Diagnosis Fisik (New)
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![Page 1: Diagnosis Fisik (New)](https://reader033.fdocument.pub/reader033/viewer/2022052307/557210db497959fc0b8dcb51/html5/thumbnails/1.jpg)
Hendromartono
DIAGNOSIS FISIK
Bagian-SMF Ilmu Penyakit DalamFK Unair -RSUD Dr. Sutomo - Surabaya
PranawaJoewono Soeroso
Kuliah, 4 September 2006
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Hendromartono
Daftar bacaan
Pedoman tramed Bates’ Guide to physical examination, 9th ed.,
2007 Buku ajar ilmu penyakit dalam, Jilid 1 ed 4, 2006
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Teknik untuk membuat diagnosis
1. Anamnesis
2. Pemeriksaan fisik
3. Pemeriksaan penunjang
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Perbedaan data subjekif dan objektif
Data subjektif
- Didapat dari
anamnesis
- Yang diceritakan
pasien
Data objektif
- Didapatkan dari
pemeriksaan
- Data pemeriksaan
fisik
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Tujuan
Mengumpulkan informasi mengenai sakit pasien sehingga dapat dibuat diagnosis
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Hendromartono
Anamnesis
Bertujuan untuk mendapatkan keterangan mengenai
I. Gambaran penyakit yang sedang diderita
II. Keadaan badan secara keseluruhan
III. Riwayat penyakit dahulu
IV. Riwayat kesehatan / penyakit keluarga
V. Keterangan pribadi dan kebiasaan
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Komponen anamnesis Data identitas Reliabilitas Keluhan utama Penyakit sekarang Riwayat penyakit dulu Riwayat keluarga Riwayat sosial dan pribadi Review sistem
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Data identifikasi
Identitas pasien Sumber anamnesis “Sumber dari rujukan”
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Identitas pasien
• Nama lengkap
• Jenis kelamin
• Umur / tanggal lahir
• Alamat
• Status perkawinan
• Agama
• Suku
• Pekerjaan
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Sumber anamnesis
• Oto-anamnesis : merupakan riwayat penyakit yang
disusun oleh dokter berdasarkan wawancara secara
yang diberikan oleh pasien
• Hetero – anamnesis : merupakan riwayat penyakit yang
disusun oleh dokter berdasarkan keterangan dari
keluarga atau orang-orang yang mengetahui tentang
kesehatan pasien
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Keluhan Utama
Merupakan keluhan yang membuat penderita
datang untuk mendapatkan pertolongan
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Komponen anamnesis Data identitas Reliabilitas Keluhan utama Penyakit sekarang Riwayat penyakit dulu Riwayat keluarga Riwayat sosial dan pribadi Review sistem
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Penyakit sekarang
Penjabaran keluhan utama ( 7 gambaran ) Termasuk pikiran dan perasaan pasien tentang sakitnya Termasuk pengobatan, alergi dan kebiasaan yang
berhubungan dengan keluhan
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Gambaran penyakit yang sedang diderita,
penjabaran keluhan utama
1. Dimn tempat yang menimbulkan keluhan itu
(LOKALISASI) ?
2. Bagaimana jenis keluhan itu (KUALITAS) ?
3. Seberapa hebatnya keluhan itu (KUANTITAS) ?
4. Bagaimana permulaan timbulnya keluhan (onset) ? Berapa
lama (durasi)? Apakah sering (frekuensi)? Bagaimana
perkembangan keluhan itu selanjutnya (kronologi)
(WAKTU)?
5. Keadaan waktu terjadi keluhan termasuk faktor lingkungan,
aktifitas pribadi, emosi dan keadaan lain (KONDISI).
6. Apa hal-hal yang meringankan atau memperberat (FAKTOR)
7. Apakah ada gejala lain yang menyertai keluhan utama
(GEJALA LAIN)?
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Komponen anamnesis Data identitas Reliabilitas Keluhan utama Penyakit sekarang Riwayat penyakit dulu Riwayat keluarga Riwayat sosial dan pribadi Review sistem
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Penyakit dulu
penyakit masa anak, penyakit dewasa sebutkan pula waktunya, imunisasi, hasil pemeriksaan
Riwayat keluarga
terdapat atau tidaknya peyakit pada keluarga misalnya hipertensi, diabetes, penyebab kematian dan usia saat meninggal dari keluarga.
