bronchitis

Definitions
Bronchitis is an inflammation in the bronkus (channel air to the lungs).
Bronchitis acute pneumonia bronko fact is that more light.
Causes
The causes can be viruses, bacteria or mikoplasma.
Clinical picture
Coughing sputum
(sputum can reddish color), when stive
do sports activity or a light, often suffering from respiratory infection
(eg flu), asthma, tired, ankle swelling, foot and
left and right leg, face, a hand or the mucous membrane color
redness, appear reddish cheeks, headache, vision disturbances.
Infeksiosa bronchitis often starts with symptoms such as runny nose, the nose
slimy, tired, shivering, back pain, muscle pain, fever and mild pain
throat.
Coughing is usually the sign of the start of bronchitis. Initially, cough
sputum not, but 1 - 2 days and then will issue a colored sputum
white or yellow. Next will be a lot of phlegm, yellow
or green.
In the heavy bronchitis, after most of the other symptoms improved, sometimes
high fever occurred during 3 - 5 days and the cough can settle for a few
sunday.
Shortness of breath occurs when airways clog.
Often found breath sounds, especially after coughing.
Pneumonia can occur.
Diagnosis
diagnosis is usually based on symptoms, particularly from the
mucus.
On examination with a stethoscope will be using sound
ronchi or the abnormal breathing sounds.
treatment

To reduce the fever, malaise and body, to the people
adults can be given paracetamol or asetosal; to children
should be given only paracetamol.
It is advisable to rest and drinking lots of liquids, and
stop the smoking habit.
Antibiotics given to patients who show symptoms that
it is a bacterial infection (sputum yellow or green
and remain high) and people who have previously
phthisis.
Given to people with Kotrimoksazol adult. Tetrasiklin 250 - 500 mg
4 x per day. Either erythromycin 250 - 500 mg x 4 a day given for 7 - 10 days.
Dose for children: either erythromycin 40 - 50 mg / kgBB / day. although
it is suspected Mycoplasma pneumoniae.
To people with children given amoxicillin.
If there are signs on the patient immediately obstruksi refferal to hospital

Stone in the urine channel

		Definitions Stones in the urine channel (uriner calculus) is a mass petrous made along the lines chew and can cause pain, bleeding, stoppage or the flow of urine infection. Causes Many of the factors to influence the occurrence of stones in the urine channel, such as drinking less, metabolic disturbances. Clinical picture - The stones can form in the kidney (kidney stones) and in the uterus urine (bladder stones). The process of stone formation is called urolitiasis (litiasis renalis, nefrolitiasis). - Stone, especially the small, can not cause symptoms. Stone in the channel chew up the cause kolik, while under the hamper small void. - Stone clog the ureter, pelvis and renalis can tubulus renalis cause back pain or kolik renalis (kolik a great pain in the area between the rib and pelvis, which is also spreading to the stomach the genitals and inner thigh). - Other symptoms are nausea and vomiting, stomach bubble, fever, quiver and the blood in the urin. People may often be un - urine, especially when stones pass ureter. - Urin often red meat such as dishwater and microscopic eritrosit show many times and have leukosit. - The stones can cause urine infection channels. If the flow of rock clog urine, the bacteria will be trapped in urin collected over stoppage, so that there were infections. - If the stoppage lasts this long, urin will flow back to channels in the kidney, the emphasis will be distend kidney (hidronefrosis) and in the end can happen kidney damage. Diagnosis Stones that do not cause symptoms, may not be known deliberate on a routine inspection analysis urin (urinalisis). Stone that causes pain is usually diagnosed based on symptoms kolik renalis, along with the pain in the back and press selangkangan or pain in the genitals with no clear cause. Urin mikroskopik analysis could indicate the existence of blood, pus or crystal a small stone. Usually does not need to be other checks, except if painful settle more than a few hours or diagnosisnya not sure. Additional checks that could help establish the diagnosis is urin collection 24 hours and blood sampling to assess calcium content, sistin, acid fiber and other materials which can cause the occurrence of stones. treatment Kolik overcome with the injection spasmolitik: atropin 0.5 - 1 mg im adults. When there is an infection should be given antibiotics: kotrimoksazol 2 x 2 tablets amoksisilin or 500 mg peroral x 3 a day for adults. Or the other which can be used. Small stones that do not cause symptoms or stoppage of infection, usually need not treated. Drinking lots of fluids will improve and help the establishment of urin throw some stones. If you have terbuang stone, then there is no need to treatment is done immediately. Stone renalis in the pelvis or ureter the top of the size of the 1 centimeters or less can often be solved by ultrasonic waves (Extracorporeal Shock Wave Lithotripsy, ESWL). Fraction next stone will be removed in urin. Immediately refer to the hospital if there is an indication of the operation, such as: o Stone> 5 mm o are Obstruksi / weight o Stone in the urine channel proksimal o recurrent infection o During the observation of stone can not be down

ASMA BRONKIALE

Definitions
Asthma is a condition in which the channel breath because constringency
hiperaktivitas against a particular stimulus, which causes inflammation and
constringency a while.
Causes
According to The Lung Association, there are two factors that a spark asthma:
1. Triggers (trigger) that cause respiratory tract and terganggunya
tauten menyempitnya or cause respiratory tract
(bronkokonstriksi) but does not cause inflammation, such as:
- Changes in weather and temperature.
- Irritated something that is alergen, such as cigarette smoke, pollen,
dust, fur, smoke, cold air, and sports, insecticides, dust,
air pollution and pets.
- Respiratory tract infection.
- Disturbances emotions.
- Work Sports physical or excessive.
2. The cause (inducer) in the mast cells release the material along bronki
histamin and leukotrien such as the response to foreign substances (alergen),
such as pollen, dust, which is fine in the house or fur,
the cause:
- Smooth muscle contraction
- Increase the formation of mucus
- Transfer of certain white blood cells to bronki.
that lead to inflammation (inflammation) in the respiratory tract
where this will reduce the diameter of the airways (called
bronkokonstriksi) and refinement of this should cause
exert every effort in order to breathe.
Clinical picture
-Difficult breath on asthma typically accompanied voice mengi due to difficulties expiration
- On auskultasi hear wheezing and ekspirasi sweep.

- The state of chock-marked with great musculature giatnya help
respiratory and sianosis known to the status that can asmatikus
fatal consequences.
- Dispnoe in the morning and throughout the night, after physical exercise (especially
when the cold weather), related to the infection channels of breath up,
associated with exposure to alergen such as pollen and fur
animals.
- Coughing that long in the morning and late at night, dealing with
iritatif factors, batuknya can be dry, but often there is a clear mukus
ekskresi channel of breath.
Diagnosis
Asthma diagnosis sometimes can ditegakkan on the basis of anamnesis and
auskultasi. Wheezing in the end ekspirasi almost always a sign of disease
paru obstruktif such as asthma. In the mild asthma, auskultasi almost always normal
when patients asimtomatik.
treatment
- The spark attacks wherever possible eliminated.
- In the light of attacks can be given injections adrenalin 1: 1000 0.2 - 0.3
ml subkutan that can be repeated several times with intervals of 10 - 15
minutes. 0.01 mg dose of the child / kgBB that can be repeated with
attention to blood pressure, pulse and respiration function.
- Bronkodilator is selected teofilin 100 - 150 mg x 3 a day on people
and adults 10 - 15 mg / day for children kgBB.
- Other options: Salbutamol 2 - 4 x 3 mg a day for adults
- Efedrin 10 - 15 mg x 3 a day can be used to add property
theofilin.
- Prednison only when needed medicines and above does not help
given only a few days to prevent asmatikus status. But
pemberiannya should not be delayed.
- People with status asmatikus require oxygen, and parenteral therapy
so that intensive care should be referred to the action as early
following:
People diinfus glucose 5%
Aminofilin 5 - 6 mg / kgBB injected iv slowly when the patient has not been
teofilin obtain oral.

Prednison 10 - 20 mg x 2 a day for several days, and then
derived dose as soon as possible so that it can be stopped.
If it has not tried to overcome adrenalin, it can be used
first adrenalin.

ARTRITIS

Definitions
Artritis is a general term for inflammation (inflamasi) and swelling in
joint area.
Causes
Artritis can be osteoartritis (oa) or artritis reumatoid (AR), but the
most often encountered in the osteoartritis. On the main factors oa
is a trauma or pengausan joints, while the immunological factors that AR
a role.
Clinical picture
- Artritis Symptoms vary depending on which joints are involved. Oa more often
the joint patron of the body. Therefore, the need to Obesity
avoided. Meanwhile, the AR first attack more often hinge-joint
small joints such as wrists or legs, but in advanced
can also attack joints such as large-joints and shoulder joints pinggul.
- Complaints that artritis is similar to the actual reumatism
network software comes from outside the joints. Which is known as a common rheumatism
most are reumatism.
- joints who fell ill usually swollen, red and painful.
- AR attack usually starts with prodromal symptoms such as body weakness,
lost appetite, stiff and sore all over the body. Symptoms usually in the joints
gradually emerged after several weeks or months.
- joints pain are missing in the AR-relief, there is the Remisi, are symmetrical
bilateral, and associated with cold air.
- Oa attacks usually sesisi. Main symptom is a painful joints
related to the movement. People also feel stiff in the joints
fell ill.
- On Radiology oa checks usually shows widening joints
at the initial stage, osteofit, sklerosis constringency hollow bones and joints between
go on stage.
- Deformitas can occur oa and AR occurred after destruksi joints.

