Fransisca Linda 2014.061.

025
Valerie Adriani 2015.061.211
• Name : Mr. Y
• Age : 70 years old
• Sex : Male
• Occupation : Retirement
• Race : Javanese
• Address : Babakan Bandung, Sukabumi
• Weight : 50 kg
• Height : 170 cm
• BMI : 17, 3kg/m2 underweight
• Chief complaint:
difficulty swallowing
• Additional complaint:
Persistent cough, weight loss, blood when
coughing, lump at the neck
• History of present illness:
Patient came with difficulty swallowing since 5
days before admitting to the hospital. He had a
persisten cough for 5 months and had received
medication for about 2 months. Bad cough came
with productive phlegm that was green in color.
Sometimes there was a stain of redness in the
phlegm. The phlegm got often swallowed by the
patient. The cough was progressively worsening.
Patient also had a weight loss for around 10 kilos
in the last 5 months. He smoked 3 pack a week for
30 years. Patient feels there is a lump at the left
neck which enlarged since 2 months.
1. General status
 General appearance : Calm
 Consciousness : Compos mentis
 Blood pressure : 120/70 mmHg
 Pulse rate : 88 x/min
 Respiratory rate : 24 x/min
 Temperature : 37,4 C
2. Pulmonal
 Inspection : Chest simetris in static and dynamic
condition
 Palpation : Stem fremitus dextra increased
 Percussion : Dull in apex region pulmonal dextra
 Auscultation : Ronchi +/+, wheezing -/-
3. ENT Status
◦ Right ear :
 Mucuos membrane : hyperemic (-), edema (-), mass (-),
Secretion (-), laceration (-), cerumen (-)
 Tymphanic membrane : intact, bulging (-), light reflex (+)

◦ Left ear :
 Mucuos membrane : hyperemic (-), edema (-), mass (-),
secretion (-), laceration (-), cerumen (-)
 Tymphanic membrane : intact, bulging (-), light reflex (+)
 Right nose :
◦ Mucous membrane: hyperemic (-), edema (-),
secretion (-), mass (-), laceration (-), crust (-)
◦ Concha: eutrophy
◦ Septum: no deviation
◦ Air passage: normal

 Left nose :
◦ Mucous membrane: hyperemic (-), edema (-),
secretion (-), mass (-), laceration (-), crust (-)
◦ Concha: eutrophy
◦ Septum: no deviation
◦ Air passage: normal
 Throat:
◦ Uvula in the middle
◦ Pharynx: normal pharyngeal arch, hyperemic (-)
◦ Tonsils : T1 / T1, detritus (-), enlarged crypt (-)

Neck: Enlarged superficial left cervical lymph nodes

with size 3 cm x 2 cm, soft consistency, immobile,
smooth surface, well defined, tenderness -
 Laboratory finding ( Complete blood count )
 Chest radiograph PA position
 Mantoux test
 Sputum test
 Direct laryngoscopy
1. Laboratory
Haemoglobin : 13.4 g/dL
WBC : 7300/uL
ESR : 70/111 mm/hour
Haematocryte: 39.3%
Platelet : 289000/uL
2. Chest Radiograph

CXR result : Active Tuberculosis in the right lung

Chronic Laryngitis e.c. suspect lung
tuberculosis
 To prevent dehydration :
◦ RL 1500 ml/24hour
 For nutrition
◦ Milk 6x200 ml
 To treat tuberculosis :
◦ Rifampisin 450 mg 1x1
◦ INH 300 mg 1x1
◦ Pirazinamid 500 mg 2x1
◦ Ethambutol 500 mg 1x1
 Laryngeal tuberculosis (tuberculosis of
larynx) occur in the throat, rear (such as
arytenoid cartilage) as well as the vocal cords,
rooms with, epiglottis,
 The onset ages move from youth to middle-
aged.
 The clinical features changed, from the back
of the throat before the moth-eaten ulcers
characterized as a major change to localized
or diffuse mucosal edema.
 Early throat, burning, dryness, rough
sound, easy fatigue pronunciation. Can be
irritating cough.
 Late hoarseness, low tone or completely
speechless. Intensifies, sore throat,
swallowing difficulty eating, cough, sputum,
increased secretions.
 laryngeal tuberculosis systemic symptoms,
such as increased body temperature, cough,
chest pain, bloody sputum, weight loss,
fatigue, weakness,
 Caused by Mycobacterium tuberculosis
infection, occurs in 20 to 40 years old. Often
by direct contact with infected also through
blood circulation and lymphatic circulation
and infection, the tuberculous allergy is one
of the causes.
 Indirect laryngoscopy or fiberoptic early see
laryngeal mucosa pale, was anemia-like side
of the vocal cords hyperemia, thickening.
 Late visible ulcers, was infestation shaped.
Jagged bottom granulation.
 The free edge of the epiglottis and vocal
cords like rat-bite-like form of tuberculous
granuloma or tuberculosis ball, can also
produce throat Perichondritis, laryngeal
edema, glottis stenosis, vocal cord movement
disorders
 Cartilage the abscess outward pierced neck
visible the fistula mouth and secretions.
 Chest x-ray examination, tuberculin skin test,
biopsy pathology, PCR.
 Identification of laryngeal tuberculosis
 With polyps, Wegener's granulomatosis,
Peyronie's disease, sarcoidosis, fungal
diseases and throat syphilis were identified.
The tuberculoma Note the identification and
laryngeal cancer, sometimes the existence of
two diseases. Via blood tests, X-ray
radiography, biopsy confirm the diagnosis.
 Anti tuberculosis drugs
 supportive therapy: The non-smoking,
improve nutrition, pay attention to rest.
 The local treatment of Laryngeal tuberculosis
◦ strict gag throat enough rest.
◦ local drug treatment available INH 0.l g+ sM 0.25g
dissolved in saline 20ml, steam or inhalation.
◦ local analgesic.
 Recommended Dosage
Dosage Maximum
Drugs
(mg/kg/day) Daily Intermitten dosage

Rifampisin 8-12 10 10 600

INH 4-6 5 10 300

Pirazinamid 20-30 25 35

Etambutol 15-20 15 30

Streptomicin 15-18 15 15 1000

 Surgical treatment
◦ tracheotomy: Suitable for obvious difficulty
breathing.
◦ surgery: scar excision, placed T-shaped pipe, such
as total laryngectomy.