Riwayat sosial dan pribadi
tingkat pendidikan, kebiasaan-hobby, asal, keadaan sos-ek
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Komponen anamnesis Data identitas Reliabilitas Keluhan utama Penyakit sekarang Riwayat penyakit dulu Riwayat keluarga Riwayat sosial dan pribadi Review sistem
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Review of systems • Umum : penurunan berat, kelemahan
• Kulit : warna kulit berubah, gatal, luka, petekie, tanda lahir, rash,
rambut rontok, perubahan pada kuku
• Kepala dan muka : nyeri kepala, pusing, trauma kepala, nyeri pada
wajah muka
• Telinga : pendengaran baik / tidak, tinitus, nanah keluar dari liang
telinga
• Mata : berkunang-kunang, kabur, buta, diplopia, fotofobia, nyeri
dimata atau dibelakang mata• Hidung dan sinus : nyeri didalam hidung, epistaksism ingus, sering pilek, sering bersin, tidak dapat mencium bau• Mulut, faring, laryng : nyeri, gusi berdarah, gigi rusak, lidah
pedih, tidak dapat mengecap rasa, sakit kerongkongan, suara parau, suara hilang, nyeri telan
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Review of systems Payudara : nyeri, bernanah atau keluar cairan, ada
benjolan / tumor Leher : pembesaran kelenjar, struma, nyeri? Kaku? Sistim pernafasan : batuk, sputum, nyeri, sesak nafas,
nafas pendek, mengi Sistim kardiovaskuler : sakit dada, dispnoe d’effort,
ortopneau, paroxismal nocturnal dispneau, edema kaki, palpitasi
Sistim pencernaan : nafsu makan, rasa mual, muntah, hematemesis, sering salah telan, sakit didaerah ulu hati, sakit perut, diare, konstipasi, alergi makanan, dll
Sistim saluran kencing : sembab muka-kaki, disuria, poliuria, kencing batu, warna kencing, kencing nanah, tidak bisa kencing/ tak lancar
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Review of systems Sistim genital : haid, menarkhe, menopausee,
metrorragia, menoragia, lekorea, nyeri, koreng Vaskuler perifer : kramp, varices, edema Sistim skelet : sakit tulang, sakit sendi, sakit pinggang,
sendi kaku / bengkak, dll Sistem hematopoeitik : gejala enemia, transfusi darah,
mudah berdarah atau berdarah banyak bila menggosok gigi, haid berlebihan, kelenjar limpa membesar
Sistim endokrin : polidipsi, poliuri, polifagi, tremor, tak tahan panas, suara serak, berkeringat banyak, impoten, frigiditas,dll
Sistim saraf : kejang, pusing, sakit kepala, muntah projektil, stroke
Sistim mental : nervus, cepat marah, cepat lupa, insomnia, kompulsif, dll
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Hendromartono
Pemeriksaan Fisik
• INSPEKSI
• PALPASI
• PERKUSI
• AUSKULTASI
Pemeriksaan untuk mengetahui adanya tanda-tanda
patologik pada tubuh pasien dengan cara :
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Hendromartono
Pemeriksaan Fisik
Keadaan umum Tanda vital Kulit Kepala dan leher Tulang belakang Toraks Abdomen Ekstremitas Syaraf Rektal dan uro-genital
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Keadaan umum
Keadaan kesehatan pasien Tingkat kesadaran Tanda distress Tinggi dan berat badan Warna kulit, rambut dan tanda khusus Cara berpakaian dan higiene Ekspresi wajah Bau badan, bau mulut Postur dan gait
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Kesadaran
Kompos mentis, apatis, delirium, somnolen (letargi, obtundan), stupor,koma
Glasgow Coma Scale (GCS), normal (E-V-M, 4-5-6)
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Tanda vital
Tekanan darah Irama dan frekuensi denyut jantung Respirasi Suhu
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> 100> 100or> 160Hypertension, stage 2Hypertension, stage 2
90-9990-99or140-159Hypertension, stage 1Hypertension, stage 1
80-8980-89or120-139Pre hypertensionPre hypertension
< 80< 80and< 120NormalNormal
BLOOD PRESSURE (mmHg)BLOOD PRESSURE (mmHg)
DiastolicDiastolicSystolicCATEGORYCATEGORY
DEFINISION AND CLASIFICATION OF BLOOD PRESSURE LEVELTHE 7th REPORT OF THE JOINT NATIONAL COMMITTEE
ON PREVENTION, DETECTION, EVALUATION, AND TREATMENT OF HIGH BLOOD PRESSURE(2003)
DEFINISION AND CLASIFICATION OF BLOOD PRESSURE LEVELTHE 7th REPORT OF THE JOINT NATIONAL COMMITTEE
ON PREVENTION, DETECTION, EVALUATION, AND TREATMENT OF HIGH BLOOD PRESSURE(2003)
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Nadi
Frekuensi, irama, isi, kualitas Pulsus seler, paradoksus, alternans, defisit
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Hendromartono
Pemeriksaan klinis sebaiknya dilakukan secara regional,
dan urutannya adalah sebagai berikut :
I. Pemeriksaan kepala dan leher 1. Pemeriksaan mata dan liang telinga
2. Pemeriksaan wajah muka
3. Pemeriksaan mulut dan tenggorokan
4. Pemeriksaan leher
II. Pemeriksaan toraks 1. Pemeriksaan sistim pernafasan
2. Pemeriksaan sistim kardiovaskuler
III. Pemeriksaan abdomen
IV. Pemeriksaan anggota gerak
V. Pemeriksaan kelamin dan daerah sekitarnya
VI. Pemeriksaan tulang belakang
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Hendromartono
Pemeriksaan klinis sebaiknya dilakukan secara regional,
dan urutannya adalah sebagai berikut :
I. Pemeriksaan kepala dan leher 1. Pemeriksaan mata dan liang telinga