Diagnosis
Pain and swelling in the joint area.
treatment
- Complaints on the joints or the network software in the surrounding areas can be take
painkillers or with nonsteroid anti inflamasi given after
eat.
Asetosal 1 gram a day x 3
Fenilbutason 200 mg x 3 a day
Ibuprofen 400 mg x 3 a day
- Spell joints needed in critical condition. Next on oa,
may need to improve the attitude of the body, reducing body weight,
or doing physiotherapy.

Antraks

Definitions
Antraks is a disease in wild animals, and pets, that is
animal-ruminant animals (herbivora), such as cows, buffaloes, goats, sheep,
pigs and horses. The disease is spread to humans, especially in people who
always related to work / adjacent to the livestock such as
cattle farmers, shepherds, veterinarians, laboratory workers, factory workers stuff
skin and bones.
Causes
Antraks bacteria (Bacillus anthracis)
Ways of transmission
This disease is usually transmitted to humans by the entrance or spore
basil antraks into the body through various ways, namely through the skin abrasions
or injury that caused skin antraks, through the mouth because the food material contamineted
food, causing intestinal antraks (digestion), inhalation
cause respiratory tract antraks pulmonal. Antrak brain inflammation
(meningitis) in general is a form of continuity antraks skin, intestinal or
pulmonal. Antraks pulmonal meningitis and very rarely been reported in Indonesia.
Going the way of direct contact with the animal people, for example,
contact with the blood out of the holes kumlah dead animals because
antraks or materials that come from animals that tercemar by spore
antraks, such as meat, offal, skin, flour, wool, and so forth. Beside
that, penularannya other sources of potential ligkungan is, among other lands,
plants (vegetables) and water tercemar by spore antraks.
Clinical picture
1. Clinical picture Antraks Skin
- Incubation period of 7 days (average 1-7 days)
- Gatal place lesi
- Papel
Basic guidelines Medicine Clinic in 2007
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- Vesikel
- Ulkus (tukak) in the middle there is a network-shaped scab nekrotik
black (the patognomonik antraks) and is usually found
eritema and oedema around tukak. In the palpability, udema is not
software and does not dent (non-pitting) when pressed. Not be here
pus unless followed by secondary infection.
- It can happen lymph gland enlargement regional
- The current fever, headache, malaise rarely have
- Predileksi antraks skin usually on the open places, such as face,
neck, arms, hands, and feet
- Antraks skin that is not treated will grow worse with the
limfe spreading to the gland, and blood continues to flow, so that
septikemia cause mortality and 5 - 20%
- Bacteriological examination of eksudat in the skin obtained lesi
the bacillus that sediaan on clear and positive culture.
2. Clinical picture Antraks intestinal
- Incubation period varies between 2 - 5 days
- The early symptoms nausea, no appetite and increased temperature
- Vomiting
- Health intense stomach
- Constipation
- It can also occur acute gastro-enteritis which sometimes bloody,
hematemesis, general weakness, fever, and there is the exposure history
with animals or food products.
- Bacteriological examination of specimens obtained feces of basil
sediaan on a clear and positive culture.
Diagnosis
1. Suspect antraks skin
When the case or the "explosion" in the animal or antraks history
the exposure to animals / animal origin of the materials and the environment tercemar
by spore / basil antraks and aberration found in the skin form of tukak
network with dead-shaped black scab in the middle (eskar),
around tukak redness, swollen, on the swollen area palpability
is not soft and does not dent and is usually not available unless the pus
followed by secondary infection.
Basic guidelines Medicine Clinic in 2007
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2. People with skin antraks (definitive diagnosis)
If the suspect is already antraks skin with diagnosisnya
bacteriological examination.
3. Suspect antraks intestinal
When the case or the "explosion" in the animal or antraks history
the exposure to the animals or food products and found the heat
with stomach pain and vomiting.
4. People with intestinal antraks (definitive diagnosis)
If the suspect is already antraks skin with diagnosisnya
bacteriological examination.
Penatalaksanaan
- Drugs choice (drug of choice) for people with skin is antraks penicillin.
Procain with a dose of penicillin 1.2 million IU im x 2 a day for 5 - 7 days
or benzilpenisilin with 250,000 IU dose every 6 hours. Before giving
do penicillin skin test. People who hipersensitif against penicillin
tetrasiklin can be given with the dose of 500 mg, 4 x day for 5 - 7 days.
Should not be given to children under age 6 years. Another drug of choice
is kloramfenikol.
- In the intestinal antraks be given penicillin G 18 - 24 million units per day
the intravena, can be added tetrasiklin 1 gram per day.
- Simtomatis medicine and drug-suportif if necessary
- Refer to the hospital when needed.
Prevention
- People are requested to report to the local health clinic when a suspect
antraks and report to the Farm when there is a sick animal with symptoms
antraks
- Not allowed to slaughter animals sick antraks
- Not allowed to consume meat derived from animals
sick antraks
- Not allowed to make goods that originate from animals such as
craft's horn, leather, fur, bones that come from animals sick / dead
because antraks disease.
- Mandatory health Health Department to report to the district when
meet people / antraks suspects.

ANGINA PEKTORIS

Definitions Angina is the clinic pektoris marked with malaise or pain in the chest due to heart muscle iskemia network. The clinical forms of angina divided in two forms, namely stable angina and unstable. Angina is an unstable form of a more serious that can be become and / or is a form of early infark so miokard people need to be examined further and diobservasi in the hospital. Causes Iskemia this occurred because the supply of oxygen carried by the coronary blood flow not sufficient oxygen miokardium needs. This occurs when the demand miokardium increased oxygen (for example, because of physical, emotional, tirotoksikosis, hypertension), or when the coronary blood flow is reduced (for example, or on spasme trombus coronary) or when they occur. Clinical picture - People complain of chest pain and various forms of location. - Nyeri started feeling as terhimpit, feeling squeezed or feel the burn spread to the inside of the left arm and sometimes up to the neck, shoulder neck and left, even to the left pinkie. - The same can be spread to the waist, throat, teeth and jaw also have to submit the right arm. - Men do not feel can be felt also in the Ulu heart, but rarely felt in the region apeks kordis. - Pain may be accompanied by painful beberapan or one of the following symptoms: sweating cold, nausea and vomiting, feeling weak, feeling the pulse and fainting (fainting). - Usually angina occur when physical activity (stable angina). - The attack will be lost if patients stop the physical activity is and rest. - The attack lasted only a few minutes (1 - 5 minutes) but can be up to more than 20 minutes. - Nyeri angina is constant. When changes occur, for example long attacks increased, more intense pain, the incidence of attacks threshold Basic guidelines Medicine Clinic in 2007 17 - Decreased or when the attack came up to bed, then the interference is necessary to diwaspadai. This change may be a sign prainfark (angina not stable). - A form of change (variant), which is called angina Prinzmetal usually arise when people are resting. - Angina said gain weight when the attack occurred after the next physical work that is lighter, for example, after eating. This is also classified unstable angina. - Check out the physical attack does not generally show a deviation means. At the time of attacks, increased heart rate, blood pressure and increased in the region prekordium hard jolt the heart feels. - On auskultasi, the voice sounded much the heart, the sound noisy sistolik mid or late sistol and heard the sound of the fourth. - Usually found risk factors: hypertension, or diabetes melitus Obesity. Diagnosis - Retrosternal chest pain - Checking EKG Penatalaksanaan - Aberration preference angina pektoris be searched, then reduced or treated. Factors that aggravate such as smoking, body weight excessive, drinking habits and coffee should be avoided. - High blood pressure treated. - Stress is - Angina is not stable, it is treated in the hospital. 1. Treatment of acute - Acute attacks with the rest in order to overcome the heart of activity is reduced. Vasodilator work to improve the provision of oxygen and reduce oxygen consumption, heart. - Sublingual nitroglycerine 0.15 - 0.6 mg is very effective. Tablet can be used several times each day without side effects except headaches. 1 When the tablet has not been repeated may help, but when repeated after 3 times symptoms do not diminish the possibility has occurred infark. - Isosorbid dinitrat (ISDN) sublingual 2.5 - 5 mg can also be repeated oral tablet or 5 - 30 mg. Basic guidelines Medicine Clinic in 2007 18 2. Prevention of attacks - Propranolol for angina pektoris effective because it can reduce the work heart muscle so that the heart needs oxygen. Effect clinic propranolol achieved when the heart rate in the rest 60 - 70 times / minute. Initial dose: 20 mg x 2 a day. Maximum dose: 120 mg a day. This medicine should not be used in angina Prinzmetal. - Nitrate working long: ISDN oral tablet 10 - 20 mg x 2 a day. - Nifedipin 10 - 20 x 4 mg a day, or diltiazem 30 - 60mg x 3 a day, verapamil or 40 - 80mg x 3 a day. - Angina unstable: need special care. - Angina variants: strong dilator: nitrate, calcium antagonis, prazosin 0.5 - 1mg X 3 a day with titrasi.
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anemia

