miranti_lbm 5 muskuloskeletal

7/28/2019 MIRANTI_LBM 5 Muskuloskeletal

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LBM 5 MUSKULOSKELETAL Miranti De

1. Mengapa pergelangan kaki kanan terasa sakit?2. Apa hubungan penyakit dengan semua makan yang ada di scenario ?3. Mengapa sakit bertambah bila digerakkan, disertai bengkak dan kemerahan ?4. Bagaimana kadar asam urat normal ?

Pada keadaan normal kadar urat serum pada laki-laki mulai meningkat setelah pubertas.Pada perempuan kadar urat tidak meningkat sampai setelah menopause karena

estrogen meningkatkan ekskresi asam urat melalui ginjal. Setelah menopause, kadar

urat serum meningkat seperti pada pria.

Nilai normal asam urat serum pada laki-laki: 5,1 +/- 1 mg/dl dan pada perempuan: 4,0

+/- 1,0 mg/dl.

Patofisiologi Sylvia a. Price Edisi 6

5. Apa saja factor yang mempengaruhi trigliseridemia ?

6. Mengapa hasil pemeriksaan laboratorium menyatakan hipertrigliseridemia danhiperurisemia ?

7. Apa DD dari scenario ?- Arthritis gout

Gout is a disease that results from an overload of

uric acid in the body. This overload of uric acid

leads to the formation of tiny crystals of urate

that deposit in tissues of the body, especially thejoints. When crystals form in the joints, it causes

recurring attacks of joint inflammation (arthritis).

Gout is considered a chronic and progressive

disease. Chronic gout can also lead to deposits

of hard lumps of uric acid in the tissues,

particularly in and around the joints and may

cause joint destruction, decreased kidney

function, andkidney stones(nephrolithiasis).

Gout has the unique distinction of being one of the most frequently recorded medical illnesses

throughout history. It is often related to an inherited abnormality in the body's ability to process uric

acid. Uric acid is a breakdown product of purines that are part of many foods we eat. An abnormality

in handling uric acid can cause attacks of painful arthritis (gout attack), kidney stones, and blockage

of the kidney-filtering tubules with uric acid crystals, leading tokidney failure. On the other hand,

some people may only develop elevated blood uric acid levels (hyperuricemia) without having

manifestations of gout, such as arthritis or kidney problems. The state of elevated levels of uric acid

in the blood without symptoms is referred to as asymptomatic hyperuricemia. Asymptomatic
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hyperuricemia is considered a precursor state to the development of gout. The term goutrefers the

disease that is caused by an overload of uric acid in the body, resulting in painful arthritic attacks

and deposits of lumps of uric acid crystals in body tissues.

Gouty arthritis is typically an extremely painful attack with a rapid onset of joint

inflammation. The joint inflammation is precipitated by deposits of uric acid crystals in thejoint fluid (synovial fluid) and joint lining (synovial lining). Intense joint inflammation

occurs as the immune system reacts, causing white blood cells to engulf the uric acid

crystals and chemical messengers of inflammation to be released, leading to pain, heat,

and redness of the joint tissues. As gout progresses, the attacks of gouty arthritis

typically occur more frequently and often in additional joints.

http://www.medicinenet.com/gout/article.htm

- Arthritis supuratif

- Arthritis septic

- Arthritis pseudogout

8. Etiologi dan PatogenesisEtiologi

Gout primer : merupakan akibat langsung pembentukan asam urat tubuh yang

berlebihan atau akibat penurunan eksskresi asam urat.

Gout skunder : disebabkan karena pembentukan asam urat yang berlebihan atau ekresi

asam urat yang berkurang akibat proses penyakit lain atau pemakaian obat-obatan

tertentu.


In addition to an inherited abnormality in handling uric

acid, other risk factors for developing gout

include obesity, excessive weight gain (especially in

youth), moderate to heavy alcohol intake, high blood

pressure, and abnormal kidney function. Certain drugs,

such as thiazide diuretics

(hydrochlorothiazide [Dyazide]), low-

doseaspirin, niacin, cyclosporine, tuberculosis

medications (pyrazinamide and ethambutol), and others

can also cause elevated uric acid levels in the blood andlead to gout. Furthermore, certain diseases lead to