2. Pemeriksaan wajah muka
3. Pemeriksaan mulut dan tenggorokan
4. Pemeriksaan leher
II. Pemeriksaan toraks 1. Pemeriksaan sistim pernafasan
2. Pemeriksaan sistim kardiovaskuler
III. Pemeriksaan abdomen
IV. Pemeriksaan anggota gerak
V. Pemeriksaan kelamin dan daerah sekitarnya
VI. Pemeriksaan tulang belakang
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PEMERIKSAAN
KEPALA DAN LEHER
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Hendromartono
Pemeriksaan Kepala dan Leher
I. Inspeksi, palpasi, dan auskultasi mata
II. Inspeksi dan palpasi telinga
III. Inspeksi dan palpasi wajah muka berikut gerakan-
gerakan otot-otot dan sensibilitasnya
IV. Inspeksi dan Palpasi nasofaring
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Pemeriksaan Kepala dan Leher
Inspeksi, palpasi, dan auskultasi mata
1. Kelopak mata
2. Konjungtiva dan sklera
3. Kornea
4. Iris
5. Peregerakan bola mata
6. Visus
7. Medan penglihatan
8. Pupil dan funduskopi
9. Auskultasi mata
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Hendromartono
Pemeriksaan Kepala dan Leher
Inspeksi dan palpasi wajah muka berikut gerakan-
gerakan otot-otot dan sensibilitasnya
• Terutama untuk melihat fungsi nervus kranialis ke V dan VII
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Hendromartono
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Hendromartono
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PEMERIKSAAN
PARU
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SITTING EXAMINATION
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BENTUK DADA
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BENTUK DADA
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BENTUK DADA
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BENTUK DADA
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BENTUK DADA
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BENTUK DADA
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LANDMARK OF THE CHEST
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LANDMARK OF THE CHEST
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Hendromartono
PALPASI EKSPANSI
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TACTILE FREMITUS
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PERKUSI
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Hendromartono
PERKUSI PADA DADA
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AUSKULTASI
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Hendromartono
PASIEN BERBARING
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Hendromartono
PEMERIKSAAN
JANTUNG
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Hendromartono
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Hendromartono
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Hendromartono
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Hendromartono
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Hendromartono
Posisi left lateral decubitus untuk memperjelas apex
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Area palpasi untuk jantung
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Area auskultasi jantung
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Hendromartono
PEMERIKSAAN
PAYUDARA
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Hendromartono
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Hendromartono
PEMERIKSAAN REGIO ABDOMEN
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Hendromartono
Rectus abdominismuscle
Umbilicus
Inguinal ligament
Pubic tubercle
Xiphoid process
Costal margin
Midline, overlyingLinea alba
Iliac crest
Symphysis pubis
Anterior superiorIliac spine
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Hendromartono
Lumbal D Lumbal S
Hypochondrial D
Inguinal D
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Hendromartono
Lower pole ofRight kidney
Liver
Sacralpromontory
Ascending colon
Cecum
Pregnantuterus
Xiphoidprocess
Aorta
Transverse colon
Descending andSigmoid colon
Iliac artery
Full bladder
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Hendromartono
Spleen
Duodenum
Stomach
Pancreas
Gallbladder
Liver
ANTERIOR VIEW
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Hendromartono
POSTERIOR VIEW
Costovertebralangel
Kidney
11th rib
12th rib
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Hendromartono
Common or Concerning Symptoms
Gastrointestinal Disorders
Indigestion or anorexiaNausea, vomiting, or hematemesisAbdominal painDysphagia and/or odynophagiaChange in bowel functionConstipation or diarrheaJaundice
Urinary and Renal Disorders
Suprapubic painDysuria, urgency, or frequencyHesitancy, decreased stream in malesPolyuria or nocturiaUrinary incontinenceHematuriaKidney or flank painUreteral colic
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Hendromartono
Epigastric pain fromthe stomach, duodenumor pancreas
Periumbilical pain fromthe small intestine,appendix, or proximalcolon
Hypogastric pain fromthe colon, bladder, oruterus. Colonic painmay be more diffusethan illustrated.
