Crescent shaped density that may run length of skull
Subdural hematomas : crescent shaped density
that may run length of the skull
Subarachnoid
Hemorrhage
Intracranial Hemorrhage
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Menurut Penyebab Stroke dibagi:
1. Stroke Hemoragik
a. Intra cerebral hemoragik (ICH)
OK : Hypertensi, Aneurysma dan arterioveneus Malformasi (AVM)
b. Sub Arachnoid Hemoragik (SAH)
diagnosis medis : CT brain scan
2. Stroke Non Hemoragik (Iskemik)
OK : Arteriosklerosis & sering dikaitkan dengan : DM,
Hypercolesterolemia, Asam urat, hyperagregasi trombosit
3. Emboli Sumber dari tronkus di arteria carotis communis di jantung Lepas trombus embolus otak.
68. STROKE
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Stroke
Manifestasi Klinis : Kelumpuhan wajah atau anggota
badan (biasanya hemiparese),timbul mendadak
Gangguan hemisensorik
Perubahan mendadak statusmental
Afasia; disartria
Gangguan penglihatan atau
diplopia Ataksia
Vertigo, mual, muntah, nyerikepala
Faktor Resiko : Usia
Riw. TIA atau stroke
Peny. Jantung koroner
Hipertensi DM
Merokok
Dislipidemia
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Intracerebral Hemorrhage
Bleeding into brain tissue
Usually caused by chronichypertension
Non-hypertension cause more
likely if: No past history of
hypertension
Lobar (i.e., peripheral, notsubcortical)
May require emergency surgery
Accounts for 10% of strokes
Hemorrhage:Symptoms only suggestive ofhemorrhage.CT or LP needed for definitivediagnosis
Headache Neck stiffness
Neck pain
Light intolerance
Nausea, vomiting
Decreased consciousness
Pada kasus ini tidak didapatkan tanda-
tanda kemungkinan stroke hemoragik
jadi kemungkinan yang terjadi adalah
stroke iskemik
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6 HEADACHE
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69. HEADACHE
MIGRAINE
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MIGRAINE
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70. MENINGITIS
Meningitis: radang pada selaput otak yang melapisi otak dansumsum tulang belakang
Manifestasi klinis : nyeri kepala, dapat menjalar ke tengkuk dan
punggung, kaku kuduk, kernig (+), brudzinsky (+)
Klasifikasi (berdasarkan perubahan pada cairan otak) : Meningitis serosa : cairan otak jernih, paling sering disebabkan oleh
Mycobacterium tuberculosa, penyebab lain: virus, toxoplasma gondhii,
ricketsia
Meningitis purulenta : cairan mengandung pus, penyebabnya antara
lain diplococcus pneumoniae, neisseria meningitidis, streptococcushaemolyticus, staphylococcus aureus, haemophilus influenza,
pseudomonas aeruginosa
Kapita Selekta
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Meningitis TB
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Meningitis TB-Diagnosis Tuberculous meningitis (TBM) is an inflammation of the meninges covering the
brain and spinal cord caused by infection with mycobacteria, most usually
Mycobacterium tuberculosis.
The condition usually presents with headache, fever, and convulsions and is
diagnosed clinically, with confirmation by microscopy and culture of
cerebrospinal fluid.
CSF Examination Usually lymphocytic pleocytosis
Paradoxic change from lymphocytic to neutrophilic predominance over
48 hr pathognomonic for TB meningitis
Elevated protein with severely depressed glucose
Repeated specimens for AFB culture necessary Other Studies
Brain imaging demonstrates hydrocephalus, basilar exudates and
inflammation, tuberculoma, cerebral edema, cerebral infarction
CXR
Abnormal, sometimes miliary pattern
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Treatment
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CSF Findings in Meningitis
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71. EPILEPSI
A seizure is defined by release of excessive and
uncontrolled electrical activity in the brain. Seizures
themselves are not a disease, they are an event.
