Penyuluhan

OSTEOPOROSIS

dr. Aulia Ayu Hartini

Rumah Sakit Hermina Grand Wisata

21 Maret 2018
 Apa itu Osteoporosis?
Suatu kondisi berkurangnya massa tulang yang
berakibat pada rendahnya kepadatan tulang,
sehingga tulang menjadi keropos dan rapuh
 Autoanamnesis on July, 29th 2017
Anamnesis
Reason for Seeking Care

Weakness of his right limb since four hours

before hospital admission
 Autoanamnesis on July, 29th 2017
Anamnesis
Additional Complaining

• Dysarthria and trouble understanding speech

• Fatigue
• Headache on the occipital of head
 Autoanamnesis on July, 29th 2017
Anamnesis
Present Health History
He was taken to the
nearest hospital, Bogor
Medical Center, and the
He was eating then
doctor said he may be
suddenly he can not
diagnosed with a stroke,
holding the fork in his Day of
and should be referred to
hand, his right body
the bigger hospital for admission
feel so weak. He also
further examination
feel his speech weird Patient still feel the
cause his wife can not Three hours weakness, fatigue, and
understand what he prior to dizziness on the back of
spoke clearly the head. Decrease
admission consciousness, nausea,
vomitting, seizure were
Four hours denied.
prior to
admission
 Autoanamnesis on July, 29th 2017
Anamnesis
History of previous medication

• The patient had a previous treatment in Bogor

Medical Center and then reffered to Port
Medical Center hospital for further
examination
 Autoanamnesis on July, 29th 2017
Anamnesis
History of previous illness

• Patient had Diabetes Mellitus history since more

than 10 years, not frequently controlled and
medicated
• Patient denied history of head trauma
• Patient denied history of hypertension disease
• Patient denied history of heart disease
Physical
Examination

• General assessment : mild-illness

• Conciousness : Composmentis
• Weight : 75 kg
• Height : 172 cm
• IMT : 25,3 kg/m2

• Vital Sign
Blood pressure : 180/110 mmHg
pulse : 81x/menit
RR : 21 x/menit
temperature : 36,10C
Physical
Examination
Head : normocephali, deformities (-)

Eyes : CA -/-, SI -/-, pupil isokhor 3mm/3mm,

direct reflex +/+, indirect reflex +/+

ENT : abnormalities did not found

Mouth : abnormalities did not found

Neck : abnormalities did not found

Physical
Examination Thorax

Cor Pulmo

• Cardiomegaly (-), • Right and left

BJ I dan II breathing
regular, gallop (- motion were
), murmur (-) symmetric,
Sonor Percussion
+/+, Vesicular
+/+, Ronkhi -/-,
Wheezing -/-
Physical
Examination

• Abdomen : Supel,BU (+), tenderness (-), hepatosplenomegaly (-)

• Ekstremities : warm, CRT <2 second, edema -/-/-/-, sianosis (-)

Neurogical
Examination

• Conciousness : Compos mentis

• GCS : E4 V5 M6

Rangsangan Meningeal

• Kaku kuduk (-)

• Test Brudzinski I (-/-)
• Test Brudzinski II (-/-)
• Kernig Sign (-/-)
• Laseque Sign (-/-)
Neurogical
Examination Motoric

Reflex Muscle tone

• Refleks Fisiologis • Hypotone : - / -

• Biceps :N / N • Hypertone : - / -
• Triceps :N / N
• Achiles :N / N
• Patella :N/ N

• Refleks Patologis
• Babinski : +/-
• Oppenheim : -/-
• Chaddock : -/-
• Gordon : -/-
• Scaeffer : -/-
• Hoffman -Trommer : -/-
Neurogical
Examination Motoric
Muscle strength