	Definition Anemia can be classified according to several criteria, but the most is a practical way of grouping based on the occurrence of post-Anemia bleeding, anemia hemolitik, defisiensi anemia, anemia and anemia aplastik because of violence. CAUSE Production of blood that is not enough (because defisiensi or bone marrow failure), excessive blood loss, excessive destruction of blood or a combination from these factors. Loss of blood and chronicles the secret, for example, in ankilostomiasis, cause anemia defisiensi Fe, while the other occurred between hemolisis defisiensi on G6PD and talasemia. Clinical Overview - Anemia due to the sudden loss of blood and many will homeostatis compensation body. Acute blood loss as much as 12 - 15% will give the symptoms of pale, takikardia with normal blood pressure or low. Lost 15 - 20% cause blood pressure to drop shock, and 20% loss can result in death. - Anemia defisiensi marked with a limp, often pulse, tired and grouchy headaches. Papil appear atrofi tongue. Heart swell and sometimes sounds murmur sistolik. At the edge of the blood picture appear anemic and hipokrom mikrositer, while low serum iron content. - Defisiensi acid and vitamin B12 anemia folat cause megaloblastik which may be accompanied by neurological symptoms. - Anemia hemolitik be followed by an increase in blood bilirubin (ikterus). Spleen is generally limited. - Anemia aplastik visible from the low rate of Hb and other systemic symptoms, without enlarging the organ. Diagnosis Inspection rate and blood Hb edge. general Hb <12 g / dl. Treatment guidelines in the Basic health 2007 15 Dealing - Successful treatment depends greatly on the ability to enforce on the level of early diagnosis. - Anemia pascaperdarahan overcome by transfusion of 10 - 20 ml / kgBB, or plasma expander. If there is no both, intravenous fluids the other can also be used. - Impact of slow can be overcome with packed red cell transfusion. - Anemia defisiensi iron overcome with adequate food, sulfas ferosus 10 mg / day kgBB 3 x Iron or shut 1mg/kgBB/hari - Anemia megaloblastik specific treatment, therefore, must be distinguished cause, defisiensi vitamin B12 or defisiensi acid folat. Doses of vitamin B12 100 mcg / day im, for 5 - 10 days as initial therapy followed by therapy rumat 100-200 mcg / be achieved remisi until months. Dose of acid folat 0.5 - 1mg/hari in oral for 10 days, resumed with 0.1 to 0.5 mg / day. The use of oral vitamin B12 is not no use in anemia pernisiosa. In addition, the thin oral more expensive. - Hemolisis autoimun overcome by prednison 2 - 5 mg / kgBB / day and peroral testosteron 1 - 2 mg / kgBB / day iv, for the long term. - Blood transfusion given only when it is needed. - Refer to the hospital
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VARISELA

Varisela or chickenpox, which is marked with vesikel in the skin and mucous membrane of this
very easily spread through saliva and contact spray. Transmission can be
occurred since 24 hours before arising aberration skin to 6 - 7 days later.
CAUSE
Varicella zoster virus.
The clinical picture
- The period of incubation 13 - 17 days.
- Symptoms of early form of dizziness, headache, fever and that is not so high.
This phenomenon is not so clear in children under five, but prominent in children age
over 10 years.
In adults, this complaint can be violent.
- Aberration skin appear initially morbili as in, and form makula
papula that became clear vesikel contain liquids. This change
take place within 24 - 48 hours.
- Rash usually more in the body than with members of the movement.
The typical on varisela this is a rash of various kinds can be found
in a moment.
- In the form of the weight difference arises in the skin throughout the body.
Diagnosis
Based on the clinical picture of Tracy with the characteristics (fluorosensi
that are papulo vesikuler that multiforme and centrifugal process penjalarannya)
Dealing
- Medicine, which provided only a simtomatis: parasetamol when fever
is very high. Do not give asetosal in children, because it can cause
reye syndrome.
- Patients are encouraged with the bath water and soap. Potassium Permanganate and
Other antiseptic is not recommended.
Then give salisil powder 1%. Try to vesikel not broken and
experienced a secondary infection.
- When there is secondary infection: Inject penicillin prokain 50,000 IU / kgBB / day
for 3 days or give Amoksilin 25 - 50 mg / kgBB / day peroral.
- Collaboration re-examined after a week.
- When you need the asiklovir 200 - 400 x 5 mg a day early in the disease
for 7 days.

XEROFTALMIA

Definition
Xeroftalmia eye aberration is due to vitamin A deficiency, especially in the
Young children and children are often found in people with malnutrition and lack of nutrition.
CAUSE
The factors that cause the high Xeroftalmia cases in Indonesia are:
- Consumption of foods that are less / does not contain enough vitamin A or
pro-vitamin A for long time
- Babies are not breastfed get Exclusive
- Disturbances of the absorption of vitamin A
- The high number of infection in children (Gastroenteritis / diarrhea)
Clinical Overview
1. Reversible symptoms:
- Blind dusk (Hemeralopia)
- Xerosis konjungtiva: namely konjungtiva dry, thick,
berkeriput, and muddy because many spot
pigment
- Xerosis corneas: konjungtiva corneas dry, thick,
berkeriput and muddy because many spot
pigment
- Bitot spot: benjolan the form of dry deposition and foamy
The silvery-gray color contains remnants
epitel konjungtiva damaged.
2. Symptoms irreversible: ulserasi cornea and sikatriks (scar)
Diagnosis
The diagnosis was based on the symptoms and the results of the eye.

- Then give salisil powder 1%. Try to vesikel not broken and
experienced a secondary infection.
- When there is secondary infection: Inject penicillin prokain 50,000 IU / kgBB / day
for 3 days or give Amoksilin 25 - 50 mg / kgBB / day peroral.
- Collaboration re-examined after a week.
- When you need the asiklovir 200 - 400 x 5 mg a day early in the disease
for 7 days.
Treatment guidelines in the Basic health 2007
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Dealing
- Provide 200,000 IU Vitamin A in oral or 100,000 IU Vitamin A injection
- Next Day, give 200,000 IU Vitamin A in oral
- 1 - 2 next week, give 200,000 IU Vitamin A in oral
- Medical diseases that accompany the infection
- Medical aberration eye, occurs when the
- Improve the nutrition status

abortus

	ABORTUS Definition The process of pregnancy interruption before the fetus can survive outside the womb. Limit use pregnancy as less than 22 weeks or fetal weight less than 500 grams. CAUSE Most of the chromosomal aberration is due to the results of conception. Some Other causes are trauma, and the difference means that the content is not known. Clinical Overview - Establishment of the symptoms of pregnancy (late cramps, nausea / vomiting in the morning) that vagina accompanied by bleeding (starting spot to gather) and / or pain in the lower abdomen, abortus lead to the diagnosis. - Abortus Imminens (Threats miscarriage) vagina marked with a little bleeding, pain or no stomach bit. Currently there are opening serviks - Abortus Insipiens (miscarriage ongoing) vagina many bleeding (can gather up-cob), stomach pain great, there are opening serviks. Sometimes it appears the network results ostium in the draft serviks. - Abortus Inkompletus (abortion is not complete) vagina many bleeding, stomach pain sedangsampai great. Historical out the results of the network concept in part, ostium serviks can still open or start closed. - Abortus Kompletus (complete miscarriage) vagina reduced bleeding starts - stop, no stomach pain, ostium serviks have been closed. Historical results out of the network concept intact, entirely. - Missed Abortion (miscarriage, which endured) Abortus with the results of the draft still detained intra uterin for 2 weeks or more. Historical vagina little bleeding, no stomach pain, ostium serviks still closed. Enlarging uterus is not appropriate (smaller) from the age gestasi that should be. Treatment guidelines in the Basic health 2007 6 Diagnosis - Is menstruation (amenorhea) less than 22 weeks. - vagina bleeding, the results may be accompanied by a network of conception. - Feel pain in the area of the simpisis. - Opening ostium serviks. Dealing In the non-care health centers: Abortus Imminens - lying at least 2 - 3 days (as in-patient) - not coitus - After tirah lying 3 days, re-evaluation of the diagnosis, if still abortus imminens tirah continue lying in the - Mobilization (and sitting - standing - running) starts when believed there is no bleeding pervaginam 24 hours Abortus next level - If possible do with the general stabilization circumstances exempting the road breath, giving oksigenasi (O2 2 - 4 liters per minute), installation of liquids intravenous kristaloid (Ringer Laktat / Ringer acetate / NaCl 0.9%) according resusitasi guidelines. - Patients referred vital signs after the normal limits to health Or hospital treatment At the health center treatment Abortus Imminens - As in the non-health care Abortus Insipiens - Antibiotic profilaksis: Ampisilin iv before kuretase action. - It needs to be done immediately the results of conception and evacuation kavum uteri. Abortus can be done with pliers, spoon curette, and curette HANDICAP - Uterotonika: Oksitosin 10 IU i.m Abortus Inkompletus Needs to be done immediately drain kavum uteri. Can be done abortus with tongs, spoon curette, and curette HANDICAP Treatment guidelines in the Basic health 2007 7 - Immediately on Emergency: 1. Oksigenisasi 2 - 4 liters / minute 2. Giving liquids iv kristaloid (NaCl 0.9%, Ringer Laktat, Ringer Acetate) 3. Transfusion when Hb less than ' 3d 8 g / dl Abortus Kompletus - Evaluation of complications does abortus (anemia and infection) - If found complications, adjusted Dealing - If no complications, does not need special Dealing. Missed Abortion - Evaluation of Hematology routine (hemoglobin, hematokrit, leukosit, trombosit) and hemostasis test (fibrinogen, bleeding time, freezing time). - If interference occurs deed hemostasis and hipofibrinogenemia, immediately refer the in hospitals that are able to transfusion trombosit / Buffy-Coat and other blood components. - The need to construct evacuation from kavum uteri. Implemented after ensure there is no interference function hemostasis.
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Acupuncture