excessive production of uric acid in the body. Examples

of these diseases include leukemias, lymphomas,

and hemoglobin disorders.http://www.medicinenet.com/gout/page2.htm
http://www.medicinenet.com/gout/article.htmhttp://www.medicinenet.com/gout/article.htmhttp://www.medicinenet.com/script/main/art.asp?articlekey=943http://www.medicinenet.com/script/main/art.asp?articlekey=24750http://www.medicinenet.com/script/main/art.asp?articlekey=8709http://www.medicinenet.com/script/main/art.asp?articlekey=378http://www.medicinenet.com/script/main/art.asp?articlekey=378http://www.medicinenet.com/script/main/art.asp?articlekey=757http://www.medicinenet.com/script/main/art.asp?articlekey=697http://www.medicinenet.com/script/main/art.asp?articlekey=39805http://www.medicinenet.com/script/main/art.asp?articlekey=45603http://www.medicinenet.com/script/main/art.asp?articlekey=505http://www.medicinenet.com/script/main/art.asp?articlekey=45799http://www.medicinenet.com/script/main/art.asp?articlekey=43903http://www.medicinenet.com/script/main/art.asp?articlekey=404http://www.medicinenet.com/script/main/art.asp?articlekey=408http://www.medicinenet.com/script/main/art.asp?articlekey=8059http://www.medicinenet.com/gout/page2.htmhttp://www.medicinenet.com/gout/page2.htmhttp://www.medicinenet.com/gout/page2.htmhttp://www.medicinenet.com/script/main/art.asp?articlekey=8059http://www.medicinenet.com/script/main/art.asp?articlekey=408http://www.medicinenet.com/script/main/art.asp?articlekey=404http://www.medicinenet.com/script/main/art.asp?articlekey=43903http://www.medicinenet.com/script/main/art.asp?articlekey=45799http://www.medicinenet.com/script/main/art.asp?articlekey=505http://www.medicinenet.com/script/main/art.asp?articlekey=45603http://www.medicinenet.com/script/main/art.asp?articlekey=39805http://www.medicinenet.com/script/main/art.asp?articlekey=697http://www.medicinenet.com/script/main/art.asp?articlekey=757http://www.medicinenet.com/script/main/art.asp?articlekey=378http://www.medicinenet.com/script/main/art.asp?articlekey=378http://www.medicinenet.com/script/main/art.asp?articlekey=8709http://www.medicinenet.com/script/main/art.asp?articlekey=24750http://www.medicinenet.com/script/main/art.asp?articlekey=943http://www.medicinenet.com/gout/article.htm


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9. Tanda dan Gejala Arthritis GoutTerdapat 4 tahap perjalanan klinis dari penyakit gout yang tidak diobati:

1. Hiperurisemia asimtomatikDalam tahap ini paseien tidak menunjukkan gejala-gejala selain dari peningkatan

asam urat serum. Hanya 20% dari pasieen hiperurisemia asimtomatik yang berlanjutmenjadi serangan gout akut.

2. Arthritis gout akutPada tahap ini terjadi awitan mendadak pembengkakan dan nyeri yang luar biasa,

biasanya pada sendi ibu jari kaki dan sendi metatarsophalangeal. Arthritis bersifat

monoartikular dan menunjukkan tanda-tanda peradangan local. Mungkin terdapat

demam dan peningkatan jumlah leukosit. Serangan dapat dipicu oleh pembedahan,

trauma, obat-obatan, alcohol, atau stress emosional. Tahap ini biasanya mendorong

pasien untuk mencari pengobatan segera. Sendi-sendi lain dapat terserang termasuk

sendi jari-jari tangan, lutut, mata kaki, pergelangan tangan, dan siku. Serangan gout

akut biasanya pulih tanpa pengobatan, tetapi dapat memakan waktu 10 14 hari.

Perkembangan dari serangan akut goutumumnya mengikuti serangkaian peristiwa

berikut ini. Mula-mula terjadi hipersaturasi dari urat plasma dan cairan tubuh.

Selanjutnya diikuti oleh penimbunandi dalam dan sekeliling sendi. Mekanisme

terjadinya kristalisasi urat setelah keluar dari serum masih belum jelas. Serangan

gout seringkali teradi sesudah trauma local atau rupture tofi (timbunan natrium

urat) yang mengakibatkan peningkatan cepat konsentrasi asam urat local. Tubuh

mungkin tidak dapat mengatasi peningkatan ini dengan baik sehingga terjadi

pengendapan asam urat di luar serum. Kristalisasi dan penimbunan asam urat akan

memicu serangan gout. Kristal-kristal asam urat memicu respons fagositik oleh

leukosit, sehingga leukosit memakan kristal-kristal urat dan memicu mekanisme

respons peradangan lainnya. Respons peradangan ini dapat dipenngaruhi oleh lokasi

dan banyaknya timbunan kristal asam urat. Reaksi peradangan dapat meluas dan

bertambah sendiri, akibat dari penambahan timbunan kristal serum.

3. Arthritis gout intercriticalTidak terdapat gejala-gejala pada masa ini, yang dapat berlangsung dari beberapa

bulan sampai tahun. Kebanyakan orang mengalami serangan gout berulang dalam

waktu kurang dari 1 tahun jika tidak diobati.