4444 5555
Ekstremitas Superior Dextra Ekstremitas Superior Sinistra

4444 5555
Ekstremitas Inferior Dextra Ekstremitas Inferior Sinistra

Siriraj Stroke Score : -2

 Laboratory Examination
On July, 29 th 2017
Pemeriksaan Hasil Nilai Normal Satuan

DARAH RUTIN
Hemoglobin 13,7 13-17 g/dl
Hematokrit 41,7 40-52 %
Leukosit 10.200 5.000-10.000 /uL
Trombosit 316.000 150rb-400rb /uL
KIMIA DARAH
Glukosa Darah Sewaktu 289 70 – 140 mg/dL
Ureum 29,7 10 – 50 mg/dL
Creatinin 1,37 0,7 – 1,3 mg/dL
SGOT 18 0 – 37 U/L
SGPT 17 0 – 49 U/L
Resume
• A man, 59 years old, suddenly get a weakness of the right limb
since four hours before hospital admission. Dysarthria (+),
fatigue (+), dizziness (+). History of Diabetes Mellitus more than
10 years, not frequently controlled and medicated.

• Phsycal examination

BP : 180/110 mmHg

• Neurogical Examination

Babinski Test +/-

Working Diagnosis

• Non Haemorrhagic Stroke + Diabetes Mellitus

Therapy

• Hospitalized + Consultation to the neurologist and internal medicine

• IVF Asering 6 tpm
• Citicolin 2 x 500 mg iv
• Mecobalamin 3 x 500 mg iv
• Amlodipin 1 x 10 mg tab
• Clopidogrel 1 x 75 mg
• Amaryl 1 x 2 mg
• Diet DM 1900 kkal
• Sleeding scale
• Adviced non contras head CT scan
Prognosis

• Quo ad vitam : Ad bonam

• Quo ad functionam : Dubia ad bonam
• Quo ad sanationam : Dubia ad bonam
FOLLOW UP
July 30th 2017
• S: Improvement the weakness of limbs,
dysarthria (+), fatigue (+), dizziness (-)
• O: BP: 160/80 mmHg, other physical
examination is normal, muscle strength
4444/5555/4444/5555
• A: Non Haemorrhagic Stroke, Diabetes Mellitus
• P: Continue therapy, urinary check up
July 31st 2017
• S: Improvement the weakness of limbs,
dizziness (+)
• O: BP: 140/80 mmHg, other physical
examination is normal, muscle strength
5555/5555/4444/5555
• A: Non Haemorrhagic Stroke, Diabetes Mellitus
• P: Continue therapy, Frego 2 x 50 mg, consul to
medical rehabilitation specialist
August 1st 2017
• S: Weakness (+), Dizziness (+)
• O: BP: 110/70 mmHg, other physical examination is normal, muscle
strength 5555/5555/4444/5555
• Sleeding Scale :
• Glucose on 06.00 : 167 mg/dL
• Glucose on 11.00 : 186 mg/dL
• Glucose on 16.00 : 204 mg/dL
• A: Non Haemorrhagic Stroke, Diabetes Mellitus
• P: Continue therapy, Frego 2 x 50 mg, forneuro 1 x 1, profil lipid check
up
• Result of medical rehab specialist : should have excersice mobilitation
one time a day. Target discharge : excercise walk with cane
August 2nd 2017
• S: (-)
• O: BP: 120/80 mmHg, other physical examination is normal,
muscle strength 5555/5555/4444/5555
• Laboratoy findings :
• Uric acid 5,9 mg/dL
• Cholesterol total 246 mg/dL
• Cholesterol HDL 40 mg/dL
• Cholesterol LDL 172 mg/dL
• Trigliserida 169 mg/dL
• A: Non Haemorrhagic Stroke, Diabetes Mellitus
• P: Continue therapy, atrovastatin 1 x 20 mg
August 3rd 2017
• S: hard to sleep
• O: BP: 110/70 mmHg, other physical examination is normal, muscle strength
5555/5555/4444/5555
• Sleeding Scale :
• Glucose on 06.00 : 166 mg/dL
• Glucose on 11.00 : 213 mg/dL
• Glucose on 16.00 : 315 mg/dL
• A: Non Haemorrhagic Stroke, Diabetes Mellitus
• P: May go home with recommended internal medicine specialist, with therapy:
• Alprazolam 1 x 0,5 mg
• Citicholin 2 x 500 mg
• Mecobalamin 2 x 500 mg
• Frego 2 x 5 mg
• Amlodipin 1 x 10 mg
• Clopidogrel 1 x 75 mg
• Metformin 1 x 500 mg
• Eclid 3 x 50 mg
• Metrix 1 x 2mg
• Aminefron 3 x 1
ANALISA KASUS
Diagnosis Stroke Non Hemoragik