Introduction Acupuncture

Acupuncture comes from the Latin word which means acus needle and pungere intend bill ..Acupuncture is similar to medical technique that uses needle puncture needle-fine point on the body known as the 'acupunture point'.

Acupuncture treatment can be said has been used by various communities such as the ancient civilization of the early people Bunti Africa, the Arab Tigris, ancient Egypt, India and China. However, medical experts gave their homage to China. This is because akupuntur this practice has long been practiced by Chinese rakyar which since 4000 years ago and forwarded that day.

History also proves there bahawabangsa China is the first nation in the world record in the history of medical akupuntur. This is evident when the emperor of China has written the book in full to ask 'IT Huang The Yellow Emperor Canon of Medicine' that be in the year 2000 BC. The book is translated in savings of an author in Beijing, China.

Features - characteristics Akupuntur

Akupuntur treatment differed little in the way of treatment of people with ancient China Treat the present time. First, the use of ancient China

stone - a sharp stone, wood and bamboo as a basis for treatment and pressing on the puncture - a certain portion. But now, the tool - this basic equipment is replaced with a more modern way, namely the use of jaurm - a fine needle has been sterilized or disucihamakan. Needle - this is the needle of various materials such as metal, silver needle syringe or silver, copper or copper needles, syringes and gold.

Syringe needle termahal gold is among the needle - fine needle. This needle can be trusted to energy 'Qi' 100 times than the double silver needle. Qi energy is the energy that moves us to find. If the energy flux is disrupted, then our body will feel sick.

In the needle-fine needle is, which is already available magnetic power over to the needle. This allows us feel like pulse - throbbing, numb, heavy and swelling when the needle - the needle being at a point in the typical body. Sense that we naturally this is known as' Deqi, 'and he spent the flow of electricity through what is called as kolestrol, channels, or meridian. In this case, all sense of pain or can be issued through the power of Qi and so provide adequate relief and cure disease.

Akupuntur medical practitioners that there are 365 Magnetic and Acupuncture is the main and more than 1,000 Magnetic and Acupuncture extraordinary in the human body. Magnetic and Acupuncture extraordinary things existed when the disease on the body's organs will realize the pain and swelling in places far from our organs. For example, pain on Diaphragm can cause pain at the end of the shoulder ..

The akupuntur also mengelaskan part of Magnetic and Acupuncture to 12 in which the main collection point - a point through this combined Meridian. Meridian, which have 12 main meridian circle oversee sex, lung, colon, stomach, limfa, heart, small intestine, Pundi urine, kidneys, Pundi hempedu, and the triple warmer heart. In addition, the number of Magnetic and Acupuncture on the meridian is different. For example, the heart meridian has nine points when urinating Pundi meridian has 67 points.

A leading researcher in pain, namely Dr. Ronald Melzack stated that the pressure on the point - a point pattern is associated with pain and excitement that something short but berkeamatan high point on it through fine needle can relieve pain. In addition, scientific research has been carried on akupuntur in the United States shows that the brain 'endorfin' that can relieve pain in a natural akupuntur during treatment. In most countries such as the United States, United Kingdom, and Hong Kong where there are many types of Heroin biller drugs, how they use akupuntur treatment because it can increase the rate of endorfin in the body. This is because most drugs have a characteristic rate endorfin lower in the liquid spina them.

In 1965, Ronald and Patrick Wall Malzack which investigators recommend that pain has a theory about the existence of similar 'door' in every phase of nerve Allows. The door is always closed and not justify pain stimulus to the brain. In addition, the door in the nerve Allows it be by two stimulus said. Some stimulus is attempting close the doors and some other stimulus also seeks to open doors. However, the advantages to the more partisan stimulus to close the door and this causes the pain does not exist dirasai despite provocation. However, the treatment may act through akupuntur to open and close the door in the nerve Allows effectively.



Form - Form of Modern Akupuntur

Akupuntur in this modern day, there are a variety of techniques practiced by experts akupuntur or akupuntur practitioners. Altogether there are more than 11 forms of modern akupuntur. There is a classic akupuntur where kebiasaanya use needles as fine-needle treatment. There are also electrically akupuntur in which he uses low-voltage electrical stimulator that does not endanger the patients and akupuntur electronic equipment that uses a small electronic equipment.

In addition, the use of blood akupuntur bruise for bruise ready menggeluarkan blood from the body's dirty. There is also a akupuntur bruise for bruise ready to use menyedut wind out of our body. Akupuntur mosibusi is akupuntur the heat on certain points. When akupuntur series, which includes the release of pressure, massage (massage) and reiki. In addition, there are also akupuntur Homeopathic, akupuntur eyes, head, ear, and so forth.

Treatment Akupuntur

Akupuntur said one of the methods of treatment Hipnosis and effective as medicines in the treatment of the sick or Anestetik. Patients may also be aware of the situation when they receive treatment akupuntur. For example, patients can tell the practitioners akupuntur if the needle is not being on Magnetic and Acupuncture. Akupuntur treatment also can be used in caring for someone affected by jet flash. This is proven when treatment has been to restore the skin as usual.

Magnetic and Acupuncture has the nature of electricity is extraordinary. Dots is able to drain off the flow of electricity on the skin and in the area near or associated. However, what is remarkable is the Magnetic and Acupuncture changed to the emotional patients. If the medical review by way of China, he is associated with energy and Qi Yin and the concept. The concept of Yin and the purpose of bringing the organ in the body known as the Yin and also known as the organ in the body that are less good. Yin and the balance in determining the stability of the health agency.

Chinese Medicine also linking weather relationship with 5 elements, namely wood, water, fire, metal and earth, with health and disease. When the organ in the body associated with 5 elements and the Yin and the. For example, liver associated with wood, the heart of the fire, limfa with the earth. However, most of the main methods of diagnosis is akupuntur pulse. This method is important because it can identify the disease that had dihidapi. This facilitates the practitioners - practitioners akupuntur easy to identify with background concerning medical patients. In addition, practitioners of traditional akupuntur can also measure the level of energy in the meridian with the radial artery pulse check on the wrist. Phase energy in the meridian can be reached so that 14 species carotid arteries in both wrists. However, experts think akupuntur pulse 5 or 6 who can return only for medical purpose. In addition, practitioners of traditional akupuntur will also examine the tongue, color, skin tissue, hair tissue, movements and body position, breathing and the sound of a voice in treatment akupuntur. In addition, lifestyle, diet, exercise sufficient sleep, fobia, and the reaction against the disease taken about succession. This process is known as' Mempalpat 'which diagnose Qia conduction disturbances and attacks against the disease in the organ.

Treatment of Akupuntur

The akupuntur holds that only the skills practiced in akupuntur can achieve the desired treatment which want to know where to stimulate the skin. Although there are many ways to stimulate the skin, such as moxibustion, massage, electrical, vibration, mechanical, heat, and magnetic hayunan in Practice good widely, but the method is the best method provocation needle.

Akupuntur needle that consists of silver needle aloi consist of silver and all the needle is diversified iron rust berkalis addition to ensure the position of the needle on Magnetic and Acupuncture, the effectiveness of treatment akupuntur depend on the number of needle akupuntur used, the depth of the skin tunnel, a period of the needle being on Magnetic and Acupuncture and the number of treatment that is run.

When the Magnetic and Acupuncture were related, akupuntur will dicucuk needle on the skin and left some patients, namely from several long time, to several minutes. Some practitioners akupuntur will use to rotate counterclockwise with the end of the finger which aims to stimulate Magnetic and Acupuncture. In addition, they will also merangsangkan Magnetic and Acupuncture needles with the use of electricity.