Right upper quadrantor epigastric pain from
the biliary tree and liver
Suprapubic or sacralpain from the rectum
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Hendromartono
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Hendromartono
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Hendromartono
Aorta
Renal Artery
Iliac Artery
Femoral Artery
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Hendromartono
TWO-HANDED DEEP PALPATION
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Hendromartono
PERCUSSING LIVER SPAN
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Hendromartono
NORMAL LIVER SPANS
4 – 8 cm inmidsternal line
6 – 12 cm in rightmidclavicular line
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Hendromartono
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Hendromartono
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Hendromartono
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Hendromartono
Normal spleen
Anterioraxillary line
Midaxillary line
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Hendromartono
Umbilicus
PALPATING THE SPLEEN-PATIENT LYING ON RIGHT SIDE
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Hendromartono
Tympany
Dullness
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Hendromartono
Tympany
Dullness
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Hendromartono
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Hendromartono
Fat
Tumor
Gas
Tympany
Dullness
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Hendromartono
Pregnancy
Ascitic Fluid
Ascitic Fluid
Tympany
Dullness
Umbilicus may beprotuberantBulging
flank
Tympany
Dullness
Tympany
Dullness
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Hendromartono
Bowel Sounds Bruits
Renal artery
Aorta
Iliac Artery
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Hendromartono
Venous Hum
Friction Rubs
Hepatic
Splenic
Epigastric andumbilical
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Hendromartono
Abdominal Wall Tenderness
Visceral Tenderness
Normal aorta
Normal or spasticsigmoid colon
Superficial tender area
Deep tender areas
Enlarged liver
Normal cecum
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Hendromartono
Acute Pleurisy Acute Salpingitis
Unilateral orbilateral, upper orlower abdomen
Tenderness from Disease in the Chest and Pelvis
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Hendromartono
Tenderness of Peritoneal Inflammation
Acute Cholecystitis Acute Pancreatitis
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Hendromartono
Right rectaltenderness
Just below themiddle of a line
joining theumbilicus and theanterior superior
iliac spine
Tenderness of Peritoneal Inflammation
Acute Apendicitis
Acute Diverticulitis
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Hendromartono
Downward Displacement ofthe Liver by a Low Diaphragm
Normal Variations inLiver Shape
Upperborder low
Height byPercussion
normal
Elongatedright lobe
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Hendromartono
Smooth Large Tender Liver Large Irregular Liver
Smooth Large Nontender Liver
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Hendromartono
Caput Medusae
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Hendromartono
Caput Medusae
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Hendromartono
Spider Nevi
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Hendromartono
Hernia Umbilicalis
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Hendromartono
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Hendromartono
ASSESSING COSTOVERTEBRAL ANGLE TENDERNESS
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Hendromartono
PEMERIKSAAN
ANGGOTA GERAK
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Hendromartono
Pemeriksaan lengan, tungkai dalam
pemeriksaan klinis meliputi :
1. Inspeksi
2. Palpasi
3. Menguji pergerakan dan kekuatan otot
4. Menguji gerakan koordinasi
5. Menguji sensibilitas
6. Memeriksa reflek- reflek
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Hendromartono
Tes Refleks
Biceps
Triceps
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Hendromartono
Tes Koordinasi
Tes koordinasi jari telunjuk ke hidung
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Hendromartono
Hip pain
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Hendromartono
Laseque Test
Neural damage
Non neural damage
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Hendromartono
Venous Insufficiency
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Hendromartono
Cellulitis
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Hendromartono
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Hendromartono
Gangrene