Epilepsy (seizure disorder) is a neurological condition,
that in different times produce brief disturbances in the
electrical functions of the brain. Seizures are a symptom
of epilepsy.
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Epilepsy - Classification
Focal seizures account for 80%of adult epilepsies
- Simple partial seizures
- Complex partial seizures
- Partial seizures secondarilly
generalised
Generalised seizures
Unclassified seizures
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Partial Seizure
Simple Seizure activity in the brain causing:
Rhythmic movements -
isolated twitching of arms, face, legs
Sensory symptoms -
tingling, weakness, sounds, smells,
tastes, feeling of upset stomach,
visual distortions
Psychic symptoms -
dj vu, hallucinations, feelings offear or anxiety
Usually last less than one minute
May precede a generalized seizure
Complex Characterized by altered
awareness Confusion, inability to respond Automatic, purposeless behaviors
such as picking at clothes,chewing or mumbling.
Emotional outbursts May be confused with:
Drunkenness or drug useWillful belligerence,
aggressiveness
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GENERALIZED SEIZURES
INVOLVE WIDE AREAS OF THE BRAIN AND LOSS OFCONSCIOUSNESS
PETIT MAL : CONSCIOUSNESS IS TRANSIENTLY LOST ANDTHE EEG DISPLAYS SPIKE AND WAVE ACTIVITY
GRAND MAL : CONSCIOUSNESS LOST FOR A LONGERPERIOD AND THE INDIVIDUAL WILL FALL IF STANDINGWHEN SEIZURE STARTS.
TONIC PHASE: GENERALIZED INCREASED MUSCLE
TONE. CLONIC PHASE: SERIES OF JERKY MOVEMENTS.
BOWEL AND BLADDER MAY EVACUATE.
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Epilepsi-Klasifikasi (etiologi)
Idiopatik epilepsi : biasanya berupa epilepsi dengan serangan kejangumum, penyebabnya tidak diketahui. Pasien dengan idiopatik epilepsi
mempunyai inteligensi normal dan hasil pemeriksaan juga normal dan
umumnya predisposisi genetik.
Kriptogenik epilepsi : Dianggap simptomatik tapi penyebabnya belum
diketahui. Kebanyakan lokasi yang berhubungan dengan epilepsi tanpadisertai lesi yang mendasari atau lesi di otak tidak diketahui. Termasuk
disini adalah sindroma West, Sindroma Lennox Gastaut dan epilepsi
mioklonik. Gambaran klinis berupa ensefalopati difus.
Simptomatik epilepsi : Pada simptomatik terdapat lesi struktural di otakyang mendasari, contohnya oleh karena sekunder dari trauma kepala,
infeksi susunan saraf pusat, kelainan kongenital, proses desak ruang di
otak, gangguan pembuluh darah diotak, toksik (alkohol, obat),
gangguan metabolik dan kelainan neurodegeneratif.Diagnosis Epilepsi Lengkap-Perdossi
PARESE N VII
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72. PARESE N. VII
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Menurut Penyebab Stroke dibagi:1. Stroke Hemoragik
a. Intra cerebral hemoragik (ICH)
OK : Hypertensi, Aneurysma dan arterioveneus Malformasi (AVM)
b. Sub Arachnoid Hemoragik (SAH)