Patients will not feel pain when treatment akupuntur run. This is because the needle used is very sharp and only a few millimeters only inserted into the skin of the patients. For patients who face disease, which chronicles a little run as a treatment once or twice a week. Conversely, a treatment that is more often given for the disease, which is rather critical. Some patients require four or five akupuntur treatment before making any changes in himself as relaxed feel, fresh, and capable of running the day-to-day activities.

The disease Diubati By Akupuntur

Akupuntur through treatment has many advantages because it can cure many diseases. The World Health Agency (WHO) has outlined several diseases that can be treated with either method through akupuntur. This treatment method can treat the interference in the respiratory system, namely Sinusitis, catarrh, and tonsilitis. Whereas for digestive disturbances such as gastrik, sembilit, sediment and bottom-bowel paralysis. In addition, he also treated as interference in the eye sore eyes and early retinismyopia interference and mouth such as toothache, gum and halkum.

In addition, the use of methods of treatment akupuntur also effective in the disease process which membabit disfungsi physiology headaches, lung, the situation is quite precarious rheumatism, menstrual problems, digestive problems and nerve problems. For example, in Britian the doctor has been treated akupuntur using methods which patients and migraine headaches. Treatment was considered successful in there when 80% of the patients were cured completely.

In addition, some doctor who has been witnessing use surgical methods akupuntur also recognize that in China medical treatment akupuntur open only on the subject disfungsi the physiology but also on the type of disease that requires treatment such as caesarean surgery, tumors, dental surgery and lung patients . All the patients are aware of the situation and did not receive any medicines anestetik. Only the needle akupuntur the dirangsang with electricity in the skin of the patients enter.

Change the Treatment Akupuntur against it.

Although the methods of treatment akupuntur give a good impression to the patients, but there are still issues that are caused due to doubt them. Various issues arising from the effects puncture needle, needle comparison, and so forth.

In fact, the treatment akupuntur get testimony from the WHO. Needle puncture does not bring any pain. This is evident when the needle-needle used is too smooth dicucuk and he is only as deep as 0.5 cm to 1 cm only. Needle puncture just like all the bite the first time.

In addition, modern needle akupuntur not bring danger because he is in the ready after my sterilized and always clean and safe to use.

In addition, people need not doubt about jangkitan AIDS through treatment akupuntur. This is because there has been no history that would AIDS through needle akupuntur. AIDS would only through a needle that is not clean, especially that used by the biller drugs.

Conclusion.

Generally, treatment akupuntur still less welcome, although the effectiveness of this method has been proven through several studies that have been run. China, for example, has more than 500,000 members akupuntur therapy when Japan also has more than 30, 000 practitioners akupuntur. Meanwhile, there are also a handful of practitioners akupuntur Germany and Peranchis that this method in practice full time. This method is getting more developed in line with the rapid development of technology in modern medical. This is because the actual treatment akupuntur able mengubati various diseases that can not be treated with modern methods. Methods tend to use more modern way of surgery and drugs as a way penyelasaian to treat the disease.









Acupuncture can not only improve the vitality, to help the process of healing the disease, but can also help the success of weight-loss program you.

Obesity and diseases

Obesity or obesity is a physiological condition where excess fat stored in the body in the network. Someone said to obesity if the weight exceeds 10% of ideal body weight. Obesity is a problem since the days of yore. This situation is one of the metabolic aberration longest recorded in history as seen on a clay sculpture that comes from the days of not less than 22,000 years BC; the statue depicting a woman who obes half old. Obesity and still always recorded throughout history, since the days of ancient Greece and Egypt, even until even now is still a problem, especially in terms of treatment.

Obesity raises the various impacts both in terms of psychosocial and medical problems. Obeis people who have many difficulties in making physical activity a day-to-day and the person who issued it obeis day-to-day costs for food and clothing and a large lebh and can also have problems in the relationship of husband and wife on a small child often found themselves the issue of identification. From the point of medical education, obesity is often to the hospital. People with obesity also have the life expectancy is lower than the normal weight population. Data New York Metropolitan Life Insurance shows that in the age group 40 - 69 years old found that obeis death rate 42% higher than the average male and 36% higher than average on women. For the sufferer obeis can also arise own inferiority complex, feeling oppressed, and the desperation and the desire to become more of the slim, with a visible passion for a variety of diet programs.

Is it enough diet?

Many problems arise when people with obesity rely on diet alone, such as: people have tried various diet and limit the range of Feed the food, people will feel that obesity is very small and difficult to reduce the already small. People are sometimes tortured with more than dietnya program kegemukkannya own problems. Go consult with the family doctor sometimes it does not help. One of the big research shows that more than half of a diet that is said to spend time with visiting doctor suggestion to ask its agencies. Other research shows that almost a third of family doctors have their own problems excess weight.

Supplements and medication management bermanfatkah make your body?

Other business that many are done with the use of various food supplements claimed to reduce body weight. I will not discuss let alone recommend medicines chemical that said effective weight loss but the side effects that harm your body. How treatment is often without real results, even drugs are often given to provide side effects such as insomnia, headaches, nervous easily, dry mouth, and sometimes arise reaction dependence.

About the food supplements that can be said to lose weight, nor necessarily safe. High-fiber diet with lots eating fresh vegetables and fruit is recommended for the health body and can help reduce fat serapan from the alimentary tract, but the use of supplements high in fiber packaging may have influence the other. In the leading medical journal The Lancet with the title of high fiber diet can damage your health? also discussed the use of high-fiber supplements, which can lead to excess proliferation of cells in the large intestine and the use of herbal medicine management agencies in some cases reported to give effect to the toxic kidney. Then sealami any material that you consume can also lead to reactions that are not natural (this may be a natural product, but can make unnatural reaction). Moreover, when the material is used in a long time and in large doses. Be careful with side effects.

Overcome obesity with Acupuncture

Use of Acupuncture as an alternative to weight reduction program has proven highly effective and without side effects. This method has been arranged and terumuskan since around 3000 years BC. The doctors akupuntur experts who have conducted various research, to the conclusion that akupuntur in the ear to provide a good effect. From the many Magnetic and Acupuncture ear used, the hungry (T 18) is the most effective. The type of ear syringe (needle press) direkat with plaster. People are holding the needle for 2-3 minutes when hungry, half hour before meals three times a day. Follow-up is done once a week for the subjective evaluation of the response in terms of reduction of hunger and cold response from the decrease in body weight. Reaction as a result of provocation in this area is more resistant hungry. The emphasis needle ear stimulate shaggy auricularis Nervus Vagus, through Nervus Vagus channeled to the branches of the memepengaruhi system or gastrointestinal part of the digestive system. Muscle contraction is so keadan bound to be calm, so that reduced hunger and hunger also reduced. Research on 802 cases of obesity, which dealt with akupuntur, 594 cases, the results provide the reduced weight. The success of therapy achieved after 8 weeks with a marked decrease in the weight of 7-10 kg

Bronkiolitis

Bronkiolitis infection is a common breath found in children, especially in infants below the age of 6-12 months. Infection is caused by a virus in the lungs that cause your child experience difficulty breathing. Viruses are the most common cause is bronkiolitis Respiratory Syncytial Virus (RSV), although bronkiolitis can also caused by other viruses such as adenovirus or parainfluenza 3.
Medicines generally does not help that the baby bronkiolitis. What is needed more rest and feeding (breastmilk, formula, food or additional appropriate age baby) in smaller portions, but more often with frequency. Thus, the child will not be too tired or dehydration.
Symptoms and Alerts

Bronkiolitis starts like common cold: fleshy nose and choke. After about a day or two days, the baby would begin coughing, fever experience, and breath will be accompanied by the sound of rapid use. Napas that quickly resulted in infants have difficulty eating or drinking. Some children with this problem need to be taken to the hospital. Musculature help people such as the muscles around the nose, neck, chest and may need to use the chest so the baby can appear interested in taking anybreath.
Symptoms generally experienced the most severe in the second or third day. Babies can be sick for 7-10 days and the cough may continue until 2-4 weeks.

Inspection Support

Bronkiolitis generally can be identified from symptoms and a characteristic signature that examination as chest X-ray or nasopharyngeal aspiration (of fluid from the cavity behind the nose) is not done routinely.

Handling

Handling bronkiolitis is:

* Always try not to smoke at home or around your baby, especially if the baby has a channel napas aberration or the heart, immune system low, or premature birth.
* Antibiotics are not required to bronkiolitis because bronkiolitis caused by the virus.
* Babies need more rest, and eat more often in smaller portions. In the baby is still in a period of exclusive breastfeeding, breasthing baby more often, but in a short time each time.
* This can be provided if the child does not feel comfortable.