Gejala Stroke Non Hemoragik Stroke Hemoragik

Onset atau awitan Mendadak Mendadak
Saat onset Istirahat Sedang aktif
Nyeri kepala +/- +++
Kejang - +
Muntah - +
Penurunan Kesadaran - +++

Pada anamnesis didapatkan keluhan kelemahan

yang mendadak, saat istirahat, nyeri kepala,
tanpa adanya kejang, muntah, dan penurunan
kesadaran
Diagnosis Stroke Non Hemoragik
 Diagnosis Stroke Non Hemoragik
Variabel Gejala Klinis Skor

Siriraj Stroke Score = (2,5 x derajat

kesadaran) + (2 x muntah) + (2 x
Derajat Kesadaran Sadar 0 sakit kepala) + (0,1 x tekanan
diastol) – (3 x ateroma) – 12.
Apatis 1
Apabila score yang didapatkan < 1
Koma 2 maka diagnosisnya stroke non
hemroagik, dan apabila didapatkan
skor >1 maka diagnosisnya stroke
Muntah Iya 1
perdarahan.
Tidak 0

Sakit Kepala Iya 1

Tidak 0 Siriraj Stroke Score pada
kasus = (2,5 x 0) + (2 x 0) +
Tanda-tanda atheroma
(2 x 1) + (0,1 x 110) – (3 x
1. Angina Pectoris Iya 1
1) – 12 = - 2  stroke non
Tidak 0
2. Claudicatio Intermitten
hemoragik
Iya 1
Tidak 0
3. Diabetes Mellitus Iya 1
Tidak 0
 Tatalaksana Stroke di IGD
Evaluasi Cepat dan Penatalaksanaan Penatalaksanaan
Terapi Umum
Diagnosis umum di ruang rawat Medis Lain
• Anamnesis • Stabilisasi jalan • Cairan • Pemantauan kadar
• Pemeriksaan Fisik napas dan • Nutrisi glukosa darah
• Pemeriksaan pernapsan • Analgesik dan
neurologis • Stabilisasi antimuntah sesuai
hemodinamik indikasi
• Pemeriksaan awal • H2 antagonis
fisik umum apabila ada indikasi
• Pengendalian • Pemeriksaan
peninggian tekanan penunjang lanjutan
intrakranial • Rehabilitasi
• Penanganan • Edukasi
transformasi • Disharge planning
hemoragik (rencana
• Pengendalian kejang pengelolaan pasien
• Pengendalian suhu di luar rumah sakit)
tubuh
• Pemeriksaan
penunjang
Tatalaksana Hipertensi
• Manajenem penurunan tekanan darah pada
pasien dengan hipertensi urgensi tidak
membutuhkan obat-obatan parenteral.
Pemberian obat-obatan oral aksi cepat akan
memberi manfaat untuk menurunkan tekanan
darah dalam 24 jam awal Mean Arterial
Pressure (MAP) dapat diturunkan tidak lebih
dari 25%. Pada fase awal standard goal
penurunan tekanan darah dapat diturunkan
sampai 160/110 mmHg
Diagnosis Diabetes Mellitus
 Tatalaksana Diabetes Mellitus

Source :Perkumpulan Endokrinologi Indonesia. Konsensus Pengendalian dan Pencegahan Diabetes Mellitus Tipe 2 di Indonesia, PB. PERKENI.
Jakarta. 2015