diagnosis medis : CT brain scan
2. Stroke Non Hemoragik (Iskemik)
OK : Arteriosklerosis & sering dikaitkan dengan : DM,
Hypercolesterolemia, Asam urat, hyperagregasi trombosit
3. EmboliSumber dari tronkus di arteria carotis communis di jantungLepastrombus embolusotak.
73. STROKE
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Tatalaksana Khusus
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Tatalaksana KhususStroke Hemoragik :
Perawatan di ICU jika didapatkan volume hematoma lebih dari 30 cc,perdarahan intraventrikuler dengan hidrosefalus dan klinis cenderungmemburuk,
Tekanan darah diturunkan sampai tekanan darah premorbid atausebanyak 15-20% bila tekanan sistolik >180, diastolik >120, MAP >130, dan
volume hematoma bertambah. Bila terdapat gagal jantung maka tekanan darah segera diturunkan
dengan labetolol intravena dengan dosis 10 mg (pemberian dalam 2menit) sampai 20 mg (pemberian dalam 10 menit) maksimum 300 mg;enelapril intravena 0,625-1.25 mg per 6 jam; Captopril 3 kali 6,25-25 mg
peroral, Jika didapatkan tanda-tanda tekanan intra kranial meningkat, maka posisi
kepala dinaikkan 30 derajat, dengan posisi kepala dan dada pada satubidang, bisa dilakukan pemberian manitol (lihat stroke iskemik), danhiperventilasi (PCO2 20-35 mmHg),
Kapita Selekta Kedokteran
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74. CRANIAL NERVES
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75 VERTIGO
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75. VERTIGO
the illusion that the environment isspinning
a subtype of dizziness, where there is afeeling of motion when one isstationery
Classification :
Peripheral
Central
Common Causes:
1.Peripheral
Physiological (motion sickness)
Benign paroxysmal positional vertigo
(BPPV)most common
Vestibular neuronitis
Labyrinthitis
Menire disease
Perilymph fistula
2.Central
Brainstem TIA/infarct
Posterior fossa tumors
Multiple sclerosis Syringobulbia
Arnold - Chiari deformity
Temporal lobe epilepsy
Basilar migraine
3.OtherCardiac, GI, psycogen, toxins, medications,
anemia, hypotension
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Vertigo
Peripheral vertigo : caused byproblems within the innerear/vestibular system; alsocalled otologic or vestibularvertigo.
The most common cause :BPPV (32%)
Central vertigo : arises frominjury to the balance centersof the CNS; less prominentmovement illusion andnausea.
Has accompanying neurologic
deficits (e.g. slurred speechand double vision), andpathologic nystagmus (pure
vertical/ torsional)
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BPPV A clinical syndrome characterized by brief recurrentepisodes of vertigo triggered by changes in head position
with respect to gravity.
Meniere disease An inner ear disorder that causes one to experienceperiods of vertigo, dizziness, nausea, ear pressure,sensitivity to light and tinnitus
Migraine with aura Suatu kondisi kronis dengan karakteristik sakit kepala
episodik unilateral yang didahului dengan gejala aura
(gangguan visual, sensasi abnormal pada kulit, mual,
muntah, dll)
6 PARKINSON
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76. PARKINSONDISEASE
Parkinson Disease : a degenerative disorder of the central
nervous system.
The motor symptoms of Parkinson's disease result from
the death of dopamine-generating cells in the substantia
nigra, a region of the midbrain; the cause of this cell death
is unknown.
3 main symptoms:
Tremors
Rigidity
Slowed motion (Bradykinesia)
Other symptoms include:
Dementia, sleep disturbances,depression, etc.
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Parkinson Disease
No definitive tests for PD. PET scans can aid to determine levels ofdopamine.
Medical history and neurological tests are conducted to diagnose.
Usually, if two of the cardinal symptoms are present
Treatment can be divided into two stages.
Early and Later stages Early stage
Onset of symptoms, treated with physical therapy and medications(Levodopa, dopamine agonists, etc)
Later stage
Usually after having received 5+ years of levodopa treatment. Wearing-offand On/Offeffect develops, other medication in
conjunction levodopa is commenced.
MAO-B and COMT inhibitors.
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Treatment Physical Therapy
Regular exercise Recommended throughout the life of disorder.
Helps maintain and improve mobility and strength.
Physical exercise aids in rigidity relief, muscle strength and
flexibility, balance, etc. Caution is advised to avoid sudden movements or strenuous
activities fall could result in serious injury.
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www
.aafp.o
rg
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