Your child should immediately be taken to a doctor or hospital if he:

* Having difficulty breathing (not very fast or regular)
* Unable to eat normally because of cough, or use
* Indicates changes color in the face when coughing
* Appears blue or pale and sweaty

In addition, if your child does not have signs of danger, as mentioned above, you need to visit your child's doctor if your child:

* Having cough that worsened
* Eat less than half the normal amount of food or refuse food / beverage
* Seem tired or very far from the usually sleepy
You feel worried

In general, handling bronkiolitis can be seen as follows:

Illness


Signature


Handling

Light


* Child-conscious, color pink
* Subject to eat well
* Saturation oxygen> 90%. Oxygen saturation simple tool known in the office of a doctor or hospital



Can be handled at home with rest and eat more often in small portions. Can do a follow-up visits to the doctor within 24 hours.

Medium


One in between:

* Difficulty eating
* Weak
* Difficulty breathing, use of musculature help people
* The existence of the heart or deviation channel napas
* Saturation oxygen <90%
* Age less than six months



Bring to a hospital, the hospital will be made:

* Provision of oxygen
* Giving intravenous fluids may be needed
* Observed every hour

Heavy


As the criteria for the category is, however:

* May not improve with the provision of oxygen
* Indicates episode interruption napas
* Shows signs Respiratory muscle fatigue or terkumpulnya too much carbon dioxide in the body.



* Monitor the heart and everywhere
* It may require treatment in the ICU
* Require a blood test to know the rate of various substances in the blood

cough

Children can experience a 6-12 Respiratory infection (acute infection of breath) in a year, usually accompanied by a cough. In most children, coughing will stop by itself in 1-3 weeks, although it can sometimes take longer. In general, if a child experienced coughing every day for more than 3 weeks, several possible causes other than the acute infection of breath should be considered:

* Children may have a difference in the channel breath, eg: tracheo-esophageal fistula (the channel between the trakea / channel breath and throat / channel food).
* Items foreigners caught in the channel is likely breath other causes, particularly in the child.
* Asthma or chronic rinitis (nasal inflammation reactions that take place continuously).
* Smoking or psychological factors can be a cause of chronic cough in teenagers.

Please note that many cough with phlegm is not common in children and the need to be examined causes.
Diagnosis

To determine the causes coughing, some important things to note. The first course should be distinguished whether cough is experienced continuously or relapse once again after recovery. Commencement cough also be important, for example, a cough that is suddenly without other symptoms may signal the existence of a foreign object in the channel napas. The type and pattern of coughing can also provide guidance in determining the cause of cough. For example, coughing experienced in the attacks that are not controlled (paroxysmal) may be caused by pertussis, Chlamydia, or a foreign object. Cough, which disappeared during sleep indicates that the cough can be experienced only because of habit (habit cough). Other symptoms that accompany the cough is also very helpful in this effort because the disease has several symptoms that typically enough, for example: Sinusitis, chronic rinitis, atopi, or asthma. In addition, the display of cigarette smoke is also an important factor in children with complaints of cough.
On physical examination, no sign of lack of oxygen (hipoksia) that must be examined chronic progress, for example, failed to grow and clubbing (hipoksia due to chronic conditions in which the boundary with the skin of the finger nails become even if dilamati side of the more visible claws and width). In addition, of course, other signs such as fever, napas fast, use, and sounds that are not symmetrical breath also must be considered.
Checking further examination, such as laboratory or X-ray is only needed in certain cases.
Handling

If the child is in the healthy and normal physical examination, which needs to be done to avoid hanyah display against the mengiritasi substances such as cigarette smoke. There is no evidence that shows the role of press cough medicine, dekongestan, anti-allergic, or antibiotics in the treatment of cough in cases such as this. A follow-up visits to the doctor can be done in 2-3 weeks.
Children who do not look healthy or a physical examination does not normally require further examination as can be seen on the flow chart below:
Children with cough more than 3 weeks
¯
What is the history / physical examination normal? ® Yes. Avoid iritan, a follow-up.
¯
No ¯
¯
What is the history / physical examination to the pertussis? ® Yes. Handling of pertussis
¯
No ¯
¯
What is the history / physical examination lead to asthma? ® Yes. Handling asthma
¯
No ¯
¯
What is the history / physical examination on a foreign object? ® Yes. Handling of foreign objects
¯
No ¯
¯
What is the history / physical examination on Sinusitis? ® Yes. Handling Sinusitis
¯
No ¯
¯
Do a chest X-ray examination and other needs.