4. Gout kronisPeradangan kronik akibat kristal-kristal asam urat mengakibatkan nyeri, sakit, dan

kaku, juga pembesaran dan penonjolan sendi yang bengkak. Serangan akut arthritis

gout dapat terjadi dalam tahap ini. Tofi terbentuk pada masa gout kronik akibat


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insolubilitas relative asam urat. Awitan dan ukuran tofi secara proporsional mungkin

berkaitan dengan kadar asam urat serum. Bursa olecranon, tendon Achilles,

permukaan ekstensor lengan bawah, bursa

infrapatelar, dan heliks telinga.


The small joint at the base of the big toe is

the most common site of an acute gout

attack of arthritis. An acute attack of gouty

arthritis at the base of the big toe is

medically referred to as podagra. Other

joints that are commonly affected includethe ankles, knees, wrists, fingers, and elbows. Acute gout attacks are characterized by a rapid

onset of pain in the affected joint followed by warmth, swelling, reddish discoloration, and

marked tenderness. Tenderness can be intense so that even a blanket touching the skin over

the affected joint can be unbearable. Patients can develop fever with the acute gout attacks.

These painful attacks usually subside in hours to days, with or without medication. In rare

instances, an attack can last for weeks. Most patients with gout will experience repeated attacks

of arthritis over the years.

Uric acid crystals can deposit in tiny fluid-filled sacs (bursae) around the joints. These urate

crystals can incite inflammation in the bursae, leading to pain and swelling around the joints (acondition calledbursitis). In rare instances, gout leads to a more chronic type of joint

inflammation that mimicsrheumatoid arthritis.

In chronic (tophaceous) gout, nodular masses of uric acid crystals (tophi) deposit in different

soft-tissue areas of the body. Even though they are most commonly found as hard nodules

around the fingers, at the tips of the elbows, in the ears, and around the big toe, tophi nodules

can appear anywhere in the body. They have been reported in unexpected areas such as in the

vocal cords or (rarely) even around the spinal cord. When tophi appear in the tissues, the gout

condition is felt to represent a substantial overload of uric acid within the body.

http://www.medicinenet.com/gout/page3.htm

10.Factor resiko dari Arthritis Gout- Diet tinggi purin pada orang yang mempunyai kelainan bawaan dalam

metabolism purin sehingga terjadi peningkatan produksi asam urat. Tetapi diet
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rendah purin juga tidak selalu dapat menurunkan kadar asam urat serum pada

setiap keadaan.

- Minuman beralkohol dapat menimbulkan serangan gout karena alcohol

meningkatkan produksi asam urat. Kadar laktat darah meningkat sebagai akibat

produk sampingan dari metabolism normal alcohol. Asam laktat menghambatekskresi asam urat oleh ginjal sehingga terjadi pengingkatan kadarnya dalam serum.

- Obat-obatan sejumlah obat dapat menghambat ekskresi asam urat oleh ginjal

sehingga dapat menyebbakan serangan gout. Diantaranya adalah aspirin dosis

rendah (kurang dari 1 sampai 2 gr/hari), sebagian besar diuretic, levodopa,

diazoksid, asam nikotinat, asetazolamid, dan etambutol.


Interestingly, one study demonstrated an increased prevalence of abnormally low thyroid

hormone levels (hypothyroidism) in patients with gout.

In patients at risk of developing gout, certain conditions can precipitate acute attacks of gout.

These conditions includedehydration, injury to the joint,fever, excessive eating, heavy alcohol

intake, and recent surgery. Gout attacks triggered by recent surgery are probably related to

changes in the body-fluid balance as patients temporarily discontinue normal oral fluid intake in

preparation for and after their operation.

http://www.medicinenet.com/gout/page2.htm

11.Klasifikasi dari Arthritis Gout

12.Pemeriksaan penunjangDIAGNOSIS:

Gout is suspected when a patient reports a history of attacks of painful arthritis, particularly at

the base of the toes. Ankles and knees are the next most commonly involved joints in gout.

Gout usually attacks one joint at a time, while other arthritis conditions, such assystemic

lupusand rheumatoid arthritis, usually attack multiple joints simultaneously.

The most reliable test for gout is finding uric acid crystals in a sample of the joint fluid obtainedbyjoint aspiration(arthrocentesis). Arthrocentesis is a common office procedure performed

under local anesthesia. Using sterile technique, fluid is withdrawn (aspirated) from the inflamed

joint using a syringe and needle. The joint fluid is then analyzed for uric acid crystals and for

infection. Shiny, needle-like uric acid crystals are best viewed with a special polarizing

microscope. The diagnosis of gout can also be made by finding these urate crystals from
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