Download - Penilaian secara klinik
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Penilaian secara klinik Clinical assestment
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1. Anamnesa (Wawancara)2. Pemeriksaan fisik Inspeksi Palpasi Perkusi Auskultasi
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• TIPE GIZI BURUK
• 1. Marasmus• sangat kurus, wajah orang tua, cengeng • dan rewel; rambut tipis, jarang, kusam,• berubah warna; kulit keriput, iga
gambang,• bokong ‘baggy pant’, perut cekung• 2. Kwashiorkor• wajah membulat sembab, cengeng, rewel,• apatis; rambut tipis, warna jagung, mudah• dicabut; kedua kaki bengkak, bercak merah kehitaman di tungkai atau di bokong• 3. Marasmik-kwashiorkor• gabungan kedua tanda tsb
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• Klinis dikenal ada 3 jenis:
MarasmusKwashiorkorMarasmus-Kwashiorkor
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Marasmus• Sangat kurus• Wajah orang tua• Cengeng dan rewel• Rambut: tipis, jarang,
kusam, berubah warna
• Iga gambang• Kulit keriput• Bokong “baggy pants”• Perut cekung
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Kwashiorkor• Wajah membulat,
sembab
• Cengeng, rewel, apatis
• Rambut: tipis, warna jagung, mudah dicabut
• Kedua kaki bengkak
• Bercak merah-kehitaman di tungkai atau bokong
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Marasmik-kwashiorkor gabungan kedua tanda tersebut
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Klasifikasi defisiensi vit A berdasarkan tanda 2 di mata
1. buta/ rabun senja (XN)2. Xerosis konjunctiva (X1A)3.Bercak Bitot (X1B)4.Xerosis kornea (X2)5.Ulcus kornea/ Keratomalacia < 1/3 permukaan kornea (X3A) > 1/3 permukaan kornea (X3B)6.Jaringan parut kornea (XS)
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Klasifikasi endemic goiter (IDD)berdasarkan tanda 2 di leher
• Grade 0: tidak teraba
• Grade I : teraba, terlihat hanya/ bila kepala ditenggakkan.
• Grade II: mudah terlihat dengan kepala pada posisi normal.
• Grade III: terlihat dari kejauhan.
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Endemic goiter – Hyphothyroid --- Cretin
• Neurologik Cretin.• Retardasi mental berat• Deaf mutism• Cerebral diplegia• Tidak ada gangguan stature• Secara klinis euthyroid• Prevalensi goiter tinggi = non
cretin• Lab: T4 lbh rendah, TSH lbh
tinggi, uptake radioiodine lbh rendah daripada non cretin
• Myxedematous Cretin,• Tidak terlalu berat• Tidak ada• Tidak ada• Dwarfism• Myxedema• Hyphothermia• Tanda 2 hyphothyroidism jelas• Prevalensi goiter < non
cretinism• Lab: T4.T3 sangat rendah,TSH
tinggi, uptake radioiodine rendah.
• Responsive pada pemberian iodine
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AnemiaAnemia (WHO): kadar hemoglobin darah < 110 g/L pada wanita hamil , anak 6 bln – 5 thn. < 120 g/L pada wanita tidak hamil < 130 g/L pada laki - laki
1. Pendarahan2. Gangguan pembentukan Anemia aplastik3. Hemolitik Anemia hemolitik4. Defisiensi Zat besi, Folat, B12.
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Defisiensi besi dan Anemia defisiensi besi
Ada 3 tahap1. Depleted iron stores tubuh tidak mempunyai lagi iron stores
(cadangan besi), tetapi kadar Hb masih di atas batas normal.
kadar serum ferritin < 12 ug/L. 2. Iron-deficient erythropoiesis. Kadar receptor transferrin meningkat Kadar protoporphyrin dalam sel darah merah
meningkat. Tahap 1 dan 2 : Defisiensi besi
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3. Anemia defisiensi besi
Bila kadar Hb dibawah nilai normal dan
cadangan besi tubuh telah kurang.
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