asma

Asthma is a disease channel napas chronicles (chronic), which most often found, particularly in developed countries. The disease usually starts since the children. Cause negative impacts such as children often do not go to school, limiting sports activities, and activities the whole family. National Asthma Guidelines for Children defines asthma as a collection of signs and symptoms of wheezing / use and / or cough with the following characteristics: 1. arise in episodik and / or chronicles, 2. tend to be on the night / early morning (nokturnal), 3. seasonal 4. the spark of factors including physical activity, and 5. reversibel be (able to recover as usual), either spontaneously or with treatment, and 6. history of asthma or atopi (a contagious tendency allergy) in the other patients / families, 7. while other reasons have been removed. COPING MECHANISMS occurrence of ASMA The concept of the latest occurrence of asthma mechanisms, namely asthma is an inflammation of the process (inflammation) chronicles / chronic unique, involving the wall of the channel respiratorik / napas, causing limited air flow, and increase reaktivitas (hiperreaktif / homogenous) napas channel. Hiperreaktivitas this is the beginning of the occurrence of stricture napas channel, as a response to the various stimulative. Typical illustration of the channel napas inflammation is the activation of cells in the blood cells and form eosinofil, mast cells, makrofag, and limfosit T cells in the mukosa (mucous membrane) and Lumen (estuary) napas channel. This change can happen, even in clinical asmanya not bergejala. Along with the process of inflammation, perlukaan epitel (layer terluar) bronkus (stem lungs) stimulate the repair process napas channel which produces functional and structural changes, known by the term remodelling. Diagnosis and classification Diagnosis Use / recurrent wheezing and / or cough is a recurring chronicles a starting point for making diagnosis. Including the need to consider the possibility of asthma is the children who only shows cough as the only signs, and signs were checked at the time wheezing, shortness and others are not arise. Difficult asthma diagnosed in children under 3 years. For children who have large (> 6 years) inspection work / function of lungs, should be done. Test your lungs, that functions with a simple peak flow meter, or a more complete with a spirometer. Others can test through provocation bronkus with histamin, metakolin, training (exercise), the air is dry and cold, or with NaCl hipertonis. Inspection is useful to support the child asthma diagnosis by 3 ways, namely to obtain: * Variability in the PFR (peak flow rate) or FEV1 (Forced expiratory volume in 1 second) ≥ 15% The daily variability is the difference in value (increase / decrease) the results of PFR in one day. Rating good can be done with the weekly variability pemeriksaannya held ≥ 2 weeks. * Reversibilitas in PFR or FEV1 ≥ 15% Reversibilitas value is the difference (increase) PFR or FEV1 after inhalation bronkodilator. * The decline ≥ 20% in FEV1 (PC20 or PD20) after provocation bronkus with metakolin or histamin. The use of peak flow meters are important and necessary effort, because in addition to supporting the diagnosis, also know the success of governance like asthma. If not available, you can use Notes Sheet Daily as an alternative. In children with signs and symptoms of asthma are clear, and the response to the asthma medication clipping, it does not need further diagnostic examination. The disease classification Degrees Child Asthma Can be seen in the table below. Tata Laksana Asthma Long Term Destination governance like asthma children in general is to ensure the achievement of the potential flower children grow optimally. In more detail, the goal is to be achieved: 1. Children can be a normal activity, including play and exercise. 2. The least the school attendance figures. 3. Symptoms do not arise day or night. 4. Senormal lungs function test may be, there is no diurnal variation (in 24 hours), which pierce. 5. Ideal for full cloning medicine needs and no attacks. 6. Side effects of drugs that can not be prevented or the least possible, particularly those affecting children to grow flowers. If the goal is not achieved, then the need to reevaluasi governance laksananya. Tata Laksana Medikamentosa (with medicines) Medicine for asthma can be divided into 2 large groups, namely drug pereda (reliever) and drug control (controller). Reliever, often called the attack drug, used to ease symptoms of asthma attack or if are arising. When the attacks go away and have no more symptoms, the medication is not used again. Controller, often called preventive medicine, is used to overcome the problem of basic asthma, which chronicles respiratorik inflammation (chronic inflammation napas channel). Thus, the use of drugs is continuously in the relatively long period of time, depending on the degree of asthma, and responnya the treatment / prevention. Controller given on Episodik Asthma, and Asthma Persisten. Rarely asthma Episodik Episodik rarely enough asthma treated with reliever form bronkodilator (dilate bronkus / stem-new lungs) beta agonis sniffs (inhaler / spray) work short (short acting β2-agonist, Saba) or groups xantin work quickly, when symptoms occur / attack. Obstacles to the use of the spray is expensive and the price is not available in all places. In addition, the use of inhaler (Metered Dose Inhaler / MDI or Dry Powder Inhaler / DPI), this requires the correct use of the technique (for most children), and need tools (for a small child / baby). When the drug sniff is not there, then given a beta agonis per oral (medicine drinking). Use of xantin work quickly (teofilin) as increasingly less bronkodilator role in the governance like asthma, because the limit of securing (the margin of safety) narrow. However, given in the beta agonis oral medication is not always there, it can use teofilin consider the potential side effects. Furthermore, can be found in Appendix 3. Most asthma Episodik If the use of beta agonis sniff is more than 3x per week (without the use of the measure before physical activity), or the attacks are / weight occur more than once a month, then use as anti-inflammation of the (controller) is required, namely low-dose steroid sniffs. Steroid drugs are often used on children is budesonid, that is used as a standard. Low-dose steroid sniff is equivalent to 100-200 mg / day budesonid (50-100 mg / day flutikason) for children aged less than 12 years, and 200-400 mg / day, to budesonid children aged above 12 years old. At doses of 100-200 mg / day has not reported any long-term side effects. In accordance with the basic mechanism which is inflammation of asthma / inflammation chronicles, controller form of anti-inflammation need time to work therapy. Assessment is done after 6-8 weeks, the time needed to control inflamasinya. If still no response (there are symptoms of asthma or sleep disturbance or activity a day-to-day), then proceed with the second stage, namely, increasing the dose of steroid pull up to 400 mg / day, including in the governance persisten like asthma. Furthermore, can be found in annex 3. Principles of treatment is: if the governance of a degree of disease like asthma is in accordance with the guidelines, but still not good response in 6-8 weeks, the degrees of governance like to move more weight (step-up). Conversely, if asmanya restrained in 6-8 weeks, the degree to switch to a more lightweight (step-down). If possible, pull discontinued steroid use. Note: before doing step-ups, should be evaluated (1) implementation of deterrence spark, (2) how the use of drugs, and (3) of the broadcaster difficult to control asthma (such as rinitis and Sinusitis). Asthma Persisten How the steroid sniffs whether starting from high to low doses during the symptoms are still restrained, or vice versa starting from low to high dose until symptoms can be managed, depending on the case. In certain circumstances, especially in children with severe disease, it is recommended to use high doses first, with oral steroid short term (3-5 days). Next dose steroid sniffs revealed until the smallest dose that is optimal. After giving a low dose of steroid sniff does not have a good response, needed an alternative to replacement therapy, namely increasing the dose of steroid into the medium or remain low dose steroid sniffs plus EARNINGS (long acting beta-2 agonist) or the teophylline added slow release (TSR) or added anti-leukotriene receptor (ALTR). Medium dose is equivalent to 200-400 mol l / day budosenid (100-200 mol l / day flutikason) for children aged less than 12 years, and 400-600 mol l / day budosenid (200-300 mol l / day flutikason) for children aged at over 12 years. When treatment with a second layer for 6-8 weeks, there are still symptoms of asthma, it can be given an alternative to the third layer, which can increase the dose kortikosteroid up with the high dose, or a fixed dose of the medium added with PROFIT, or TSR, or ALTR. The definition of high dose is equivalent to> 400 mol l / day budesonid (> 200 mol l / day flutikason), for children aged less than 12 years, and> 600 mol l / day budesonid (> 300 mol l / day flutikason) for children aged above 12 years old. The addition of the steroid PROFIT sniffs can be proven to improve FEV1, reduce symptoms of asthma, and improve the quality of life. When the dose steroid sniffs reached> 800 mg / day but did not achieve a response, the new steroid use oral (systemic). So the use of oral kortikosteroid as a controller (control) is the last road. This step is taken only when the danger of asmanya greater than the danger of side effects of drugs. As the initial dose, oral steroid can be given 1-2 mg / kgBB / day. Dose and then lowered to the smallest dose given the lapse of the day in the morning. Systemic side effects of steroid can be found in the annex 4. Giving antileukotrien (zafirlukas) dikontraindikasikan aberration in the liver. Giving anti-drug histamin new generation of non sedatif (for example setirizin and ketotifen), should be considered in children with asthma who accompanied rinitis. How medicine Giving Ways of asthma drugs should be adjusted to the age of the children, because of differences in the ability to use tools inhalation. Training needs to be done correctly and repeatedly. The use of perenggang (spacer) to reduce deposisi (cumulation) drugs in the mouth (orofaring), thereby reducing the amount of drugs consumed, and reduce systemic effects. Deposisi (storage) in the lungs, even better, so the effect is obtained terapetik (treatment) is good. Sniff drugs in the form of dry powder (DPI = Dry Powder Inhaler) as Spinhaler, Diskhaler, Rotahaler, Turbuhaler, Easyhaler, Twisthaler need inspiration (efforts to attract / breathe napas) strong. Generally, this form is recommended for school age children. Prevention and Early Intervention Prevention and early action should be the main objective in dealing with children's asthma. Controlling the environment, the provision of exclusive breastfeeding at least 6 months, tergiversation food alergenik potential (capable of allergic reaction), reduction of Exposure to house dust mite and rontokan fur, proven to reduce the manifestation of food allergy, and dermatitis atopik especially in infants, also asthma. Antihistamin the use of non sedatif (do not cause drowsiness) as ketotifen and setirizin reported long-term can prevent asthma in children with dermatitis atopik. However, medicines are not useful as a drug of asthma (controller), Allergy and Environmental Factors (Avoiding fuse) While this has been a lot of evidence that allergy is one of the important factors for development of asthma. 75-90% at least five children asthma has proven allergy, both in developing countries and developed countries. Atopi (trend has one or several types of large groups of allergy) is a real risk factor for menetapnya hiperreaktivitas asthma symptoms bronkus and. There is a relationship between allergens Exposure (spark allergic) with sensitisasi. Exposure to high associated with increased symptoms of asthma in children. Controlling the environment must be made for each child's asthma. Avoidance of cigarette smoke is an important recommendation. Families with children's asthma is recommended not keep furry animals, like cats, dogs, birds. Repair ventilation room, deterrence and humidity room for children who need to be sensitive to house dust and tungaunya. It should be noted that children often suffer from asthma and allergic rinitis / or Sinusitis, which make asmanya unruly. Detection and diagnosis second difference is that followed by adekuat therapy will improve symptoms asmanya. Some research found that many babies wheezing with asthma do not continue to be on the children and teenagers, they. The existence of asthma on parents, and dermatitis (skin disease eczema) in children with atopik on one of the indicators of the occurrence of asthma later in the day. When there are two things, the possibility of a greater asthma. Tata Laksana Asthma Attack GINA governance like to share a two asthma attacks, like governance at home and in hospitals. Procedures like in the home by children asthma (or parents) in their own homes. This can be done by those who have undergone previous therapy with regular, and have enough education. Inhalation form of therapy early beta agonis short work until three times in one hour. Then the children or their families are asked to assess the response of determining the degree assault, to be followed up according to rank. However, for the conditions in our countries, the initial therapy in the home such as the significant risk, and the ability to do the assessment also still in question. With such reasons, then, when after the inhalation one does not have a good response, the doctor recommended to seek help. Other drugs for Asthma Attack * Magnesium Sulphate In the research multisenter, giving intravenous magnesium sulphate (Doofus) in the hospital have the same effectiveness of beta agonis. * Mukolitik Giving mukolitik (for example Bisolvon syrup) in asthma attacks can only be given, but must be careful in children with cough reflex that is not optimal. Giving mukolitik by inhalation (sniff) do not have a significant effect, but must be careful on the weight of asthma attacks. * Antibiotics Giving antibiotics in asthma is not recommended, because most of the pencetusnya not a bacterial infection, but infection with the virus. In certain circumstances, antibiotics can be given, namely the infection napas suspected because the bacteria, or suspected Sinusitis that accompany asthma. * Medicine for sedation (have the effect of making drowsiness) Provision of sedation medication in asthma attacks is not recommended, because the press everywhere. * Anti histamin (anti-allergy) Anti histamin not given in asthma attacks, because they do not have a meaningful effect, could even aggravate the situation. TERAPI inhalation Asthma treatment aims to stop the asthma attack as soon as possible, and prevent the next attack, or when the attacks arise again, serangannya not heavy. To achieve these objectives, need to bronkodilator given the drugs at the time of the attack, and anti-inflammation drugs as drug usage to reduce the inflammation that arises. Giving medicine in asthma can be through various ways, namely parenteral (through Doofus), per oral (tablets drunk), or by inhalation. Giving per inhalation is the drug directly into the channel napas pull through. In asthma, the use of drugs by inhalation can reduce the side effects that often occur in the per parenteral or oral, because the doses are very small compared to other types. To get the optimal benefits of drugs, medicines, which must be given by inhalation can be reached at work in the channel napas. Drugs used usually in the form of aerosols, the suspension of particles in the gas. Special types of inhalation Giving the aerosol idel with tools that are simple, easy to carry, not expensive, are selective channel napas reached the bottom, only slightly behind in the channel napas above, and can be used by children, the disabled, and parents. However, the ideal situation can not be fully achieved. Here are some tools inhalation therapy: * Metered Dose Inhaler (MDI) 1. MDI without Spacer 2. MDI with Spacer Spacer (station equipment) will increase the distance between the mouth with a tool, so the speed at the time These aerosols to be reduced. This reduces settling in orofaring (channel napas above). This form of spacer tube (80 ml volume can be) with a length of 10-20 cm, or other form of a cone with a volume of 700-1000 ml. The use of the spacer is very beneficial to the child. * Dry Powder Inhaler (DPI) The use of drugs dry powder (dried powder) on the DPI requires a strong pull. In a small child, this is difficult. In a larger children, the use of the drug powder can be more easily, because it needs less coordination than MDI. Deposisi (storage) of drugs in the lungs, higher than the MDI and more constant. So it is recommended given to the child above 5 years old. * Nebulizer Tool nebulizer medicines that can change the shape of a solution aerosols continuously, with the energy that comes from the air dipadatkan, or Ultrasonic waves. Dihirup aerosols that are formed by people or through the mouth piece sungkup. Bronkodilator provided with a nebulizer to give effect bronkodilatasi meaningful without causing side effects. The results of treatment with a nebulizer more depending on the type of nebulizer, which is used. There is a nebulizer, which produces aerosol particles continuously, there is also the aerosol can be regulated so that only arise when people do inhalation, so many wasted tdak drugs.
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Food Allergy

The term food allergy (food allergy) is part of a broader terminology, namely hipersensitivitas food (food hypersensitivity), as translated all the unexpected reactions that arise related to food, and can be differentiated:

1. Allergic to food (food allergy), which is associated with the reaction mechanism imunologis, and by the imunoglobulin E (IgE), or non-IgE.
2. Getting food (food intolerance), which is not by the mechanism imunologis. Intolerance occur as a result of the materials contained in food, such as toxins / poisons (such as food poisoning histamin the sea / fish), or use the farmakologis (for example tiramin in cheese or red wine). This reaction occurs in people who are very healthy even if the food was consumed in large doses. Unlike with food allergy, which occurs even if the food is quite small doses. The possibility of other causes of food intolerance is the congenital metabolic diseases (for example defisiensi enzyme laktase the cause of intolerance laktosa). Food intolerance is not discussed in this paper.


Prevalence

Food allergy occurs more frequently in children, compared with adults. Food allergy by the IgE, which occurred in 6% of children under 3 years, and 2% in adults. Children with allergic disease (atopi) such as eczema (dermatitis atopi) and asthma are more vulnerable to food allergy. More than 95% of food allergy relief on the types of food such as eggs, milk, beans, wheat, soybean, and fish. Reached the age of 5 years old, allergic to eggs, wheat, milk, soy and disappeared in most of the children. However allergic to nuts and seafood to survive in the age of 80% of adult children.

Clinical Overview

The following will explain the clinical picture that can be found in the food allergy Mediated IgE and non-IgE.

IgE Mediated Food allergy

This diagnosis was based on a thorough anamnesis complaints / symptoms are. Allergic reactions usually arise in 30 minutes after swallowing allergens, and cause one more signs and symptoms of the following:

- Skin: Natal, urtikaria, angioedema

- Gastrointestinal : vomiting, diarrhea, stomach pain

- Channel breath: cough, hoarse voice, stridor, use

- Circulatory hipotensi, fainting

Food allergy is not mediated IgE

Signs and symptoms appear several hours / days after swallowing allergens. Various is:

1. Enterokolitis syndrome triggered by a protein food. This difference arises in the baby milk cow or soy milk, or food cereals such as rice. Symptoms arise in the 1 - 3 hours after swallowing allergens, in the form of vomiting continuously bile colored liquids. Hipotensi occurred in 15% of cases, with symptoms of pale and weak, so often different diagnosis as sepsis. No symptoms rarely repeated until finally known as a cause of food allergy.
2. Enteropati triggered by the protein food. Symptoms appear in the form of infant diarrhea, vomiting, and failed to grow. Most often due to cow's milk protein, can also indirectly from soybeans, eggs, wheat, rice, chicken and fish.


Mixed IgE Food Allergy and Non-IgE (IgE Mixed IgE Mediated and Non-Food allergy)

Other allergic diseases experienced by this group:

1. Esofagitis Eosinofilik Alergika (Allergic Eosinophilic Esophagitis). Appears on the baby to teenagers, with symptoms refluks gastroesofagus chronicles not recover with the anti-drug refluks, namely: vomiting, do not want to eat, stomach pain, and exacting.
2. Gastritis Eosinofilik Alergika (Allergic Eosinophilic Gastritis). Can arise in infants up to teenagers, with symptoms after eating such as nausea, vomiting, stomach pain and do not want to eat, until obstruksi / sumbatan channel digested.
3. Gastroenteritis Eosinofilik Alergika (Allergic Eosinophilic Gastroenteritis). Occurred in all age with symptoms fail to grow (failure to thrive), body weight decreased, and the symptoms of gastritis and esofagitis.
4. Proktokolitis Eosinofilika (Eosinophilic Proctocolitis). Arise in infants due to the influx of protein food through breastmilk or formula milk in the cow / soy. Blood found in the feces, but the baby did not appear sick with good growth.


Diagnosis

Food Allergy mediated IgE

The existence of a specific food IgE antibodies can be detected with a skin test Prick (Skin Prick Test / PST) or blood (RAST - Radioallergosorbent test), which measures the rate of IgE antibodies specific allergens in the skin or blood. Prick skin test simple, fast, and not too expensive, but it should be done by doctors trained in the methodology and reading / interpretation of the results, given the false positive results (false positive) quite often. Negative results of this audit can be trusted enough (rare false negative). RAST test, while more expensive, with a limited number of akergen that can be examined at time . The results also can be obtained in one week.

Definitive diagnosis / allergic to certain foods to see the reaction was immediate from the exposure of food (and graded food challenge). This test can not be done at home, if there is suspicion that food allergy by the IgE.

Still there are some other techniques to test food allergy, haft, but have not yet recognized scientific, expensive, and can impact on the maturation against food-beverage that should not be.

Food allergy is not mediated IgE

Currently there are supporting the inspection / diagnostic specific to the syndrome hipersensitivitas food that is not mediated IgE. The only way is the avoidance / maturation certain types of food, followed by re-exposure (food challenge). Of the food is done with the supervision of a doctor who competence in allergy, and to ensure Feed nutrition also .

In a mixture of IgE syndrome / non-IgE, Prick skin test can be used. Endoscopic biopsy channel and indigestion can check, if the symptoms involve the sign-channel involvement digested.

treatment

There is no cure to food allergy. The only therapy that has proved successful is the strict avoidance (Strict avoidance) of food allergens are known. Patients and their parents taught how to read food labels packaged with right, and know the terms specific allergens and food products. Experts on nutrition / diet (dietisian) can be involved in this case.

Patients with hipersensitivitas food mediated IgE equipped with quality planning in case of immediate reaction / sudden allergic food unexpectedly, for example, using the tools adrenalin injection (EpiPen ® / junior EpiPen ®). This is done with the guidance of specialist doctors child, or allergy-immunology experts, including education and planning characteristic anafilaksis written.

Advanced Supervision (Follow-up)

Most of the allergic food (except nuts and fish / shellfish) lost itself over time, the patient is monitored regularly to see a reduction in allergy attacks, and plans if the situation occurred due to serious allergic-emergency.

Nutritional adequacy of each person also considered giving the supplements needed, for example kaslium supplements on children in the 12 months to avoid the consumption of cow's milk.

Also be given routine immunization schedule appropriate. MMR vaccination is safe in children with allergic to eggs, but influenza vaccination contraindication
Prevention of Food Allergies

Infants with high risk (for example: no history of allergy to the parents / family, which is significant), said the latest recommendations of exclusive breastfeeding for 6 months. Dietary restrictions (of food) during the breastfeeding mothers to prevent allergy is also not recommended. If the baby is consuming milk formula, the formula hidrolisis (milk protein, already split) recommended in infants with high risk. Formula hidrolisis part (partially hydrolysed formula) such as NAN HA ® can be purchased without a prescription, while all hidrolisis formula (extensively hydrolysed formula), for example Peptijunior ® can be obtained only by prescription, and its use limited to the baby proved allergic to cow's milk and soy. Although there is no evidence that describes the time when the start consuming solid food (solid foods), are often recommended to delay the introduction of solid food until the baby reaches the age of 6 months, and delay the nuts and fish / shellfish until the baby with a high risk age 3 - 4 years.

Kelirumologi General (Common Misconceptions)

Hiperaktivitas such behavior often associated with a food allergy, but there is no evidence.
Also, there is no evidence that the increase milk production of mucus , and avoidance of milk and wheat is only useful in patients who have proved allergic to this type of food.